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

Towards a national health insurance system in Yemen – Part 1: Background and assessments 45
“There is very little coordination, at all levels of government, of plans with budgets. Actual spending
differs, often considerably, from approved budgets, and there is no accountability for budgets or
spending levels. The representatives of the Ministry of Finance seem to exercise a disproportionate
degree of control over spending at all levels of the government health system, and the budgeting and
disbursement practices do not seem to support implementation needs of government programs. The
timing of the release of investment funds is counterproductive to smooth execution of planned
projects, and the release of funds for current operations, requiring invoices in advance of
disbursement, makes it very difficult for health managers to have the resources they need when they
need them.” (Fairbank 2005, p. 25) From the point of view of health professionals recurrent funds are
provided at levels far below requests and needs. From the point of view of the officials in the Ministry
of Finance many of the requests are unfounded in terms of an effective and efficient expenditure
pattern. The result is a severe under-funding of public health care. (Constable 2002) Main victims are
the cost-sharing patients who have to compensate for this.
The opinion of the leaders
91 % of opinion leaders say:
Cost-sharing leads to postponement of treatments
63 % of opinion leaders say:
Exempted diseases are not exempted
from cost-sharing
Source: GTZ&EC survey 2005
3.2.5 Health care benefits
Currently, the Ministry of Public Health and Population does not define a benefit package that has to
be provided to the ge neral population by public hospitals, health centres or health units. The
management of each institution is thus free to offer a range of benefits as they like - the preferences of
the population were not evaluated, the catalogues are not based on evident needs. In the best case, the
benefit packages might be based on the expertise of the health professionals and the available
equipment. In the worst case, the benefits offered are tailored to maximise cost-sharing revenues and
revenues from informal payments in a health facility. Because of rudimentary and unreliable statistics
on the health services actually provided at all levels of the health care system it is virtually impossible
for the Ministry or for an external reviewer to get a picture of the benefits currently provided to the
population without recurring to major audits. Likewise, utilisation data from the private sector is not
available. Therefore, some proxy measures have to be taken into account to get a rough picture of
benefits and prices of health services currently offered to patients in Yemen.
The opinion of the leaders
77 % of opinion leaders say:
Drugs should be included in benefit package of health insurance
Source: GTZ&EC survey 2005
One proxy measure used here is utilisation data based on health surveys. Others include MoPH&P and
hospital statistics as well as official price lists of hospitals and financial statistics from company health
benefit schemes.
Survey data: According to the Beatty et alii (1998) survey, the majority of health care visits in the
survey population were for curative care. In rural areas only 0.6 to 2.4% of outpatient visits were for
preventive care. In urban areas, the preventive care was soug ht in 6% of visits. The reasons for seeking
care elicited in this survey give a rough idea of the demand for health services in Yemen (Table 21).