Cash-flow analysis for the Catastrophic Expenses Fund Mara-Cristina - - PowerPoint PPT Presentation

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Cash-flow analysis for the Catastrophic Expenses Fund Mara-Cristina - - PowerPoint PPT Presentation

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Cash-flow analysis for the Catastrophic Expenses Fund Mara-Cristina Gutirrez-Delgado Economic Analysis Unit, Mexican Ministry of Health Second International Colloquium Dresden, April 2004. Contents. Background. Reform to the

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SLIDE 1

Cash-flow analysis for the Catastrophic Expenses Fund

María-Cristina Gutiérrez-Delgado Economic Analysis Unit, Mexican Ministry of Health

Second International Colloquium Dresden, April 2004.

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SLIDE 2

Contents.

  • Background.
  • Reform to the Mexican General Health Law.
  • The Catastrophic Expenses Fund.
  • Results, conclusions and recommendations.
  • Next steps.
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SLIDE 3

Background.

The Mexican health system.

Private sector Middle class Poor

Urban/Rural

Public Private

Functions

Provision Financing Stewardship

Non-salaried workers in informal sector

Population groups

Federal and state departments

  • f health

Social Security System

IMSS ISSSTE

Salaried workers in formal sector

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SLIDE 4

Financial characteristics.

  • 1. Level: insufficient investment (5.8% of GDP)
  • 2. Source: predominance of out-of-pocket payments (55%)
  • 3. Distribution

– Among populations: 1.7 times between insured and uninsured – Among states: 7 to 1 between the state with the highest expenditure on the insured and the one with the lowest

  • n the uninsured
  • 4. State contributions: 109 to 1
  • 5. Allocation items: payroll expenditure vs. investment

Source: Mexican Ministry of Health, 2003.

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SLIDE 5

Distribution of healthcare expenditure.

Source: Mexican Ministry of Health,2003.

42%

3%

55%

Public Out-of-pocket Pre-paid services

Federal Gv´t State Gv´t

Social Security Uninsured

31.8%

6.6%

61.6%

31.8% 61.6%

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SLIDE 6

Reform to the General Health Law.

System of Social Protection in Health.

Aims

  • Offer financial protection to uninsured through a

public healthcare insurance scheme.

  • Promote a culture of pre-payment among uninsured.
  • Strengthen a culture of preventive healthcare.
  • Decrease the number of uninsured families facing poverty

because of healthcare costs at point of delivery.

Source: Mexican Ministry of Health,2003.

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SLIDE 7

System of Social Protection in Health.

Healthcare goods and funds.

Personal health services (Popular Health Insurance) Public health goods Budget of the Federal Ministry of Health Catastrophic Expenses Fund Personal Health Services Fund Community Health Services Fund

Funds

  • Catastrophic

interventions

  • Essential health

interventions

  • Stewardship function
  • Information, research &

human resources development

  • Community health

services

Goods

Source: Mexican Ministry of Health,2003.

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SLIDE 8

Structure of Financial Contributions.

Universal Health Insurance.

Source: Mexican Ministry of Health,2003. **Proposal for future reform to ISSSTE Law.

Popular Health Insurance, SSPH

(informal sector, self- employed and unemployed)

ISSSTE (public-sector salaried employees) ** IMSS (private-sector salaried employees)

Federal Government

(social contribution)

State Gov´t

Public employer

Contributors Public Insurance Scheme

Federal Gov´t

Employee Employee Family Private employer

Federal government

(social contribution)

Federal government

(social contribution)

solidarity contribution

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SLIDE 9

Structure of Financial Contributions.

SSPH.

Social Contribution Federal Solidarity Contribution State Solidarity Contribution Contributions to SSPH: USD$675.52 per family during 2004

89 % USD$675.52 USD$601.21 Personal Health Services 8 % 3 % USD$ 54.04 Catastrophic Expenses USD$ 20.27 Annual budget reserve

Source: Mexican Ministry of Health,2003.

Family Contribution Operative reserve for drugs and medical material necessary for essential interventions According to socioeconomic conditions

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SLIDE 10

The Catastrophic Expenses Fund.

Source: Mexican Ministry of Health,2003.

Aim

Purchasing of covered catastrophic expenses.

Catastrophic expenses Those derived from the treatment of diseases which pose a financial burden to the SSPH. Coverage of catastrophic expenses will be gradual following criteria defined in the General Health Law.

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SLIDE 11

Diseases or treatments that generate catastrophic expenses.

The General Health Council is responsible for the identification

  • f diseases, definition of treatments and drugs that generate

catastrophic expenses for the SSPH.

Source: General Health Council,2003.

Total Dialysis Transplants Neonatal intensive care Rehabilitation

Category

Injuries HIV/AIDS Neuro-vascular Cardio-vascular Cancer

Category

5 1 3 2 12,8

No.

53 2 6 8 6

No.

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SLIDE 12

Financial cash-flow.

CEF Covered Services

Interest Balance of annual budget reserve at end of tax year

Cash in-flow (income)

Payment to authorized providers (Operative expenses)

Cash out-flow (expenses)

Administrative expenses

8% of Federal & States contributions

Source: Mexican Ministry of Health,2003.

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SLIDE 13

Financial sufficiency.

Source: Mexican Ministry of Health,2003.

How many diseases or treatments can be covered with available resources?

  • Short and mid-term financial sustainability.
  • Selection of diseases, based on budgetary

resources, cost-effectiveness, infrastructure and national healthcare priorities, is responsibility of the National Commission of Social Protection in Health.

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SLIDE 14

Available information.

Set 4 plus bone marrow transplant. 5 Set 1: 2004; Set 2: 2005; Set 3: 2006; Set 4: 2009; Set 5: 2010. 6 Set 3 plus kidney transplant. 4 Set 2 plus breast cancer. 3 Set 1 plus acute myocardial infarctation. 2 HIV/AIDS, acute lymphoblastic leukemia, cervix-uterine cancer. 1

Disease or treatment Set

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SLIDE 15

Available information.

Short & mid-term projections.

Biometric: Target population; affiliation rates; incidence rates; mortality rates not included. Financial: Minimum daily wage, interest rates; inflation rates. Expenses: Annual number of cases per disease/treatment; annual average cost per case; annual administrative expenses; quarterly payment. Income: Quarterly budget income; interest accrued quarterly; balance of annual budget reserve at end of tax year.

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SLIDE 16

Results under initial assumptions.

Paquete 1

  • 5

10 15 2004 2005 2006 2007 2008 2009 2010 Miles de millones de pesos Año Acumulado Gasto Paquete 4

  • 5

10 15 2004 2005 2006 2007 2008 2009 2010 Miles de millones de pesos Año Acumulado Gasto Paquete 3

  • 5

10 15 2004 2005 2006 2007 2008 2009 2010 Miles de millones de pesos Año Acumulado Gasto Paquete 5

  • 5

10 15 2004 2005 2006 2007 2008 2009 2010 Miles de millones de pesos Año Acumulado Gasto Paquete 6

  • 5

10 15 2004 2005 2006 2007 2008 2009 2010 Miles de millones de pesos Año Acumulado Gasto Paquete 2

  • 5

10 15 2004 2005 2006 2007 2008 2009 2010 Miles de millones de pesos Año Acumulado Gasto

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SLIDE 17

Results discounting the inflation effect.

Paquete 1

  • 5

10 15 2004 2005 2006 2007 2008 2009 2010 Miles de millones de pesos Año Acumulado Gasto Paquete 4

  • 5

10 15 2004 2005 2006 2007 2008 2009 2010 Miles de millones de pesos Año Acumulado Gasto Paquete 3

  • 5

10 15 2004 2005 2006 2007 2008 2009 2010 Miles de millones de pesos Año Acumulado Gasto Paquete 5

  • 5

10 15 2004 2005 2006 2007 2008 2009 2010 Miles de millones de pesos Año Acumulado Gasto Paquete 6

  • 5

10 15 2004 2005 2006 2007 2008 2009 2010 Miles de millones de pesos Año Acumulado Gasto Paquete 2

  • 5

10 15 2004 2005 2006 2007 2008 2009 2010 Miles de millones de pesos Año Acumulado Gasto

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SLIDE 18

Results under decrease of annual average cost per case.

Paquete 1

  • 5

10 15 2004 2005 2006 2007 2008 2009 2010 Miles de millones de pesos Año Acumulado Gasto Paquete 4

  • 5

10 15 2004 2005 2006 2007 2008 2009 2010 Miles de millones de pesos Año Acumulado Gasto Paquete 3

  • 5

10 15 2004 2005 2006 2007 2008 2009 2010 Miles de millones de pesos Año

Acumulado Gasto Paquete 5

  • 5

10 15 2004 2005 2006 2007 2008 2009 2010 Miles de millones de pesos Año Acumulado Gasto Paquete 6

  • 5

10 15 2004 2005 2006 2007 2008 2009 2010 Miles de millones de pesos Año

Acumulado Gasto Paquete 2

  • 5

10 15 2004 2005 2006 2007 2008 2009 2010 Miles de millones de pesos Año Acumulado Gasto

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SLIDE 19

Results under increase of annual average cost per case.

Paquete 1

  • 5

10 15 2004 2005 2006 2007 2008 2009 2010 M i l e s d e m i l l

  • n

e s d e p e s

  • s

Año

Acumulado Gasto Paquete 4

  • 5

10 15 2004 2005 2006 2007 2008 2009 2010 M i l e s d e m i l l

  • n

e s d e p e s

  • s

Año

Acumulado Gasto

Paquete 3

  • 5

10 15 2004 2005 2006 2007 2008 2009 2010 Miles de millones de pesos Año

Acumulado Gasto Paquete 5

  • 5

10 15 2004 2005 2006 2007 2008 2009 2010 M i l e s d e m i l l

  • n

e s d e p e s

  • s

Año

Acumulado Gasto Paquete 6

  • 5

10 15 2004 2005 2006 2007 2008 2009 2010 Miles de millones de pesos Año

Acumulado Gasto Paquete 2

  • 5

10 15 2004 2005 2006 2007 2008 2009 2010 Miles de millones de pesos Año Acumulado Gasto

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SLIDE 20

Conclusions and recommendations.

  • Key factor for sufficiency is the initial number of

diseases or interventions to be covered.

  • Second most important factor is annual average cost

per case.

  • Ratio between general and medical services inflation

rates is very important.

  • Increases in target population show little impact in

cash-flow, but might become important once the “universal coverage” is attained.

  • Results help recommending to policy-makers starting
  • perations with most conservative set.
  • Annual

evaluation

  • f

CEF performance for implementing required adjustments.

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SLIDE 21

Next steps

  • Incidence and prevalence rates among target population for

the 53 diseases?

  • Mortality rates among target population for the 53 diseases?
  • Cost of treatment for the 53 diseases?
  • Risk premiums for the 53 diseases?
  • Operative reserve for the CEF?
  • How much is needed to cover, in a

sustainable way, the 53 diseases?

  • What is the best strategy for gradually

increase the number of covered diseases?

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SLIDE 22

Next steps

Your comments are highly appreciated. Thank you.