Modelling in health care finance
İÇİNDEKİLERCONTENTS Foreword Acknowledgements AboUt the authors Part I The context of modelling 1 Introduction 1.1 Background 1.2 Modelling 1.3 Objectives and audience 1.4 The structure of this book 2 Scope and focus 2.1 Modelling in health care financing: Focus, context and process 2.2 The dual processes of health policy design and modelling 2.3 Model limitations and the learning process 2.4 Summary 3 The modelling object 3.1 The economics and economic environment of the health sector 3.2 National health care financing systems 3.3 Public health care financing systems 3.4 Summary Part II Model building 4 Databases 4.1 Health accounting 4.2 Health statistics 4.3 Core statistical data and data sources for financial modelling 4.4 Data handling for modellers 4.5 Summary 5 The modelling process 5.1 The six steps of the modelling process 5.2 Methodological philosophy and principles: Six ground rules 5.3 A typical model design 5.4 Summary 6 Calculation techniques 6.1 A standard population projection method 6.2 Key projection factors 6.3 Income projections 6.4 Projecting expenditure 6.5 Plausibility controls 6.6 Calculation of a medium-term contribution rate 6.7 A pragmatic, stochastic extension of the modelling approach 6.8 Summary 7 Model examples 7.1 The actuarial model of Management Sciences for Health (MSH) 7.2 The WHO model for local governments 7.3 The WHO budget model for ministries of health (SimFin) 7.4 The model of the Australian Health Insurance Commission 7.5 The Japanese Ministry of Health social health insurance model 7.6 The stochastic model of the German Ministry of Labour 7.7 Some ıLO models 7.8 Summary Part III Using models in policy decisions 8 Policy decisions 8.1 What are the most critical health needs? 8.2 How can a health system provide effective and efficient services? 8.3 How can countries finance their health systems? 8.4 What is the appropriate mix of the public and private sectors in the delivery and financing of health care? 8.5 Summary 9 Conclusion Issue brief 1: Concepts of health economics 1.1 Health and health gains as crucial products of the health care sector 1.2 The nature of the health care market 1.3 Demand for health care goods and services 1.4 Supply of health care goods and services 1.5 Market characteristics and the financing of health care: An economic discussion Issue brief 2: Financial management and accounting for health schemes 2.1 Basics for the management of insurance scheme finances 2.2 The importance of financial management 2.3 The financial management cycle 2.4 Budget formulation 2.5 An accounting framework for a national health insurance scheme 2.6 Monitoring Issue brief 3: A primer on the mathematics of private health insurance 3.1 The characteristics of private health insurance 3.2 Calculation of the risk premium (RP) 3.3 Calculation of the net constant individual premium (CIP) 3.4 Calculation of the annual gross premium 3.5 Reserve calculations 3.6 The influence of change in the basic variables Issue brief 4: Regression analysis 4.1 Linear regression (for one independent variable) 4.2 Multiple regression analysis 4.3 Example: Estimating the utilization of physician services Annex: International reference statistics A. Global health statistics: Basic indicators B. Ten country profiles Glossary Bibliography Index Tables Notes: E = Example (e.g. Table E2.1 is found in Example ,2.1 in Chapter 2) B = Box (e.g. Table B3.1 is found in Box 3.1, in Chapter 3) IB = Issue Brief (e.g. Table IB2.1 is found in Issue Brief 2) E2.1 Cost estimate for the coverage of pharmaceuticals in outpatient care E2.2a SHI Demoland: Status quo projection E2.2b SHI Demoland: New benefit simulation E2.2c SHI Demoland: Effect of new benefit on national social budget 3.1 Financing of health systems in the OECD, early 1990s 3.2 National social health insurance models 3.3 Pure payment methods and their application B3.1 Incentive structure of payment mechanisms B4.1a ICHE-HA functional classification of medical care B4.1 b ICHE-HP classification of providers of medical care B4.1c ICHE-HF classification of medical care financing 4.1 The hierarchy of health statistics 5.1 An aggregated national health income and expenditure statement 5.2 Matrix representation of a national health care budget5.3 A typical data list for a national health budget model 5.4 The core contents of the legal description of the scheme 5.5 A possible disaggregation of the insured population 5.6 Common forms of co-payments and their usual use 5.7 Variables and projection parameters in a social insurance model E5.1 Applying the 12 equations E6.1a Income distribution of individuals in Demoland, 1998 E6.1b Sensitivity testing and the effect of income ceilings B6.4 Observed and approximated values of the J-curve for a utilization indicator E6.2 Calculation of the constant contribution rate 7.1 Contribution rate calculation, MSH model 7.2 Population, health insurance membership and care cases in Hai Pho Viet Nam 7.3 Financial results of model for the health insurance scheme in Hai Phong, Viet Nam 7.4 Summary of expenditure by type of service, Turkish health care system 7.5 Summary of expenditure by source of funds, Turkish health care system 7.6 Financial effects of 1997 amendments to the Employees' Health Insurance scheme in Japan 7.7 Financial projections for the Employees' Health Insurance scheme in Japan 7.8 Projected contribution rates for the Statutory Health Insurance System in the Federal Republic of Germany, 1981-1985 7.9 Estimated fund operation in short-term benefits, 1996-2007 7.10 Assumptions for health care financing and social budget projection for Ukraine, 1995-2015 7.11 Ukraine's social budget as a percentage of GDP 7.12 Health care parameters and assumptions for the Ukrainian exercise 7.13 Projections for the government health care delivery system in Ukraine 7.14 Health care projections: Results of the Ukrainian exercise 7.15 Calculation of contribution base (in Euroland currency units) 7.16 Per capita costs in Euroland currency units (CU), 1997 7.17 Total health costs in Euroland CUs 7.18 Consolidated income and expenditure forecast 7.19 Costs shared through co-payments 7.20 Simulating alternative policy options in Euroland IB2.1 Systems of financial accounting IB2.2 Sample components for annual reports IB4.1 Data for multiple regression analysisNotes: B = Box (e.g. Figure B2.1 is found in Box 2.1, in Chapter 2) IB = Issue Brief (e.g. Figure IB2.1 is found in Issue Brief 2) 1.1 A roadmap through this book, or What this book does 2.1 Three basic transformations in national health sectors and the scope of financial models B2.1 Income levels and life expectancy 2.2 The financial equilibrium of a health care financing scheme and its determining factors 2.3 The hierarchy of models and accounts in social protection and health care B2.2 Algorithm of critical decisions in policy design 3.1 Health expenditure as a share of GDP and per capita GDP in 60 countries in the mid-1990s 3.2 Categories of health care financing systems 3.3 The bipolar structure of a public health service system 3.4 The structure of a social insurance health care finance and delivery system 3.5 Expected macroeconomic effects of rising health care costs under a social health insurance scheme B4.2 The flow of data in the pluralistic health care system of the Federal Republic of Germany 5.1 A standard flow chart for a financial model of a health care scheme B6.1a The log-normal distribution of mean 10,000 and standard deviation 4,000 B6.1b Income distribution B6.4 The J-curve and its proxy 7.1 The sustainability of health insurance 7.2 Valuation results under partial premium payment compliance 7.3 Valuation results under full premium payment compliance 7.4 Projected and real development of contribution rates in the Federal Republic of Germany 7.5 Contribution rates under alternative policy options 7.6 Development of reserves and deficits under alternative policy options IB2.1 Summary of the accounting process IB4.1 Result of sample regression  |
