Health Financing for Policymakers
Uploaded by
ADB Health Sector GroupHealth Financing for Policymakers
Uploaded by
ADB Health Sector GroupUniversal Health coverage
and health accounts
Tessa Tan-Torres Edejer
WHO/HIS/HGF/CEP
tantorrest@[Link]
Disclaimer: The views expressed in this paper/presentation are the views of the author and do not
necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of
Governors, or the governments they represent. ADB does not guarantee the accuracy of the data
included in this paper and accepts no responsibility for any consequence of their use. Terminology
used may not necessarily be consistent with ADB official terms
Possible overall goal and equity
Overall goal
Ensure healthy lives and
promote wellbeing for all at all
ages
Equity
Reduce the gap between
poorest population (20%/40%)
and the whole population
Proposed target specifics
Indicator
Increase (healthy) life
Life expectancy at birth
expectancy by: 6 years in
(N of deaths under 70)
developing and 2 years in
developed countries (including
40% reduction in deaths before
age 70)
Increase life expectancy for the
poorest by an additional two
years over the national increase
Reduce mortality before age 70
by 50% among the poorest
compared to 40% overall
Overall goal
1 Reduce the global maternal mortality
ratio to less than 70 per 100,000 live
births
2 End preventable newborn and under-5
child deaths;
Proposed target specifics
Reduce the global MMR to less than 70 and no country to have
MMR above 140
Indicator
Maternal deaths per 100,000 live births
All countries to reduce under-5 mortality to 25/1,000 or less
Under-five mortality per 1,000 live births
All countries reduce neonatal mortality to 12/1,000 or less
3 End the epidemics of AIDS, TB, malaria 90% reduction in new adult HIV infections, including among key
and NTD
populations
HIV Zero new infections among children
90% reduction in AIDS-related deaths
TB 80% reduction in tuberculosis incidence rate (< 20 cases per
100,000 population)
90% reduction in tuberculosis deaths
Malaria 90% reduction in global malaria case incidence
90% reduction in global malaria mortality rate
Neglected Tropical Diseases No targets for 2030 at present
3 And Combat hepatitis, water-borne
90% reduction in hepatitis B and C incidence rate
diseases and other communicable
diseases
Water-borne diseases
Other communicable diseases
4 Reduce premature mortality from NCDs One-third reduction of premature mortality from NCD
through prevention and treatment and
promote mental health and wellbeing
10% reduction in suicide-related mortality
5 Strengthen prevention and treatment 10% reduction of alcohol per capita consumption
of substance abuse, including narcotic
drug use and harmful use of alcohol
6 Reduce deaths and injuries due to road Halve the number of global traffic deaths (from 1.2 million to
traffic accidents
600,000)
7 Ensure universal access to sexual and
Ensure universal access to sexual and reproductive health care
reproductive health-care services
services
8 Achieve UHC
All populations, independent of household income, expenditure
or wealth, place of residence or sex, have at a minimum 80%
essential health services coverage
Everyone has 100% financial protection from out-of-pocket
payments for health services
Neonatal mortality per 1,000 live births
HIV incidence rate per 100 adult person years /
per 100 children person years
HIV deaths per 100,000 population
TB incidence per 1000 person years
TB deaths per 100,000 population
Malaria incident cases per 1000 person years
Malaria deaths per 100,000 population
Hepatitis B antibody prevalence in children
under 5 years
Presence of IHR core capacities for surveillance
and response
Probability of dying of cardiovascular disease,
cancer, chronic respiratory disease or diabetes at
ages 30-70
Suicide-related mortality per 100,000 population
Alcohol per capita consumption
Number of deaths due to road traffic accidents
Demand met for modern contraceptives (>75%)
Antenatal care use (4+ visits) (>80%)
Skilled birth attendance (>90%)
Coverage with a set of tracer interventions for
prevention and treatment services**
% population protected against impoverishment
by out-of-pocket health expenditures, % of
Universal Health Coverage
Universal Health
Coverage is defined as
ensuring that all people can
use the promotive,
preventive, curative,
rehabilitative and
palliative health services
they need, of sufficient
quality to be effective, while
ensuring that the use of these
service does not expose
other user to financial
hardship. (WHO)
Millions miss out on needed health services
Millions suffer financial ruin when they use health services
When people use health services:
Globally around 150 million suffer severe financial
hardship each year
100 million are pushed into poverty because they
must pay out-of-pocket at the time they receive
them.
Health expenditures and SDG/UHC:
catastrophic/impoverishing health expenditures
OOPs and GGHE
Total Health
Expenditure (THE)
Total expenditure on health as a
percentage of gross domestic product
(%): 2012 (WHO Global Health
Observatory)
East Asian countries
(China, Korea, Japan): have a
THE that is more than 5% of
GDP
Indonesia, Myanmar &
Pakistan have the lowest
THE as percentage of GDP
Developing countries in
Asia generally spends less at
<5% of GDP
Two caveats
Per capita values vs %
Distribution
Per capita vs normative 86 US$
Why is this health expenditure tracking
(health accounts) important?
Because it answers questions on
FINANCIAL LEVELS:
How much is being spent on health
THE as a proportion of GDP
(share in macroeconomy)
GGHE/GGE
GGHE as a proportion of GDP
OOP/THE, catastrophic/improverishing
Per capita (normative)
Background
SHA 1.0, OECD, 2000 International Classification of
Health Accounts (ICHA)
Producer's Guide, WHO, WB, USAID, 2003 Guide
NHA estimations in the developing countries
SHA 2011, WHO, OECD, EUROSTAT, 2011
Based on SHA1.0
Greater importance given to policy relevance, feasibility and
sustainability
who produces health accounts?
health accounts (HA) = typically produced by a multidisciplinary
team (ministry of health, ministry of finance, central statistical
office)
usually housed within the Department of Planning of the
Ministry of Health
often produced by a core team of 1-2 health accountants,
typically statisticians and/or economists, supported by a larger
non-core team
the work is to collect data (from records + surveys) to track all
expenditures on health and reproduce financial flows
69.50 USD/capita
Lessons learned
On availability and use of data
UPDATED: Financial data that is T-2 or more years is not valued by policy makers; they prefer
the most recent data on expenditures
ROUTINE: More information is provided with trend analysis for expenditures
More DISAGGREGATION provides more policy relevant info and increases demand (by disease,
by inputs e.g. pharma, HR, by geography for decentralized countries)
INCREASE USE of data will improve quality of data through feedback
On measurement/quality issues:
Greatest weakness is data from the private sector, including providers
"accurate" out-of pocket expenditures are difficult to obtain; known biases in household
surveys due to recall, number of questions or prompts, single respondent, etc. Need to
triangulate with other sources
Need better methods of estimation; especially with demands for more disaggregation on
classifications
On production of data (operational):
Constant turnover of trained staff
Multiple, inefficient initiatives to collect expenditure data; less rigorous, standardized; double
counting.
2030: desirable systems
Goal by 2030
production of regular, (annual) standardized (SHA2011), comprehensive (public/private) and
up-to-date (T-1) information on health expenditures
Use of health expenditure information by different audiences together with other health data
by different audiences
Continuing strategies:
-invest in and maximize use of IT , single platform (automation, linkage of budgets with
expenditures, centralization, analysis and documentation and dissemination)
-standardize production through training and documentation
- Provide incentives for private sector reporting
-educate users and link to other health data
Short-medium term work:
--technical work to improve quality of collecting/estimating HH health and total expenditures
-technical work to improve estimation for further disaggregation
Key messages:
Advocacy: UHC /financial protection/post 2015 SDGs:
Large OOPs at 60% of THE
Very few Asian countries spend >5% government health
expenditures/GDP
There is fiscal space for increasing spending in health in
countries
Technical support:
Health accounts illustrate the health sector in terms of
funding flows and patterns of spending
Health accounts can be the starting point for discussions
on fiscal space for health and financial protection,
efficiency, sustainability, equity.
WHO GHED - [Link]
Thank you!
