SLIDE 1
Dealing with growing pressures for private financing in health care:
- pportunities and
Dealing with growing pressures for private financing in health - - PowerPoint PPT Presentation
Dealing with growing pressures for private financing in health - - PowerPoint PPT Presentation
Dealing with growing pressures for private financing in health care: opportunities and constraints Sarah Thomson Barcelona, 16 th May 2012 Where do the pressures come from? political preferences potential winners financial crisis
SLIDE 2
SLIDE 3
What are the opportunities?
An opportunity for clarity about policy goals, problems and tools Do you know what you want, what the problems are and which tools will help you solve them?
SLIDE 4
Arguments for user charges
reduce excess demand caused by full insurance (moral hazard) contain costs direct people to more cost-effective use raise revenue
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22 27 5 10 15 20 25 30 Appropriate admissions Inappropriate admissions
User charges: a blunt tool with very limited selective effect
% reduction in hospital admissions per 1000 person years among those who had to pay (compared to free care)
Source: Siu et al (1986) New Engl J Med, RAND study
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43 117 78 97 20 40 60 80 100 120 140 Unwanted
- utcomes*
Emergency visits Older people Poorer people
User charges do not seem to result in net savings
Source: Tamblyn et al (2001), JAMA
% increase in incidence of unwanted
- utcomes
following introduction of prescription drug charges (hospitalisation, nursing home admission, death)
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Are user charges the right tool?
does it make economic sense to create financial barriers to care you want people to use? would it be more effective to target supply? requires careful policy design
SLIDE 8
Arguments for VHI
relieve pressure on public budgets address gaps in coverage (population, services, costs)
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What role for VHI?
supplementary complementary (user charges) complementary (services) substitutive VHI role Ireland, Poland, UK faster access & consumer choice consumer satisfaction Croatia, France, Latvia, Slovenia statutory user charges coverage depth Canada, NL, Hungary excluded services coverage scope Germany, Chile, NL pre-2006 groups excluded or
- pting out
coverage breadth Examples VHI covers Market driver
Gaps in statutory coverage create space for VHI but are not sufficient for market development
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Is VHI the right tool?
will VHI cover important gaps? will those who need VHI have access to it? can this be achieved without undermining value in public spending on health? requires careful policy design, understanding
- f how VHI interacts with the health system,
clarity about goals, regulatory capacity,
- versight
SLIDE 11
Risks associated with VHI
VHI may exacerbate fiscal pressure VHI may undermine value in public spending, especially if public resources subsidise private access risk segmentation, tax relief, non-aligned incentives, distortion of public priorities: the larger the market, the larger the challenges many of these risks could be avoided or mitigated by strong policy design
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5 10 15 20 25 30 35 40 45 50 55 France Slovenia Germany Ireland Cyprus Netherlands Spain Austria Belgium Portugal Luxembourg Malta Hungary Greece Finland Denmark UK Italy Latvia Lithuania Bulgaria Estonia Sweden Cz Republic Poland Romania Slovakia
VHI does not do well in filling gaps in coverage
VHI and OOP as % of total health spending, EU (2009)
VHI > 25% of private spending
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