Transcript 1 - IHPP
-Thailand Program Health Policy International -Thailand Program Policy Health International Determinants of National Health Expenditure NHA TEAM International Health Policy Program Draft report presentation for external peer review October 7, 2009 Program Health Policy International -Thailand Program Policy Health International -Thailand How Much Does the World Spend on Health? • • • • In 1998, the world spent nearly 7.9% of global income on health care. There are large variation in health spending across countries. These difference are not restricted to lowand high-income countries but exist within and across countries at the same level of economic development. Over the decades growth in health expenditure has tended to outstrip general inflation rates in most countries. We analyze and identify that determine health expenditure and how these determinants vary across countries at different levels of economic development. 2 Program Health Policy International -Thailand Program Policy Health International -Thailand Determinants of National Health Expenditures 3 Program Health Policy International -Thailand Program Policy Health International -Thailand Government and organization of the Health System Policies • How a health-care system in a country is managed and organize influences how much that country spends on health care. • At the most fundamental level the policies that government enact and the roll they play in managing the health system influences all inputs into health system. Financing • Governments can use a mix of financing methods to mobilize health funds. • National Health Accounts studies have shown that low-andmiddle-income countries use a multiplicity of financing methods and have underdeveloped insurance markets and high out-of-pocket expenditures. 4 Total Health Expendituure by Financing Source, 1994-2008 50% percentage Program Health Policy International -Thailand Program Policy Health International -Thailand Total Health Expenditure by Financing-Thailand 40% 30% 20% 10% 0% 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Central Gov. Household Local Gov. Other CSMBS UC year Social security 5 Program Health Policy International -Thailand Program Policy Health International -Thailand Purchasing • There exists significant variation across countries in how the purchasing function is organized effect overall health expenditure. Provider Payments • The main aim of provider payment is to create incentives that influence the behavior of provider to achieve policy objectives of government such as equity, efficiency and increased access to care. • There are three principle methods of provider payment - the purchaser pays salaries and makes available facilities and medical supplies - contracting for services - allocating an annual budget that could be set on the basis of expected services or enrolled population 6 Program Health Policy International -Thailand Program Policy Health International -Thailand Health Needs of the population Population structure • • • The sheer increase in the number of individuals in a country increase health needs Change in population structure affects the need and demand of health-care-services. A lot of studies showed that change in demographic affect health expenditure. Epidemiology • “Epidemiology transition” : preponderance of communicable disease noncommunicable conditions account for a large part of the disease burden 7 Program Health Policy International -Thailand Program Policy Health International -Thailand Lifestyles • Lifestyles also affect health expenditures. Healthy lifestyles tend to improve health and reduce health expenditure, and unhealthy lifestyles result in poor health and increased health expenditure. 8 •There exists a positive correlation between GDP per capita and share of total health expenditures as a percentage of GDP. Program Health Policy International -Thailand Program Policy Health International -Thailand The Effect of Income on health Expenditures 9 Program Health Policy International -Thailand Program Policy Health International -Thailand •There exists a positive correlation between GDP per capita and per capita health expenditures. •There exists a positive correlation between GDP per capita and the government share of total health expenditures. 10 Ratio of THE to GDP: Thailand 400,000 6.0% 350,000 250,000 200,000 3.6% 3.8% 3.7% 3.6% 3.7% 3.2% 3.4%3.3%3.3% 3.4% 3.1%3.2% 3.1%3.0% 4.2% 150,000 4.0% 2.0% THE % GDP 300,000 Mln.Baht Program Health Policy International -Thailand Program Policy Health International -Thailand Amount of THE and ratio of THE to GDP, constant prices, 1994-2008 100,000 50,000 0 0.0% 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 year ปี investment Operating health expenditure Ratio of THE to GDP (%) 11 -Thailand Program Health Policy International -Thailand Program Policy Health International • The report of the Commission on Macroeconomics (2001) shows that the health status is important in explaining the difference in economic growth even when one controls for macro-economic variables. • Studies conducted in both developed and developing countries bear out the positive relationship between household income and the health status of children. • Household income also is a strong predictor of the demand for health-care services and expenditures. • In conclusion, income is an importance determinant of health expenditures at both the level of country and households. 12 Program Health Policy International -Thailand Program Policy Health International -Thailand Effect of Health Insurance on Health Expenditures • Governments should undertake insurance where the market for whatever reason, has failed to emerge. • Demand elasticities for medical care are non zero and indeed the response to cost sharing is nontrivial 13 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 Percentage Program Health Policy International -Thailand Program Policy Health International -Thailand Social security&WCF as percentage of THE: Thailand Social security&WCF as percentage of total health expenditure 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Year 14 -Thailand Program Health Policy International -Thailand Program Policy Health International • • The significant association observed in the United States and other developed countries between insurance and demand, as well as expenditures on health care, might not hold in the case of low-and middle income countries. Analysis of Household Health Care Expenditure and Utilization Surveys in middleincome countries do not always support the hypothesis that the presence of insurance increase demand and expenditures on health care. 15 Program Health Policy International -Thailand Program Policy Health International -Thailand The Effect of Physician Behavior on Health Expenditure • The physician has the ability to induce demand and this will positively affect the physician’s income. • Balance the gain from recommending and performing expensive treatments and the losses from possessing a bad reputation. 16 Program Health Policy International -Thailand Program Policy Health International -Thailand The Rule of Technology in determining Health Expenditure • There is a relationship between health insurance and technology. • The long run growth of health care expenditures is a by product of the interaction of the R&D process with the health insurance system. • The relationship between technology availability and health-care spending: More availability is associated with higher use and expenditures. • Not many studies exits on the development, diffusion, and adoption of technology and its impact on health expenditure and its impact on health ever, information contained in low-and middle-income countries. 17 Program Health Policy International -Thailand Program Policy Health International -Thailand Expenditures on Pharmaceuticals 18 -Thailand Program Health Policy International -Thailand Program Policy Health International • Expenditures on pharmaceuticals accounted for a significant proportion of total health expenditures. • In countries at all levels of economic development, expenditures on pharmaceuticals represent a fairly significant proportion of total health expenditures, and the current consensus is this will increase over time. • R&D exits in rich countries but in poor countries, little or no R&D investment takes place. 19 08 20 06 20 04 20 02 20 Year Medical goods dispensed to out-patients as percentage of total health expenditure 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% Year 20 08 20 06 20 04 20 02 20 00 19 98 19 96 0.0% 19 94 Percentage 00 20 98 19 96 19 94 Percentage 0.25% 0.20% 0.15% 0.10% 0.05% 0.00% 19 Program Health Policy International -Thailand Program Policy Health International -Thailand Medical goods dispensed to out-patents as percentage of GDP 20 Program Health Policy International -Thailand Program Policy Health International -Thailand Conclusion • Many countries consider health care to be a basic human right. • Our analysis of the determinants of health expenditures shows that how health systems are organized and manages. • The magnitude and share of these determinants in health expenditures varies across countries. • There is a need to more systematically study this issue in the context of low-and middleincome countries. 21 2222 Program Health Policy International -Thailand Program Policy Health International -Thailand