2016年-世界发展银行全球_Health_Financing_Policy___The_Macroeconomic_Fiscal_and_Public_Finance_Context_77页_1mb

报告摘要

Summary of Health Financing Policy: The Macroeconomic, Fiscal, and Public Finance Context

Core Content

This World Bank study explores the macroeconomic, fiscal, and public finance context of health financing policy, with a focus on how governments can better align their spending with health system objectives while ensuring fiscal sustainability and efficiency. The document emphasizes the importance of understanding the broader economic and financial environment to inform effective health financing strategies.

Main Objectives

To provide a framework for health financing policy dialogue that considers macroeconomic, fiscal, and public financial management (PFM) realities.
To guide country-level discussions on the role of government in health financing, the resources required, and how health spending should be prioritized and managed.
To identify potential new revenue sources and improve the efficiency and equity of health funding.

Key Questions and Topics

1. Realistic Government Health Spending Scenarios

What are the realistic scenarios for total government health spending, given macroeconomic and fiscal realities and competing budget priorities?
What is the overall size of the economy and its expected growth over the next five years?
How effectively does economic growth translate into government revenue?
How significant is development assistance in the economy, and what are its implications for macroeconomic and fiscal contexts?
How much of the government budget can be feasibly reallocated to health spending?

2. Potential New Revenue Sources for the Health Sector

Which new revenue sources could generate additional funds in the most efficient and equitable way?
Which revenue sources are administratively and politically feasible?
Which revenue sources could generate additional funds without simply offsetting existing government health spending?
Which revenue sources align with the pooling and purchasing functions of health financing?

3. Aligning Health Spending with Health System Objectives

What constraints in the current PFM system could be eased to improve pooling and purchasing?
To what extent does fiscal decentralization support or inhibit pooling, redistribution, and cross-subsidization of health funds?
How many different funding pools exist in the health sector?
Are there mechanisms to accumulate and redistribute health funds across different pools?
Can health sector budgets be developed, disbursed, and accounted for based on priority populations, programs, and services rather than inputs?
What accountability measures can be put in place to ensure funds are used effectively for priority populations, programs, and services?

4. Fiscal Sustainability of Current Health Spending Patterns

To what extent are health sector objectives being met without expenditures regularly exceeding revenue?
Do expenditures regularly exceed revenues in the health system or subsystems?
Are there efficiency gains that could make better use of existing funds?
What institutional investments are needed to address inefficiencies in the short, medium, and long term?
What incentives exist at different levels of the system to generate efficiency gains?

Key Information

Universal Health Coverage (UHC) requires adequate financial resources that are both pooled and redistributed to ensure equity and financial protection.
Government revenue is essential for achieving UHC, as private voluntary funding is insufficient to cover the entire population.
Fiscal space is a critical concept in health financing, referring to the budgetary room available for increasing or reallocating health spending.
Bottom-up costing is often impractical for informing total resource requirements due to inflated estimates and lack of coordination between cost estimates, implementation plans, and budget processes.
Program-based budgeting is becoming more common in OECD countries, but such tools are not yet widely used in low- and middle-income countries.
Fiscal decentralization can influence the ability to pool and redistribute health funds effectively.
Public financial management (PFM) is crucial for aligning health spending with system objectives and ensuring accountability.

Case Studies and Examples

Peru: The Essential Health Services Plan (PEAS) was developed using cost and disease burden criteria, but implementation was hindered by a lack of coordination.
Ghana: The government health budget increased by 113%, but the resource gap remained significant.
India: The estimated annual resource gap for the health sector was $6.6 billion.
Zambia: A $1.2 billion gap was projected over five years.
Kazakhstan: A new health revenue source displaced government budget allocations.
France, Japan, and Ghana: These countries have explored diversified revenue sources for the health sector.
Brazil and India/Vietnam: Fiscal decentralization has influenced the priority of health in the budget.

Conclusion

The study highlights the need for a comprehensive understanding of the macroeconomic, fiscal, and PFM context to inform effective health financing policy. It stresses the importance of aligning health spending with system objectives, improving fiscal sustainability, and enhancing efficiency through better resource pooling and purchasing mechanisms. The guidance note provides a structured approach for policy dialogue and decision-making at the country level.

References and Resources

The document references key reports such as the World Health Report (2010) and the World Bank's Health Financing Revisited (2006).
It also draws on 11 case studies from the Japan-World Bank Partnership Program for Universal Health Coverage.
The study emphasizes the use of data and tools from the System of Health Accounts (SHA) and the Global Health Expenditure Database (GHEDB) to support analysis and decision-making.

Abbreviations

UHC: Universal Health Coverage
GHEDB: Global Health Expenditure Database
SHA: System of Health Accounts
PFM: Public Financial Management
GFM: Global Fiscal Model
GFS: Government Finance Statistics
NHI: National Health Insurance
NHIS: National Health Insurance Scheme
SIS: Comprehensive Health Insurance
SSNIT: Social Security and National Insurance Trust
SUS: Unified Health System
PEAS: Essential Health Services Plan
DRG: Diagnosis-Related Group
CSG: Generalized Social Contribution
OOP: Out-of-Pocket Health Expenditure
GNI: Gross National Income
GDP: Gross Domestic Product
IMF: International Monetary Fund
OECD: Organisation for Economic Co-operation and Development
JLN: Joint Learning Network for Universal Health Coverage
RBF: Results-Based Financing
PHRD: Partnership for Human Resources Development
PEPFAR: President's Emergency Plan for AIDS Relief
WHO: World Health Organization
VAT: Value-Added Tax
VSS: Vietnam Social Security
HNP: Health, Nutrition, and Population
NHA: National Health Accounts
MOH: Ministry of Health
NHSO: National Health Security Office
HCP: Health Coverage for the Poor

This guidance note is a valuable tool for policymakers and international partners to better understand and address the challenges of health financing in the context of macroeconomic and fiscal realities.

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