Expenditure tracking

Transcription

1 Expenditure tracking

2 National health accounts- the past Popularized in the last decade; over 100 countries have done health accounts; including OECD member states In developing countries: USAID (up to the present), SIDA, EU and World Bank have been the major funders of health accounts. Some developing countries have started to fund yearly activties. Funding has also flowed for disease specific accounts like NASAs (AIDS), repro health, child health and malaria plus a few TB subaccounts; NCD subaccounts are starting to be done as well. Most of these are being funded by donors interested in those specific areas Health accounts have been undertaken mostly as projects or "rounds"; estimates were not being updated yearly; Health accounts are done by national health accountants, mostly situated in the department of planning in MOHs; some are in national statistics offices 2 Resource tracking using single platform 02 September 2013

3 Background SHA 1.0, OECD, 2000 International Classification of Health Accounts (ICHA) Producer's Guide, WHO, WB, USAID, 2003 Guide NHA estimations in the developing countries SHA 2011, WHO, OECD, EUROSTAT, 2011 Based on SHA1.0 Greater importance given to policy relevance, feasibility and sustainability 3 Resource tracking using single platform 02 September 2013

4 Health accounting new generation Then Health accounting (SHA 1.0) Health expenditures only Project approach T-(2+) "rounds" NHA launch and report Now Health Accounting and policy analysis (SHA 2011) Health expenditures, more disaggregation (disease, inputs) and links with other data (macroeconomy and health) Routine production T-1 Time trend analysis Annual Health Sector review and report; link to budget 4 Resource tracking using single platform 02 September 2013

5 Multiple global initiatives with resource tracking elements; Commission on Information and Accountability for Women's and Children's health Counterpart financing tracking for GFATM Family Planning 20/20 Decade of Vaccines UN commission on life saving commodities for women and children Universal health coverage 5 Resource tracking using single platform 02 September 2013

6 Types of beneficiary expenditures 1. Earmarked expenditures (e.g. TB control programme spending, drugs and specific commodities) 2. Directly allocatable % of shared expenditures mostly at level of individual provision of care (OP,IP) Sometimes at population level provision of care (spraying programmesfor malaria or dengue in asian countries?) Residual, to be labelled as others 3. Non-directly allocatable % of shared expenditures E.g. administrative bureaucracy of MOH or health insurance (HC7) May use same attributable share as above, if deemed appropriate Total beneficiary expenditures may be reported as or 1+2 ; policy implications particularly per capita 6

7 1. Earmarked Expenditures Earmarked expenditures can be identified by: Financing revenue/scheme/agent: Project funding (e.g. GFATM, PMI, PEPFAR, GAVI, UNFPA, UNAIDS) Type of provider: e.g. specialized hospitals or centers (psychiatric hospitals or dialysis centers) Type of resource input: Drugs (e.g. anti-retroviral treatment, malaria, family planning supplies) Supplies (insecticide treated nets, diagnostic tests) Equipment (if identifiable; e.g. home based blood glucose monitoring) Type of Function Prevention (disease control programme staff or project management staff) 7

8 2. Directly allocatable % of shared expenditures Need to determine basis (keys) for allocation Best to allocate all (not just to HIV and others, or malaria and others, or repro health and others) Information is already there; marginal effort; but more informative with regard to allocative efficiency issues More technically rigorous; exhaustive allocation means that the same allocation basis is being used, and all expenditures are being allocated to one category alone. Ensures that the sum is 100% 8

9 Top down approach example Disease Attributable Fraction calculated by utilization only Number of outpatient visits Disease A at Total number of outpatient visits at Number of outpatient visits Disease B at Total number of outpatient visits at Number of outpatient visits Disease C at Total number of outpatient visits at X X X Total OP expenditure at given provider = Total OP expenditure at given provider = Total OP expenditure at given provider = Disease A expenditures at Disease B expenditures at Disease C expenditures at Etc. Sum above = Total expenditures at given provider. Illustrative example- using UTILIZATION for the fraction 9