1. APHA 2001 Conference Atlanta, Georgia 22 October 2001 Does resource allocation meet policy priorities? Tania Dmytraczenko, Ph.D. Patricia Hernandez, M.D., Ph.D.

2. Organization of the presentation  Purpose  Methodology  Results  Policy implications

3. Purpose  To determine the redistributive nature of spending on health public, non insurance public, non insurance social health insurance social health insurance private not-for-profit private not-for-profit private for profit private for profit  Identify areas for improvement

4. Tracking expenditures using the NHA methodology  Describes and quantifies the flow of financial resources through the health system  Public expenditures v public treasury funds v compulsory social insurance contributions v external loans and grants  Private expenditures v out-of-pocket expenditures by households v direct payments by firms v expenditures through health insurance v charitable contributions sources  financing agents  providers  uses  beneficiaries

5. Health spending in Ecuador Source: WHO World Health Report 2000

6. Approach  Function of public expenditures  Distribution: geographic geographic demographic demographic income income levels of care levels of care

7. 24.3% 23.9% 3.1% 34.4% 11.8% 2.5 % Limited redistributive capacity Public spending accounts for less than 1/2 of THE

8. A situation that is unlikely to change in the near future Percent of public expenditures allocated to health have declined steadily Source: Central Bank of Ecuador; 1980 constant US$

9. Are public health funds being used to mitigate differences in geographical access to care? Health exp. by covered pop. Provinces PoorestRichest

10. Are health funds being used to mitigate differences in access to care by demographic needs? 29% 32%12%27%1%

11. Are public health funds being used to mitigate differences in access to care by income level? Health expenditures (US$ millions)

12. Are MOH funds being used to mitigate differences in access to levels of care? Health expenditures (US$ millions)

13. Are social security funds being used to mitigate differences in access to levels of care? Health expenditures (US$ millions)

14. Conclusions