Etudes par pays volume 2, PDF, 346 p., 1,4 Mo - Femise

11873_2002 Study D2: Poverty, Informal Sector, Health and Labour
The OGA for farmers, with 2.2 million insured persons, has no clinics of its
own, its beneficiaries having a free access to the Health Centers of the NHS.
The beneficiaries of the fund for civil servants have a free of charge access
to any physician on a list of contracting physicians paid by the fund on a
case by case basis with very low fixed fees. Finally, the beneficiaries of the
fund for merchants and business owners may visit physicians of 9
specialties who are paid by the fund according to the number of patients
registered with them.
Apart from these, the rest of the numerous funds cover special groups of
beneficiaries, such as employees of banks, public utilities, or certain
occupational groups, such as lawyers, physicians, engineers, etc. Among
them, they offer health insurance coverage to about 1.3 million people. A
few of them have their own clinics.
Turning to the financial issues of health care, we may note that the NHS is
financed by the state budget, the Social Insurance Funds in a case by case
manner and the households that make use of the health services. Despite the
supposedly free of charge services to all citizens by the NHS, a high share
of the overall cost for health is incurred by households, feeding a flourishing
private sector supply of health services. By 1989, the share of each of the
above three sources of finance was roughly one-third of total expenditure.
These shares changed however over time. In 2000, social insurance funds
represented 46 per cent of total health expenditure, the private sector 42 per
cent and the rest 12 per cent came directly from the government budget. In
other words, the two major sources of finance took a much higher burden
than in the past. Concerning the allocation of expenditure, the non-private
spending, i.e. social insurance funds plus the government budget, goes
mostly to hospital treatment (56 per cent in 1998), whereas primary health
care absorbed only 28 per cent. Households’ medical expenses are heavily
(72 per cent) directed to the primary health care, including dental treatment
that takes almost half of it (34 percentage points). Households spent 12 per
cent of their health expenditure for hospital treatment and 15 per cent for
pharmaceuticals, just about the same proportion as paid by the public sector
at large (table 5).
FONDAZIONE CENSIS
137