Embed Size (px)
Citation preview
Methods and findings of the OECD survey
of health budgeting practices
Camila Vammalle (GOV/BUD)
Fiscal Space, Public Finance Management and
Health Financing Meeting
Montreux, 10 December 2014
OECD Survey of budget officials on budgeting
practices for health
Novel and blunt tool
Prepared in April-July 2013
Answered by 27 OECD countries in September-December 2013
Workshop with budget officials in January 2014
Presented at annual meeting to both health and budget officials in April 2014
Synthesis included in coming publication
Structure of the survey
1. General Information
2. Projecting health expenditure
3. Decentralisation of health financing and expenditure
4. Decision making and assessment
5. Expenditure frameworks and ceilings on health expenditure
6. Revenues
7. Deficits
4
A great variety of different budgeting systems for health
National Health
Systems
Social Insurance Systems
Decentralised Systems
Decentralised, social insurance
systems
Decentralised, national health
systems
1. General information
5
Where do the funds for health care appear and who
decides on their allocation?
1. General information
Central government
budget? Social Security budget?
Social Insurance
Funds?
Sub-national government
budgets?
International donors’ agencies?
Health expenditure
Partly 69%
Fully 23%
No 8%
Is health expenditure part of the central government budget?
6
A great variety of different budgeting systems for health
1. General information
Allocation of the French budget (2014) – (Total spending = 367.9 b€)
Health: 1.3 b€
ONDAM (targeted
health spending)
2015 = 178.5 b€
7
Other questions in this section
1. General information
Years of estimates for health spending in the budget (range from 0 to 5)
Share of mandatory (entitlement) vs. discretionary spending in health
Does the budget allocation specify allocation (or ceilings)
by sub-category of health services? (hospitals, primary care, pharma, etc.)
By specific health objectives? (cancer, disability, etc.)
8
Additional information relevant for LMICs
1. General information
Share of the population covered by public health system
Objectives for population coverage
9
Questions from the survey
2. Projecting Health Expenditure
How many years do these LT projections cover? Mainly 31-50 years; Denmark: 100years
Which institution carries them out? Mostly MoH. MoF often involved.
What do they cover? Total health expenditure, public health expenditure,
private health expenditure, by age group, by categories of health
What are they used for? Influence public debate for difficult reforms rather
than year to year decision.
10
Coverage of LT health expenditure
projections
0
5
10
15
20
25
Public healthexpenditure
Categories ofhealth
expenditures
Expenditureby age groups
Total healthexpenditure
Private healthexpenditure
2. Projecting Health Expenditure
11
Possible additional questions for LMICs
2. Projecting Health Expenditure
Evaluation of cost of covering additional population? Projections of health financing under different coverage scenarios.
12
Questions from the survey
3. Decentralisation of health financing and expenditure
Share of SNGs in public health expenditure
How is it financed? General purpose grants, block grants for health,
earmarked grants for specific programmes, etc.
Ability of CG to vary these resources
Who monitors SNG spending on health and quality?
Stability and predictability of SNG revenues for health
Sources of revenues for financing SNG health expenditure
Source: OECD survey of budget officials on budgeting practices for health, 2013, Question 14 and 16
transfers from
CG 44% Own
revenues
42%
Transfers from
SS 14%
To a large extent 14%
To a moderate
extent 29%
To a small extent 36%
Resources can only be varied on a multy year
basis 21%
To what extent can the CG or SS vary total transfers for health from one year to the next?
3. Decentralisation of health financing and expenditure
Policy setting and control over SNG health care spending
Do CGs set targets for health spending by SNGs?
Source: OECD survey of budget officials on budgeting practices for health, 2013, Question 14
Do CGs monitor SNG performance on health spending?
Yes 60%
No 40%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Does CG establishperformance
targets for SNGs?
Does CG prescribeoutputs or
outcome measureson health for
SNGs?
Does CG requireSNGs to carry outvalue for money
analysis?
yes no
3. Decentralisation of health financing and expenditure
15
Timeliness of information
0 1 2 3 4 5 6
NetherlandsSwitzerland
FinlandAustria
Czech Rep.France
GermanyMexico
NorwayUK
AustraliaChile
DenmarkEstonia
HungaryNew Zealand
PolandSlovak Rep.
SloveniaKorea
(months) None 1 to 2 3 to 6 6 to 12 12 to 24
Delays in reporting expenditures
4. Decision making and assessment
16
Existence of a formal coordination body between the
MoF and MoH, and other institutions for coordination
4. Decision making and assessment
Source: OECD survey of budget officials on budgeting practices for health, 2013, Question 25
Yes 22%
Regular informal
consultation and meetings
29%
Ad hoc bodies
created for specific needs (discussing a reform, etc.)
4%
Consultation for budget
preparation only 30%
None 15%
17
Perceived co-ordination challenges?
0
5
10
15
20
25
Sharing of informationbetween the Ministry of
Health and the CBA
Lack of incentives forco-operation between
the CBA and theMinistry of Health
Lack of establishedrelationships betweenofficials from the CBA
and the Ministry ofHealth
Lack of capacity at theCBA to assess policies
proposed by theMinistry of Health
Is a major challenge Is somewhat of a challenge Is not a challenge
Source: OECD survey of budget officials on budgeting practices for health, 2013, Q. 26
4. Decision making and assessment
18
Top priority areas for health expenditure control
0 2 4 6 8 10 12 14 16 18
Outpatient care spending
Primary health care services
Spending on prevention programs
Long term care spending
Pharmaceutical costs
Hospital expenditure
Source: OECD survey of budget officials on budgeting practices for health, 2013, Q. 37
4. Decision making and assessment
19
Questions from the survey
4. Decision making and assessment
Functions of CBA in health expenditure
Costing of new health programmes?
Spending targets?
Existence and role of economic assessments of expected health benefits from new programmes?
New drugs vs. delisting
Automatic reductions in health expenditure
Performance agreements with MoH?
Spending reviews?
20
Questions from the survey
5. Expenditure frameworks and ceilings on health expenditure
Existence of specific ceilings on health expenditure
Factors influencing ceilings
Overruns/underspending
Early warning systems
21
Factors when establishing ceilings for health
0 2 4 6 8 10 12
value for money
promotion health vs socialprotection
Share health in total govspending
expenditure estimates
GDP growth
Objectives for fiscal position
most important factors second most important factors
5. Expenditure frameworks and ceilings on health expenditure
22
Overspending on health
0
1
2
3
4
5
6
7
8
Years out of last 7 without overspending
Years out of last 7 with overspending
Source: OECD survey of budget officials on budgeting practices for health, 2013, Q. 48
5. Expenditure frameworks and ceilings on health expenditure
23
Questions from the survey
6. Revenues
How are revenues for health identified? Specific social contributions for health
A share of total government revenues is earmarked for health
A shared of revenues from specific taxes/levies/duties is earmarked for health
Specific taxes/levies/duties are entirely appropriated to health
Which institution determines amount of revenues for health?
Who collects these revenues? Share of different revenue sources Could include question on revenues from
international aid
24
Questions from the survey
7. Deficits
Deficits/surpluses policy for SS agencies
Data on deficits since 2000 (if applicable)
Existence of a plan to reduce deficits?
Level of health debt? Plan to reduce it?
