OECD Survey on Budgeting Practices for Health LAC and CESEE countries: preliminary

results

Ivor Beazley Senior Policy Analyst GOV/BUD

Public Financing for UHC: Towards Implementation

Montreux, 31 October - 2 November 2017

Joint Network on Fiscal Sustainability of Public Health Systems

Reduce poverty and increase economic growth

Surveys

Annual meetings

Case studies

Analytical research

Benchmark good practices and identify bottlenecks

Catalyze processes for better alignment between

budgeting and health

Increase coverage and improve service quality

More effective and efficient use of financial resources

Reduce morbidity and increase life expectancy

Document health budget

tools and practices

Improve capacity

and create dialogue

Global transfer of knowledge – the OECD Joint Network on Fiscal Sustainability of Health Systems

OECD countries (annual) next meeting February 2019

Latin America & Caribbean July 2016 April 2018

Central Eastern Europe December 2016, December 2018

Asia May 2017, May 2109

Africa (w/CABRI) December 2015, November 2018

+ country case studies + surveys on budgeting practices for health

Budgeting for Health Surveys

5

Survey implementation: collaborative approach

Who is the survey targeted to?

Officials working in Budget Authorities who focus on health issues

Officials working in the Ministry of Health in relation with the budget authorities

Region Status Countries

LAC (short

version)

Fully implemented

13 (Argentina, Peru, Uruguay, Honduras, Colombia, Mexico, Guatemala, Ecuador, Paraguay, Chile, Belize, Costa Rica and

Brazil)

CESSE Data cleaning process ongoing

12 (Armenia, Azerbaijan, Czech Republic, Estonia, Georgia, Greece, Kazakhstan, Kyrgyzstan, Lithuania, Malta, Slovakia,

and Republic of Slovenia)

Asia and Oceania

Implementation ongoing

9 (Australia, South Korea, Japan, Laos, Myanmar, New Zealand, Philippines,

Papua New Guinea and Vietnam)

Africa About to start

What is the current status?

What is the scope of the survey?

1. Basic characteristics of health systems 2.Health budget formulation

4. Budget monitoring 3.Purchasing and provider payments, Health Budget

execution

6. Budgeting for social insurance funds/agencies

7. Management of development assistance for health

8. Decentralization

5. Fiscal sustainability

Health financing systems remain highly fragmented in the LAC region

0% NI 0% 0%

6% 4%

18%

6%

19%

2% 0%

7% 5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

BRA PRY BLZ ARG ECU GTM HND MEX PER COL URY CHL CRI

Government financing scheme Social health insuranceVoluntary private insurance Compulsory private insuranceOther Not covered by any explicit arrangement

Popu

lati

on c

over

ed

In most CESEE surveyed countries there is a single main health financing scheme

… but, boundaries between schemes have become blurred: trend towards mixed revenue sources

In both regions, countries are planning to increase publicly funded health coverage

No 38%

Yes 62%

• Increase population coverage remains the first priority in both regions

• Many countries are also seeking to increase service coverage and financial protection

In CESSE countries most public heath expenditure is included in the CGB

Most countries have a separate budget for the social health insurance system

KGZ

LTU

AZE

GRCSVN

SZE

EST

SVK

Yes 75 %

No 25 %No 8%

Yes 92%

CESSE LAC

Use of ceilings

ARG

URY

CHL

BLZ

HND ECU

GTM

MEX

PRY

PER

COL None 27%

Floors 27%

Ceilings 27%

Floors and ceilings

18% ARM

EST

LTU

AZE

MLT SZE

KAZ

SVK

GRC

SVN

KGZ

Floors 8%

Ceilings 17%

None 75%

LAC CESEE

In LAC, reporting delays vary depending on the health financing scheme

Source : Question 9 Survey on Budget Practices for Health in LAC countries (2015)

Most CESEE countries tend to have timely information available for central government HE

18

In contrast with OECD, LAC countries have an underspend problem

19

There is a mixed picture regarding budget execution in CESEE

Most budget agencies in the LAC region have a multi-year vision of health spending

Source : Question 21 Survey on Budget Practices for Health in LAC countries (2015)

Number of future years estimated in the budget for health care spending

CESE countries tend to estimate less years in the budget for health care spending

Source : Question 21 Survey on Budget Practices for Health in LAC countries (2015)

Number of future years estimated in the budget for health care spending

URY

MEX

CRI

CHL

COL

PERGTM

ECU

PRY

HND

BLZ

ARG

BRA

No 71%

Yes 29%

Long term projections are less common

CESE LAC

Public health expenditure has outpaced economic growth in OECD countries in the last couple of decades and is expected to continue growing as a share of GDP in the decades to come.

23

AUS

AUT BEL

CAN

CHL

CZE

DNK

EST

FIN

FRA

DEU

GRC HUN

ISL

IRL

ISR

ITA

JPN

KOR

LUX

MEX

NLD NZL

NOR

POL

PRT

SVK

SVN

ESP

SWE CHE

TUR

GBR

USA

0%

2%

4%

6%

8%

0% 2% 4% 6% 8%

Gro

wth

in r

eal h

ealt

h s

pen

din

g p

er c

apit

a

Growth in real GDP per capita

Average annual growth rate of real total health spending and GDP p.c. 1990-2012 (or nearest year)

5.5

7.9

11.8 0.8

1.6

2.1

0

2

4

6

8

10

12

14

16

OECD

% Health careLong term care

Average (2006-2010)

Cost-containment scenario: 2060

Cost-pressure scenario: 2060

Projected public health and long-term care expenditure as % of GDP in 2060

Source: De La Maisonneuve and Oliveira Martins, 2013

Source: OECD Statistics

Most OECD countries enjoy universal health coverage. Their main challenge is ensuring the fiscal sustainability of the system

• Increasing publicly funded health coverage • Reducing fragmentation and increase

coordination of functions across subsystems (LAC)

• Fully execute budget allocated to health • Improve cost containment strategies • Develop long term projections

In contrast, for non-OECD countries some of the bigger challenges are:

• Decentralization in the health sector and capacity building at the subnational level

• Reasons behind under-spending and ways to overcome it

• Budget rigidities and mechanisms to increase flexibility

• Additions and cuts in budget allocations made during the budget execution year

• Effectiveness and challenges of using performance budgeting tools

Areas for further research

THANK YOU

Ivor.Beazley@oecd.org