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Meeting the demands of a changing world 8-10 October 2014 Da Nang, Viet Nam

Direct and indirect approaches in collecting of healthcare expenditures By Mr. Khaled MA. Qalalwa , State of Palestine. Meeting the demands of a changing world 8-10 October 2014 Da Nang, Viet Nam. Palestinian context Background Methodology Results Discussion. Agenda.

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Meeting the demands of a changing world 8-10 October 2014 Da Nang, Viet Nam

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  1. Direct and indirect approaches in collecting of healthcare expenditures By Mr. Khaled MA. Qalalwa , State of Palestine. Meeting the demands of a changing world 8-10 October 2014 Da Nang, Viet Nam

  2. Palestinian context Background Methodology Results Discussion Agenda

  3. Total area 27,000 Km2. Israel control 6% before UN resolution for partition of Palestine in 1947. UN resolution gave Israel 50%. Separation Wall swallows 13% Now, Israel control 85%. Gaza is the most crowded area over the World (about 4500 individuals per km2,while in Israel it is 350 individuals). Palestinians Have Two Cancers; The Cancers of Settlement and disease

  4. Total Population: 4.4 millions Life Expectancy at birth is 72 years Crude Birth Rate per 1000 persons was 31 Crude death rate deaths per 1000 persons was 2.7 Child Mortality Rate: 24.7 Total Fertility Rate:4.2 Illiteracy Rate: 4.1% GDP: seven billions Unemployment Rate and under Poverty Line about 25% Health Expenditure out of GDP: 13% Sociodemographic Indicators

  5. Health Expenditure Trend Line in Palestine 0-2012 1.Background; Why we need to assess HE

  6. Distribution of Expenditure on Health in Palestine by Source of Funding 1.Background; Why we need to assess HE

  7. Distribution of Expenditure on Health by Function of Care in Palestine 2012 1.Background; Why we need to assess HE

  8. To identify the types and quantities of health care services provided by the various principle health care providers, and to assess expenditures on these services. To build up a database of a wide range of indicators of health care expenditures that would help establish a system of National Health Accounts for Palestine. 2. Methodology;Health Care Providers and Beneficiaries Survey,2005” (PB)

  9. single-stage stratified random sampling, private and NGOs. number of institutions was 1,202; generalists’ or specialists’ medical clinics, medical laboratories, physiotherapy, rehabilitation centers, dental clinics or hospitals. All hospitals were included. number of interviewed beneficiaries amounted to 3,265 beneficiaries, The responses rate of both institutions and beneficiaries was about 81.0% . 2. Methodology;study sample

  10. An institution questionnaire: market share in nominal (No. of served patients per day; type of provided care; human resources) and real terms. A patient questionnaire: users' behavior, perceptions (quality); satisfaction; WTP for different funding mechanisms 2. Methodology;study instruments

  11. ‘Institution Questionnaire’ consists of five sections: ONE, about the health care provider her/himself: profession and specialty, activity in terms of number of working hours and places of practice. TWO, about the health care itself: type and nature of provided care, offered services and existing equipments, and available human resources. THREE, questions about institution’s activity in terms of: number of working hours per day, number of working days per year, type and size of provided services, and average unit charge per service. To provide an indirect estimation of institution’s expenditures/revenues, and hence, the provider’s share from total national health expenditures. FOUR, covers the institutions’ expenditures in (monetary) terms; e.g., wages and salaries; running costs including. And institutions’ revenues in (monetary) terms; e.g., fees and charges from medications and from hospital stay and emergency services. FIVE, to estimate capital outlays. It covers all institution’s capital properties and investments, including: lands, buildings and equipments. 2. Methodology;study instruments

  12. annex.pdf Model of questions

  13. Figure 1: Market Share Based on Annual Number of Visits 3. Results; Market share of healthcare providers

  14. Figure 2: Market share of Total Expenditures by Method 3. Results; Direct Vs indirect method

  15. Figure 3: Total Expenditures by Method (Millions$) 3. Results; Direct Vs indirect method

  16. Figure 4: Total Revenues by Method (Millions$) 3. Results; Direct Vs indirect method

  17. Variation in market share compared between direct and indirect approaches is unexpected but; might be consistent with interests of each health care provider; And due to absent of administrative or financial records, where about half of health institutions do not possess any records. Estimated health expenditures are limited to the spectrum of surveyed health care services e.g., health expenditures directed toward private pharmacies were not included in this estimation. Also the estimation of the market share using the indirect method should be interpreted with caution, and is mainly valid when health expenditures are assessed from a societal perspective. High expenditure levels suggest likelihood that many families face impoverishing expenditures and growing need for social protection. 4. Discussions

  18. Thank you foryour attention!

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