national health accounts in egypt
TRANSCRIPT
Abt Associates Inc. In collaboration with:I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health
better systems, better health
National Health Accounts (NHA) in Egypt
Overview and Key Findings
Dr. Mahmoud Farag
Evolution of NHA in Egypt
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Since 1994, the MOHP in collaboration with USAID, has been a pioneer in the area of NHA.
Egypt was among the first low and middle income countries to conduct National Health Accounts.
Lead the NHA efforts in the region: First round: 1992 -93 Second round: 2001-02 Third round: 2007-08 Fourth round 2008-09
Lack of institutionalization has meant sporadic production and use of NHA.
Key Findings
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1994/95 2001/02 2007/08 2008/09 THE* per Capita (LE) 127.0 346.0 566.4 800.1 Percent of GDP Spent on Health 3.7% 6.0% 4.8% 5.9% Public Health Expenditures Percent of THE 33.0% 30.0% 33.0% 24.8% MOHP Expenditures Percent of THE
22.0% 23.0% 24.0% 16.5%
Out-of-Pocket Expenditures as Percent of THE
51.0% 62.0% 60.0% 71.8%
Pharmaceuticals as Percent of THE 36.0% 37.0% 26.0% 34.2% Public Spending as Percent of GOE Expenditures
5.0% 5.0% 4.3%
MOHP Expenditures as Percent of GOE Expenditures
4.0% 3.5% 2.8%* THE: Total Health Expenditures
Key Findings
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1994/95 2001/02 2007/08 2008/09
Total Population (Million) 59.2 66.7 75.1 76.8 GDP* Estimates (LE Billion) 203.1 385.0 896.5 1040.0 Total Health Expenditure (THE) (LE Billion)
7.5 23.1 42.5 61.4
Public Health Expenditures (LE Billion) 2.5 6.8 13.9 15.2 MOHP Expenditures (LE Billion) 1.6 5.2 10.2 10.1 Household Expenditures (LE Billion) 3.8 14.3 25.5 44.1 Pharmaceuticals (LE Billion) 2.7 8.6 11.0 21.0
* GDP and GOE expenditure data from Ministry of Finance
Sources of Financing: Who Pays for Healthcare?
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Households continue to remain the single largest source of health financing
Financing Agents: Who Manages the Health Funds?
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Providers: Where Does the Money Go?
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In 2008/09, spending at private facilities accounted for 64 percent of total health spending. Of this spending, pharmaceuticals and private clinics accounted for half of all health spending in Egypt
Egypt Compared to other Middle Income Countries in the Region
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Percent GDP Spent on Health
Government Spending as
Percentage of THE
Health Spending as
Percentage of Total
Government Budget
Out-of-Pocket Expenditure as Percentage of
THE
Algeria 4.49% 83.85% 10.65% 15.30%Djibouti 8.54% 76.07% 14.15% 23.60%Egypt 5.90% 24.80% 4.30% 71.80%Iran 6.30% 45.72% 11.40% 51.68%Jordan 9.10% 62.20% 11.35% 33.40%Lebanon 8.76% 48.99% 12.39% 39.95%Libya 2.80% 75.88% 5.38% 24.12%Morocco 5.33% 34.97% 6.17% 56.13%Syria 3.23% 45.13% 6.01% 54.87%Tunisia 5.95% 49.57% 8.90% 42.52%Sources: World Health Organization (WHO) NHA data, Egypt NHA results, Jordan NHA Report Egypt has highest burden of out-of-pocket spending. Government spending both as a percent of THE and Budget is the lowest.
Summary of Overall Findings
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The private sector remains the primary provider of outpatient services accounting for 80% of all visits: Private clinics and pharmacies are main private providers. More visits occur at MOHP hospitals as compared with MOHP
outpatient facilities.
The Ministry of Health and other public providers account for 62% of all inpatient admissions.
Summary of Overall Findings
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There are a number of differentials in per capita spending: Urban areas spend more than rural areas. Major cities spend the most and rural upper Egypt the
least. Females spend more than Males. Those in the highest income quintile spend nearly 4.5
times as compared with those in the lowest income quintiles.
The insured spend less as compared with the uninsured.
Inequity
Highest income quintile uses over twice as many outpatient visits as compared with those in the lowest income quintile
Highest income quintiles spend four times more on outpatient care and over ten times as much on inpatient care
However, the poor spend a higher proportion of household income on health as compared with the rich
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NHA Implications on Health Sector
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Policy Implications
Increase public investments in health. Need for “smart spending”.
Need to address inequities between rich and poor, urban and rural.
Fast-track comprehensive insurance reforms Comprehensive pharmaceutical reforms Make the private sector a true partner
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MOHP can not tell on a monthly basis what it spends by governorate, by hospital, by primary health care facility or by program. •Hospitals and primary health care centers do not have information on the cost and efficiency of services they produce.•Put a system in place whereby:
oNHA,oExpenditure tracking routine activities of the MOHoCosting
Institutionalizing NHAs Institutionalizing NHAs
Abt Associates Inc. In collaboration with:I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health
better systems, better health
Thank you