Does resource allocation meet policy priorities

1
Does resource allocation meet policy priorities?

• Tania Dmytraczenko, Ph.D.
• Patricia Hernandez, M.D., Ph.D.

2
Organization of the presentation

• Purpose
• Methodology
• Results
• Policy implications

3
Purpose

• To determine the redistributive nature of
  spending on health
• public, non insurance
• social health insurance
• private not-for-profit
• private for profit
• Identify areas for improvement

4
Tracking expenditures using the NHA methodology

• Describes and quantifies the flow of financial
  resources through the health system
• Public expenditures
• public treasury funds
• compulsory social insurance contributions
• external loans and grants
• Private expenditures
• out-of-pocket expenditures by households
• direct payments by firms
• expenditures through health insurance
• charitable contributions

sources ? financing agents ? providers ? uses ?
beneficiaries
5
Health spending in Ecuador
Source WHO World Health Report 2000
6
Approach

• Function of public expenditures
• Distribution
• geographic
• demographic
• income
• levels of care

7
Limited redistributive capacity
Public spending accounts for less than 1/2 of THE
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A situation that is unlikely to change in the
near future
Percent of public expenditures allocated to
health have declined steadily
Source Central Bank of Ecuador 1980 constant
US
9
Are public health funds being used to mitigate
differences in geographical access to care?
Health exp. by covered pop.
Provinces
Poorest
Richest
10
Are health funds being used to mitigate
differences in access to care by demographic
needs?
11
Are public health funds being used to mitigate
differences in access to care by income level?
Health expenditures (US millions)
12
Are MOH funds being used to mitigate differences
in access to levels of care?
Health expenditures (US millions)
13
Are social security funds being used to mitigate
differences in access to levels of care?
Health expenditures (US millions)
14
Conclusions