NATIONAL HEALTH ACCOUNTS STUDY School of Public Health The Ministry of Health, Turkey Salih MOLLAHALILOGLU MD, MSc Mehtap KARTAL MD 2018.11.17 *Results of Draft Final Report

NATIONAL HEALTH ACCOUNTS STUDY Key questions which will be helpful for answering NHA; How big are the health system and its components in economy? Who, How much does someone pay? What are those payment mechanisms? How do the resources are distributed among service providers and kinds of service? How does the financial value of the benefits is distributed ? Where do we stand when we are compared with other countries? 2018.11.17 *Results of Draft Final Report

NATIONAL HEALTH ACCOUNTS STUDY TURKEY*; Health financing highly fragmented Difficult to ascertain spending across different functions by different agents Different funding sources have different incentive implications affecting provider and consumer behavior differently Difficult to ensure efficiency and equity in public spending Fragmentation increases administrative costs *Mukesh CHAWLA, World Bank, Presentation of NHA Training, Turkey 2018.11.17 *Results of Draft Final Report

NATIONAL HEALTH ACCOUNTS STUDY Health Financing Flows Sources Financing Agents Health Providers Taxes Public Institutions Public Public Public Payments Social Security Funds Liabilities Private Private Sector / Private Insurance Enterprices Credits Loans Employers Private Aids Private Household Out-of Pocket Out-of-Pocket Expenditures Employers 2018.11.17 *Results of Draft Final Report

NATIONAL HEALTH ACCOUNTS STUDY Health Financing Flows 2018.11.17 *Results of Draft Final Report

NATIONAL HEALTH ACCOUNTS STUDY Prepared Data Collection Tools; Associations (Sample prepared for 3704 associations related with health ) Foundations (Questionnaires sent to all 256 foundations related with health which were given by General Directorate of Foundations) Private Hospitals (via Association of Private Health Institutions) Private Health Insurance (via Turkey Insurance and Reasurance Companies Associations) Private Business Enterprise (Addresses provided from Ministry of Labor) 2018.11.17 *Results of Draft Final Report

NATIONAL HEALTH ACCOUNTS STUDY Prepared Data Collection Tools; State-owned economic Enterprise (provided through the agency of the Treasury, only 1 is missing) Privatization Administration (The information has been partly reached) Social Security Units under the provisional article of 20 of Social Insurance Organization Law (Provided through Ministry of Labor) Municipalities (Questionnaires sent to all 3200 municipalities by Ministry of Internal Affairs) Private Provincial Administrations (Questionnaires answered by all 81 provinces) 2018.11.17 *Results of Draft Final Report

NATIONAL HEALTH ACCOUNTS STUDY Hospital Study; Determining how payments are provided for Service Providers/hospitals and how these financial resources including general budget are spent and used for which services by service providers. Data base depends on, hospitals’ curative care division by; Inpatient curative care Outpatient curative care Dental care Services of Rehabilitative care and Education-training of Health personnel according their ratio within the hospitals. 2018.11.17 *Results of Draft Final Report

NATIONAL HEALTH ACCOUNTS STUDY Household Study; The general goal of the Household Survey is to estimate out-of-pocket expenditures on all levels of health care for a representative sample of 10,675 household. The answering rate is generally 91.85%. As we do not have the final report we don’t have the details of this study. But some results presented in the last meeting on 19-20 June 2003. The insurance coverage is 67.20%. 2018.11.17 *Results of Draft Final Report

NATIONAL HEALTH ACCOUNTS STUDY Annual Per Capita Health Expenditures by Region 20,000,000 40,000,000 60,000,000 80,000,000 100,000,000 120,000,000 140,000,000 160,000,000 North South East & S.East Central Average West Regions Health Expenditures (TL) 2018.11.17 *Results of Draft Final Report

NATIONAL HEALTH ACCOUNTS STUDY 2018.11.17 *Results of Draft Final Report

NATIONAL HEALTH ACCOUNTS STUDY Turkey 2018.11.17 *Results of Draft Final Report

NATIONAL HEALTH ACCOUNTS STUDY 2018.11.17 *Results of Draft Final Report

NATIONAL HEALTH ACCOUNTS STUDY Main Challenges of the Study; Institutionalization SPO take NHA as a project to be done by SIS and its budget given to SIS Regular, standart data collections Use of data by Policy-makers 2018.11.17 *Results of Draft Final Report