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National Health Accounts in Bolivia Main Policy Uses

National Health Accounts in Bolivia Main Policy Uses . Presenter: Marina Cárdenas Health Transformation Project - Bolivia. Main Policy Uses (1). NHA was used by the MoH in Bolivia as a tool to monitor the financial resources available to implement key public policies in the health sector

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National Health Accounts in Bolivia Main Policy Uses

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  1. National Health Accounts in Bolivia Main Policy Uses Presenter: Marina Cárdenas Health Transformation Project - Bolivia

  2. Main Policy Uses (1) • NHA was used by the MoH in Bolivia as a tool to monitor the financial resources available to implement key public policies in the health sector • Basic Public Health Insurance • Budgetary negotiations with the Ministry of Finance • Agreements with Municipal Governments. • Analysis of health finance data from specific national programs • Expanded Immunization Program (EPI) • Inclusion as one of the 8 basic indicators tracked by the Health Reform Unit Marina Cardenas NHA Bolivia

  3. Main Policy Uses (2) • Succint tool that provides a complete picture of health financing in a few tables • Used extensively by main health authorities • Minister of Health, for example, included the tables in his main presentations • Showing the relative weight of different sub sectors and possible structural reforms that are needed to improve the efficiency of health expenditures Marina Cardenas NHA Bolivia

  4. Main Policy Uses (3) • Use of NHA data by donor agencies • Inclusion of NHA data in the health chapter of the World Bank’s Public Expenditure Review 1999 • PAHO’s Country Health System Profiles Marina Cardenas NHA Bolivia

  5. Relative weight of different subsectors: Possible structural reforms Marina Cardenas NHA Bolivia

  6. Insurance funds: Disparities in per capita expenditures 56 (Per capita expenditure in US$) Marina Cardenas NHA Bolivia

  7. Policy decisions supported by this data • Ministry of Health uses the NHA to promote discussion on health sector reform • He used the NHA information to negociate with insurance funds the payment of contributions to the MOH for coverage of the Expanded Program of Immunizations • Up to 5% of the budget of the insurance funds transferred Marina Cardenas NHA Bolivia

  8. Monitoring decentralization: Transfer of resources to municipalities in US$ Marina Cardenas NHA Bolivia

  9. Policy uses of municipal NHA data • Based on annual NHA data, it is possible to built temporal series in order to monitor the continuous performance of a health system in its monetized dimension • Municipalities use same data to negotiate budgetary allocation from the MOH • Human resource allocation • Increased contribution of municipalities to the Universal Insurance for Mothers and Children • From 6.4% to 10% Marina Cardenas NHA Bolivia

  10. Projected HIPC funds and municipal resources Marina Cardenas NHA Bolivia

  11. Policy decisions supported by this data • HIPC II funds earmarked for health • Previously, the health sector was executing less than 10% of HIPC I resources available for health projects Marina Cardenas NHA Bolivia

  12. Institutional issues • Responsibility for data collect lies with an inter-institutional NHA team • National Institute of Statistics, MOH/ Health Reform Project (WB), MOF, Health Transformation Project (DFID) • Challenge of institutionalization • Separation of functions: collection and policy analysis • Equity Health Observatory, UDAPSE (a social policy think tank) Marina Cardenas NHA Bolivia

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