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

2. 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?
*Results of Draft Final Report

3. 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
*Results of Draft Final Report

4. 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
*Results of Draft Final Report

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

6. 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)
*Results of Draft Final Report

7. 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)
*Results of Draft Final Report

8. 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.
*Results of Draft Final Report

9. 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 June 2003.
The insurance coverage is 67.20%.
*Results of Draft Final Report

10. 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)
*Results of Draft Final Report

11. NATIONAL HEALTH ACCOUNTS STUDY
*Results of Draft Final Report

12. NATIONAL HEALTH ACCOUNTS STUDY
Turkey
*Results of Draft Final Report

13. NATIONAL HEALTH ACCOUNTS STUDY
*Results of Draft Final Report

14. 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
*Results of Draft Final Report