Overview of decentralisation of
health financing and expenditure
in OECD countries
Camila Vammalle (OECD)
Claudia Hulbert ...
1. Background information
1. Role of SNGs in financing health care
2. Increasing weight of health expenditure in SNG
spend...
In about half OECD countries, SNGs are a major
player in health care systems
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
D...
The share of health expenditure in SNGs’ total
expenditure has increased since 2000
Health as a share of total SNG expendi...
Stability and predictability of SNG revenues for health
Sources of revenues for financing SNG
health expenditure
Source: O...
Policy setting and control over SNG health care spending
Do CGs set targets for health spending
by SNGs?
Source: OECD surv...
• Volatility of revenues
• Geographical variations
• Changes in population, internal migration
• Reporting health expendit...
THANK YOU!
camila.vammalle@oecd.org
8
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DELSA/GOV 3rd Health meeting - Camila VAMMALLE and Claudia HULBERT

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This presentation by Camila VAMMALLE and Claudia HULBERT was made at the 3rd Joint DELSA/GOV Health Meeting, Paris 24-25 April 2014. Find out more at www.oecd.org/gov/budgeting/3rdmeetingdelsagovnetworkfiscalsustainabilityofhealthsystems2014.htm

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DELSA/GOV 3rd Health meeting - Camila VAMMALLE and Claudia HULBERT

  1. 1. Overview of decentralisation of health financing and expenditure in OECD countries Camila Vammalle (OECD) Claudia Hulbert (Consultant) 3rd Meeting of the Joint Network on Fiscal Sustainability of Health Systems OECD Conference Center, 24-25 April, Paris
  2. 2. 1. Background information 1. Role of SNGs in financing health care 2. Increasing weight of health expenditure in SNG spending 2. Specific challenges in decentralised frameworks 1. Stability and predictability of SNG revenues 2. Policy setting and control over SNG health spending 3. Other challenges Overview of the presentation
  3. 3. In about half OECD countries, SNGs are a major player in health care systems 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Denmark Italy Switzerland Sweden Spain Finland Austria Estonia Poland Norway Slovenia Hungary Korea Germany Portugal CzechRepublic Netherlands Belgium France Iceland Israel SlovakRepublic Luxembourg Greece Ireland UnitedKingdom SNGs CG Social Security SS 39% SNG 30% CG 31% Repartition of health care spending between levels of government (2012) Source: OECD National Accounts
  4. 4. The share of health expenditure in SNGs’ total expenditure has increased since 2000 Health as a share of total SNG expenditure (2000-2012) Source: OECD National Accounts 0% 10% 20% 30% 40% 50% 60% 2000 2007 2012
  5. 5. Stability and predictability of SNG revenues for health Sources of revenues for financing SNG health expenditure Source: OECD survey of budget officials on budgeting practices for health, 2013, Question 14 and 16 transfers from CG 44% Own revenues 42% Transfer s from SS 14% To a large extent 14% To a moderate extent 29% To a small extent 36% Resources can only be varied on a multy year basis 21% To what extent can the CG or SS vary total transfers for health from one year to the next?
  6. 6. Policy setting and control over SNG health care spending Do CGs set targets for health spending by SNGs? Source: OECD survey of budget officials on budgeting practices for health, 2013, Question 14 Do CGs monitor SNG performance on health spending? Yes 60% No 40% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Does CG establish performance targets for SNGs? Does CG prescribe outputs or outcome measures on health for SNGs? Does CG require SNGs to carry out value for money analysis? yes no
  7. 7. • Volatility of revenues • Geographical variations • Changes in population, internal migration • Reporting health expenditure to central governments’ budget authorities • Size of SNGs may not be optimal for service delivery Other specific challenges
  8. 8. THANK YOU! camila.vammalle@oecd.org 8

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