MEETING THE DEMANDS OF A CHANGING WORLD 8-10 OCTOBER 2014 DA NANG, VIET NAM

Direct and indirect approaches in collecting of healthcare expenditures

By Mr. Khaled MA. Qalalwa , State of Palestine.

AGENDA

Palestinian context Background Methodology Results Discussion

PALESTINIANS HAVE TWO CANCERS; The Cancers of Settlement and disease

Total area 27,000 Km2.Israel control 6% before UN resolution for partition of Palestine in 1947.UN resolution gave Israel 50%.Separation Wall swallows 13%Now, Israel control 85%.Gaza is the most crowded area over the World (about 4500 individuals per km2,while in Israel it is 350 individuals).

SOCIODEMOGRAPHIC INDICATORS

Total Population: 4.4 millionsLife Expectancy at birth is 72 yearsCrude Birth Rate per 1000 persons was 31Crude death rate deaths per 1000 persons was 2.7 Child Mortality Rate: 24.7Total Fertility Rate:4.2Illiteracy Rate: 4.1%GDP: seven billionsUnemployment Rate and under Poverty Line about 25%Health Expenditure out of GDP: 13%

1.BACKGROUND; Why we need to assess HE

Health Expenditure Trend Line in Palestine

0-2012

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120

200

400

600

800

1,000

1,200

1,400

397. 2

1261.9

1.BACKGROUND; Why we need to assess HE

Distribution of Expenditure on Health in Palestine by Source of Funding

0

5

10

15

20

25

30

35

40

45

50

35.3

1.5

43.1

19.0

1.1

38.7

2.3

39.8

18.3

0.9

2011 2012

%

1.BACKGROUND; Why we need to assess HE

Distribution of Expenditure on Health by Function of Care in Palestine 2012

In-Patient long-term nursing care 0.1% Ancillary services to health care 3.4%

Medical goods dispensed to out-patient 16.5%

Prevention and Public health services 6.8%

Health Administration and health Insurance 7.4%

In-patient curative care 22.8%

Out-patient curative care 36.6%

Non classified Services of curative care 6.4%

2. METHODOLOGY; Health Care Providers and Beneficiaries Survey,2005” (PB)

To identify the types and quantities of health care services provided by the various principle health care providers, and to assess expenditures on these services.

To build up a database of a wide range of indicators of health care expenditures that would help establish a system of National Health Accounts for Palestine.

2. METHODOLOGY; study sample

single-stage stratified random sampling, private and NGOs.

number of institutions was 1,202; generalists’ or specialists’ medical clinics, medical laboratories, physiotherapy, rehabilitation centers, dental clinics or hospitals.

All hospitals were included. number of interviewed beneficiaries amounted to

3,265 beneficiaries, The responses rate of both institutions and

beneficiaries was about 81.0% .

2. METHODOLOGY; study instruments

An institution questionnaire: market share in nominal (No. of served patients per day; type of provided care; human resources) and real terms.

A patient questionnaire: users' behavior, perceptions (quality); satisfaction; WTP for different funding mechanisms

2. METHODOLOGY; study instruments ‘Institution Questionnaire’ consists of five sections: ONE, about the health care provider her/himself: profession and specialty,

activity in terms of number of working hours and places of practice. TWO, about the health care itself: type and nature of provided care, offered

services and existing equipments, and available human resources.

THREE, questions about institution’s activity in terms of: number of working hours per day, number of working days per year, type and size of provided services, and average unit charge per service. To provide an indirect estimation of institution’s expenditures/revenues, and hence, the provider’s share from total national health expenditures.

FOUR, covers the institutions’ expenditures in (monetary) terms; e.g., wages and salaries; running costs including. And institutions’ revenues in (monetary) terms; e.g., fees and charges from medications and from hospital stay and emergency services.

FIVE, to estimate capital outlays. It covers all institution’s capital properties and investments, including: lands, buildings and equipments.

MODEL OF QUESTIONS

annex.pdf

3. RESULTS; Market share of healthcare providers

Figure 1: Market Share Based on Annual Number of Visits

Private; 21.4

NGOs; 12.8

MoH; 46.1

UNRWA; 19.7

3. RESULTS; Direct Vs indirect method

Figure 2: Market share of Total Expenditures by Method

Private NGOs MoH UNRWA0

5

10

15

20

25

30

35

40

4540.5

14.5

35.2

9.8

24.521.4

42.3

11.8

Indirect Direct

3. RESULTS; Direct Vs indirect method

Figure 3: Total Expenditures by Method (Millions$)

Indirect Direct0

10

20

30

40

50

60

70

80

29.7

71

27.1

64.5Private

NGOs

3. RESULTS; Direct Vs indirect method

Figure 4: Total Revenues by Method (Millions$)

Private

NGOs

0

10

20

30

40

50

60

70

80 73.6

32.236.1

28

Indirect Direct

4. DISCUSSIONS

Variation in market share compared between direct and indirect approaches is unexpected but; might be consistent with interests of each health care provider;

And due to absent of administrative or financial records, where about half of health institutions do not possess any records.

Estimated health expenditures are limited to the spectrum of surveyed health care services e.g., health expenditures directed toward private pharmacies were not included in this estimation.

Also the estimation of the market share using the indirect method should be interpreted with caution, and is mainly valid when health expenditures are assessed from a societal perspective.

High expenditure levels suggest likelihood that many families face impoverishing expenditures and growing need for social protection.

THANK YOU FORYOUR ATTENTION!