Health Financing

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I- Introduction :

health care costs have become a major concern for virtually all governments. The need to provide universal coverage for essential care is generally recognized value. Spending on care growing faster than the wealth in many countries the trend is not temporary. The evolution of technologies and practices and the aging population are factors that put pressure on the Health Financing.

II- Financing of health system :

A- Cover of disease risk :

  1. individual coverage (individual funding)
  2. Collective cover commercial type (d & rsquo funds; private insurance)
  3. Collective cover non-commercial type (mutual…)
  4. mandatory coverage organized by the State (public, mandatory)
  5. Free group coverage (total or partial)

B- Levels of analysis :

  1. macro level
  2. meso level
  3. micro level
  • Health does not produce income
  • Income from economic sectors
  • Funding Health = make transfers
  • Ability to raise capital?

C- possible sources :

1- Financing on own resources :
state
Assurances, mutual…
Payment by the patient

2- Funding from external resources :
Dons (multilateral, bilateral)
Subsidies
Interest loans or commercial rate

D- Criteria Analysis :

1- Equity: 2 interpretations:
Provide the services necessary to those who need it
Taken depending on the level of each resource

2- Efficiency: 2 interpretations:
Allows you & rsquo; achieve the objectives
Allows you to manage so rational resources

3- sustainability : 2 interpretations :
Sustainable over time
May be reproduced with local resources

E- compensation arrangements :

  • Remuneration to the & rsquo; act
  • Case payment (the episode)
  • daily package (day hospital).
  • flat rate (payment bonuses)
  • Capitation
  • Salary
  • Budget
  • high efficiency, high cost (FFS)
  • low efficiency / low cost (salary, budget)
  • high efficiency, low cost optimal -solution- (in case, day pass, payment bonuses, capitation)

F- global health expenditure (1990) :

  • Total estimated 1.700 billion $ (8% World GDP)
  • Western countries (90% you total)
  • USA (41% du total occidental)
  • Developing countries (10% you total)
  • developed economies (15% of the population consume 90% of global spending)
  • Developing Economies (85% of the world population consume 10% of global spending)

G- The formulation of health policies :

Can be done :

  • No information on health financing
  • Policymakers need National Health Accounts (CNS), financing tool, to develop effective health policies

H- National Health Accounts :

A tool that can:

  • To summarize
  • To describe
  • Analyze care systems funding

I- Brief history of financing the Algerian health system :

The structuring of the health system has evolved according 3 distinct periods :

  • 1962-1974
  • 1974 -1986
  • 1986 and beyond

J- Period of mixed funding (1962-1974) :

Legacy of a colonial health sector

first emergency : keep the system operating in a difficult environment

  • Access to health care of insured multiple regimes was based on a daily rate and was about 30% DNS
  • Treasury took over indigent (60% DNS)
  • The details (professions) paid directly to their care (10% DNS).

K- Period of free (1974-1986) :

-> Socialist Option / political will involved the construction of a national health system

  • Institution of free medicine / equal access
  • institutional deadlock private sector, State monopoly on medicines / medical equipment
  • Resource mobilization (hospital infrastructure, light units and intensified training of medical and paramedical personnel)
  • Substitution of direct payments (act and daily rates) by the phrase "global budget"

-> overall, significant improvement in the health status

L- Period contribution of households and reform (1986-nowadays) :

Serious economic crisis / severe application of structural adjustment plan (88-98) : funding problems.

Commitment deep reforms :

  • Revision of free health care and the public sector dominance.
  • Sunrise private institutional deadlock (rapid and unplanned growth)
  • Monopolization of the drug market / medical equipment
  • Financial participation up users

M- Contribution of users :

  • Since 1985 : stop of the free distribution of medicines in ambulatory care
  • Since 1986 : User participation in height 20% the cost of exams, exploration and analysis
  • Since January 1995: User participation in height 50 GIVES (CG), 100 GIVES (CS) and 100 GIVES (JH) (1$DA = 100) with exemptions (children, chronically ill, the elderly, mujahideen, unemployed, health workers…)

N- Effects of the economic crisis and health policy :

  • deteriorated health outcomes, stop health progress
  • Conversely some indicators especially in the countryside (TMI. Rising incidence of communicable diseases previously eradicated)
  • Many medicines shortages and other health goods
  • Despite public component of importance, competition with a vibrant private sector whose services are expensive and of average quality

O- Financial highlights :

1- Readjustment socialized mode of financing the most important implication health of the financial participation of users + forte contribution SS

  • BIPOLARISE, the health financing became TRIANGULAR : STATE, SOCIAL SECURITY, HOUSEHOLDS.

2- In the wake of economic difficulties, l & rsquo; private medical practice will experience the lifting of all the institutional barriers that bordered on an insignificant role and open the way to a dramatic development since it

P- Types of financing methods :

CAPITAL RESOURCES AND DNS(MDA) :

70 80 90 96 99 02 07
1. 0.3 1.9 10.9 30.5 38.5 60.7 117
II. 0.1 3.1 14.2 57.8 70.2 58.5 124
III. 1.8 6.6 21.0 25.0 38.0 70
IV. 5.0 11.7 27
T 0.4 6.8 13.7 109.3 132.7 168.9 338
DNS / START 1.7 4.2 5.7 4.3 4.2 4.5 4.8
  • I : STATE
  • The : SOCIAL SECURITY
  • III: HOUSEHOLDS
  • IV : OTHER (mutual, economic enterprises, foreign cooperation…)

Q- Constraints funders :

a- state :

-> economic context and financial concern (1988-2000) :

  • successive deficits
  • external and internal debt
  • Disengagement political will of health funding from 1993 (successive finance laws) only to support public service constraints (classical functions)

-> Background of affluence (2000 nowadays) :

  • Catch up on its infrastructure (extensions, renovations, amenities, formations…)
  • Strengthening budgets (salary increase, pharmaceuticals)
  • Strengthening the Development of the Liberal sector

b- Social Security :

-> economic context and financial concern (1988-2000) :

  • Large structural deficits since 1990 (400.000 compressed jobs)
  • Pressure on limited resources
  • Drug price inflation (devaluation)

-> fragile recovery from surplus 2002 :

  • Strengthening the third device fee (pharmaceuticals, map Chiffa, 5 large regional centers function tests)
  • Widening conventionnement (cardiovascular illnesses, dialysis including transportation…) and proposed "family doctor"

c- households :

-> difficult economic (1988-2000) :

  • Strong involvement in the context of weakening revenue (loss of income and wage freeze) "Depletion of broad social classes by raising subsidies and price support including first need
  • affluent s & rsquo; cater to foreign health facilities (France, Suisse, Tunisia, Turkey…), minimal contribution to local financing

-> Background to boost employment (2000 nowadays) :

  • Reducing unemployment and gradual rise of financial participation capacity
  • Improved living standards and health status

R- Current situation :

-> until the end 2014 :

  • financial upturn, resources of the State (128 billion $ foreign exchange reserves)
  • Improved financial stability of health insurance agencies
  • Improved household incomes and reducing unemployment

-> From 2014 (collapse in oil prices) :

  • Expected strong financial imbalances of health insurance agencies
  • Stagnation, or reduction of household income and return to rising unemployment

S- future trends :

  • The share of the state is likely to remain confined within the range (44-46%) but will be oriented more towards the care of the poor and prevention activities
  • Boosted by boosting employment and reducing unemployment (Oil prices fall ?) Social Security will be more involved in health funding for the coming years

Cours du Dr Kirati – Faculty of Constantine