Funding health care: The role of public and private and the role of the actuary

Size: px

Start display at page:

Download "Funding health care: The role of public and private and the role of the actuary"

Jeffery Atkins
7 years ago
Views:

1 Funding health care: The role of public and private and the role of the actuary Alva ro Castro-Gutiérrez and Giovanna Ferrara Sw itzerland In te r na tion a l He a lth Se m in a r 27th ICA, Cancun 2002

2 Contents 1. Organization and provision of health care: Outlook of principles and current issues 2. Financing and funding options 3. Current issues in health care financing 4. The role of the actuary 5. Actuarial expertise: two examples

3 1. Organization and provision of health care: Principles and issues Main objectives of a health care delivery system: ma inta in or improve the health status of the population Re spon sibilitie s for p roviding he a lth care: State and private involvement

inta in or improve the health status of the population Re spon

4 1. Organization and provision of health care: Principles and issues Ce n t r a l p r o b le m s: How to provide adequa te hea lth ca re to as many people as possible at a reasonable cost How to keep the financing of health ca re within the ca pa city of the na tiona l economy

to as many people as possible at a reasonable cost How to keep the

5 1. Organization and provision of health care: Principles and issues Organization and provision of health care is dependent on: Public interventions Personal health services preferences Availability of choice for the individual

dependent on: Public interventions Personal health

6 1. Organization and provision of health care: Principles and issues Almost all OECD countries have extended public health systems to the entire population More tha n 110 countries have sickness and maternity schemes for the working population

systems to the entire population More tha n 110 countries

7 2. Financing health services and funding options Public health services: Financed by governments Provided through governmentmandated systems

8 2. Financing health services and funding options Access to personal health care depends on (mechanisms) Degree of government financial involvement Social and private social insurance schemes NGO s Foreign donors Communities Families Individuals

government financial involvement Social and private social

9 2. Financing health services and funding options Ma in m e ch a n isms for h e a lth ca re fin a n cin g Ta xa t io n Insurance (private and social) Non-insurance funding systems = = > > Most countries use a combination of mechanisms

Insurance (private and social) Non-insurance funding

10 2. Financing health services and funding options Taxation instruments: Dire ct (e x. in com e ta x = > form a l sector) Indirect (ex. VAT = > consumers) Earmarked taxes Other government revenues

11 2. Financing health services and funding options In su ra n ce : Social health insurance Private health insurance Mixed Social/Private Other forms of health insurance

12 3. Current issues in health care financing The fundamental issues: Who is to finance? How a re providers to be paid? What benefits are to be financed?

13 3. Current issues in health care financing Who is to finance? Ta xp a ye rs? Employers? Private individuals? = => > Varying importance and roles of private insurances are confirmed in both % of persons insured and type of organization (mandatory or complementary)

= => > Varying importance and roles of private insurances are

14 3. Current issues in health care financing How a re the p rovid ers to be pa id? Two general principles: The hea lth ma rket ca nnot ma ximize the tota l utility of the overa ll resource allocation in a n economy but ca n be remedied throug h the ma rketiza tion of the h e a lth ca re se ctor via m icroe con om ic in ce n tive sfor providers and patients Regula tory controls ensure tha t the right a mount of medica l ca re is is consumed by the right people (by lim itin g th e sup p ly th roug h strict lice n sin g procedures)

but ca n be remedied throug h the ma rketiza tion of the h e a lth ca re se ctor via m icroe con om ic in ce n tive sfor providers

15 3. Current issues in health care financing = =>> The two issues are to be placed in the context of questions such as: Are cost-savings to be expected from fee for service ca pita tion of fee per ca se? Is hospital budgeting more efficient than fee per ca se? Are providers to be paid directly by beneficiaries or through third pa rties? =>

16 3. Current issues in health care financing = =>> The two issues are to be placed in the context of questions such as: Limita tions to free choice of doctors a nd hospita ls? Managed Care and managed competition can lead to cost reductions without loss of quality? HMO patients can regularly benefit from medical advances and not just to be treated according to standard practices?

Managed Care and managed competition can lead to cost reductions without loss of quality?

17 3. Current issues in health care financing What benefits are to be financed? Ba sic q u e stio n : Th e e xte n t of re im b ursa b le se rvice s The extent of reimbursement by mandatory and complementary schemes Criteria for the choice of trea tment a ccording to the list of benefits Cost transfers to patients by way of user fees? Increases in expenditure to allow population to b e n e fit from me d ica l p rog re ss? Preventive measures to be financed to avoid longterm costs?

complementary schemes Criteria for the choice of trea tment a ccording to the list of benefits Cost transfers to

18 4. The role of the actuary The main question of policy makers: How much? How much the existing system cost? Aggregate cost of increasing doctors fees by x? Savings by increasing co-payment by y? Redistribution (between government, employers and employees) of future financial burden of introducing a national health service

Aggregate cost of increasing doctors fees by x?

19 4. The role of the actuary Role of actuaries and health economists (a bit of history) Private health insurance => actuaries Social health insurance => actuaries (ILO) Na tiona l hea lth services = > hea lth economists (WHO) Health reform = > Health economists (WB and IMF)

health insurance => actuaries (ILO) Na tiona l hea lth services = >

20 4. The role of the actuary Ma in a re a s of a ctu a ria l in vo lve me n t in he a lth ca re include: Income protection insurance Priva te m e d ica l in sura n ce Critica l illne ss cove r Long-term care insurance Underwriting and genetics

21 5. Actuarial expertise: Two examples Field experiences: Morocco Tunisia

22 5. Actuarial expertise: New problems from the field Diferent (very different) realities between industrialized and developing countries for the provision of health care Micro-insurance programmes? Small voluntary schemes

23 2. Financing health services and funding options Non insurance funding: User fee s Medical sa vings accounts

1.- L a m e j o r o p c ió n e s c l o na r e l d i s co ( s e e x p li c a r á d es p u é s ).

1.- L a m e j o r o p c ió n e s c l o na r e l d i s co ( s e e x p li c a r á d es p u é s ). PROCEDIMIENTO DE RECUPERACION Y COPIAS DE SEGURIDAD DEL CORTAFUEGOS LINUX P ar a p od e r re c u p e ra r nu e s t r o c o rt a f u e go s an t e un d es a s t r e ( r ot u r a d e l di s c o o d e l a