Public financing of healh in developing countries: a cross-national systematic analysis

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Institute for Health Metrics and Evaluation - University of Washington

This presentation discusses IHME's research in public financing of health in developing countries, including study design, findings, study limitations, and recommendations for governments and future research. For more information please visit www.healthmetricsandevaluation.org

Education

Public financing of health in developing countries: a cross-national systematic analysis Chunling Lu, Matthew Schneider, Paul Gubbins, Katherine Leach-Kemon, Dean Jamison, Christopher Murray

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Development assistance for health has increased dramatically. The vast majority of health expenditure is still financed by developing country governments and households. Ravishankar et al 2009 The Lancet

[object Object],[object Object],[object Object],What Are the Determinants of Public Financing of Health in Developing Countries?

[object Object],[object Object],[object Object],[object Object],Demand for Health Services Will Increase

[object Object],[object Object],Broad Approach

[object Object],[object Object],[object Object],[object Object],Some Definitions

[object Object],[object Object],[object Object],[object Object],Tracking GHE-A and GHE-S is Not Easy

[object Object],[object Object],[object Object],Missing Data in Time-Series Cross-Sectional Datasets

Statistical Model We express key quantities of interest as percentage of GDP to avoid exchange rate and GDP deflation issues.

WHO Imputed Datasets Show in Real Dollars GHE-S is Increasing

IMF Imputed Datasets Show in Real Dollars GHE-S is Increasing

Decomposing Changes in GHE-S into Changes in GDP, Changes in Size of Government (GGE/GDP) and Changes in Government Commitment to Health (GHE-S/GDP)

IMF Change in Government Health Expenditure as a share of General Government Expenditure

WHO Change in Government Health Expenditure as a share of General Government Expenditure

Development Assistance for Health change in Global Burden of Disease developing regions in 1999-2002 compared with 2003-2006

Table 2: Time-series cross-sectional regression results for GHE-S/GDP for countries in GDB developing regions based on the Arellano-Bover/Blundell-Bond model

Coefficients of Development Assistance for Health to Governments as a proportion of Gross Domestic Product WHO IMF WHO IMF WHO IMF ,[object Object],[object Object]

Coefficients of Development Assistance for Health to Non-Governments as a proportion of Gross Domestic Product ,[object Object],[object Object]

[object Object],[object Object],[object Object],Heterogeneous Effects

[object Object],[object Object],[object Object],[object Object],[object Object],Sub-Additionality May Have Magnified Effect on Health Priorities

[object Object],[object Object],[object Object],[object Object],Data Limitations

[object Object],[object Object],Other Limitations

Recommendations ,[object Object],[object Object],[object Object]

Recommendations ,[object Object],[object Object],[object Object],[object Object],[object Object]

Recommendations ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],The Big Picture

This presentation was given by Professor Kara Hanson at the BMC Health Services Research Conference, in July 2014. The presentation illustrates the important role that strategic purchasing can play in achieving effective health coverage, and how the topic is being studied by researchers. It highlights RESYST's multi-country study of purchasing arrangements that is currently taking place in Nigeria, Kenya, Tanzania, South Africa, India, Thailand and Vietnam.

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The health of a people to a very large extent determines their productivity and wealth. The 2010 Population and Housing Census indicates that a significant proportion of the Bunkpurugu-Yunyoo District in Ghana (over 75%) are living below the poverty line of GH¢228.00 per annum (approximately US $120 per annum). It then implies that approximately the same proportion or even a little above that might not be able to access health care under the ‘cash and carry’ system. Inability to access health care will lead to poor health status of the residents and thus lower their productivity.

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Resource Type: Brief Authors: Jose Carlos Gutierrez, Sharon Nakhimovsky, Carlos Avila Published: 04/01/2015 Resource Description: In lower middle-income countries, many questions remain around how to scale up health systems to reach Universal Health Coverage. Where will the money come from; what financing mechanisms are available to policymakers; and what are the trade-offs that must be taken into account? This brief highlights the key questions and findings behind HFG’s technical report, “Domestic Innovative Financing for Health: Learning from Country Experience.” The report provides a framework for analyzing innovative options for raising additional revenue for health and reviews different countries’ experiences with each option. In the context of this report, “innovative” options are those that are new for a country and generate additional resources for the health sector. The successes and failures of these approaches provide food for thought as policymakers seek to leverage more resources for health. The full report is also available for download. - https://www.hfgproject.org/brief-exploring-new-sources-of-revenue-for-health/

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Worldwide, health systems are being asked to do more with less. In many countries, donor funds have stagnated or are declining. This sharp decline could have broad implications for the health sector— particularly Namibia’s HIV and AIDS response which relies heavily on donor resources. New and emerging threats, such as Zika and Ebola, are also testing weak and fragile health systems, such as those in Guinea and Liberia. And costly noncommunicable diseases, like diabetes and cancers, are on the rise in low- and middle-income countries (LMICs). With the end of the MDGs and start of the new SDGS, momentum is growing for countries around the world to pursue Universal Health Coverage (UHC) reforms and to expand affordable access to health care services, without risk of financial hardship, while facing real resource constraints in the aftermath of the global economic crisis. In short, countries need to make their limited health resources go a long way. It is a financing challenge as well as a governance one. Countries cannot manage what they cannot measure. Countries need to measure their health spending – know where the money comes from, how much is spent and where, and how it can be spent more efficiently and equitably. Policymakers can influence public and private health spending to improve efficiency, quality, equity, and expand access to life-saving health services. To succeed, however, governments need evidence around their health financing landscape. More and more, policymakers are appreciating the value of health resource tracking –that is, a range of methods, data collection initiatives, and estimation tools aimed at measuring the flow of funds to and through the health system.

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Chapter 2 Where Are We? American health care is in a state of flux as new scientific knowledge and clinical experience continue to change our definitions of illness and wellness. As a society, we respond by changing the ways health care is delivered. Health services increasingly impact our society—from health status to employment to budgetary economics to recreation to professional concerns to our perceptions of our own well-being. American health care is also in flux because now that it has grown to more than one-sixth of our economy it threatens to squeeze out public goods such as education and infrastructure maintenance. People have wanted to do something about cost and access to care problems for a long time. The 2010 Affordable Care Act (ACA) is doing much to address access issues, but opposition to certain provisions is strong. Employers are steadily shifting more risk to employees and their families, and there is a real tension between Washington and the state capitols over Medicaid expansion. Medicare trust funds are forecast to disappear over the next decade or so. Washington is unlikely to tolerate another major health reform battle, although major changes may come as a side effect of a “grand” government overhaul of spending and tax policies. The future is highly uncertain, and still we must plan and act as we go along. This chapter reviews the current status of the U.S. health care system from several points of view: • Current outcomes and costs • Quality • Leadership • Complexity • Industrializing structures for delivery • Medicalization of our society • Redistribution of wealth 2.1 Current Outcomes and Costs Previous section Next section 2.1 CURRENT OUTCOMES AND COSTS Health care expenditures were projected to rise to close to 20% of the U.S. gross domestic product (GDP) by 2015 (Borger et al., 2006), but more recent estimates from the Centers for Medicare & Medicaid Services (CMS) project it to be 18.2% for 2015 and 19.5% by 2021 (CMS, 2012). Average annual family health insurance premiums were estimated for 2012 at $15,745, with $11,429 paid by employers. The 4% growth rate for 2012 was slow by historical standards but still more than twice the growth rate of wage income. The comparable total insurance cost for a single individual was $5,615. Large employers (98%) offered health care benefits to workers but were cutting back on retiree health benefits. Only 50% of firms with 3 to 9 workers and 73% with 10 to 24 workers offered health benefits. Many small companies do not provide health benefits. At the same time, control of health care by health professionals is being threatened by outsiders calling for more reliance on government programs, more consumer-centered care, or both. High Comparative Costs and Low Comparative Outcomes The United States spends far more on health care per capita and as a percentage of GDP than other developed countries, yet does not seem to be much better off for it. Table 2-1 illustrates this ...

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Public financing of healh in developing countries: a cross-national systematic analysis

1. Public financing of health in developing countries: a cross-national systematic analysis Chunling Lu, Matthew Schneider, Paul Gubbins, Katherine Leach-Kemon, Dean Jamison, Christopher Murray

3. Development assistance for health has increased dramatically. The vast majority of health expenditure is still financed by developing country governments and households. Ravishankar et al 2009 The Lancet

10.

11. Statistical Model We express key quantities of interest as percentage of GDP to avoid exchange rate and GDP deflation issues.

12.

13. WHO Imputed Datasets Show in Real Dollars GHE-S is Increasing

14. IMF Imputed Datasets Show in Real Dollars GHE-S is Increasing

15. Decomposing Changes in GHE-S into Changes in GDP, Changes in Size of Government (GGE/GDP) and Changes in Government Commitment to Health (GHE-S/GDP)

16. IMF Change in Government Health Expenditure as a share of General Government Expenditure

17. WHO Change in Government Health Expenditure as a share of General Government Expenditure

18. Development Assistance for Health change in Global Burden of Disease developing regions in 1999-2002 compared with 2003-2006

19. Table 2: Time-series cross-sectional regression results for GHE-S/GDP for countries in GDB developing regions based on the Arellano-Bover/Blundell-Bond model

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

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34.

35.

Public financing of healh in developing countries: a cross-national systematic analysis

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