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PUBLIC FINANCING FOR UHC: TOWARDS IMPLEMENTATION Perspectives on - - PowerPoint PPT Presentation
PUBLIC FINANCING FOR UHC: TOWARDS IMPLEMENTATION Perspectives on - - PowerPoint PPT Presentation
PUBLIC FINANCING FOR UHC: TOWARDS IMPLEMENTATION Perspectives on earmarking as a health financing instrument? Dr Aboubacar INOUA, MD, MPH, HEC WCO GABON 1 | CNAMGS experience in earmarking 2 | SESSION OUTLINE Context Objectives
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Context Objectives Choice & creation of the « Redevance Obligatoire l’Assurance Maladie » (ROAM) Impacts & limits of the ROAM Creation of the “Contribution Spéciale de Solidarité” Bottlenecks Conclusion
SESSION OUTLINE
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CONTEXT
30% of the population living below the poverty line; Bankruptcy of the insurance system designed to poor people; 20% of the population benefits from health insurance; General Government Health Expenditure : 7% of GGE; Out Of Pocket Expenditure : 47% of DTS; DTS: 3% of GDP ; Low performance of the health system; Low health indicators : RMM, TMM5, HIV/AIDS…
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Objectives
Provide health insurance to the poor people:
Ensure financial accessibility to quality care for the population, especially the poorest; Reduce Out Of Pocket Expenditure.
Identify additional income and earmarking to the health of the poor; Ensure equity in financial contributions; Improve the management of financial resources in the health sector.
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Choice & creation of the ROAM (1)
Criteria for choosing taxes
Sufficient resources EQUITY Low impact on the consumption EFFICIENCY STABILITY & PREDICTABILITY
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Choice & creation of the ROAM (2)
Taxe under review
- Tobacco & Alchool
- Airline tickets
- Hydrocarbons and
mining
- Mobile phones
- Financial
transactions
Negociations
- Employer hostility
- Mistrust from unions
- Resistance from
private insurers
- Pressure from
unions fighting against poverty
Withheld taxes
Tax on mobile phones
( Expanding Sectors, luxury products)
Tax on financial transactions (country
with strong immigration)
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Choice & creation of the ROAM (3)
Act n°0022/PR/2007 of 21 August 2007, establishment of the health insurance ; ROAM indirect tax is composed of:
Tax of 10% of turnover on mobile phone companies; Tax of 1.5% on remittances abroad (outside the CEMAC zone) and foreign exchange transactions..
Liability, base tax and rates set by the Finance Act; ROAM is deductable from Personal Income Tax and Corporate Tax.
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Impact of the ROAM
Extension of health coverage to the poor people (700 000 people); Increase on DTS; Increased GGEH ; Decline of Out Of Pocket Expenditure; Fungibility of funds or economic crisis ?
50,000,000,000 100,000,000,000 150,000,000,000 200,000,000,000 250,000,000,000 300,000,000,000 350,000,000,000
2010 2011 2012 2013 2014 2015 Dépenses Totales de Santé (DTS) Régimes de l'administration publique Régimes contributifs
- bligatoires
ROAM
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Limits of the ROAM
R² = 0.88 R² = 0.8462 5 10 15 20 25 30 2009 2010 2011 2012 2013 2014 2015 2016 2017 BILLION
ROAM et TTF Total dépenses
- Log. (ROAM et TTF)
Linear (Total dépenses)
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Special Contribution for Solidarity (CSS)
Remove of the tax on mobile telephony in 2017 :
Economic crisis and employer pressure; Stagnation of income from ROAM; Reduced profit margin made by mobile phone companies..
CSS: 1% of the tax free amount applicable to all invoices for goods and services provided countrywide; Tax on consumption in line with VAT; Increase ROAM's income to meet the health care costs of the poor.
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Bottlenecks
Resistance of targeted economic operators; Heavy administrative burden for tax collection procedures; Involvement of several administrations in the tax management; Non-involvement of CNAMGS in the tax settlement; Delays, by the public treasury, to reverse the revenue; Absence of control over the frequency of payments; Absence of the pooling with other ressources.
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