MMI submission on the funding of National Health Insurance - - PowerPoint PPT Presentation
MMI submission on the funding of National Health Insurance Presented to Davis Tax Committee 1 November 2016 Boshoff Steenekamp Industry Relations Team MMI Health Centre of Excellence 1 Content What NHI and Universal Health Coverage are
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Presented to Davis Tax Committee 1 November 2016
Boshoff Steenekamp Industry Relations Team MMI Health Centre of Excellence
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UHC can never be fully achieved – the box keeps on growing. Does not imply a specific delivery system or financing mechanism.
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Kutzin, Joseph, Yip, Winnie and Cashin, Cheryl. Alternative Financing Strategies for Universal Health Coverage. [ed.] Richard M Scheffle. World Scientific Handbook of Global Health Economics and Public Policy. s.l. : World Scientific Publishing Company Pty Ltd, 2016, pp. 267-309.
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Institute for Health Metrics and Evaluation (IHME). Rethinking Development and Health: Findings from the Global Burden of Disease
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Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015 The Lancet DOI: 10.1016/S0140-6736(16)31467-2
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Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015 The Lancet DOI: 10.1016/S0140-6736(16)31467-2
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Financing Financing
Creating resources Creating resources Revenue collection Revenue collection Service delivery Service delivery Stewardship, governance, oversight Stewardship, governance, oversight Pooling Pooling Purchasing Purchasing Benefits Benefits
Equity in resource distribution Equity in resource distribution Efficiency Efficiency Transparency and accountability Transparency and accountability Utilisation in relation to need Utilisation in relation to need Financial protection and equity in finance Financial protection and equity in finance Quality Quality
Steenekamp, Boshoff. Review of South African healthcare financing: towards Universal Health Coverage. A contribution towards the debate on achieving Universal Health Coverage in South Africa. Centurion, South Africa : MMI Health, 15 July 2016. McIntyre, Diane and Kutzin, Joseph. Health financing country diagnostic: a foundation for national strategy development. Health Systems Governance &
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… and provide a solid foundation for future development of a system…
Joe Kutzin, Study material, WHO advanced course on health financing for universal health coverage for low and middle income countries.
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shortfall*, additional taxes of R13bn in 2017-18*
Security policy
* Ensor, Linda. Pravin Gordhan’s medium-term budget in a nutshell: big tax increases, spending cuts. Business Day. 26 OCTOBER 2016.
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Forecasts and actual
Ensor, Linda. Pravin Gordhan’s medium-term budget in a nutshell: big tax increases, spending cuts. Business Day. 26 OCTOBER 2016.
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Forecasts and actual
Ensor, Linda. Pravin Gordhan’s medium-term budget in a nutshell: big tax increases, spending cuts. Business Day. 26 OCTOBER 2016.
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% of non-interest expenditure
5 10 15 20 25 30 35 40 45 FY15/16 FY16/17 FY17/18 FY18/19 FY19/20
% of Non-interest expenditure 2016 Budget 2016 MTBPS
van Papendorp, Herman and Packirisamy, Sanisha. MTBPS 2016: Additional taxes and spending cuts used to negate weaker growth impact
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3 6 9 12 15 18 Philippines Kenya Mali Malaysia Romania Cote d'Ivoire Netherlands Moldova Ghana UK Kosovo El Salvador Ireland Jamaica Honduras Portugal SA France Tunisia Zimbabwe
Government wage bill as % of GDP
van Papendorp, Herman and Packirisamy, Sanisha. MTBPS 2016: Additional taxes and spending cuts used to negate weaker growth impact
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National Planning Commission. National Development Plan 2030 Our future - make it work. Department of the
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Risk adjustment mechanism for medical schemes Risk adjustment mechanism for medical schemes
Norms and standards for equitable financing in provinces Norms and standards for equitable financing in provinces
Priority setting authority (NICE or HITAP) Priority setting authority (NICE or HITAP) Coding, remuneration, and outcomes authority Coding, remuneration, and outcomes authority Transversal contracts for medicines, surgicals, labs and equipment Transversal contracts for medicines, surgicals, labs and equipment Prepare for a purchaser provider split, improve service delivery Prepare for a purchaser provider split, improve service delivery State sponsorship for missing middle State sponsorship for missing middle Stewardship, governance and oversight Stewardship, governance and oversight Creating resources Creating resources
Revenue collection Revenue collection
Single health information platform Single health information platform Service delivery, creating resources, stewardship, governance and oversight Service delivery, creating resources, stewardship, governance and oversight
Revenue collection Revenue collection Pooling Pooling Purchasing Purchasing Benefits Benefits
Virtual single risk pool Virtual single risk pool
Based on: MMI Health. MMI Comments on NHI White Paper. Pretoria : MMI Holdings, 31 May 2016.
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Based on: Moreno-Serra, Rodrigo. The impact of cost-containment policies on health expenditure. [book auth.] OECD. Fiscal Sustainability of Health Systems. Bridging Health and Finance Perspectives. Paris : OECD Publishing, 2015.
THE
Total Health Expenditure
THE
Total Health Expenditure
HEO/I
Health Expenditure (Outpatient and Inpatient)
HEO/I
Health Expenditure (Outpatient and Inpatient)
HEPH
Health Expenditure (Pharmaceuticals)
HEPH
Health Expenditure (Pharmaceuticals)
HEADM
Health Expenditure (Administration)
HEADM
Health Expenditure (Administration)
PO/I
Price (Outpatient and Inpatient)
PO/I
Price (Outpatient and Inpatient)
QO/I
Quantity (Outpatient and Inpatient)
QO/I
Quantity (Outpatient and Inpatient)
PPH
Price (Pharmaceuticals)
PPH
Price (Pharmaceuticals)
QPH
Quantity (Pharmaceuticals)
QPH
Quantity (Pharmaceuticals)
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OECD publication
Based on: Moreno-Serra, Rodrigo. The impact of cost-containment policies on health expenditure. [book auth.] OECD. Fiscal Sustainability of Health Systems. Bridging Health and Finance Perspectives. Paris : OECD Publishing, 2015.
THE THE HEO/I HEO/I HEPH HEPH HEADM HEADM PO/I PO/I QO/I QO/I PPH PPH QPH QPH
Supply side Supply side Demand side Demand side Public management, coordination and financing Public management, coordination and financing
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Based on: Moreno-Serra, Rodrigo. The impact of cost-containment policies on health expenditure. [book auth.] OECD. Fiscal Sustainability of Health Systems. Bridging Health and Finance Perspectives. Paris : OECD Publishing, 2015.
THE THE
Supply side Supply side Demand side Demand side Public coordination Public coordination
mechanisms
competition
and selective contracting
legislation
legislation
mechanisms
competition
and selective contracting
legislation
legislation
subsidies
benefit package
subsidies
benefit package
pharmaceutical prices/profits
health system functions
system financing
assessment
pharmaceutical prices/profits
health system functions
system financing
assessment
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Based on: Moreno-Serra, Rodrigo. The impact of cost-containment policies on health expenditure. [book auth.] OECD. Fiscal Sustainability of Health Systems. Bridging Health and Finance Perspectives. Paris : OECD Publishing, 2015.
THE THE
Supply side Supply side Demand side Demand side Public coordination Public coordination
mechanisms
competition
and selective contracting
legislation
legislation
mechanisms
competition
and selective contracting
legislation
legislation
subsidies
benefit package
subsidies
benefit package
pharmaceutical prices/profits
health system functions
system financing
assessment
pharmaceutical prices/profits
health system functions
system financing
assessment
Coding, remuneration, and outcomes authority Coding, remuneration, and outcomes authority
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Based on: Moreno-Serra, Rodrigo. The impact of cost-containment policies on health expenditure. [book auth.] OECD. Fiscal Sustainability of Health Systems. Bridging Health and Finance Perspectives. Paris : OECD Publishing, 2015.
THE THE
Supply side Supply side Demand side Demand side Public coordination Public coordination
mechanisms
competition
and selective contracting
legislation
legislation
mechanisms
competition
and selective contracting
legislation
legislation
subsidies
benefit package
subsidies
benefit package
pharmaceutical prices/profits
health system functions
system financing
assessment
pharmaceutical prices/profits
health system functions
system financing
assessment Coding, remuneration, and outcomes authority Coding, remuneration, and outcomes authority Risk adjustment mechanism for medical schemes Risk adjustment mechanism for medical schemes
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Based on: Moreno-Serra, Rodrigo. The impact of cost-containment policies on health expenditure. [book auth.] OECD. Fiscal Sustainability of Health Systems. Bridging Health and Finance Perspectives. Paris : OECD Publishing, 2015.
THE THE
Supply side Supply side Demand side Demand side Public coordination Public coordination
mechanisms
competition
and selective contracting
legislation
legislation
mechanisms
competition
and selective contracting
legislation
legislation
subsidies
benefit package
subsidies
benefit package
pharmaceutical prices/profits
health system functions
system financing
assessment
pharmaceutical prices/profits
health system functions
system financing
assessment Coding, remuneration, and outcomes authority Coding, remuneration, and outcomes authority Risk adjustment mechanism for medical schemes Risk adjustment mechanism for medical schemes Priority setting authority (NICE or HITAP) Priority setting authority (NICE or HITAP)
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Missing middle Missing middle Purchasing efficiency Competition challenges Coding, remuneration, outcomes authority Transversal contracts Purchasing efficiency Competition challenges Coding, remuneration, outcomes authority Transversal contracts Pooling problems Pooling problems Priority setting Revenue collection Fiscal space Priority setting Revenue collection Fiscal space
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Risk adjustment mechanism for medical schemes Risk adjustment mechanism for medical schemes
Norms and standards for equitable financing in provinces Norms and standards for equitable financing in provinces
Priority setting authority (NICE or HITAP) Priority setting authority (NICE or HITAP) Coding, remuneration, and outcomes authority Coding, remuneration, and outcomes authority Transversal contracts for medicines, surgicals, labs and equipment Transversal contracts for medicines, surgicals, labs and equipment Prepare for a purchaser provider split, improve service delivery Prepare for a purchaser provider split, improve service delivery State sponsorship for missing middle State sponsorship for missing middle Stewardship, governance and oversight Stewardship, governance and oversight Creating resources Creating resources HIV independent of donor funding HIV independent of donor funding Total Single health information platform
(Million Rands)
Virtual single risk pool Virtual single risk pool
1,000 1,000 20 20 10 10 10 10 20 20 20 20 5 5 10 10 6,600 6,600 5 5 100 100 12,800 12,800 5,000 5,000
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generated as a result of stronger economic growth, improved tax compliance, expenditure reprioritisation, elimination of inefficiency and corruption and increased effectiveness of public spending.”*
expenditure cut over two years mostly affects the health system, the provision of free basic services, the roads network and rural water and electricity provision). * *
members of medical schemes.
magic numbers.
* The Davis Tax Committee. The tax system and inclusive growth in South Africa: Towards an analytical framework for the Davis Tax
* * Ensor, Linda and Paton, Carol. Health and basic services to feel pain of R40bn spending cut. Business Day. 27 OCTOBER 2016
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─ Rigidity ─ Payroll taxes and non-wage cost of employment ─ Political commitment to health is more important
World Health Report not appropriate in SA
─ High rates on a narrow tax base
─ Rather improve the effective tax rate* from 17% to 28%
* The Davis Tax Committee. The tax system and inclusive growth in South Africa: towards an analytical framework for the Davis Tax
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van Papendorp, Herman and Packirisamy, Sanisha. MTBPS 2016: additional taxes and spending cuts used to negate weaker growth impact on fiscus. Macro Research and Asset Allocation. Pretoria : Momentum Collective Investments (RF) (Pty) Ltd, 26 October 2016.
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─ Exempted basic goods and social spending appears to negate the
regressive nature of VAT
─ Simplicity linked with robustness, depth and breadth ─ Best vehicle for expansion of NHI as benefits expand through the
proposed virtual single risk pool
─ Give small tax credits to reward healthy behaviour ─ Rewards programme similar to wellness programmes in the market
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MMI passionately supports the drive towards Universal Health Coverage for all South Africans. MMI’s purpose, which is to enhance the lifetime financial wellness of people, communities and businesses, is 100% aligned with this objective.
* National Planning Commission. National Development Plan 2030 Our future - make it work. Department of the
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Lluis Masriera. Sombras reflejadas (1920)