Financial Sustainability in Health Systems: Theory and Practice

Contents

THE AUTHOR

ABSAM HEALTH POLICIES CENTRE

HEALTH POLICY BOOKS (HPBS)

FOREWORD

ABBREVIATIONS

1. INTRODUCTION

1.1. Introduction

2. HEALTH SYSTEMS

2.1. Introduction

2.2. Definition and Scope of a Health System

2.3. Goals and Functions of the Health System

2.3.1. Management and Stewardship

2.3.2. Delivery of Services

2.3.3. Resource Generation

2.3.4. Health Financing

2.4. Health System(s) Production Function

2.4.1. Factors that Determine the Level of Health Spending

2.4.1.1. Politics and Socioeconomic Variables

2.4.1.2. Technological Innovation and Developments

2.4.1.3. Population Ageing and Demographic Change

2.4.1.4. Higher Expectations

2.4.2. Approaches to Determining the Level of Health Expenditure: How Much Should Countries Spend on Health?

2.4.2.1. The Peer Pressure Approach

2.4.2.2. The Political Economy Approach

2.4.2.3. The Health Production Function Approach

2.4.2.4. The Budget Approach

2.4.3. Does Turkey Allocate Adequate Resources for its Health?

3. FINANCIAL SUSTAINABILITY IN HEALTH SYSTEMS

3.1. Introduction

3.2. Societal Sustainability

3.3. Sustainability in Health Systems

3.4. Financial Sustainability in Health Systems

3.4.1. The Concept of Financial Sustainability in Health Systems

3.4.2. Measurement and Assessment of Financial Sustainability in Health systems

3.4.2.1. Measurement and Assessment Based on Health Expenditures and Revenues/Resources

3.4.2.2. Stakeholder Views on Measurements and Assessments

3.4.3. Factors Affecting Financial Sustainability in Health Systems: the Nature of Financial Sustainability in Health Systems and Challenges

3.4.3.1. Increase in Health Expenditure

3.4.3.2. Limited Resources

3.4.4. What Must be Done to Achieve and Manage Financial Sustainability in Health Systems?

3.4.4.1. The Strategies Approach Aiming to Establish a Balance Between Expenditure and Revenue

3.4.4.2. The Framework of Paths to Sustainability Approach

3.4.4.3. The Framework of the Principles and Factors for Sustainable Health Systems Approach

4. FINANCIAL SUSTAINABILITY IN HEALTH SYSTEMS: THE TURKISH CASE

4.1. Introduction

4.2. Turkey’s Health System

4.2.1. Historical Background

4.2.1.1. The Pre-Reform Period: 1920-1960

4.2.1.2. The First-Wave Health Reforms: 1961-1980

4.2.1.3. The Second-Wave Health Reforms: 1981-2002

4.2.1.4. The Third-Wave Health Reforms: Health Transformation Program (HTP) 2003-2013

4.2.1.5. The New Turkey’s Health Vision: 2014-2023

4.2.2. Health Financing and Health Expenditure in Turkey

4.2.2.1. Health Spending as a Percentage of Gross Domestic Product

4.2.2.2. Health Expenditure Per Capita

4.2.2.3. Public Health Expenditure

4.2.2.4. Out-of-Pocket Health Expenditure

4.2.2.5. Pharmaceutical Expenditure

4.2.2.6. Distribution of Health Expenditure by Function and Financing Agent in Turkey

4.2.3. The Health Care Delivery System

4.2.4. Financial Resource Allocation and Payment Methods in Health Services

4.3. Financial Sustainability in Turkey’s Health System

5. RESEARCH: TESTING THE FINANCIAL SUSTAINABILITY OF TURKEY’S HEALTH SYSTEM

5.1. Introduction: Materials and Method

5.1.1. Objective

5.1.2. The Problem

5.1.3. Universe and Sample

5.1.4. Limitations and Assumptions

5.1.5. Data Collection

5.1.6. Data Analysis

5.2. Testing the Financial Sustainability of Turkey’s Health System Based on Numerical Data: Assessments Based on Health Expenditures and Revenues

5.2.1. Total Health Expenditure as a Percentage of Gross Domestic Product

5.2.1.1. Public and Private Health Expenditure Per Capita by Year

5.2.1.2. Upward Trend in Public Health Expenditure

5.2.1.3. Health Care Inflation Rates

5.2.1.4. Projection of Revenue and Expenditure Levels for Universal Health Insurance (2006-2023)

5.2.1.5. Actuarial Analysis of Alternative Growth Paths for Health Expenditure, 2008-2033

5.2.1.6. Upward Trend of Health Expenditure in Turkey and its Causes/Determinants

5.3. Testing Financial Sustainability in the Turkish Health System Based on Stakeholders’ Views

5.3.1. General Findings: Personal and Demographic Information: Descriptive Characteristics of Stakeholders Participated in the Research

5.3.2. Stakeholders’ Views on Ensuring Financial Sustainability

5.3.3. The Comparison of the Issue of Ensuring Financial Sustainability by Descriptive Characteristics

5.3.4. The Findings of Content Analysis

5.3.4.1. The Concept of Financial Sustainability of the Health System

5.3.4.2. Sustainability of Turkey’s Health System in Financial Terms

5.3.4.3. The Scope of the SSI’s Current Benefits Package

5.3.4.4. Stakeholders’ Views on Complementary Health Insurance

5.3.4.5. The Priority Status of Financial Sustainability for Turkey’s Health System

5.3.4.6. How Financial Sustainability can be Achieved in Turkey’s Health System

5.3.4.7. Parties That Should Take Part in the Process of Ensuring Financial Sustainability of Turkey’s Health System

5.3.4.8. Major Barriers/Risks to Financial Sustainability of Turkey’s Health System

5.3.4.9. Views on the Level of Turkey’s Health Expenditure

5.3.4.10. Views on the Factors Leading to Increase in Health Expenditure

6. DISCUSSION AND SUGGESTIONS: THE PATHS TO SUSTAINABILITY

6.1. Introduction

6.2. The Concept of Financial Sustainability

6.3. Sustainability as a Priority Issue

6.4. Financial Sustainability of Turkey’s Health System

6.5. The Basic Benefits Package

6.6. Complementary Health Insurance

6.7. Rational Drug Use

6.8. Actors in the Process of Ensuring Financial Sustainability

6.9. Challenges/Risks in the Process of Ensuring Financial Sustainability

6.10. Political and Socioeconomic Status

6.11. The Level of Health Expenditure

6.12. Performance-Based Payment

6.13. Stakeholder Preferences Related to Financial Sustainability

6.14. Empowerment of Citizens: Health Literacy

6.15. Maintaining a Balance Among the Objectives of the Health System

6.16. Generating More Revenues

6.17. Cost Containment and Contribution Rates

6.18. Addressing the Determinants of Health in a Comprehensive Manner

6.19. Improvement of Institutional Capacities

6.20. Primary Care Health Services, Family Medicine, and the Referral System

6.21. Decentralization, Autonomy, Hospitals, and Professional Management

6.22. Information and Communications Technologies

6.23. The Role of the Integrated Health Services in the Management of Chronic Diseases

6.24. The MoH Strategic Plan 2013-2017 and Suggestions for Sustainability

6.25. The Philosophy-Based Strategic Policy Suggestions for Sustainability

REFERENCES