Funding of health promotion focus on older people Jelena - PowerPoint PPT Presentation

Funding of health promotion focus on older people Jelena Arsenijevic Christoph Sowada Stanisława Golinowska Wim Groot Bilateral meeting 15-16 of June Maastricht

Outline of the presentation 1. Place of health promotion, public health and health system 2. Statistics on funding of public health and health promotions: sources, scope of data, limitation 3. Institutional responsibilities for health promotion 4. Pooling and national public health policy 5. Potential funds for health promotion; public, private and others 6. Research concept 7. First answers from a questionnaire 8. What should be done to continue research

Public health place in health system I. Health promotion and prevention – definition II. Statistics – expenditures on prevention and public health services III. Institutional responsibilities for health promotion IV.Securing funds for health promotion V. Estimation of expenditures on health promotion in analyzed countries

Statistics What we know - data concerning level and share of expenditures on public health - Eurostat - OECD - WHO What we don’t know - data concerning the level and share of expenditures on health promotion

Expenditure on prevention and public health services, 2012 or nearest year (Eurostat)

% of total current health expenditure 0 1 2 3 4 5 6 7 Expenditure on prevention and public health Romania services, 2012 or nearest year (Eurostat) Finland Slovenia Sweden Netherlands Hungary Estonia Germany Slovakia Norway Denmark Croatia Switzerland Spain Portugal Czech Republic France Poland Luxembourg Austria Iceland Lithuania Greece Belgium

Expenditures on prevention and public health services (OECD 12.06.2015) Countries Year % of total General General Social Privat sector HE Government Government Security % of total % of total excl social Funds % of HE HE security % total HE of total HE Australia 2011 1,9 1,9 Austria 2012 1,7 1,4 0,7 0,7 0,3 Belgium 2012 1,1 1,1 1 0,1 Canada 2011 5,6 5,6 5,4 0,1 Czech 2012 2 1,7 0,9 1,4 0,3 Republic Denmark 2012 2,2 2,1 2,1 0,1 Estonia 2012 3,3 2,8 2,1 0,7 0,2 Finland 2012 5,9 3,5 1,7 1,8 2,4 France 2012 1,9 1,3 0,9 0,4 0,6 Germany 2012 3,2 2,7 0,7 2 0,5

Expenditures on prevention and public health services (OECD 12.06.2015) Countries Year % of total General General Social Privat sector HE Government Government Security % of total % of total excl social Funds % of HE HE security % total HE of total HE Greece 2012 1,1 1,1 1,1 Hungary 2012 3,3 1,6 0,7 0,9 1,7 Japan 2011 2,9 1,9 0,8 1 1 Netherlands 2011 3,5 2,5 1,3 1,2 1 Norway 2012 2,4 2,2 2,2 0,2 Poland 2012 1,9 1,3 0,9 0,4 0,6 Portugal 2011 2 1,4 1,4 0,6 Slovak 2012 4 1,1 1,1 2,9 Republic Spain 2012 2,1 2 2 Sweden 2012 3,7 2,9 2,9 0,9 USA 2012 2,9 2,9

Pooling and national public health policy Examples Countries Responsible body PH council PH services Funds Sweden Ministry of Health Swedish National Within team-based Taxes levied by the and Social Protection, Institute for Public primary health care county council and Health and National additionally regional (county) Public Health government subsidy councils Committee (strategy allocated according to and reporting tasks) a per capita measures Spain Ministry of Health Within primery Territorial and Social Policy health care (family government budgets (General Directorate doctors) (devolution reforms) of Public health), Regional health ministers, Autonomus Community Portugal Central DGH – Directorate- ACES - Groups of Contracts from state Administration of the General of Health primary care centres and regional budgets Health System, for public health services Regional Health Administration

Pooling and national public health policy - continuation Countries Responsible body PH institutions / PH services Funds councils France National government The High Committee of On the adequate Not specified generally, Public Health and territorial level National Institute for defined by Health regional groups for Prevention and Health and Territories Act public health Education Germany States offices for A lot of specific health- Öffentlichen Statutory Health public health at related institutes, since Insurance and Gesundheitsdienste states governments 2002 – das Deutsche Länder budgets and Arztpraxen (Länder) Forum für Prävention und Gesundheitsförderung Italy Ministry of Health (3 A lot of specific health- Within primary care Not specified departments) and 12 related instituts focused on group regional agencies prctices (since 1999)

Pooling and national public health policy – continuation Countries Responsible body Public health PH services Funds institution – council Poland Ministry of Health NIZP – PZH Different units: Central budget, regional (2 Departments) Statutory health inspectorate, insurance, PIS – State Sanitary primery health and Inspection Territorial self- clinics government budgets USA States Centers for Disease Budgets of states Control and Prevention (CDC) Trust for America's Health (TFAH) Canada Federal Public Health Chief Territorial government Agency, public/medical budgets health officer on the Public health territorial level departments in provincial ministries

Responsibilities for health promotion • Public institutions: – Central government and central public agencies • Ministry of health • Other ministries: e.g. ministry of education, sport, work force, social • Social insurance: health, long-term care, pension , accident, unemployment • Joint financed public foundations – Territorial self-government • Non – public institutions: – Employers – Voluntary sector – NGOs’, self help organizations – Private insurances – Private households/consumers

Potential sources of financial funds ( to be estimated) • Public funds: – General taxes – Earmarked taxes – Social insurance contributions • Private funds: – Employers cost – Fund – rising by NGOs/Foundations – Out of pocket – Others (e.g. private insurance) • External aid – WHO grants – PAHO

Public sources • General taxes: – Excise, VAT, IT – Tax allowances and tax exemptions (e.g. 500 euro rule in Germany) • Earmarked taxes – excise e.g. tobacco tax (e.g. earmarked revenues of tobacco tax increase in Australia, USA tobacco tax, Thailand tobacco and alcohol tax) – assigning % of personal income tax to foundation (Hungary, Poland) • Social insurance contributions – extra surcharge to Health Promotion Organizations/Foundations (e.g. for Health Promotion Switzerland, emarked percentage of insurance budget in Estonia)) – direct purchasing of health promotion and disease prevention services by providers (e.g. Satzungsleistungen and compulsory prevention services in German GKV

Public sources • Social insurance contributions – extra surcharge to Health Promotion Organizations/Foundations (e.g. Health Promotion Switzerland, earmarked percentage of insurance budget in Estonia)) – direct purchasing of health promotion and disease prevention services by providers (e.g. Satzungsleistungen and compulsory prevention services in German GKV, obligatory vaccinations and screening services in France, Belgium, Luxemburg, additional health promoting services voluntarily in Belgium) Stanisława Golinowska Christoph Sowada

Private and other sources • Employers (eg. Work Health Promotion Programs in Germany) • Fund – rising by NGOs/Foundations (very often with public subsidies, e.g. Health promotion foundation Austria, Health Promotion Switzerland, VicHealth Australia) • Out of pocket • Others (e.g. private insurance) • External aid (e.g. Hungarian Health21, Central America Diabetes Initiative)

Research concept – subjects 1. Subject: health promotion programmes (initiative, intervention) providing in analysed countries in main sectors: Government and territorial self-government • Health sector • Education • Social sector • Sport • Enterprises • Voluntary • 2. Analysed countries: main partners (NL, PL, Italy, Germany) and collaborating countries (Hungary, Czech Republic, Bulgaria, Lithuania, Greece and Portugal)

Research concept – methods • Desk research on funding public health and health promotion for older people (including domestic grey literature) in 10 analysed countries and other European and non-European countries. • Questionnaire prepared in WP 6 on institutional arrangements of health promotion, including questions on funding of public health activities, health promotion generally and health promotion addressed to older people • Template prepared in WP6 on programmes of health promotion for older people in selected sectors: health care, territorial self- government, education, sport and voluntary, including questions on founding

Research concept – respondents Respondents: Experts from analysed countries: general experts and experts with special competency of the analysed sectors and programmes.