This document discusses options for developing a health sector financing formula to accompany fiscal decentralization reforms in Laos. It reviews 6 potential approaches and recommends an interim formula based on non-wage expenditures and health worker numbers. This interim formula would be developed over 1-2 years into a full health financing formula incorporating incentives and program-level funding once additional health policy issues are addressed. The formula aims to equalize funding while ensuring sufficient budgets for service delivery across diverse regions.
From the medium term fiscal frameworkto ministries' ceilingsJean-Marc Lepain
This presentation lay out the methodology for constructing sector expenditure ceiling starting from a Medium-Term Fiscal Framework and allocating expenditures by expenditure categories.
From the medium term fiscal frameworkto ministries' ceilingsJean-Marc Lepain
This presentation lay out the methodology for constructing sector expenditure ceiling starting from a Medium-Term Fiscal Framework and allocating expenditures by expenditure categories.
Investment planning and public investment plans: Inssues and Best PracticesJean-Marc Lepain
This presentation goes through the issues in investment appraisal that result in poor outcomes. It introduces Public Investment Plans as a systematic methodology to address these issues.
Spending Reviews - Naida CARSIMAMOVIC, World BankOECD Governance
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Using Performance Data to Inform Budgeting at the Subnational Level: The Onta...OECD Governance
Presentation by Greg Orencsak at the 10th annual meeting of the Senior Budget Officials Performance and Results Network held on 24-25 November 2014. Find more information at http://www.oecd.org/gov/budgeting
Capital Budgeting - Iryna SCHERBYNA, World BankOECD Governance
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OECD, 35th Meeting of Senior Budget Officials - Lars Ostergaard - DenmarkOECD Governance
This presentation by Lars Ostergaard, Denmark, was made at the 35th Meeting of Senior Budget Officials held in Berlin on 12-13 June 2014. Find more information at http://www.oecd.org/gov/budgeting/35thannualmeetingofoecdseniorbudgetofficialssboberlingermany12-13june2014.htm
Implementing Spending Reviews: Dilemmas and Choices by Martin Kelleners OECD Governance
Presentation by Martin Kelleners at the 10th annual meeting of the Senior Budget Officials Performance and Results Network held on 24-25 November 2014. Find more information at http://www.oecd.org/gov/budgeting
Performance Budgeting: The French Experience by Veronique FouqueOECD Governance
Presentation by Veronique Fouque at the 10th annual meeting of the Senior Budget Officials Performance and Results Network held on 24-25 November 2014. Find more information at http://www.oecd.org/gov/budgeting
Myanmar Strategic Purchasing 2: Calculating a Capitation PaymentHFG Project
This is the second in a series of briefs examining practical considerations in the design and implementation of a strategic purchasing pilot project among private general practitioners (GPs) in Myanmar. This pilot will start developing the important functions of, and provide valuable lessons around, contracting of health providers and purchasing that will contribute to the broader health financing agenda. More specifically, it is introducing a blended payment system that mixes capitation payments and performance-based incentives to reduce households’ out-of-pocket spending and to incentivize providers to deliver an essential package of primary care services
Investment planning and public investment plans: Inssues and Best PracticesJean-Marc Lepain
This presentation goes through the issues in investment appraisal that result in poor outcomes. It introduces Public Investment Plans as a systematic methodology to address these issues.
Spending Reviews - Naida CARSIMAMOVIC, World BankOECD Governance
This presentation was made by Naida CARSIMAMOVIC, World Bank, at the 15th Annual Meeting of OECD-CESEE Senior Budget Officials held in Minsk, Belarus, on 4-5 July 2019
Using Performance Data to Inform Budgeting at the Subnational Level: The Onta...OECD Governance
Presentation by Greg Orencsak at the 10th annual meeting of the Senior Budget Officials Performance and Results Network held on 24-25 November 2014. Find more information at http://www.oecd.org/gov/budgeting
Capital Budgeting - Iryna SCHERBYNA, World BankOECD Governance
This presentation was made by Iryna SCHERBYNA, World Bank, at the 15th Annual Meeting of OECD-CESEE Senior Budget Officials held in Minsk, Belarus, on 4-5 July 2019
OECD, 35th Meeting of Senior Budget Officials - Lars Ostergaard - DenmarkOECD Governance
This presentation by Lars Ostergaard, Denmark, was made at the 35th Meeting of Senior Budget Officials held in Berlin on 12-13 June 2014. Find more information at http://www.oecd.org/gov/budgeting/35thannualmeetingofoecdseniorbudgetofficialssboberlingermany12-13june2014.htm
Implementing Spending Reviews: Dilemmas and Choices by Martin Kelleners OECD Governance
Presentation by Martin Kelleners at the 10th annual meeting of the Senior Budget Officials Performance and Results Network held on 24-25 November 2014. Find more information at http://www.oecd.org/gov/budgeting
Performance Budgeting: The French Experience by Veronique FouqueOECD Governance
Presentation by Veronique Fouque at the 10th annual meeting of the Senior Budget Officials Performance and Results Network held on 24-25 November 2014. Find more information at http://www.oecd.org/gov/budgeting
Myanmar Strategic Purchasing 2: Calculating a Capitation PaymentHFG Project
This is the second in a series of briefs examining practical considerations in the design and implementation of a strategic purchasing pilot project among private general practitioners (GPs) in Myanmar. This pilot will start developing the important functions of, and provide valuable lessons around, contracting of health providers and purchasing that will contribute to the broader health financing agenda. More specifically, it is introducing a blended payment system that mixes capitation payments and performance-based incentives to reduce households’ out-of-pocket spending and to incentivize providers to deliver an essential package of primary care services
Case study on establishing low cost hospitals in 4 states with low health ind...Shubhenduchakravorty
This Case Study was created for a specific purpose of exploring a model to establish and clarify operational details of Low Cost Healthcare Hospitals in the States of Bihar, Jharkhand, Chhattisgarh and Madhya Pradesh. The name of the Hospital and the base presumptions are fictitious. However, all data used in the Case Study and the Models are genuine and referred from various sources.
Value-Based Purchasing and the Role of Home Care TechnologyAlayaCare
While shifting financial models is a major challenge facing healthcare, we can safely assume where that shift is heading. As it stands, there continues to be a paucity of good evidence as to how to run an effective Value-Based Purchasing (VBP) program, and definitive metrics on how it can lead to better outcomes. Thus, this shift is underway filled with far more expectations than answers.
With this guide will you learn how your home care agency can prepare, adapt and thrive in a value-based purchasing landscape with the help of modern home care technology.
Today, there is a strong media coverage on the increasing cost of health care in the United States andin many other countries around the world. This gives rise to a common concern in these countries. So, the question is how best to control the rate of growth in health care expenditures whilst still delivering good healthcare.
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
Lessons from pfm in the health sector finalHFG Project
Over the past five years, the Health Finance and Governance (HFG) project has supported over 35 countries and programs in their efforts to strengthen public financial management (PFM) systems. Activities have been tailored to address key priorities within a health system context, and have ranged from improving financial data systems to conducting costing exercises, financial analyses, and capacity-building workshops. Across these activities, several lessons have emerged.
Insights in this brief stem from analysis of over 200 HFG financing activities; interviews with stakeholders from Ukraine and Vietnam; and experience from cross-cutting program activities. These lessons are shared as a resource for fellow implementing partners, country practitioners, and donor agencies. As the project ends, this brief considers the global context and established frameworks for PFM alongside the contributions of the HFG experience, and suggests a way forward.
Section27 Health Reform Brief 1 July 2013Section 27
SECTION27 is proud to launch its Health Reform Briefs in an effort to broaden discussion about the different ways in which the health sector is changing. The briefs will look at reform in the health care sector through the lens of the Constitution and public interest, tying together economics, health systems theory and the law.
The first edition focuses on the design of NHI pilots. These briefs will be published every six weeks or so. If you would like to continue receiving these briefs, please send an email to: info@section27.org.za. And please share widely with others you think might be interested.
To lower health costs, physician networks and medical homes must employ a closed loop population management program that focus on patient SOH stratification, chronic disease management, care coordination and incentive management. This approach will enable them to consistently reduce ER and inpatient admissions, which are the greatest expenditures in health care today.
The National Health Council conducted research, did an analysis, and prepared proposed regulatory language to assist the Secretary of Health and Human Services with the preparation of an essential health benefits (EHB) package that will serve the needs of people with chronic diseases and disabilities. This slide show is from a NHC briefing on EHB, given August 3, 2011.
Les pre-reqis de la gestion budgetaire par programmeJean-Marc Lepain
L'introduction de la gestion budgetaire par programme necessite un certain niveau de developpement du systeme de finance publique. La credibilite du budget doit etre etablie au prealable et des systemes robustes de gestion, de reporting et de comptabilite doivent etre mis en place.
La mise en oeuvre de la gestion budgetaire par programme require une reforme de l'Etat et de ses services ainsi que l'application de nouvelles regles de gestion qui implique la mise en place de differents outils de suivi.
Medium Term Budget Frameworks in West Africa: Lessons learntJean-Marc Lepain
Conclusion of the five day seminar on medium trer budget framework and fiscal planning in West Africa. MTFF and MTFB have constributed to strengthen the budget preparation process. However these tools are not sufficient to ensure fiscal discipline and budget credibility that remains an issue across the region. The solution is the coordination of fiscal planning reforms with other reforms.
Methodology for developping expenditure ceilings (aggregated and disaggregated), including integration of sector strategies, baase-line expenditure, no-policy-change basis, design, scope, time horizon, comprehensiveness, policy costing, inflation adjustment, etc.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Fiscal decentralisation and health sector financing formulae (lao pdr)
1. FISCAL DECENTRALIZATION AND HEALTH SECTOR FINANCING FORMULAE
By: Jean-Marc Lepain
Public Finance Specialist
Intergovernmental Fiscal Advisor, Ministry of Finance
Date: June 8th, 2009
This paper is intended to be used as a basis for discussion between the Ministry of Health and the
Ministry of Finance for the selection of a budget norm formula for the financing of the health sector
within the framework of the forthcoming fiscal decentralization reform. It is an interim report and it
does not reflect necessarily the project final conclusions.
This report does not take into consideration needs that might arise as a result of the reform of the
health insurance system. This will be done at a latter stage of the Expenditure Need Assessment.
After reviewing the literature available on the subject1, it appears that the health sector funding
approach the most adapted to Lao PDR seems to be a formula based on area-based capitation
adjusted to take into consideration variations in costs and needs. Typically, capitation methods takes
a measure of the size and characteristics of local population, for example in the form of risk factors
and costs such as levels of disease, poverty, population structure and geography, and infers the
expected level of local service expenditure without reference to actual local health service use.
However it does not appear that the health financing formula can be based hundred percent on
capitation because of the heterogeneity of services provided across the territory of the Lao PDR and
the need to provide incentives for increasing the number of patients visiting health facilities. We
might consider disaggregating the capitation amount by broad types of services in order to avoid
allocating funds for services which are not provided. We might also consider the possibility of ex
post adjustments for adjusting the funding made available to local performance, such as number of
patients treated or number of visits to villages.
Following the various discussions we had with people in the MoH and with a number of experts
(World Bank, WHO and Swiss Red Cross), five possible approaches have been identified. Making a
choice between these different approaches should be put in the wider perspective of the health
sector financing strategy based on a national health policy framework that still need to be prepared.
MoH can decide either to adopt an interim solution based on budget norms and applicable only for
one or two budget cycles or undertake immediately the design of a health financing formula.
1
I have paid special consideration to Formula Funding for Health Services ; Learning from Experience in some
Developed Countries, WHO Discussion Paper No 1 2008 by Peter C. Smith and Achieving Universal Health
Coverage: Developing the Health Financing System, WHO Technical Brief for Policy Makers No 1 2005, by G.
Carrin, C. James and D. Evans.
2. A. Selection of a formula
1) Approach based on salaries
Based on the observation that salaries are the main expenditure in the health sector and one of the
only reliable indicators of service, we try to equalize the number of health workers and provide
incentive for remote and difficult districts. Then non-wage recurrent expenditures can be expressed
as a percentage of salaries or can be based on other indicators.
Strength of the approach:
We are using data which are easily available
We can disaggregate the staff numbers by categories and facilities (provincial hospital,
district hospital, health centres)
The formula can ensure that sufficient funding is available for non-wage recurring
expenditures
Weakness of the approach:
Increasing the number of civil servants is difficult in Lao DPR and requires a long process
The equalisation impact will be very limited. There is a risk of freezing the existing situation.
Staffing is not a good indicator of needs and the formula does not provide any mechanism
for correcting under spending
2) Approach based on number of health workers
This approach is very similar to the previous one. It substitute to salaries the number of health
workers to avoid the problem of variable elements in salary compensation. There is no objective of
equalization of the number of health workers. This will require the desegregation of the number of
health workers into a few categories such as: general practitioners, specialized doctors, nurses,
paramedics , etc.
Strength of the approach:
The number of health worker is known and cannot be questioned
This is a better approach than the number of beds because beds can be unoccupied
This approach can be a good step in the direction of a heath financing formula or block grants
Weakness of the approach:
3. This approach works well for the equalisation of non-wage expenditure but does not give a
solution for the equalization of wage
The equalization impact is very limited
3) Approach based on capitation and case payments
A number of countries use formulae that combine capitation with case payments. A health facility
can be financed 60% by capitation and 40% by case payments.
Strength of the approach:
It provides a strong incentive for increasing service outreach
The equalization impact remains strong
Weakness of the approach:
This approach works well only when case payments are reimbursed according the diagnosis
and treatment of the patients. It implies knowing precisely the cost of each treatment;
something that does not appear feasible in Lao PDR.
The method requires a system able to check on the validity of the local data and the
appropriateness of the services being delivered. Either it requires a large investment in it or a
strong administrative structure. Without such system data can be easily manipulated and
audit requirements will become costly and administratively demanding.
4) Approach based on needs and cost
This is the simplest solution and the one that was envisaged when the Budget Norm Policy
Framework was prepared. We start from a notional level of spending per capita that we adjust in
every province to take into consideration needs and costs. For example: 20,000 kip per capita + 10%
to 20% based on a need indicator + 5% to 25% based on a cost indicator. As in the previous approach,
we ensure that a correct ratio wage/non-wage applies.
Suggested need indicators are life expectancy, infant mortality, nutrition, percentage of
population under the poverty line, etc.
Suggested cost indicators are ethnic structure of the population, population density, altitude,
etc.
Strength of this approach
The equalization effect will be maximum
It meets all the requirements of the budget law and would get easily political support
The formula can ensure that sufficient funding is available for non-wage recurring
expenditures
4. Weakness of this approach
Suggested needs indicators (life expectancy, infant mortality) appear to be all questionable
The equalization effect might be too fast resulting in allocation of funds that cannot be
properly used. The increase of the local budget should be limited over time or based on the
submission of an implementation plan.
5) Approach based on cost of infrastructures and programmes
This approach combines the two previous one. It distinguishes the cost of infrastructure from the
cost of other programmes.
Infrastructure cost is calculated by “bed” with a minimum allocation by bed that includes
salary cost and Goods & Services and by block grant for health centres. A substitute for beds
could be the number of qualified doctors.
Like in the previous formula, the allocation to other programmes is calculated on the based
of a minimum allocation per capita adjusted for cost and needs. However this time are
calculated by programme on the basis of a 10% (or more) increase in their coverage.
Strength of this approach:
This is the most equitable approach in terms of a balance between needs and costs
This approach solves the problem of insufficient funding for district hospital and health
centres. District hospital could be financed by a block grant calculated on that basis.
It is consistent with programme budgeting which is the direction toward MoH wants to move
Weakness of this approach
The formula become more complex
Experience shows that at the district level the bed occupancy rate is very low. One can
question the financing of bed if they are not used
It might be difficult to distinguish between infrastructure cost (expenditure per bed) and
other health services provided from the same health facilities.
6) Approach based on cost and service delivery
This approach build on the previous one but includes some adjustments in order to take in
consideration the quantitative aspect of services provided and to offer incentives for better use of
facilities and more services provided.
5. The cost of beds and other infrastructure is financed only to a certain level (between 60% and 80%).
The difference is covered by a payment made on the basis of the number of patients treated (case
payments).
Other incentives are introduced in other programmes. In the case of Lao PDR we can include lump
sum payments for each visit to a village in a priority district or even modulate the lump sum by village
types.
Strength of this approach:
It combines the advantages of the approach based on cost of infrastructure and programmes
with a strong incentive to increase service delivery.
The system is fairer and avoids financing facilities which are not efficiently used.
Weakness of this approach:
The formula can become too complex and difficult to calculate.
Data on use of services might be difficult to collect or manipulated.
B. Conclusion of the formula selection
Approach No 1 does not bring the equalization effect required and in fact exacerbate horizontal
imbalance for non-wage expenditures. According to a test run with the macro fiscal model when
wage expenditure fluctuate between 13,000 kips and 23,000 kips (if we exclude Vientiane Capital and
Attapeu which are special cases), non wage expenditures fluctuate between 7% and 94% of wage
expenditures.
The conclusion that we should draw from the test is that we might consider limiting the capitation to
non-wage expenditure. Equalization of salaries and compensation is impossible in the short term and
should be considered as a long term goal that requires a proper mechanism.
Approach No 2 is the one MoF’s Budget Department favors the more because it does not raise the
issue of salaries and the equalization of wage expenditure. A formula limited to non-wage
expenditures should take in consideration the staff structure of the health sector, the deployment of
programmes in a given province, specific need factors and factors that affect cost of service delivery.
Approach No 3 appears to be impracticable in Lao PDR.
Approach 4 and 5 appear as good candidate for the interim formula if we accept that the final health
financing formula should be developed over one or two years. A financing based on the number of
beds does not appear as a good approach due to the very low occupancy rate. That leaves the
number of qualified doctors as the only indicator of need.
6. Approach 6 can be considered, but look more like a basis for a more elaborated health financing
formula.
So far the best approach seems to be Approach No 2 seen as a transition formula toward a Health
Financing Formula developed on the basis of approach No 4 with a strong incentive component
and a clear objective of increasing the utilisation of heath facilities.
C. Analysis of cost drivers
The main cost drivers in Lao PDR seem to be geography and population structure. Reaching
minorities in high lands is more expensive than reaching Lao Loums in Mekong plain. Probably the
best approach would be classifying provinces and districts in four or five broad categories associated
with different cost levels based on some characteristics such percentage of minorities, percentage of
urban population, population density, etc.
D. Decisions that need to be made
We need to decide the scope of the financing formula. Certain health services might be
excluded from the formula and financed by ad hoc grants. It might be the case of specialized
hospitals. The formula should be linked to a health package available on a national basis.
At the moment it looks more likely that budget norms for the health sector will be
introduced in different stages. The different stages could be (a) a formula for non-wage
expenditure, (b) a formula for intergovernmental transfers giving an indication on the broas
size of the general budget in the provinces, (c) a complete health financing formula
MoH needs to look at the process for rationalizing the number of health workers in provinces
by developing staffing norms.
Do we take a full-fledge capitation approach based on a minimum spending per capita
(approach 1 and 2) or do we want to disaggregate the formula in a number of service type?
Do we want to use the health financing formula to provide incentive for heath delivery?
E. Conclusion and Recommendations
Designing a complete health financing formula is a complex task that cannot be rushed. It can be
done only when a number of health policy issues have been clarified such has the content of the
health package, the new universal insurance scheme, user fee policy, incentive policy, and hospital
management autonomy. We expect that these issues will be clarified within a year when a Health
Policy Paper will be published as part of PRSO triggers.
From the previous analysis we are able to make a few recommendations:
An interim budget norm formula applying for one or two budget cycles seems to be the best
approach. A full-fledge health formula can de develop in parallel in one or two stages an
introduced for the preparation of 2010/11 budget.
7. The interim formula should prefigure the health financing formula in order to avoid any
disruption.
Health facilities, activities and programmes outside the scope of the formula should be
identified immediately and will be financed through ad hoc grants.
The selection of the formula should be based on its equalization effect and on its capacity to
ensure that sufficient funding is available for non-wage recurring expenditures.
At this stage there is no guarantee that an increase in non-wage recurrent budget will cause
a reduction of user fees. This objective can only be achieved if proper instructions are given
to health facilities. Work on user fee policy and instructions (or regulation) should start in
parallel with the design of the budget norm formula.
Additional components of the formula such as incentive, program financing desegregation
and availability of funds at the district level will be reviewed in the next forth coming weeks
and it will be decided if they become part of the interim formula or not.
If the option of an interim formula is chosen, it is important to create a dynamic with time
constrains that will ensure that the final outcome (the complete heath financing formula) is
not postponed indefinitely. Objectives of the health financing formula should be defined in
the Health Policy Paper under preparation.
A satisfactory health financing formula requires better data than exist presently in Lao DPR.
For that reason we believe that the health financing formula should de developed in several
stages. Meanwhile other actions must be taken:
o A database must be created for the systematic collection of health
management data;
o A statistical model for analysing spending variations amongst health
facilities, programmes, provinces and districts must be developed ;
o The Medium-Term Expenditure Framework (MTEF) must be
completed;
o The MTEF should be used to create a link between investment
decisions and recurrent costs. No investment should be approved
unless there is sufficient additional funding for its operation and
maintenance.
o A more detailed heath budget must be produced and consideration
should be given to the introduction of programme budgeting;
o The health budget should include user fees and user fees should be
reflected in the national budget;
o Accounting rules should be revised in order to provide better
information on central/local expenditures, recurrent/investment
expenditures and the used of donors’ funding.
o A reporting mechanism on budget execution should be put in place
between Provincial Health Offices and MoH. This reporting
mechanism should provide data by district, by programme and by
health facility
o User fees should be fully reflected in health facilities’ accounting and
proper regulation must ensure that user fees are always linked to a
traceable service.
8. o For the sake of reporting, transparency and effective public finance
management, an agreement should be reached with the Treasury
for they management through the Single Treasury Account while
ensuring that the fund collected remain fully available at the local
level.
o In accordance with good public finance management practices, user
fees should be included as resource of the Health Budget.
F. Way forward
In the first stage this paper will be used as a basis for discussion in an informal way. The objective
will be to eliminate impracticable approaches, identified other possible options and refine the
strategy. When a consensus will have emerged we might consider organizing a round table to reach a
final decision.