Jui-fen Rachel Lu Chang Gung University, Taiwan Equitap Meeting June 30-July 01, 2011 Email: rachel@mail.cgu.edu.tw
Agenda Current project status Preliminary results Results for Equitap 2 Comparative results for Equitap 1 vs 2 2
Partners Countries covered in the catastrophic payments /medical impoverishment analyses No Equitap 2 Equitap 1 World Bank income group 1 Bangladesh Low 2 Cambodia Low 3 Kyrgyz Rep. Low 4 Laos Low 5 Nepal Low 6 Solomon Islands Low 7 China Lower middle 8 India Lower middle 9 Indonesia Lower middle 10 Maldives Lower middle 11 Mongolia Lower middle 12 Pakistan Lower middle 13 Philippines Lower middle 14 Sri Lanka Lower middle 15 Thailand Lower middle 16 Timor Leste Lower middle 17 Vietnam Lower middle 18 Malaysia Upper middle 19 Fiji Upper middle 20 Hong Kong SAR High 21 Japan High 22 South Korea High 23 Taiwan High Note: Income group: Economies are divided according to 2009 GNI per capita, calculated using the World Bank Atlas method. 4
Results submission status for catastrophic payment & impoverishment analyses No. Territories Catastrophic payment Impoverishment T-SC Table-1 Table-2 Table-3 Table-4 Table-5 Table-6 Table-7 Table-8 Pen Parade 1 Bangladesh 2 Cambodia 3 China (Gansu) China (Heilongjiang) 4 Fiji 5 Hong Kong SAR 6 India 7 Indonesia 8 Japan 9 Korea 10 Kyrgyz Rep. 11 Lao PDR Note: Results complete Results need revisions Not yet received templates received before Aug.10, 2010 5
Result submission status for catastrophic payment & impoverishment analyses No. Territories Catastrophic payment Impoverishment T-SC Table-1 Table-2 Table-3 Table-4 Table-5 Table-6 Table-7 Table-8 Pen Parade 12 Malaysia 13 Maldives 14 Mongolia 15 Nepal 16 Pakistan 17 Philippines 18 Solomon Island 19 Sri Lanka 20 Taiwan 21 Thailand 22 Timor Leste 23 Vietnam Note: Results complete Results need revisions Not yet received templates received before Aug.10, 2010 6
Demographic and economic indicators, 2007 No. Territories Population size (million) GDP per capita (US$ PPP exchange rates) Economic indicators TEH as % of GDP TEH per capita (US$ PPP exchange rates) 1 Bangladesh - - - - 2 Cambodia 14.32 1,833 5.94% 108.05 3 China (Gansu) 26.17 4,903 5.45% 267 China (Heilongjiang) 38.24 8,767 4.89% 429 4 Fiji 0.84 3,738 4.23% 158 5 Hong Kong SAR 6.93 42,353 4.8% 2069 6 India 1,138 2,800 - - 7 Indonesia 224.67 3,734 2.2% 44 8 Japan 1.28 34,800 8.10% 2300 9 Korea 48.46 26,574 6.30% 1685 10 Kyrgyz Rep. - - - - 11 Lao PDR 6.09 714 4% 27 8
Demographic and economic indicators, 2007 No. Territories Population size (million) GDP per capita (US$ PPP exchange rates) Economic indicators TEH as % of GDP TEH per capita (US$ PPP exchange rates) 12 Malaysia 27.17 13,509 4.4% 604 13 Maldives 3.05 4,740 - - 14 Mongolia 2.64 803 4.3% 138 15 Nepal 26.40 383 - - 16 Pakistan 161 2,500 2% 51 17 Philippines - - - - 18 Solomon Island - - - - 19 Sri Lanka 20 4,244 4.2% 156 20 Taiwan 22.96 17,507 6.16% 1056 21 Thailand - - - - 22 Timor Leste 1.015 *year:2006 2,103 13.6% 286 23 Vietnam 85.16 2,599 6.21% 161 9
TEH as % of GDP, 2007 10
GDP per capita, 2007 (US$ PPP exchange rates) 11
TEH per capita, 2007 (US$ PPP exchange rates) 12
Infant mortality rate, 2007 13
Financing mix, 2007 14
OOP payment share (%) for health care 15
Licensed practitioners, 2007 16
Acute beds per 1,000 population, 2007 17
Types of services for which user charges are levied under SHI No. Territories 1 Bangladesh Hospital care Primary care Prescribed Inpt. Outpt. Med. Visits Med. med. Dental care Diagnostic tests Family planning services Vac. and immun. Other (Specify) 2 Cambodia Med. certificate 3 China (Gansu) China (Heilongjiang) 4 Fiji 5 Hong Kong SAR Including drugs 6 India 7 Indonesia 8 Japan Health checkup 9 Korea 10 Kyrgyz Rep. 11 Lao PDR Note: Inpt.: Inpatient; Outpt.: Outpatient; Med.: Medicine; Vac.: Vaccinations; Immun.: Immunizations 18
Types of services for which user charges are levied under SHI No. Territories Hospital care Primary care Prescribed Inpt. Outpt. Med. Visits Med. med. Dental care Diagnostic tests Family planning services Vac. and immun. Other (Specify) 12 Malaysia 13 Maldives 14 Mongolia 15 Nepal 16 Pakistan 17 Philippines 18 Solomon Islands 19 Sri Lanka 20 Taiwan 21 Thailand 22 Timor Leste 23 Vietnam Copayment for service exceeding Note: Inpt.: Inpatient; Outpt.: Outpatient; Med.: Medicine; Vac.: Vaccinations; Immun.: Immunizations 19
Services exempt from charges No. Territories 1 Bangladesh Hospital care Primary care Prescribed Inpt. Outpt. Med. Visits Med. med. Dental care Diagnostic tests Family planning services 2 Cambodia 3 China (Gansu) China (Heilongjiang) 4 Fiji 5 Hong Kong SAR Vac. and immun. Other (Specify) TB/leprosy treatment; Medicine 6 India 7 Indonesia 8 Japan Health/prenatal checkup 9 Korea 10 Kyrgyz Rep. 11 Lao PDR Children are free in health centers Note: Inpt.: Inpatient; Outpt.: Outpatient; Med.: Medicine; Vac.: Vaccinations; Immun.: Immunizations 20
Services exempt from charges No. Territories Hospital care Primary care Prescribed Inpt. Outpt. Med. Visits Med. med. Dental care Diagnostic tests Family planning services 12 Malaysia 13 Maldives 14 Mongolia Vac. and immun. Other (Specify) Pre/postnatal; Outpatient and Dental for special groups 15 Nepal 16 Pakistan 17 Philippines 18 Solomon Islands 19 Sri Lanka 20 Taiwan No fully funded 21 Thailand 22 Timor Leste 23 Vietnam Note: Inpt.: Inpatient; Outpt.: Outpatient; Med.: Medicine; Vac.: Vaccinations; Immun.: Immunizations TB/leprosy treatment; school health basic care 21
Description of surveys No. Territories Survey Year Survey institution Response rate Sample size 1 Bangladesh 2 Cambodia Cambodia Socio-Economic Survey 2007 National Institute of Statistics(NIS),, 99.78% 3,592 (CSES) Ministry of Planning 3 China (Gansu) HHIS 2008 Department of Health in Gansu N/A 3,158 China (Heilongjiang) HHIS 2008 Department of Health in Heilongjiang N/A 5,531 4 Fiji 2008-09 Household Income and 2008-Sep Fiji Islands Bureau of Statistics >80% 3,573 Expenditure Survey 5 Hong Kong SAR Household Expenditure Survey 2004/05 Census & Statistics Department 81% + 93% 7,675 6 India Consumer Expenditure Surveys 2004/05 National Sample Survey Organization 98% 124,644 (CES) 7 Indonesia Social Economic Survey 2007 National/Central Board of Statistic N/A 285,186 8 Japan National survey of family income and 2004 Bureau of Statistics, Ministry of Internal N/A 54,374 expenditure Affairs and Communications 9 Korea HIES 2008 National Statistical Office 80% 67,691 10 Kyrgyz Rep. 11 Lao PDR Lao Expenditure and Consumption Survey (LECS III) 2002/03 National Statistics Center 99.90% 8,100 22
Description of surveys No. Territories Survey Year Survey institution Response rate Sample size 12 Malaysia Household Expenditure Survey 2004/05 Department of Statistics, Malaysia 69% 14,084 13 Maldives Vulnerability and Poverty 2004 Ministry of Planning And National 97.78% 2,728 Assessment II Development 14 Mongolia Household Socio-Economic Survey 2007/08 National Statistics Office 99% 11,172 (HSES) 15 Nepal Nepal living standard Survey (NLSS) 2003/04 Central bureau of statistics 96.80% 3,912 16 Pakistan Houshold Integrated Economic Survey 17 Philippines 2004/05 Federal Bureau of Statistics 14,788 18 Solomon Islands 19 Sri Lanka The Consumer Finances and Socio Economic Survey 20 Taiwan The Survey of Family Income and Expenditure (HHS) 21 Thailand 22 Timor Leste Poverty assessment project: Timor Leste survey of living standards 2006 23 Vietnam Vietnam Household Living Standards Survey 2003/04 Central Bank of Sri Lanka 99.60% 11,722 1991-2008 Direct-General of Budget, Accounting and Statistics, Executive Yuan, R.O.C 100% 13,776 2006 100% (83.2% of the originally selected) 2006 Vietnam General Statistics Office 100% 9,189 23
Description of survey design No. Territories Survey design Weights 1 Bangladesh 2 Cambodia Stratified sampling of 37 strata in urban and rural areas of the 21 provinces in Cambodia 3 China (Gansu) Stratified, cluster sample China Stratified, cluster sample (Heilongjiang) 4 Fiji A 2-stage sampling strategy. In the 1st stage the frame was divided into 7 strata from which samples of urban and rural enumeration areas were selected. 5 Hong Kong SAR Stratified sample Household weight and person weight Household weights calculated and provided. 6 India Two-stage Stratified Ramdom Sampling 7 Indonesia Stratified sampling self-weighted 8 Japan Stratified, cluster sample. Weights applied. Weight in the data set represents the number of households represented by the sampled household. These were multiplied by HH size to get population weights. 9 Korea Stratified, cluster sampling Yes 10 Kyrgyz Rep. 11 Lao PDR Two stage stratified random sampling, clusters sample and weight applied Yes, The selected households were with "access to road" and "no access to road" for unbiased estimated 24
Description of survey design No. Territories Survey design Weights 12 Malaysia Multi-staged stratified Weights used to inflate the sample to total population in country. Weights were provided by the statistical agency and had been adjusted for non-response. 13 Maldives Stratified random sample 14 Mongolia Stratified sampling Weight in the data set represents the number of households represented by the sampled household. 15 Nepal Two-stage stratified 16 Pakistan Two-stage stratified Sampling 17 Philippines 18 Solomon Island 19 Sri Lanka Two-stage stratified sample 20 Taiwan Stratified 2-Stage Random Sampling is used. 0.2% of all households are to be chosen as samples. 21 Thailand Weight in the data set represents the number of households represented by the sampled household. These were multiplied by HH size to get population weights. 22 Timor Leste The sample design called for replacing households with other pre-selected households if the household is unavailable or unwilling to respond yielding a 100% response rate. 23 Vietnam Stratified, cluster sample. Weights applied. Weight in the data set represents the number of households represented by the sampled household. These were multiplied by HH size to get population weights. 25
Definitions and measures of living standards No. Territories Concept Food expenditures Period 1 Bangladesh 2 Cambodia Consumption Food diary 7 days 3 China (Gansu) Expenditure Regular food items over 12 months, both purchased and home-produced 1 year China (Heilongjiang) Expenditure Regular food items over 12 months, both purchased and home-produced 1 year 4 Fiji Consumption Over 100 food categories, included food purchased, food self-produced, and food 7 day recall period received in kind. 5 Hong Kong SAR Expenditure Reported 1 month 6 India Consumption, Food expenditures have been identified on the basis of expenditure incurred during 30 days for all items of Expenditure the last one month of the survey on approximately 125 food items including direct expenditures purchase and imputed value of home grown produce. 7 Indonesia Expenditure Reported 1 month 8 Japan Consumption Account book on each item of food bought by the household during the survey period 9 Korea Expenditure Reported 1 month 10 Kyrgyz Rep. 2 months for single household, 3 month for household equal to or larger than 2 11 Lao PDR Consumption, Expenditure Yes 1 month 26
Definitions and measures of living standards No. Territories Concept Food expenditures Period 12 Malaysia Consumption Expenditures for over 350 food items collected HH consumption calculated for 1 year. 13 Maldives Household food consumption expenditure by item (Expenditure Diary) 1 month consumption 14 Mongolia Consumption, The survey records information on food consumption at the household level for 122 1 month expenditure items, organized in 13 categories: flour, and flour products; meat and meat products; fish and seafood; milk, cheese and eggs; oils and fat; fruits; vegetables; sugar and jam; other food; tea and coffee; mineral water and soft drinks; alcoholic beverages; and tobacco and cigarettes 15 Nepal Consumption Including home production 1 year 16 Pakistan Expenditure Consumption expenditure of the HH on food items (Paid and Consumed, unpaid and consumed) 17 Philippines fortnightly (once 2 weeks) 18 Solomon Islands 19 Sri Lanka Household Expenditures for about 200 items of food. consumption. 20 Taiwan Expenditure major food items (rice, wheat, food grains other than rice and wheat), meat, seafood, fresh produce, eggs, dairy product (milk, butter etc) 21 Thailand 22 Timor Leste Consumption Over 100 food categories, included food purchased, food self-produced, and food received in kind 23 Vietnam Consumption 24 holiday items, 57 regular food items over 12 months, both purchased and homeproduced Spending Unit consumption calculated for the past year. 1 year 7 day recall period 1 year 27
Definitions and measures of OOP payments No. Territories Inpt. Outpt. Drugs Med. supplies Travel cost Other 1 Bangladesh 2 Cambodia Other medical services 3 China (Gansu) China (Heilongjiang) 4 Fiji 5 Hong Kong SAR 6 India Immunisation 7 Indonesia 8 Japan 9 Korea Dental 10 Kyrgyz Rep. 11 Lao PDR Self-medication including payment of consultation fees, medicines, tests, imaging, not including transport, gifts, hired caregivers Self-medication including payment of consultation fees, medicines, tests, imaging, not including transport, gifts, hired caregivers Traditional Chinese Medicine, dental, health supplement and other health care payments Dental, payment of consultation fees, medicines, tests, imaging, medical devices. Note: Inpt.: Inpatient; Outpt.: Outpatient; Med.: Medicine 28
Definitions and measures of OOP payments No. Territories Inpt. Outpt. Drugs Med. supplies Travel cost 12 Malaysia Dental Other 13 Maldives 14 Mongolia 15 Nepal Fees (western and traditional) 16 Pakistan 17 Philippines 18 Solomon Islands Dental/optical care and all other expenses on healthcare not classified elsewhere. 19 Sri Lanka Spectacles, dental, homeopathy, acupuncture, charms and others 20 Taiwan 21 Thailand Nursing home, home care, diagnostic testing, alternative medicines, private personal accident and health insurance premiums. 22 Timor Leste 23 Vietnam Self-medication including payment of consultation fees, medicines, tests, imaging, transport, gifts, medical devices, hired caregivers Note: Inpt.: Inpatient; Outpt.: Outpatient; Med.: Medicine 29
OOP payment share (%) for health care 30
OOP payments for health care as % of total household consumption/expenditure - exclude travel costs 31
OOP payments for health care as % of total household consumption/expenditure - exclude travel costs 32
OOP payments for health care as % of total household consumption/expenditure - exclude travel costs 33
OOP payments for health care as % of household non-food consumption/expenditure - exclude travel costs 34
OOP payments for health care as % of household non-food consumption/expenditure - exclude travel costs 35
OOP payments for health care as % of household non-food consumption/expenditure - exclude travel costs 36
OOP payments for health care as % of household non-food consumption/expenditure - exclude travel costs 37
OOP payments for health care as % of total household consumption/expenditure - include travel costs 38
OOP payments for health care as % of household non-food consumption/expenditure - include travel costs 39
Distribution of households by OOP payments as % of total household consumption / expenditure 40
Distribution of households by OOP payments as % of household non-food consumption / expenditure 41
Incidence and CI of catastrophic headcount z=10% (total expenditures) CI 42
Intensity and CI of catastrophic payment overshoot, z=10% (total expenditures) CI 43
Incidence and CI of catastrophic headcount z=25% (non-food expenditures) CI 44
Intensity and CI of catastrophic payment overshoot, z=25% (non-food expenditures) CI 45
Incidence and CI of catastrophic headcount (inc travel costs), z=10% (total expenditures) CI 46
Incidence and CI of catastrophic overshoot (inc travel costs), z=10% (total expenditures) CI 47
Incidence and CI of catastrophic headcount (inc travel costs), z=25% (non-food expenditures) CI 48
Incidence and CI of catastrophic overshoot (inc travel costs), z=25% (non-food expenditures) CI 49
Issues Non-separation of inpatient and outpatient exp data Cambodia, China, Japan, Lao PDR, Malaysia, Maldives, Mongolia, Nepal, Timor Leste Travel cost Can not be separated: Cambodia, Mongolia, Viet Nam Can be separated: Maldives, Nepal Fiji Table 5: OOP excluding travel cost Table 7: OOP including travel cost 50
Issues Major health reforms? 51
Comparative results Equitap 1 vs 2
Catastrophic headcount, z=10% (total exp) 53
CI of catastrophic headcount, z=10% (total exp). 54
Catastrophic payment overshoot, z=10% (total exp) 55
CI of catastrophic payment overshoot, z=10% (total exp) 56
Catastrophic headcount z=25% (non-food exp) 57
CI of catastrophic headcount z=25% (non-food exp) 58
Catastrophic payment overshoot z=25% (non-food exp) 59
CI of catastrophic payment overshoot z=25% (non-food exp) 60
Catastrophic headcount against OOP financing share (OOP>25% of non-food exp.) % hhs. OOP > 25% of non-food exp. OOP as % of total health expenditure 61