DELSA/GOV 3rd Health meeting - Gijs VAN DER VLUGT, Camila VAMMALLE, Claudia HULBERT
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This presentation by Gijs VAN DER VLUGT, Camila VAMMALLE and Claudia HULBERT was made at the 3rd Joint DELSA/GOV Health Meeting, Paris 24-25 April 2014. Find out more at www.oecd.org/gov/budgeting/3rdmeetingdelsagovnetworkfiscalsustainabilityofhealthsystems2014.htm
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DELSA/GOV 3rd Health meeting - Gijs VAN DER VLUGT, Camila VAMMALLE, Claudia HULBERT
- 1. BUDGETING PRACTICES FOR HEALTH Gijs Van der Vlugt (Dutch Ministry of Finance) Camila Vammalle (OECD) Claudia Hulbert (Consultant) 3rd Meeting of the Joint Network on Fiscal Sustainability of Health Systems OECD Conference Center, 24-25 April, Paris
- 2. Country respondents Answers for 27 countries Provincial answers (Canada) Australia Austria Canada Chile Czech Republic Denmark Estonia Finland France Germany Hungary Iceland Italy Japan Korea Mexico Netherlands New Zealand Norway Poland Portugal Slovak Republic Slovenia Sweden Switzerland Turkey United Kingdom British Columbia Manitoba Northwest Territories Sakatchewan Quebec Yukon
- 3. 1. General issues on budgeting for health 2. Expenditure frameworks and ceilings 3. Bringing efficiency gains back to the budget 4. Leeway and influence of central budget authority on health expenditure 5. Main co-ordination challenges 6. Conclusion 3 Overview of the presentation
- 4. 4 A great variety of different budgeting systems for health Centralised, National Health Systems Social Insurance Systems Decentralised Systems Decentralised, social insurance systems Decentralised, national health systems 1. General issues on budgeting for health
- 5. 5 Most countries use budget ceilings for central government’s expenditure on health Use of budget ceilings for health expenditure by central governments Source: OECD survey of budget officials on budgeting practices for health, 2013, Q. 45 2. Expenditure frameworks and ceilings No specific ceilings for health 13% Expenditure ceilings for overall expenditure by the Ministry of Health (or Social… Expenditure ceilings by program 16% Expenditure ceilings by category of health services (e.g. hospitals, primary care, etc.) 35%
- 6. 6 Many countries have developed early warning systems but delays in reporting expenditure information may reduce their ability to take corrective measures Delay in reporting expenditure to CBA Source: OECD survey of budget officials on budgeting practices for health, 2013, Q. 49 and 22 2. Expenditure frameworks and ceilings 0 1 2 3 4 5 6 Netherlands Switzerland Finland Austria Czech Rep. France Germany Mexico Norway UK Australia Chile Denmark Estonia Hungary New Zealand Poland Slovak Rep. Slovenia Korea (months) None 1 to 2 3 to 6 6 to 12 12 to 24 8% 35% 19% 38% There is an EWS and sets in motion required action for future years There is an EWS and sets in motion required action for the current year There is an EWS, but an alert does not legally require action No EWS Existence of an Early Warning System
- 7. 7 While most countries produce long-term projections, these do not always influence policy making or debate Use of automatic reductions in health care spending Source: OECD survey of budget officials on budgeting practices for health, 2013, Q. 38 and 4 3. Bringing efficiency gains back to the budget No 72% Yes but only on part of HCE 28% YES 44% NO 56% Use of spending reviews as a tool to identify possible cuts in health care expenditure
- 8. 8 Share of discretionary vs. mandatory health spending (average 2006-2012) 0% 20% 40% 60% 80% 100% Korea Italy Germany Netherlands Mexico Finland Estonia Switzerland Austria Norway Sweden Australia AVERAGE Slovenia Slovak Rep. Iceland Denmark Czech Rep. Japan New Zealand Discretionary Mandatory 4. Leeway and influence of CBAs on health expenditure Source: OECD survey of budget officials on budgeting practices for health, 2013, Q. 5
- 9. 9 Top priority areas for health expenditure control for budget officials 0 2 4 6 8 10 12 14 16 18 Outpatient care spending Primary health care services Spending on prevention programs Long term care spending Pharmaceutical costs Hospital expenditure 4. Leeway and influence of CBAs on health expenditure Source: OECD survey of budget officials on budgeting practices for health, 2013, Q. 37
- 10. 10 Influence of the CBA over health care-related policies 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Hospital tariffs Hospital budgets Pharmaceutical prices Listing of new drugs Listing of new medical services Payments to doctors Spending on public health programs considerable moderate little none 4. Leeway and influence of CBAs on health expenditure Source: OECD survey of budget officials on budgeting practices for health, 2013, Q. 34
- 11. 11 Number of years with overspending out of the last 7 years 0 1 2 3 4 5 6 7 8 Years out of last 7 with overspending Years out of last 7 without overspending 4. Leeway and influence of CBAs on health expenditure Source: OECD survey of budget officials on budgeting practices for health, 2013, Q. 48
- 12. 12 Size of over- and under-spending in percentage of budgeted spending, max and min (2006-2012) -15 -10 -5 0 5 10 15 20 Under/overspendingasashareoftotalhealth careexpenditure 4. Leeway and influence of CBAs on health expenditure Source: OECD survey of budget officials on budgeting practices for health, 2013, Q. 48
- 13. 13 Perceived co-ordination challenges between the MoH and the CBA 0 5 10 15 20 25 Sharing of information between the Ministry of Health and the CBA Lack of incentives for co-operation between the CBA and the Ministry of Health Lack of established relationships between officials from the CBA and the Ministry of Health Lack of capacity at the CBA to assess policies proposed by the Ministry of Health Is a major challenge Is somewhat of a challenge Is not a challenge 5. Main co-ordination challenges Source: OECD survey of budget officials on budgeting practices for health, 2013, Q. 26
- 14. 14 Types of relations between CBA and MoH 0 1 2 3 4 5 6 7 8 9 Specific co- ordination body gathering officials from CBA and MoH Regular informal consultation and meetings Ad hoc bodies created for specific needs (discussing a reform, etc.) Consultation for budget preparation only None 5. Main co-ordination challenges
- 15. 15 Controlling health expenditure: a difficult but often successful task Health is one of the top two policy areas from which it is hardest to achieve savings 19% In general, it is harder to achieve savings in health than in most areas 50% Health is as hard as any other area of governme nt spending 31% More successful than in other areas of policy 19% As successful as in other areas of policy 58% Less successful than in other areas of policy 23% Perceived difficulty of achieving savings in health vs. other expenditure areas Perceived success in controlling health expenditure Source: OECD survey of budget officials on budgeting practices for health, 2013, Q. 42 an 29 6. Conclusion