Towards a national health insurance system in ... - Detlef Schwefel

Towards a national health insurance system in Yemen – Part 1: Background and assessments 39
3.2.4 Health care financing
National health account data of 2003 were updated by WHO by end of September 2005 (Driss 2005).
The following table summarises the most relevant updated data on health care financing in Yemen.
Table 17 Health care financing in Yemen
Total Health Expenditure
115,102,000,000 YR
627,000,000 US-$
Estimated per capita household expenditure in 2003 ( 1998 pric es) 64.543 YR
Total Health Expenditure per cap ita 33 U S-$
Total Health Ex penditure as % of the G DP 5 .6%
Total household expenditure on health in 2003, current prices
39,292,240,138 YR
214,038,284 US-$
Total per capita households expenditures on health in 2003 (current prices)
11,3 US-$
Household out-of-pocket payments as % of Total Health Expenditure 57%
Public expenditures 32%
Private expenditures 59%
International donors 9%
Source: Driss 2005
The most recent update of the national health accounts for Y emen reveals the following purposes
househo lds in Yemen are spending their money for health care on.
Table 18
Household health spending in Yemen
Spending YR
US-$ %
Uses
(millions) (millions) of total
Medicines and drugs 24,086 131 37,1%
Treatment abroad 31,253 170 48,1%
Doctors' fees 3,851 21 5,9%
Surgery 2,082 11 3,2%
Medical supplies 1,572 9 2,4%
Hospital stays 864 5 1,3%
Other 1,297 7 2,0%
Total households expenditures 65,005 354 100%
Treatment abroad paid by MoF 1,108
Treatment abroad paid by employers 1,400
Treatment abroad by MoF and employers 2,508
Source: Driss 2005
The figures are different according to different sources. This is quite understandable since all such data
is based on very rough estimations and educated guesses. There is no way of accounting for national
health as accounting for a small company. The total amount spent for health ranges between about 26
US$ and 69 US$ according to different sources. (Constable 2002, Soeters 2004, Rhodes 2004)
The highest share in the national health accounts has the household when paying for health at the time
of use. This is exactly what health insurance tries to revert into pre-payment. WHO calculates 66% as
the private share of total spending for health, the health accounts arrive at 62%, the World Bank
estimated 75% for 1998. The most recent estimate arrives at 59%. Private spending is especially high
for catastrophic diseases. This is indicated by the fact, that 40% - according to the most recent