Desafios del aseguramiento universal

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17/04/2008

Macroeconomia y Salud
El Desafio del Aseguramiento Universal
Cristian Baeza Asesor Principal en Politica de Salud Region de America Latina y el Caribe Banco Mundial

Presentacion
• Aspectos Generales de la relacion economia y salud • Contribucion de los Sistemas de Salud y sus determinantes • Aseguramiento en Salud y Proteccion Financiera • Que es Aseguramiento Universal? •Aspectos criticos de la universalidad y los desafios para su implementacion

17/04/2008

Circulo Virtuoso Economia y Salud
•Incremento Ingresos y I Consumo

Mercado del Trabajo T b j

•Producto Agregado •Competitividad Pais •Innovacion

•Incremento Productividad

Hogar / Trabador Saludable

Crecimiento y Desarrollo Socio-Economico

Desarrollo Humano

•Servicios de Salud•Proteccion Social •Seguridad y Justicia •Educacion •Vivienda •Inclusion Social

Health Systems as contributors to Human Development: today Income Housing

Citizens

Producers

Financial Protection Providers

Health interventions

Utilization

Health
Country Competitiveness C titi

Human Development
Household Human Capital Production Function

Poverty Reduction

Consumers ContributorsDignity

Food
Social Integration

Education

17/04/2008

Oversight
(Stewardship)(d)

Financing (a)
Funding (Public, Oops and DAH), Contribution, Pooling and Payment Mechanisms

Resource Generation
HR, Pharma, M d HR Ph Med. Equipment, (f)
Patients And Population Health service/status Financial Protection Country fiscal & Competitiveness Dignity

Public and Private Providers(e)

Health, Nutrition and Population interventions (g)

Demand (c)
Preferences, believes and behaviors

System Governance,
including fiduciary arrangements and other systems (b)
Cristian C. Baeza The World Bank

17/04/2008

El costo de tratar una enfermedad es la segunda causa mas frecuente de shock al ingreso reportada por el hogar

(Responses to the question “In the past threeyears, has your household experienced an event that has caused a significant loss in income?”, PRIESO surveys, Santiago Chile, 2000, and Lima, Peru, 2002)

45.0 40.0 35.0 30.0 25.0 20.0 15.0 10.0

42.6

Peru

Percenta (%) of Total Reported Shocks age

18.6 16.9 12.3 12 3

6.1 5.0 1.2 0.0 Recession, Policy/political usually loss of change job Natural disaster & crime Other disasterDisability of Death of Sickness Other sudden family member family member costly to treat increase in HH costs 1.2 1.0

El costo de tratar una enfermedad es la segunda causa mas frecuente de shock al ingreso reportada por el hogar
(Responses to the question “In the past three years, has your household experienced an event that has caused a significant loss in income?”, PRIESO surveys, Santiago Chile,2000, and Lima, Peru, 2002)

35.0

Chile
29.4

30.0

Perc centage (%) of Total Reported Shocks

25.0 20.2 20.0

15.0

10.0

5.0 2.2 0.0 Recession, usually loss of job Policy /political change

4.1 2.5

4.6 2.5 0.9

Natural disaster & crime

Disability of family member

Death of family member

Sickness costly to treat

Other sudden increase in HH costs

Help to F&Foutside HH

17/04/2008

Causes for Impoverishing Effects of Health Events (shocks)
• Loss of income
– Unemployment – Reduced returns from labor market participation

• Excess Expenditures
– Out-of-Pocket – Insurance Premiums – Taxation

Inequality in out-of-pocket expenditures
Mexico 2000
Mean Total OOPs % HH Exp
14%

Colombia 2000
Mean Total OOPs % HH Exp
12%

Adjusted MeanTotal OOPs % HH Exp

Adjusted Mean Total OOPs % HH Exp

12%

10%

10%
8%

8%
6%

6% 4% 4%

2%

2%

0% Q1 (poorest) Q2 Q3 Q4 Q5 (richest)

0% Q1 (poorest) Q2 Q3 Q4 Q5 (richest)

17/04/2008

Income Effects of Health Expenditures
Honduras: Household Income, Poverty and Health Expenditures
Graph VII-1: Average Previsional Household Monthly Per Capita Income Pre- and...
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