 ...To Understand Patterns of Spending
Health accounts, if conducted on annual basis over a period of
several years, are invaluable in helping to understand the impact of
specific policies on the health care system. Presented below
are examples of how health accounts, by allowing policy-makers to
follow patterns of expenditures, goods and services production and
utilization over time, and to compare them to achieved health outcome and health care access
indicators, can contribute to the formulation of truly effective
policies.
Health Finance Reforms
Financing
is a critical factor in the realization of a viable health system.
It is the mechanism
by which plans and policies are translated into action through the
allocation of
resources.
Health financing reforms include changes in revenue
collection, involving the
concept of pooling,
and reforms in the purchasing of health services. Following the impact of these reforms on health
expenditure indicators over the
years would
reveal whether they had the intended effect, and which population
and provider groups they impacted the most.
Health
finance reforms have largely been driven by a desire to improve access to
healthcare,
advance equity in health service provision and promote the use of
cost-effective technologies
in order to obtain the best possible health outcomes for populations.
However,
such reforms have also been seen by governments as a means of controlling the
costs of health care and of spreading them to other players, especially
the users of
services.
According to the WHO, in planning health system
reforms policy-makers
and health planners should address the following key questions:
- How can sufficient funds be mobilized to finance health services and
the required infrastructure?
- How can those funds be allocated and how can the delivery of health
care
be organized so that defined needs and priorities are addressed?
- How can the cost of care be controlled?
For example, in Colombia health
accounts indicators helped determine if the health system's per
capita spending level established by the planners could be
sustained, given the resources available and expenditures incurred,
based on a 4-year trend between 1997 and 2000.
Health accounts indicators are
used to provide a measure of progress of health finance reforms.
Some of the common indicators are:
-
social spending
-
national expenditure on health
-
coverage of health services
-
production and use of health services
-
intermediate and final consumption of health services and
pharmaceutical products
-
gross capital formation
-
exports and imports
-
gross value of production
-
value added of health care services industries
-
employment
The
steps that might be taken to reform health financing at a sub-national
level (municipal, institution, province), are as follows:
-
Understand the broad health care financing context.
-
Map the health system in order to understand the
level of current resources and how they are used.
-
Develop the resource base for health services.
-
Allocate funds to address planning priorities.
-
Build budgets for management and accountability.
-
Purchase health services so as to optimize effectiveness
and efficiency.
-
Develop the infrastructure for the financing of
health care.
-
Use financing as a tool to change the delivery of health
services.
-
Re-examine
periodically the impact of financing changes on access to care,
quality of services, outcome indicators, and financial indicators.
Sub-Accounts for HIV/AIDS
As
of April 2004, National
HIV/AIDS accounts have been undertaken in 20 LAC countries with the support from SIDALAC,
a regional initiative on HIV/AIDS financed by the World Bank and
administered by FUNSALUD. They follow a methodology
integrating the OECD SHA and Harvard
NHA models (a PDF document in Spanish
and English
is available for download).
Since the countries
have followed the same methodology and have produced data for
roughly the same years, an informative international comparison of
spending patterns on HIV/AIDS in the region is possible. For
example, it has become clear that, although technical experts
recommended emphasis on purchasing preventive treatments, a bulk of
the expenditures is on curative care. In light of the
information provided by the national HIV/AIDS accounts, the observed
HIV/AIDS infection rates in specific countries may point to the
effectiveness to specific treatment approaches. A publication on
this topic is available at the SIDALAC webpage.
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