Performance of Health Financing Function and Overview of Main Policy Challenges Georgian Health Care 2020 Washington DC, February 1-2, 2010 Bakhuti Shengelia Senior Health Specialist East Asia and Pacific Region, Human Development Network The World Bank
34
Embed
Performance of Health Financing Function and Overview of Main Policy Challenges Georgian Health Care 2020 Washington DC, February 1-2, 2010 Bakhuti Shengelia.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Performance of Health Financing Function and Overview of Main Policy Challenges
Georgian Health Care 2020Washington DC, February 1-2, 2010
Bakhuti ShengeliaSenior Health Specialist
East Asia and Pacific Region, Human Development NetworkThe World Bank
Outline• Current architecture of the Georgian health care system• Framework for evaluating the performance of the financing
system• Health expenditure profile and trends
– The issue of out-of-pocket payments– Composition of private expenditure and drivers of cost
inflation• Financial access to health services• Impact of health care costs on households and equity in
health financing• Conclusions and Policy issues to be address
Organization of Health Financing
What Do We Mean By Performance of the Health Financing System?
Raising resources
Pooling
Purchasing
Protection of population from financial risk/shocks
Ensuring access to services for all when needed
Fairness of financial contribution
Sub-functions Performance goals
HOW MUCH ARE WE SPENDING ON HEALTH?
WHO PAYS FOR HEALTH CARE?
Health Expenditures in Relation to GDP
In 2007 - 8.6% of GDPIn 2009 – 10.1% of GDP
EU – 8.9%CIS – 5.5%
Per Capita Total Health Spending
• US$245 equivalent (GEL409.9) • In $PPP terms – $459• CIS in $PPP terms – $621
Switz
erlan
dMalt
a
Fran
ce
German
y
Denmark
Belgium
United Kingd
om
Finlan
d EU Italy
Monaco
Israe
l
Euro
pean Reg
ion
Czech Rep
ublic
Hungary
Estonia
Poland
Bulgaria
Russian
Federa
tion
Belaru
s
Turke
y CIS
Ukraine
Kazakh
stan
Azerbaij
an
Kyrgyzs
tan
Turkm
enist
an0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Per capita health spending in EURO region in $PPP (2008)
Trends in Health System Financing2001-2009 (GEL,000,000)
The size of the health care spending in the total government spending is the direct measure of how much priority the government gives to the health of the nation!
Source: National Health Accounts, Georgia, WHO HFA database.
How Would Health Spending Change if the Government Gave More Priority to Health?
Current(7.8 % of total gov. Spending)
Scenario 112.9% of the total gov. spending (WHO-EURO average)
Scenario 29.3% of the total gov. spending (CIS average)
Scenario 315% of the total gov. spending (Abuja declaration)
Total gov. spending 419 mln GEL 696 mln GEL 502 mln GEL 810 mln GEL
Public expenditure as % of THE
23% 38% 28% 45%
Per capita spending
410 GELPPP$ 459
472 GELPPP$ 530
427 GELPPP$ 479
498 GELPPP$ 560
THE 1.8 bln (GEL) 2.1 bln (GEL) 1.9 bln (GEL) 2.2 bln GEL
Health spending as % of GDP
10.1% 11.7% 10.6% 12.2%
Does Health Financing System Provide Adequate Access?
Can People Get Care When They Need it?
Trends in Health Insurance Coverage
Utilization of Health Services
Indicator Year Total Urban Rural
Average number of consultations / contacts per person per annum (all sources of care) (2)
2007 2.01 2.36 1.67
2010 1.91 1.85 *** 1.97 **
Average number of outpatient consultations (all types) per person per annum (1)
2007 1.74 2.03 1.46
2010 1.66 1.60 1.72
Percentage of total population who reported being sick with any condition in last 6 months and consulted a healthcare provider (2)
2007 59.5 59.8 59.3
2010 60.3 59.6 60.9
Percentage of occurrences of acute illness in the past 30 days where a healthcare provider was consulted (2)
2007 56.5 55.6 57.9
2010 66.0 *** 68.0 *** 64.3 *
Notes: (1) Significance of difference not tested; (2) Statistical significance of difference with baseline figure: *** p<0.01; ** p<0.05; * p<0.1.
Do Georgians Use More or Less Health Care Compared to the Rest of the Region?
Outpatient contacts per person per year - 7, in 1990
Outpatient contacts per person per year – 1.9 in 2009
Cost of Care is a Serious Access Barrier2007 2010
Percentage of consultations where medicine wasprescribed
82.1% 80.4%
Percentage of consultations where medicine wasprescribed but not purchased because it was tooexpensive (base: consultations where medicines were prescribed)
14.5% 16.3%
Percentage of consultations where a lab test wasprescribed
43.5% 45.1%
Percentage of consultations where a lab test wasprescribed but not done because it was too expensive (base: consultations were lab tests were prescribed)
9.6% 9.3%
Percentage of population who were reported to need hospitalization in the last year but were not hospitalized
4.4% 3.4%
Percentage of population who were reported to needhospitalization in the last year but were not hospitalizedbecause it was too expensive/they did not haveenough money (base: those that were not hospitalized)
89% 76.4%
Composition of Per Capita Private Spending (in GEL)
2001 2002 2003 2004 2005 2006 2007 2008 20090
50
100
150
200
250
300
350
22 24 28 33 38 44 51 65 71 17 19 21 25 31 35 41
45 50
35 51
67 76
89 89
105
128
151
1013
1518
2026
33
41
59 The rest of private expenditure
Medicines and other consumables
Outpatient
Inpatient care
Source: National Health Accounts, MoH
435% increase in pharmaceutical spending323% increase in inpatient spending289% increase in outpatient spending
Expenditure on Pharmaceuticals as % of Total Health Expenditure (OECD versus Georgia, 2008)
New Ze
aland
Netherl
ands
Icelan
d
Swed
en
Belgium
German
y
Canad
a
France
Slove
niaSp
ain
Estonia
Czech Rep
ublic
Poland
Korea
Hungary
Georgi
a0
5
10
15
20
25
30
35
40
45
5043.2
2001 2002 2003 2004 2005 2006 2007 2008 20090.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
48.0%53.1%
56.7% 54.4%51.5% 50.2% 51.3%
45.0%
56.4%
Private Expenditure of Pharmaceuticals as % of Total Private Expenditure on Health