Abt Associates Inc.  In collaboration with:Broad Branch Associates | Development Alternatives Inc. (DAI) | Futures Institute | Johns Hopkins Bloomberg School of Public Health (JHSPH) | Results for Development Institute (R4D) | RTI International | Training Resources Group, Inc. (TRG)

Dr. Carlos Avila Senior Health Economist

Health Finance and Governance Project

Impact of Healthcare Costs on Universal Health Coverage: global perspective

NAMAF 8TH ANNUAL CONFERENCE22 SEPTEMBER 2014

WINDHOEK, NAMIBIA

Outline

Universal Health CoveragePopulation and UtilizationHealth Care Costs and FinancingPotential Solutions

What is the relationship between costs and UHC?

There is an unquestionable imperative to: Optimize the effectiveness of the investment in health systems Achieve Universal Health Coverage Provide Financial Risk Protection

Government health expenditure as a source Spending by governments on health as sourced domestically was $613.5

billion in 2011. This means that, on average, countries spent 20 times more of their own

resources on health than they received in assistance

UHC: “all people have access to services and do not suffer financial hardship paying for them”UHC: “all people have access to services and do not suffer

financial hardship paying for them”

HEALTH CARE UTILIZATION

Population and Utilization

DemographicsBurden of diseaseBehavioursAccess

Population Projections

Population Projections

The world's population pyramid is changing shape

The world's population map is changing shape, 2050

The 10 Leading Causes of DALY, Global, 2000 and 2012

No Causes of DALY, 2000 DALY(million)

% of DALY

No Causes of DALY, 2012 DALY(million)

% of DALY

1 Lower respiratory infections 208 7.3 1 Ischaemic heart disease 166 6.0

2 Diarrhoeal diseases 161 5.6 2 Lower respiratory infections 147 5.4

3 Ischaemic heart disease 142 5.0 3 Stroke 141 5.2

4 Stroke 125 4.4 4 Prematurity 107 3.9

5 Prematurity 123 4.3 5 Diarrhoeal diseases 100 3.6

6 Birth asphyxia and trauma 102 3.6 6 COPD 92 3.4

7 HIV/AIDS 102 3.5 7 HIV/AIDS 92 3.4

8 COPD 89 3.1 8 Road injury 79 2.9

9 Malaria 78 2.7 9 Depression 77 2.8

10 Road injury 69 2.4 10 Birth asphyxia and trauma 75 2.7

11 Depression 64 2.2

12 Malaria 55 2.0

Age-standardized Mortality Rates by Causeby WHO Region and World Bank Income Categories, 2000-2012

Population Density in 2015

Percentage of Adults with BMI >30

Years of Life Lost due to Obesity

“Sin-Taxes”: Sugars

Taxation of empty calories, such as sugar-sweetened beverages, can: reduce the prevalence of obesity and generate public revenue

Taxation on sugar-sweetened beverages does not hurt the poor

The main dietary problem in low-income groups is poor dietary quality rather than insufficient energy

HEALTH CARE COSTS AND FINANCING

Health Care Financing

Health Care Costs & FinancingCosts of ServicesMedical ProceduresDrugs and diagnosisHealth Financing

Health Care Inflation

New Technologies

Costs of hospital procedures

Health Care Consumption

Variation in the costs of pharmaceuticals

COST AND HEALTH OUTCOMES

Raising Cigarette Taxes Lowers Consumption

BRICS and Namibia: selected indicators

BRIC GDP per capita†

(2012)

THE as % GDP‡

(2012)

THE per capita‡

(2012)

OOP as % of THE‡

(2012)

Infant Mortality* ‡

(2012)

Maternal Mortality **

‡ (2013)

Brazil $11,437 9.3% $1,057 31% 13 69Russia $14,015 6.3% $887 34% 9 24India $1,514 4.1% $61 62% 44 190China $6,077 5.4% $322 34% 12 32Namibia $5,461 5.0% $445 37% 34 200

*IMR = infant mortality rate per 1000 births**MMR = annual number of female deaths per 100,000 live births†International Monetary Fund. 2014. World Economic Outlook. Washington, DC: IMF. ‡World Health Organization. 2013. Global Health Observatory: Data Repository.

Growth in domestic health spending in 43 countries, under economic growth and Abuja commitment, by source, 2000-2020

Current spending (2010) Projections based on economic growth (2020)

Projections based on economic growth and Abuja commitment (2020)

Per capita DHE US$ 76 Per capita DHE US$ 106 Per capita DHE US$ 146

DHE US$ 60 billion DHE US$ 127 billion DHE US$ 162 billion

Public sources $25 billion (36%)Private sources $16 billion (23%)Households $19 billion (28%)

Public sources $44 billion (34%)Private sources $30 billion (23%)Households $43 billion (33%)

Public sources $92 billion (53%)Private sources $30 billion (17%)Households $43 billion (25%)

DHE as % GDP 5.7% DHE as % GDP 6.0% DHE as % GDP 7.0%

SummaryHealth Financing Projections: SSA, 2020

Health spending trends in Namibia

Year THE (USD) PPH expenditures

(USD)

THE per capita (USD)

PPH expenditur

es per capita (USD)

2001-2002 573,678,397 21,347,339 291 11 2002-2003 609,908,768 21,434,273 304 11 2003-2004 643,437,184 22,637,811 315 11 2004-2005 704,681,307 57,425,350 339 28 2005-2006 843,152,390 84,194,214 398 40 2006-2007 923,770,410 133,545,320 428 62 2007-2008 947,877,271 142,087,036 431 65 2008-2009 997,145,409 139,997,707 445 62

Health spending by priority area, Namibia

2001-2002

2002-2003

2003-2004

2004-2005

2005-2006

2006-2007

2007-2008

2008-2009

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

71%

71%

71%

68%

65%

62%

54%

53%

7%

8%

8%

8%

7%

6%

11%

11%

4%

4%

4%

8%

10%

14%

15%

14%

13%

12%

12%

12%

12%

14%

10%

11%

4%

4%

4%

2%

3%

1%

6%

8%

2%

2%

2%

3%

3%

2%

3%

4%

Services for curative care

Medical goods dispensed to outpa-tients

Prevention and public health services

Health administration and health insurance

Capital formation and expenditures not specified by kind

Other

POTENTIAL SOLUTIONS

Health Care Costs

Why Health Care Costs Are High and Growing Rapidly?

How high health care Cost are threatening the economy?

What Can Be Done About Health Care Costs?

Potential solutions

Investing on behavior, literacy and prevention Client centered solutions Integration and efficiency Outsourcing Health Technology Assessment Risk pooling

Efficiency in US Hospitals

Increasing Resources and Improving Efficiency

Health Financing Platform

Effective Allocation

TechnicalEfficiency

Paying for Results

Better Money

More MoneyPublic Private

IncomeTaxes

Diaspora BondsConsumption

Taxes

Catalytic Investments

LotteriesSocial Bonds

CSR

MatchingPrograms Crowd

Funding

F4DPPPs

DebtSwaps

Road Map to UHC

Africa Rising

Abt Associates Inc.  In collaboration with:Broad Branch Associates | Development Alternatives Inc. (DAI) | Futures Institute | Johns Hopkins Bloomberg School of Public Health (JHSPH) | Results for Development Institute (R4D) | RTI International | Training Resources Group, Inc. (TRG)

Thank you

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