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Issues of health care financing May 2003. Dr Gyula Kincses. Basic trends characterising 21st century societies. Extension of life, transformation of society’s age structure ;
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Issues of health care financingMay2003 Dr Gyula Kincses
Basic trends characterising 21st century societies • Extension of life, transformation of society’s age structure; • Harmonisation of certain diseases with life, thereby increasing the proportion of people living with diseases and disabilities; • Increasing demand to improve quality of life for people with disabilities; • Expected leaps in the development of medicine and medical technology (genetic engineering, biotechnology).
Consequence of the trends • The health care delivery system cannot be financed in a lasting and sustainable way based on traditional principles. • Directions for solution: - specification and selection of risks treated by compulsory health insurance, - restructuring the resources of compulsory health insurance, - improving self-care, preference of health saving - specification of services and provisions.
Specification and selection of risks treated by compulsory health insurance • Separation of risks having outside interest: occupational health, competitive sports • Separation of other types of risks: nursing insurance • Shifting of the costs of damages caused by a third party: traffic accident, physical injury etc. • Deflection of voluntary risks to supplementary insurance: extreme sports, dangerous animals
Restructuring the resources of compulsory health insurance • Elimination of health contribution (EHO), keeping the money within the sector. • Restructuring the rate of employer-employee contribution. • The principle “everyone possesses legal status based on demonstrablecontribution payment” should be actualised. • The principle “everyone is paid by whoever grants livelihood” should be in force. • The system cannot be financed by contributions tied exclusively to wages. • Budgetary support should be planned support rather than planned deficit. • Settlement of the situation of those not living on wages.
Specification of services and provisions • The service catalogue cannot be fully made, but - The authorisation order based on minimum conditions is taking this direction. - Financing rules (“book of rules”) are also suitable for specification of service package. - The “examination-therapy” procedural order is still an existing instrument. • This issue will come up again in this conference in connection with innovation policy.
Improving self-care, preference of health saving
Inequalities in the health care system • Considering social polarisation and the burden weighing on underprivileged groups, the rate of private financing is high in Hungary; • Private financing is unevenly burdened and appears almost exclusively as incidental cash payment; • There are great regional inequalities in the accessibility of the delivery system.
Health care system of different countriesfrom the viewpoint of the equity of financing % Source: M. Schneider Gesundheitssysteme im internationalen Vergleich, OECH database . On the basis of data between 1994 and 1998
Restructuring the regulatory system of the health fund • membership fee based on 100% solidarity principle, in place of the 40-60% mixed system for the public services of the health fund: - assessment of health status, screening, making of health plan - community prevention and life style programmes - organisation of services - consumer protection. • Optional health account for members, though not only the health fund can manage health accounts.
Definition of health account The Health Account is a current account that is • supported with tax benefits equal to the health funds • at a specified account manager - financial institution - health fund - business insurer for which reimbursement can be performed in case of purchase at • qualified service provider • special professional enterprise
Services of the Health Account • Health services in kind - obligatory share of services financed by social insurance - voluntary supplementary fee (hotel, meal etc.) in line with services financed by social insurance - services used at providers not financed by social insurance • Purchase of drugs and medical aids, other medical technology products • Nursing care • Income-supplementing services following accumulation/deposit time (in other areas of social security, life annuity etc.).
Tax benefits of Health Account • Health Account receives tax benefits equal to the health funds. • Business insurance covering mostly health care services should also receive identical tax benefits. • The rate of tax benefits – as health-oriented saving – should be determined in a common platform. • Short-term “flowing” financing and health saving should be differentiated in tax benefits.
Stimulation of service market • The condition for the spread of supplementary financing is the development of the service market. • Consensus-based provider agglomeration withcommon accreditation. • Extension of optimal co-payment system: - choice of doctor and institute (with the exception of primary care) - services without regional obligation to provide.
