1. Health care financing Case study GROUP II

2. Contents Scrutinizing the health care financing systemScrutinizing the health care financing system –Collection –Pooling –Purchasing Overview on health care financing in EmroviaOverview on health care financing in Emrovia Suggested solutionsSuggested solutions

3. Collection Total expenditure on health = $1.2 billionTotal expenditure on health = $1.2 billion Total health expenditure per capita = $24Total health expenditure per capita = $24 % of health expenditure / total government budget = 3.2% of health expenditure / total government budget = 3.2% % of health expenditure / GDP = 2.7% of health expenditure / GDP = 2.7% Out-of-pocket expenditure = $ 844.3 M = 70% of total expenditureOut-of-pocket expenditure = $ 844.3 M = 70% of total expenditure

4. Pooling Aprox. 9% of population insuredAprox. 9% of population insured For uncovered population: Average visits to MOH facilities per person per year 0.7For uncovered population: Average visits to MOH facilities per person per year 0.7 In Civil Servants Health Insurance Scheme: $12.5 per person per yearIn Civil Servants Health Insurance Scheme: $12.5 per person per year In private health insurance: $ 19 per person per yearIn private health insurance: $ 19 per person per year

5. Pooling (cont’d) Distribution of facilities (per capita):Distribution of facilities (per capita): –20 times more facilities in capital than east –48 times more facilities in capital than west Public health services are under-utilizedPublic health services are under-utilized 80% of HCWs No of beds 20% of HCWs Admission

6. Purchasing Almost 50% out-of-pocket expenditure on medicinesAlmost 50% out-of-pocket expenditure on medicines For civil servants scheme:For civil servants scheme: –60% of hospital care abroad –23% in private facilities –Only 17% in public hospitals Civil Servants and private insurance schemes are under-funded perhaps high co-paymentsCivil Servants and private insurance schemes are under-funded perhaps high co-payments

7. Overview Low government budgetLow government budget Public sector paying about 65% of costs in clinics and 96% in hospitalsPublic sector paying about 65% of costs in clinics and 96% in hospitals Emphasis on secondary and tertiary care rather than primary careEmphasis on secondary and tertiary care rather than primary care Low number of people (9%) have limited social protectionLow number of people (9%) have limited social protection Share of GDP allocated to health is very limited (even for LIC)Share of GDP allocated to health is very limited (even for LIC)

8. Recommendations Government should allocate more resources to primary health care especially in rural areas and the westGovernment should allocate more resources to primary health care especially in rural areas and the west Advocate for primary health care approachAdvocate for primary health care approach More equitable distribution of health facilitiesMore equitable distribution of health facilities Improve quality of care in public facilitiesImprove quality of care in public facilities Incentives to health care providers to go west/rural (e.g. % of revenues)Incentives to health care providers to go west/rural (e.g. % of revenues) Decrease travel abroad for inpatient careDecrease travel abroad for inpatient care Explore high expenditures on medicines:Explore high expenditures on medicines: –Generics – EML - formulary – unified/central procurement (e.g. Egypt saved 400M on meds)

9. Recommendations (cont’d) Research on health-seeking-behaviours of uninsured population:Research on health-seeking-behaviours of uninsured population: –Who are providing services (traditional healers, faith-based NGOs, TBAs/midwives, etc.) –Utilization Explore community-based health insuranceExplore community-based health insurance Intermediate measure: Strengthen existing mechanismsIntermediate measure: Strengthen existing mechanisms Long-term: Formulate strategic plan for improving health systemLong-term: Formulate strategic plan for improving health system

10. Thank you