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OECD Network on Fiscal Sustainability of Health Systems , 17th February 2015
Sandra KAISER
Performance Budgeting in Austria
Example: Health
Outline
• Introduction
• Performance Budgeting Framework
• Budget structure & documents
• Conclusions and way forward
2
Characteristics of the Austrian health system
• Cooperation of a large number of actors - Federal Ministry of Health
- Federal Ministry of Labour, Social Affairs and Consumer Protection
- Social Security Institutions
• Competencies are regulated by law - Federal Government plays central role
- Many competencies are delegated to provinces or to social security institutions
3
Health expenditures
• Financing health care*: - in total (public + private) ~ 34 bn. EUR = 11,1% GDP
- Public government incl. Social Security Institutions ~ 25 bn. EUR
76% of health expenditures are directly financed by the
public
• Federal Ministry of Health:
Budget sum 2015 ~ 900 Mio. EUR
* OECD definition: System of Health Accounts, 2012
4
5
2nd Stage as of 2013: Performance Budgeting
Objectives and benefits
• Establishes comprehensive link between outputs & outcomes with existing budgetary resources
• Facilitates priority setting in policy-making
• Strengthens performance accountability
• Enables transparent presentation of results achieved by the government and its administration for the public and the parliament
Performance Budgeting
Performance budgeting framework
Max. 5 outcome objectives
at least 1 Gender
Global Budget 1 – 5 primary
activities at least 1 Gender
Detail budget
Detail budget
Detail budget
Detail budget
Detail budget
Detail budget
Budget Chapter
P e r f o r m a n c e C o n t r a c t s (internal)
Mission statement
Detail budget
Detail budget
Detail budget
Objectives and
Activities
Global Budget 1 – 5 primary
activities at least 1 Gender
Global Budget 1 – 5 primary
activities at least 1 Gender
Objectives and
Activities
Objectives and
Activities
Objectives and
Activities
Objectives and
Activities
Objectives and
Activities
Objectives and
Activities
Objectives and
Activities
Objectives and
Activities
6
Annual Budget Statement
Explanatory budget documents
Budget structure – health example
• Heading/ Rubric - Employment, Social Services, Health and Family
• Budget chapter - Health (UG 24)
• Global budgets - 1. Management and Services
- 2. Financing of the Health Care System
- 3. Prevention and Health of Consumers
• Detail budgets - Ad 1. Center/Ministry of Health
- Ad 1. Shareholdings and Transfers
- Ad 2. Financing of Hospitals
- Ad 2. Additional payments caused by the Family Burden Equalization fund
- Ad 2. Activities for the Social Security Insurance
- Ad 3. Health Promotion, Prevention, and Fight against Drug Abuse
- Ad 3. Veterinary, Foodstuff and Gene Technology Affairs
7
Annual budget statement (budget chapter)
MTEF = medium term expenditure framework
Cash Flow Statement Ceiling
MTEF
Budget
2015
Budget
2014
Actual
2013
Receipts 48,713 48,113 85,993
Expenditures – fix ceiling 308,693 308,693 323,644 364,700
Expenditures – variable ceiling 648,351 648,351 629,669 603,902
Total expenditures 957,044 957,044 953,313 968,602
Net cash balance -908,331 -905,200 -882,609
Operating Statement Budget
2015
Budget
2014
Actual
2013
Revenues 49,382 48,702 87,256
Expenses 957,493 953,779 971,008
Net balance -908,111 -905,077 -883,752 Le
ga
lly b
ind
ing
Budget chapter: Health (in Mio. EUR)
9 9
Budget chapter 24 – Health
Mission statement “To enable the population a healthy life” (in brief)
Outcome objective 3 Securing the support, maintenance and regeneration of health
Outcome objective 4 Preventive protection of consumers´ health status
Outcome objective 5 Securing health status of animals and animal care
Annual outcome statement (budget chapter)
Outcome objective 2 Equal access to health care services
Outcome objective 1 Securing a nationwide, easy accessible, jointly
financed and integrated health care system
a
bs
tr
ac
ts
10 10
Outcome objective 2 Equal access to health care services
Annual outcome statement (budget chapter)
Last available value
2012:
925,688
(women:501,194,
men:424,494)
Target value 2014
1,020.570
(women: 529,658, men:
490,912)
Indicator 1
number of women
and men who
attend preventive
health
examination
No Last available value
available, since it was
launched in 2014
Target value 2014
45%
Indicator 2
% of women
between 45 and
70 years who
participate at
breast cancer
screening
Budget chapter at a glance
11
= financial information
= performance information
(outcome statement)
Budget chapter: Health
Global budget 24.01
Management &
Services
Global budget 24.03 Prevention and Health
of consumers
Global budget 24.02 Financing of the
Health Care System
12
Outcome objective 2
Equal access to health care services
Annual output statement (global budget)
Link to
outcome
objective
How is this objective achieved?
Measures:
How would success look like? Milestone
and indicators for 2013
Status quo
1 Jointly financing of the HC system: Securing
financial sustainability of the HC system
through consolidation of the financial
capacities, inter alia through binding
contracts of financial targets (expenditure
dampening path) and their implementation
while considering the legally binding budget.
No more debts of the regional
sickness insurance funds by the end of
2013.
The public HC insurance funds have no
deficit in 2013.
According to the 2009
closing of accounts, the
regional sickness insurance
funds had 692 million € of
debts. According to the 2011
numbers, there was no
indebtedness any more, but
net assets of 120 million €.
2 & 3 Quality of results will be analyzed according
to gender as a basis for a monitoring to
achieve a comparable quality of results for
both genders. The basis for this evaluation is
routine data coming from hospitals: Austrian
Inpatient Quality Indicators (A-IQI).
Until the end of 2013, there will be an
instrument for quality of results
monitoring, which will enable a nationwide
standardized measurement in hospitals. They
will mainly analyze statistical peculiarities and
look for reasons for non-compliance with agreed
targets. Afterwards, there will be an external
quality assurance. There will be an analysis in
cardiology differentiated by gender.
Technical implementation is
completed and the available
data material can be used for
monitoring.
!! only a selection !!
13
Global budget: Prevention and Health of consumers
= financial information
= performance information (output statement)
= recommendations by the Court of Audit
Global budget at a glance
Explanatory budget documents (detail budget)
Detail budget
24.03.01
Health Promotion,
Prevention, and
Fight against
Drug Abuse
Activity 1 mother-and-child
healthcare
Indicator/Milestone 1 Improvement of
prevention of mother-and
child-healthcare
Objective 2 Ensuring a high quality health of children and
young people, Implementation of a public
vaccination policies, promoting of healthy
nutrition;
Activity 2 suicide prevention with
focus on young people
Indicator/Milestone 2 Carrying out of training
program in various settings
Soft linkage with budget
!!! only a selection of objectives and activities !!!
Detail budget at a glance
15
Detail budget: Health Promotion, Prevention, and Fight against Drug Abuse
= financial information
= performance information
Conclusions and way forward
• Discussion in Parliament (Experiences from two past budget-debates)
- Strong focus on outcome objectives, activities and indicators, not on detail budgets
- Debate shifts from unsystematic, input-oriented questions to priorities and strategies of ministries
- All political parties refer to performance information
- Needs to settle down
• Evaluation of the budget reform - done by the Ministry of Finance, involving the line ministries and
the Federal Chancellery (second half of 2014 + 2015)
- One topic: readability and clarity of the budget documents and reports
- Overload of budget information
16
Thank you for your attention
17
Contact: Sandra Kaiser Advisor on Budget Reform Austrian Federal Ministry of Finance Directorate General II - Budget and Public Finances Tel: +43 1 514 33 502009 [email protected] www.bmf.gv.at