2012年-CEPS欧洲政策研究中心_Health_Expenditure_Scenarios_in_the_New_Member_States_64页_907kb

Summary of "Health Expenditure Scenarios in the New Member States"

Core Content

This report presents a comparative analysis of health expenditure scenarios in five Central and Eastern European (CEE) countries: Bulgaria, Estonia, Hungary, Poland, and Slovakia. It is based on the ILO social budget model, which is used to project health care system revenues and expenditures. The study examines the impact of demographic, economic, and policy factors on the financial sustainability of health care systems in these countries.

Main Views and Key Information

1. Health Expenditure Projections

Health expenditure projections are based on the ILO social budget model, which is designed to analyze the financial balance of health care systems. The model incorporates a wide range of factors, including:

• Demographic changes (e.g., aging population, life expectancy)
• Labour market developments (e.g., employment rates, participation rates)
• Macroeconomic factors (e.g., GDP growth, inflation, productivity)
• Health status and utilization patterns

The report evaluates several scenarios, including:

• Baseline scenario: Assumes continued trends in health expenditures and population aging.
• Scenario of increased expenditures in the last year of life: Highlights the impact of higher costs for the elderly.
• Diverse longevity scenarios: Explores the effect of different life expectancy improvements on health expenditures.
• Diversified wage growth scenario: Examines the influence of varying wage growth on financial balance.
• Labour market indicators diversified development scenario: Analyzes the impact of different employment and participation rates.
• Sensitivity analysis: Assesses the effect of variations in key variables on health expenditure outcomes.

2. Health Care Systems in the New Member States

The five countries have undergone significant health care reforms, transitioning from integrated budgetary funding to health insurance systems funded by payroll taxes. Key points:

• Health insurance introduction years:

  • Bulgaria: 1999
  • Estonia: 1991
  • Hungary: 1990 (social insurance), 1996 (separate health insurance)
  • Poland: 1999
  • Slovakia: 1994

• Contribution rates:

  • Bulgaria: 6.0%
  • Estonia: 13.0%
  • Hungary: 14.0%
  • Poland: 9.0%
  • Slovakia: 14.0%

• Share of health insurance in total health care funding:

  • Bulgaria: 32%
  • Estonia: 66%
  • Hungary: 71.6%
  • Poland: 62.7%
  • Slovakia: 86%

The introduction of health insurance was supported by medical circles, as it provides a more stable and predictable funding mechanism compared to budgetary allocations, which are subject to political decisions.

3. Data Sources

The projections are based on both national and international data sources:

• National data:

  • National statistical offices
  • National health and social insurance institutions
  • Governmental agencies (e.g., Ministry of Health, Ministry of Finance)
  • National banks

• International data:

  • United Nations
  • OECD
  • ILO
  • Eurostat
  • European Commission

Due to the rapidly changing economic environment in transition countries, historical data used in the model is often an average over a longer period rather than data valid for the base year. In some cases, long-term data is not fully reliable for projections.

4. Assumptions and Variable Development

• Demographic variables: Based on total fertility rate (TFR), life expectancy (LE), and population structure (especially the share of the 65+ population).
• Labour market variables: Includes employment and participation rates, unemployment rates, and wage growth.
• Macroeconomic variables: GDP, inflation, and productivity.
• Income elasticity: Assumed to be a key factor influencing health expenditures.
• Health status and utilization: Based on age-specific health service usage and mortality rates.

5. Projection Results

• Public health expenditures as a share of GDP are projected to increase due to aging populations and higher health needs in later life.
• Deficit/surplus is influenced by changes in health expenditures, revenues, and policy assumptions.
• Death-related costs are an important factor in the financial balance of health care systems, especially in Hungary and Poland.
• Longevity scenarios show that even small increases in life expectancy can significantly raise health expenditures.
• Wage growth and employment rate scenarios indicate that economic conditions have a major impact on the financial sustainability of health care systems.

6. Conclusions and Policy Recommendations

• The financial sustainability of health care systems in the New Member States is increasingly challenged by aging populations and rising health expenditures.
• The ILO model provides a comprehensive framework for analyzing these trends, although it requires adjustments to reflect specific national contexts.
• Policy recommendations include:
  • Improving financial mechanisms to ensure long-term sustainability.
  • Enhancing data collection and reliability.
  • Considering the impact of demographic changes on health financing.
  • Implementing reforms that address the rising costs associated with aging populations and last-year-of-life expenditures.

Key Takeaways

• Health expenditures are significantly influenced by demographic changes, especially aging populations.
• ILO model is a robust tool for projecting health expenditures and financial balance, but it must be adapted to national conditions.
• Policy variables were not included in the analysis, assuming that the legal and financial frameworks remain stable.
• Sensitivity analysis highlights the importance of variables such as life expectancy, wage growth, and employment rates in determining health care system outcomes.
• Comparative analysis reveals differences in health financing structures and the impact of various reforms across the five countries.