Abt Associates Inc. In collaboration with:Broad Branch Associates | Development Alternatives Inc. (DAI) | Futures Institute | Johns Hopkins Bloomberg School of Public Health (JHSPH) | Results for Development Institute (R4D) | RTI International | Training Resources Group, Inc. (TRG)
Dr. Carlos Avila Senior Health Economist
Health Finance and Governance Project
Impact of Healthcare Costs on Universal Health Coverage: global perspective
NAMAF 8TH ANNUAL CONFERENCE22 SEPTEMBER 2014
WINDHOEK, NAMIBIA
Outline
Universal Health CoveragePopulation and UtilizationHealth Care Costs and FinancingPotential Solutions
What is the relationship between costs and UHC?
There is an unquestionable imperative to: Optimize the effectiveness of the investment in health systems Achieve Universal Health Coverage Provide Financial Risk Protection
Government health expenditure as a source Spending by governments on health as sourced domestically was $613.5
billion in 2011. This means that, on average, countries spent 20 times more of their own
resources on health than they received in assistance
UHC: “all people have access to services and do not suffer financial hardship paying for them”UHC: “all people have access to services and do not suffer
financial hardship paying for them”
HEALTH CARE UTILIZATION
Population and Utilization
DemographicsBurden of diseaseBehavioursAccess
Population Projections
Population Projections
The world's population pyramid is changing shape
The world's population map is changing shape, 2050
The 10 Leading Causes of DALY, Global, 2000 and 2012
No Causes of DALY, 2000 DALY(million)
% of DALY
No Causes of DALY, 2012 DALY(million)
% of DALY
1 Lower respiratory infections 208 7.3 1 Ischaemic heart disease 166 6.0
2 Diarrhoeal diseases 161 5.6 2 Lower respiratory infections 147 5.4
3 Ischaemic heart disease 142 5.0 3 Stroke 141 5.2
4 Stroke 125 4.4 4 Prematurity 107 3.9
5 Prematurity 123 4.3 5 Diarrhoeal diseases 100 3.6
6 Birth asphyxia and trauma 102 3.6 6 COPD 92 3.4
7 HIV/AIDS 102 3.5 7 HIV/AIDS 92 3.4
8 COPD 89 3.1 8 Road injury 79 2.9
9 Malaria 78 2.7 9 Depression 77 2.8
10 Road injury 69 2.4 10 Birth asphyxia and trauma 75 2.7
11 Depression 64 2.2
12 Malaria 55 2.0
Age-standardized Mortality Rates by Causeby WHO Region and World Bank Income Categories, 2000-2012
Population Density in 2015
Percentage of Adults with BMI >30
Years of Life Lost due to Obesity
“Sin-Taxes”: Sugars
Taxation of empty calories, such as sugar-sweetened beverages, can: reduce the prevalence of obesity and generate public revenue
Taxation on sugar-sweetened beverages does not hurt the poor
The main dietary problem in low-income groups is poor dietary quality rather than insufficient energy
HEALTH CARE COSTS AND FINANCING
Health Care Financing
Health Care Costs & FinancingCosts of ServicesMedical ProceduresDrugs and diagnosisHealth Financing
Health Care Inflation
New Technologies
Costs of hospital procedures
Health Care Consumption
Variation in the costs of pharmaceuticals
COST AND HEALTH OUTCOMES
Raising Cigarette Taxes Lowers Consumption
BRICS and Namibia: selected indicators
BRIC GDP per capita†
(2012)
THE as % GDP‡
(2012)
THE per capita‡
(2012)
OOP as % of THE‡
(2012)
Infant Mortality* ‡
(2012)
Maternal Mortality **
‡ (2013)
Brazil $11,437 9.3% $1,057 31% 13 69Russia $14,015 6.3% $887 34% 9 24India $1,514 4.1% $61 62% 44 190China $6,077 5.4% $322 34% 12 32Namibia $5,461 5.0% $445 37% 34 200
*IMR = infant mortality rate per 1000 births**MMR = annual number of female deaths per 100,000 live births†International Monetary Fund. 2014. World Economic Outlook. Washington, DC: IMF. ‡World Health Organization. 2013. Global Health Observatory: Data Repository.
Growth in domestic health spending in 43 countries, under economic growth and Abuja commitment, by source, 2000-2020
Current spending (2010) Projections based on economic growth (2020)
Projections based on economic growth and Abuja commitment (2020)
Per capita DHE US$ 76 Per capita DHE US$ 106 Per capita DHE US$ 146
DHE US$ 60 billion DHE US$ 127 billion DHE US$ 162 billion
Public sources $25 billion (36%)Private sources $16 billion (23%)Households $19 billion (28%)
Public sources $44 billion (34%)Private sources $30 billion (23%)Households $43 billion (33%)
Public sources $92 billion (53%)Private sources $30 billion (17%)Households $43 billion (25%)
DHE as % GDP 5.7% DHE as % GDP 6.0% DHE as % GDP 7.0%
SummaryHealth Financing Projections: SSA, 2020
Health spending trends in Namibia
Year THE (USD) PPH expenditures
(USD)
THE per capita (USD)
PPH expenditur
es per capita (USD)
2001-2002 573,678,397 21,347,339 291 11 2002-2003 609,908,768 21,434,273 304 11 2003-2004 643,437,184 22,637,811 315 11 2004-2005 704,681,307 57,425,350 339 28 2005-2006 843,152,390 84,194,214 398 40 2006-2007 923,770,410 133,545,320 428 62 2007-2008 947,877,271 142,087,036 431 65 2008-2009 997,145,409 139,997,707 445 62
Health spending by priority area, Namibia
2001-2002
2002-2003
2003-2004
2004-2005
2005-2006
2006-2007
2007-2008
2008-2009
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
71%
71%
71%
68%
65%
62%
54%
53%
7%
8%
8%
8%
7%
6%
11%
11%
4%
4%
4%
8%
10%
14%
15%
14%
13%
12%
12%
12%
12%
14%
10%
11%
4%
4%
4%
2%
3%
1%
6%
8%
2%
2%
2%
3%
3%
2%
3%
4%
Services for curative care
Medical goods dispensed to outpa-tients
Prevention and public health services
Health administration and health insurance
Capital formation and expenditures not specified by kind
Other
POTENTIAL SOLUTIONS
Health Care Costs
Why Health Care Costs Are High and Growing Rapidly?
How high health care Cost are threatening the economy?
What Can Be Done About Health Care Costs?
Potential solutions
Investing on behavior, literacy and prevention Client centered solutions Integration and efficiency Outsourcing Health Technology Assessment Risk pooling
Efficiency in US Hospitals
Increasing Resources and Improving Efficiency
Health Financing Platform
Effective Allocation
TechnicalEfficiency
Paying for Results
Better Money
More MoneyPublic Private
IncomeTaxes
Diaspora BondsConsumption
Taxes
Catalytic Investments
LotteriesSocial Bonds
CSR
MatchingPrograms Crowd
Funding
F4DPPPs
DebtSwaps
Road Map to UHC
Africa Rising
Abt Associates Inc. In collaboration with:Broad Branch Associates | Development Alternatives Inc. (DAI) | Futures Institute | Johns Hopkins Bloomberg School of Public Health (JHSPH) | Results for Development Institute (R4D) | RTI International | Training Resources Group, Inc. (TRG)
Thank you
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