Financing Options In Health Care: Suneeta Singh

FINANCING OPTIONS IN HEALTH CARE

Suneeta Singh New Delhi Office The World Bank

1. Universal coverage 2. Equal access 3. Control of expenditures 4. Efficient use of resources 5. Equity in finance 6. Consumer choice

COMMON GOALS OF HEALTH SYSTEMS

Private goods goods goods Negative externalities Positive externalities goods

Public goods TYPES OF GOODS

Charity Public money

Insurance : public / private

Personal money

WAYS IN WHICH MONEY IS ORGANIZED

FINANCING IS DISTINCT FROM

PROVISION

WAYS IN WHICH MONEY IS ORGANIZED

TYPES OF GOODS

MEANS OF PROVISION

PUBLIC SECTOR

PUBLIC PRIVATE MIX

NGO SECTOR PRIVATE SECTOR

MEANS OF PROVISION

Public

Financing

Public

Risk pooling

Private

Immunization by ♦ the government health system

Service Delivery NGO

Cataract surgery ♦ under the NPCB at an NGO run camp

Private

STD treatment at a ♦ NACO franchised private clinic

Medical benefits Group insurance Reimbursement of ♦ ♦ ♦ through the scheme for charges for medical Employees State workers registered treatment by private Insurance Scheme with SEWA doctor through Mediclaim User charges for Private financing ♦ Free bypass surgery ♦ ♦ deliveries at a (charity) of NGOs at a private hospital public hospital working in leprosy work

PUBLIC PRIVATE MIX IN PROVISION AND FINANCING PUBLIC PRIVATE PARTNERSHIPS IN HEA;LTH : WB

• Moderate levels of overall spending on health (4.5% GDP) (middle 20% of countries) • Low public expenditures on health (0.8% GDP; 3.9% of govt spending) (bottom 10% of countries) • High proportion of private health expenditure (87% private; 3.8% GDP) (highest 10% of countries)

HOW DOES INDIA’S FINANCING LOOK PUBLIC PRIVATE PARTNERSHIPS IN HEA;LTH : WB

Sources Public Uses Primary Care Curative Preventive & Promotive Secondary and Tertiary Care Non-service Provision TOTAL

Central Government 4.3 0.4 3.9

State and Local Government 5.6 3.0 2.7

0.9

Private Third Party Households (Employers)

Total

0.8 0.8 ..

48.0 45.6 2.4

58.7 49.7 9.0

8.4

2.5

27.0

38.8

0.9

1.6

..

..

2.5

6.1

15.6

3.3

75.0

100

Distribution of Health Spending by Sources and Uses (Percent of Total Health Spending) PUBLIC PRIVATE PARTNERSHIPS IN HEA;LTH : WB

Richest 20%

15%

60%-80%

19%

1/6

19%

Middle 20%

20%-40%

18%

Poorest 20%

21%

0

200

400

600

800

1000

1200

1400

1600

Visits Per 1,000 Population Public

Private

1/5

All India: Public and Private Sector Shares of Outpatient Care by Income Quintile PUBLIC PRIVATE PARTNERSHIPS IN HEA;LTH : WB

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1986-87

1995-96 All Govt. Sources

All Non-Govt. sources

All India: Changes in Utilization (%) of Public & Private Facilities for Hospitalization (NSSO 42 & 52 Rounds) PUBLIC PRIVATE PARTNERSHIPS IN HEA;LTH : WB

eneral tax financing issues : cost control

ocial insurance

issues : resource allocations cost control due to aging populations

luralistic issues : cost control gaps in coverage

FINANCING IN OTHER SETTINGS