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  Choice & creation of the « Redevance Obligatoire l’Assurance Maladie » (ROAM)  Impacts & limits of the ROAM  Creation of the “Contribution Spéciale de Solidarité”  Bottlenecks  Conclusion 3 |

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… 4 |

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. 5 |

Choice & creation of the ROAM (1) Sufficient resources STABILITY & EQUITY PREDICTABILITY Criteria for choosing taxes Low impact on EFFICIENCY the consumption 6 |

Choice & creation of the ROAM (2) Taxe under Negociations Withheld taxes review • Employer hostility Tax on mobile • Mistrust from unions • Tobacco & Alchool phones • Resistance from • Airline tickets private insurers • Hydrocarbons and ( Expanding Sectors, luxury products) • Pressure from mining Tax on financial unions fighting • Mobile phones transactions (country against poverty • Financial with strong immigration) transactions 7 |

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. 8 |

Impact of the ROAM Dépenses Totales de  Extension of health Santé (DTS) 350,000,000,000 Régimes de l'administration publique coverage to the poor Régimes contributifs obligatoires ROAM 300,000,000,000 people (700 000 people); 250,000,000,000  Increase on DTS; 200,000,000,000  Increased GGEH ; 150,000,000,000  Decline of Out Of Pocket 100,000,000,000 Expenditure; 50,000,000,000  Fungibility of funds or 0 2010 2011 2012 2013 2014 2015 economic crisis ? 9 |

Limits of the ROAM 30 BILLION 25 R² = 0.8462 R² = 0.88 20 15 10 ROAM et TTF 5 Total dépenses Log. (ROAM et TTF) Linear (Total dépenses) 0 2009 2010 2011 2012 2013 2014 2015 2016 2017 10 |

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. 11 |

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. 12 |

Conclusion Political leadership ; Strong health financing Strong partnership between instrument; MOF and MOH Increase DTS, GGHE ; Tax base financing (ROAM) Reduction of OOP (20%); is a political instrument ; Increase providers resources; 90% of the poor covered ; Improved tax collection; Accountability: Largest pooling of resources; National Health Account (NHA) Control of health insurance Public Expenditure Review (PER) expenditure; Quality of service? Strategic purchasing; People satisfaction? Inefficiency of expenditure 13 |