National Health Accounts Research Articles

Universal health coverage in Rwanda: a report of innovations to increase enrolment in community-based health insurance

BackgroundRwanda's community-based health insurance programme (Mutuelle de Santé) has been the focus of several large studies and much debate in global health policy. Comprehensive insurance reform enacted in mid-2011 transformed Mutuelle de Santé to a system of tiered premiums to make it more financially progressive and sustainable. Many governments in sub-Saharan Africa and south Asia have studied Rwanda's approach, particularly mechanisms to achieve high coverage, which exceeded 90% by 2010. We assessed the effect of different community-based initiatives on Rwanda's progress towards universal health-care coverage and increased use of health services. MethodsWe reviewed Rwandan interventions developed for villages that have enabled the scale-up of Mutuelle de Santé. We reviewed data from the Ubudehe database (proportion of people in each wealth category across districts), the Community Based Health Insurance database (coverage across districts), the preliminary National Health Accounts 2009–10 (out-of-pocket spending as a proportion of total health expenditure), and the Demographic and Health Survey 2010 (contacts per year and out-of-pocket spending). FindingsOver the first decade, national Mutuelle de Santé covered more than 90% of the population, has reduced out-of-pocket spending for health from 28% to 12% of total health expenditure, and increased service use to 1·8 contacts per year. A wealth categorisation programme (Ubudehe) was originally developed as a basic community target scheme, and modified after the 1994 genocide to enrol the most vulnerable citizens into national social protection programmes. It was then adapted to enable communities to assess the socioeconomic status of each citizen to provide a more progressive tiered premium collection system that includes full subsidies for members of the two poorest sub-categories. Ubudehe ratings account for income, household assets, and ability to work and each person is assessed collectively by the members of their village. Additionally, local leaders and 45 000 community health-care workers were incentivised to support individual enrolment in Mutuelle de Santé by inclusion of district coverage levels as a key indicator in their performance-based financing scheme. Finally, a household cooperative savings mechanism (Ibimina), which was developed by one rural district, has spread throughout Rwanda, with several districts reporting that up to 40% of premiums are being fully pre-paid 3 months before the start of the next financial year. Districts that use Ibimina have reduced administrative costs for Mutuelle de Santé programme management, and increased participation in decision making by village residents. InterpretationAs universal health coverage becomes a global health priority, countries should learn from community-level interventions to break down both financial and geographical barriers to access. FundingNone.

Improving Comparability and Availability of Private Health Expenditure Data in Health Accounts in the Asia-Pacific Region: A Case of India

National Health Accounts is a well-designed and accepted tool used globally to track the flow of funds in the health sector. It systematically analyzes the sources of funds, their use by different providers and delivery of services in the health sector. Providing a framework to collect and analyze health spending and its use, this tool provides inputs in designing policy, monitoring and evaluation of various programmes. Producing national health accounts on a regular basis in India is fraught with many challenges and lack of accurate data for some components of private sector health expenditure is a major constraint. Accounting for more than 75 per cent of health expenditure by the private sector, this requires systematic sources of data for production of regular health accounts. As on date, estimation of expenditure by local bodies, firms, and NGOs is based upon some independent surveys. The last two health accounts provided some estimates based upon this. For strengthening the health accounts there should be appropriate mechanisms in place for production of private sector data on a regular basis. This article provides a systematic analysis of sources, estimation process and constraints in estimation of private sector health expenditure in India.

Financing universal coverage in Malaysia: a case study.

One of the challenges to maintain an agenda for universal coverage and equitable health system is to develop effective structuring and management of health financing. Global experiences with different systems of health financing suggests that a strong public role in health financing is essential for health systems to protect the poor and health systems with the strongest state role are likely the more equitable and achieve better aggregate health outcomes. Using Malaysia as a case study, this paper seeks to evaluate the progress and capacity of a middle income country in terms of health financing for universal coverage, and also to highlight some of the key underlying health systems challenges.The WHO Health Financing Strategy for the Asia Pacific Region (2010-2015) was used as the framework to evaluate the Malaysian healthcare financing system in terms of the provision of universal coverage for the population, and the Malaysian National Health Accounts (2008) provided the latest Malaysian data on health spending. Measuring against the four target indicators outlined, Malaysia fared credibly with total health expenditure close to 5% of its GDP (4.75%), out-of-pocket payment below 40% of total health expenditure (30.7%), comprehensive social safety nets for vulnerable populations, and a tax-based financing system that fundamentally poses as a national risk-pooled scheme for the population.Nonetheless, within a holistic systems framework, the financing component interacts synergistically with other health system spheres. In Malaysia, outmigration of public health workers particularly specialist doctors remains an issue and financing strategies critically needs to incorporate a comprehensive workforce compensation strategy to improve the health workforce skill mix. Health expenditure information is systematically collated, but feedback from the private sector remains a challenge. Service delivery-wise, there is a need to enhance financing capacity to expand preventive care, in better managing escalating healthcare costs associated with the increasing trend of non-communicable diseases. In tandem, health financing policies need to infuse the element of cost-effectiveness to better manage the purchasing of new medical supplies and equipment. Ultimately, good governance and leadership are needed to ensure adequate public spending on health and maintain the focus on the attainment of universal coverage, as well as making healthcare financing more accountable to the public, particularly in regards to inefficiencies and better utilisation of public funds and resources.

Impacts of rising health care costs on families with employment-based private insurance: a national analysis with state fixed effects.

Given the rapid growth of health care costs, some experts were concerned with erosion of employment-based private insurance (EBPI). This empirical analysis aims to quantify the concern. Using the National Health Account, we generated a cost index to represent state-level annual cost growth. We merged it with the 1996-2003 Medical Expenditure Panel Survey. The unit of analysis is the family. We conducted both bivariate and multivariate logistic analyses. The bivariate analysis found a significant inverse association between the cost index and the proportion of families receiving an offer of EBPI. The multivariate analysis showed that the cost index was significantly negatively associated with the likelihood of receiving an EBPI offer for the entire sample and for families in the first, second, and third quartiles of income distribution. The cost index was also significantly negatively associated with the proportion of families with EBPI for the entire year for each family member (EBPI-EYEM). The multivariate analysis confirmed significance of the relationship for the entire sample, and for families in the second and third quartiles of income distribution. Among the families with EBPI-EYEM, there was a positive relationship between the cost index and this group's likelihood of having out-of-pocket expenditures exceeding 10 percent of family income. The multivariate analysis confirmed significance of the relationship for the entire group and for families in the second and third quartiles of income distribution. Rising health costs reduce EBPI availability and enrollment, and the financial protection provided by it, especially for middle-class families.

Triangulating Health Expenditure Estimates from Different Data Sources in Developing Countries

This article deals with the accuracy of statistical records used for political decision making and international comparative analysis. In developing countries, even major macroeconomic indicators can include data inadequacies and methodological differences in data generation between statistical agencies. Existing data show that total health expenditure as a percentage of GDP is about 50% lower in Pakistan than in other low-income countries (LIC). To determine whether these results reflect the actual situation in Pakistan or whether they are due to statistical error, Pakistan produced National Health Accounts (NHA) for the first time in 2009 to assess health spending in 2005-6. Improved NHA estimates are also being made for 2007-8, which will be based on the following: public expenditure data published with time lags; survey results for 2007-8; and multivariate analyses of data from 2010 and 2011 surveys on health-specific out-of-pocket (OOP) expenditure, healthcare providers, non-profit institutions and census data on autonomous bodies and large hospitals. Since these data are not yet available, a best estimate of health expenditure has to be made to support policy decision making and to provide a point of comparison for future NHA results. Health expenditure data are available from different data sources and estimates have been made by applying different methods, leading to a range of health spending estimates. As a result of this diversity of estimates and data, each with its own inaccuracies or gaps, there was a clear need to triangulate the available information and to identify a best possible estimate. This article compares estimates of household health expenditure from different sources, such as the Household Integrated Economic Survey, the Family Budget Survey and National Accounts (NA). The analysis shows that health expenditure figures for Pakistan have been underestimated by both WHO and the NHA. An adjusted estimate shows OOP spending to be twice as high as previously thought. Previous per capita total health expenditure estimates ranged from $US16 to $US19. The revised estimate showed per capita total health expenditure to be $US33, based on NA data. This puts Pakistan in a different position in international comparisons, with health expenditure exceeding the level of India ($US32.5) and the average of all LIC ($US24.5). Methodological differences in estimating expenditure and the multiple and conflicting estimates might cause stakeholders to make potentially adverse or even erroneous policy decisions on the allocation of resources. Because policy makers make decisions based on the estimates provided, the provision of a best estimate, made following a review of the advantages and limitations of existing sources and methods, is key.

Trends in Scale and Structure of Korea's Health Expenditure over Last Three Decades (1980-2009): Financing, Functions and Providers

This paper introduces statistics related to the size and composition of Korea's total health expenditure. The figures produced were tailored to the OECD's system of health accounts. Korea's total health expenditure in 2009 was estimated at 73.7 trillion won (US$ 57.7 billion). The annual per capita health expenditure was equivalent to US$ PPP 1,879. Korea's total health expenditure as a share of gross domestic product was 6.9% in 2009, far below the OECD average of 9.5%. Korea's public financing share of total health expenditure increased rapidly from less than 50% before 2000 to 58.2% in 2009. However, despite this growth, Korea's share remained the fourth lowest among OECD countries that had an average public share of 71.5%. Inpatient, outpatient, and pharmaceutical care accounted for 32.1%, 33.0%, and 23.7% of current health expenditure in 2009, respectively. A total of 41.1% of current health expenditure went to hospitals, 28.1% to providers of ambulatory healthcare (15.9% on doctor's clinics), and 17.9% to pharmacies. More investment in the translation of national health account data into policy-relevant information is suggested for future progress.

Resource flows and levels of spending for the response to HIV and AIDS in Belarus

BackgroundBelarus has a focused HIV epidemic concentrated among injecting drug users, female sex workers and men who have sex with men. However, until 2008, Belarus had no way of evaluating HIV spending priorities. In 2008, Belarus committed to undertaking a comprehensive National AIDS Spending Assessment (NASA) in order to analyze HIV spending priorities. NASA was used to 'follow the money' from the funding sources to agents and providers, and eventually to beneficiary populations.FindingsBelarus spent the majority of its funding on prevention, diagnosis and treatment of sexually transmitted infections and on securing the blood supply. International donors and NGOs working within Belarus spent the majority of their funding on preventative activities for high risk groups while Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) solely funded antiretroviral treatment.ConclusionsThe data and experience obtained through conducting NASA will help build capacity for future resource tracking activities for HIV and other health priorities. This experience established the foundation for enhanced and future consistent quality-reporting of National Health Accounts. Monitoring the flow of resources for Belarus' HIV response provides valuable strategic information that can improve operations and planning as well as mobilize greater resources. NASA offers Belarusian policy makers an overview of HIV activities that merit their priority attention. In addition, the findings from Belarus are particularly relevant for the rest of the Commonwealth of Independent States due to their similar epidemiological profiles and centrally planned systems. The Belarusian government faces future challenges, especially in increasing public investments in HIV prevention for female sex workers and their clients, men who have sex with men, and among intravenous drug users.

The private sector role in HIV/AIDS in the context of an expanded global response: expenditure trends in five sub-Saharan African countries

Global financing for the HIV response has reached unprecedented levels in recent years. Over US$10 billion were mobilized in 2007, an effort credited with saving the lives of millions of people living with HIV (PLHIV). A relatively unexamined aspect of the global HIV response is the role of the private sector in financing HIV/AIDS services. As the nature of the response evolves from emergency relief to long-term sustainability, understanding current and potential contributions from the private sector is critical. This paper examines trends in private sector financing, management and resource consumption related to HIV/AIDS in five sub-Saharan African countries, with a particular emphasis on the effects of recently scaled-up donor funding on private sector contributions. We analysed National Health Accounts HIV/AIDS subaccount data for Kenya, Malawi, Rwanda, Tanzania and Zambia between 2002 and 2006. HIV subaccounts provide comparable data on the flow of HIV/AIDS funding from source to use. Findings indicate that private sector contributions decreased in all countries except Tanzania. With regards to managing HIV/AIDS funds, non-governmental organizations are increasingly controlling the largest share of resources relative to other stakeholders, whereas private for-profit entities are managing fewer HIV/AIDS resources since the donor influx. The majority of HIV/AIDS funds were spent in the public sector, although a considerable amount was spent at private facilities, largely fuelled by out-of-pocket (OOP) payments. On the whole, OOP spending by PLHIV decreased over the 4-year period, with the exception of Malawi, demonstrating that PLHIV have increased access to free or subsidized HIV/AIDS services. Our findings suggest that the influx of donor funding has led to decreased private contributions for HIV/AIDS. The reduction in private sector investment and engagement raises concerns about the sustainability of HIV/AIDS programmes over the long term, particularly in light of current global economic crisis and emerging competing priorities.

O que dizem os gastos com o Programa Saúde da Família em um município da Bahia?

The Family Health Program (PSF) was established by the federal government as a strategy to reverse the care model. This article aimed to identify the flow of accounts from local sources of funding to the activities of health; problematize and evaluate the allocation of financial resources and implementation of the PSF budget in the municipality of Santo Antonio de Jesus (Bahia, Brazil) in the year of 2005. The financial data were collected through four tables proposed by the National Health Accounts (NHA) and compared with data of official reports. The data result on the survey showed a expenditure per capita of 16 PSF units ranging from R$ 465.40 to R$ 62.30 per capita/unit/year. The average expenditure of a unit was R$ 17.302/unit/month) in 2005 and the federal government spent R$ 2.834/unit/month. there was a decisory financing of the PSF by the federal government and a lack of co-financing from state of Bahia; there was a great effort from the council to expand access to health services through the PSF. The choice of the municipality by this strategy may have make unviable other priority activities due to scarce resources; and the limits found in the expenditure description of activities register a profile that will allow comparisons in future researches.

Assessing public and private sector contributions in reproductive health financing and utilization for six sub-Saharan African countries

The present study provides evidence to support enhanced attention to reproductive health and comprehensive measures to increase access to quality reproductive health services. We compare and contrast the financing and utilization of reproductive health services in six sub-Saharan African countries using data from National Health Accounts and Demographic and Health Surveys. Spending on reproductive health in 2006 ranged from US$4 per woman of reproductive age in Ethiopia to US$17 in Uganda. These are below the necessary level for assuring adequate services given that an internationally recommended spending level for family planning alone was US$16 for 2006. Moreover, reproductive health spending shows signs of decline in tandem with insufficient improvement in service utilization. Public providers played a predominant role in antenatal and delivery care for institutional births, but home deliveries with unqualified attendants dominated. The private sector was a major supplier of condoms, oral pills and IUDs. Private clinics, pharmacies and drug vendors were important sources of STI treatment. The findings highlight the need to commit greatly increased funding for reproductive health services as well as more policy attention to the contribution of public, private and informal providers and the role of collaboration among them to expand access to services for under-served populations.

Resource flows for health care: Namibia reproductive health sub-accounts

BackgroundImplementing initiatives to achieve the targets of MDG 5 requires sufficient financial resources that are mobilized and utilized in an equitable, efficient and sustainable manner. Informed decision making to this end requires the availability of reliable health financing information. This is accomplished by means of Reproductive Health (RH) sub-account, which captures and organizes expenditure on RH services in two-dimensional tables from financing sources to end users. The specific objectives of this study are: (i) to quantify total expenditure on reproductive health services; and (ii) to examine the flow of RH funds from sources to end users.MethodsThe RH sub-account was part of the general National Health Accounts exercise covering the Financial Years 2007/08 and 2008/09. Primary data were collected from employers, medical aid schemes, donors and government ministries using questionnaire. Secondary data were obtained from various documents of the Namibian Government and the health financing database of the World Health Organization. Data were analyzed using a data screen designed in Microsoft Excel.ResultsRH expenditure per woman of reproductive age was US$ 148 and US$ 126 in the 2007/08 and 2008/09 financial years respectively. This is by far higher than what is observed in most African countries. RH expenditure constituted more than 10-12% of the total expenditure on health. Out-of-pocket payment for RH was minimal (less than 4% of the RH spending in both years). Government is the key source of RH spending. Moreover, the public sector is the main financing agent with programmatic control of RH funds and also the main provider of services. Most of the RH expenditure is spent on services of curative care (both in- and out-patient). The proportion allocated for preventive and public health services was not more than 5% in the two financial years.ConclusionNamibia's expenditure on reproductive health is remarkable by the standards of Africa and other middle-income countries. However, an increasing maternal mortality ratio does not bode well with the level of reproductive health expenditure. It is therefore important to critically examine the state of efficiency in the allocation and use of reproductive health expenditures in order to improve health outcomes.

National Health Accounts of Nigeria: Results from Second Round of Estimation

National Health Accounts (NHA) tracks the flows of health spending from financial sources to end users. This paper uses the framework to capture the general health expend it lire and updates the earlier NHA for Nigeria by providing estimates for 2003 2005. The estimates were prepared in line with the WHO’s guide to the NHA estimation. Our estimates reveal that households are the major source of health funds in Nigeria. Government funding accounts for a quarter of the health funds and but the main incidence still lies with households. These funds were spent about equally in private and public health facilities. Although resource pooling is not widespread health insurance show promise as a significant potential option in health care financing. Given health as a public good, the implication is that there is need for government focus on the responsibility to lessening the burden of health expenditure 011 poor households if its stewardship role is not to be called to question.

Health financing in Malawi: Evidence from National Health Accounts

BackgroundNational health accounts provide useful information to understand the functioning of a health financing system. This article attempts to present a profile of the health system financing in Malawi using data from NHA. It specifically attempts to document the health financing situation in the country and proposes recommendations relevant for developing a comprehensive health financing policy and strategic plan.MethodsData from three rounds of national health accounts covering the Financial Years 1998/1999 to 2005/2006 was used to describe the flow of funds and their uses in the health system. Analysis was performed in line with the various NHA entities and health system financing functions.ResultsThe total health expenditure per capita increased from US$ 12 in 1998/1999 to US$25 in 2005/2006. In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. The country had not met the Abuja of allocating at least 15% of national budget on health. The percentage of total health expenditure from households' direct out-of-pocket payments decreased from 26% in 1998/99 to 12.1% in 2005/2006.ConclusionThere is a need to increase government contribution to the total health expenditure to at least the levels of the Abuja Declaration of 15% of the national budget. In addition, the country urgently needs to develop and implement a prepaid health financing system within a comprehensive health financing policy and strategy with a view to assuring universal access to essential health services for all citizens.

AIDS Funds: Rwanda

In their Policy Forum “Global HIV/AIDS policy in transition” (11 June, p. [1359][1]), J. Bongaarts and M. Over conclude that antiretroviral therapy for AIDS is not a cost-effective use of donor funding for global health. We believe that Bongaarts and Over omitted key aspects of a complete cost-effectiveness assessment: numerous positive spinoffs to other services, the effect on increased attention on global health, and the ability to mobilize resources that would not otherwise have been available for global health. The situation in Rwanda serves as an example. Rwanda's total health expenditure declined from 1998 through 2002, but because of advocacy for HIV resources, total health expenditure doubled between 2002 and 2003 ([ 1 ][2]). HIV funding, even before the current focus on integration, provided resources for the renovation of health facilities, equipment, training, and management, as well as a culture of openness for best practices. With integration of HIV services into other health services, resources have had an even wider benefit, especially for maternal health services. Integration is still in progress, but successful steps have been made ([ 2 ][3], [ 3 ][4]). Rwanda's 2006 National Health Accounts reported that although reproductive health spending did not grow as rapidly as overall spending, it increased by 15% between 2002 and 2006 ([ 4 ][5]), and maternal mortality rate decreased from 1071 (in 2000) to 750 per 100,000 births (in 2005) and is expected to fall to about 350 in 2010. Rates of assisted deliveries, use of family planning, and receipt of four standard prenatal care services have seen a marked increase ([ 4 ][5]–[ 6 ][6]). Consistent with the results in Rwanda, a recent Lancet article correlated maternal mortality with HIV mortality in women ([ 7 ][7]). These improvements cannot be attributed to reproductive health spending alone; major health initiatives made possible by HIV funding are largely responsible. HIV resources also paid for the community-based health insurance premiums of many of the poorest segments of the population; the funding thus contributed to the increase in community-based health insurance enrollment rate from 7% in 2003 to 85% in 2008. The literature cited by Bongaarts and Over failed to consider all benefits gained beyond direct HIV services, including the value of saving a mother and its contribution to quality of life for her children and family and societal productivity. In doing so, Bongaarts and Over have greatly underestimated the impact of HIV funding on both HIV and non-HIV health results. 1. [↵][8] Rwanda Ministry of Health, “National health accounts 2006” (2008). 2. [↵][9] National AIDS Commission, “National strategic plan 2009–2012” (2009). 3. [↵][10] UNAIDS, “Rwanda country progress report 2008–2009” (UNAIDS, Geneva, 2010). 4. [↵][11] Rwanda Ministry of Health, “Rwanda demographic and health survey 2000” (2001). 5. Rwanda Ministry of Health, “Rwanda demographic and health survey 2005” (2006). 6. [↵][12] Rwanda Ministry of Health, “Rwanda demographic and health survey 2007–2008” (2009). 7. [↵][13] 1. M. C. Hogan 2. et al ., Lancet 375, 1967 (2010). [OpenUrl][14][CrossRef][15][PubMed][16][Web of Science][17] [1]: /lookup/doi/10.1126/science.1191804 [2]: #ref-1 [3]: #ref-2 [4]: #ref-3 [5]: #ref-4 [6]: #ref-6 [7]: #ref-7 [8]: #xref-ref-1-1 View reference 1 in text [9]: #xref-ref-2-1 View reference 2 in text [10]: #xref-ref-3-1 View reference 3 in text [11]: #xref-ref-4-1 View reference 4 in text [12]: #xref-ref-6-1 View reference 6 in text [13]: #xref-ref-7-1 View reference 7 in text [14]: {openurl}?query=rft.jtitle%253DLancet%26rft.stitle%253DLancet%26rft.aulast%253DMcCaw-Binns%26rft.auinit1%253DA.%26rft.volume%253D375%26rft.issue%253D9730%26rft.spage%253D1967%26rft.epage%253D1968%26rft.atitle%253DNew%2Bmodelled%2Bestimates%2Bof%2Bmaternal%2Bmortality.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0140-6736%252810%252960924-5%26rft_id%253Dinfo%253Apmid%252F20569839%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [15]: /lookup/external-ref?access_num=10.1016/S0140-6736(10)60924-5&link_type=DOI [16]: /lookup/external-ref?access_num=20569839&link_type=MED&atom=%2Fsci%2F330%2F6001%2F176.1.atom [17]: /lookup/external-ref?access_num=000278689600024&link_type=ISI

Out-of-Pocket Household Health Expenditures and Their Use in National Health Accounts: Evidence from Pakistan

Out-of-pocket (OoP) household health expenditures are among the most difficult factors to measure in the context of National Health Accounts (NHA). Yet their measurement is important: OoP household expenditures are typically the first or second largest source of health care financing in developing countries. Their incorrect measurement can undermine the credibility of total health spending estimates and thus NHA statistics, which are an otherwise important resource for policy makers. In most countries, private expenditures account for the biggest margin of error in national health spending estimates and represent the most substantial barrier to reliable international comparisons. Differences in accounting methods explain much of the discrepancy across nations. To further the academic investigation of this important issue, this paper focuses on OoP household health expenditures in Pakistan’s NHA and suggests steps toward estimating such expenditures more effectively.

Health Expenditures in Pakistan: Cross-Checking Household Expenditure Data on Health for NHA and Adjustment with National Accounts

According to hitherto available data, health expenditures in Pakistan are relatively low in international comparison. Data1F published by the World Health Organization (WHO) for the year 2005 shows a lack of Pakistani health expenditures in most indicators, compared to other low-income countries (LIC). To answer the question whether these results reflect the real situation in Pakistan or whether they exist due to statistical problems, Pakistan, for the first time, developed its National Health Accounts (NHA) in 2009. Only the availability of good estimates of health expenditures allows for evidence-based policy-making and therefore good governance.The results clearly indicate that the situation in Pakistan is better than what was earlier estimated; however, the total health expenditure (THE) is still low compared to neighboring countries and other LIC. As a result, it is clear that the WHO health expenditure figures for Pakistan are understated, because they mainly comprise public and household out-of-pocket expenditures on health. Expenditures of many other entities, like military, cantonment boards, autonomous bodies, private hospitals, and so on, have not been taken into account in earlier estimations. Therefore, expenditure figures of NHA Pakistan are higher than those of WHO. Overall, the official NHA results show that THE is 27 percent higher than the WHO figure.Furthermore, this paper cross-checks NHA results with other already available data sources on household expenditure. This comparison includes preliminary results of the Family Budget Survey (FBS), which also includes health items as well as National Accounts (NA) data. In line with this comparison, we calculate a raising factor that can be used for the adjustment of NHA results according to NA. The raised NHA result shows 102 percent higher out-of-pocket (OOP) spending on health; this would result in OOP health expenditures of $25.15 USD per capita (compared to only $12.45 USD per capita in the NHA estimation). This result, based on the NA figure with $33 USD THE per capita, leads to a different evaluation in international comparison, since it nearly reaches the level of India, with $37.5 USD and more than the average of all LIC with $27 USD.

Assessing a population's need for scintigraphy: use under universal health insurance in Taiwan

The aim of this study is to estimate how much scintigraphy the population will need in a well-developed healthcare system with fairly equitable access to healthcare. This is a retrospective population-based study. The data used came from Taiwan's National Health Insurance reimbursement claims dataset, the National Account compiled by Taiwan's Statistical Bureau of the Directorate General of Budget, Accounting and Statistics, and the National Health Account by Taiwan's Department of Health from 2001 to 2005. Frequency and expenditure variables were derived from these datasets. The annual scintigraphy use rate in Taiwan was 13.57/1000 people from 2001-2005. On average, expenditures for scintigraphy accounted for 0.24% of National Health Insurance expenditures, 0.13% of the nation's total health expenditures and 0.00008% of the gross domestic product of Taiwan. The ratio of scintigraphy to computed tomography use was 0.37 and the scintigraphy to magnetic resonance imaging ratio was 1.14. The ratio of expenditures for scintigraphy and computed tomography was 0.23 and that for scintigraphy and magnetic resonance imaging was 0.36. A comparative approach is useful for assessing healthcare needs. Although the Taiwanese experience might not apply to all countries, the results of this study can serve as an international benchmark for assessing the need for scintigraphy in countries around the world.

Reducing inequities in healthcare: a priority for European policies and measures

Goals: This study is intended to highlight the importance of health determinants and equity in healthcare in an international and European context, to provide an overview on health inequities and on how they correlate with the political decisions for the ethical allocation of resources in the healthcare system from Romania. Methodology: The distribution of health socio-economic determinants was assessed by using data from two studies conducted by the National Institute of Statistics. Data for 2009 processed by NSPHHM were used in order to analyze the indicators regarding the main aspects of hospital activity and admitted morbidities. Concerning the analysis of the main demographic aspects and the trend of health expenses at national and/or regional level, the utilized data came from NCOPIISH 2 (for 2007), EUROSTAT (statistical database 2009) and from WHO’s National Health Account database. Absolute values were also used and rates for assessing inequalities and inequities in resource allocation in healthcare system (medical doctors, nurses, beds, high-tech medical equipment) were calculated per development regions. Outcomes: The demand of healthcare services exceeds the ability to finance them from public funds (state budgets for health and social security funds). The share of out-of-pocket payments made by households in the total healthcare expenses is considerable (over 20%) This situation exposes households to a catastrophic risk (over 40% of the overall costs of a household). In the same time, decision makers face difficulties in a better understanding of the consumption causes in the healthcare system in order to create the premises of a better allocation of available resources. Inequalities between development regions are induced by: inequalities in health status and structure of risk factors to which the population from a certain region is exposed; inequalities in the need for healthcare services; inequalities in the service offer; inequality in providing service continuity; inequalities in the capacity of local authorities (DHA, DHIH, town-halls and county councils) to make organizational changes.

Assessment of financial flow in the health system of Serbia in a period 2003-2006

The main goal of every health policy is not merely the establishment of the health system sustainability, but the accessability of health services to the whole population, as well. This objective is shared in European Union countries, and the consequence is the implementation of National Health Accounts (NHA). NHA, as a tool for evidence-based management, provides data regarding financial flow in health at national level and allows international comparability. The aim of this study was to determine Serbian overall health spending patterns by National Health Accounts, and to determine health care indices to provide policy makers with internationally comparable health indicators. A retrospective analysis of healthcare expenditures was obtained from the published final financial reports of relevant state institutions during a period of 2003 to 2006. The various sources of data on healthcare expenditures were connected according to instructions by the OECD "A System of Health Accounts (SHA)" Version 1.0. The obtained results showed: health expenditures in Serbia made up 8.6%, 8.3%, 8.7% and 9% of the GDP in 2003, 2004, 2005 and 2006, respectively; the Health Insurance Fund was a predominant financing source of the public sector with 93% in 2006; the largest part of the total health expenditures went towards hospitals and for health services; the expenditure per capita in 2006 was 365 US$; Serbian population finances the state institutions "out of pocket" with 21.28% of their sources, which was 7.3% of the total healthcare expenditures, and the private institutions with 78.72% of their financial sources, which is 27% of the total healthcare expenditures. In 2006 Serbia allocated financial resources out of GDP in the amount similar to the European Unity, while comparing to the countries of the region, these funds were less only than in Bosnia and Hertzegovina. This allocating of financial resources in total, however, was low as the consequence of relatively low level of GDP in Serbia. Establishing NHA provided a pattern of national healthcare spending and allowed a comparison of healthcare system in Serbia with the systems of other countries. Analysing a period 2003-2006 revealed a similarity between Serbia and the countries of the European Unity in regard to the level of average financial resources allocation for healthcare expressed as a percentage of GDP, as well as in regard to financiers in the system of healthcare. A high purchasing power disparity, however, in healthcare services was observed between the population of Serbia and other European countries.

Number of Uninsured Appears Poised for Dramatic Surge

Back to table of contents Previous article Next article Professional NewsFull AccessNumber of Uninsured Appears Poised for Dramatic SurgeMark MoranMark MoranSearch for more papers by this authorPublished Online:17 Jul 2009https://doi.org/10.1176/pn.44.14.0012aRising health care costs and slow growth in personal income related to the current recession will add at least another 6.9 million nonelderly Americans to the rolls of the uninsured by 2010, according to a study published May 28 on the Web site of the journal Health Affairs.In the study report, researchers Todd Gilmer, Ph.D., and Richard Kronick, Ph.D., of the University of California, San Diego, predicted that 19.2 percent of all nonelderly Americans will be uninsured by 2010, an increase of 2 percentage points from 2007.The researchers used a complex method that involves several data sources to calculate an “affordability index,” defined as the ratio of per-capita health spending for insured adults to the median income among workers. Those data sources included the National Health Accounts developed by the Office of the Actuary at the Centers for Medicare and Medicaid Services, the 1977 National Medical Care Expenditure Survey, the 1987 National Medical Expenditure Survey, and the 1996 and 1999 Medical Expenditure Panel Surveys. Their analysis also takes into account employment characteristics such as firm size, industry, and self-employment and part-time status, as well as demographic and socioeconomic characteristics such as age, sex, marital status, race and ethnicity, education, and home ownership. After using their index to derive predictions for uninsurance rates among workers, Gilmer and Kronick used the historical relationship between coverage rates for workers and for all nonelderly adults to generate predicted uninsurance rates for all nonelderly adults.They estimate that the number of uninsured Americans will reach 52 million in 2010. Among workers not covered by a dependent's plan or by a public program, the fraction that is uninsured is expected to increase sharply, reaching 26.4 percent in 2010.Moreover, Gilmer and Kronick acknowledged that their model cannot completely account for uninsurance that will arise from job losses during the current recession.“Our model focuses on forecasting the rate of uninsurance among workers,” they write. “It does not directly take unemployment into account. During recessions we would expect the number of uninsured people to increase by more than projected by the model, because some of the newly unemployed will lose coverage when they lose their jobs.”They cited researchers at Kaiser Family Foundation who have estimated that each 1 percent increase in unemployment leads to a 0.59 percent increase in the percentage uninsured among nonelderly adults. If unemployment were to increase to 10 percent, the number of uninsured people would increase by close to 6 million in the absence of policy change.“Some of this projected increase would be in addition to our projected increase of 6.9 million, which will occur primarily as a result of the increasing unaffordability of health care for adults who continue working,” Gilmer and Kronick wrote.They noted that the American Recovery and Reinvestment Act of 2009 may somewhat attenuate the effects of increasing unemployment on the number of uninsured people and that extension and expansion of the State Children's Health Insurance Program is expected to reduce the number of uninsured children.“Given major uncertainties about the depth and length of the recession, about federal and state policy responses, and about the effect of any public policy response, it would be foolish to attempt to offer precise forecasts of the number of uninsured Americans,” the researchers observed. “These caveats notwithstanding, our work demonstrates that if personal income grows as slowly as projected... and health care costs grow at the rate projected by CMS, then the number of uninsured people is likely to grow by at least 6.9 million during 2008-10.”Gilmer is an associate professor in the Department of Family and Preventive Medicine at the University of California at San Diego, and Kronick is a professor in that department.“Hard Times and Health Insurance: How Many Americans Will be Uninsured in 2010” is posted at<http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.4.w573>.▪ ISSUES NewArchived