2014年-世界发展银行全球_Timor_Leste___Health_Equity_and_Financial_Protection_Project_32页_2mb

Health Equity and Financial Protection Report - Timor-Leste

Core Content

This report provides an analysis of health equity and financial protection in Timor-Leste, focusing on disparities in health outcomes, utilization of health services, benefit incidence of government spending, and the progressivity of health financing. It draws on data from various household surveys and uses the ADePT software for analysis.

Main Topics Covered

• Health Equity: Inequalities in health outcomes and behaviors across different wealth quintiles.
• Health Financing: The composition and distribution of health expenditures, including government and out-of-pocket (OOP) spending.
• Financial Protection: The impact of OOP payments on household financial well-being and the risk of impoverishment.
• Progressivity of Health Financing: Analysis of how health financing is distributed among income groups.
• Policy Implications: Recommendations for improving health equity and financial protection in the country.

Key Findings

1. Health Inequalities

• Ill health is more concentrated among the poor, as evidenced by higher rates of infant mortality, under-five mortality, stunting, and underweight.
• Wealthier households are more likely to report child illnesses like diarrhea and fever, possibly due to better recognition of symptoms.
• Obesity among non-pregnant women and sexually transmitted diseases (STDs) among men are more prevalent among the better-off.
• Smoking is more common among the poor for both men and women.

2. Health Care Utilization

• Health care utilization is concentrated among the better-off.
• Immunizations, treatment of acute respiratory infections (ARI), and use of bed nets are more common in wealthier households.
• Skilled antenatal care and delivery, contraceptive prevalence, and use of bed nets are also higher among wealthier women.

3. Government Spending on Health

• Government spending on health is pro-rich, especially for hospital care.
• For lower-level services like community health centers (CHCs), health posts, and mobile clinics, government spending is pro-poor under two of three methodological assumptions.
• Total government subsidies for health are pro-rich.
• The share of government expenditure on health as a percentage of GDP has been declining, from 5.1% in 2011 to lower levels in recent years.
• Government health spending is relatively low compared to other East Asian countries, even though it is a high proportion of total health expenditure.

4. Out-of-Pocket (OOP) Payments

• OOP spending accounts for about 4% of total health expenditure (THE) in Timor-Leste.
• Only 0.9% of households spend 10% or more of their household income on OOP payments.
• 9.6% of households spend 10% or more of their non-food consumption on OOP payments.
• Health spending has a minor effect on increasing the poverty rate, with less than 1% of households falling below the $1.25/day poverty line due to health costs.

5. Progressivity of Health Financing

• Health financing is progressive, with the wealthiest 20% covering 74% of total health care payments, compared to 39% of consumption.
• The poorest two quintiles spend only 5% of total health care payments, while their share of consumption is 22%.

Policy Implications

1. Improve Frontline Services:

   • Strengthen the availability and quality of services at community health centers (CHCs), health posts, and mobile clinics.
   • Leverage the influx of newly trained doctors to enhance primary care, especially in rural areas.
   • Improve infrastructure and management to support health workers and ensure quality care.

2. Enhance Access to Secondary Care:

   • Address barriers to secondary care for the poor, including physical access to hospitals.
   • Consider introducing travel vouchers or partial reimbursement for those needing referrals to secondary care.
   • Improve transparency in overseas referral programs to ensure equitable resource allocation.

3. Monitor Fiscal Impact on Health Services:

   • Closely monitor the effects of tightening fiscal space on service utilization, especially for the poor.
   • Use household surveys (e.g., DHS, TLSLS) to track the impact of health spending on poverty and financial protection.

Key Data Sources

• Demographic and Health Survey (DHS): 2009/2010
• Living Standards and Measurement Survey (TLSLS): 2007/2008
• Household Income and Expenditure Survey (HIES): 2011/2012
• Ministry of Finance (MoF): Budget data and health expenditure statistics

Abbreviations

• ARI: Acute respiratory infection
• BIA: Benefit-incidence analysis
• CHC: Community health centers
• CI: Concentration index
• CPI: Consumer price index
• DHS: Demographic and Health Survey
• EAP: East Asia and Pacific
• GDP: Gross domestic product
• GHE: Government health expenditures
• GNI: Gross national income
• HIES: Household Income and Expenditures Survey
• HNGV: Hospital Nacional Guido Valadares
• MCH: Maternal and child health
• MICS: Multiple Indicator Cluster Survey
• MoH: Ministry of Health
• NHA: National health accounts
• OOPs: Out-of-pocket spending
• PPP: Purchasing power parity
• SAMES: Servico Autonomo de Medicamentos e Equipamentos de Saude
• SISCa: Sistema Integradu Saude Communitaria
• THE: Total health expenditure
• WHO: World Health Organization

Methodology

• Analyses are conducted using the ADePT software.
• The report uses a concentration index (CI) to measure inequality, where negative values indicate higher prevalence among the poor and positive values indicate higher prevalence among the better-off.
• Data on health outcomes and utilization are drawn from household surveys, including the DHS and TLSLS.

Conclusion

The report highlights significant health inequalities in Timor-Leste, particularly in child and adult health outcomes, and underscores the need for targeted interventions to improve access to health services and ensure financial protection for the poor. While government spending is relatively high in proportion to total health expenditure, its distribution favors the better-off, indicating a need for more equitable resource allocation. The progressivity of health financing is noted, but further efforts are required to translate this into improved health outcomes for all segments of the population.