Issues of health care financing May 2003

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Issues of health care financing May 2003

• Dr Gyula Kincses

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Basic trends characterising 21st century
societies

• Extension of life, transformation of societys
  age structure
• Harmonisation of certain diseases with life,
  thereby increasing the proportion of people
  living with diseases and disabilities
• Increasing demand to improve quality of life for
  people with disabilities
• Expected leaps in the development of medicine and
  medical technology (genetic engineering,
  biotechnology).

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Consequence of the trends

• The health care delivery system cannot be
  financed in a lasting and sustainable way based
  on traditional principles.
• Directions for solution
• -  specification and selection of risks treated
  by compulsory health insurance,
• -  restructuring the resources of compulsory
  health insurance,
• -  improving self-care, preference of health
  saving
• - specification of services and provisions.

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Specification and selection of risks treated by
compulsory health insurance

• Separation of risks having outside interest
• occupational health, competitive sports
• Separation of other types of risks
• nursing insurance
• Shifting of the costs of damages caused by a
  third party
• traffic accident, physical injury etc.
• Deflection of voluntary risks to supplementary
  insurance
• extreme sports, dangerous animals

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Restructuring the resources of compulsory health
insurance

• Elimination of health contribution (EHO),
  keeping the money within the sector.
• Restructuring the rate of employer-employee
  contribution.
• The principle everyone possesses legal status
  based on demonstrable contribution payment
  should be actualised.
• The principle everyone is paid by whoever grants
  livelihood should be in force.
• The system cannot be financed by contributions
  tied exclusively to wages.
• Budgetary support should be planned support
  rather than planned deficit.
• Settlement of the situation of those not living
  on wages.

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Specification of services and provisions

• The service catalogue cannot be fully made, but
• -         The authorisation order based on
  minimum conditions is taking this direction.
• -         Financing rules (book of rules) are
  also suitable for specification of service
  package.
• -         The examination-therapy procedural
  order is still an existing instrument.
• This issue will come up again in this conference
  in connection with innovation policy.

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Improving self-care, preference of health saving
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Inequalities in the health care system

• Considering social polarisation and the burden
  weighing on underprivileged groups, the rate of
  private financing is high in Hungary
• Private financing is unevenly burdened and
  appears almost exclusively as incidental cash
  payment
• There are great regional inequalities in the
  accessibility of the delivery system.

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Health care system of different countriesfrom
the viewpoint of the equity of financing

Source M. Schneider Gesundheitssysteme im
internationalen Vergleich, OECH database . On the
basis of data between 1994 and 1998
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Restructuring the regulatory system of the
health fund

• membership fee based on 100 solidarity
  principle, in place of the 40-60 mixed system
  for the public services of the health fund
• -         assessment of health status, screening,
  making of health plan
• -         community prevention and life style
  programmes
• -         organisation of services
• -         consumer protection.
• Optional health account for members, though not
  only the health fund can manage health accounts.

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Definition of health account

• The Health Account is a current account that is
• supported with tax benefits equal to the health
  funds
• at a specified account manager
• -         financial institution
• -         health fund
• -         business insurer
• for which reimbursement can be performed in case
  of purchase at
• qualified service provider
• special professional enterprise

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Services of the Health Account

• Health services in kind
• -         obligatory share of services financed
  by social insurance
• -         voluntary supplementary fee (hotel,
  meal etc.) in line with services financed by
  social insurance
• -         services used at providers not financed
  by social insurance
• Purchase of drugs and medical aids, other
  medical technology products
• Nursing care
• Income-supplementing services following
  accumulation/deposit time (in other areas of
  social security, life annuity etc.).

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Tax benefits of Health Account

• Health Account receives tax benefits equal to the
  health funds.
• Business insurance covering mostly health care
  services should also receive identical tax
  benefits.
• The rate of tax benefits as health-oriented
  saving should be determined in a common
  platform.
• Short-term flowing financing and health saving
  should be differentiated in tax benefits.

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Stimulation of service market

• The condition for the spread of supplementary
  financing is the development of the service
  market.
• Consensus-based provider agglomeration with
  common accreditation.
• Extension of optimal co-payment system
• -    choice of doctor and institute (with the
  exception of primary care)
• - services without regional obligation to
  provide.

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Thank you for your attention