Transcript PAHO-MOH BELIZE CONSULTANCY

IMPLICATIONS OF NATIONAL HEALTH
ACCOUNTS (NHA) FINDINGS FOR
UNIVERSAL HEALTH COVERAGE (UHC)
IN BELIZE
By
Dr Stanley Lalta—HEU/UWI
Presented at PAHO-MOH Belize Forum on Health in
Development
October 10, 2013
OUTLINE OF PRESENTATION
• NHA as Measuring-Policy Tool for Flow of Funds
• Summary—Scope of Study and Main Findings
• Inferences from Findings:Effectiveness of Spending
Efficiency of Spending
Adequacy of Spending
Equity in Funding
Sustainability of Funding
National Health Insurance Option(s)
NHA AS A MEASUREMENT-POLICY TOOL FOR FLOW OF FUNDS
Donors
NGO’s
Admin
Overseas
Prevention
Business
Insurers
NGO’s
Pharmacy-Lab
SSB
H.H’s
H.H’s
Gov’t
Financing
Sources:
-who pays/
contributes
MoH
Financing
Agents:
-who pools,
manages funds,
purchases
services
Private for
Profit
Public
Facilities
Health
Providers:
-who provides
services, owns
facilities
Outpatient Public/Private
Inpatient CarePublic/Private
Health
Functions:
-what services
are bought
Summary-Scope of Study & Main Findings
Scope
Analyse existing health accounts of the MOH along with related
reports on health spending in Belize (IDB, WHO, WB, PAHO)
Total Health
Expend (THE)
About 5.3% of GDP or US$235 per capita in 2010. In real terms, THE
grew faster than GDP in all except 2 years between 1991-2007
Public Share of
THE
Public share (i.e largely MOH spending) was 65%. MOH received
about 12% of overall gov’t budget. In real terms, MOH budget grew
faster than overall budget in all except 3 years between 1991-2007.
Private Share
of THE
Private share was 30% with Out of Pocket Payments (OOP)
constituting the bulk of this .
Social Security
Relatively limited role in funding (vs managing NHI) health care.
External
Support
Donors provide about 5% of funds expended in health sector
Inferences(1)-Effectiveness (using
WHO, 2010 data)
Country
THE per cap
(US$)
THE%GDP
Life Expectancy (years)
Probability of Dying
0- 5 years (per ‘000)
Probability of
Dying 15—60 years
(per ‘000)
Belize
239
5.2
75
18
166
Bahamas
Barbados
Guyana
Dominica
Jamaica
1481
974
122
337
256
7.2
6.7
8.1
6.0
4.8
76
76
67
74
71
12
11
35
10
31
164
108
257
147
177
Surinam
T& T
423
908
7.2
4.7
72
70
26
35
172
172
Costa Rica
Guatemala
Mexico
618
184
588
9.6
6.9
7.6
79
71
77
11
40
17
93
214
122
Inferences (2)—Efficiency in Spending
 Reasonable ‘allocative’ efficiency in MOH spend:• 30% of funds to health promotion, illness
prevention and primary care.
• About 5% to administration
 More data needed on ‘technical’ efficiency in public
and private sector i.e avoidance of waste in
procurement of supplies, inventory management,
length of inpatient stay, maintenance, use of
treatment protocols, duplication of tests, referrals
for overseas care.
Inferences (3)—Adequacy of Spending
With THE amounting to 5.3% GDP, Belize is
spending less on health than comparable
Caribbean (about 6%) and Central American
neighbours (about 6.5%).
Given its burden of disease (triple burden of
infectious and maternal-child health
conditions; CNCDs and trauma) and middle
income status (GDP per cap of US$4180 in
2011), Belize should be progressively
spending 6%--7% of GDP on health.
Inferences (4)-Equity in Funding
• Equity in funding issues relate to: High poverty rate (41% in 2009 Poverty Study)
 High OOP payments (30% THE)
 Limited private insurance coverage
 Limited coverage under NHI.
• In keeping with UHC principles, need for more
universal prepaid risk-income pooling plans so
regressive ‘catastrophic’ burden of OOP and health
inequalities are minimised
Equity in Health and UHC
Inferences (5)-Sustainability of Funding
• Sustainability of funding issues relate to:Increasing resource gap (see graph)between
a) Increasing demand for and costs of services
(due to epidemiology, technology,
demography, expectations etc)
b) Slow growing supply/availability of
resources (due to fiscal/budgetary
constraints, shifting of donor funds
Health Financing Dilemma
$
• Aging Population
• Chronic Diseases
•Technology
• Inefficiencies
• Workers’ Demands
• Expectations
• Slow Growing Economy
• Demand from Other Sectors
• Less External Support/Grants
Demand for &
Cost of Health
Services
Availability of
Resources
Time Period
Inferences (6)—NHI Option(s)
 Given challenges with
• Adequacy of spending
• Equity and sustainability of funding
• Securing goals of UHC
 Renew consideration of NHI option(s) bearing in mind
• SSB’s experience/expertise in benefits management
• SSB’s contribution rate (8%) is less than the 10% ++ in
most Caribbean countries
• Experience with NHI in other Caribbean countries
• International experience with SHI avoiding US pitfalls
Current and Proposed NHI Plans in Caribbean
(S—Single Carrier; M—Multiple Carriers)
A. Universal Coverage; Broad Package
B. Partial Coverage; Broad Package
Current—
Aruba (S)
Cayman Is (M)
Current—
Antigua (S)
Surinam (M)
Proposed—
Anguilla (S)
Bahamas (S)
St Vincent (S)
T’dad & T’bgo (S)
Bermuda (M)
Turks & Caicos (S)
Curacao (M)
St Maarten (M)
BVI (S)
Jamaica (M)
St Lucia (S)
C. Universal Coverage, Limited Package
D. Partial Coverage, Limited Package
Current-
Current—
Bahamas (S)
T’dad & T’bgo (S)
Belize (S)
Jamaica (S)
Barbados (S)
Obamacare—Mandated Universal
Coverage or Individual Choice
Policy Choices in Universal Health Coverage
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