WELCOME to Health Finance Food Court: What’s Cooking? Mini-University March 7, 2014 Catherine...

WELCOME to

Health Finance Food Court: What’s Cooking? Mini-University

March 7, 2014Catherine Connor, Deputy Director, HFGCarlos Avila, Sr. Health Economist, HFGJosef Tayag, Health Insurance Specialist, Abt AssociatesKarishmah Bhuwanee, Health Economist, HFG

Abt Associates | pg 2

Today’s menu

Introduction to health financing – fast food version

Group country case study – “If you can’t stand the heat…”

Share – 2 small bites from each group

Country case reveal – what really happened?

Leave with indigestion from too many bad food puns

2


The 3 health financing functions: your ingredients for a comprehensive HF strategy

Collection of funds

Pooling of funds

Risk Pooling

3

Spending of Funds

Allocation

Provider Payment

Resource Mobilization Risk Pooling Purchasing

Resource Mobilization


Resource Mobilization for Health

to provide citizens with services that both improves health outcomes and provides financial protection against unpredictable financial losses caused

by illness and injury.

Raise sufficient and sustainable revenues efficiently and equitably


Resource mobilizationFunding Sources

Individual/families/ employees

Employers/corporate entities

Foreign and domestic NGOs and charities

Foreign Governments and multilateral agencies

Foreign and multinational companies

Contribution Mechanism

(1) Direct taxes

(2) Indirect Taxes

(3) Payroll taxes

(4) Other compulsory contributions (mandates)

(5) Voluntary prepaid contributions

(6) Grants

(7) Loans

Collecting Organization

Central Government

Local Governments

Social Security Agency

Commercial Insurance Fund

Other Insurance Fund

Employer earmarked savings fund

Health care providers

Risk Pooling


Risk and Poverty


Risk Pooling (Stick it in a pot!)

9


Risk Pooling

Varies by:

– Funding source (individuals, employers, NGOs, companies)

– How the money is collected

– Who manages the fund

Types:

– General Tax-Based Provision

– National Health Insurance

– Social Health Insurance

– Private Health Insurance

– Community-Based Health Insurance

Hi Mini-U!

Purchasing


Purchasing

WHAT services?

WHO to purchase from?

HOW to purchase? (e.g. input/output-based)

Consider: Access to care, quality, cost-control, staff motivation, incentives,

implementation capacity


Provider payment mechanisms

HOW services purchased from providers

Input-based

– E.g. Line item budget /global budget

Output-based

– E.g. Per capita, per diem, fee-for-service, pay-for-performance

Differ in complexity of implementation and objectives

Mechanisms are not mutually-exclusive

Examples


HF strategy example: Mixed systemMexico prior to 2003 Seguro Popular

Central government

mobilizes funds from other taxes

and sources

Social health insurance fund

Risk pool = Formal sector workers ONLY

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Social security institute

mobilizes funds from payroll

taxes

General tax revenue

Risk pool = Everybody else


provides services and pays

independent providers

Nominal fees

Ministry of Health provides

servicesFree services


Form

al s

ecto

r wor

kers

Ever

yone

els

e


Health financing strategies:Taste good or bad? How to judge?

Collection of funds

Pooling of funds

16

Spending of Funds

AllocationProvider Payment

EquityEfficiencyQuality



HF in Mexico: How to judge?

Central government

mobilizes funds from other taxes

and sources

Social health insurance fund

Risk pool = Formal sector workers ONLY

17


mobilizes funds from payroll

taxes

General tax revenue

Risk pool = Everybody else


provides services and pays

independent providers

Nominal fees

Ministry of Health provides

servicesFree services


Form

al s

ecto

r wor

kers

Ever

yone

els

eTaxes areefficient.Equitable?

Equity: 2 class system

Paying for inputs (salaries) limits incentives for efficiency & quality

Group Assignment


Group assignment – Get cookin!

Form small groups – by HF function

You are now HF experts

Read and discuss country case: Ushikamano

What reforms would you recommend?

YOU HAVE 30 MINUTES

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The Big Reveal


HF Function BEFORE 2003 AFTER 2003: National Health Insurance Voluntary enrolment

Resource mobilization

General taxes, payroll taxes, user fees, CBHI premium payments

VAT tax + payroll tax + wealthy to pay premium

Risk pooling High user fees erode risk poolCBHI schemes are small, fragmented risk pools

Single national risk poolNHI absorbs CHBIs

Purchasing Inadequate government financing of inputs (salaries, drugs, op costs)Patients and CBHI schemes paying fee-for-service

National Health Insurance Agency pays public and private providers fee-for-service

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What really happened? Ghana 2003 launch of National Health Insurance


What really happened? Ghana 2003 launch of National Health Insurance

Members (compared to non-members)

– Pay less out-of-pocket for health care

– Have higher utilization of health services

Single payer (National Health Insurance Agency) more efficient and professional than multiple CBHI schemes

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Ghana National Health Insurance

Fee-for-service limits incentives for provider efficiency and quality

Costs spiraling, payer flooded with paper claims, delays in paying providers

Impact on quality inconclusive

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Thank you!

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WELCOME to Health Finance Food Court: What’s Cooking? Mini-University March 7, 2014 Catherine...

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