DELSA/GOV 3rd Health meeting - Anita CHARLESWORTH

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This presentation by Anita CHARLESWORTH 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 - Anita CHARLESWORTH

  1. 1. © Nuffield Trust25 April 2014 User Changes and Co-payments: How useful and how dangerous? Anita Charlesworth Chief Economist Nuffield Trust
  2. 2. © Nuffield Trust The concerns about user charges and co-payments • User charges increase the financial burden on households, and, in general, they do not differentiate effectively between cost-effective and low-value care. • They reduce use among lower-income individuals and older people, even when the level of user charges is low. • Increasing user charges in primary or ambulatory care may worsen health outcomes. In some cases they may increase spending in more expensive acute, emergency care. • The transaction costs involved may be significant. (Wagstaff and others 1992, Newhouse & Rand Corporation Insurance Experiment Group,1993; Gemmill and others 2008 Braithwaite and Rosen, 2007; Bach, 2008; Thomson and others, 2009, Trivedi and others 2008, Goldman and others 2007).
  3. 3. © Nuffield Trust 0% 10% 20% 30% 40% 50% 60% Proportionofhealthspending% out of pocket as a % of spending Average Out of pocket spending Source: OECD 2013 Out of pocket spending and health spending as a share of GDP across the OECD
  4. 4. © Nuffield Trust Out of pocket spending and health spending as a share of GDP across developed countries Source: OECD 2013 0% 5% 10% 15% 20% 25% 30% 35% Proportionofhealthspending% out of pocket as a % of spending health spending as a share of GDP Average out of pocket Average health spending as share of GDP
  5. 5. © Nuffield Trust Why do user charges and co-payment policies continue to be such a focus on policy debate and action • Unpalatable alternatives? • Scope to raise revenue which although comparatively small are important in an economic and fiscal crisis?
  6. 6. © Nuffield Trust Bringing tax and spend back to pre-crisis levels
  7. 7. © Nuffield Trust Government spending as a share of total budget
  8. 8. © Nuffield Trust
  9. 9. © Nuffield Trust Relationship between out of pocket expenditure and male PYLL (23 countries) R² = 0.0033 0 1000 2000 3000 4000 5000 6000 7000 0% 5% 10% 15% 20% 25% 30% 35% Potentialyearlifelossmale Out of pocket as a proportion of spending %
  10. 10. © Nuffield Trust Relationship between out of pocket expenditure and female PYLL (23 countries) R² = 0.1307 0 500 1000 1500 2000 2500 3000 3500 4000 0 5 10 15 20 25 PYLLallcausesfemale Out of pocket as proportion of spending %
  11. 11. © Nuffield Trust Relationship between Out of pocket expenditure and gap between male/female, potential year life loss (PYLL) (23 countries). R² = 0.2656 0% 10% 20% 30% 40% 50% 60% 0% 5% 10% 15% 20% 25% 30% 35% percentagechangebetweenmaleandfemale,PYLL allcauses Out of pocket as a proportion of spending %
  12. 12. © Nuffield Trust What is the role of user charges and co-payments in health system sustainability • Increasing user charges and co-payments in countries with universal coverage is tempting as a short-term source of additional revenue. But they are unlikely to improve system efficiency. • In assessing the health effects policy makings need to consider the alternatives which may have equal if not greater negative impacts on health or well being. • User charges and co-payments are unlikely to improve long- term sustainability for which stable funding growth and sustained productivity growth is key.
  13. 13. © Nuffield Trust Size of over and underspending in percentage of budgeted spending (2006 – 2012)
  14. 14. © Nuffield Trust23 April 2014 www.nuffieldtrust.org.uk Sign-up for our newsletter www.nuffieldtrust.org.uk/newsletter Follow us on Twitter: Twitter.com/NuffieldTrust © Nuffield Trust Insert presenter’s email address here

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