Health insurance before, during and after(?) crisis ESTONIAN CASE

Transcription

1 Health insurance before, during and after(?) crisis ESTONIAN CASE Triin Habicht Head of Department of Health Care THE HEALTH SYSTEM AND ECONOMIC DOWNTURNS : IDENTIFYING AND MANAGING RISKS SEPTEMBER 27, 2012 WASHINGTON, DC

2 Background Population: 1,34 million Re-gained independence: 1991 Member of EU since 2004, eurozone since 2011, OECD since 2010 ALE at birth 76 years (2010) Health Expenditure (2010) 6.3 % of GDP Per person (US$895) Public expenditure 78.9 % Social health insurance 68.2% Social health insurance coverage 95-96% of population

3 Estonian Health Insurance Fund (EHIF) public law, public ownership Hospitals (acute care, nursing care) Health care provider private law, public or private ownership Family physisians (primary health care) Other providers

4 Long term sustainability

5 Impact of financial crisis Year GDP growth rate (%) Unemployme nt (%) Government expenditures (% of GDP) Public balance (% of GDP) ,7 4,7 34,0 2, ,6 5,5 39,5-2, ,2 13,8 45,2-2, ,3 16,9 40,6 0, ,6 12,5 38,2 1,0 Source: Estonian Statistics,

6 EHIF s budget in 2012 Type of expenditures Budget (plan, million euro) % Health services % Prevention programmes 7 1% Primary care 72 9% Specialist care % Long-term care 17 2% Dental care 19 2% Health promotion 1 0% Pharmaceuticals (out-patient) % Temporary sick leave benefits 88 11% Other monetary benefits 9 1% Other expenditures 16 2% Health insurance expenditures in total % EHIF administrative costs 8,0 1% Expenditures in total % Source: EHIF,

7 By law: Solvency reserve 6% of total budget EHIF reserves policy To balance macroeconomic risks Needs government approval Risk reserve 2% of health insurance budget To balance the risks of health insurance obligations Needs EHIF s supervisory board approval EHIF initiative: Surplus Difference between forecasted revenues and expenditures Needs EHIF s supervisory board approval (<30% of total surplus, <7% of previous period s health care services budget)

8 EHIF revenues, expenditures and reserves Source: EHIF,

9 Decisions made coping the crisis dental care and nursing care Before 2009 all insured persons aged 19 and over were entitled for dental care cash benefit of eur, but from 2009 only retired persons retained this right 15% co-insurance rate for nursing inpatient care, 2010

10 Decisions made coping the crisis temporary sick leave benefits Sharing responsibilities between patient and employer from July 2009: - No benefits paid for the first 3 days of sickness or injury (previously only one day) - Employer pays benefits from 4 to 8 days, from 9th pays EHIF (previously employer did not participate) - Reducing benefit rate from 80% to 70%

11 Decisions made coping the crisis 2009 reducing tariffs - Reducing all health services tariffs by 6% Raising health services tariffs by 1% in general, primary care 3% 2012 Tariffs raised to pre-crisis level

12 Decisions made coping the crisis access to care Maximum waiting times for outpatient specialists visits increased in from four to six weeks (2009) All other types of waiting times were kept at pre-crisis level Priority was to keep the financing of the primary care and outpatient care to the precrisis level

13 Impact of the crisis some indicators

14 Health outcomes Source: Estonian Statistics,

15 Financial protection OOP for EHIF reimbursed medications % Total OOP has decreased from 24 per cent 2006 to 19 per cent 2011 but this may also be caused of decreased utilization of services OOP has fallen within last 5 years for medications Required ATC based prescriptions since 2010 Implementing electronic prescription with prescription centre 2010 Requested offering of cheapest medication in pharmacies 2012 Awareness campaigns for public Source: EHIF,

16 Source: EHIF, Public satisfaction

17 Access to care number of visits per insured person Source: EHIF,

18 Lessons learned Assess your risks regularly and be ready for crisis situations before the crisis During the crisis introduce reasoned actions, avoid delays Some decisions have been waiting the crisis, do not miss the opportunity When you need to make cuts, try to retain balance of burden on providers and insured persons Retain sustainability of health system

19 Thank you for your attention!