The analysis of National Health Accounts and financial communications network in Iran health insurance ecosystem

BACKGROUND

One of the major reforms in the health system of any country is the financing reform. Network analysis as a practical method for investigating complex systems allows distinguishing prominent actors in the relation networks. Leading to the identification of the effective actors and key links between them, the analysis of financial networks helps policymakers to implement reformations by providing appropriate evidence. This study aimed to design and analyze the network of National Health Accounts (NHA) and the cost network in the Iran health insurance ecosystem.

METHODS

The present study is a network analysis study based on the data from NHA, and both cost and referral rates that was conducted in 2021. Data, which was for the years 2014 to 2018 and related to NHA, was collected from the Statistical Center of Iran, and cost data and referral rates, which were both related to Basic Insurance Organizations (BIOs), were collected from statistical yearbooks. To analyze the network and identify the key actors, macro indicators, such as network size and density, and micro indicators, such as centrality indicators and the combined importance index, were used.

RESULTS

In the financing of the health system in Iran, insurance organizations, as agents and sources of financing, do not have a very good position, so direct payments have become a key element in the network of NHA. Providing treatment-oriented services is quite prior. Regarded to health services, hospitals and outpatient services, such as pharmacies and physicians are the key elements of cost and referral rates respectively.

CONCLUSION

Consisting of several organizations with different insurance policies and being supervised under different ministries, Iran's health financing system lacks a coherent structure. It is suggested to create a coherent insurance system by creating a single governance system and paying more attention to health-oriented instead of treatment-oriented services. The health insurance ecosystem has become a health-oriented system to reduce the direct payments as well as cost management.

Tracking government spending on immunization: The joint reporting forms, national health accounts, comprehensive multi-year plans and co-financing data

Background

Coverage rates for immunization have dropped in lower income countries during the COVID-19 pandemic, raising concerns regarding potential outbreaks and premature death. In order to re-invigorate immunization service delivery, sufficient financing must be made available from all sources, and particularly from government resources. This study utilizes the most recent data available to provide an updated comparison of available data sources on government spending on immunization.

Methods

We examined data from WHO/UNICEF’s Joint Reporting Form (JRF), country Comprehensive Multi-Year Plan (cMYP), country co-financing data for Gavi, and WHO National Health Accounts (NHA) on government spending on immunization for consistency by comparing routine and vaccine spending where both values were reported. We also examined spending trends across time, quantified underreporting and utilized concordance analyses to assess the magnitude of difference between the data sources.

Results

Routine immunization spending reported through the cMYP was nearly double that reported through the JRF (rho = 0.64, 95% 0.53 to 0.77) and almost four times higher than that reported through the NHA on average (rho = 3.71, 95% 1.00 to 13.87). Routine immunization spending from the JRF was comparable to spending reported in the NHA (rho = 1.30, 95% 0.97 to 1.75) and vaccine spending from the JRF was comparable to that from the cMYP data (rho = 0.97, 95% 0.84 to 1.12). Vaccine spending from both the JRF and cMYP was higher than Gavi co-financing by a at least two (rho = 2.66, 95% 2.45 to 2.89) and (rho = 2.66, 95% 2.15 to 3.30), respectively.

Implications

Overall, our comparative analysis provides a degree of confidence in the validity of existing reporting mechanisms for immunization spending while highlighting areas for potential improvements. Users of these data sources should factor these into consideration when utilizing the data. Additionally, partners should work with governments to encourage more reliable, comprehensive, and accurate reporting of vaccine and immunization spending.

How much does the treatment of each major disease cost? A decomposition of Swiss National Health Accounts

In most countries, surprisingly little is known on how national healthcare spending is distributed across diseases. Single-disease cost-of-illness studies cover only a few of the diseases affecting a population and in some cases lead to untenably large estimates. The objective of this study was to decompose healthcare spending in 2011, according to Swiss National Health Accounts, into 21 collectively exhaustive and mutually exclusive major disease categories. Diseases were classified following the Global Burden of Disease Study. We first assigned the expenditures directly mapping from National Health Accounts to the 21 diseases. The remaining expenditures were assigned based on diagnostic codes and clues contained in a variety of microdata sources. Expenditures were dominated by non-communicable diseases with a share of 79.4%. Cardiovascular diseases stood out with 15.6% of total spending, followed by musculoskeletal disorders (13.4%), and mental and substance use disorders (10.6%). Neoplasms (6.0% of the total) ranked only sixth, although they are the leading cause of premature death in Switzerland. These results may be useful for the design of health policies, as they illustrate how healthcare spending is influenced by the epidemiological transition and increasing life expectancy. They also provide a plausibility check for single cost-of-illness studies. Our study may serve as a starting point for further research on the drivers of the constant growth of healthcare spending.