NATIONAL HEALTH ACCOUNTS STUDY

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NATIONAL HEALTH ACCOUNTS STUDY

• School of Public Health
• The Ministry of Health, Turkey
• Salih MOLLAHALILOGLU MD, MSc
• Mehtap KARTAL MD

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NATIONAL HEALTH ACCOUNTS STUDY

• Key questions which will be helpful for
  answering NHA
• How big are the health system and its components
  in economy?
• Who, How much does someone pay?
• What are those payment mechanisms?
• How do the resources are distributed among
  service providers and kinds of service?
• How does the financial value of the benefits is
  distributed ?
• Where do we stand when we are compared with other
  countries?

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NATIONAL HEALTH ACCOUNTS STUDY

• TURKEY
• Health financing highly fragmented
• Difficult to ascertain spending across different
  functions by different agents
• Different funding sources have different
  incentive implications affecting provider and
  consumer behavior differently
• Difficult to ensure efficiency and equity in
  public spending
• Fragmentation increases administrative costs
• Mukesh CHAWLA, World Bank, Presentation of NHA
  Training, Turkey

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NATIONAL HEALTH ACCOUNTS STUDY Health Financing
Flows
Sources
Financing Agents
Health Providers
Taxes
Public Institutions
Public
Public
Public Payments
Social Security Funds
Liabilities
Private
Private Sector / Private Insurance Enterprices
Credits
Loans
Employers
Private
Aids
Private Household Out-of Pocket
Out-of-Pocket Expenditures
Employers
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NATIONAL HEALTH ACCOUNTS STUDY
Health Financing Flows
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NATIONAL HEALTH ACCOUNTS STUDY

• Prepared Data Collection Tools
• Associations (Sample prepared for 3704
  associations related with health )
• Foundations (Questionnaires sent to all 256
  foundations related with health which were given
  by General Directorate of Foundations)
• Private Hospitals (via Association of Private
  Health Institutions)
• Private Health Insurance (via Turkey Insurance
  and Reasurance Companies Associations)
• Private Business Enterprise (Addresses provided
  from Ministry of Labor)

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NATIONAL HEALTH ACCOUNTS STUDY

• Prepared Data Collection Tools
• State-owned economic Enterprise (provided through
  the agency of the Treasury, only 1 is missing)
• Privatization Administration (The information has
  been partly reached)
• Social Security Units under the provisional
  article of 20 of Social Insurance Organization
  Law (Provided through Ministry of Labor)
• Municipalities (Questionnaires sent to all 3200
  municipalities by Ministry of Internal Affairs)
• Private Provincial Administrations
  (Questionnaires answered by all 81 provinces)

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NATIONAL HEALTH ACCOUNTS STUDY

• Hospital Study
• Determining how payments are provided for
  Service Providers/hospitals and how these
  financial resources including general budget are
  spent and used for which services by service
  providers. Data base depends on, hospitals
  curative care division by
• Inpatient curative care
• Outpatient curative care
• Dental care
• Services of Rehabilitative care and
• Education-training of Health personnel
• according their ratio within the hospitals.

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NATIONAL HEALTH ACCOUNTS STUDY

• Household Study
• The general goal of the Household Survey is to
  estimate out-of-pocket expenditures on all levels
  of health care for a representative sample of
  10,675 household. The answering rate is generally
  91.85. As we do not have the final report we
  dont have the details of this study. But some
  results presented in the last meeting on 19-20
  June 2003.
• The insurance coverage is 67.20.

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NATIONAL HEALTH ACCOUNTS STUDY
Annual Per Capita Health Expenditures by Region
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NATIONAL HEALTH ACCOUNTS STUDY
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NATIONAL HEALTH ACCOUNTS STUDY
Turkey
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NATIONAL HEALTH ACCOUNTS STUDY
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NATIONAL HEALTH ACCOUNTS STUDY

• Main Challenges of the Study
• Institutionalization
• SPO take NHA as a project to be done by SIS and
  its budget given to SIS
• Regular, standart data collections
• Use of data by Policy-makers