1 wb-ihpp workshop on the development of models for sustainable health care financing wb-thai...
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WB-IHPP Workshop on the Development of Models for Sustainable Health WB-IHPP Workshop on the Development of Models for Sustainable Health Care FinancingCare Financing
WB-Thai Development Partnership in Health (CDP-H)WB-Thai Development Partnership in Health (CDP-H)
Wolfgang ScholzILO - Social Security Department
Holiday Inn Silom HotelBangkok, 11 & 12 June 2007
Modeling Sustainable Modeling Sustainable Health FinancingHealth Financing
in Thailandin Thailand
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The ModelThe Model: overview: overview
Population (sex and single ages)
Labour supply (sex and single ages)
Economy (wages, prices, employment, etc.)
Health expenditure (revenue) outputs
NHSO SSO CSMBS IHPP
CapitationCapitation Base Rate NHA
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Health Expenditure ModelHealth Expenditure Model
ExpScheme = PopScheme * Frequency of contactsScheme * Costs per contactScheme
e0 Sch
e1 Sch
e2 Sch
...
...
...
e100 Sch
p0 Sch
p1 Sch
p2 Sch
...
...
...
p100 Sch
f0 Sch
f1 Sch
f2 Sch
...
...
...
f100 Sch
c0 Sch
c1 Sch
c2 Sch
...
...
...
c100 Sch
Costs per contactScheme = Costs per contactHospitals
?SUMe SUMp
Capitation = SUMe / SUMp
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Health Expenditure Model:Health Expenditure Model:designing the population modeldesigning the population model
with
PopTOT =: PopUC + PopSSO + PopCSMBS + PopOTH
PopUC =: UC covered population (age: 0 to 100)
PopSSO =: SSO covered population (age: 15 to [69])
PopCSMBS =: CSMBS covered population (age: 15 to [100])
PopOTH =: Residual (non-CSMBS public (age: 15 to [100])schemes; residency abroad; others)
PopUC = PopTOT – PopSSO – PopCSMBS – PopOTH
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How do population How do population models work?models work?
PopulationStock (t+1)
= PopulationStock (t)
+ ImmigrationFlow (t+1) – EmigrationFlow (t+1)alternative:
[EntriesFlow (t+1) – ExitsFlow (t+1)]
+ NewbornsFlow (t+1) – DeathsFlow (t+1)
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Id e a o f co h o rtId e a o f co h o rt --w ise p ro jec tio nw ise p ro jec tio n-- d e m o g ra p h ic p ro je c tio nsd e m o g ra p h ic p ro je c tio ns
Ye a rA g e T T +1 T +2
+ N e w b irth0 + N e t m ig ra tio n ( = Im m ig ratio n - E m ig ra tio n )
- D e a th
1 + N e t m ig ra tio n ( = Im m ig ratio n - E m ig ra tio n )- D e a th
2 + N e t m ig ra tio n ( = Im m ig ratio n - E m ig ra tio n )- D e a th
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4...
1 0 0
How do population models How do population models work?work?
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Base population in year tRates of survival by sex and ageby sex and age
Net migrationby sex and age Population in year t+1
by sex and age (age>1)
Rates of fertility Population in year t+1by age of mothers by sex and age
Number of the newbornSex ratio
of the newbornNumber of thenewborn by sex
Population of age 0in year t+1 by sex
How do population models How do population models work?work?
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Health Expenditure Model:Health Expenditure Model:designing the population modeldesigning the population model
PopTOT =: Data base MoI
Weakness: fertility and mortality data
Solution: standard UN parameters (?)
PopOTH = k * PopTOT k =: PopOTH / PopTOT => exog; constant (?)
PopSSO =: Data base SSO
Problem: labour market entries & exits; mortality
Solution: construction of theoretical rates (?)
PopCSMBS =: Data base CSMBS
Problem: dependents (children; spouses; parents) = f (actives)
Solution: ??? [under investigation]
Problems / solutions:
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How do population How do population models work?models work?
PopulationStock (t+1)
= PopulationStock (t)
+ ImmigrationFlow (t+1) – EmigrationFlow (t+1)alternative:
[EntriesFlow (t+1) – ExitsFlow (t+1)]
+ NewbornsFlow (t+1) – DeathsFlow (t+1)
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Health Expenditure Model:Health Expenditure Model:designing the population modeldesigning the population model
Scheme specific
UC SSO CSMBS
Frequencies of contacts:
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Health Expenditure Model:Health Expenditure Model:designing the population modeldesigning the population model
Scheme specific
UC [« hospital costs / shadow fees »] SSO [« hospital costs / shadow fees »] CSMBS [« hospital fees for service »]
Costs per contact:
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Health Expenditure Model:Health Expenditure Model:Hospital Expenditure StructureHospital Expenditure Structure
Month YearOperating expense / personell expense
Salary and wagesSalary X XWages X XTemporary wages X XOther salary and wages X X
Other personal expense X XNon-operating expense
Compensation X XSundries X XCost of goods
Drugs X XMedical material X X
SuppliesEquipment X XOther X X
Public utility X XDepreciation and amortization
Depreciation X XAmortization X X
Other operating expense
Bad debt X XDoubtful accounts X XCross expense X XReimbursement to other hospitals X X
Other expense X XTotal operating expense
Non-operating expenseGovernment revenue (tax) expense X XTotal expense
Item
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Hospital labour costs:
Per capita wages (by profession (?)) =: Cost indexNumber of staff (by profession (?)) =: Volume index
Hospital non-labour costs:
For Sundries,Pharmaceutical drugs,Medical material (goods),Equipment, Other supplies,Electricity / energy
Price Indexes to be developed=> Volume indexes follow
Hospital Expenditure Structure:Hospital Expenditure Structure:Cost and Volume IndicatorsCost and Volume Indicators
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Open questionsOpen questions
Permanently many.