Budgeting based on need: a model to determine sub-national allocation of resources for health services in Indonesia

Cost Effectiveness and Resource Allocation

Patrick Vaughan⁶  Untung Suseno¹  Stephanus Indradjaya⁹  Franz von Roenne⁵  Diah ayu Puspandari²  Ali Ghufron Mukti⁴  Alex Manu³  David Dunlop⁷  Hafidz Firdaus^1,10  Tim Ensor⁸ 

[1] Senior advisor to the Minister of Health Republic of Indonesia, Jl HR Rasuna Said blok x-5 kav 4-9, Jakarta, 12950, Indonesia;Diah Ayu Puspandari, Center for Health Financing Policy and Insurance Management (Pusat KP-MAK), Fakultas Kedokteran, Universitas Gadjah Mada, Gedung Radyoputro, Lt 2 Sayap Barat, Jl. Farmako, Sekip Utara, Yogyakarta, 55281, Indonesia;Associate Consultant, Oxford Policy Management, 6 St Aldates Courtyard, 38 St Aldates, Oxford, OX1 1BN, United Kingdom;Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Jl Farmako, Sekip Utara, Yogyakarta, 55281, Indonesia;Head of the Health Section, Abteilung Bildung, Gesundheit, Soziale Sicherung, Division of Education, Health, Social Protection, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Postfach 5180, Eschborn, 65726, Germany;Professor Emeritus in Epidemiology and Public Health at the London School of Hygiene and Tropical Medicine, and Associate Consultant to Oxford Policy Management, London, United Kingdom;Consultant to the Center of Health Economics and Policy Analysis and Lecturer, School of Public Health, University of Indonesia, Depok, 16424, Indonesia;Nuffield Centre for International Health and Development, Leeds Institute for Health Sciences, University of Leeds, Leeds, LS29LJ, United Kingdom;GIZ Consultant, Pluit Kencana V/9, Jakarta, 14450, Indonesia;Pusat-KPMAK (Center for Health Financing Policy and Insurance Management), Faculty of medicine, Universitas Gadjah Mada, Gedung Radioputro, Lt 2 Sayap Barat.Jl. Farmako, Sekip Utara, Yogyakarta, 55281, Indonesia

关键词: Benefits package;    Costing;    Resource allocation;   

Others  :  810849
DOI  :  10.1186/1478-7547-10-11

 received in 2011-11-21, accepted in 2012-08-02,  发布年份 2012

【 摘 要 】

Background

Allocating national resources to regions based on need is a key policy issue in most health systems. Many systems utilise proxy measures of need as the basis for allocation formulae. Increasingly these are underpinned by complex statistical methods to separate need from supplier induced utilisation. Assessment of need is then used to allocate existing global budgets to geographic areas. Many low and middle income countries are beginning to use formula methods for funding however these attempts are often hampered by a lack of information on utilisation, relative needs and whether the budgets allocated bear any relationship to cost. An alternative is to develop bottom-up estimates of the cost of providing for local need. This method is viable where public funding is focused on a relatively small number of targeted services. We describe a bottom-up approach to developing a formula for the allocation of resources. The method is illustrated in the context of the state minimum service package mandated to be provided by the Indonesian public health system.

Methods

A standardised costing methodology was developed that is sensitive to the main expected drivers of local cost variation including demographic structure, epidemiology and location. Essential package costing is often undertaken at a country level. It is less usual to utilise the methods across different parts of a country in a way that takes account of variation in population needs and location. Costing was based on best clinical practice in Indonesia and province specific data on distribution and costs of facilities. The resulting model was used to estimate essential package costs in a representative district in each province of the country.

Findings

Substantial differences in the costs of providing basic services ranging from USD 15 in urban Yogyakarta to USD 48 in sparsely populated North Maluku. These costs are driven largely by the structure of the population, particularly numbers of births, infants and children and also key diseases with high cost/prevalence and variation, most notably the level of malnutrition. The approach to resource allocation was implemented using existing data sources and permitted the rapid construction of a needs based formula that is highly specific to the package mandated across the country. Refinement could focus more on resources required to finance demand side costs and expansion of the service package to include priority non-communicable services.

【 授权许可】

   
2012 Ensor et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Rice N, Smith PC: Strategic resource allocation and funding decisions. In Funding health care: options for Europe. Edited by Figueras J, et al. Buckingham, UK & Philadelphia. Open University, USA; 2002:309.
• [2]Smith PC: Resource allocation and purchasing in the health sector: the English experience. Bull World Health Organ 2008, 86(11):884-888.
• [3]Beddard K, Dorland JAWG, Roberts J: Needs-based health care funding: implications for resource allocation in Ontario. Canadian Journal of Economics 2000, 33:981-1008.
• [4]Rice N, Smith PC: Capitation and risk adjustment in health care financing: an international progress report. The Milbank quarterly 2001, 79(1):81-113. IV
• [5]Carr-Hill R, Hardman G, Martin S, Peacock S, Sheldon T, Smith P: A Formula for distributing NHS revenues based on small area use of hospital beds. University of York, York; 1994.
• [6]Sutton M, Gravelle H, Morris S, Leyland A, Windmeijer F, Dibden C, Muirhead M: Allocation of resources to English areas: individual and small area determinants of morbidity and use of healthcare resources. RARP 26, Department of Health, London; 2002.
• [7]McIntyre D, Chitah B, Mabandi L, Masiye F, Mbeeli T, Shamu S: Progress towards equitable health care resource allocation in East and Southern Africa. Cape Town. Equinet Discussion Paper 52; 2007.
• [8]Cortez R, Farial M, Rabbani G, Najmul H, Faiz N, Huq N, Sultana S, Tasnim T: Targeting Resources for the Poor in Bangladesh, Bangladesh Development Series – paper no. 5. World Bank, Dhaka; 2005.
• [9]Banful AB: Do formula-based intergovernmental transfer mechanisms eliminate politically motivated targeting? Evidence from Ghana. Journal of Development Economics 2011, 96:380-390.
• [10]Asthana S, Gibson A: Health care equity, health equity & resource allocation: Towards a normative approach to achieving the core principles of the NHS. UK, Radical Statistics; 2008:96.
• [11]Asthana S, Gibson A, Moon G, Dicker J, Brigham P: The pursuit of equity in NHS resource allocation: should morbidity replace utilisation as the basis for setting health care capitations? Soc Sci Med 2004, 58:539-551.
• [12]Jamison DT, Mosley WH, Measham AR, Bobadilla JL: Disease Control Priorities in Developing Countries. Oxford University Press, New York; 1993.
• [13]Sachs J: Macroeconomics and Health: investing in health for economic development. World Health Organisation, Geneva; 2001.
• [14]Lieberman SS, Capuno JJ, Van Minh H: Decentralizing health: lessons from Indonesia, the Philippines and Vietnam, in East Asia Decentralizes. In Making Local Government Work. Edited by Subbarao D, White R. The World Bank, Washington; 2005.
• [15]Bank W: Spending for Development: Making the Most of Indonesia’s New Opportunities Indonesia Public Expenditure Review. World Bank, Jakarta; 2007.
• [16]Rokx C, et al.: Health Financing in Indonesia: a reform road map. Washington, The World Bank; 2009.
• [17]Research H, Agency D: Riset Kesehatan Dasar (Riskesdas), Report National Primary Health Care: Departemen Kesehatan (Ministry of Health). Republic of Indonesia, Jakarta; 2007.
• [18]Statistics Indonesia (Badan Pusat Statistik—BPS) and Macro International: Indonesia Demographic and Health Survey. BPS and Macro International, Calverton, Maryland, USA; 2008.
• [19]Shiffman J: Generating political will for safe motherhood in Indonesia. Social Science & Medicine 2003, 56:1197-1207.
• [20]WHO: Mother baby package: implementing safe motherhood in developing countries. WHO/FHE/MSM/94.11 World Health Organisation, Geneva; 1994.
• [21]Lewis E: McMennamin T, Collins D: User's Guide for CORE Plus (nalyais of Cost and Revenue Plus) Tool Version 1. Management Sciences for Health, Cambridge, MI; 2007.
• [22]Bitran RA: A Supply-Demand Model of Health Care Financing with an Application to Zaire: A Training Tool Washington: Economic Development Institute of the World Bank. World Bank; 1994.
• [23]Kosen S, Rao C, Dunlop D: The Economic Impact of the Changing Pattern of Death in Indonesia. AusAid, Jakarta; 2009.
• [24]Ensor T, Cooper S: Overcoming barriers to health service access: influencing the demand side. Health Policy Planning 2004, 19(2):69-79.