Universal Health coverage and health accounts

Tessa Tan-Torres Edejer

WHO/HIS/HGF/CEP

tantorrest@who.int

Disclaimer: The views expressed in this paper/presentation are the views of the author and do not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. Terminology used may not necessarily be consistent with ADB official terms

Possible overall goal and equity

Overall goal Proposed target specifics Indicator

Ensure healthy lives and promote wellbeing for all at all ages

Increase (healthy) life expectancy by: 6 years in developing and 2 years in developed countries (including 40% reduction in deaths before age 70)

Life expectancy at birth (N of deaths under 70)

Equity

Reduce the gap between poorest population (20%/40%) and the whole population

Increase life expectancy for the poorest by an additional two years over the national increase

Reduce mortality before age 70 by 50% among the poorest compared to 40% overall

Overall goal Proposed target specifics Indicator 1 Reduce the global maternal mortality ratio to less than 70 per 100,000 live births

Reduce the global MMR to less than 70 and no country to have MMR above 140

Maternal deaths per 100,000 live births

2 End preventable newborn and under-5 child deaths;

All countries to reduce under-5 mortality to 25/1,000 or less Under-five mortality per 1,000 live births

All countries reduce neonatal mortality to 12/1,000 or less Neonatal mortality per 1,000 live births

3 End the epidemics of AIDS, TB, malaria and NTD

HIV

90% reduction in new adult HIV infections, including among key populations Zero new infections among children 90% reduction in AIDS-related deaths

HIV incidence rate per 100 adult person years / per 100 children person years HIV deaths per 100,000 population

TB 80% reduction in tuberculosis incidence rate (< 20 cases per 100,000 population) 90% reduction in tuberculosis deaths

TB incidence per 1000 person years TB deaths per 100,000 population

Malaria 90% reduction in global malaria case incidence 90% reduction in global malaria mortality rate

Malaria incident cases per 1000 person years Malaria deaths per 100,000 population

Neglected Tropical Diseases No targets for 2030 at present 3 And Combat hepatitis, water-borne diseases and other communicable diseases

90% reduction in hepatitis B and C incidence rate Hepatitis B antibody prevalence in children under 5 years

Water-borne diseases Other communicable diseases Presence of IHR core capacities for surveillance

and response 4 Reduce premature mortality from NCDs through prevention and treatment and promote mental health and wellbeing

One-third reduction of premature mortality from NCD Probability of dying of cardiovascular disease, cancer, chronic respiratory disease or diabetes at ages 30-70

10% reduction in suicide-related mortality Suicide-related mortality per 100,000 population

5 Strengthen prevention and treatment of substance abuse, including narcotic drug use and harmful use of alcohol

10% reduction of alcohol per capita consumption Alcohol per capita consumption

6 Reduce deaths and injuries due to road traffic accidents

Halve the number of global traffic deaths (from 1.2 million to 600,000)

Number of deaths due to road traffic accidents

7 Ensure universal access to sexual and reproductive health-care services

Ensure universal access to sexual and reproductive health care services

Demand met for modern contraceptives (>75%) Antenatal care use (4+ visits) (>80%) Skilled birth attendance (>90%)

8 Achieve UHC All populations, independent of household income, expenditure or wealth, place of residence or sex, have at a minimum 80% essential health services coverage Everyone has 100% financial protection from out-of-pocket payments for health services

Coverage with a set of tracer interventions for prevention and treatment services** % population protected against impoverishment by out-of-pocket health expenditures, % of households protected from incurring catastrophic out-of-pocket health expenditure.

Universal Health Coverage

Universal Health Coverage is defined as

ensuring that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while ensuring that the use of these service does not expose other user to financial hardship. (WHO)

Millions miss out on needed health services

Millions suffer financial ruin when they use health services

When people use health services:

Globally around 150 million suffer severe financial hardship each year

100 million are pushed into poverty because they must pay out-of-pocket at the time they receive

them.

Health expenditures and SDG/UHC: catastrophic/impoverishing health expenditures

OOPs and GGHE

Total Health Expenditure (THE) Total expenditure on health as a percentage of gross domestic product (%): 2012 (WHO Global Health Observatory)

• East Asian countries (China, Korea, Japan): have a THE that is more than 5% of

GDP • Indonesia, Myanmar &

Pakistan have the lowest THE as percentage of GDP

• Developing countries in Asia generally spends less at <5% of GDP

Two caveats

• Per capita values vs %

• Distribution

Per capita vs normative 86 US$

Why is this health expenditure tracking (health accounts) important?

• Because it answers questions on

– FINANCIAL LEVELS:

– How much is being spent on health

• THE as a proportion of GDP (share in macroeconomy)

• GGHE/GGE

• GGHE as a proportion of GDP

• OOP/THE, catastrophic/improverishing

• Per capita (normative)

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

who produces health accounts?

• health accounts (HA) = typically produced by a multidisciplinary team (ministry of health, ministry of finance, central statistical office)

• usually housed within the Department of Planning of the Ministry of Health

• often produced by a core team of 1-2 health accountants, typically statisticians and/or economists, supported by a larger non-core team

• the work is to collect data (from records + surveys) to track all expenditures on health and reproduce financial flows

69.50 USD/capita

Lessons learned

• On availability and use of data – UPDATED: Financial data that is T-2 or more years is not valued by policy makers; they prefer

the most recent data on expenditures – ROUTINE: More information is provided with trend analysis for expenditures – More DISAGGREGATION provides more policy relevant info and increases demand (by disease,

by inputs e.g. pharma, HR, by geography for decentralized countries) – INCREASE USE of data will improve quality of data through feedback

• On measurement/quality issues: – Greatest weakness is data from the private sector, including providers – "accurate" out-of pocket expenditures are difficult to obtain; known biases in household

surveys due to recall, number of questions or prompts, single respondent, etc. Need to triangulate with other sources

– Need better methods of estimation; especially with demands for more disaggregation on classifications

• On production of data (operational): – Constant turnover of trained staff – Multiple, inefficient initiatives to collect expenditure data; less rigorous, standardized; double

counting.

2030: desirable systems

• Goal by 2030 – production of regular, (annual) standardized (SHA2011), comprehensive (public/private) and

up-to-date (T-1) information on health expenditures – Use of health expenditure information by different audiences together with other health data

by different audiences Continuing strategies: -invest in and maximize use of IT , single platform (automation, linkage of budgets with expenditures, centralization, analysis and documentation and dissemination) -standardize production through training and documentation - Provide incentives for private sector reporting -educate users and link to other health data Short-medium term work: --technical work to improve quality of collecting/estimating HH health and total expenditures -technical work to improve estimation for further disaggregation

Key messages:

• Advocacy: UHC /financial protection/post 2015 SDGs: – Large OOPs at 60% of THE – Very few Asian countries spend >5% government health

expenditures/GDP – There is fiscal space for increasing spending in health in

countries

• Technical support: – Health accounts illustrate the health sector in terms of

funding flows and patterns of spending – Health accounts can be the starting point for discussions

on fiscal space for health and financial protection, efficiency, sustainability, equity.

WHO GHED - http://who.int/health-

accounts/en/

Thank you!