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R 858 .Z95 1989 c.3
The Health Finance Simulation Model
User's Manual and Program. Diskette
Manuel Zymelman
A World Bank Public~ JOINT BANK-FUND UBRARY
JLC169059
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The Health Finance Simulation Model
User's Manual and Program. Diskette
Manuel Zymelman
The World Bank Washington, D.C.
© 1989 The International Bank for Reconstruction and Development/THE woRLD BANK 1818 H Street, N.W., Wasl}ington, D.C. 20433, U.S.A.
All rights reserved First printing July 1989 Manufactured in the United States of America
The Health Finance Simulation Model (HEALTHFISIMO) is a utility designed for use with Lotus 1 -2-3 on IBM and IBM-compatible personal computers with a minimum of 640K memory. The HEALTHFISIMO program was written to assist in the operational work of the World Bank; it is solely the work of its author. The World Bank, the members of its Board of Executive Directors, and the countries they represent make no representation or warranty with respect to HEALTHFISIMO. The purchaser assumes all risk for the installation and use of, and results obtained from, the program. The World Bank shall not be liable for any error contained in the program or in the supporting manual or documentation supplied with the program or for incidental or consequential damage resulting from the furnishing, performance, or use of the program.
IBM is a registered trademark of International Business Machines Corporation. Lotus and 1-2-3 are registered trademarks of Lotus Development Corporation.
Preface Acknowledgments
CONTENTS
Conventions Used in This Manual
v Vl
Vll
Introduction 1 1 Description of HEALTHFISIMO 5
Budget Submodel 5 Delivery System Submodel 7 Nurses Submodel 8 Nurses' Training Model 8 Outputs 9
2 How to Operate the Model 13 The User Command Menu 13 Selecting a Command 15
Locate Command 15 Print Command 22 Calc & Print Command 25 Reset Command 25 Graph Command 25 Save Command 28 Exit Command 28 Quit Command 28
3 How to Use the Model 29 Data Required 29
Budget 29 Activities 30 Resources 30 Prices 30 Nurses' Salary 31 Population 31 Nurses' Training 31 Rates of Growth 32
Simulating Policies 32 Financial Policies 33 Operational Policies 3 7
Other Features of HEALTHFISIMO 48
Appendix A. HEALTHFISIMO'S Spreadsheet 54 Appendix B. Data Required to Operate the Model, with the
Location of Values in the Spreadsheet 55 Program Diskette Following page 60
iii
Preface
This manual has three chapters. The first describes the Health Finance
Simulation Model and presents the outline of the model. The second and
third provide step-by-step instructions on how to use the model. Chapter 2
explains the commands by which the user manipulates the model. These
explanations are accompanied by copies of what will appear on the computer
monitor at the various stage~ of operating the model. ·Chapter 3 uses a
hypothetical country to show how to apply the model to solve specific
problems. Financial and operational policies are simulated, and the results
are presented in tables.
Two appendixes provide further details about the model. The schematic
map in appendix A will help the user locate the various parts of the model
on the worksheet. Appendix B presents a list of data required by the model,
along with their labels and.locations in.the spreadsheet.
Users who have questions about the operation of the model may contact
the author by calling (202) 477-1234 or writing care of the World Bank, 1818
H Street, N.W., Washington, D.C. 20433, U.S.A.
v
Acknowledgments
I would like to thank Professor Ron Vogel and Dr. Carlo de Ninno for
their help and useful. suggestions, and Bill Knight for his assistance in
programming.
vi
Conventions Used in This Manual
Certain conventions are used throughout this manual to show the user
what to do at the computer keyboard.
Keys to be pressed are given in brackets. "Press [Enter]" means to
press the key marked "Enter" or "Return" on the keyboard. "Press [PJ then
[S]" means to press the key marked "P," release it, and press the key marked
"S." "Press [Alt-M]" means to press the key marked "Alt" and, while holding
it down, press the key marked "M."
vii
Introduction
Decisionmakers and administrators of health care systems in developing
countries face difficult choices today. Limited budgets and increasing
demand for health services compel them to look for new alternatives and to
search for solutions to new problems. But dealing with a system as
complicated as health care requires sophisticated tools of analysis. The
Health Finance Simulation Model (HEALTHFISIMO), used with a personal
computer (PC) and Lotus 1-2-3 software, is such a tool. This model deals
only with macro-level problems of the health sector. The questions this
computer model can answer include:
•
•
•
How can priorities in the budget be reordered to increase the access of a population to a particular type of health care?
What operational changes in the production function of the health care delivery system are necessary to lower unit costs and thereby provide more health services within the same budget?
What effect do present salary scales and prices of drugs have on the provision of health care?
Existing simulation models for the macro~level planning and budgeting
of health services in developing countries involve, explicitly or
implicitly, the following steps:
1. Forecasting the services to be provided
2. Forecasting the physical requirements (doctors, nurses, drugs, buildings, and so on)
1
2
3. Es1;imating the cost of these requirements
4. Forecasting financial resources at time t
5. Comparing the figures from steps 3 and 4 (calculation of deficits or surpluses).
With such models, however, it is difficult to achieve a congruence between
costs and forecasted budgets. HEALTHFISIMO differs from other models by
making health services a function of an exogenous budget and the unit costs,
which in turn depend on the characteristics of the health care delivery
system. Moreover, the financial effect of policies designed to affect the
operation of the system is always within budget. HEALTHFISIMO also makes it
possible to simulate the effect of changes in various components of the
budget of a given ministry of health (MOH), in the budget itself, and in the
operation of the system.
HEALTHFISIMO calculates and prints for each of twelve years:
• Total budget of the MOH
• Budget for patient care
Proportion of the MOH budget assigned to patient care
• Distribution of the budget for patient care among three types of health care delivery systems
Ratios of three types of health care services, or interventions, to population
• Total investment.
For the purposes of HEALTHFISIMO, the three types of health care
delivery systems are defined as follows:
Primary care: Health posts and similar facilities.
Secondary care: Health centers or clinics and similar facilities.
Tertiary care: Hospitals and hospital-like facilities.
3
The primary, secondary, and tertiary care delivery systems are denoted in
HEALTHFISIMO by the terms type 1, type 2, and type 3. For each of these
types, HEALTHFISIMO calculates:
•
•
•
•
•
•
Budget
Unit cost
Number of interventions in three categories: preventive, inpatient, and outpatient
Required doctors
Required nurses
Investment .
I Description of HEALTHFISIMO
HEALTHFISIMO has three interlocking parts: a budget submodel, a
patient care delivery system submodel, and a nurses submodel (see figure
1). These three parts interact to provide a series of outputs. A separate
nurses' training model is also included.
Budget Submodel
The budget available for health services, or patient care, is a
function of the government's total operational budget, which in turn can be
made a function of the gross national product, the share allocated to the
ministry of health (MOH), the share of the other claimants on the MOH
budget, income from fees, and financing from other sources (such as local
governments and nongovernmental organizations).
where
s-1
k=l
BG,=BG,_ 1 (1 +rg,)
BMH*,=BMHkt-1 (1 +rkt)
BMH~a + FEES, + OF,
PATBUD =budget allocated to patient care BG =government's operational budget
B=share of MOH in government's budget BMHk =budget for components of the MOH
FEES income from fees OF= other financing
t=time s =claimants on the MOH budget
rg =rate of growth of BG rk rate of growth of BMHk.
5
~::,0 --+ "Y B1 U1 ....
YUC1
0 8 B2 U2
YUC2
LG l-'Y-8 B3 U3 Available Budget
A UC3
LJ t .._____
I ::E <D
9 c
~ t;
0> :£; c (;; E ·c:
~ g .c 5
BG !YQ
t Units
Unit Casts
i Units
Unit Costs
1 Units
Unit Casts
Figure 1 HEALTHFISIMO
(Health Finance Simulation Model)
RN1
RN2
RN3
Inputs per Salaries Unital and
l Output
[ r Prices
r Inputs per Salaries Unital and Output Prices
Inputs per Salaries Unit of and Output Prices
Average Salary of Nurses
~ Required Nurses RN 1 v -M r-+" I
Available Nurses ( T\.
New Nurses A ~ ~
Ni(1-AI)
4 L. - L..,..
N1 N6 A Ni Tn
I
~~-~ r--'\
01
___J •
t Ni NI(1-AI) Nn
- ~ - ~ N7 B
Wai I
~~,~
Y.~-.,.-
7
The budget allocated to each type of health care delivery system at
time t is the budget of the preceding year plus a share of the increase in
the total patient budget.
where
PATBUD1,=PATBUD1,_ 1 + ")', (PATBUD, PATBUD,_ 1)
PATBUD2,=PATBUm,_ 1 + o, (PATBUD,- PATBUD,_,)
PATBUD3,=PATBUD3t-! + (1-")',-o,) (PATBUD, - PATBUD,_ 1)
PATBUDl =budget of primary care delivery system PATBUm =budget of secondary care delivery system PATBUD3 =budget of tertiary care delivery system
'Y = share of primary care delivery system in the budget increase o share of secondary care delivery system in the budget increase.
Delivery System Submodel
Each of the three delivery systems is described by physical inputs,
salaries and prices, and outputs. These variables are reflected in the unit
costs of the various types of interventions. The external variable driving
the systems is the budget allocated to them.
where
UC1,=U1, [(DIU)it wdt + (NIU);, wnt +(TIU);, w" + (WIU)it wWI + (MIU);, X p mt + (Dr/U)it X pdt + (OIU);, X Po, + Adm;/U1,]
Adm;, = Adm;,_, (1 + ra)
UC1 =unit cost of intervention in delivery system i U =units of patient care (number of interventions) D=doctors
Wd =average wage of doctors N=nurses
Wn =average wage of nurses T =technicians
W, =average wage of technicians W =other workers
Ww average wage of other workers M =materials p m = price of materials Dr= drugs and other medicines P d =price of drugs and other medicines 0 =other expenditures P
0 =price of other expenditures
Adm =administrative overnead ra =rate of growth of administrative expenditures.
8
Nurses Submodel
The nurses submodel is a detailed flow model that--given initial
conditions, transition rates from one step of the salary scale to the next,
and attrition rate by step of the salary scale--calculates the number of
nurses (by type and by step of the salary scale) over time. The user should
define the three types of nurses, which might be defined according to
certification required, degree of skill and experience, or other criteria.
The external variable driving this system is the number of new nurses
required, which in turn is determined by the budget available to the
delivery systems and unit costs, the ratio of nurses to interventions, and
the number of available nurses.
where
~mt=~(m-l)(t-1) (l-Am)
~~=E ~mt m
RN =required nurses E~ =entering nurses of type j at salary step m AN= available nurses
PC~= proportion of entering nurses of type j ~=nurses of type j A"' = attrition rate at salary step m "fm =average wage of nurses of type j at salary step m.
Nurses' Training Model
The nurses' training model is a flow model that yields the output
(nurses) required by the health care delivery system and calculates the cost
9
associated with this output. Driven by the requirements of the public and
private health care systems for new nurses, this model allows the user to
analyze the training of up to three types of nurses.
where
Ej, =PC~ X RNN,+h/kj X aj
RNN, = RNNput + (RNNprt - NTprt)
S~,=S~t-1 - Gjt-1 - DRjt-1 + Ej,
Gj, = Ejt-h X aj
DRj, = S~, X drj
Bj, = ucj, x s~,
TB,=BB-j jl
E; = entrants to nurses' training oftype j RNN =required new nurses
NT= nurses trained SN =student nurses G =graduates
DR= dropouts TB =total budget for training nurses
h =length of training k=proportion of graduates who enter the profession a =proportion of entrants who graduate after h years
pu = public sector pr =private sector dr =dropout rate.
Outputs
Each delivery system provides three types of care: preventive,
outpatient, and inpatient. For the purposes of HEALTHFISIMO, each delivery
system may be said to have a synthetic unit of care, which is a composite of
the three types of care. The synthetic unit of each system_uses the most
prevalent type of care in that system as a numeraire. For example, the
numeraire in the primary care delivery system is preventive care.
Outpatient services are translated into the equivalent preventive services
by relating inputs dedicated to outpatient services to inputs dedicated to
10
preventive services. This synthetic unit can, in turn, be transformed into
three types of health care: preventive, outpatient, and inpatient. Although
it is difficult for any one intervention to typify, say, preventive
services, the number of immunizations given could serve as a prototypical
preventive intervention. Likewise, the number of outpatients treated could
be the prototypical outpatient intervention, and the number of patient days
could be the prototypical inpatient intervention. The synthetic units are
calculated as follows:
where
U1, = B1/ ucit-l
NPRE~=x;U1
NINPAT; = z;U1
U1 = synthetic units of delivery system i B1 =budget of delivery system i
UC1 =unit cost in delivery system i NPREV =number of preventive interventions
NOlnPAT=number of outpatient interventions NINPAT= number of inpatient interventions
x, y, and z =coefficients relating the number of preventive, outpatient, and inpatient interventions, respectively, to synthetic units.
This allows one to calculate the ratios of interventions to population for
each type of care:
where
RPRE~=NPREV;)Pop,
ROUTPAT, = NOUTPAT;/Pop,
RINPAT,=NINPAT,/Pop,
RPREV =ratio of preventive interventions to population Pop= population
ROUTPAT= ratio of outpatient interventions to population RINPAT= ratio of inpatient interventions to population.
11
Fees used in the budget submodel are calculated as follows:
where
FEES1=NPREYr_ 1 x Fprev, + NOUTPATe-1 X Foutp, + NINPA~-t X Finp,
Fprev =fee for preventive unit of care Foutp =fee for outpatient unit of care
Finp =fee for inpatient unit of care.
Investment is calculated as follows:
where
I;= investment required in delivery system i U; =unit of output in delivery system i
(II U) =investment per unit of output.
NOTE: Most parameters in the model are a function of time; in the case
of wages, for example,
where
r d =rate of growth of wages.
Prices have their own rate of growth, which can be adjusted on a yearly
basis.
The model calculates the average wage of nurses. When the index of
nurses' wages departs from the general price index, it is possible to modify
the average nurses' wage by a coefficient (labeled PRICEINDEX in the
spreadsheet) relating the index of wages to the general price inder..
where
W,. adjusted average wage of nurses PI=price index.
12
For example, if the cost of living increases by 10 percent during the year,
and the level of nurses' salaries by 5 percent, the amount entered in the
cell labeled PRICEINDEX becomes .95, anq the adjusted wage becomes the
nominal wage multiplied by .95.
2 How to Operate the Model
HEALTHFISIMO is made up of several components, all of them controlled
by the Lotus 1-2-3 spreadsheet program. The user communicates with the
system through a keyboard and monitor. To activate the model, the user
types in a set of Lotus system commands. Lotus 1-2-3 responds by
retrieving the desired spreadsheet file and displaying it on the monitor.
The user runs the model by entering the appropriate commands while in the
spread~heet. The spreadsheet can be stored as a Lotus file or discarded on
completion. A chart depicting the organization of HEALTHFISIMO's
spreadsheet is given in appendix A. It is possible to scroll through the
spreadsheet's entire matrix to view all or any part of the model by using
the directional keys or by entering a special command (see ~Locate Command,"
later in this section)~
The User Command Menu
Once the model is loaded, consult HEALTHFISIMO's main user command menu
to select the activity (for example, data entry, model calculation,
graphing, or printing) you wish to perform. To reach this menu, first make
sure that the word "READY" appears in the upper right-hand corner of the
screen, then press [Alt-M] (for Menu) . 1 (See screen 1.) The word "MENU" in
1. This command, [Alt-M], can be used every time you want to return to the user command menu.
13
14
Screen 1
the upper right-hand corner always indicates that you are at a user command
menu.
The main user command menu gives a choice of eight commands:
• Locate
• · Calc & Print
• Reset
• Graph
• Save
• Exit
• Quit.
or
15
Selecting a Command
There are two ways to select a command:
• Use the directional keys to move the cursor to the command and then press [Enter].
• Press the key that corresponds to the first letter of the command's name. For example, press [L] to execute the Locate command. (This is the method shown in the rest of this manual.)
To stop executing any command, press [Esc] until the word "READY"
appears in the upper right-hand corner of the screen.
Locate Command
The Locate command allows you to go directly to one of the areas in
which data are entered, to the area for ·outputs, or to the summary table
without having to scroll through the entire spreadsheet. When you select
this command (by pressing [L] while in the user command menu), you will see
a list of options (screen 2).
There are five areas in which the data required .to run the model can be
entered or changed: the inputs area, the nurses' training model, the
nurses' salary area, the population table, and the rates area. To introduce
or change data, locate the appropriate area, use the arrow keys to select a
cell, type in the data, and press [Enter] or move the cursor to another
cell.
16
MENU
Screen 2
Locate conunand option Explanation
Input Go to the area for inputs
Output Go to the area for outputs
Nurses' Training Go to the nurses' training model
Nurses' Salary Go to the area for nurses' salaries
Population Go to the population table
Rates Go to the area for annual rates of growth
Sununary Go to the sununary table
If you press [I] (for Input) while in Locate, you will have a choice of
several areas for inputs (screen 3). Move the cursor to the desired option
and press [Enter], or press the key that corresponds to the first letter of
the option's name.
Input area option
Budgets
Activities
Resources
Explanation
Go to the area for budgets
Go to the area for data on activities
Go to the area for data on allocated resources
Prices
Training
17
Screen 3
Go to the area for prices and salaries of inputs
Go to the area for inputs for nurses' training
If you press (B] (for Budgets) while in Input you will see the area for
budgets (screen 4).
Screen 4
18
If you press [A] (for Activities) while in Input you will see the area
for activities and units of patient care, or interventions (screen 5).
Cll tW!21 READY
I 2 ------~--- ACTIVITIES 3 BUDGETS AMD UMHS NUftBER SHARE 4 Ill==== ===::=• = "'-"' == = =· = =:::::::: = = === === = :=: =-= = = ··= ::=: = = = = == :=: ::::=== = == 5 GOVBUD $100,000,000 PREVENT! 10000 70. 0~ b ALPHA 2. 001 OUTPATI 2000 30,01 7 BETA s.u INPATI 0 0.07.
Screen 5 B ftHL THBUD tS, 356,038 UNITS I 14286 9 ADftiN l700,000 PREVENT2 2000 30.01 10 TRAtNlN6 S20, 000 OUTPAT2 5000 bO. 01 II OTHER I tSO, 000 INPAT2 100 10.01 12 OTHER2 S25, 000 UNITS2 8333 13 OTHERJ so PREVENTJ 2000 20.01 14 FEES so OUTPATJ 7000 20. ox IS OTHFINCON so INPAT3 6000 60.01 !b PATBUD t4, Sb 1, 038 UN!TS3 10000 17 TVPEI Sl,l1B,02b U-COSTS I t92. 26 18 TVPE2 u, 194,952 U-COSTS2 1143.39 19 TYPEJ S2,048,060 U-COSTSl l204.81 20 SHARE I 28,9X INV/UN!TI s2s. oo !6-ftay-89 08:35 Aft CALC
If you press [RJ (for Resources) while in Input you will see the area
for resources (screen 6).
61: (W!Ol READY
RESOURCE INPUTS INPUTS/UNITS OF SERVICE
• :::::;;:c:::===;;.: Ty~o I Type 2 Typo 3 Typil I Type 2 Tv~• 3 5 GDOC 30 50 70 o. 00 o.ot o. 01
• QNURSE 300 200 400 o. 02 0.02 0.04 7 QTECH 5 10 20 o. 00 o. 00 o.oo
Screen 6 B QWORK 350 300 500 0.02 0. 04 o.os 9 ftATEXP S20,000 S!S,OOO S27, 000 U.40 u.ao t2. 70 10 DRUGEXP sso,ooo >40,000 l70,000 S3,50 H.eo l7 ,00 II OTHEREXP S3, 000 S2, 000 ss, 000 so. 21 so. 24 tO.SO 12 ADft!NEIP 1121,500 U09,000 UBB, 000 SS,SI 113.08 ua. eo 13 I 4 DDCPRIV 30 15 DRUGEXPGRD DOCPR!VG 0.1 lBO TOTAL DOCT 16 PRICE INDEX NURSPRIV 100 0. 02 ATT. DOC 17 ADMNEXPGRO NURSPRIVG o. 05 1000 TOTAL NURS IB ftATEXPGRO TR_NURS_PR!V 20 0.02 ATT.NURSPR 19 OTHEXPGRO T RNURSPR I VG 0. OS 20 lb-ftay-89 08:30 Aft CALC
19
If you press [P] (for Prices) while in Input you will see the area for
salaries, prices, and fees (screen 7).
01' (WI OJ
SALARIES, PRICES ~ FEES
4 ;;;::::e:!!e:<:::::::;:
s DOC SAL •o, ooo b NURSE SAL t.l' 701 7 TECHSAl 13,000 8 WORKSAL '1,200 9 HATPRICE $\.0 10 DRUGPR!CE 1!.0 11 OTHERPR!CE 11.0 12 AOHINPR!CE 11.0 13 14 OOCSALGRO IS TECHSALGRO lb WORKSALGRO 17 18 19 2a 1 b-Hav-89 08:39 AM
FEES PER PATIENT
FEEPRE~ F€€0UTPAT FEE INPAT
10.00 10.00 la.oo
ACCOUNTING IDENTITY CHECK - UNIT COSTS Type 1 Type 2 Type 3
U.C. lBud/TCI S92,2b S!43.39 OZ04.BI U.C. !Suo UCI $92.39 $143.54 $205,04
CALC
READY
Screen 7
If you press (T] (for Training) while in Input you will see the area
for inputs for nurses' training (screen 8).
AH: !Will
34 35 INPUT FOR NURSES' TRA!NINS lb 37 38 39 40 41 42 43 44 45 4b 47 48 49 50 51 52 53
rate
Length of training in years (h)
Graduotu .. no enter nursing ( k I X of et"'trants who graduate !a I
Rate of dropouts !dl nursing studentl in year a
entering students in 0-3 entering students in a-2 entering student& in 0-1
entering students in 0 unit cosh of training nurses
initial nurses training bttdget of growth of nur. train. budget
!b-Hay-99 oB: 40 AH
Type A 2
a. 9 a. 15
0.1 30 1S 15 15 15
no a 119,980
0.03
CALC
Type B 2
o. 9 a. 75
o.1 30 15 IS 15 15
$30a
Type C 2
a. 9 a. 75
o.1 IO 5 5 5 5
300
REAnY
Screen 8
20
If you press [OJ (for Output) while in Locate, you will see the first
part of the results for each year of the twelve-year simulation (screen 9).
To see results for other years press [PgDn).
WI: (W7l 1- READY
w X AA AB --------------------YEAR 1-------------------------------------------PATBUD $5,316,079 TYPE 1 TYPE 2 TYPE 3
FEES H64,000 DOCTORS S209, 797 $349' 602 t4B9,527 4 OTF INCH $0 MURSES $574,017 $382,678 $765,356 5 B!PC U,536,214 TECHNICIANS $17.483 $34, lfbb $69.932 b B2PC 'ft, 392, 7bb WORKERS $489' 527 S419t59S t099,325 7 B3PC $2,387,099 NON.HED.MAT $23,311 u 1' 483 $31,470
Screen 9 8 HHLT BUD $5,463,159 DRUGS~ HED sse, 277 $46,622 set~ sea 9 BUO.NUR $20,579 OTHER INPUT t3. 497 $2,331 $5,828 10 ADHINISTRAT U2!,500 -~:~~,~~~ USB, 000 I! U1 CARE I 6,651 12 U2CAR£ 9, 713 TOTAL S1,497,410 11t362,336 $2,33!,026 13 U3CARE 1') 65'5 UNIT $89.93 $140.26 t200. 00 14 15 TYPE l TYPE 2 TYPE 3 TOTAL !6 17 PREY£ NT 11) b55 2, 331 2' 331 16,318 18 OUT-PAT 21331 5,829 8, !59 16,318 19 IN-PAT 0 117 b. 993 7' 11Q 20 lb-hy-89 08:42 AM CALC
If you press [N] (for Nurses' Training) while in Locate, you will see
the area with yearly results on nurses' training (screen 10).
Screen 10
AKI:
9 10 1! !2 !3 14 IS 1 b 17 !B 19 20
AK AL AH AN NURSES' TRAINING MODULE
-----<YEAR 1>---TYPE A ---TYPE B £(11 2B 28 Sill 44 44 G C 11 11 11 BC!l i13,144 t13,144
-----<YEAR 2>---TYPE A ---TYPE B E <21 14 14 5 (21 44 44 G C21 11 11 8 <21 ~13,1bb $13, 1bb
16-Hav-99 09:44 A"
AD
---TYPE C 37 43
4 $12,800
---TYPE .c 19 57
4 $17,104
CALC
AP
-----TOTAL 94
130 2b
139' 087
-----TOTAL 48
145 26
U3,436
READY
21
If you move the cursor to "Nurses' Salary" and press [Enter], you will
see the area for data on nurses' salaries (screen 11). This is the only
option that cannot be selected by pressing its initial letter, since [N] is
reserved for selecting the Nurses' Training option.
ASB: lWISl READY
AS AT AU AV AW B NURSES' SALARY nODEL 9 ------ ~---- ---------10 SALARY STEP II ----------------------- ---------- ----------12 TYPE A NURSE 10 5 35 13 WAGE TYPE A $1,385.00 $1,385.00 $1,426.00 14 TYPE 8 NURSE 15 !B 5 15 WAGE TYPE B tt,6t2.oo $1,612.00 $1,722.00 Screen II 16 TYPE C NURSE l l I 17 WAGE TYPE C $1,319.00 $1,319.00 H,296. 00 !8 AITR!HON o. 009 0.009 o. 009 19 20 21 22 WAGE BILL-A $13,850 $6' 925 $49,910 n WAGE 8 ILL -B S24, lBO $29, 0!6 $8t610 24 WAGE BILL-C $1,319 $! '319 Sl, 296 25 26 27 16-Hay-89 08:45 An CALC
If ~ou press [P] (for Population) while in Locate, you will see the
area for data on population (screen 12).
ARI: !Nl21 'POPULATION TABLE
10 II 12 13 14 15 16 17 18 19 20
AQ AR
16-Mav-89 08:48 AM
AS
POPULATION - A RATE GROWTH
AT AU
1,210,000 1,246,300 o. 03
SALARY STEP
TYPE A NURSE WAGE TYPE A TYPE B NURSE WAGE TYPE B TYPE C NURSE WAGE TYPE C ATTRITION
NURSES' SALARY MODEL
10 11.385. 00
15 H, 6!2. 00
1 Sl, 3!9. 00
o. 009
CALC
READY
Screen I2
22
If you press [R] (for Rates) while in Locate, you will see the area
for yearly parameters and growth rates (screen 13).
CAl: IW12l READY
CA CB CC CD CE CF CG CH C 1 TABLE OF ANNUAL GROWTH RATES
-------------------------------YEARS----------------------
Screen 13 ALPHA
BETA SHARE!
9 SHARE2 10 SHARE3 11 OTHF I"GRO 12 ADMINGRO 13 OTH!GRO 14 OTH2GRO 15 OTH3GRO 16 DRUGEXPGRO 17 ADMNEXPGRO 18 MTEXPGRO 19 OTHEXPGRO 20 DDCSALGRO 16-Hav-89 09:50 AM
1 2 3 4 5 b
o. 02 0.05356 0. 28898 0.26199 0.44903
0 o. 02 o. 02 0.02
0 0 0 0 0 0
0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.054 0.054 0.054 0.054 0.054 0.054 0.054 0.289 0.289 0.289 0.289 0.289 0.289 0.289 0.262 0.262 0.262 0.262 0.262 0.262 0.262 0.449 0.449 0.449 0.449 0.449 0.449 0,449
0 0 0 0 0 0 0 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 CALC
0 0
If you press [S] (for Summary) while in Locate, you will see the first
part of the summary table (screen 14 and table 1). In the table, the
parameters of the system are shoWn below the summary of results. Summary
results comprise data on budgets, investments, unit-costs, number of
interventions, and the ratio of interventions to population. It shows all
of these for each of the three delivery systems and for the health care
system as a whole. Yearly figures can be obtained by scrolling through the
spreadsheet.
Print Command
The Print command allows you to print out summary tables. If you press
[P] while in the user command menu, you will see a list of options (screen
15).
23
COl: [W4l .... OUTPUT SU~~ARY ~ .. HEALTH FINANCE SI~ULATION ~ODEL READY
co CP CQ CR cs CT cu ... OUTPUT SU~~ARY ... HEALTH FINANCE SI~ULATION ~ODEL Distribution of
<----------- Budgets ---------> <------ Patient Budget -----> Year Health Patient Pat/HIt Type 1 Type 2 Type
---------- ----------b t5, 356,038 t4,5bl,038 as. tbl 2a. qoY. 2b. 201 44. qoY. 7 ts, 463, tsq tS,Jlb,OH q7. 317. 2a. qox 2b. 201. 44. qox a tS,S72,422 ss,sta,eJs qq, 047. 2a. qox 2b. 207. 44. qox Screen 14 q SS 1 b83 1 870 tS,bb2,422 qq, 627. 2a. qox 26.207. 44. qo7.
10 4 ts, 797,548 tS, 794,378 qq, 777. 2a. qor. 26.201 44. qor.
11 s $5 1 913,499 SS,900 1 027 qq, 777. 2a. qox 26.207. 44. qox
12 6 $6,031, 76q $6,016,721 qq, 757. 2a. qor. 26.201 44. qox
13 7 tb, 152,404 Sb, 133,958 qq, 707. 2a. qox 26.207. 44. qox
14 a tb,275,4S2 tb, 253,946 qq, 667. 2a. qor. 26.207. 44. qor. 15 q tb,400,9bl tb, 374' 298 qq. sax 2a.qox 26.207. 44. qo1. 16 10 t6,S2a,qao Sb, 4qa, qoo qq, 547. 2a. qor. 26.207. 44. qo7. 17 11 tb,b59,Sb0 tb,b2b,930 qq, 51 r. 2a. qox 26. 20Y. 44. qox ta 12 tb, 792,751 tb, 761,163 qq,S3X 2a. qor. 26.207. 44. qo1. I q == = = == = = = = = = = = = :& = = == == = = == = = ==== = == = = = = = = = = = = == = = = = = = = = = = = = = = = = = = = = = = = = = 20 For SL.IIIIIIary of inputs press lPgDnl 16-~ay-aq oa: 52 A~ CALC
~ENU
Summary Nurses' Tri.ining Both Print outnut su••arv tables
Screen 15
Print ,command option
Summary
Nurses' Training
Both
Explanation
Print the summary table
Print summary of nurses' training model
Print summary table and summary of nurses' training model
24
If you wish to print out the surrunary table, make sure that the printer
is ready. Then press [P] and [S], and the computer will print out a copy of
the summary table. NOTE: The program diskette is set up to print on a
wide-carriage printer. It is possible to change the set-up string by going
to cell C385, introducing the string demanded by the particular printer, and
activating the macro by pressing [Alt-O].
How to print any part of the spreadsheet. If you want to print any
part of the spreadsheet other than the surrunary table or the summary of the
nurses' training model, follow these steps:
1.
2.
3.
4.
Press [/] to reach the Lotus system menu.
Press [ p] to select the Print command.
Press [R] to select the Range command.
Press [Esc] after you see
Enter Print range: A198 .. H259.
You will then see
Enter Print range: Al98.
Move the cursor to the cell in the upper left-hand corner of the area you wish to print.
5. Press [.] (the period key) and then move the cursor to the cell in the lower right-hand corner of the area you wish to print.
6. Press [Enter] to return to the Lotus system menu.
7. Make sure that your printer is ready and then press [G].
How to print a screen. If you want to print exactly what is on the
screen, press [Shift-PrtSc].
25
Calc & Print Command
The Calc & Print command allows you to calculate the spreadsheet before
printing the summary table or the summary of the nurses' training model, or
both. To execute the command, press [C) while in the user command menu.
NOTE: You can calculate the spreadsheet without printing by pressing [F9].
Reset Command
The Reset command resets the yearly growth rates to their original
values. To execute the command, press [R) while in the user command menu.
Graph Command
The Graph command allows you to view any of seven graphs as either a
line graph or a bar graph and to save graphs as files for later printing.
When you select this command (by pressing [G) while in the user command
menu), you will have a choice of graph styles (screen 16).
=
Ll ne uar Line graph
---=1:6=:: IRA IN I NG
II OTMERl =---T2 Q I AER2
t2A-.--ftMt==:=-£Htfp-Af-'l SftOft··· --=t.-:f):;::0:X==----S5C,l0l - t•••n toe=· = -mfE~ ·=-~~--
==Lfrfit_- -~=&.-M.== .' 1-HfJtij - -~~-- - -~o-.-:o-.t.
~·-··-···
!_L_ll8 • o:U=====tJ 60S I s r . ~m~-~~--.. _ · --
--- ---------------------------- --- ---------- -- -·-
MENU
== -·c===== .c= Screen 16
26
Graph command option Explanation
Line Select line graph
Bar Select bar graph
After you select the style of graph, by pressing [LJ or [BJ, you will have a
choice of graphs (screen 17).
Screen 17
Graph option
Patient
Investment
Dist.-Pat.
Unit Cost
Ratios
Bud + Inv
Services
Explanation
Patient budget by type of care
Investment by type of care
Distribution of patient budget by type of care
Unit cost by type of care
Ratio of services to population
Total patient budget plus total investment
Preventive, outpatient, and inpatient services by type of care
Press the key that corresponds to the first letter of the desired graph; if
the PC has a graphics monitor the graph will appear on the screen. If you
27
press [Enter] (or any other key), you will have a choice of No Save or Save
(screen 18). To select No Save and go back to the Graph command (screen
16), press [N). To save the current graph, press [S). You will then be
prompted to type in the name of the graph (screen 19). After doing so,
press [Enter] and the graph will be saved.
MENU
Screen 18
FILES Enter Ql'"aph file namE>: C:\123\t.pic JNVEST.PJC LISRARVI
Screen 19
28
Save Command
The Save command allows you to save the simulation model with the new
values you have entered (the original data will be overwritten).
After you have entered the new data, return to the user command menu
(by pressing [Alt-M)). Press [S], enter the file name, and press [Enter].
Exit Command
The Exit command allows you to end the session and exit to Lotus
1-2-3. If you press [E) while in the user command menu, you will exit from
the spreadsheet and have the option of returning to Lotus.
Quit Command
The Quit command returns you to the preceding screen. If you press [Q]
while in the user command menu, the word "READY" will appear in the upper
right-hand corner of the screen.
To get back to the user command menu from the «READY" screen, press
[Alt-M). If you wish to go from the "READY" screen to the Lotus system
menu, press [/].
3 How to Use the Model
After you have familiarized yourself with HEALTHFISIMO's user command
menu and the various areas of the spreadsheet, you are ready to begin
entering the data required to run the model. Select the Locate command and,
if applicable, the Input option, then the area in which you wish to enter
data (Budgets, Prices, Population, and so on). Move the cursor to the
appropriate cell, type in the value, and then either press [Enter) or move
the cursor to another cell. The cell locations of the data needed are given
in appendix B.
Data Required
To run the model, you must enter data on the following initial
conditions:
Budgets
•
•
Total recurrent budget of the government
The share of the ministry of health (MOH) in this budget
The budget for patient care (the sum of the budgets for primary, secondary, and tertiary health care)
Other components of the MOH budget
Income from fees
Other income
29
30
Activities
In each of the three delivery systems:
• Number of preventive interventions
• Number of outpatient interventions
• Number of inpatient interventions
• Share of resources dedicated to preventive care, outpatient care, and inpatient care
Resources
In each of the three delivery systems:
• Number of doctors
• Number of nurses
• Number of technicians
• Number of other workers
• Expenditures on drugs and other medicines
• Expenditures on materials
• Other expenditures
• Cost of administration
Prices
• Average annual salary of doctors
• Average annual salary of nurses
• Average annual salary of technicians
Average annual salary of other workers
• Unit price of materials
Unit price of drugs and other medicines
31
•
•
Unit price of other expenditures
Unit price of administration
NOTE: Data on unit costs of interventions, calculated either from
inputs and their prices or by dividing total budgets by the number of
interventions in the initial period, must be the same regardless of the
method of calculation. To facilitate cross-checking, an accounting identity
check of unit costs is provided in range R13 .. Ul7.
Nurses' Salary
For each type of nurse (up to three types) and each step of the salary
scale (up to thirty steps):
• Number of nurses
• Yearly total salary
• Attrition rate
Population
• Yearly forecast of the population for the next twelve years
Nurses' Training
If this model is not being used, this part can be ignored or the values
can be set to zero.
32
For the training of each type of nurse (up to three types):
Entrants in each of the past three years
• Number of students at time 0
• Proportion of entrants who graduate
• Length of training
• Proportion of graduates who· enter nursing
• Rate of dropouts
• Unit costs
Rates of Growth
Besides the data on initial conditions, you must also provide the rate
of growth of the total government budget, the only independent variable of
the model. In most cases this rate can be determined from economic
forecasts. Values for the rates of growth of all components of the MOH
budget other than the budget for patient care must also be entered.
Although any values are valid, it is desirable to use historical rates for a
first run or to assume that every component will grow at the same rate as
the total MOH budget, so that the relative shares are kept more or less
constant.
Simulating Policies
Various policies or combinations of policies can be simulated to assess
their effect on the delivery of health care. The results for a hypothetical
country, shown in table 1, can be considered a base run with which the
results of alternative policies can be compared.
33
Health care policies can be classified into two groups: financial and
operational. There are countless combinations of both types of policies
from which policymakers can choose the ones that are most feasible.
To simulate financial policies we can:
• change the share of the MOH in the government's budget
• change the share of patient care in the MOH budget
• change the allocation of the increases of the patient care budget among the three types of health care
• introduce fees for health services.
We can also simulate the effect of assumptions about the growth of the
government budget.
To simulate operation~! policies we can:
•
•
•
•
change the number of doctors, nurses, and other personnel per unit of service
increase or decrease expenditure on drugs
change the salary scale of nurses
change the distribution of new nurses by type
change the cost of administration.
Financial Policies
The base run shows that, given the operating conditions of the health
care system and a rate of growth of the government budget of 2 percent a
year, the ratios of preventive, outpatient, and inpatient interventions to
'lltble I
Ut OUTPUT SUIIIIARY tU HEALTH F IIIAIICE SIIIULA TIDil IIODEl ut OUTPUT SUIIIIIIRY m BY TYPE OF SERVICE Dl•trlblltlon of Output to Populltl on <··-···-····--·-······- Typt 1 Cart ·····-·············-········)
< --····--- Budgets ·-·-···· > <······ Pati111t Budget ---> < ······- Rati 01 ----·} ·Total <·· Rtquirtd ··> Year Health Patilllt Pat/Hit Type I Typt 2 Typt 3 Prev111t Out-Pat In-Pat IRYIIt, Ytar Budget Unit Cost Prt¥tnt Out-Pat In-Pat Doctors· Nurut InYiat 1 --- ---------· ..................... - _ ............ ---- ----- ---· ---·-- ................ ----- ------ ..... _ ----·-· ................ _ -----
0 t5,356,038 44,561,038 85.1bl 28.901 26.201 44.901 1.16% 1.16% 0.50% 0 tl,3181026 $92.26 10,000 2,000 0 30 300 1 t5,406,000 $4,594,921 85.00% 28.901 26.20% 44.90% 1.13'% 1.13% 0.491 $21,844 1 t1,327 ,817 $91.78 10,074 2,015 0 30 302 t2,653 2 t5,514,120 t4,686,613 84.991 28.901 26.201 44.901 1.131 t.m 0.491 $72,753 2 t1,354,314 $91.79 10,329 2,066 0 31 310 t9,086 3 t5,624,402 t417801134 84.991 28.901 26.201 44.901 s.m 1.111 0.491 t61,313 3 f1,381,339 $92.02 10,535 2,107 0 32 316 t7,350 4 $5,736,890 t4,875,518 84,991 28.901 26.201 44.901 1.101 1.101 0.481 t55,842 4 $1,408,903 $92,20 10,717 2,143 0 32 322 t6,534 5 t5,851,628 t4,972,803 84.981 28.901 26.201 44.901 1.091 t.on 0.471 t58,401 5 tl,437,016 $92.49 10,910 2,182 0 33 327 t6,87l 6 t5,968,661 t5,072,028 84.981 28.901 26.201 44.901 1.081 1.081 0.471 t56,384 6 t1,465,689 m.74 11,093 2,219 0 33 333 t6,557 7 t6,088,034 . t5, 173,230 84.971 28.901 26.201 44.901 1.061 1.061 0.461 t58,247 7 t1,m,t34 t93.13 11,284 2;257 0 34 339 t6,795 a *6,209,795 *5,276,449 84.971 28.901 26.201 44.901 1.051 1.051 0.461 t54,957 8 tl,524,762 $93,34 11,460 2,292 0 34 344 t6,302 9 $6,333,991 t5,381,725 84.971 28,901 26.201 44.901 1.041 1.041 0.451 tlil,647 9 t1,555,184 t93.45 11,662 2,332 0 35 350 t7,224
10 to,460,1170 t514891098 84.9111 28.901 211.201 44.901 1.021 1.03% 0.451 t66,178 10 $1,586,212 $93.15 11,882 2,370 0 36 356 t7,837 11 t6,589,884 t515981612 84.961 28.901 26.201 44.901 1.021 1.021 0.441 t80,762 11 $1,617,859 $92.74 12,158 2,432 0 36 365 $91873 12 t6,721,682 t5, 710,307 84.951 28.901 26.201 44.901 1.011 1.011 0.441 t79,523 12 $1,650,136 $93.13 12,429 2,486 0 37 373 t9,667
••••••••-an••••• .. na•••-•uaancaaaaanaanaacaaana ... aaaauaau-.aa• ... •n••n•anuca
m IIIPUT SUIIIIIIRY tU HEM. TH FIIIANCIM. SIIIIIUTIOII IIIIDEL II Rate of II <·-·-·-·--········.····- Typt 2 Cart ·······-····--·-·-····--··>
Budgttl Vllut BrOith II <·· Required -> --·--- ---- ----- II Year Budget Unit Cost PrtYIIIt D11t-Pat In-Pat Doctors Nunes Inv11t 2
Soverntent Budget tl0010001000 2.001 II ......... --------- -----·-·- ------II
Portion of Bov't. Budget for llin. of Htalth 0.05356038 II 0 tt,l94,952 tl43.39 2,000 5,000 100 50 200 lliniltry of tt.llth Budget t5,356,038 II I t1,203,829 t142.83 2,015 5,037 101 50 201 t4,333
Adtlnistration of htalth strvlcts budttt *700,000 2.001 u 2 tl,227,852 t142.77 2,063 5,158 103 52 206 $14,085 Vl
Training budget t20,000 3.001 II 3 t1,252,353 t142.97 2,105 5,263 105 53 211 t12,280 -1:'-
Other 811dget I t50,000 2.001 II 4 $1,277,343 $143.10 2,144 5,361 107 54 214 ttl,390 othtr Budget 2 t25,000 2.00% II 5 tl,302,831 $143.36 2,185 5,462 109 55 218 tl1,864 other Budget 3 to 0.001 II 6 t1,328,827 t143.59 2,225 5,561 Ill 56 222 tll,553 II
Share II 7 tl,355,341 tl43.97 2,265 5,664 113 57 227 tll,908 Health B11dgtt far Patient Cart t4,561,03B ----- II 8 t1,382,383 t144.15 2,304 5,761 115 58 230 t11,376
Patient Care budget for Type 1 servicll tt,318,026 28.901 II 9 t1,409,965 t144.21 2,347 5,869 117 59 235 f12,564 Patient Care budget for Type 2 services tl, 194,952 26.201 II 10 t1,438,096 tl43.80 2,393 5,983 120 60 239 t13,381 Patient C1r1 budgtt for Type 3 services $21048,060 44.901 II 11 tl,466,787 t143.59 2,448 6,120 122 61 245 tl5,936 Fee payaent by patlrnh . tO II 12 tl,496,0lll $143.97 2,502 6,255 125 63 250 t15, 761 other fiuncill contributions tO 0.001 II
" II
" < --···-·--····-··-··-·-··-- Type 3 Cart ·-···-····--····--··--·--·-> II
Inputs per Unit of Servica II < •• lleqtli nd -· > ( ···--·--·-----------····) Sllarits it Year Budget Unit Cost Prevent Out·Pat ln·Pat Doctors Nursts Invest 3 Type I Type 2 Type 3 and Prices .. ··- -------- ---·-·-- .......... -...... " ................. ·----- ----- .. .............. _ ... _ " 0 $2,048,060 t204.81 2,000 7,000 6,000 70 400 II
Doctors 0.0021 0.0060 0.0070 t6,000 II 1 t2,063,274 t203.88 2,015 7,052 6,045 71 403 tl4,857 llllnts 0.0210 0.0240 0.0400 tl,701 II 2 t2,104,448 1203.83 2,064 7,226 6,193 72 413 t49,582 Technician• 0.0004 0.0012 0,0020 t31000 II 3 t2, 146,441 t204.22 2,106 7,371 6,318 74 421 $41,683 Other llorktrl 0.0245 0.0360 0.0500 t1,200 .. 4 t2,189,2n t204.51 2,144 7,504 6,'432 75 429 t37,918 " .Exp111di tuns on lllterills 1.4000 1.8000 2. 7000 ti.OO II 5 t2,232,957 $205.00 2,184 7,643 6,551 76 437 t39,665 Expend I tur11 on Drugs 3.5000 4.8000 7.0000 ti.OO II 6 t2,277,512 t205.43 2,222 7,777 6,666 78 444 t38,274 Other Ex ptnditurtl 0.2100 0.2400 0.5000 11.00 .. 7 t2,322,955 t206.13 2,262 7,915 6,785 79 452 t39,544
" Ad•ini&tration Expenditures 8.5050 13.0800 18.8000 ti.OO II 8 t2,369,304 t206.49 2,299 8,046 6,896 80 460 t37,279 II 9 t2,416,576 t206.64 2,341 8,192 7,022 82 468 t41,859
llll1ber Br011th Rate .. 10 12,464,790 t206.01 2,386 8,350 7,157 83 477 t44,959 .. ______ .. ___ II 11 t2,513,966 t205.43 2,441 8,542 7,322 85 488 t54,953
Doctors in Private Sector 30 10.001 " 12 $2,564,121 t206.13 2,495 8,731 7,484 87 499 t54,094 " llurut In Privata Stctor 100 s.oox II ..
Tclble 1 (continued)
TABLE OF AIIIIUAL PARA"ETERS AND SRDIITH RATES ----........................................................ _________________ < ------------------------------------------------ YEAR ------------------------------------·--··· ----->
1 2 3 4 5 6 7 8 9 10 11 12 ---- ---... .. ........... _ ............ ----- ........ -... ... ......... ... .......... ............. ... ......... ... ........ ... ......... Sovtrnlent Budget (ALPHA) , ............. , ............ ., .. , • 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 Portion of 6ov't. Budgtt for "in. of Health IBETAI ........ 0.053 0,053 0.053 0.053 0,053 0.053 0.053 0.053 0,053 0.053 0.053 0.053 Ad1iniltr1tion Cost of he&l th servitll IAD"INSROI .... , .... 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 Other Financial Contribution !OTHFIN8RDI .................. 0.000 0.000 o.ooo o.ooo 0.000 o.ooo 0.000 o.ooo o.ooo o.ooo 0.000 o.ooo Dthtr Blldgtt l COTHl&ROl •• I ........... I ................... 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 . 0.020 other Budgtt 2 COTH28R0) .......................... ,, .. ,._,,, 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0,020 0.020 other Budget 3 IOTH3BRDI , ................................. o.ooo o.ooo 0.000 0.000 0.000 0.000 o.ooo o.ooo o.ooo 0.000 0.000 o.ooo Sllart of Typt I nrvicn in 8ud9tt I ncr tall ISHAREll •• , ... 0,289 0.289 0.289 0.289 0,289 0.289 0,289 o.289 &.289 0.289 0.289 &.289 Sllart of Typt 2 aervicu in Budoet I ncr tall !SHARE21 ...... 0.262 Oo262 o.262 0.262 &.262 0.262 0.262 0.262 0.262 0.262 0.262 0.262 Shart of Typ1 3 urvi til in 8ud91t Incrtalt ISHARE31 ...... 0.449 0,449 0,449 0.449 0.449 0.449 0,449 0,449 0.449 0.449 0.449 0.449 Drua Eaptnditurt QrOIIth rate IDRIJSEXPBROI .... ,., .......... 0.000 o.ooo 0.000 o.ooo 0.000 o.ooo o.ooo o.ooo 0.000 o.ooo 0.000 o.ooo Adllnhtration EKptnditure grOIIth rate IADIIIIEXPBROI ....... o.ooo 0.000 o.ooo o.ooo o.ooo o.ooo 0.000 o.ooo 0.000 o.ooo o.ooo 0,000 httrhll Exptndl ture gr011th ratt IMTEXPBRDI ............. 0.000 o.ooo o.ooo o.ooo 0.000 o.ooo 0.000 0.000 o.ooo o.ooo o.ooo o.ooo Oth~r Expenditurn erawtb ratt IOTIIEXPBRDI ..... • .......... o.ooo o.ooo 0.000 o.ooo o.ooo o.ooo o.ooo o.ooo 0.000 o.ooo 0.000 0.000 Doctors' Salary trDIIth nb !DOCSALBROI ................... o.ooo 0.000 0.000 o.ooo 0.000 o.ooo o.ooo o.ooo o.ooo 0.000 0.000 o.ooo Technicians' Salary grOIIth rate !TECHSALBRDI .............. o.ooo o.ooo o.ooo o.ooo o.ooo o.ooo o.ooo o.ooo o.ooo o.ooo 0.000 o.ooo other llorkers Salary QrDIIth rate IIIORKSALBROI ............. o.ooo 0.000 o.ooo 0.000 o.ooo o.ooo 0.000 o.ooo 0.000 o.ooo 0.000 o.ooo Fees for Prtvtntivt Cart IFEEPREY61 """'""'"""'"" 0.000 o.ooo 0.000 o.ooo o.ooo o.ooo o.ooo o.ooo o.ooo 0.000 0.000 0.000 Ftn for Outpatient Catt IFEEDUTPATI , ..................... 0.000 0.000 o.ooo 0.000 0.000 o.ooo o.ooo o.ooo 0.000 o.ooo o.ooo o.ooo Ftta for lnpatitnt Cart IFEEINPATl , ,. ................... 0.000 o.ooo 0.000 o.ooo 0.000 0.000 o.ooo 0.000 0.000 o.ooo 0.000 0,000 llursn Salary Pritt Indn !PRICEINDEXI .................... 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 Oocton per ant t of servl ce -· Type I !RDDCPERSERYII ...... 0.002 0.002 0.002 0.002 0.002 0.002 0,002 0,002 0,002 0.002 0.002 0.002 t..l
Doctors per unit of 11rvlce -· Type 2 IIDOCPERSERY21 ...... 0.006 0.006 0.006 0.006 0.006 0.006 0.006 0.006 0.006 0,006 0.006 0,006 Ut
Doctors per unit of mvltt -- Type 3 IRDOCPERSERY31 ...... 0.007 0.007 0.007 0.007 0,007 0,007 0.007 0.007 0.007 0.007 0,007 0,007 Nurm per unit of aervict ·- Typt I !QIRSPERSERYII ....... 0.021 0.021 0.021 0.021 0.021 0.021 0.021 0.021 0.021 0.021 0.021 0.021 llurm per unl t of servl ct -- Type 2 IIIIRSPERSERY2l .. , .... 0.024 0.024 0.024 0.024 0.024 0.024 0,024 0.024 0.024 0.024 0.024 0.024 llursn per unit of tervi ct -- Type 3 UlMRSPERSERY3r ....... 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 Technicians per unit of strvice - Type 1 !RTECPERSERYII .. 0.000 0.000 0.000 o.ooo 0.000 o.ooo 0.000 o.ooo o.ooo o.ooo o.ooo o.ooo Technicians per unit of service -- Type 2 IQTECPEfiSERY21 .. 0.001 0,001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 Technician& p1r unit of 11rvlct - Type 3 IQTECPERSERY31 .. 0.002 0,002 0.002 0.002 0.002 0,002 0,002 0.002 0,002 0,002 0.002 0.002 other liorkers per unl t of 11rvic1 - Type 1 IQIIRKPERSERYU. 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 other Markers per unl t of servlu - Type 2 IUMRKPERSERY21. 0.036 0.036 0.036 0.036 0.036 0.036 0.036 0.036 0,036 0.036 0.036 0.036 other llorktn per unit of service -- Type 3 IQIIRKPERSERY31, 0.050 0.050 o.oso 0.050 0.050 0.050 0.050 o.oso 0,050 0.050 0.050 0.050
36
population will decrease over time. What can be done to maintain or
increase these ratios over time? Using financial measures, we could
increase the ratios by increasing the share of the MOH in the government's
budget, for example, from .053 to .063. But this increase would not be made
in a single year. The model makes it possible to introduce all parameters
in yearly steps. For example, in year 1, the MOH share would be .053; in
year 2, .056; in year 3, .059; in year 4, .063. This can be done by
choosing the Locate command and then the Rates option. This action brings
up the table of annual growth rates, in which the new data can be entered
(in the cell labeled BETA).2 The effect of this policy change is to
increase the ratios of interventions to population (table 2).
Another way to increase the ratios of interventions to population is to
increase the share of the MOH budget dedicated to patient care. This can be
achieved by decreasing the rate of growth of the other components of the
budget. For example, administrative expenditures could be frozen and the
growth rate of the budgets for, say, research and planning reduced to 1
percent. These changes can be entered in the model by entering zero in the
cell labeled R-GR.C.ADM and .01 in those labeled R-GR.OTHER1 and R-
GR.OTHER2. Increasing the share of MOH and the share of PATBUD (patient
budget) changes the ratio of interventions to population (table 3).
Changes in financial policies can be used to reorient activities. For
example, if we wish to increase preventive care relative to inpatient care
we could increase the share of preventive care in the budget increase.
2. Data must be entered only for the years in which the data have changed from the preceding year. If no changes are entered, the program will automatically copy the figure from the preceding cell. Before introducing data, it is advisable to press [Alt-R] to clear the table.
37
This can be accomplished, for example, by ~ncreasing the present share,
.289, to .589 over a period of four years. To introduce this data, go to
the table of annual growth rates and in the cell labeled SHARE1 enter .289
in year 1, .389 in year 2, .489 in year 3, and .589 in year 4. These
changes have the effect of increasing the ratio of preventive interventions
to population from 1.16 in year 1 to 1.58 in year 12 (table 4). In the run
shown in table 3, the ratio increased to only 1.31.
Another way of increasing resources for health care is to introduce
fees that, when collected, would augment the resources available for patient
care. The model can simulate the effect of introducing fees on the amount
of services provided. Assume, for example, that we introduce fees of $2,
$5, and $20 for preventive, outpatient, and inpatient care. These fees
would be entered in the cells labeled FEEPREV, FEEOUTPAT, and FEEINPAT.
These changes increase the number of interventions (compare table 5 with
table 4} .
Operational Policies
Operational policies that lower unit costs can increase the provision
of health services. One way to lower unit costs is to reduce the average
salaries of nurses. This can be accomplished without affecting nurses
already employed by increasing the proportion of lower-paid nurses among
those newly hired--that is, by increasing the percentage of type C nurses
and decreasing those of types A and B. For example, we could increase the
figure in the cell labeled PCTC to 80 percent and decrease those in PCTA and
PCTB to 10 percent each. These changes lower the unit costs (compare table
6 with table 5).
Thble 2
IU OUTPUT SUIIIIARY IU HEALTH FINANCE SIIIULATIDN IIDDEL Ul OUTPUT SUIIIIARY Ut BY TYPE OF SERVICE Di stri butian of Output to Papulation <------------------····----- Type 1 Cire ----·-··--·------·······-··>
<--·-·•N••• Bllllgltl -------·-> <·--··· Patient Bllllget ----> <·····-·· Ratios --····-> Total < -- Rtqlli red --> Year Health Patient Pat/Hlt Type 1 Typt 2 Type 3 Pnvtnt Out-Pat In-Pat Inv11t. Year Budget Unit Ca1t Prtvtnt D11t-Pat In-Pat Doc:.tars Nurses Invest I --- __ ,.. _____ --------- .................. ----· ·-··· ............... ................. .. ................ .............. ... ............. ---- -------- -------· .................
0 t5,356,038 t4,561,038 85.161 28.901 26.201 44.901 1.161 1.161 O.SOI 0 t1131B1026 192.26 10,000 2,000 0 30 300 1 $5,406,000 $4,594,921 85.001 28.901 26.201 44.901 1.131 1.131 o.m t21,844 1 U13271817 $91,78 10,074 2,015 0 30 302 t2,653 2 $5,826,240 14,998,733 85.801 28.901 26.201 44.901 1.201 1.201 0.521 $274,884 2 $1,444,509 190.n 11,017 2,203 0 33 330 133,653 3 16,261,127 $5,416,858 86.521 28.901 26.201 44.901 1.281 t.m 0.561 $302,491 3 $1,565,337 190.28 12,050 2,410 0 36 361 $36,900 4 16,819,323 15,957,950 87.371 28.901 26.201 44.901 1.37% 1.371 o.601 1381,765 4 t1,721,699 t89.47 13,350 2,670 0 40 401 146,442 5 $6,955,709 $6,076,884 87.371 28.901 26.201 44.901 1.371 1.m o.601 $113,369 5 $1,756,068 $89.62 13,739 2,748 0 41 412 t13,903 6 t7,094,823 t6, 198,190 87.361 28.901 26.201 44.901 1.361 1.351 0.591 f75,853 6 tl, 791,122 189.90 13,990 2,798 0 42 420 18,962 7 17,236,720 t6,321,915 87.361 28.901 26.201 44.901 1.341 1.341 0.581 t7l, 716 7 t1,826,876 t90.27 14,225 2,845 0 43 427 t8,368 B $7,381,454 t6,448, 108 87.361 28.901 26.201 44.901 1.321 1.321 0.581 t69,484 8 t118631342 $90.55 14,449 2,8'10 0 43 433 $8,018 9 $7,529,083 t6, 571t1817 87.351 28.901 26.201 44.901 1.301 1.301 0.571. t14,151 9 t1,900,536 190,72 14,691 2,938 0 44 441 t8,650
. 10 t7,679,665 $6,708,093 87.351 28.901 26,201 44.901 1.291 1.2U 0.561 t80,257 10 t1,938,471 190.60 14,957 2,991 0 45 449 19,483 II 17,833,258 t6,841,986 87.351 28.90Z 26.201 44.901 1.281 1.281 0.561. 194,073 11 t1,9n,l63 189.90 15,276 3,055 0 46 458 t11,4ll 12 t7,989,923 16,978,549 87.341 28.901 26.201 44.90% 1.271 1.271 o.ssz m,719 12 $2,016,626 $90.27 15,601 3,120 0 47 468 t11,606
•••••n••a•••••••••o••••••••••••n••••aaaaanaanaanaanuas••••--••a .... ••••••-••••••••• tn INPUT SUIIIIARY IU HEALTH FIIIAIICIAL SINULATliiK IIODEl II
Rate of II <·----·-········-····---· Typt 2 Cart ·-·-···-----···--····-··) Budgets Yal111 Brllllth ll <·- R1q11irtd -->
" Yw 81111get Unit Cost Prevent D11t•Pat In-Pat Ooc:.tars Nurses lnvtat 2 " Bovernlllftt Budget uoo,ooo,ooo 2.001 II --- ·-------- --·----- ----Portion of 8DV't. Budgtt for Nin. of Htalth 0.05356038 II 0 11,194,952 1143.39 2,000 5,000 100 50 200 ftiniltry of Hulth Budott t5,356,038 II I 11,203,829 1142.83 2,015 5,037 101 so 201 t4,333
Adlinhtntian of health nrvices budgtt uoo,ooo 2.001 II 2 11,309,624 tl41.59 2,201 5,501 110 55 220 t54,161 Ul .. Tulni119 budgtt 120,000 3.001 II 3 t1,419, 169 tl40.58 2,406 11,014 120 60 241 159,791 00
Otllll' Bwtget 1 150,000 2.00Z II 4 tl,560,931 1139.39 2,665 6,662 133 67 266 t75,626 Othtr 811d9tt 2 125,000 2.001 " 5 U1592,090 tl39.49 2,741 6,853 137 69 274 $22,309 .. other Bllllgtt 3 tO 0.001 .. 6 t1,623,872 1139.76 2,794 6,985 140 70 279 115,360 "
Share II 7 $1,656,286 tl40.13 2,844 7,111 142 71 284 t14,657 Haith Budget for Patient Cart t4,561,038 ............. " B $1 111891348 tl4o.41 2,893 7,233 145 72 289 t14,315 " Pltient Cart b11dget far Typt 1 ltrvitll 11,318,026 28.901 II 9 11,723,068 1140.55 2,945 7,363 147 74 295 t15, 160
Patient Cart blllloet for Typt 2 services t1,194,952 26.201 " 10 t1,757,462 t140.36 3,001 7,503 150 75 300 t111,255 11
Patitnt Care budgtt far Type 3 strvicu t2,048,060 44.901 II 11 t1,7'12,540 1139.711 3,0115 7,663 153 77 307 t18,678 II
Fte pay11nt by patients tO II 12 U,B28,319 t140. 13 3,130 7,826 157 78 313 t19,010 Dthtr financial cantrib11tions tO o.ooz II
II II
II <--·----------····--·------- Type 3 Care ···-···--···-····--·-·-··> lnp11tl ptr Unl t of Strvitt II < ·• Req11i rtd -->
( -···-------------------) Sahri11 .. Year 8wto•t Unit Cost Prevent Out-Pat In-Pat Ooc:.ton llursts Invest 3 " Typt 1 Type 2 Type 3 and Prien II ---- ... ..,.,. _____ -------- -----.. ---------- II 0 t2,04B,060 1204.81 2,000 7,000 6,000 70 400 II
Doctors 0.0021 0.0060 0.0070 t6,000 II 1 12,063,274 t203.88 2,015 7,052 6,045 71 403 $14,857 Nunes 0.0210 0.0240 0,0400 tl, 701 II 2 12,244,600 t202.05 2,202 7,707 6,6011 77 440 UB7 1070 II
Technicians 0.0004 0.0012 0.0020 t3,000 H 3 12,432,352 1200.59 2,408 8,427 7,223 84 482 t20S,801 Other llarkera 0.0245 0.0360 0.0500 tl,200 II 4 12,675,321 t198.84 2,6117 9,336 8,002 93 533 1259,698 Expenditarll on lllttrilll 1.4000 1.8000 2.7000 $1.00 II 5 $2,728,726 t199.08 2,745 9,606 8,234 96 549 177,158 II
Exp111ditarn an Drugs · 3.5000 4.8000 7.0000 $1,00 .. 6 t2,783,197 t199.57 2,796 9,786 8,388 98 559 151,531 " other Exp111di t11rn 0.2100 0.2400 o.sooo $1,00 II 7 12,838,753 t200.24 2,845 9,957 8,534 100 569 *41,691 Ad1lnhtratian Expenditurts 8.5050 13.0800 18.8000 ti.OO II 8 *2,895,418 $200.74 2,892 10,122 8,676 101 578 t47,151
II 9 12,953,213 1201.02 2,942 10,298 8,827 103 588 tS0,342 Nullber 8rllllth Rata II 10 13,012,160 1200.75 2,997 10,489 8,990 105 599 154,519 --------- " " ll t3,072,283 $199.57 3,0111 10,713 9,182 107 612 163,985
Ooc:.tan in Prhate Sector 30 10.001 .. 12 13,133,604 t200.24 3,126 10,941 9,378 109 625 t65,103 " lll&rsn in Pri nte Stctar 100 5.001 II
Tclble 2 (continued)
TABLE OF ANNUAL PARAIIETERS AND &RDNTH RATES ---------·-------------------............................... _ < -········--·······--·--------------------------- YEAR ······-··-····-----------------------------·---->
I 2 3 4 5 6 7 B 9 10 11 12 --- ... ____ ----- ............ ........... . .
Sovern1ent Budq1t tALPHA) ••• , • , , ......... u •• .............. 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0~020 0.020 0.020 Portion of 8o,•t, Budget for "in. of Health IBETAl ........ 0.053 0.051> 0.059 0.003 0.063 0.063 0.063 0.063 0.063 0.063 0.063 0.063 Adtiniltration Cost of health services IADIIlN&RDl ......... 0.020 0.020 0.020 0.020 0.020 0.020 0,020 0.020 0.020 0.020 0.020 0,020 Othtr Financial Contribution tOTHFIN&RDl ............... , .. o.ooo o.ooo 0.000 0.000 o.ooo o.ooo o.ooo o.ooo o.ooo 0.000 0.000 o.ooo Other Budget I IOTiti&ROl ....... , .... , ................. , ... 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 Other Budget 2 IDTH28ROl ...................... , ........ , .. 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0,020 0.020 0.020 Other Budget 3 (0TH3BROl ., •••••••••• ~ ....... ._. • u ......... 0.000 0.000 o.ooo o.ooo o.ooo 0,000 o.ooo 0.000 o.ooo o.ooo o.ooo o.ooo Share of Typt I services in Budget Increase tSHAREU ...... 0.289 0,289 0.289 0.289 0.289 0.289 0.289 0.289 0.289 0.289 0.289 0.289 Share of Type 2 servittS in Budget lncreau ISHARE2l ...... 0.262 0.262 0.262 0.262 0.262 0.262 0.262 0.262 0.262 0.262 0.262 0.262 Share of Type 3 senices in Budgtt lntrtall tSHARE3l ...... 0,449 0.449 0.449 0.449 0.449 0.449 0.449 0,449 0,449 0.449 0 .• 449 0.449 Drug Elptnditure growth rate !DRU6EXP6RDl ................. o.ooo o.ooo o.ooo 0.000 0.000 0.000 0.000 0.000 o.ooo o.ooo o.ooo o.ooo Adtinistration Expenditure growth rate IADIINEXP&ROI ....... o.ooo o.ooo o.ooo o.ooo 0.000 0.000 o.ooo o.ooo 0.000 o.ooo o.ooo o.ooo "aterials Expenditure gr1111th rate tnATEXPBRDl ............. o.ooo 0.000 0.000 0.000 o.ooo o.ooo 0.000 o.ooo o.ooo o.ooo o.ooo o.ooo Other Expend! tuns growth rate IDTHEXP9ROl ...... , ........ , o.ooo o.ooo 0.000 0.000 o.ooo o.ooo o.ooo o.ooo 0.000 0.000 o.ooo 0.000 Doctors' Salary gr1111th rate IDOCSAL&ROl ................... 0.000 0.000 o.ooo o.ooo 0.000 0.000 0.000 o.ooo 0.000 0.000 o.ooo o.ooo Technicians' Salary groMth rate tTECHSAUROI .............. o.ooo o.ooo o.ooo o.ooo 0.000 0.000 o.ooo o.ooo 0.000 0.000 o.ooo o.ooo Other llarkers Salary growth rate IIIORKSAL&RDI ............. o.ooo 0.000 o.ooo o.ooo o.ooo o.ooo 0.000 0.000 o.ooo o.ooo 0.000 0.000 Fees for Preventive Care IFEEPREY&I ....................... o.ooo 0.000 0.000 o.ooo o.ooo o.ooo o.ooo o.ooo o.ooo o.ooo 0.000 0.000 Fees for Outpatient Cate IFEEOUTPAn ..................... , 0.000 0.000 0.000 o.ooo 0.000 0.000 o.ooo o.ooo o.ooo o.ooo 0.000 o.ooo Fets for Inpatient Cart IFEElNPATI ...................... o.ooo o.ooo 0.000 o.ooo o.ooo o.ooo 0.000 o.ooo o.ooo 0.000 0.000 0.000 Nursts Salary Price lndn IPRlCEINDEil .................... 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 Doctors per unit of service -- Type I IIIDOCPERSERYU ...... 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0,002 0.002 0.002 0.002 Ul
Doctors per unit of service -- Typ• 2 IIIDOCPER9ERY21 ...... 0.006 0.006 0.006 0,006 0.006 0,006 0.006 0.006 0.006 0.006 0.006 0.006 10
Doctors per unit of service -- Type 3 UIDOCPERSERY3l ...... 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 Nurses per unit of service -- Type I !QIIRSPERSERVII ....... 0.021 0.021 0.021 0.021 0.021 0.021 0.021 0.021 0,021 0.021 0.021 0.021 Nurses per unit of service -- Type 2 IQIIRSPERSERY21 ....... 0.024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 Mur~ts per unit of service -· Type 3 IQIIRSPERSERY3l ....... 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 Technicians per unit of urvice -- Type I lllTECPERSERVU .. o.ooo 0.000 o.ooo o.ooo 0.000 0.000 o.ooo o.ooo 0.000 o.ooo o.ooo 0.000 Technicians per unit of senice -- Type 2 IIITECPERSERY21 .. 0.001 0.001 0.001 0.001 0.001 0.001 0,001 0,001 0.001 0.001 0.001 0.001 Technicians per unit of llr,ice -- Type 3 IIITECPERSERY31 .. 0.002 0.002 0.002 0,002 0,002 0.002 0.002 0.002 0.002 0.002 0,002 0.002 Other llorkers per unit of service -· Type I IIIIIRlPERSERVU. 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 Other llorktrs per unit of service -- TYP' 2 IQIIRKPERSERV2l. 0.036 0.036 0.036 0.036 0.036 0.036 0.036 0.036 0.036 0.036 0.036 0.036 Other Markers per unit of strvice ·-Type 3 !IIIIRKPERSERY3l. 0.050 0.050 0.050 0.050 0.050 0.050 0.050 0.050 0.050 0.050 0.050 0.050
Thble 3
lU OUTPUT SUKMARY m HEALTH FINANCE SIMULATIDN "ODEL ut OUTPUT SUft"ARY ut BY TYPE OF SERVICE Distribution of Output to Population <···························-· Type 1 Care ······--·------------·-····>
<······----- Budgets ---------> < •••••• Patient Budqet ··-· > <·-·····Ratios ······-> Total <-· Required ·-> Year Health Patient Pat/Hit Type 1 Type 2 Type 3 Prevent Out ·Pat In·Pat Invest. Year B11dget Unit Cott Prevent Out-Pat In-Pat Doctors Nurses Invest I _ ....... ---------...
.. .......... ____ ---·-- --·--- ------ ------ ................. .. ........... __ .,. ____ _ __ ...... _ ... ---- ______ ..... _ .......................... -------
0 f5,356,038 t4,561,038 85.161 28.,01 26.201 44.901 !.161 !. 161 o.501 0 $1 1318,026 $92.26 10,000 2,000 0 30 300 1 f5,406,000 t4,609,671 85.211 28.901 26.201 4M01 1.141 1.141 0.491 $31,353 I tt,m,oso $91,74 10,107 2,021 0 30 303 *3,808 2 f5,826,240 f5,028,536 86.311 28.901 26.201 44.901 1.211 1.21% 0.53'1. $286,132 2 $1 14531121 $90.85 11,088 2,218 0 33 333 t35,033 3 f6,261,127 $5,462,022 87.241 28.901 26.201 44.901 1.291 1.291 0.561 $314,252 3 $1,578,388 $90,17 12,161 2,432 0 36 365 $38,344 4 *6,819,323 $6,018,790 88.261 28.901 26.201 44.90'1. 1,391 1.39'1.. 0.601 $393,759 4 U,739,280 $89.34 13,503 2,701 0 41 405 t47,9!4 5 $6,955,709 t6,t53,nt 88.471 28.901 26.201 44.901 !.39% 1.391 o.m $125,148 5 u,n8,272 $89.47 13,932 2,786 0 42 418 t15,345 6 $7,094,823 $6,291,352 88.681 28.901 26.201 44.90'1. 1.381 1.381 0.601 f87,893 6 t1,818,044 $89,12 14,225 2,845 0 43 427 $10,435 7 $7,236,720 t6,431,731 88.881 28.901 26.201 44.901 1.361 1.361 0.591 $84,022 1 $1,858,611 i90.06 14,501 2,900 0 44 435 *9,873 8 $7,381,454 t6,574,930 89.011 28,907. 26.201 44.907. 1.351 1.351 0.591 t81,U6 8 U,8991990 i90.31 14,768 2,954 0 44 443 t9,537 9 t7 ,529,083 t6,n0,987 89.271 28.901 26.207. 44.901 1.341 1.341 0.581 $86,839 9 t1,942,197 $90,45 15,054 3,011 0 45 452 flO, 198
10 t7,019,665 $6,869,967 89.461 28.901 26.201 44.,01 1.321 1.331 0.581 m,tB4 10 f1,985,249 $90.31 15,363 3,073 0 46 461 f11,060 11 t7,833,258 $7,021,926 89.64% 28.901 26.20X 44.901 1.32% 1.321 0.571 $107,311 11 $2,029,161 $89,72 15,728 3,146 0 47 472 t13,027 12 $7,989,923 n, m,925 89,82X 28.901 26.20X 44.901 1.311 1.31% 0.571 $109,121 12 $2,073,952 $90,06 16,099 3,220 0 48 483 t13,24!
:::s:::a:c:::::::::c:a:a=::::::===:sn::a::::saa===-=======•'l::::a::::::a::::::•••========::===•====:.====•==•===
Ul INPUT SUKKARY tu HEALTH FINAIICIAL SIKULATIOM IIODEL tl .. Rate of " " <-----------·····--····-·····- Type 2 Care -----·····-·····-·-····-··-·· >
Budgets Value 6r011th II <·· Required ··> tl Year Budget Unit Cost Prevent Dut·Pat In-Pat Doctors Nurses Invest 2 11
6overnaent Budget uoo,ooo,ooo 2.00X II ............ ____ ... _____ ---------- ____ ...... _
Portion of Sov't. Budget far Min. af He<b 0.05356038 tl .. 0 U,194,952 $143.39 2,000 5,000 100 50 200 "inistry of Health Budget $5,356,038 tl 1 $1,207,693 $142.77 2,021 5,053 101 51 202 $6,220 tl
Adlinlstration af health services budget $700,000 o.oox " 2 $1,317,432 $141,48 2,215 5,537 111 55 221 $56,375 ~ " Training budget $20,000 3.00X II 3 $1,431,002 $140.43 2,428 6,069 121 61 243 $62,103 0 tl
Other Budget 1 $50,000 !.OOX II 4 $1,576,870 $139.22 2,695 6,737 135 67 269 m,985 Other Budget 2 $25,000 1.001 .. 5 $1,612,221 $139.28 2,m 6,948 139 69 278 $24,630 .. Other Bud91t 3 tO 0.001 .. II $1 1648,279 S139.51 2,840 7,100 142 71 284 $17,735 ..
Share II 7 $1,685,059 t139.85 2,899 7,247 145 72 290 U7,084 " Health Budget for Patient Care $41561 10JB ........... II 8 u, 722,574 $140.08 2,956 7,391 148 74 296 $16,773 II
Patient Care budget fer Type 1 services t1,318,m 28.90X II 9 t!, 760,840 $140,19 3,017 7,542 15! 75 302 U7,667 Patient Care budget for Type 2 servi tes $1,194,952 26.201 II 10 u, 799,871 $139.98 3,081 7,703 154 77 308 $18,809 Patient Care budget fer Type 3 services $2,048,060 44.901 .. 11 $1,839,683 $139.51 3,154 7,886 158 79 315 $21,292 It
Fee pay1ent by patients $0 II 12 $1,880,291 $139.85 3,229 8,071 161 81 323 t21,659 It
Other financial contributions $0 o.ooz '' ,, " ( ···---------·-------------··· Type 3 Care ··----····--···---·-···--···} " Inputs per Unit af Service " <-- Required --> II
{ --------------------------> Salaries t: Vu.r Budget Unit Cost Prevent Out-Pat In-Pat Doctors Nurses Invest 3 Type 1 Type 2 Type 3 and Prices II __ ,.,.. ---------- ........ _ .............................. .............. .. .... -..... ---·-- ___ .......... -..... II 0 $2,048,060 $204.81 2,000 7,000 6,000 70 400
Doctors 0.0021 0.0060 0.0070 $6,000 " I S2,069,898 $203.78 2,021 7,075 6,064 71 404 t21,325 " Nurses 0.0210 0.0240 0.0400 $1,701 :: 2 $2,257,982 $201.87 2,216 7, 756 6,648 78 443 U94,725 Technicians 0.0004 0.0012 0.0020 $3,000 " 3 $2,452,632 $200.37 2,430 8,504 7,290 85 486 $213,805 It
Other Workers 0.0245 0.0360 0.0500 $1,200 ll 4 $2,702,640 $198.59 2,698 9,442 8,093 94 540 *267,860 Expenditures on Kateriah 1.4000 1.8000 2.7000 $1.00 " 5 $2,763,228 $198.76 2, 783 9, 740 8,349 97 557 $85,173 " Expenditures an Drugs 3.5000 4.8000 7 .oooo .1.00 " 6 $2,825,029 $199.20 2,843 9,949 8,528 99 569 *59,724 " Other fxpendi tures o. 2!00 0.2400 0.5000 $1.00 II 7 $2,888,067 $199.80 2,900 10,149 8,099 101 580 $57,064 Adli nhtration EKpendi tures 8.5050 13.0800 18.8000 $1.00 II 8 $2,952,365 $200.24 2,955 10,344 8,866 103 591 $55,616 " II 9 $3,017,950 $200.47 3,014 10,550 9,043 105 603 $58,974 II
N111ber Growth Rate " 10 $3,084,847 $200.16 3,078 10,772 9,233 lOB 6!6 $03,314 " ----------- II 11 $3,153,082 $199.20 3,151 11,027 9,452 110 630 $72,992 .. Doctors in Private Sector 30 10.001 " 12 $3,222,681 $199.80 3,225 11,287 9,674 113 645 $74,221 II
tiurst!J in Private Sector 100 5,00X
Thble 3 (continued)
TABLE OF ANNUAL PARAIIETERS AIID GROWTH RATES -----·-------........................ -----------................ ___ < ·····--···-···········----------------·--····---~- VEAR ····----------------------· ······-···--·-------->
I 2 3 4 5 6 7 8 9 10 11 12 .............. ... -~ ... - ___ ..,_ .. ____ _ __ .,._ ............ ... ......... ... ......... .......... _ ......... - ... ....... . ......
Savern•ent Budget !ALPHA I .. , .............................. 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 Portion of 6ov't. Budget for "in. of Health !BETA I ........ 0.053 0,056 0.059 0.063 0.063 0.063 0.063 0.063 0.063 0.063 0.063 0.063 Adainistration Cost of health services IAD"INBROl ......... o.ooo 0.000 0.000 0.000 0.000 o.ooo 0.000 o.ooo 0.000 0.000 o.ooo 0.000 Other Financial Contribution !OTHFINSROI .................. 0.000 o.ooo 0.000 o.ooo 0.000 o.ooo 0.000 0.000 0.000 o.ooo o.ooo 0.000 Other Budget 1 IOTH1SROI .... , .................... , ....... , 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 Other Budget 2 IOTH2SROI .................... ·~• ........ , ... 0.010 0.010 0;010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 Other Budget 3 IOTH3GROI .... , .. , .... , ........ , ............ o.ooo 0.000 0.000 o.ooo 0.000 0.000 0.000 o.ooo 0.000 o.ooo 0.000 o.ooo Share of Type 1 services In Budget Increase !SHARE!I ...... 0.289 0.289 0.289 0.289 0.289 0.289 0.289 0.289 0.289 0,289 0.289 0.289 Share of Type 2 services in Budget Increase ISHARE21 ...... 0.262 0.262 0.2&2 0.262 0.262 0.262 0-262 0.262 0,262 0.262 0.262 0.262 Share of Type 3 services in Budget Increase !SHARE3J ...... 0,449 o.m 0.449 0.449 0.449 0.449 o.m 0-449 0.449 0,449 0.449 0.449 Drug Expenditure growth rate lllRUGEXPSROl ................. 0.000 o.ooo o.ooo 0,000 0.000 o.ooo o.ooo o.ooo 0.000 o.ooo o.ooo o.ooo Adainistrati on Expenditure growth rate IAD"NEXPSROl ....... o.ooo o.ooo 0.000 o.ooo o.ooo o.ooo o.ooo o.ooo 0.000 0.000 0.000 0.000 "'teriah Expenditure groMth rate I"ATEXPf!ROI ............. o.ooo 0.000 0.000 o.ooo o.ooo 0.000 0.000 o.ooo o.ooo o.ooo 0.000 o.ooo Other Expenditures growth ra~e IOTHEXPSROI ............ , ... o.ooo o-.ooo o.ooo o.ooo 0.000 o.ooo o.ooo 0.000 0.000 0,000 0.000 o.ooo Doctors' Salary growth rate IDOCSALSROl ................... o.ooo o.ooo 0.000 o.ooo o.ooo 0.000 o.ooo 0.000 o.ooo o.ooo o.ooo o.ooo Techniciant' Salary gr011th rate !TECHSAL6ROI .............. o.ooo o.ooo o.ooo o.ooo 0.000 o.ooo o.ooo 0.000 0.000 o.ooo 0.000 0.000 Other llorkers Salary gro11th rate !IIORKSAL&ROI ............. 0.000 0.000 o.ooo o.ooo o.ooo 0.000 o.ooo o.ooo 0.000 0.000 0.000 0,000 Fees for Preventive Care (FEEPREVIII ....................... o.ooo o.ooo 0.000 o.ooo 0.000 0.000 o.ooo 0.000 o.ooo o.ooo o.ooo o.ooo Fees for Outpatient Cate !FEEOUTPATI ............. ;., ...... 0.000 0.000 o.ooo 0.000 0.000 0.000 o.ooo o.ooo o.ooo 0.000 0.000 o.ooo Fees far Inpatient Care !FEEINPiiTI ......... , ............. 0.000 0.000 0.000 o.ooo o.ooo o.ooo 0.000 o.ooo o.ooo o.ooo o.ooo o.ooo Nurses Salary Price Index IPRICEINDEU .................... 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 Doctors per unit of service -- Type 1 IQDOCPERSERVIl ...... 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 -I:'
Doctors per unit of service •• Type 2 (QDOCPERSERV21 , ..... 0,006 0.006 0.006 0.006 0.006 0.006 0.006 0.006 0.006 0.006 0.006 0.006 1-'
Doctors per unit of service - Type 3 IQDDCPERSERV31 ...... 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 Nurses per unit of service •• Type 1 (QIIRSPERSERVII ....... 0,021 0.021 0.021 0.021 0.021 0.021 0.021 0.021 0.021 0.021 0.021 0,021
·Nurses per unit of service -- Type 2 (QNRSPER~SERV21 ....... 0.024 0.024 0.024 0.024 0.024 0,024 0.024 0.024 0.024 0.024 0.024 0.024 Nurses per unit of serv1ce -· Type 3 (QIIRSPERSERV31 ....... 0,040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 Technicians per unit of service-· Type 1 IQTECPERSERVll .. o.ooo 0.000 0.000 o.ooo o.ooo 0.000 0.000 o.ooo o.ooo o.ooo o.ooo o.ooo Technicians per unit of service •• Type 2 IQTECPERSERV2l .. 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 Technichns per unit of service -- Type 3 IQTECPERSERY31 .. 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 Other Workers per unit af service -- Type 1 UIWRKPERSERVll. 0,025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 Other Workers per unit af service -- Type 2 IQWRKPERSERV2l, 0.036 0.036 0.036 0.036 0.036 0.036 0.036 0.036 0.036 0.036 0.036 0.036 Other Workers per unit of service -- Type 3 IQWRKPERSERV3l. 0.050 0.050 0.050 o.oso 0.050 0.050 0.050 0.050 0.050 0.050 0,050 0.050
Th.ble 4
U* OUTPUT SUKKARY *U HEALTH FINANCE SIKULATIDN KODEL Ul OUTPUT SUKKARY m BY TYPE OF SERVICE Distribution of Output to Population < ·····--···--·-··-······-· Type 1 Care ·······----·---------------->
< ----------- Budgth ---------> < ------ Patient Budget ----·> <-------- Ratios -------> Total <-- Required --> Year Health Patient Pat/Hit Type 1 Type 2 Type 3 Prevent Out ·P&t In·P&t Invnt. Vaar Budget Unit Coat Prevent Out-Pat In-Pat Doctors Nur111 Invest I ---- --------- _________ .., ------- ............... .............. ----- ------- ------- ----- ................ --- ............... ___ ---------- __ ... ___ _ .............. ------ ....... __ .............. .. .............
0 $5,356,038 $4,561,038 85.161 28.901 26.201 44. '101 1.161 1.161 0,50% 0 $1,318,026 $92.26 10,000 2,000 0 30 300 I $5,406,000 t4,609,671 85.271 28.901 26.201 44.901 1.141 1.14% o.m m,353 I $1,332,080 $91.74 10,107 2,021 0 30 303 $3,808 2 $5,826,240 15,028,530 86.311 29.131 26.201 44.071 1.231 1.201 0.52% $256,431 2 tt,495,018 $'10,63 11,407 2,281 0 34 342 M6,450 3 $6,261,127 $5,462,022 87.241 31.251 26.201 42.551 1.35% t.m 0.53% $249,619 3 $1,706,993 $89.60 !3,184 2,637 0 40 396 *63,466 4 $6,819,323 $6,018,790 88.261 33.811 26.201 39,991 1,54% 1.341 0.54% $268,593 4 $2,034,929 $88.35 15,897 3,179 0 48 477 $96,897 5 $6,955,709 t6, 153,721 88.m 34.361 26.20% 39.441 1.571 1.341 0.531 tU,415 5 $2,114,404 $88,39 16,752 3,350 0 50 503 *30,519 6 $7,094,823 *6,291,352 88.681 34.901 26.201 38.'101 1.511 1.321. 0.521 $56,269 6 $2,195,468 $88.58 11,387 3,417 0 52 522 $22,687 1 $7,236,720 $6,431,737 88.881 35.421 26.201 38.381 1.511 1.311 o.50Z $52,533 1 $2,278,155 $88.85 18,004 3,601 0 54 540 $22,021 B *7,381,454 $11,574,930 89.071 35.931 26.201 31.871 1.571 1.291 0.491 $50,397 8 $2,362,4911 $89.06 18,612 3,722 0 56 558 m,m 9 $7,529,083 $6,720,987 89.271 36.431 26.201 37.371 1.571 1.271 0.481 $54,483 9 $2,448,524 $89,15 19,246 3,849 0 58 577 $22,1145
.10 $7,679,665 $6,869,967 89.461 36.921 26.201 36.88% 1.57% 1.261 o.m $59,935 10 $2,536,272 $88.98 19,914 3,983 0 60 597 $231871 11 f7,833,258 $7,021,926 89.64% 37.391 26.201 36.41'& t.m 1.24% G.46Z i12,096 11 $2,625,776 $88.58 20,658 4,132 0 112 620 $26,553 12 $7,989,923 $7,176,925 89.821 37.861 26.201 35.941 1.581 1.231 0.451 m,4IB 12 S2,117,071 $88.85 21,414 4,283 0 64 642 $27,019
c••••=======••a•=====s:u=•=•==m=z:•:a:c=•====••=•z::au:ca:aullnaaaaan:a•:a••na•••••=••=•••nnn:: Ut INPUT SUMARV tU HEALTH FliiANCIAL Slt!ULATION IIODEL II
II
Rate of .. ( --------------------------- Type 2 Care ----------------------------> 11
Budgth Value 8r011th .. <-- Required ··> " ................... ---- ____ ... " Year Budget Unit Cost Prevent Out-Pat In·ht Doctors Nurtts InYest 2 II
&overnunt Budget $100,000,000 2.001 II ............ _________ ... ____ ............. ... .............. .. ............. ----- -----· ------ ............ ___
Portion of Sov't. Budget for tlin. of Health 0.05356038 II 0 $1,194,952 $143.39 2,000 s,ooo 100 50 200 11
"lnhtry of Kulth IUII;tt $5,356,038 II 1 $1,207,693 $142.77 2,021 5,053 101 51 202 *6,220 Adainhtration of hlllth 11rvicn budgat $700,000 0.001 .n 2 tl,m,m tl41.41 2,21B M37 Ill ss 221 t56,375 .c:-Training budget $20,000 3.00% .. 3 $1,431,002 U4o.41 2,428 6;069 121 61 243 $62,142 N II
Otbtr Budgat I $50,000 1,001 II 4 $1,576,870 $139.17 2,695 6,738 135 67 270 $78,082 Other Budget 2 $25,000 1.001 II 5 $1,612,221 $!39.22 2,780 6,951 139 70 278 $24,788 Other Budget 3 $0 0.001 II 6 $1,1148,279 $139.45 2,841 7,104 142 71 284 $!7,804 II
Share .. 1 t1,685,059 U39.77 2,900 7,250 145 73 290 $17,129 II
Heal tn Budget for Patient Care $4,561,038 ---- II 8 $1,122,574 $140.00 2,958 7,395 148 74 296 $16,836 II
Patient Care budget for Type I servictl $11318,026 28.901 II 9 $1,760,840 $140,10 3,019 7,546 151 75 302 t11,7!0 Patient Care budget for Type 2 services t1,194,952 26.20% .. 10 tl, 799,871 tl39.89 3,083 7,708 154 11 308 $18,853 " Patient Care budget for Type 3 services $2,048,060 44.901 !I II $1,839,683 $139.45 3,156 7,891 !58 79 3!6 $21,291 Fee pay1ent by patients $0 II 12 $1,880,291 $139.77 3, 231 8,076 162 81 323 $21,683 II
Other financial contributions $0 0.001 ll .. II II
" < ---------------------------- Type 3 Care -----------------------------) Inputs per Unit of Service II <-- Required --> ( -----·--------------------> Salaries .. Year Budget Unit Cost Prevent Out-Pat In-Pat Doctors Nurses Invest 3 II
Type I Type 2 Type 3 and Prices II ---- _ ... _ .................. ................ -- .............. II
----- ............. _ -··--- _ ................... - .. 0 $2,048,060 $204.81 2,000 7,000 6,000 10 400 II
Doctors 0.0021 0.0060 0.0070 $6,000 II I $2,069,898 $203.78 2,021 7,075 6,.064 71 404 $21,325 Nurses 0.0210 0.0240 0.0400 $1,701 II 2 $2,216,085 $202.18 2,115 7,612 6,525 76 435 $153,606 " Technicians 0.0004 0.0012 0.0020 n,ooo II 3 $2,324,027 $201.21 2,299 8,046 6,897 80 460 $124,011 .. Other Morken 0.0245 0,0360 0,0500 $1,200 II 4 $2,406,990 $206.28 2,393 8,374 7,178 84 479 m,614 Eu1nd!turn on Mttlrlall 1.4000 1.8000 2.7000 $1.00 II 5 $2,427,096 $200.67 2,424 8,483 7,271 85 485 m, 108 Expend! turts on Drug1 3;5000 4.8000 7.0000 $1.00 " 6 $2,447,605 $201.28 2,439 8,538 7,318 85 488 $15,778 II
Other Expenditures 0.2100 0.2400 o.sooo $!.00 II 1 $2,468,523 $202.04 2,453 8,585 7,358 86 491 $13,384 II
Ad•inistratian Expenditures 8.5050 13.0800 18.8000 ii.OO .. 8 $2,489,860 $202.65 2,465 8,626 7,394 86 493 $11,842 .. " .. 9 $2,511,624 $203.03 2,479 8,676 7,436 87 496 m.,t28
Nutber Growth Rate .. 10 $2,533,823 $202.87 2,496 8,736 7,488 87 499 $17,210 " ----------- II II $2,556,467 $201.28 2,520 8,821 7,561 88 504 S24,252 Doctors in Private Sector 30 IO.OOt II 12 $2,579,563 $202.04 2,545 8,907 7,635 89 509 $24,116 Nurses in Pri vete Sector 100 5.oot ll
Thble 4 (continued)
TABLE OF ANNUAL PARAIIETERS AND 6ROIITH RATES .................................... _ ........................ ___ ... _____ ,... .. ___ < ·--·····-····-··----····--·········-···--···- YEAR ·····-···-····-·····-···-····-······--·····--· >
I 2 3 4 5 6 7 8 9 10 II 12 ----- ----- __ ,.. __ ----· ............ ..... ___ ----- ---
6overnunt Budget !ALPHA I ................. , ............... 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 Portion of Sov't. Budget far "in. of He1lth !BETA! ........ 0.053 0.056 0.059 0.063 0.063 0.063 0.063 0.063 0.063 0.063 0.063 0.063 Ad1inistration Cost of hnlth services !AD"IM&ROI ......... 0.000 0.000 0.000 0.000 o.ooo o.ooo o.ooo o.ooo 0.000 o.ooo 0.000 0.000 other Financitl Contribution !DTHFlN&ROI .................. o.ooo 0.000 0.000 0.000 0.000 0.000 o.ooo 0.000 0.000 0.000 o.ooo o.ooo other Budget 1 !OTHI&RDI .................................. 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.0!0 other Budget 2 !OTH26RDI .. , ............................... 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.0!0 Other Budget 3 tDTH3&RDI ................ , ........... , ..... 0.000 0.000 0.000 0.000 0.000 o.ooo o.ooo o.ooo o.ooo o.ooo 0.000 o.ooo Sh~re of Type I services in Budget lncreiil! (SHARE!l ...... 0.289 0.389 o. 4119 0.589 0.589 0.589 0.589 0.589 0.589 0.589 0,589 0.589 Share of Type 2 aervicts in Budget Increase !SHARE21 ...... 0.262 0.262 0.262 0,262 0.262 0,262 0.262 0.262 0.262 0,262 0.262 0.262 Shire of Type 3 services in Budget Increase !SHARE31 , ..... 0,449 0.349 0.249 0.149 0.149 0.149 0.149 0.149 0.149 0.149 0.149 0.149 Dr114 Expenditure grollth nte !DRU6EXP&ROI , .... , ........... o.ooo o.ooo 0,000 o.ooo 0.000 o.ooo o.ooo o.ooo o.ooo o.ooo 0.000 0.000 Adli ni strati on Expenditure growth r1te !ADKNEXI'GROI ... ,. .. o.ooo o.ooo 0.000 o.ooo o.ooo 0.000 o.ooo o.ooo 0,000 0.000 o.ooo 0.000 "aterials Exptnditllrt growth rate I"ATEXPBROI "'""""" 0.000 o.ooo o.ooo o.ooo o.ooo 0.000 o.ooo o.ooo o.ooo 0.000 o.ooo o.ooo Dther Expenditures grallth rate IOTHEXPBROI """""""" o.ooo o.ooo 0.000 0.000 o.ooo 0.000 o.ooo o.ooo o.ooo o.ooo o.ooo o.ooo Doctors' Salary growth rate IOOCSAL8ROI .. ; ................ o.ooo 0.000 0.000 o.ooo 0.000 0.000 o.ooo 0.000 0.000 o.ooo o.ooo o.ooo Technicians' Slllry growth rate !TECHSAL&RDI .............. o.ooo o.ooo o.ooo o.ooo 0.000 o.ooo 0.000 0.000 0.000 0.000 o.ooo o.ooo other llork1r1 Salary gro•th rate !IDRKSAL&ROI .. , ....... , • o.ooo 0.000 0.000 0.000 o.ooo o.ooo o.ooo 0.000 o.ooo o.ooo o.ooo o.ooo Fees for Preventi n Care !FEEPREYSl .. , .... ., .. ., .... ., ... 0.000 0.000 o.ooo o.ooo 0.000 o.ooo o.ooo 0.000 0.000 o.ooo o.ooo o.ooo Fen far Outpatient Cate tFEEOUTPATl ...................... o.ooo o.ooo o.ooo 0.000 0.000 0.000 0.000 0.000 o.ooo o.ooo 0,000 o.ooo Fees far Inpatient Cart IFEEINPATI "'"'""'""""'" o.ooo 0.000 0.000 o.ooo 0.000 0,000 0.000 0.000 0.000 0.000 o.ooo o.ooo Nur111 Salary Pritt Index !PRICElNDEXl .................... 1.000 1.000 !.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 !.000 1.000 Doctors per unit of service •• Type I !QOOCPERSERYII ...... 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 ~
Doctors per unit of urvict -- Type 2 IQDDCPERSERY21 ... , • 0.006 0.006 0,006 0.006 0,006 0.006 0.006 0.006 0.006 0.006 0.006 0.006 w
Doctors per unit of servitt -- Type 3 (QDDCPERSERV31 .. , ... 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0,007 0,007 0.007 Nurns per unit of service ·- Type I IQIIRSPERSERYU • ,. .. ., 0.021 0,021 0.021 0.021 0.021 0,021 0.021 0.021 0.021 0.021 0.021 0.021 Nurs11 per unit of service •• Type 2 !QIIRSPERSERY21 ....... 0.024 0,024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 Nurses per unit of service -- Type 3 IQNRSPERSERY31 ....... 0.040 0.040 0.040 0.040 0.040 0.040 0,040 0,040 0.040 0.040 0.040 0.040 Technicitns per 11nit of service •• Type I !QTECPERSERYII .. o.ooo 0.000 o.ooo o.ooo o.ooo 0.000 o.ooo o.ooo o.ooo o.ooo 0.000 o.ooo Technicim per unit of service -- Type 2 UITECPERSERY2l .. 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0,001 0.001 0.001 0.00! 0.001 T.echnitians per unit of ltrvitt -- Type 3 (QTECPERSERY31 .. 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 other Workers per unit of service -- Type I UIWRkPERSERYll. 0.025 0.025 0.025 0.025 0.025 0,025 0.025 0.025 0.025 0,025 0.025 0.025 other llorkers ptr unit of service •• Type 2 (QWRKPERSERY21. 0.036 0.036 0.036 0.036 0.036 0.036 0.036 0.036 0.036 0.036 0.036 0.036 other llorker1 per unit of urvict -· Type 3 UIMRKPERSERY31. 0.050 0,050 0.050 0.050 0.050 0.050 0.050 0.050 0.050 0,050 0.050 0.050
5
U* OUTPUT SUKIIARV m HEALTH FIMAHCE S!ntiLATIDN HODEL Ui OUTPUT SUII"ARV U1 BY TYPE OF SERVICE Distribution of Output to Population < ---------------······--·----- Type I Care ---------·------------------>
< ·---------- Budgets ---------> < ------ Patient Budget -----> <---·--·- Ratios -------> Total <-- Required --> Year Heal tb Patient Pat/Hlt Type I Type 2 Type 3 Prevent llllt-Pat In-Pat Invest. Yur Budget Unit Cost Prevent Out-Pat In-Pat Doctors Nurses Invest I ---- _____ ... ___ .., ........................ ........ -..... ------ --..... - ... ... -....... .................. .. .. _ ............ ------ .., ______ --- __ ................. .............. -.............................
0 $5,356,038 $4,561,038 85.16% 28.90X 26.201 44.90% 1.16% 1.161 o.soz 0 $1,318,026 m.26 10,000 2,000 0 30 300 1 $5,406,000 $4,829,071 89.341 2B.90Z 26.201 44.90X t.m t.tn 0.52% $173,186 I $1,395,654 m.12 10,589 2,118 0 32 318 $21,035 2 $5,826,240 $5,261,493 9o.:m 29.72% 26.20% 44.08% 1,30% 1.27X 0,54% $286,213 2 $1,563,633 $90.00 12,012 2,402 0 36 360 $50,823 3 $6,261,127 $5,716,321 91.301 31.241 26.20% 42.561 t.m 1.33% 0.561 $264,628 3 tt, 786,044 $89.05 13,891 2,778 0 42 417 $67,122 4 $6,819,323 $6,292,696 92.28% 33.781 26.20% 40.021 1.621 1.41% o.5n $278,239 4 $2,125,529 $87.88 16,709 3,342 0 50 501 U00,626 5 $6,955,709 $6,448,066 92.701 34.381 26.201 39. 42Z 1.651 1.41% 0.561 $95,342 5 $2,217,042 t87.92 17,659 3,532 0 53 530 $33,933 6 $7,094,823 $6,592,706 92.92% 34.92% 26.20% 38.88% 1.65% 1.391 0.54% $59,251 6 $2,302,234 $88.11 18,330 3,666 0 55 550 $23,946 7 $7,236,720 $6,737,414 93.101 35.44% 26.20% 38.36% 1.651 1.38% 0.531 $54,493 7 $2,387,467 $88.42 18,968 3, 794 0 57 569 $22,811 8 *7,381,454 $6,884,574 93.27% 35.94% 26.20% 37.86% 1.651 1.361 0.52% $50,626 8 $2,474,145 $88,63 19,588 3,918 0 59 588 t22, 126 9 S7,529,083 $7,034,305 93.43% 36.43% 26.201 37.371 1.651 1.34% 0.511 $55,683 9 $2,562,337 $88.74 20,238 4,048 0 61 607 $23,217
10 *7,619,665 $7,187,338 93.591 36.90% 26.201 36.90% 1.65% 1.321 0.491 $61,078 10 $2,652,473 $88.59 20,923 4, IB5 0 63 628 $24,453 II *7,833,258 n ,m, 754 93.751 37.371 26.201 36.431 1.651 1.31% o.m $73,960 II $2,744,602 $88.11 21,687 4,337 0 65 651 $27,308 12 $7,989,923 $7,504,179 93.92% 37.831 26.201 35.971 1.651 1.29% o.4BZ $74,753 12 $2,839,092 $88.42 22,464 4,493 0 67 674 $27,729
&::c:c••••a:~:caaac=•===•===••:ca:::lac:::aal:ca:t::a:::uao=e==z=nuuu•=c==•==••••••==•===•==••==•==•=
nt INPUT SU""ARY tu IEALTH FlNANCIAL SIMULATlON IIDDEL II Rite of II < ----------------------------- Type 2 Cire ----------------------------->
Budgets Yalue Br011th It < -- Required --> It
------ ........... .............. II Year Budget IIIIi t Cost Prevent Out-Pat In-Pat Doctors Nurses lnnst 2 " 6onrnnnt Budget $100,000,000 2.00% " ...... -------- -------· ------" Portion oi Sov't, 8udget far "in. of Htalth 0.05356038 II 0 tl, 194,952 $!43.39 2,000 s,ooo too 50 200 "inistry of Health Budget $5,356,038 II I $1,265,331 $141.91 2,118 5,294 106 53 212 $34,357
Ad1iniltnti011 of health sarvitll budget $700,000 o.oo1 II 2 $1,378,465 $140.59 2,331 5,B2B 117 58 233 $62,260 II .l:" Training bu-get $20,000 3.001 II 3 $1,497,626 $139.60 2,557 6,392 128 64 256 $65,736 .l:"
Other Budget 1 $50,000 1.ooz " 4 $1,648,631 $138.45 2,834 7,086 142 71 283 t80,977 II
Dthll' Budget 2 $25,000 1.00% II 5 $1,689,337 $138.51 2,928 7,321 146 73 293 $27,460 Othll' BudQet 3 $0 o.oox II 6 $1,7%7,231 $138.73 2,993 7,482 150 75 299 ttB,778
Sllart II 7 $1,765,143 $139.09 3,054 7,634 153 76 305 m,m Health Budget for Patint Cart M1561,038 ·---· .. a t1,803,698 $139.33 3,112 7,781 156 78 311 m,m II
Pltitat Cart budget for Type I III'Vitll $1,318,026 28.901 II 9 $1,842,926 $139,46 3,174 7,936 159 79 317 $18,U7 Patltat Cln budget for Typt 2 sarvittl ti,IM1952 26.201 II 10 tl,BB3,020 $139.27 3,241 a, 101 162 81 324 tt9,284 " Patint Cart budget for Type 3 III'Vitll t2,04B,060 44.90% II 11 $1,923,999 $138.73 3,316 8,289 166 83 332 $21,875 ftt PIYIIIIt by Pltientl $0 " 12 $1,966,029 $139.09 3,392 B,479 170 85 339 $22,212 " other financial coatributions $0 0.001 .. ..
II II
II < -----------------------··-·· Type 3 Clre -------·--··---------------> Inputs per lllit of Service II <-- Required ··> " < --------------------·----·} Salaries " Year Budget Unit Cost Prevent Out-Pat In·Pit Doctors Nurses Invest 3 II
Type I Type 2 Type 3 and Prices II _ ..,_,.. _,.. ___ .., ___ ,.. ..... ------- _.,. _____
" ...... -..... ---- " 0 t2,048,060 t204.81 2,000 7,000 6,000 70 400 " Doctors 0.0021 0.0060 0.0070 $6,000 " I $2,168,685 $202.49 2,118 7,412 6,353 74 424 $117,795 II
Nurses 0.0210 0.0240 0.0400 $1,701 :: 2 $2,319,395 $200.S2 2,291 8,018 6,873 BO 458 $173,130 Technicians 0.0004 0.0012 0.0020 $3,000 " 3 $2,432,651 $199.94 2,423 8,479 7,268 85 485 $131,771 " Other Workers 0.0245 o. 0360 0,0500 U,200 " 4 $2,518,536 $199,09 2,519 8,818 7,558 88 504 m,636 " Expenditures on "ateri ah 1.4000 1.8000 2.7000 u.oo .. 5 $2,541,687 $199.49 2,553 8,936 7,660 89 511 $33,950 II
Expenditures on Drugs 3.5000 4.8000 7.0000 $1.00 II It $2,563,240 $200.08 2,570 8,994 7,709 90 514 U6,527 II
Other Expenditures 0.2100 0.2400 0.5000 $1.00 " " 7 $2,584,803 $200.89 2,584 9,043 7,751 90 517 $13,939 Adlinistration Expenditures 8.5050 13.0800 18.8000 $1,00 II 8 $2,606,731 $201.50 2,595 9,083 7,785 91 m $11,401 " II 9 $2,629,042 $201.91 2,609 9,133 7,828 91 522 $14,329
Nuaber SroMth Rate " 10 $2,651,845 $201.78 2,627 9,194 7,880 n 525 $17,342 " --------.. -- II 11 $2,675,153 $200.08 2,652 9,281 7,955 93 530 $24,777 Doctors in Private Sector 30 10.001 " 12 $2,699,058 t200.89 2,676 9,367 8,029 94 535 $24,813 II
Nurses in Private Sector 100 5.00% II
Tctble 5 (continued)
TABlE OF ANNUAL PARA"ETERS AND 6ROMTH RATES ---··-----........ ________________ ,.. __ ... _________
< -------·· ··--····--···--··--·-··············--·-··- YEAR -----•• ·----·-···········-········-----·-·····--> I 2 3 4 5 6 7 8 9 10 11 12 _ .. ___ ----- ----- ----- ___ ..,.,. .., ____ ----- ---
6overn1ent Budget (AlPHA) ......................... , ....... 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 Portion of Gov't, Budget for Min, of Health tBETAI ........ 0.053 0.056 o.o5q 0.063 0.063 0,063 0.063 0.063 0.063 0.063 0.063 0.063 Adainistration Cost of htalth 1m ices !AD"INGRD) .. , .. , ... 0.000 o.ooo o.ooo o.ooo o.ooo 0.000 0.000 o.ooo 0.000 o.ooo 0.000 o.ooo Other Financial Contribution (OTHFIMGRD! .................. 0.000 0.000 o.ooo o.ooo 0.000 o.ooo o.ooo o.ooo o.ooo o. 000 " 0.000 0.000 Other Budget 1 (fiTHlGROI .................................. 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 Other Budgtt 2 !OTH26RDI .................... , ............. 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 Other Buctoet 3 (QTH36ROl ............... u ... ,. ..... "' ..... o.ooo o.ooo 0.000 o.ooo 0.000 0.000 o.ooo 0.000 o.ooo o.ooo 0.000 0.000 Share of Type I services in Budget Increase ISHAREII ...... 0.289 o. 38, . o. 489 o.saq 0.589 0.589 0.589 0,589 0.589 0.589 0.589 0.589 Share of Type 2 strvictl in Budget Increase ISHARE2l •• , • , • 0.262 0.262 0.262 0.262 0.262 0.262 0.262 0.262 0.262 0,262 0.262 0.262 Share of Type 3 urvices in Budget Increase ISHARE3l .. , ... o.m 0.34' o.m 0.149 0.149 0.149 0.149 0.149 0.149 0.149 o.t4q 0.149 Drug E•ptnditure grllllth rate IDRU6EIPGRDl ................. 0.000 0.000 o.ooo o.ooo 0.000 0.000 o.ooo o.ooo 0.000 0.000 0.000 o.ooo Ad•inistration E•penditure groNth r&te (ADKNEXPSRDI ....... o.ooo o.ooo o.ooo 0.000 o.ooo o.ooo o.ooo 0.000 0.000 o.ooo o.ooo o.ooo "at trials Expenditure growth rate I"ATEXPGROl ............. 0.000 o.ooo o.ooo o.ooo 0.000 0.000 o.ooo o.ooo 0.000 0.000 0.000 o.ooo other E•penditurll gr011th ra~e IDTHEXPIIROI ..... ........ : .. 0.000 0.000 0.000 o.ooo 0.000 0.000 o.ooo .0.000 o.ooo o.ooo 0.000 o.ooo Doctors' Salary growth rate IDOCSALSROl ....... ;, .......... o.ooo o.ooo o.ooo o.ooo o.ooo o.ooo o.ooo 0.000 0.000 o.ooo o.ooo 0.000 Technicians' Salary gr011th rate ITECHSAl6RDI .............. o.ooo 0.000 0.000 o.ooo o.ooo o.ooo 0.000 o.ooo o.ooo o.ooo 0.000 0.000 other llorktrs Salary grllllth rate IIIDRKSALiiROl .. , .......... 0.000 o.ooo o.ooo o.ooo 0.000 o.ooo o.ooo o.ooo 0.000 o.ooo o.ooo o.ooo Fees for Prtventi vt Care IFEEPREYBl ...... , .......... , .... , 2.000 2.000 2.000 2.000 2.000 2.000 2.000 2.000 2.000 2.000 2.000 2.000 Fees for Outpatient Cate IFEEOUTPATl ....... , ............. , 5.000 5.000 s.ooo 5,000 5.000 s.ooo 5.000 5.000 5.000 5.000 5,000 . 5,000 Fees for Inpatient Care IFEEINPATI ...................... 20.000 20.000 20.000 20.000 20.000 20.000 20.000 20.000 20.000 20.000 20.000 20.000 Nurses Salary Price lnde• IPRICEINDEXI ........ , ........... 1.000 LOOO 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 Doctors per unit of servict -- Type 1 IQOOCP~RSER'IIl ...... 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 1>-
Doctors per unit of service •• Type 2 IQOOCPERSERY2l ...... 0.006 0.006 0.006 0.006 0.006 0.006 0.006 0.006 0.006 0.006 0.006 0.006 VI
Doctors per unit of service •• Type 3 IQDDCPERSER'I3l ...... 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 Nurses per unit of ltrYi ce •• Type I lllNRSPERSERVI l ....... 0.021 0.021 0.021 0.021 0.021 0.021 0.021 0.021 0.021 0.021 0.021 0.021 Nurses ptr unit of service •• Type 2 (QNRSPERSERV2l ....... 0.024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 Nurses per unit of srrvice •• Type 3 (flNRSPERSERY3l ....... 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 Technicians per unit of srrvice •• Type 1 IQTECPERSERVII .. 0.000 o.ooo o.ooo o.ooo o.ooo o.ooo 0,000 o.ooo 0.000 o.ooo o.ooo o.ooo Technicians per unit of service •• Type 2 UITECPERSERV21 .. 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 Technicians per unit of service •• Type 3 lQTECPERSERV31 .. 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0,002 0.002 0.002 0.002 0.002 other llorkers per unit of service·- Type I HIIIRkPERSERVU. 0.025 0.025 0.025 0.025 0.025 0,025 0.025 0.025 0.025 0.025 0.025 0.025 Other ~orkers per unit of service •• Type 2 lQNRKPERSERV21. 0.036 0,036 0.036 0.036 0.036 0.036 0.036 0.036 0.036 0.036 0.036 0.036 other llorken per unit of service ·- Type 3 IQNRKPERSERV3l. 0.050 0.050 0.050 0.050 0,050 0.050 0,050 0.050 0.050 0.050 0.050 0.050
Table 6
m OUTPUT SUIIIIARV ut HEALTH FiNANCE SIIIULATION IIODEL Ui OUTPUT SUIIIIARV Ul BV TVPE OF SERYICE Distribution of Output to Population < ----------------------------- Type I Care ----------------------------->
< ----------~ Budgets ---------> <------ Patient Budget -----> < ------- Ratios -------> Total <-- Required --> Year Heal tb Patient Pat/HIt Type 1 Type 2 Type 3 Prevent Out-Pat In-Pat Invest • Year Budget Unit Cost Prevent Out-Pat In-Pat Doctors Nurses Invest 1 ... _ .... -----·---- ...... -.................... .................... ........ _ .. - ...... - ----... ------ ........ -...... ...--··- ........... __ --- .............. _ ....... ......................... ... ......... -.....
0 $5,356,038 ·~.561,038 85.161 28.901 26.20% 44.90% 1.16% 1.16% 0.501 0 t1,31B,02b $92.26 10,000 2,000 0 30 300 I S514061000 $4,829,671 89.341 28.901 26.201 44.901 I. 191 1.m 0.52% U73,186 I $1,395,654 $90.79 10,589 2,118 0 32 318 m,035 2 $5,826,240 $5,261,493 90.31% 29.721 26.20% 44.08% 1. 30% 1.27% 0.551 $296,646 2 $1,563,633 $89,51 12,055 2,411 0 36 362 $52,371 3 $6,2111,127 ss, 717,110 91.311 31.251 26.201 42.551 I. 43% 1.341 0.56% $271 1739 3 $1,786,430 t88.28 13,971 2,794 0 42 419 $68,412 4 S6,819,323 $0,294,022 92.301 33.781 26.201 40.02% 1.63% 1.421 0.571 $290,256 4 $2,126,231 $86.94 16,859 3,372 0 51 5011 $103,142 5 S619551 709 $6,450,298 92.731 34.391 26.201 39.41X 1.67% 1.42% 0.561 $104,082 5 $212181278 $86.78 17,861 3,572 0 54 536 $35,788 6 S7 1094,823 $61595,5'17 92.'1117. 34.931 26.201 3a.B7% 1.681 t.m 0,551 S67, '110 6 S2,303,B58 $86.81 18,583 3, 717 0 56 557 S251 786 7 $7,236,720 $6,740,957 93.151 35.451 26.201 38.351 1.68% 1.39% . 0.541 S61 1931 7 $2,389,476 m.oo 19,268 3,854 0 58 578 $24,465 8 $7,381,454 $6,888,678 93.321 35.95% 26.201 37.85% 1.681 1.m 0.53% $56,284 B $2,476,483 $87 .II 19,925 3,985 0 60 5'18 $23,466 9 $7,529,083 S71038,835 '13.m 36.441 26.201 37.36% 1.6Bl 1.36% O.SIX $60,742 '1 $2,564,926 $87.18 20,610 4,122 0 62 618 $24,469
10 $7,679,665 $7,192,248 93.1.51 36.921 26.201 36.881 1.681 1.341 0.501 $64,428 10 $2,655,286 $86.97 21,321 4,264 0 64 640 $25,386 II $7,833,258 $7,348,916 '13.821 37.391 26.20% 36.41l 1.681 1.331 o.m $77,154 11 $2,747,564 $86.81 22,115 4,423 0 66 663 t28,364 12 $7,989,923 $7,509,626 93.9'17. . 37.85l 26.201 35.9SX 1.69% 1.32% MBX $80,070 12 $2,842,222 $87.00 22,931 4,586 0 69 688 $29,136
c•====•===••==========tJ::::rs::::a==•==•==•=:a::s:c:::c:::::m:::::u:=== .. •======:=••===n===============::n::n:: Ut INPUT SUIIIIARY Ul HEALTH FINANCIAL SIIIULATION IIOOEL II
II
Rate of II < --------------------------·-- Type 2 Care -----------------------------> Budgets Value Growth .. <-- Required --> II
_ .............. _ ----- ............... II Year Budoet Unit Cost Prevent Out·Pat In-Pat Doctors Nurses Invest 2 II
&overnnnt Budget stoo,ooo,ooo 2.001 " ..... _ ,.. ... ________
........................ _ --·---" Portion of 6ov't, Budgtt for llin. of Health 0.05356038 It 0 $1,194,952 $143,39 2,000 5,000 100 50 200
llinistry of Health Budget $5,356,038 II I $1,265,331 $141.54 2,118 5,294 106 53 212 $34,357 " Ad•inistration of health services budget $700,000 0.001 II 2 $1,378,465 $140.02 2,337 5,844 117 58 234 $64,060 II ...,. Training budget $20,000 3.001 II 3 $1 1 4971833 $138,73 2,567 6,418 128 64 257 $67,042 0\
Other Budget I $50,000 1.00% II 4 Sl,648,m $137.36 2,853 7,132 143 71 285 S831258 Other Budget 2 m,ooo 1.001 It 5 $1,689,922 $137.20 2,953 7,382 148 74 295 $29,136 It
Other Budget 3 $0 o.ooz It 6 S1 1727 1989 $137.23 3,023 7,557 151 76 302 $20,444 It
Sh1re " 7 Sl, 7661072 $137.46 3,089 71721 154 77 30'1 . $19,203 II
Health Budget for Patient Care $4,561,038 ----- .. 8 Sl,804, 773 $137.58 3,151 7,878 158 79 315 $18,245 II
Patient Care budget for Type I services $1,3181026 28.90% " 9 tl,844,113 $137,65 3,217 8,042 161 80 322 m, 175 II
Patient Care budget for Type 2 services $1 11941952 26.201 .. 10 $1 1884,306 $137.39 3,285 8,214 164 82 32'1 $20,005 .. Patient Care budget for Type 3 services $2,048,060 44.901 " II $1,925,352 $137.23 3,363 8,408 168 84 336 $22,672 II
fee payunt by patients $0 " 12 Sl, '167 1456 $137.46 3,443 8,608 .172 86 344 $23,308 II
Otber fintncial contributions so 0.001 .. It
~ : II <----------------·------------ Type 3 Care ----------------------------->
Inputs per Unit of Service .. <--Required --> " { --------------------------> Salaries .. Year Budget Unit Cost Prevent Out-Pat In-Pat Doctors liurses Invest 3 " Type I Type 2 Type 3 and Prices .. ... ... - .,.,. ___ ... .., ___ --------- -------..
..... -.... -......... .. 0 $2,048,060 S204.81 2,000 7,000 6,000 70 400 .. Dot tors 0.0021 0.0060 0.0070 $6,000 .. I $2,168,685 $201.86 2,118 7,412 6,353 74 424 Sl17,795 .. Nurses 0.0210 o. 0240 0.0400 Sl, 701 .. 2 $2,319,395 $199.88 2,2'18 8,043 6,894 80 460 SIBO, 215 .. Technicians 0.0004 o. 0012 0.0020 $3,000 .. 3 $2,432,848 $198.48 2,434 8,520 7,303 85 487 $136,285 .. Other Nor ker s 0.0245 o. 0360 0.0500 $1,200· " 4 $2,518,812 $197.27 2,538 8,884 7,614 89 508 U03,856 " Expenditures on "aterials 1.4000 1.8000 2. 7000 $1,00 II 5 $2,542,099 m7.29 2,577 9,021 7,732 90 515 m,m It
Expenditures on Drugs 3.5000 4.8000 7.0000 $1.00 " 6 S2,563, 750 $197.57 2,599 9,096 7,797 91 520 S21 1680 "
Other Expandi tures 0.2100 0.2400 0.5000 $1.00 II 7 S2,5851410 $198.15 2,617 9,160 7,852 92 523 $18,263 Adti ni strati on Expenditures 8.5050 13.0800 18.8000 $1,00 :I 8 t2,607' 421 $198.56 2,632 9,211 7,895 92 526 $14,573
" 9 $2,629,796 $198.85 2,649 9,271 7,947 93 530 $17,098 .. Nuaber GroMth Rate ll 10 $2,652,656 $198.61 2,668 9,338 8,004 93 534 m,037 __ .,._.._ __ .. ___ ..
" II $21616,001 $197.57 2,695 9,431 8,084 94 539 $26,718 Dodors in Private Sector 30 10.001 tl 12 $2,699,948 Sl98.15 2,722 9,528 8,167 95 544 $27,626 Nurses in Private Sector 100 5.001
Table 6 (continued)
TABLE OF ANNUAL PARAIIETERS AND GROIITH RATES ......... -..... -..... -...................... -............. _., __ ... ..,_ ............
( -------·---····--------····---------------------·- YEAR ----------·-········-·-··············--·-------· > 1 2 3 4 5 6 7 8 9 10 11 12
......... ......... - .. ........ .. .......... -........... .......... -&avern1ent Budget (ALPHA) • t, ............................... 0.020 0.020 0.020 0.02.0 0.020 0,020 0.020 0.020 0.020 0.020 0.020 0.020 Portion of Sov't, Budget for "in. of Health I BET AI ........ 0,053 0.056 0.059 0.063 0.063 0.063 0.063 0.063 0.063 0.063 0.063 0.063 Ad•inistration Cost of health services IAD"!NSRDI ......... o.ooo 0.000 0.000 0.000 0.000 0.000 o.ooo 0.000 o.ooo o.ooo 0.000 o.ooo Other Financial Contribution IOTHFlN&ROl .................. o.ooo 0.000 o.ooo 0.000 o.ooo 0.000 o.ooo o.ooo o.ooo 0.000 0.000 o.ooo Other Budget I IOTH1SRDI .................................. 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 Other Budget 2 (0TH2BRDl .......... , ...................... , 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0,010 0.010 0.010 0.010 Other Budget 3 tOTH3GRO~ .......... , ..... .. ............. , •• 0.000 o.ooo 0.000 o.ooo o.ooo o.ooo o.ooo 0.000 o.ooo 0.000 o.ooo 0.000 Share of Type I services In Budget Increase !SHARE I) ...... 0.289 0.389 0.489 0.589 0,589 0.589 0.589 0.589 0.589 0.589 0.589 o.589 Share of Type 2 services in Budget lncreue ISHARE2l ...... 0.262 0.262 0.262 0.262 0.262 0.262 0.262 0.262 0.262 0.262 0.262 0.262 Share of Type 3 services In Budget Increase ISHARE31 ...... 0.44'1 0.349 0.249 0.149 0.149 0.149 0.149 0.149 0.149 0.149 0.149 0.149 Drug Expenditure growth rate IDRUBEXPBRDI ................. o.ooo o.ooo 0.000 0.000 0.000 0.000 o.ooo 0.000 0.000 o.ooo o.ooo o.ooo Adlinistration Expenditure growth ratt IAD"NEXPBRDl ....... o.ooo 0.000 0.000 o.ooo 0.000 0.000 0.000 o.ooo 0.000 0.000 o.ooo 0.000 "aterials Expenditure growth ratt I"ATEXPBRDl ............. 0.000 o.ooo 0.000 o.ooo o.ooo 0.000 0.000 o.ooo o.ooo o.ooo o.ooo 0.000 Other E•pendltures growth rate IDTHEXPSRDl ................ 0.000 o.ooo o.ooo o.ooo o.ooo o.ooo o.ooo 0.000 o.ooo 0.000 o.ooo o.ooo Doctor1' Salary growth rafe IDDCSALSRDl ................... 0.000 o.ooo. o.ooo 0.000 o.ooo 0.000 o.ooo 0.000 0.000 0.000 o.ooo o.ooo Technicians' Salary growth rate ITECHSALSROI ............. , o.ooo o.ooo o.ooo o.ooo o.ooo 0.000 o.ooo o.ooo o.ooo o.ooo o.ooo 0.000 Other Workers Salary growth rate IIIDRKSALBRDl ............. 0.000 o.ooo o.ooo 0.000 0.000 0.000 o.ooo o.ooo 0.000 0.000 o.ooo o.ooo Fees for Preventive Care IFEEPREVSI ....................... 2.000 2.000 2.000 2.000 2.000 2.000 2.000 2.000 2.000 2.000 2.000 2.000 fees for Outpatient Cate !FEEDUTPAT! ...................... 5.000 5.000 5.000 5,000 5.000 5.000 5.000 5.000 5.000 5.000 5.000 5.000 Fees for Inpatient Care IFEEINPAT! ...................... 20.000 20.000 20.000 20.000 20.000 . 20.000 20.000 20.000 20.000 20.000 20.000 20.000 Nurses Salary. Pritt Index IPRICElNDEII .................... 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 Doctors ptr unit of service -- Type 1 UIDOCPERSERY!l ...... 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0,002 0.002 0.002 0,002 0.002 .,. Doctors per unit of service -- Type 2 IIIDOCPERSERV2l ...... 0.006 0.006 0.006 0.006 0.006 0,006 0.006 0.006 0.006 0.006 0.006 0.006 -..J
Doctors per unit of service -- Type 3 19DOCPERSERV3l ...... 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 Nurses per unit of service -- Type I IQNRSPERSERYI) ....... 0.021 0.021 0.021 0.021 0.021 0,021 0.021 0.021 0.021 0.021 0.021 0.021 Nurses per unit of service -- Type 2 !QNRSPERSERY2) ....... 0.024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 Nurses per unit of service -- Type 3 (QiiRSPERSERV3) ....... 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 Technicians per unit of service-- Type 1 !UTECPERSERVll .. o.ooo 0.000 0.000 o.ooo 0.000 o.ooo o.ooo 0.000 o.ooo 0.000 o.ooo o.ooo Technicians per unit of service -- Type 2 IDTECPERSERV2i .. 0.001 0.001 0,001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 Technicians per unit of service -- Type 3 tUTECPERSERV31 .. 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0,002 Other Markers per unit of service -- Type 1 IQNRKPERSERV!l. 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 Other Workers per unit of service-- Type 2 UiiNRKPERSERV2l. 0.036 0.036 0.036 0,036 0.036 0.036 0.036 0.036 0,036 0,036 0.036 0.036 Other llorkers per unit of service -- Type 3 IQWRKPERSERV31. 0.050 0.050 0.050 0.050 0.050 0.050 0.050 0.050 0.050 0.050 0.050 0.050
48
If some parts of the health care system are not being utilized to full
capacity, or if there are inefficiencies, unit costs can be lowered and more
services provided within the same budget by changing the initial ratios of
inputs to interventions. For example, if nurses in primary care facilities
are underutilized (the present ratio of nurses to interventions is .021),
more efficient methods can be introduced to decrease the ratio to .01. To
introduce this data, go to the table of annual growth rates and enter .01 in
the cell labeled QNRSPERSERVl. The ratio of preventive interventions to
population in year 12 will increase from 1.69 percent (table 6) to 2.05
percent (table 7). Conversely, an increase in the cost of drugs, say, from
$3.50 per unit of primary care to $23.50 per unit (enter the data in the
cell labeled DRUGEXP) will noticeably reduce the number of primary care
interventions (compare table 8 with table 7).
•
•
•
•
Other Features of HEALTHFISIMO
Because the model integrates production functions and prices, it is possible to calculate the budgets required for achieving goals in preventive, outpatient, and inpatient care.
Since the model combines budgets, production functions, and prices, it is possible to calculate the improvements in efficiency that are required to balance increases in prices ~~d maintain a certain level of service.
By taking into account variable fees, the model calculates increases in services, if any, that occur as a result of these fees. It also calculates the fees that are required to expand services.
With the ability to shift budgets among the different types of patient care, the model becomes a tool for analyzing costeffectiveness.
The ability to simulate the effect on the budget of financial and operational policies and the cost effectiveness of efficiency and financial measures, the speed with which these calculations can be made, and the ease with which data can be introduced and changed make HEALTHFISIMO an effective tool for World Bank staff and
49
borrowers. The model makes it possible for users to. engage in dialogue in which the policies discussed can be simulated to ascertain their effect. A series of solutions to given problems can present decisionmakers with a wide variety of policies from which to choose those that are feasible in the local context.
Thble 7
IU OUTPUT SU"MARY U* HEALTH F !NANCE SI ~ULATIOII "OilEL ut OUTPUT SUMMARY U $ BY TYPE OF SERVICE Distribution of Output to Population <·--------------------------- Type 1 Care ·····--····-------------·--·->
< ----------- Budgets ---------> <-----· Patient Budget -----> <-------- Ratios -------> Total <-- Required --> Year Health Patient Pat/HIt Type 1 Type 2 Type 3 Prevent Out-Pat In-Pat Invest. Year Budget Unit Cost Prevent Dut·Pat In-Pilt Doctors Nurse~ Invest I ---- _ ....................... ....... -.......... -- ___ ,. ___ ------ ................. .. -.... -.. ................. .. ............ _ ----...... .................. ........ _______ .. ___ .. ....................................
0 $5,356,038 $4,561,038 85.1bl 28. 90X 26.201 44.90X 1.161 1.16~ o.sox 0 $1,318,026 m.26 10,000 2,000 0 30 300 1 $5,406,000 $4,829,671 89.341 28.901 26.20t 44.901 1.191 1.191 0.521 $173,186 I $1,395,654 $73.29 10,589 2,118 0 32 151 S21,035 2 $5,826,240 $5,261,493 90.31% 29. 72X 26.201 44.081 1.521 1.301 0.541 $364,538 2 $1,563,633 $70,67 14,935 2,987 0 45 213 $155,209 3 $6,261,127 $5,723,157 91.411 31.271 26.201 42.54X 1.721 1.391 o. 561 $307,680 3 $1,789,387 $69,64 17,725 3,545 0 53 253 $99,638 4 $6,819,323 $6,303,038 92.431 33.811 26.201 39.99t t.m 1.48l O.S6X $319,544 4 $2,130,936 $68.67 21,421 4,284 0 64 306 $132,008 5 $6,955,709 $6,461,773 92.901 34.42X 26.20X 39.381 2.0U 1.481 0.561 $112,462 5 $2,224,431 $68.52 22,674 4,535 0 68 324 $44,746 6 $7,094,823 $6,607,779 93.14X 34.m 26.201 38.841 2.021 1.m o.m m,99s 6 $2,310,429 $68.50 23,604 4,721 0 71 337 $33,214 7 $7,236,720 $6,753,740 93.331 35.481 26.20X 38.321 2.031 1.45X 0.531 $66,859 7 $2,396,400 $68.51 24,488 4,898 0 73 350 $31,586 8 $7,381,454 $6,901,899 93.501 35.991 26.201 37.821 2.031 t.m 0.521 $66,742 8 $2,483,665 $68.54 25,378 5,076 0 76 363 nt, 784 9 $7,529,083 $7,052,913 93.681 36.481 26.201 37.321 2.031 1.421 o.m $66,246 9 $2,572,613 $68.51 26,275 5,255 0 79 375 $32,013
10 $7,679,665 $7,206,811 93.84t 36.951 26.201 36.851 2.041 1.401 0.501 m,975 10 $2,663,259 $68.35 27;212 5,442 0 82 389 $33,466 11 $7,833,258 $7,364,194 94.0U 37.421 26.201 36.381 2.041 1.39% o.m $86,037 11 $2,755,957 $68.50 2S,223 5,645 0 85 403 U6,134 12 $7,989,923 $7,525,595 94.19X 37.881 26.20X 35.921 2.051 1.381 0.481 $91,155 12 $2,851,023 $68.51 29,275 s,sss 0 88 418 m,S56
=====-==========::==================-======================================================================= IU INPUT SU""ARV In HEALTH FINANCIAL SlftULATION ft0D£L II
II
Rate of II <--------------·-------------- Type 2 Care ---------·-----------------·· > II
Budgets Value Grllllth II <-- Required ··> ............... ............. ... ................. II Year Budget Unit Cost Prevent Out-Pit In-Pat Doctors Nurses Invest 2 II
6overn1ent Budget $100,000,000 2.001 II .................................... .. .............. _ ..... -------Portion of Gov't. Budget for ftin. of Hulth 0.05356038 II 0 $1,194,952 $143.39 2,000 s,ooo 100 50 200 II
ftini stry of Health Budget 15,356,038 " I tl,265,331 $143.02 2,118 5,294 106 53 212 $34,357 II
Ad1inistration of health services budget $700,000 0.001 " 2 S1,378,465 $141.30 2,313 5,783 116 58 231 $56,975 VI II
Training budget $20,000 3.001 II 3 $1,499,417 $139.94 2,547 6,367 127 64 255 $68,138 0
Other Budget 1 $50,000 1.001 II 4 $1,651,341 $138.58 2,832 7,080 142 71 283 $83,239 II
Other Budget 2 $25,000 1.oox II 5 $1,692,928 $138.42 2,932 7,330 147 73 293 $29,086 II
Other Budget 3 $0 0.001 II 6 $1 1731 1 ISO $138.53 3,002 7,504 150 75 300 $20,337 II
Share II 7 Sl, 769,421 $138.67 3,066 7,664 153 77 307 $18,651 Health Budget for Patient Care $4,561,038 ----- II 8 S1,808,237 $138.87 3,130 7 ,B24 156 78 313 U8167S "
Patient Care budget for Type I services S1,318,026 2S.90X II 9 11,847 ,BOt $138.90 3,194 7,984 160 so 319 f1S,656 " Patient Care budget for Type 2 services $1,194,952 26.20X II 10 11,8881121 $138,62 3,262 8,156 163 S2 326 $20,058 .. Patient Care budget for Type 3 services $2,048,060 44.901 ll 11 $1,929,354 $138.53 3,340 8,351 167 84 334 $22,754 Fee ~ayunt by patients to II 12 $1,971,640 $138.67 3,422 S,556 171 86 342 m,m II
Other financial contributions $0 0.001 " " II " <----···-----·--··-··----··- Type 3 Care ·------------·--------····-> ..
Inputs per Unit of Service .. <·· Required --> II
< --------------------···--· > Salaries II Year Budoet Unit Cost Prevent Out-Pat In-Pat Doctors Nurses Invest 3 II
Ty~e I Type 2 Type 3 and Prices " ........ - ........................ ____ .,. ___ ..,_ -------II
................ ........... _ ................ .......................... II 0 $2,048,060 $204.81 2,000 7,000 6,000 70 400 II
Doctors 0,0021 0.0060 0.0070 $6,000 II I S2,16B,685 $204.34 2, us 7,412 6,353 74 424 $117,795 II
Nurses 0.0210 0.0240 0.0400 ll, 701 II 2 $2,319,395 $202.02 2,270 7,946 6,810 79 454 $152,355 Technicians 0.0004 0.0012 0.0020 S3,000 II 3 $2,434,353 $200,51 2,410 8,435 7,230 84 482 $139,904 II
Other Workers 0.0245 0.0360 0.0500 $1,200 II 4 $2,520,761 $199.33 2,514 8,800 7,543 88 503 $!04,297 II
Expenditures on Katerials 1.4000 1.8000 2. 7000 $1.00 .. 5 $2,544,414 $199.36 2,553 8,935 7,659 89 511 $3S,630 II
Expend\ tuns on Drugs 3.5000 4.8000 7.0000 $1.00 II 6 $2,566,170 $199.76 2,574 9,010 7,723 90 515 $21,447 II
Other Expenditures 0.2100 0.2400 0,5000 $1,00 II 7 t2,587,m $200.20 2,591 9,069 7,773 91 518 $16,621 Ad1i ni strati on Expend\ tures 8.5050 13.0800 18.8000 $1.00 II 8 $2,609,996 S200, 73 2,607 9,126 7,822 91 521 $16,280 II
9 $2,632,4119 $206.99 2,623 9, lBO 7,S69 92 525 $15,577 lluaber Sr011th Rate II 10 $2,655,431 $200.70 2,642 9,248 7,927 92 528 m,450 II
_ .................... -... " II $2,678,882 $199.76 2,670 9,343 8,009 93 534 $27,149 II
Doctors in Private Sector 30 10.001 " 12 $2,702,932 $200.20 2,699 9,447 8,098 94 540 $29,685 II
Nurses in Private Sector 100 5.001 " ..
Table 7 (continued)
TABLE OF A"NU~L PARMETERS AND SROIITH RATES ........ ___ .. .,. .... ___ ..,.,. ... ___ .,_*"'"'"' .................. '!" ...... _______
< ·····-----------·····--···········---···---------- YEAR ···----···-----------------···········----------> I 2 3 4 5 6 7 8 9 10 11 12
·--- ·---- ............... -----.. . .......... .. ........... ............. ----- ............. ............... ----... flovernaent Budget !ALPHA! ................................. 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0,020 0.020 Portion of Gov't. Budget for "in. of Health IBETAt ........ 0.053 0.056 0.059 0,063 0.063 0.063 0.063 0.063 0.063 0.063 0.063 0.063 Ad1iniltration Cost of health mvices (AD"INSROI ........ , 0.000 o.ooo 0.000 o.ooo 0.000 o.ooo 0.000 0.000 o.ooo o.ooo 0.000 0.000 Other Financial Contribution lOTHFINBROl .................. 0.000 0,000 0.000 0.000 o.ooo 0.000 0.000 0.000 o.ooo o.ooo 0.000 o.ooo Other Budget I IOTHI&ROI .......... ,. , ..................... 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 -o. 010 Other Budget 2 IDTH26ROI .................................. 0.010 0.010 0.010 0.010 0,010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 Other Budget 3 lOTH3SRDl .................................. 0.000 0.000 0.000 o.ooo 0.000 o.ooo 0.000 o.ooo 0.000 0.000 0.000 o.ooo Shart of Type I smim in Budget Inmm ISHAREII ...... 0.289 0.389 0.489 0.589 O.S89 O.S89 0.589 0.589 0.599 0.589 0.589 0.589 Share of Type 2 services in Budget Increase ISHARE2l , ..... 0.262 0.262 0.262 0.262 o.m 0.262 0.262 0.262 0.262 0.262 0.262 0.262 Share of Type 3 services in Budqet Increase ISHARE3l ...... 0.449 0.349 0.249 0.149 0.149 0.149 0.149 0.149 0.149 0.149 0.149 0.149 Drug Expenditure gro11th rate IDRUSEXPBRDI ................. o.ooo o.ooo 0.000 o.ooo 0.000 0.000 o.ooo o.ooo 0.000 o.ooo o.ooo 0.000 Ad•inistration Exptnditurt Qrowth rate IR~NEXPBRDI ...... , o.ooo 0.000 0.000 0.000 0.000 o.ooo 0.000 o.ooo 0.000 o.ooo o.ooo 0.000 Materials Exprndlturt gr011th rate I"RTEXPBRDl ............. 0.000 o.ooo o.ooo 0.000 o.ooo o.ooo o.ooo o.ooo o.ooo o.ooo 0.000 0.000 Othtr ExpenditurtS gro•th· rate IOTHEXPSROl ................ o.ooo o.ooo o.ooo o.ooo o.ooo 0.000 o.ooo o.ooo o.ooo o.ooo o.ooo o.ooo Doctors' Salary gro•th rate IDDCSALSROI ................... o.ooo 0.000 o.ooo 0.000 0.000 o.ooo 0.000 o.ooo 0.000 0.000 o.ooo o.ooo Technicians' Salary oro11th rah ITECHSRLSROI .............. o.ooo 0.000 0.000 0.000 0.000 0,000 o.ooo 0.000 o.ooo 0.000 0.000 0.000 other llorkers Salary oro•th rate IIIDRKSAl6ROl ............. o.ooo 0.000 o.ooo o.ooo o.ooo 0.000 0.000 0.000 o.ooo 0.000 0.000 o.ooo Fees for Preventive Care tFEEPREVBl ....................... 2.000 2.000 2.000 2.000 2.000 2.000 2.000 2.000 2.000 2.000 2.000 2.000 Fees for Outpatient Cate IFEEOUTPATI ...................... 5.000 5.000 5.000 5.000 5.000 5.000 5.000 5.000 5.000 5,000 5.000 5.000 Fees for Inpatient Care IFEEINPAT! ...................... 20.000 20.000 20.000 20.000 20.000 20.000 20.000 20.000 20.000 20.000 20.000 20.000 llursts Salary Price Index IPRICEINDEU .................... 1.000 1.000 1,000 1.000 1.000 1.000 1.000 1.000 1,000 1.000 1.000 1.000 Doctors per unit of service •• Type 1 IQDDCPERSERYil ...... 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 U1
Doctors per unit of mvict ·- Type 2 IQDOCPERSERV2l ...... 0.006 0.006 0.006 0,006 0,006 0.006 0.006 0,006 0.006 0.006 0.006 0,006 1-'
Doctors per unit of service •• Type 3 19DOCPERSERY3l ...... 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 Nurses per unit of service -· Type 1 IQIIRSPERSERVII ....... 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 Nurses ptr unit of service •• Type 2 IIIIIRSPERSERV2l ....... 0.024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 Nurses per unit of service •• Type 3 t9NRSPERSERY3l ....... 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 0.040 Technicians per unit of srrvice •• Type 1 tUTECPERSERYII .. o.ooo o.ooo 0.000 o.ooo 0.000 0.000 0.000 0.000 0.000 o.ooo o.ooo 0.000 Technicians per unit of service -- Type 2 IQTECPERSERV2l .. 0.001 0,001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 Technicians per unit of service ·- Type 3 IQTECPERSERY31 •• 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 Other llorkers per unit of service -- Type I IQIIRKPERSERYil. 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 Other Workers per unit of service •• Type 2 IIIIIRKPERSERY21. 0.036 0.036 0.036 0.036 0.036 0.036 0.036 0.036 0.036 0.03& 0.036 0.036 Other Workers per unit of service -- Type 3 IIIIIRKPERSERY3). 0.050 0.050 0.050 0.050 0.050 0.050 0.050 o.oso 0.050 0.050 0.050 0.050
8
tU OUTPUT SUMHARY m HEALTH FINANCE S!KULATION MODEL m OUTPUT SUHitARY *U BY TYPE OF SERVICE Distribution of Output to Population < ·-····-·--------------------- Type 1 Cart ----·----·------------------->
< ··--------- Budgets ---------> < ------ Patient Budget -----> < •••••••• Ratios ••••••• > Total < •• Required •• > Year Health Patient Pat/Hlt Type I Type 2 Type 3 Prevent Out-Pat ln·Pat Invest. Year Budget Unit Cost Prevent Dut·Pat In-Pat Doctors Nurses lnvnt 1 ........... -........ --......... - -----..... --... ............ -.... ---·-- ... ............. ................. ... ......... ~ ... - ........ - ..... .......... __ ------- ---- ·-------- ---------- ... _ .. ___
0 15,356,038 $4,561,038 85.161 28.'10% 26.201 44.901 I. 16X 1.164 0.501 0 $1 1318,026 $'12.26 10,000 2,000 0 30 300 1 $5,406,000 $4,82'1,671 89.34X 28.901 26.201 44.901 1.191 1.1'11 0.521 $173,186 I 11,395,654 $93.29 10,589 2,!18 0 32 151 $21,035 2 $5,826,240 $5,261,493 90.311 29.72% 26.201 44.081 t.m 1.251 o.su $250,186 2 $1,563,633 $92.40 11,733 2,347 0 35 168 $40,856 3 16,261,127 $5,713,551 '11.251 31.24X 26.201 42.561 1.401 !.321 0.551 $257,763 3 $1,784,690 $91.34 13,521 2, 704 0 41 193 $63,851 4 $6,819,323 $6,289,393 92.231 33. 77X 26.201 40.031 1.591 1.401 0,56t $280,474 4 $2,123,860 $90.16 16,276 3,255 0 49 233 m,m 5 $6,955,709 $6,444,914 92.661 34.38X 26.201 39.43% t.m 1.401 0.551 m,m 5 $2,215,462 $89.96 17.201 3,440 0 52 246 $33,008 6 $7,094,823 $6,589,736 92.881 34.911 26.201 38.891 1.621 1.381 o.m $65,240 6 $2,300,762 $89.91 17,903 3,581 0 54 256 $25,087 7 $7,236,720 $6,734,898 93.071 JS.m 26.201 38,37l 1.631 1.371 0.531 $58,297 7 $21386,262 $89.88 18,579 3,716 0 56 265 m, 152 8 $7,381,454 $6,882,352 93,24% 35.931 26,20X 37.87% 1.634 1.35% o.sn m,m 8 $2,473, lt3 $89.87 19,261 3,852 0 58 275 $24,333 9 $7,529,083 $7,032,646 93.411 36.42% 26.201 37.381 1.631 1.331 o.sox $58,982 9 $2,561,636 $89.80 19,953 3, 991 0 60 285 m, 729
10 $7,679,665 $7' 185,937 93.m 36.90% 26.201 36.901 1.631 1.32% o.m $64,649 10 $2,651,924 $89.59 20,671 4,134 0 b2 295 $25,647 II $7,833,258 $7,342,628 93.74X 37.37% 26.201 36.43% 1.641 1,3o;: 0.481 $77,974 11 $2,744,216 $89.91 21,440 4,288 0 64 306 m,m 12 $7,989,923 $7,503,348 93.91% 37.83% 26.201 35.97% 1.64% 1.29% 0.481 $82,131 12 $2,838,880 $89,88 22,236 4,447 0 67 318 $28,415
=•=======aa:;n::=======::u::::s:::===•======'Z••===••n:=•===•=•==-====:.===•===a•=•========•ru:;;:a1::;;=n:::::c: m INPUT SU"MARY U1 HEALTH FINANCIAL SIIIULATIDN MODEL 10
" Rate of 10 < ·--------------------·------ Type 2 Care -----------------------------> " Budgets Value Growth II <·- Required -·>
10 Year B~dget Unit Cost Prevent llut-Pat ln·Pat Doctors Nurses Invest 2 II
6overn1ent Budget uoo,ooo,ooo 2.001 " .................... -.... ,._ .... _ ............. -------10
Portion of Gov't. Budget for Min, of Health 0,05356038 " 0 $1,194,952 $143,39 2,000 5,000 100 50 200 .. "ini stry of Health Budget $5,356,038 " I $1,265,331 $143.02 2,118 5,294 106 53 212 $34,357 10
Ad1inhtration of health services budget · $700,000 o.oox " 2 $1,378,465 $141.72 2,313 5,783 116 58 231 $56,975 1./1 " Training budget $20,000 3.00% II 3 $1,496,900 $140.50 2,535 6,337 127 63 253 $64,693 N II
Other Budget I $50,000 t.oox " 4 $1,647' 766 $139.20 2,815 7,037 141 70 281 $81,603 II
Other B11dqet 2 m,ooo 1.001 II 5 $1 1688,511 $139.08 2,911 7,278 146 73 291 $28,170 " Other Budget 3 to 0.001 II 6 $1,726,453 $139,21 2,'179 7,448 149 74 298 m,B31 .. Share II 7 u, 764,484 $139.39 3,042 7,605 152 76 304 $18,291 II
Health Budget for Patient Cart $4,561,038 ........ II 8 $1,803,116 $139.57 3,105 7,762 155 . 78 310 UB1277 II
Patil!llt Care budget for Type I services $1,318,026 28.90% " 9 $1,842,492 $139.61 3,168 7,921 158 79 317 $18,564 " Patient Care budget for Type 2 5trvices $1,194,952 26.201 " 10 $1,882,652 $139.29 3,236 8,091 162 81 324 $19,848 .. Patient Care budget for Type 3 services $2,048,060 44.90% " II $1,923,704 $139.21 3,315 8,286 166 83 331 $22,803 .. Fee pay1ent by patients $0 " 12 $1,965,811 $139.39 3,396 8,491 170 85 340 $23,848 " llther financial contributions $0 o.oox .. ..
II II
" < -·-···-·--------------------- Type 3 Care ------·--····--····--·-·-----} II
Inputs per Unit of Service II < -- Required •• > II
< --------------------------> Salaries II Year Budget Unit Cost Prevent llut-Pat In-Pat Doctors Nurses Invest 3 Type I Type 2 Type 3 and Prices " ---- ---------- _____ .,. ____ ------- .. ------ ------ ·------ ------ .. ----..... -" __ .. _.,. __ ..... _
" 0 $2,048,060 $204.81 2,000 7,000 6,000 70 400 " Dodors o. 0021 0.0060 0.0070 $6,000 II I $2,168,685 $204.34 2,118 7,412 6,353 74 424 sm,m II
Nurses 0.0210 0.0240 0.0400 $! '701 " 2 $2,319,395 $202.72 2,270 7,946 6,810 79 454 $152,355 II
Technicians 0.0004 0.0012 0,0020 $3,000 .. 3 $2,431,961 $201.44 2,399 8,398 7,198 84 480 $129,219 II
Other Workers 0.0245 0.0360 0.0500. $1' 200 '' 4 $2,517,767 $200.34 2,500 8,749 7,499 87 500 $100,459 " Expenditures on "aterials 1.4000 1.8000 2. 7000 $1.00 " 5 $2,540,941 $200.44 2,537 8,878 7,610 89 507 S36, 741 " Expenditures on Drugs 23.5000 4.8000 7.0000 $1.00 " 6 $2,562,521 $200.89 2,557 8,949 7,671 89 511 $20,322 '' Other Expenditures 0.2100 o. 2400 0.5000 $1.00 II 7 $2,584,151 $201.39 2,573 9,005 7, 718 90 515 S15,854 II
Adlinistration Expenditures 8.5050 13.0800 18.8000 $1.00 II 8 $2,606,123 $201.90 2,588 9,058 7,764 91 518 $15,365 II
H 9 $2,628,518 $202.17 2,604 9,113 7,811 91 521 $15,688 Nulber Growth Rate " 10 $2,651,360 $201.82 2,623 9,180 7,869 92 525 $19,155 " -... --... ---.. -- II II $2,674,708 $200.89 2,651 9,277 7,952 93 530 m,m " Doctors in Private Sector 30 IO.OOX " 12 $2,698,657 $201.39 2,681 9,382 8,042 94 536 $29,868 "
Mursn in Private Sector 100 5.001 " "
Thble 8 (continued)
TABLE OF ANNUAL PARA"ETERS AND SRONTH RATES ------·-----------------------------------
< -------------------------------------------------- YEAR ------------------------------------------------> I 2 3 4 5 6 7 8 9 10 II 12
.............. ... ........... ----- .. ......... .............. ---Governtent Budget I ALPHA) ... , , • ,., •••• , , .• , ....... , .• , ••••• , 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 0.020 Portion of Gov't. Budget for Min. of Health I BETA) ........ 0.053 0.056 0.059 0.063 0.063 0.063 O.Ob3 0.063 0.063 0.063 0.063 0.063 Administration Cost of health services IADMINGRm ......... 0.000 0.000 0.000 o.ooo 0.000 o.ooo 0.000 0.000 0.000 0.000 0.000 0.000 Other Financial Contribution IOTHFINGROl .................. 0.000 0.000 0.000 0.000 0.000 o.ooo o.ooo 0.000 0.000 o.ooo o.ooo 0.000 Other Budget I IOTHISROl ........... , .......... , .. , , .. , , ... 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 Other Budget 2 IOTH26ROl ... , , • , .... , , • , ................ , , • 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 Other Budget 3 IOTH36ROl .... , , , .. , .. , , .. , , , .. , , ........... 0.000 0.000 o.ooo 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 Share of Type I services in Budget Increase I SHARE!) ...... 0.289 0.389 0.489 0.589 0.589 0.589 0.589 0.589 0.589 0.589 0.589 0.589 Share of Type 2 services in Budget lncreue ISHARE2l ...... 0.262 0.262 0.262 0.262 0.262 0.262 0.262 0,262 0.262 0.262 0,262 0.262 Share of Type 3 servicn in Budget Increase ISHARE3) ...... o.m 0,349 o.m 0,149 0.149 o.m 0.149 o.m 0.149 0.149 0.149 o.m Drug Expenditure growth rate IDRUBEXP6RO) ................ , 0.000 0.000 0.000 o.ooo 0.000 0.000 o.ooo 0.000 0.000 o.ooo 0.000 o.ooo Ad1i ni strati on Expenditure growth rate IADKNEXPSROl ...... , 0.000 0.000 0.000 0.000 0.000 o.ooo 0.000 0.000 0.000 o.ooo 0.000 0.000 "ateriah Expenditure growth rate I"ATEXPBROl ............ , 0.000 0.000 o.ooo 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 Other Expenditures growth rate IOTHEXPBRDl ................ 0.000 o.ooo 0.000 o.ooo o.ooo 0.000 0.000 0.000 0.000 o.ooo 0.000 0.000 Doctors' Salary growth rate IDOCSALBRDl ................... 0.000 0.000 0.000 0.000 o.ooo o.ooo o.ooo 0.000 o.ooo 0.000 0.000 0.000 Technicians' Salary growth rate ITECHSAL&ROl .. """""'.' 0.000 0.000 0.000 0.000 0.000 o.ooo 0.000 0.000 0.000 0.000 0.000 0.000 Other Workers Salary growth rate IWORKSALBRDl ............ , 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 o.ooo o.ooo 0.000 Fees for Preventive Care IFEEPREYBl ...................... , 2.000 2.000 2.000 2.000 2.000 2.000 2.000 2.000 2.000 2.000 2.000 2.0_00 Fees for Outpatient Cate IFEEDUTPATl ...................... 5.000 5.000 5.000 5.000 5,000 5.000 5.000 5.000 5.000 5.000 5.000 5,000 Fees for Inpatient Care IFEEINPATl ...................... 20.000 20.000 20.000 20,000 20.000 20.000 20.000 20.000 20.000 20.000 20.000 20.000 Nurns Salary Price lndn IPRICEINDEXI .................... 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 Doctors per unit of service -- Type I IQDOCPERSERY!l ...... 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 V1 Doctors per unit of service -- Type 2 IQDDCPERSERY2l ...... 0.006 0,006 0.006 0.006 0.006 0.006 0.006 0,006 0.006 0.006 0.006 0.006 w
Doctors per unit of service -- Type 3 IQDDCPERSERY3l ...... 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0.007 0,007 0.007 0.007 Nurses per unit of service -- Type I IQNRSPERSERY!l ...... , 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 0.010 Nurses per unit of service -- Type 2 IQNRSPERSERY2l ...... , 0.024 0.024 0,024 o. 024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 0.024 Nurses per unit of service -- Type 3 IQNRSPERSERY3l ....... 0.040 0.040 0.040 0.040 0.040 0'.040 0.040 0.040 0.040 0,040 0.040 0.040 Technicians per unit of service -- Type I IQTECPERSERY!l , , 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 o.ooo 0.000 Technicians per unit of service --Type 2 IQTECPERSERY2l .. 0.001 0.001 0.001 0,001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 Technicians per unit of service -- Type 3 IQTECPERSERY3) .. 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 0.002 Other Workers per unit of service-- Type 1 IQWRKPERSERYil. 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025 . 0.025 0.025 Other Workers per unit of service -- Type 2 IQNRKPERSERY2l. 0.03b 0.036 0.036 0.036 0.036 0.036 0.036 0.036 0,036 0.036 0.036 0.036 Other Workers per unit of service -- Type 3 IQWRKPERSERY3l. 0.050 0.050 0.050 0.050 0.050 0.050 0.050 0.050 0.050 0.050 0.050 0.050
A1
Input area
U48
A247
Macros
G378
Appendix A HEALTHFISIMO'S Spreadsheet
W1
Yearly outputs
AC239
AL1 AR1
I 4Population BF4
ATS
Nurses' training model
AP116
AK141
Nurses' ~ training
summary
A0218
jAL222l Nurses' ~training
AP23& inputs
Nurses' salary model
54
BY147
CA1
Annual rates of growth
CM39
C01
Output summary
DL58
AppendixB Data Required to Operate the Model, with the
Location of Values in the Spreadsheet
Item
Budgets
Government's operational budget Recurrent budget of ministry of healtha
Central administration budget Training budget Budget for primary care Budget for secondary care Budget for tertiary care Other budget 1b Other budget 2 Other budget 3 Income from fees Other income
Activities
Primary care Al (preventive services)
Numberc Percentage of budget
A2 (outpatient services) Number Percentage of budget
A3 (inpatient services) Number
Label Cell
GOVBUD B5 MHLTHBUD BB ADMIN B9 TRAINING BlO TYPEl Bl7 TYPE2 Bl8 TYPE3 Bl9 OTHER! Bll OTHER2 B12 OTHER3 B13 FEES Bl4 OTHFINCON B15
PREVENT! D5 E5
OUTPATl D6 E6
INPATl D7
a. Recurrent budget of ministry of health is the total of all other budgets that appear after it in this list.
b. The categories other budget 1, other budget 2, and other budget 3 include activities defined by the user.
c. See "Outputs," under "Description of HEALTHFISIMO," for an explanation of the numbers that might be used.
55
Item
Activities (continued)
Secondary care Al (preventive services)
Number Percentage of budget
A2 (outpatient services) Number Percentage of budget
A3 (inpatient services) Number
Tertiary care Al (preventive services)
Number Percentage of budget
AZ (outpatient services) Number Percentage of budget
A3 (inpatient services) Number
56
Resources
Public sector (primary care) Number of doctors Number of nurses Number of technicians Number of other workers Expenditures on materials Expenditures on
drugs and other medicines Expenditures on other Cost of administration
Public sector (secondary care) Number of doctors Number of nurses Number of technicians Number of other workers Expenditures on materials Expenditures on
drugs and other medicines Expenditures on other Cost of administration
Label Cell
PREVENT2 D9 E9
OUTPAT2 DlO ElO
INPAT2 Dll
PREVENT3 D13 E13
OUTPAT3 D14 E14
INPAT3 D15
QDOC HS QNURSE H6 QTECH H7 QWORK H8 W.TEXP H9
DRUGEXP HlO OTHEREXP Hll ADMINEXP H12
QDOC IS QNURSE 16 QTECH 17 QWORK 18 MATEXP 19
DRUGEXP IlO OTHEREXP Ill ADMINEXP 112
Item
Resources (continued)
Public sector (tertiary care) Number of doctors Number of nurses Number of technicians Number of other workers Expenditures on materials Expenditures on
drugs and other medicines Expenditures on other Cost of administration
Private sector Number of doctors Number of nurses Yearly number of nurses
trained in private sector
57
Prices
Average salary of doctors Average salary of nurses Average salary of technicians Average salary of other workers Unit price of materials Unit price of drugs Unit price of other expenditures Unit price of administration
Nurses' salary
Type A nurses Number of nurses. at each salary step Yearly wages at each salary step Percent entering nurses
Type B nu:r:ses Number of nurses at each salary step Yearly wages at each salary step Percent entering nurses
Type C nurses Number of nurses at each salary step Yearly wages at each salary step Percent entering nurses
Label Cell
QDOC J5 QNURSE J6 QTECH J7 QWORK JB MATEXP J9
DRUGEXP JlO OTHEREXP Jll ADMINEXP Jl2
DOCPRIV Kl4 NURSPRIV Kl6
TR NURS PRIV Kl8
DOC SAL PS NURSE SAL P6 TECH SAL P7 WORKSAL PB MATPRICE P9 DRUG PRICE PlQ OTHERPRICE Pll ADMINPRICE Pl2
TYPE A NURSE AU12-BX12 WAGE TYPE A AU13-BX13 PCTA D31
TYPE B NURSE AU14-BX14 WAGE TYPE B AU15-BX15 PCTB D32
TYPE C NURSE AU16-BX16 WAGE TYPE C AU17-BX17 PCTC D33
58
Item Label Cell
Nurses' salary (continued)
All nurses Attrition rate at each salary step ATTRITION AU18-BX18
Nurses' training
TyEe A nurses Entrants to nurses' training in time 0-3 D42 Entrants to nurses' training in time 0-2 D43 Entrants to nurses' training in time 0-1 D44 Entrants to nurses' training in time 0 D45 Students at time 0 D41 Proportion of entrants who graduate (a) D39 Length of training (h) D37 Proportion of graduates who enter nursing (k) D38
Rate of dropouts (d) D40 Unit costs D46
TyEe B nurses Entrants to nurses' training in time 0-3, E42 Entrants to nurses' training in time 0-2 E43 Entrants to nurses' training in time 0-1 E44 Entrants to nurses' training in time 0 E45 Students at time 0 E41 Proportion of entrants who graduate (a) E39 Length of training (h) E37 Proportion of graduates who enter nursing (k) E38
Rate of dropouts (d) E40 Unit costs E46
TyEe C nurses Entrants to nurses' training in time 0-3 F42 Entrants to nurses' training in time 0-2 F43 Entrants to nurses' training in time 0-1 F44 Entrants to nurses' training in time 0 F45 Students at time 0 F41 Proportion of entrants who graduate (a) F39 Length of training ( h:) F37 Proportion of graduates who enter nursing (k) F38
Rate of dropouts (d) F40 Unit costs F46
59
Item
Nurses' training (continued)
All nurses Initial nurses' training budget Rate of growth of nurses' training budget
Other data required
Rate of growth of government's budget Rate of growth of central admin. Rate of growth of other budget 1 Rate of growth of other budget 2 Rate of growth of other budget 3 Rate of growth of other financing Investment per unit in 1 Investment per unit in 2 Investment per unit in 3 Rate of growth of prices of drugs Nurses' salary price index Rate of growth of adm. price index Rate of growth of materials price
index Rate of growth of other expenditure
index Rate of growth of doctors (private) Rate of growth of nurses (private) Rate of growth of training nurses Rate of attrition for doctors Rate of attrition for nurses (private) Rate of growth of salary (doctors) Rate of growth of salary (technicians) Rate of growth of salary (workers) Fee per unit preventive care Fee per unit outpatient care Fee per unit inpatient care
Label Cell
D47 D48
ALPHA B6 R-GR.C.ADM B23 R-GR.OTHERl B24 R-GR.OTHERZ B25 R-GR.OTHER3 B26 R-GR.OTHFIN B27 INV/UNITl DZO INV/UNITZ D21 INV/UNIT3 D22 DRUGEXPGRO HlS PRICEINDEX Hl6 ADMNEXPGRO Hl7
MATEXPGRO Hl8
OTHEXPGRO Hl9 DOCPRIVG KlS NURSPRIVG Kl7 TRNURSPRIVG Kl9 ATT.DOC 116 ATT.NURSPR 118 DOCSALGRO Pl4 TECHSALGRO Pl5 WORKSALGRO Pl6 FEEPREV 86 FEEOUTPAT S7 FEEINPAT 88
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Aftlca Boolc Servia. (B.A.) 1.1<1. !'.O.Box41095 The Middle llaot Clboe<ver p .O.llox 45245 Crolglull BO.awarii.Stroet Nalrob! )~2024 Cairo
Kollli.A, JWI'IlBUC OF Pen ICDrea lloak Corporation P.O. Box 101, Kwangwlwnl.lh Seoul
The World Bank
Limited budgets and increasing demand for health services are compelling policymakers and administrators in developing countries to reorder their priorities and rationalize their operations. The Health Finance Simulation Model (HEALTIIFI
siMo) can quickly simulate the budgetary effect of various operational and financial policies and the cost-effectiveness of different measures. In this way, a wide range of policy options. and combinations thereof, can be tested and compared in a short time.
The que~tions · this computer model can answer include: • H~fcan;£riontie$ i? :ihe budget be f~O~dered to increase the access of a
population to a parucular type of health care? • What operational changes in the health care delivery system are necessary to
lower unit costs and thereby provide more services within the same budget? • What effect do present salary scales and prices of drugs have on the provi
sion of health care? HEALTHFISIMO provides automatic printouts of simulation results, summ<!-ry ta
bles, and graphs. Yearly parameters can be introduced. which allows for the simulation of all kinds of nonlinearities. A submodel for nurses' training calculates student flows in training institutions and the costs of training the new nurses required by the health care system.
The user's manual provides step-by-step, illustrated instructions on how to operate the model and how to use it to solve specific problems. The model's system design, ii?.nut requirements. and output are also described. A program diskette. ready for use with an IBM or IBM-compatible personal computer and the Lotus l-2-3 pro:gram. is included with the manual.
Manuel Zy~elman is a senior adviser in the 'Yorld Bank's Africa Technical Departm~nt.
' • I
ISBN 0-8213-1232-4
