Transcript NATIONAL HEALTH ACCOUNTS STUDY

NATIONAL HEALTH ACCOUNTS STUDY
School of Public Health
The Ministry of Health, Turkey
Salih MOLLAHALILOGLU MD, MSc
Mehtap KARTAL MD
2015.07.28
*Results of Draft Final Report
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NATIONAL HEALTH ACCOUNTS STUDY
Key questions which will be helpful for answering NHA;
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How big are the health system and its components in economy?
Who, How much does someone pay?
What are those payment mechanisms?
How do the resources are distributed among service providers and kinds
of service?
• How does the financial value of the benefits is distributed ?
• Where do we stand when we are compared with other countries?
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NATIONAL HEALTH ACCOUNTS STUDY
TURKEY*;
• Health financing highly fragmented
• Difficult to ascertain spending across different functions by different
agents
• Different funding sources have different incentive implications affecting
provider and consumer behavior differently
• Difficult to ensure efficiency and equity in public spending
• Fragmentation increases administrative costs
*Mukesh CHAWLA, World Bank, Presentation of NHA Training, Turkey
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NATIONAL HEALTH ACCOUNTS STUDY
Health Financing Flows
Sources
Financing Agents
Public
Taxes
Health Providers
Public Institutions
Public Payments
Public
Social Security Funds
Liabilities
Credits
Private
Loans
Private Sector /
Private Insurance
Enterprices
Private
Employers
Aids
Out-of-Pocket
Expenditures
Private Household
Out-of Pocket
Employers
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NATIONAL HEALTH ACCOUNTS STUDY
Health Financing Flows
Financing
Agents
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Central
Government
Local
Government
Financing
Mechanism
s
Budgets
Hospitals
MOH
Hospitals
Social Security
Fund for
workers
Other
Social
Security
Funds
Revolving
Funds
SSK
Hospitals
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Private
Insurance
Out of
pocket
Foundations/
Associations
University
Hospitals
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NATIONAL HEALTH ACCOUNTS STUDY
Prepared Data Collection Tools;
• Associations (Sample prepared for 3704 associations related with
health )
• Foundations (Questionnaires sent to all 256 foundations related
with health which were given by General Directorate of
Foundations)
• Private Hospitals (via Association of Private Health Institutions)
• Private Health Insurance (via Turkey Insurance and Reasurance
Companies Associations)
• Private Business Enterprise (Addresses provided from Ministry of
Labor)
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NATIONAL HEALTH ACCOUNTS STUDY
Prepared Data Collection Tools;
• State-owned economic Enterprise (provided through the agency
of the Treasury, only 1 is missing)
• Privatization Administration (The information has been partly
reached)
• Social Security Units under the provisional article of 20 of Social
Insurance Organization Law (Provided through Ministry of Labor)
• Municipalities (Questionnaires sent to all 3200 municipalities by
Ministry of Internal Affairs)
• Private Provincial Administrations (Questionnaires answered by
all 81 provinces)
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NATIONAL HEALTH ACCOUNTS STUDY
Hospital Study;
Determining how payments are provided for Service
Providers/hospitals and how these financial resources
including general budget are spent and used for which
services by service providers. Data base depends on,
hospitals’ curative care division by;
Inpatient curative care
Outpatient curative care
Dental care
Services of Rehabilitative care and
– Education-training of Health personnel
–
–
–
–
according their ratio within the hospitals.
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NATIONAL HEALTH ACCOUNTS STUDY
Household Study;
The general goal of the Household Survey is to estimate
out-of-pocket expenditures on all levels of health care for a
representative sample of 10,675 household. The answering
rate is generally 91.85%. As we do not have the final report
we don’t have the details of this study. But some results
presented in the last meeting on 19-20 June 2003.
• The insurance coverage is 67.20%.
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NATIONAL HEALTH ACCOUNTS STUDY
Annual Per Capita Health Expenditures by Region
Health Expenditures (TL)
160,000,000
140,000,000
120,000,000
100,000,000
80,000,000
60,000,000
40,000,000
20,000,000
0
North
South
East & S.East
Central
Average
West
Regions
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NATIONAL HEALTH ACCOUNTS STUDY
Total Health Expenditures (2000)
Corporations
Direct
Expenditure
3,6%
Other
1,4%
Central
Government
24,2%
Household out of
Pocket Spending
27,5%
Local Government
4,0%
Private Insurance
Enterprices
3,6%
Private Social
Insurance
0,7%
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Social Security
Funds
35,0%
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0
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5,9 5,9
5,4
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Turkey previous
6
Mexico
6
Slovak Republic
6,2
Korea
6,8 6,7 6,6
6,5
Luxembourg
10,7 10,6
Poland
12
Turkey
Finland
Ireland
7,3 7,2
Hungary
Czech Republic
7,9 7,9 7,8 7,8 7,7
United Kingdom
Spain
Norway
Japan
8
OECD Average
8
Sweden
8
New Zealand
8,3 8,3 8,3 8,2 8,1 8,1
Austria
Netherlands
Italy
Portugal
Greece
Denmark
9,1 8,9
8,7
Hungary
Belgium
Iceland
9,5
Canada
10
France
Germany
14
Switzerland
United States
Percent of GDP
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Total Expenditure on Health as a Percent of GDP (2000)
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Turkey
5,1
4
2
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Public Share
*Results of Draft Final Report
United States
Korea
Mexico
Greece
Switzerland
Turkey
Netherlands
Turkey Previous
Austria
Spain
Poland
Portugal
Belgium
Canada
Australia
OECD Average
Italy
Germany
Finland
Hungary
Ireland
France
Japan
New Zealand
United Kingdom
Denmark
Iceland
Norway
Slovak Republic
Czech Republic
Luxembourg
Percent of Total Expenditure on Health
NATIONAL HEALTH ACCOUNTS STUDY
Public and Private Shares of Total Expenditure on Health (2000)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Private Share
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NATIONAL HEALTH ACCOUNTS STUDY
Main Challenges of the Study;
• Institutionalization
SPO take NHA as a project to be done by SIS and its
budget given to SIS
• Regular, standart data collections
• Use of data by Policy-makers
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