NATIONAL HEALTH ACCOUNTS IN TURKEY (1999-2000)

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NATIONAL HEALTH ACCOUNTS IN TURKEY (1999-2000)

• School of Public Health
• The Ministry of Health, Turkey
• Salih MOLLAHALILOGLU MD, MSc
• Mehtap KARTAL, MD
• Results of Final Draft Report

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• 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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• TURKEY
• Data existing within the system is only in gross
  terms
• Data needed for comparison is in detail so that
  must be collected in different ways
• Especially it is hard to have the data for
  different functions by different financing agents
  and health-care providers
• Different funding sources, health-care providers
  have different legal and administrative structure
  leading to different data basis with different
  problem for collection.

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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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Health Financing Flows
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NATIONAL HEALTH ACCOUNTS IN TURKEY

• It was done as a World Bank Project by the School
  of Public Health, Ministry of Health of Turkey
  between 2002 and 2003. The study was carried out
  by a partnership between the International Health
  Systems Program, Department of Population and
  International Health, Harvard School of Public
  Health and the School of Health Administration,
  Hacettepe University.
• The study used advantage of more recent
  methodological developments, particularly the
  development by the OECD of the System of Health
  Accounts framework (SHA) and the International
  Classification of Health Accounts (ICHA) in 2000.
  It also incorporated additional methodological
  advances from the Guide to Producing National
  Health Accounts with Special Applications for
  Low-income and Middle-income Countries of the
  World Bank, World Health Organization, and U.S.
  Agency for International Development, published
  in 2003.

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TURKISH NHA FRAMEWORK

• A sub-committee of the Steering Committee to
  work on the development of a Turkish NHA
  framework. The committee concluded that Turkey
  should be able to report health expenditure data
  to the OECD using the SHA framework, but that for
  domestic policy purposes greater detail and some
  departures from certain SHA recommendations were
  needed. The Turkey NHA
• uses a broader definition of health expenditure
  than that proposed in SHA but retains additional
  health expenditure items in separate
  classifications so that these can easily be
  removed to create SHA-compatible tables.
• includes some elements of health-related
  functions in the totals reported for domestic
  use.
• have been added additional classifications beyond
  the basic levels to capture specific
  institutional conditions in Turkey that are
  relevant for policy.

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NATIONAL HEALTH ACCOUNTS IN TURKEY

• 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 Reassurance Companies Associations)
• Private Business Enterprise (Addresses provided
  from Ministry of Labor)

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NATIONAL HEALTH ACCOUNTS IN TURKEY

• 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 IN TURKEY

• Hospital Survey
• 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 IN TURKEY

• Household Survey (2002-2003)
• 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 households in 2 rounds.
• First round is done between September-November
  2002, while the second round March-April 2003.
• The answering rate is generally 91.85.

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NATIONAL HEALTH ACCOUNTS RESULTS

• Household Survey (2002-2003)
• The insurance coverage is 67.20.
• Annual Utilization Rate per Person
• Out-patient visits 4.23
• Hospital admissions 0.077
• Annual per capita out-of-pocket health spending
  estimated after reimbursement
• Total out-patient expenditures 58,7
• Total hospitalization expenditures 10,3

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Shares of Total Current Health Expenditure
Flowing from Different Financing Agents Turkey,
2000
Financing Agent Percentage of Total Current Health Expenditure
Central Government 24.2
MoH Health Programs Green Card Annexed budget institutions Civil servants health benefits Other 10.2 2.3 2.8 7.1 1.8
Local Government 4.0
Social Security Funds 35.0
SSK GERF Bag-Kur 18.8 7.5 8.7
Total Public 63,2
Private social insurance .7
Private insurance enterprises 3.6
Household out of pocket spending 27.5
Corporations direct expenditure 3.6
Other 1.4
Total Private 36,8
Total 100.0
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NATIONAL HEALTH ACCOUNTS RESULTS
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NATIONAL HEALTH ACCOUNTS RESULTS
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NATIONAL HEALTH ACCOUNTS RESULTS
Turkey
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NATIONAL HEALTH ACCOUNTS

• Main Challenges of the Study
• Institutionalization Important as it will
  support the solutions of systems problems
  especially for reliable data. SPO take NHA as a
  project to be done by SIS and its budget given to
  SIS.
• Regular, standard data collection Its hard as
  the health system is fragmented (each financing
  agents, health-care providers by different laws).
  
• Use of data by Policy-makers All data not used
  for policy-makers are not useful for the society.

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NATIONAL HEALTH ACCOUNTS IN TURKEY (1999-2000)

• School of Public Health
• The Ministry of Health, Turkey
• Salih MOLLAHALILOGLU MD, MSc
• salih_at_spgk.saglik.gov.tr
• Mehtap KARTAL, MD
• mehtap_at_spgk.saglik.gov.tr
• Results of Final Draft Report
• THANKS TO ALL PARTIES TAKE PLACE IN THIS STUDY