Health Care Financing: Funding Mechanisms Flashcards
(29 cards)
Several factors contribute to the rising cost of health care globally:
An _________ population
Increased ______________
_________ advancements
Growing health _________
Change in disease patterns (_________
_________)
_________ factors
_________ factors
ageing ; population coverage
Technological ; expectations
epidemiological transition
Economic ; Political
Budgetary allocation to health
This refers to the proportion of the budget (Federal, state, local, organizational) allocated to health.
Proportion of the federal budget allocated to health has decreased from ____% to _____% between 1996 and 2006.
Below ____% agreed upon by AU members in the Abuja Declaration of 2001
Nigeria’s total health expenditure (THE) is 4.1% of GDP, lower than most resource-poor countries in SSA, depicting low investment in the health
sector
7.1% ; 3.5%
15%
Budgetary allocation within health sector
Bulk of spending is on _________ care (74% of THE)
Preventive care accounted for only _____% of THE in 2002 (National Health Accounts)
Health expenditure data in Nigeria not broken down to show expenditure on patient sub-groups, e.g. newborns, under 5s, elderly
curative
1%
Determinants of resource allocation
Health ________
Health __________ of decision-makers
_________ influences
policies
priorities
External
Major issues to consider in selecting healthcare financing methods
________ - Who pays? Who benefits?
(Fairness) (Universal Coverage)
◦- Distribution
◦- Access to services (esp. financial barriers)
__________ - Productivity & Output
◦- Allocation
◦- Production
EFFECTIVENESS - Actual _______
◦- _________ of Care
◦- Actual Impact on Health Status of Target Pop.
_____________ - Economic Viability
EQUITY
EFFICIENCY
Outcomes ; Quality of Care
SUSTAINABILITY
All health care is funded either directly or
indirectly by ____________.
individuals.
Basically, health care financing represents a flow of funds from patients (clients) to health care
providers in exchange for services. This can be done in 2 major ways:
1. ___________ payments
2. ___________ payments
Out-of-pocket payments
Third-party payments
Out-of-pocket payments:
These include:
_______ consultations with doctors (user fees)
– this is what readily comes to mind when the term ‘out of pocket’ is used
_______________ drugs
____________ (in third party mechanisms, due to increased cost-sharing)
Services not covered by _________
Unofficial fees
Private
Over the counter
Co-payments ; insurance
Out-of-pocket payments play an important role, especially in many developing countries
In 2006, out-of-pocket spending on health in Nigeria contributed ____% of THE
Overall, out-of-pocket spending is increasing due to the growing proportion of _______, and increasing _________ in third-party mechanisms
63%
OTC drugs,
cost-sharing
THE??
Total health expenditure
Third party/ Group oriented systems
A third party is an entity, usually an ________ company or _________ agency, that pays for medical services but does not receive or provide health care services.
insurance
government agency
A basic characteristic of health care systems in all developed countries is that the majority of payments for medical services flows through
_____________________.
third parties
Reasons for development of third-party financing
◦ people wanted to insure against the _______ and ___________ cost of illness, and
◦ governments wanted to assure access to health care for its citizens (_______________)
large ; uncertain
universal coverage
Third-Party systems
___________ financing (_____ taxes)
Insurance
- _________ (_________) health insurance
- _________ (_________) insurance
- _________-based health insurance
Private ; voluntary
Social ; compulsory
Community
Financing models for achieving Universal coverage:
◦ __________ insurance (Bismarck model)
◦ ____________ services (Beveridge model)
Compulsory insurance (Bismarck model)
Tax-funded services (Beveridge model)
ADVANTAGES of third party groups
Resource mobilization
Risk-_________
__________ benefits
Promotes _______________
Stronger ____________ power vis-à-vis Providers
pooling
Earmarked ; social solidarity
bargaining power
DISADVANTAGES of third party groups
______________ – excessive
consumption of covered or “free” services
Adverse Selection - attempts to exclude ________ people and to avoid coverage of the ______________ areas
Cream skimming or cherry picking- physicians
maximizing financial gains by selecting patients with the _________
_______________ costs
Moral Hazard
high risk ; non-lucrative
best risks; Adminstrative
Social solidarity?
Rich supporting the poor
Healthy supporting the sick
Community based health insurance scheme
Some key principles of CBHI:
_________
Prepayment
Risk _______
Transparency and Accountability
Solidarity/Social Movement
Community Control/Democratic Participation
__________ Profit; and
___________ Membership.
Autonomy
Sharing
Not-for-Profit
Voluntary
Medical Savings Accounts (MSA)
A medical savings account (MSA) is a process whereby _________ save and pay for their own medical expenses. In some parts of the world they are known as ‘_______________________’ (HSA).
individuals
Health savings account
Medical Savings Account (MSA)
Tax-_____________ deposits are made by the contributor towards medical expenses. Withdrawals from the MSA are tax-_________ if used to pay for qualified medical expenses.
The MSA is used in conjunction with a ‘________________ (catastrophic) health insurance plan’
deferred
free
high-deductible
high-deductible health plan (HDHP), also called _________ insurance.
catastrophic
The World Health Organisation (WHO), definesUniversal Health Coverage as “ensuring that ______ people have access to ________ health services of
__________ quality to be ________ while also ensuring that the use of these services does not expose the user the __________ .”
all; needed
sufficient; effective
financial hardship
Nigeria’s commitment to Universal Health Coverage (UHC) is symbolised by the passage of the ______________ of __________.
National health act
2014
