Funding of health promotion focus on older people Jelena - - PowerPoint PPT Presentation

Funding of health promotion focus on older people

Jelena Arsenijevic Christoph Sowada Stanisława Golinowska Wim Groot

Bilateral meeting 15-16 of June Maastricht

Outline of the presentation

1. Place of health promotion, public health and health system 2. Statistics on funding of public health and health promotions: sources, scope of data, limitation 3. Institutional responsibilities for health promotion 4. Pooling and national public health policy 5. Potential funds for health promotion; public, private and others 6. Research concept 7. First answers from a questionnaire 8. What should be done to continue research

Public health place in health system

I. Health promotion and prevention – definition

• II. Statistics – expenditures on prevention and

public health services

• III. Institutional responsibilities for health promotion

IV.Securing funds for health promotion

• V. Estimation of expenditures on health promotion

in analyzed countries

Statistics What we know - data concerning level and share of expenditures on public health

• Eurostat
• OECD
• WHO

What we don’t know - data concerning the level and share of expenditures on health promotion

Expenditure on prevention and public health services, 2012 or nearest year (Eurostat)

Expenditure on prevention and public health services, 2012 or nearest year (Eurostat)

1 2 3 4 5 6 7 Romania Finland Slovenia Sweden Netherlands Hungary Estonia Germany Slovakia Norway Denmark Croatia Switzerland Spain Portugal Czech Republic France Poland Luxembourg Austria Iceland Lithuania Greece Belgium % of total current health expenditure

Expenditures on prevention and public health services (OECD 12.06.2015)

Countries Year % of total HE General Government % of total HE General Government excl social security %

• f total HE

Social Security Funds % of total HE Privat sector % of total HE Australia 2011 1,9 1,9 Austria 2012 1,7 1,4 0,7 0,7 0,3 Belgium 2012 1,1 1,1 1 0,1 Canada 2011 5,6 5,6 5,4 0,1 Czech Republic 2012 2 1,7 0,9 1,4 0,3 Denmark 2012 2,2 2,1 2,1 0,1 Estonia 2012 3,3 2,8 2,1 0,7 0,2 Finland 2012 5,9 3,5 1,7 1,8 2,4 France 2012 1,9 1,3 0,9 0,4 0,6 Germany 2012 3,2 2,7 0,7 2 0,5

Countries Year % of total HE General Government % of total HE General Government excl social security %

• f total HE

Social Security Funds % of total HE Privat sector % of total HE Greece 2012 1,1 1,1 1,1 Hungary 2012 3,3 1,6 0,7 0,9 1,7 Japan 2011 2,9 1,9 0,8 1 1 Netherlands 2011 3,5 2,5 1,3 1,2 1 Norway 2012 2,4 2,2 2,2 0,2 Poland 2012 1,9 1,3 0,9 0,4 0,6 Portugal 2011 2 1,4 1,4 0,6 Slovak Republic 2012 4 1,1 1,1 2,9 Spain 2012 2,1 2 2 Sweden 2012 3,7 2,9 2,9 0,9 USA 2012 2,9 2,9

Expenditures on prevention and public health services (OECD 12.06.2015)

Pooling and national public health policy Examples

Countries Responsible body PH council PH services Funds Sweden Ministry of Health and Social Protection, regional (county) councils Swedish National Institute for Public Health and National Public Health Committee (strategy and reporting tasks) Within team-based primary health care Taxes levied by the county council and additionally government subsidy allocated according to a per capita measures Spain Ministry of Health and Social Policy (General Directorate

• f Public health),

Regional health ministers, Autonomus Community Within primery health care (family doctors) Territorial government budgets (devolution reforms) Portugal Central Administration of the Health System, Regional Health Administration DGH – Directorate- General of Health ACES - Groups of primary care centres Contracts from state and regional budgets for public health services

Pooling and national public health policy - continuation

Countries Responsible body PH institutions / councils PH services Funds France National government generally, regional groups for public health The High Committee of Public Health and National Institute for Prevention and Health Education On the adequate territorial level defined by Health and Territories Act Not specified Germany States offices for public health at states governments (Länder) A lot of specific health- related institutes, since 2002 – das Deutsche Forum für Prävention und Gesundheitsförderung Öffentlichen Gesundheitsdienste and Arztpraxen Statutory Health Insurance and Länder budgets Italy Ministry of Health (3 departments) and 12 regional agencies A lot of specific health- related instituts Within primary care focused on group prctices (since 1999) Not specified

Pooling and national public health policy – continuation

Countries Responsible body Public health institution – council PH services Funds Poland Ministry of Health (2 Departments) PIS – State Sanitary Inspection NIZP – PZH Different units: regional inspectorate, primery health and clinics Central budget, Statutory health insurance, Territorial self- government budgets USA States Centers for Disease Control and Prevention (CDC) Trust for America's Health (TFAH) Budgets of states Canada Federal Public Health Agency, Public health departments in provincial ministries Chief public/medical health officer on the territorial level Territorial government budgets

Responsibilities for health promotion

• Public institutions:

– Central government and central public agencies

• Ministry of health
• Other ministries: e.g. ministry of education, sport, work force, social
• Social insurance: health, long-term care, pension , accident, unemployment
• Joint financed public foundations

– Territorial self-government

• Non – public institutions:

– Employers – Voluntary sector – NGOs’, self help organizations – Private insurances – Private households/consumers

Potential sources of financial funds

(to be estimated)

• Public funds:

– General taxes – Earmarked taxes – Social insurance contributions

• Private funds:

– Employers cost – Fund – rising by NGOs/Foundations – Out of pocket – Others (e.g. private insurance)

• External aid

– WHO grants – PAHO

Public sources

• General taxes:

– Excise, VAT, IT – Tax allowances and tax exemptions (e.g. 500 euro rule in Germany)

• Earmarked taxes

– excise e.g. tobacco tax (e.g. earmarked revenues of tobacco tax increase in Australia, USA tobacco tax, Thailand tobacco and alcohol tax) – assigning % of personal income tax to foundation (Hungary, Poland)

• Social insurance contributions

– extra surcharge to Health Promotion Organizations/Foundations (e.g. for Health Promotion Switzerland, emarked percentage of insurance budget in Estonia)) – direct purchasing of health promotion and disease prevention services by providers (e.g. Satzungsleistungen and compulsory prevention services in German GKV

Public sources

• Social insurance contributions

– extra surcharge to Health Promotion Organizations/Foundations (e.g. Health Promotion Switzerland, earmarked percentage of insurance budget in Estonia)) – direct purchasing of health promotion and disease prevention services by providers (e.g. Satzungsleistungen and compulsory prevention services in German GKV, obligatory vaccinations and screening services in France, Belgium, Luxemburg, additional health promoting services voluntarily in Belgium)

Stanisława Golinowska Christoph Sowada

Private and other sources

• Employers (eg. Work Health Promotion Programs in

Germany)

• Fund – rising by NGOs/Foundations (very often with public

subsidies, e.g. Health promotion foundation Austria, Health Promotion Switzerland, VicHealth Australia)

• Out of pocket
• Others (e.g. private insurance)
• External aid (e.g. Hungarian Health21, Central America

Diabetes Initiative)

Research concept – subjects

• 1. Subject: health promotion programmes (initiative, intervention)

providing in analysed countries in main sectors:

• Government and territorial self-government
• Health sector
• Education
• Social sector
• Sport
• Enterprises
• Voluntary
• 2. Analysed countries: main partners (NL, PL, Italy, Germany) and

collaborating countries (Hungary, Czech Republic, Bulgaria, Lithuania, Greece and Portugal)

Research concept – methods

• Desk research on funding public health and health promotion for
• lder people (including domestic grey literature) in 10 analysed

countries and other European and non-European countries.

• Questionnaire prepared in WP 6 on institutional arrangements of

health promotion, including questions on funding of public health activities, health promotion generally and health promotion addressed to older people

• Template prepared in WP6 on programmes of health promotion

for older people in selected sectors: health care, territorial self- government, education, sport and voluntary, including questions

• n founding

Research concept – respondents

Respondents: Experts from analysed countries: general experts and experts with special competency of the analysed sectors and programmes.

First information from the questionnaire Case of Poland

Health promotion generally Health promotion addressed to older people↓ How the health promotion activities are funded in your country Partially from the public budget, partially by employers, sometimes by NGOs (e.g. foundations) From National Health Fund (governmental money), Public Health Fund, from local government budgets (in this case it is rather trace expanses). Who is a main public payer for those Health Promotion activities? State Budget (Ministry of Health), Local Governments Budgets, National Health Funds Public Health Fund – which is in Ministry of Health disposer and Local Governments Budgets (both from county and province level / powiat and województwo ) Are there any non-public financial resources spend for it? Employers, NGOs, private housholdes No precise data is available, but taking into account that:

• non-public financial

expenditures on health amounts to 30% and

• we can observe health

promotion as an element of NGO (from different social field) actions

• we can assume that non-

public financial resources are scattered but more significant that we see in official reports

First information from the questionnaire Case of Netherlands

Health promotion generally Health promotion addressed to older people↓ How the health promotion activities are funded in your country

• Public funding
• Private companies (for specific sub-
• --population groups-older workers)
• Fees paid by participants of HPA
• Funding provided by basic health

insurance packages such as “bewegen op recept” where sport activities are provided through referral of GP’s or physiotherapist

• r dietitian. People diagnosed with

diabetes, overweight, back pain and depression are eligible for this. Same as general health promotion, however there is no direct line/pattern for financing the HPA for elderly (Schippers et al., 2009)

Who is a main public payer for those Health Promotion activities?

In 2015, Ministry of Health, Welfare and Sport provides subsidies for TRIMBOS (prevention

• f addictive behaviour, alcohol,

tobacco and mental health prevention, for RIVM and looketgezonde to provide information of consistent and effective HPA activities. To PHAROS for providing effective and qualitative care for migrants and De Stichting Veilig-heidNL for injury prevention (Rijksbergroting 2015, VWS)

• most of the public health funds are

transferred to local municipalities and through them to GGDs’(Wcpv)

Are there any non-public financial resources spend for it?

Private expenditure of individuals who participate in HPA Same as for general health promotion

First information from the questionnaire Case of Lithuania

Health promotion generally Health promotion addressed to older people How the health promotion activities are funded in your country Since 2014, municipalities receive the state budget targeted dotation Since 2014, municipalities receive the state budget targeted dotation Who is a main public payer for those Health Promotion activities? The state budget European Structural Funds Are there any non-public financial resources spend for it? N.a.

First information from questionnaire Case of Italy

Health promotion generally Health promotion addressed to older people How the health promotion activities are funded in your country About 3-4 % of the National Health Budget Who is a main public payer for those Health Promotion activities? Ministry of Health Ministry of Health Are there any non-public financial resources spend for it? Voluntary Workplace Welfare Program

First information from the questionnaire Case of Hungary

Health promotion generally Health promotion addressed to older people How the health promotion activities are funded in your country mostly from the central government budget (health care services are financed via social health insurance contributions) Who is a main public payer for those Health Promotion activities? government (health care services are financed by the National Health Insurance Fund Administration) Are there any non-public financial resources spend for it?

First information from the questionnaire Case of Germany

Health promotion generally Health promotion addressed to older people How the health promotion activities are funded in your country Funding of prevention, health protection and health promotion (in 2013): Statutory health insurance (45%) Public budgets (19%) Statutory accident insurance (11%) Private households (10%) Employers (9%) Who is a main public payer for those Health Promotion activities? Statutory health insurance, public budgets, statutory accident insurance (see above) Are there any non-public financial resources spend for it? Private households, employers (see above)

First information from the questionnaire Case of Czech Republik

Health promotion generally Health promotion addressed to older people How the health promotion activities are funded in your country Public budgets mostly. Funding operating costs of public institutions, offering grants for others (mainly NNOs) Who is a main public payer for those Health Promotion activities? Regional governments Are there any non-public financial resources spend for it? Yes

First information from questionnaire Case of Bulgaria

Health promotion generally Health promotion addressed to older people How the health promotion activities are funded in your country Budgetary, state financing as well as project financing Who is a main public payer for those Health Promotion activities? Health promotion activities are exclusively financed by the national and regional government budgets Are there any non-public financial resources spend for it? NGOs funds & project funds

What should be done to continue research

• Putting adequate/additional questions in templates prepared for

selected sectors in analysed countries

• Contacting experts/respondents from analysed countries
• Meeting with experts from analysed countries to discuss and

responding template

• Collecting information from desk research and templates
• Describing funding issues by sectors/programmes and by

countries