Definition and Comparability Cambodia and Myanmar

4.2. FINANCING OF HEALTH CARE

Figure 4.2.1 shows the change in the public share of External funding for health care is quite relevant in health financing between 2000 and 2012. On average, the most developing countries and economies in Asia/Pacific. public share of health spending has slightly increased in In Cambodia, Lao PDR and Papua New Guinea more than the Asian countries and economies, from 44.2 % in 2000 to 20% of funds spent on health were from external resources 48.1 % in 2012. This is about the same share as in the United in 2012 (Figure 4.2.4), while external resources accounted States, but is much lower than the average in OECD coun- for between around 7 and 10 % of total health expenditure tries, where the public sector accounted for 72.7% of financ- in Nepal, Myanmar, Fiji and Bangladesh. ing in 2012, similar to 2000. In Thailand, Japan, New Zealand, Papua New Guinea, Brunei Darussalam, and the Solomon Islands, public financing accounted for more than 75% of all health expenditure, while it accounted for less than one third of total health spending in India, Pakistan, Definition and comparability Cambodia and Myanmar. The financing classification used in the OECD The public share of health spending has increased sig- System of Health Accounts 2011 provides a complete nificantly over the past twelve years in Thailand, China and breakdown of health expenditure into public and Lao PDR (15 points of share or more), while it has decreased private units incurring expenditure on health. Public substantially in Mongolia and Fiji (15 points or more). financing includes general government expenditure Out-of-pocket payments represented more than 50% and social security funds. Private sector comprises of total expenditure on health in the Philippines, India, pre-paid and risk pooling plans, household out-of- Singapore, Cambodia, Pakistan and Bangladesh, while they pocket expenditure and non-profit institutions reached 71.3% in Myanmar (Figure 4.2.2). This share was serving households and corporations. Out-of-pocket less than 20% in Japan, Thailand, New Zealand, Papua New payments are expenditures borne directly by the Guinea, Brunei Darussalam, and the Solomon Islands. On patient. They include cost-sharing and, in certain average, in Asian countries and economies, the share of countries, estimations of informal payments to health total health spending paid out-of-pocket has fallen by care providers. 5 percentage points to 43.9 % since 2000. External funding for health is measured as Official The trend is quite diverse across the countries and the Development Assistance disbursements for health economies in the study. However, two thirds of the coun- from all donors. Disbursements represent the actual tries and economies reported a decrease, including more international transfer of financial resources. than 20 percentage points between 2000 and 2012 for Disbursements for health are identified by using the China, Lao PDR and Thailand. Eight reported an increase, classification of sector of destination codes 121 with a growth of more than 10 percentage points in the (health, general except 12181, medical education/ Philippines, Fiji and Mongolia in the same period. training and 12182, medical research), 122 (basic In general, private household out-of-pocket payments, health) and 130 (population policies/programmes and comprising direct payments, and cost-sharing payments, reproductive health except 13010 Population policy form the greater part of private funding sources and administrative management), and 510 (general (Figure 4.2.3). In Mongolia, Pakistan, Myanmar, Bangladesh, budget support) (OECD, 2014a). General budget Singapore and Brunei Darussalam, out-of-pocket health support to health is estimated by applying the share spending represents 90% or more of private health spend- of government expenditure on health over total ing. In addition to OECD countries, private prepaid and risk general government expenditures to the value pooling plans play a role in Thailand, Malaysia, the Philippines reported in ODA. Given that disbursement money is and Fiji where their share in private health spending is 10% spent over several years by countries, funds disbursed or higher. It is worth noting that private sector also com- at year t are compared to total health expenditure in prises health expenditure by corporations and non-profit year t+1. institutions serving households.

82 HEALTH AT A GLANCE: ASIA/PACIFIC 2014 © OECD/WHO 2014 4.2. FINANCING OF HEALTH CARE

4.2.1. Change in public share of total expenditure 4.2.2. Change in out-of-pocket spending as a share on health, 2000-12 of total expenditure on health, 2000-12

Diff. public share, 2000-12 Public share, 2012 Diff. OOP share, 2000-12 OOP share, 2012

9.7 Myanmar 23.9 Solomon Islands -1.1 2.2 4.2 Cambodia 24.7 Brunei Darussalam -5.3 8.1 9.7 Pakistan 31.4 Papua New Guinea -0.8 9.5 7.1 India 33.1 New Zealand -4.4 10.9 Bangladesh -4.6 34.4 Thailand -20.6 13.1 Singapore -7.4 37.6 Japan -1.3 14.1 0.6 Philippines -9.8 37.7 Australia 20.4 14.9 12.1 Nepal 39.5 Fiji 22.5 3.5 Indonesia 39.6 China -24.6 34.3 22.7 Sri Lanka (2000-11) -6.3 42.1 Mongolia 34.6 11.6 1.3 Viet Nam 42.6 Malaysia 35.6 4.0 Asia19 48.1 Korea, Republic -3.4 36.1 16.1 Lao PDR 51.2 Lao PDR -21.4 38.2 4.0 Korea, Republic 54.0 Asia19 -5.0 43.9 Malaysia -0.8 55.0 Indonesia -1.2 45.3 17.7 6.4 China 56.0 Sri Lanka (2000-11) 48.1 -19.3 Mongolia 62.8 Viet Nam -17.2 48.8 -18.7 Fiji 64.9 Nepal -19.6 49.2 11.5 Australia -0.6 66.2 Philippines 52.0 20.3 Thailand 76.4 India -10.4 57.6 1.7 5.9 Japan 82.5 Singapore 58.6 4.7 New Zealand 82.7 Cambodia -9.5 61.7 1.3 Papua New Guinea 83.1 Pakistan -1.5 61.9 5.3 5.3 Brunei Darussalam 91.8 Bangladesh 63.3 96.2 Solomon Islands 1.9 Myanmar -14.5 71.3 -20 0620 40 080100 -40 -20 0 20 40 60 80 % of total expenditure on health % of total expenditure on health

Source: WHO GHO 2014, OECD Health Statistics 2014. Source: WHO GHO 2014, OECD Health Statistics 2014.

4.2.3. Out-of-pocket and private prepaid plans spending 4.2.4. External resources as a share of total expenditure as a share of private expenditure, 2012 on health, 2005 and 2012

Out-of-pocket Private prepaid plans 2005 2012

Thailand 14.1 Cambodia 23.0 Papua New Guinea 16.6 Solomon Islands Lao PDR 22.0 Australia Papua New Guinea 24.8 New Zealand 21.8 10.0 Fiji Nepal 10.1 Indonesia Myanmar 9.1 China 7.5 Lao PDR 8.7 Fiji 7.3 Malaysia 5.6 Korea, Republic Bangladesh 6.9 Japan 2.4 Mongolia 4.0 Nepal 4.7 Cambodia Pakistan 3.6 Sri Lanka (2011) 2.7 Viet Nam 3.3 Philippines 1.2 Asia19 Sri Lanka 1.9 Viet Nam India 1.6 India 1.1 1.3 Pakistan Philippines 1.0 Mongolia 1.3 Myanmar Indonesia 0.8 Singapore 0.6 Thailand 0.6 Bangladesh 0.2 Brunei Darussalam China 0.0 0102030405060708090 0 5 10 15 20 25 30 % of private expenditure % of total expenditure on health

Source: WHO GHO 2014, OECD Health Statistics. Source: WHO GHO 2014, OECD Health Statistics 2014. 1 2 http://dx.doi.org/10.1787/888933152824

HEALTH AT A GLANCE: ASIA/PACIFIC 2014 © OECD/WHO 2014 83 From: Health at a Glance: Asia/Pacific 2014 Measuring Progress towards Universal Health Coverage

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Please cite this chapter as:

OECD/World Health Organization (2014), “Financing of health care”, in Health at a Glance: Asia/Pacific 2014: Measuring Progress towards Universal Health Coverage, OECD Publishing, Paris.

DOI: https://doi.org/10.1787/health_glance_ap-2014-36-en

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