National Health Accounts in Egypt

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Dr. Mahmoud Farag, Health Systems 20/20

Presented April 23, 2012

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  • Out-of-pocket spending remains the single largest source, accounting for 72% of total health spending. High burden of out-of-pocket spending highlights the need for increasing risk pooling and strengthening safety nets for the poor and near poor
  • After household the Ministry of Health is the largest financing agent. Important to note that HIO as a financing agent represents only 6% of total health spending though it is responsible for insuring over 50% of the population.
  • Expenditures on pharmaceuticals and private clinics account for half of all health spending. As we saw earlier spending on pharmaceuticals continues to be a significant proportion of total health spending in the country. The private sector remains the largest provider of health care in Egypt. This is financed largely from out-of-pocket spending MOH Hospitals include those of THIO, CCO and specialized centers
  • Public spending, Health spending as percent of government budget lowest. Household spending is highest Low public investment and high burden of out-of-pocket spending.
  • National Health Accounts in Egypt

    1. 1. better systems, better health National Health Accounts (NHA) in Egypt Overview and Key Findings Dr. Mahmoud FaragAbt Associates Inc.  In collaboration with:I Aga Khan Foundation I Bitrán y AsociadosI BRAC University I Broad Branch AssociatesI Deloitte Consulting, LLP I Forum One CommunicationsI RTI International I Training Resources GroupI Tulane University’s School of Public Health
    2. 2. Evolution of NHA in Egypt  Since 1994, the MOHP in collaboration with USAID, has been a pioneer in the area of NHA.  Egypt was among the first low and middle income countries to conduct National Health Accounts.  Lead the NHA efforts in the region:  First round: 1992 -93  Second round: 2001-02  Third round: 2007-08  Fourth round 2008-09  Lack of institutionalization has meant sporadic production and use of NHA. 2
    3. 3. Key Findings   1994/95 2001/02 2007/08 2008/09THE* per Capita (LE) 127.0 346.0 566.4 800.1Percent of GDP Spent on Health 3.7% 6.0% 4.8% 5.9%Public Health Expenditures 33.0% 30.0% 33.0% 24.8%Percent of THEMOHP Expenditures Percent of 22.0% 23.0% 24.0% 16.5% THEOut-of-Pocket Expenditures as 51.0% 62.0% 60.0% 71.8%Percent of THEPharmaceuticals as Percent of THE 36.0% 37.0% 26.0% 34.2%Public Spending as Percent of GOE   5.0% 5.0% 4.3%ExpendituresMOHP Expenditures as Percent of   4.0% 3.5% 2.8%GOE Expenditures 3* THE: Total Health Expenditures
    4. 4. Key Findings   1994/95 2001/02 2007/08 2008/09Total Population (Million) 59.2 66.7 75.1 76.8GDP* Estimates (LE Billion) 203.1 385.0 896.5 1040.0Total Health Expenditure (THE) 7.5 23.1 42.5 61.4(LE Billion)Public Health Expenditures 2.5 6.8 13.9 15.2(LE Billion)MOHP Expenditures (LE Billion) 1.6 5.2 10.2 10.1Household Expenditures (LE Billion) 3.8 14.3 25.5 44.1Pharmaceuticals (LE Billion) 2.7 8.6 11.0 21.0* GDP and GOE expenditure data from Ministry of Finance 4
    5. 5. Sources of Financing: Who Pays for Healthcare?Householdscontinue to remainthe single largestsource of healthfinancing 5
    6. 6. :Financing Agents?Who Manages the Health Funds 6
    7. 7. Providers: Where Does the Money Go?In 2008/09, spending atprivate facilitiesaccounted for 64percent of total healthspending.Of this spending,pharmaceuticals andprivate clinics accountedfor half of all healthspending in Egypt 7
    8. 8. Egypt Compared to other Middle Income Countries in the Region Health Spending Government Out-of-Pocket Percent GDP as Percentage of Spending as Expenditure as Spent on Total Percentage of Percentage of Health Government THE THE BudgetAlgeria 4.49% 83.85% 10.65% 15.30%Djibouti 8.54% 76.07% 14.15% 23.60%Egypt 5.90% 24.80% 4.30% 71.80%Iran 6.30% 45.72% 11.40% 51.68%Jordan 9.10% 62.20% 11.35% 33.40%Lebanon 8.76% 48.99% 12.39% 39.95%Libya 2.80% 75.88% 5.38% 24.12%Morocco 5.33% 34.97% 6.17% 56.13%Syria 3.23% 45.13% 6.01% 54.87%Tunisia 5.95% 49.57% 8.90% 42.52%Sources: World Health Organization (WHO) NHA data, Egypt NHA results, Jordan NHA Report Egypt has highest burden of out-of-pocket spending. Government spending both as a percent of THE and Budget is the lowest. 8
    9. 9. Summary of Overall Findings The private sector remains the primary provider of outpatient services accounting for 80% of all visits:  Private clinics and pharmacies are main private providers.  More visits occur at MOHP hospitals as compared with MOHP outpatient facilities. The Ministry of Health and other public providers account for 62% of all inpatient admissions. 9
    10. 10. Summary of Overall Findings There are a number of differentials in per capita spending:  Urban areas spend more than rural areas.  Major cities spend the most and rural upper Egypt the least.  Females spend more than Males.  Those in the highest income quintile spend nearly 4.5 times as compared with those in the lowest income quintiles.  The insured spend less as compared with the uninsured. 10
    11. 11. Inequity Highest income quintile uses over twice as many outpatient visits as compared with those in the lowest income quintile Highest income quintiles spend four times more on outpatient care and over ten times as much on inpatient care However, the poor spend a higher proportion of household income on health as compared with the rich 11
    12. 12. NHA Implications on Health Sector 12
    13. 13. Policy Implications Increase public investments in health. Need for “smart spending”. Need to address inequities between rich and poor, urban and rural. Fast-track comprehensive insurance reforms Comprehensive pharmaceutical reforms Make the private sector a true partner 13
    14. 14. Institutionalizing NHAsMOHP can not tell on a monthly basis what it spends bygovernorate, by hospital, by primary health care facility or byprogram.•Hospitals and primary health care centers do not haveinformation on the cost and efficiency of services theyproduce.•Put a system in place whereby: oNHA, oExpenditure tracking routine activities of the MOH oCosting 14
    15. 15. better systems, better health Thank youAbt Associates Inc.  In collaboration with:I Aga Khan Foundation I Bitrán y AsociadosI BRAC University I Broad Branch AssociatesI Deloitte Consulting, LLP I Forum One CommunicationsI RTI International I Training Resources GroupI Tulane University’s School of Public Health

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