DELSA/GOV 3rd Health meeting - Anita CHARLESWORTH
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Transcript of DELSA/GOV 3rd Health meeting - Anita CHARLESWORTH
© Nuffield Trust 25 April 2014
User Changes and Co-payments: How useful and how dangerous?
Anita Charlesworth Chief Economist Nuffield Trust
© Nuffield Trust
The concerns about user charges and co-payments
• User charges increase the financial burden on households, and, in general, they do not differentiate effectively between cost-effective and low-value care.
• They reduce use among lower-income individuals and older people, even when the level of user charges is low.
• Increasing user charges in primary or ambulatory care may worsen health outcomes. In some cases they may increase spending in more expensive acute, emergency care.
• The transaction costs involved may be significant.
(Wagstaff and others 1992, Newhouse & Rand Corporation Insurance Experiment Group,1993; Gemmill
and others 2008 Braithwaite and Rosen, 2007; Bach, 2008; Thomson and others, 2009, Trivedi and others
2008, Goldman and others 2007).
© Nuffield Trust
0%
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out of pocket as a % of spending Average Out of pocket spending
Source: OECD 2013
Out of pocket spending and health spending as a share of GDP across the OECD
© Nuffield Trust
Out of pocket spending and health spending as a share of GDP across developed countries
Source: OECD 2013
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out of pocket as a % of spending health spending as a share of GDP
Average out of pocket Average health spending as share of GDP
© Nuffield Trust
Why do user charges and co-payment policies continue to be such a focus on policy debate and action
• Unpalatable alternatives?
• Scope to raise revenue which although comparatively small are important in an economic and fiscal crisis?
© Nuffield Trust
Bringing tax and spend back to pre-crisis levels
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Government spending as a share of total budget
© Nuffield Trust
© Nuffield Trust
Relationship between out of pocket expenditure and male PYLL (23 countries)
R² = 0.0033
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Out of pocket as a proportion of spending %
© Nuffield Trust
Relationship between out of pocket expenditure and female PYLL (23 countries)
R² = 0.1307
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Out of pocket as proportion of spending %
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Relationship between Out of pocket expenditure and gap between male/female, potential year life loss (PYLL) (23 countries).
R² = 0.2656
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perc
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Out of pocket as a proportion of spending %
© Nuffield Trust
What is the role of user charges and co-payments in health system sustainability
• Increasing user charges and co-payments in countries with universal coverage is tempting as a short-term source of additional revenue. But they are unlikely to improve system efficiency.
• In assessing the health effects policy makings need to consider the alternatives which may have equal if not greater negative impacts on health or well being.
• User charges and co-payments are unlikely to improve long-term sustainability for which stable funding growth and sustained productivity growth is key.
© Nuffield Trust
Size of over and underspending in percentage of budgeted spending (2006 – 2012)
© Nuffield Trust 23 April 2014
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