welcome to health finance food court: what’s cooking? mini-university march 7, 2014 catherine...
TRANSCRIPT
WELCOME to
Health Finance Food Court: What’s Cooking? Mini-University
March 7, 2014Catherine Connor, Deputy Director, HFGCarlos Avila, Sr. Health Economist, HFGJosef Tayag, Health Insurance Specialist, Abt AssociatesKarishmah Bhuwanee, Health Economist, HFG
Abt Associates | pg 2
Today’s menu
Introduction to health financing – fast food version
Group country case study – “If you can’t stand the heat…”
Share – 2 small bites from each group
Country case reveal – what really happened?
Leave with indigestion from too many bad food puns
2
Abt Associates | pg 3
The 3 health financing functions: your ingredients for a comprehensive HF strategy
Collection of funds
Pooling of funds
Risk Pooling
3
Spending of Funds
Allocation
Provider Payment
Resource Mobilization Risk Pooling Purchasing
Resource Mobilization
Abt Associates | pg 5
Resource Mobilization for Health
to provide citizens with services that both improves health outcomes and provides financial protection against unpredictable financial losses caused
by illness and injury.
Raise sufficient and sustainable revenues efficiently and equitably
Abt Associates | pg 6
Resource mobilizationFunding Sources
Individual/families/ employees
Employers/corporate entities
Foreign and domestic NGOs and charities
Foreign Governments and multilateral agencies
Foreign and multinational companies
Contribution Mechanism
(1) Direct taxes
(2) Indirect Taxes
(3) Payroll taxes
(4) Other compulsory contributions (mandates)
(5) Voluntary prepaid contributions
(6) Grants
(7) Loans
Collecting Organization
Central Government
Local Governments
Social Security Agency
Commercial Insurance Fund
Other Insurance Fund
Employer earmarked savings fund
Health care providers
Risk Pooling
Abt Associates | pg 8
Risk and Poverty
Abt Associates | pg 9
Risk Pooling (Stick it in a pot!)
9
Abt Associates | pg 10
Risk Pooling
Varies by:
– Funding source (individuals, employers, NGOs, companies)
– How the money is collected
– Who manages the fund
Types:
– General Tax-Based Provision
– National Health Insurance
– Social Health Insurance
– Private Health Insurance
– Community-Based Health Insurance
Hi Mini-U!
Purchasing
Abt Associates | pg 12
Purchasing
WHAT services?
WHO to purchase from?
HOW to purchase? (e.g. input/output-based)
Consider: Access to care, quality, cost-control, staff motivation, incentives,
implementation capacity
Abt Associates | pg 13
Provider payment mechanisms
HOW services purchased from providers
Input-based
– E.g. Line item budget /global budget
Output-based
– E.g. Per capita, per diem, fee-for-service, pay-for-performance
Differ in complexity of implementation and objectives
Mechanisms are not mutually-exclusive
Examples
Abt Associates | pg 15
HF strategy example: Mixed systemMexico prior to 2003 Seguro Popular
Central government
mobilizes funds from other taxes
and sources
Social health insurance fund
Risk pool = Formal sector workers ONLY
15
Social security institute
mobilizes funds from payroll
taxes
General tax revenue
Risk pool = Everybody else
Social security institute
provides services and pays
independent providers
Nominal fees
Ministry of Health provides
servicesFree services
Resource Mobilization Risk Pooling Purchasing
Form
al s
ecto
r wor
kers
Ever
yone
els
e
Abt Associates | pg 16
Health financing strategies:Taste good or bad? How to judge?
Collection of funds
Pooling of funds
16
Spending of Funds
AllocationProvider Payment
EquityEfficiencyQuality
Resource Mobilization Risk Pooling Purchasing
Abt Associates | pg 17
HF in Mexico: How to judge?
Central government
mobilizes funds from other taxes
and sources
Social health insurance fund
Risk pool = Formal sector workers ONLY
17
Social security institute
mobilizes funds from payroll
taxes
General tax revenue
Risk pool = Everybody else
Social security institute
provides services and pays
independent providers
Nominal fees
Ministry of Health provides
servicesFree services
Resource Mobilization Risk Pooling Purchasing
Form
al s
ecto
r wor
kers
Ever
yone
els
eTaxes areefficient.Equitable?
Equity: 2 class system
Paying for inputs (salaries) limits incentives for efficiency & quality
Group Assignment
Abt Associates | pg 19
Group assignment – Get cookin!
Form small groups – by HF function
You are now HF experts
Read and discuss country case: Ushikamano
What reforms would you recommend?
YOU HAVE 30 MINUTES
19
The Big Reveal
Abt Associates | pg 21
HF Function BEFORE 2003 AFTER 2003: National Health Insurance Voluntary enrolment
Resource mobilization
General taxes, payroll taxes, user fees, CBHI premium payments
VAT tax + payroll tax + wealthy to pay premium
Risk pooling High user fees erode risk poolCBHI schemes are small, fragmented risk pools
Single national risk poolNHI absorbs CHBIs
Purchasing Inadequate government financing of inputs (salaries, drugs, op costs)Patients and CBHI schemes paying fee-for-service
National Health Insurance Agency pays public and private providers fee-for-service
21
What really happened? Ghana 2003 launch of National Health Insurance
Abt Associates | pg 22
What really happened? Ghana 2003 launch of National Health Insurance
Members (compared to non-members)
– Pay less out-of-pocket for health care
– Have higher utilization of health services
Single payer (National Health Insurance Agency) more efficient and professional than multiple CBHI schemes
22
Abt Associates | pg 23
Ghana National Health Insurance
Fee-for-service limits incentives for provider efficiency and quality
Costs spiraling, payer flooded with paper claims, delays in paying providers
Impact on quality inconclusive
23
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