QATAR NATIONAL HEALTH ACCOUNTS REPORT 2013
QATAR NATIONAL HEALTH ACCOUNTS REPORT 2013
© 2015 General Secretariat, Supreme Council of Health Supreme Council of Health, Qatar P.O. Box 42 Doha, Qatar www.sch.gov.qa Printed in Qatar, 2015.
TABLE OF CONTENTS FOREWORD // 2 ACKNOWLEDGEMENTS // 3 ABBREVIATIONS // 5 EXECUTIVE SUMMARY // 6 CHAPTER 1 INTRODUCTION // 8 1.1 BACKGROUND // 9 1.2 REPORT STRUCTURE // 10 CHAPTER 2 HEALTHCARE SYSTEM IN QATAR: OVERVIEW AND DEVELOPMENTS // 12 2.1 DEMOGRAPHIC AND ECONOMIC DEVELOPMENT // 13
CHAPTER 5 DISCUSSION AND POLICY IMPLICATIONS // 50 SUMMARY OF HEALTHCARE FINANCING INDICATORS // 52 NATIONAL HEALTH INSURANCE SCHEME - SEHA // 54 SEHA - FUNDING MECHANISMS // 55 PERFORMANCE-BASED BUDGETING // 55
2.2 HEALTHCARE SYSTEM IN QATAR: ORGANIZATION AND GOVERNANCE //15
CAPITAL FORMATION // 56
2.3 FINANCING HEALTHCARE: 2013 AND BEYOND // 17
CONCLUDING REMARKS // 56
CHAPTER 3 METHODOLOGY // 20 3.1 OVERVIEW: METHODOLOGICAL COMPARISON
WITH PREVIOUS REPORTS // 21
3.2 DATA SOURCES AND ASSUMPTIONS // 22
3.2.1 GENERAL NOTES // 24
3.2.2 NOTES ON DATA SOURCES // 24
3.3 LIMITATIONS AND WAY FORWARD // 25 CHAPTER 4 QATAR SYSTEM OF HEALTH ACCOUNTS 2013: FINDINGS // 26 4.1 FINANCING DIMENSIONS // 27
OBSERVED TREND // 33
CROSS COUNTRY COMPARISON // 34
4.2 USES OF FUNDS // 35
HEALTHCARE FUNCTIONS // 35
HEALTHCARE PROVIDERS // 35
OBSERVED TREND // 42
CROSS COUNTRY COMPARISON // 45
4.3 FACTORS OF HEALTH CARE PROVISION // 46
MAIN FINDINGS // 46
4.4 GROSS CAPITAL FORMATION // 48
MAIN FINDINGS // 48
OBSERVED TREND // 49
TREATMENT ABROAD // 56
REFERENCES // 58 NOTES // 60 ANNEXES // 62 KEY SHA 2011 CONCEPTS // 62 SHA CORE TABLES SHA MATRIX 1: FS X HF (IN QAR MILLION) // 68 SHA MATRIX 2: FS X FA (IN QAR MILLION) // 70 SHA MATRIX 3: FA X HF (IN QAR MILLION) // 72 SHA MATRIX 4: HF X HP (IN QAR MILLION) // 74 SHA MATRIX 5: HF X HC (IN QAR MILLION) // 76 SHA MATRIX 6: HP X HC (IN QARMILLION) // 78 SHA MATRIX 7: HP X FP (IN QAR MILLION) // 81 SHA MATRIX 8: CAPITAL ACCOUNT (IN QAR MILLION) // 82
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Qatar National Health Accounts Report 2013
FOREWORD The release of the Qatar National Health Accounts 2013 provides healthcare policy makers, healthcare providers, health insurance companies and the population of Qatar with the most comprehensive information on healthcare financing. The National Health Accounts provide comprehensive review and analysis of all financial dimensions in the healthcare system in Qatar. These financial dimensions are analyzed from static, supported by international comparisons, and dynamic perspectives. The current report is built on a substantially enhanced methodology and data collection mechanisms, including comprehensive coverage of capital formation in the healthcare sector and more accurate estimations of the outof-pocket expenditure. The results show that total health funding have increased to 18.3 billion QAR in 2013, or 20.6 per cent compared to 2012. As in the previous years, the lion share of healthcare expenditure was financed by the Government of Qatar reflecting its efforts to provide comprehensive healthcare services to all residents. The year 2013 was an important year in the implementation of the National Health Strategy 2011-16 marked by the launch of the National Health Insurance Scheme – Seha. This is the first year when activity-based funding was introduced and successfully trialed. These and other strategic developments related to the introduction of the mandatory health insurance change the philosophy of healthcare financing in Qatar and are reflected in this Report. The Qatar National Health Accounts Report 2013 is the realization of close collaboration between the Supreme Council of Health (SCH) and its partners. This report would not have been possible without the contribution of many organizations. I gratefully acknowledge the data and qualitative information provided by the participants of the household health surveys, all healthcare providers, governmental organizations, health insurance companies. I look forward to continuing support from all stakeholder organizations in the production of future reports.
His Excellency Abdulla bin Khalid Al Qahtani Minister of Public Health Supreme Council of Health
Foreword and Acknowledgements
ACKNOWLEDGEMENTS Production of the Qatar National Health Accounts Report – 2013 was realized in close collaboration with and support of many individuals and organizations. The overall project of establishment and institutionalization of the Qatar National Health Accounts was made possible due to the support of His Excellency Abdulla bin Khalid Al Qahtani, the Minister of Public Health. His Excellency Al Qahtani secured political support at the highest level and issued a Ministerial Decree to form the Steering Committee. Dr. Faleh Mohamed Hussain Ali, Assistant Secretary General for Policy Affairs provided leadership, guidance and support in production of this report. Dr. Renata Hasanova managed the technical team, supervised the analysis, and led the development of this report. Mrs. Eman Habib Sailani, Dr. Marija Gulija and Mrs. Fadela Al-Mansouri provided technical support. Mrs. Lolwa Al-Kuwari provided administrative support. Mr. Husein Reka and Mrs. Orsida Gjebrea provided inputs and revisions. Mr. Robert Moorhead and Ms. Anupama Natarajan provided resource support on behalf of the Project Management Office, National Health Strategy. Other departments of the SCH - Policy Coordination and Innovation Unit (PCIU), Health Planning and Assessment Department (HPA) and Finance Department (FD) provided continuous collaboration and support throughout the production of this report. We thank all organizations for their support with the data and discussions crucial for the production of this report.
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ACKNOWLEDGEMENTS HEALTHCARE PROVIDERS AND FINANCING AGENTS
INSURANCE COMPANIES • Al Khaleej Takaful Group
• Al-Ahli Hospital • Al Koot Insurance & Reinsurance Company • Al Ahmadani Medical Center • Allianz Worldwide Care Products • Al Emadi Hospital • American Life Insurance Company (MetLife Alico) • Al Hayat Medical Center • Arabia Insurance Company • American Hospital • AXA Insurance Company • Amiri Guard • Daman Health Insurance • Aspetar - Orthopaedic and Sports Medicine Hospital • Doha Bank Assurance Company • Doha Clinic Hospital • Doha Insurance Company • Hamad Medical Corporation • Libano-Suisse Insurance Company • Ministry of Finance • National Health Insurance Company • Ministry of Interior • Qatar General Insurance and Reinsurance • Primary Health Care Corporation • Qatar Islamic Insurance Company • Qatar Armed Forces • Qatar Life & Medical Insurance Company • Qatar Petroleum • Qatar Takaful Insurance • Qatar Red Crescent Society • SEIB Insurance and Reinsurance Company • Supreme Council of Health • Zakat Fund
NON-HEALTHCARE ORGANIZATIONS: STATISTICAL AND SURVEYING INSTITUTIONS, CAPITAL WORKS DEVELOPERS • Ministry of Development Planning and Statistics • Public Works Authority - Ashghal • Social and Economic Survey Research Institute (SESRI) - Qatar University
Abbreviations
ABBREVIATIONS AG Amiri Guard CCHI Compulsory contributory health insurance (schemes) CHE Current health expenditure FA Financing Agents FP Factors for health care provision FS Revenues of health financing schemes GCC Gulf Cooperation Council GCF Gross capital formation GDP Gross Domestic Product GFCF Gross fixed capital formation GGEH General Government expenditure on health HA Health accounts HC Health care functions HF Financing schemes HH Household HMC Hamad Medical Corporation HP Health care providers HUES Health utilization and expenditure survey ICHA International classification for health accounts MC Medical Commission MDPS Ministry of Development, Planning and Statistics MoF Ministry of Finance MoI Ministry of Interior MoP Mode-of-provision (of consumed health care services) n.e.c Not elsewhere classified NHIC National Health Insurance Company NHIS-Seha National Health Insurance Scheme - Seha NPISH Non-for profit institution serving household OECD Organization for Economic Cooperation and Development OHS Online health survey OOP Out-of-pocket (health expenditure) OTC Over-the-counter Drugs PHC Primary health care PHCC Primary Health Care Corporation PHI Private health insurance PPP Purchasing Power Parity PVHI Private voluntary health insurance QAF Qatar Armed Forces QCON Qatar Certificate of Need QHFMP Qatar Healthcare Facilities Master Plan QNHA Qatar National Health Accounts Report QHR Qatar Health Report QRCS Qatar Red Crescent Society SCH Supreme Council of Health SCH AR SCH Annual Report SESRI Social and Economic Survey Research Institute SHA System of Health Accounts TA Treatment abroad TCAM Traditional, complementary and alternative medicine THE Total health expenditure VHI Voluntary health insurance WHO World Health Organization
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EXECUTIVE SUMMARY The healthcare system in Qatar is going through rapid, deep and comprehensive structural reforms. At the same time, the population in Qatar is growing at world’s fastest growth rates. The first stage of the National Health Insurance Scheme – Seha was introduced in 2013, thereby cementing the first milestone of fundamental changes in the healthcare financing. It is important for policy-makers, healthcare providers and patients to understand the financial flows – investment and expenditure – in the healthcare sector and the impact of changing healthcare financing landscape. The Qatar National Health Accounts – built on the internationally adopted and standardized classification – provide this platform. The main findings of QNHA-2013 are:
CURRENT HEALTH EXPENDITURE AND EXPENDITURE ON GROSS CAPITAL FORMATION IN HEALTHCARE Qatar spent 18.26 billion QAR in total on healthcare in 2013, up by 20.6% from 2012 (15.14 billion QAR). The per capita expenditure has increased from 8,261 QAR (2,270 US$) to 9,114 QAR (2,504 US$) in 2013 (an increase by 10.3%). 3.15 billion QAR (17.3%) was spent on gross capital formation (GCF). The remaining 15.11 billion QAR (or 82.7%) financed current healthcare expenditure (CHE) in 2013.
REVENUES AND MANAGEMENT OF HEALTHCARE FINANCING SCHEMES – CURRENT HEALTH EXPENDITURE (CHE) • Government financed 12.64 billion QAR (83.7%) of CHE through various schemes, including internal transfers (12.52 billion QAR, or 99%). The contribution towards running the National Health Insurance Scheme accounted for 0.08 billion QAR (0.5% of CHE) • Voluntary prepayment (made by employers or individuals) through the private health insurance companies at 1.03 billion QAR or 6.8% of all revenues • Other domestic revenues included households at 1.04 billion QAR (6.9% of all funds) (including charitable contributions) • 0.31 billion QAR of revenues came from corporations (2.1%) Overall, general government expenditure on health, including funding through the parastatal organizations, amounted to 16.04 billion QAR with 3.12 billion invested in the healthcare infrastructure (capital formation) and 12.92 billion QAR to provision of healthcare services.
Executive Summary
The current healthcare expenditure from the government financing schemes were managed by the following entities:
FINANCING OF HEALTHCARE PROVIDERS The 15.11 billion QAR CHE was distributed to the following healthcare providers:
• Supreme Council of Health was responsible for 2.70 billion QAR (17.9%)
• Hospitals: 9.05 billion QAR (59.9%)
• Hamad Medical Corporation absorbed 8.12 billion QAR (53.7%)
• Providers of ambulatory care: 2.07 billion QAR (13.7%)
• Primary Health Care Corporation accounted for another 1.12 billion QAR (7.4%)
• Providers of ancillary services: 0.50 billion QAR (3.3%)
• Other line ministries (Ministry of Interior, Qatar Armed Forces and Amiri Guard) accounted for 0.24 billion QAR (1.6%)
• Retailers and other providers of medical goods: 0.37 billion QAR (2.4%)
• National Health Insurance Company 0.08 billion QAR (0.05%) • Aspire Zone Foundation and Qatar Petroleum managed 0.66 billion QAR (or 4.4%)
SERVICES FINANCED
(HEALTHCARE
FUNCTIONS)
The 15.11 billion QAR CHE was allocated to the following services: • Curative inpatient care: 6.77 billion QAR (44.8%) • Curative outpatient care: 3.76 billion QAR (24.9%) • Ancillary services: 1.47 billion QAR (9.7%) • Long-term care, day curative care and rehabilitative care: 0.57 billion QAR (2.3%) • Preventive care: 0.14 billion QAR (0.9%) • Medical goods: 1.56 billion QAR (10.3%) • Governance and administration: 0.85 billion QAR (5.6%)
• Providers of health care system administration and financing: 0.85 billion QAR (5.6%) • Rest of the world (Treatment Abroad): 2.22 billion QAR (14.7%)
GROSS CAPITAL FORMATION (GCF) Investments in capital infrastructure remained stable at 3.15 billion in 2013 (3.25 billion QAR in 2012). 2.76 billion QAR (87.7%) of GCF was related to investment in physical healthcare infrastructure; 0.28 billion QAR (8.7%) was invested in equipment and 0.11 billion QAR (3.6%) in intellectual property.
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INTRODUCTION
1. Introduction
1.1 BACKGROUND The Supreme Council of Health (SCH) Qatar has commenced the analysis of healthcare expenditure in the Qatar healthcare system through the System of Health Accounts (SHA) framework in 2009. The first report – Qatar National Health Accounts (QNHA) 2009-2010 – covered both calendar years and was based on the SHA 1.0 classification. Beginning from 2011, the production of QNHAs was based on the latest classification of SHA 2011 Edition developed by the Organization for Economic Cooperation and Development (OECD), World Health Organization (WHO) and the Eurostat [1]. The QNHA 2013 Report is a further refinement of already well established methodology. Similar to the previous 1 years, the expenditure data were collected from • healthcare providers, both private and public, including Hamad Medical Corporation (HMC), Primary Health Care Corporation (PHCC), Aspetar Sports Orthopaedic and Medicine Hospital (Aspetar); and private hospitals (Al Emadi, Al Ahli, Doha Clinic Hospital, and American Hospital); • Ministry of Finance as the financing agent and the Supreme Council of Health as a financing, regulatory and healthcare provider agent; • Other governmental agencies involved in the healthcare provision (Ministry of Interior, Qatar Armed Forces and Amiri Guard); parastatal organizations, such as Qatar Petroleum (QP); • Private Health Insurance companies (PHI) currently registered and providing healthcare insurance to the residents in the State of Qatar; • Population through the annual Health Utilization and Expenditure (HUES) Survey; • The National Health Insurance Company (NHIC); and • Public Works Authority Ashghal as a developer and implementing building agent of the healthcare sector capital works;
There was a fundamental change in the landscape of the financing healthcare services: the year 2013 witnessed the first year of the National Health Insurance Scheme (NHIS – Seha) implementation. Following immediately the Law No.7 of 2013, the first pilot stage of NHIS-Seha was launched in July 2013. The National Health Insurance Company (NHIC) – responsible for administering and managing the Scheme – was also founded in 2013. The thought process around Seha design and underlying principles, and subsequent implementation significantly altered the philosophy and landscape of healthcare financing, moving away from the traditional line-item budgeting framework to the outputand outcome- based financing mechanisms. The activity-based funding lies in the core of the financing mechanisms. The Fee Schedules were developed using the first in the country and in the GCC region local bottom-up costing and benchmarked against the international pricing. Over the period 2014 to 2016, the activity-based funding mechanisms will be supported with quality-enhancing incentives and performance based budgeting. The move to the activity-based funding also has a substantial positive impact on the quality of healthcare activity and financing data. The transition to the National Health Insurance and associated impact on the healthcare financing are further discussed in the relevant sections of the report. Similar to the previous years, the Qatar National Health Accounts report summarizes the financial flows in the healthcare sector of Qatar in 2013, including • sources of financing, • the use of funds, • the agents involved in the collection, pooling and further purchasing of healthcare services This information and accompanying analysis helps to understand the performance, efficiency and issues impacting the Qatar healthcare system.
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1.2 REPORT STRUCTURE HEALTHCARE SYSTEM IN QATAR: OVERVIEW AND DEVELOPMENTS This section provides a general background to the healthcare system in Qatar, discusses the challenges and outlines recent structural changes affecting financing architecture.
METHODOLOGY This section provides a description of improvements made in the application of SHA 2011 to construction of Qatar National Health Accounts; challenges faced by the QNHA team in data collection and processing; solutions and underlying assumptions to address those challenges and limitations that remain to be addressed in the future.
QATAR SYSTEM OF HEALTH ACCOUNTS: FINDINGS This section outlines the main findings of QNHA 2013. Each dimension interface (financing, provision and consumption) is described from different perspectives and compared to the previous years. The findings are cross-referenced with key reform implementation issues.
DISCUSSION AND POLICY IMPLICATIONS This section assesses Qatar's performance against key SHA indicators with comparative analysis against selected countries and regions; and highlights some key reform implementation issues and their implications on SHA in Qatar in the future.
ANNEXES Annexes contain definitions of the System of Health Accounts, core SHA matrixes and other charts and tables with health and economic indicators referred to throughout the report.
Box 1. DEFINING HEALTH EXPENDITURE Health expenditure includes all expenditure for activities which primary purpose is to restore, improve and maintain health of the individuals during a defined period of time. This definition applies regardless of the type of the institution or entity providing or paying for the health activity and thereby covers all public and private healthcare providers. The total health expenditure are derived as a sum of current and capital expenditure on health. Unless stated otherwise, the expenditure are reported at current prices, with no adjustment for inflation; and are interpreted as 'nominal expenditure'. This implies that changes reflect the combined effect of price and volume changes.
1. Introduction
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HEALTHCARE SYSTEM IN QATAR: OVERVIEW AND DEVELOPMENTS
2. Healthcare System in Qatar: Overview and Developments
2.1 DEMOGRAPHIC AND ECONOMIC DEVELOPMENT During 2012-2013, Qatar has maintained its position among the cluster of countries with very high levels of human development and its rank in human development has moved from 36th to 31st [2] position. The World Bank classifies Qatar among the “High income non-OECD” countries with 86,790 US$ Gross National Income (GNI) per capita [3]. Qatar experiences one of the fastest population growth in the world: the growth rate over 2000 – 2010 period averaged at 10.8 per cent per annum [4] and population size more than tripled since 2000 (from 613.9 thousand in 2000 to 2,003.7 thousand in 2013 [5]). The population growth, together with the underlying demographical structure, pose substantial challenges to the design and provision of healthcare, fast and easy access to it and efficient mechanisms of healthcare financing. The extraordinary population growth present one aspect of challenges to the healthcare system: the facilities and workforce must be carefully planned to meet current and future demand for healthcare. The demographic structure of the population adds another dimension to the challenge: although on average the population in Qatar is relatively young, compared to other countries; the life-style factors are leading to worsening chronic conditions, including high obesity rates, high prevalence of diabetes and cardiovascular diseases [4]. In addition, the expatriate labour force (nearly three quarters of total population) is dominated by young male population with a substantial proportion employed in high-risk occupational industries. Finally, high turnover rates of the migrant population generate profound effect on future healthcare demand projections. Given the uniqueness of the population structure, QNHA 2009-2010 developed the notion and model of the adjusted population in order to compare meaningfully the key performance indicators between Qatar and the rest of the world, including OECD countries. A statistical model, based on an imputation procedure, was used to produce an adjusted male population aged 25 to 60 years. The extension of this model was followed in the subsequent reports, resulting in 1,120 thousand for 2013.
Box 2. Selected Demographic Indicators – Qatar, 2013 The demographic structure of Qatar differs significantly from the rest of the world, including OECD or high income countries. The population is dominated by young males, resulting in high ratio of males to females, and large working age component. This is due to the large expatriate employees and has implications for health expenditure analysis. The proportion of population in working age (15-64 years old) is 84.1% of the population; As a result, age dependency ratio of 18.9 [6] is considerably lower in comparison to the rest of the world: OECD average age-dependency ratio is at 51.6 and for high income non-OECD countries is 40.5 [7]) continued on page 14
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Box 2. continued from page 13 Non - Qatari Nationals
Qatari Nationals 75 - 79 65 - 69 55 - 59 45 - 49
35 - 39
25 - 29
15 - 19 5-9
0 20%
15%
10%
5%
0%
0%
Percent of total Non-Qatari population Female
Male
Female
120
100
80
60
40
20 Qatar 0 Figure B1.2 Age Dependency Ratio1, Number of dependent (younger than 15 and older than 65) to working age population
10%
15%
Percent of total Qatari population
Figure B1.1 Population Pyramid 2013, Qatari and Non-Qatari Population
1
5%
Source: World Bank, 2013 World Development Indicators
Male
Source: MDPS
20%
2. Healthcare System in Qatar: Overview and Developments
2.2 HEALTHCARE SYSTEM IN QATAR: ORGANIZATION AND GOVERNANCE Healthcare is an important part to the present and future of Qatar. It is one of the cornerstones of Human, Social and Economic Development and reflected in the Qatar National Development Vision (QNV) 2030. In order to achieve the Goals of the Vision, the Supreme Council of Health (SCH) – the Qatar’s highest health authority – has developed the National Health Strategy 2011-16 (NHS) articulating the Health Sector contribution to the QNV. As of 2013, the NHS strategy contained 38 active projects with over 190 outputs [4]. The establishment of a mandatory health insurance scheme in the State of Qatar was one of the key synergistic elements of the NHS 2011-2016 programme and the cogwheel that put into motion many other initiatives [8]. The move towards insurance-based principles for the whole healthcare sector in Qatar significantly altered the financing healthcare landscape. The Supreme Council of Health guides the process of national reform in health sector and ensures the progress towards internationally-renowned care. As a steward of health, SCH develops strategies, policies and programs to improve population health. It also monitors and evaluates progress towards achieving national goals. SCH vests in the responsibility for health care provision to public, semi-public and private providers, regulates all service providers, and is responsible for planning of health care services and health insurance. The schematic representation of the healthcare sector governance is given in Figure 2.1. Qatar has a long-standing tradition of public health care provision, with two main public providers: Hamad Medical Corporation (HMC) and Primary Health Care Corporation (PHCC). The history of healthcare sector development has been well documented in the previous QNHA reports (see for example [9] [10]). The up-to-date structural changes and challenges are well discussed in SCH Annual Reports [11] [4] and Qatar Health Reports [12] [13] [14].
SCH Funding and Oversight
PHCC
Figure 2.1 SCH Governance
HMC
Funding
QCHP
Oversight
OTHER PROVIDERS
Source: [4]
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The public healthcare provision dominates: in 2013, based on activity measures, HMC provided 27 per cent of outpatient and 75 per cent of inpatient care, while PHCC provided 39 per cent of outpatient care across the entire health sector [4]. Both HMC and PHCC report to the Minister of Public Health and the SCH while the Ministry of Finance (MoF) is the ultimate financing agent for the public healthcare provision: HMC and PHCC obtain yearly budget approvals from the SCH prior submission to the MOF. In 2013, the actual expenditure by HMC and PHCC accounted for 53.7 per cent and 7.4 per cent of the current health expenditure respectively when financed from the government budget (see current report). Other public health care providers include Qatar Armed Forces (QAF), Amiri Guard (AG) and the Ministry of Interior (MoI), all of which operate employee clinics. The Qatar Petroleum (QP) also runs clinics for its employees as well as employees of other organizations. The Qatar Red Crescent Society (QRCS) – a non-for-profit organization – operates workers primary health care centres on behalf of the SCH.
The semi-public providers are Qatar Orthopaedic and Sports Medicine Hospital (Aspetar) – part of the Aspire 2 Zone Foundation , and the Sidra Medical and Research 3 Centre (Sidra) – the entity of the Qatar Foundation . The Aspetar is a fully functional specialized hospital which provides both inpatient and outpatient services together with the sophisticated diagnostics. Sidra has not been yet operational at its capacity of providing specialized maternity and children services during 2013. The major private providers in Qatar include four hospitals: Al Ahli Hospital, Al Emadi Hospital, Doha Clinic Hospital and American Hospital. As of 2012-2013, smaller private healthcare providers included over 302 healthcare centers and clinics, 61 diagnostics centers and 251 pharmacies [15].
2. Healthcare System in Qatar: Overview and Developments
2.3 FINANCING HEALTHCARE: 2013 AND BEYOND CURRENT EXPENDITURE During the first Stage, three out of four private hospitals and the Hamad Medical Corporation formed the first ring 5 of the healthcare providers network . Given operational and information technology challenges, associated time required to introduce and test the solutions, HMC was participating in the NHIS through the shadow-billing arrangements. The first stage was also used to test the system for its readiness before any large-scale operations were in place.
The year 2013 was a historical year for the Qatar healthcare system with the launch of the first stage of the National Health Insurance Scheme – Seha. Choice of provider, high quality services provision and population health are the goals of this important project with ultimately aim to improve health status and outcomes of the population. The activity-based funding system was introduced for the first time to fund healthcare provision based on the first regional bottom up costing fee schedule.
To illustrate the changes in the financial landscape and financial flows brought by the NHIS-Seha we reproduce the first healthcare financing map for Qatar (Figure 2.2) developed by the QNHA 2009-2010. All flows from the MoF to the public financing agents were in a form of line-items budgets; while private providers were operating on a feefor-service basis. With the introduction of the NHIS-Seha, the services of all healthcare providers in the insurance network are purchased through the activity-based funding mechanisms and:
The first stage of the NHIS was launched on the 17th July 2013, immediately after the Law No. 7 of 2013 came into force. This first pilot stage focused on Qatari female population age 12 years and above and covered women health, maternity and newborn health care services. The NHIS-Seha was further extended in April 2014 to all Qatari 4 nationals for the comprehensive health benefit package . In the coming years, the Scheme will be further rolled out to cover all groups of the population, including Non-Qatari residents and visitors.
Financing Sources
Financing Agents
A1
MOF
A4 A NHIS B NHIS C NHIS D NHIS
Households
1a NHIS a 7a
A2 A3
Parastatal Firms: QP
SCH
Healthcare Providers
Other Gov. Org. (MOI, QAF, AG)
Aspire Zone Found QF NHIC
B5
Parastatal Firms
B6
Private Insurance
D6 C7
Private Firms C8
1b NHIS b 7b 8b 1c NHIS c 7c
Charitable Orgs.
HMC Hospitals PHCC
2d NHIS d
Government Employers Clinics
3e NHIS e 7e
Aspetar
NHIS f 7f 5f 6f
Parastatal Clinics
7g
Private providers: Clinics, hospitals, pharmacies, etc.
4h NHIS h
Sidra
6g NHIS g
Households
SCH
D8
Figure 2.2 Flow of Funds
Source: [9] with authors’ modifications
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• Under NHIS-Seha funds are pooled into a single pool administered by the NHIC for the defined healthcare benefit package for specified groups of the population; • NHIC pools the funds from the Government of Qatar as a premium payer for the Qatari nationals and from Employers for the Non-Qatari nationals. The solid and dashed lines represent currently existing and soon to be activated links; • NHIC purchases healthcare services from the participating providers: the solid links correspond to those segments of providers which were active in 2013 (three private hospitals (actual claims) and HMC (shadow-billing)). Over the coming years, Seha will activate the remaining links (dashed lines).
The detailed discussion of the NHIS history of establishment, principles of operations, the approaches undertaken to design and implement the activity-based funding and build up of the fee schedules are discussed in the forthcoming publication "Social Health Insurance: Ensuring Health Care for All. An overview of the National Health Insurance Scheme of Qatar” [16] During the transition period, the financing landscape for the public healthcare sector will be a mix of traditional budget financing and an increasing penetration of the activity-based funding as both HMC and PHCC improve their capacity and operational readiness to function under the NHIS. Over the coming years, the activity-based funding will be supported with the quality-enhancing incentives. Beginning from 2015, the public healthcare system finance will also 6 be reinforced by the performance-based budgeting . The healthcare provision in the private sector will be funded on the activity basis once a provider joins the NHIS-Seha 7 network; or remain to be financed on a fee-for-service basis outside the NHIS-Seha.
2. Healthcare System in Qatar: Overview and Developments
CAPITAL EXPENDITURE Qatar is going through a tremendous capital expansion phase, and healthcare sector is not an exception. The expanding population challenge discussed earlier puts tremendous pressures on the current structure and capacities of the healthcare system, which nevertheless has been performing well despite the challenges associated 8 with healthcare demand and its structure . It is clear, however, that currently existing healthcare capacities are under strain and current capital projects assume significant extension of the capacities. According to the SCH Annual Report 2013, SCH, HMC and PHCC advanced the construction of 56 health facilities, 9 support facilities and 3,841 hospital beds during that year [4]. In addition to the healthcare sector agents, including private hospitals, the construction of healthcare facilities involved active engagement from the outside healthcare sector: the Ministry of Finance as a financing agent for capital expenditure and Public Works Authority Ashghal and Private Engineering Office as developers and constructors of healthcare facilities. The total estimated capital expenditure during 2013 reached 3.15 billion QAR. It is expected that Qatar will continue expanding its healthcare capital formation at the pace needed to meet the demand.
The Qatar Healthcare Facilities Master Plan (QHFMP) 20132033 provided the first set of estimates for the growth and composition of key healthcare infrastructure for the next two decades [17]. The project delivered the numbers, types, location and illustrative costs for hospitals, primary health care centers, pharmacies and major medical equipment required up to 2033. The cost estimates produced by the QHFMP are being continuously updated as projected facilities are refined and QHFMP moves from planning to implementation phase. Another important development which influences capital formation in the healthcare sector is the establishment of the Qatar Certificate of Needs (QCON) 9 programmes . The QCON regulates major healthcare infrastructure and investments and aims at [18] • reviewing and containing health care facilities costs alongside the coordinated planning and services and/or construction of new facilities, while improving access and quality; • regulating provision by facilitating enough capacity to meet demonstrated needs, and • increasing access to care for patients by making the right services available in the right place at the right time.
64
65 4
46 22 6 33 Operational
23
Construction Design 20
Planning Total
23
36
8
2012
2013
2014
Figure 2.3 Healthcare Expansion, Facilities 2012-2014
Source: SCH AR 2013
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METHODOLOGY
3. Methodology
3.1 OVERVIEW: METHODOLOGICAL COMPARISON WITH PREVIOUS REPORTS The QNHA 2013 builds on the 2011 and 2012 National Health Accounts with some modifications. The important methodological differences include: 1. Estimation of out-of-pocket (OOP) expenditure in QNHA 2013 was based on the healthcare providers’ information and cross-referenced with three population-based surveys: Health Utilization 10 and Expenditure Survey (HUES) 2012 and 2014 and Household Income and Expenditure Survey 11 2012-2013 . Compared to the previous reports, this provides a substantially greater degree of accuracy: QNHA 2011 and 2012 based the OOP estimations on the HUES (QNHA 2012) or Online Health Survey (QNHA 2011) only. Given the recollection bias typical for many household surveys and the need to extrapolate to the calendar year across the entire population, the resulting OOP estimations in the previous Health Accounts were prone to a certain degree of the bias. The bias is typical to many systems which use household surveys for the 12 compilation of National Accounts . As a result, the QNHA 2013 approximates the information for the OOP sustained in the private clinics, pharmacies and over-the-counter medication and medical devices only. Reported patients revenues from larger healthcare providers (HMC, PHCC, private hospitals, Aspetar, Qatar Red Crescent Society workers clinics, QP clinics) are used for the major bulk of OOP estimations.
2. Compared to the QNHA 2012, a methodological improvement to the allocation of the providers’ administration costs was made: the overhead costs 13 were distributed according to the direct costs . While the resulting distribution of the administrative costs is not entirely perfect, this approach is attuned with the costing standards which have been rolled out across the entire healthcare sector in Qatar as part of the National Health Insurance requirements.
3. While the data collection instruments were maintained in line with the previous QNHAs, the QNHA 2013 expanded the efforts: a. To extend the data collection to private polyclinics and other smaller providers; b. To address the beneficiary distribution of the healthcare expenditure from the healthcare providers’ information; and c. To improve the collection of the capital expenditure data. With regard to the first objective – only two private 14 policlinics returned partially completed instruments: their information was utilized to the extent possible. The provided information allowed to understand better the cost structure of the factors of provision in the private outpatient settings. The QNHA 2013 experience showed that reporting expenditure breakdown by beneficiary characteristics based on limited information collected from providers was prone to too many assumptions and therefore inaccuracies; especially in light of a very specific population structure (see Section 2.1 for a discussion of the demographic structure in Qatar). We anticipate that this shortcoming will be addressed in the next round of QNHA due to significant expansion of Seha coverage in three important dimensions: beneficiaries, healthcare benefit package and providers participation. As per the requirements of the NHIS-Seha, a provider is able to join Seha network only when proper clinical coding capacities are in place (ICD 10 AM and ACHI). By the end of 2014 more than 160 providers signed up to the 15 Seha network , and therefore satisfied the data reporting requirements as per the Minimum Dataset (MDS). This will allow tracing the beneficiary structure in comprehensive and holistic manner addressed in QNHA 2014. Lastly, QNHA 2013 managed to collect the most complete capital expenditure information compared to the previous rounds. This is particularly important given the significance of capital formation for the Qatar healthcare system.
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Qatar National Health Accounts Report 2013
3.2 DATA SOURCES AND ASSUMPTIONS 3.2.1 GENERAL NOTES Financial information on expenditure and revenues was collected from health care providers, health insurance companies and governmental agencies. Demographic and macroeconomic trends have been collected from official 16 national sources . In the absence of official information, sources used in previous QNHA reports were used to ensure continuity and consistency. In order to achieve the granularity of SHA classification, estimation of some data points required set of assumptions. The details are explained below. QNHA team received financial information 17 fiscal and calendar year. Where possible, of the information were requested to provide disaggregated to quarterly data for 2013 and arrive to calendar year estimates.
for both suppliers the data 2014, to
International information was sourced from the OECD Health Statistics [19] for the OECD countries and WHO for the GCC region [20].
3.2.2 NOTES ON DATA SOURCES GOVERNMENT MINISTRY OF FINANCE Similar to the previous years, information received from the Ministry of Finance provided the breakdown of expenditure at the high levels of General Ledger categories: remuneration to the labour force (wages and salaries), services and materials used and capital expenditure. The information was also limited to the direct financing of the healthcare sector agents and excluded capital expenditure managed by the Ashghal and Private Engineering Office (PEO). The MoF information was therefore used for the triangulation purposes to ensure the consistency with the received providers information.
SUPREME COUNCIL OF HEALTH In addition to its role as a supervisor and the regulator of healthcare provision, SCH also directly financed the expenditure for: • Treatment Abroad programme; • Operations of Qatar Red Crescent Society on behalf of the SCH in workers healthcare clinics; and • Partial expenditure related to the construction of naufar18 – a new highly specialized mental health facility. Expenditure related to treatment abroad (TA) was allocated to specialized inpatient curative care received from the overseas providers. This is based on the fact that the Medical Commission Committee (currently operated by the HMC) for Treatment Abroad approves treatment overseas based on the urgency of healthcare required and availability of highly specialized healthcare in Qatar. The analysis of household information (HUES 2012 and HUES 2014) also confirmed that treatment abroad was mainly for satisfying the demand for highly specialized healthcare. 19
As a result, the reflection of TA in QNHA 2013 follows a blend of QNHA 2011 and QNHA 2012: we maintained the classification FP.M for the factors of provision by the healthcare systems of the Rest-of-the-world, and assumed highly specialized inpatient care HC.1.1.2 provided by overseas healthcare providers HP.9.
3. Methodology
MINISTRY OF INTERIOR, QATAR ARMED FORCES AND AMIRI GUARD
PRIVATE HOSPITALS
Similar to the previous years, the provided data were reported at high-level aggregates of expenditure. Contrary to the previous rounds, we allocated the expenditure to the types of outpatient functions (general, dental and specialized) using professional staff numbers as the allocation keys.
Three out of four private hospitals provided information aggregated to the levels and classifications required for the QNHA 2013. All hospitals supplied expenditure and revenues information. The revenues information – private health insurance, direct payments by patients and the employers – allowed for proper allocation to the financing schemes and financing agents. Similar to QNHA 2011, we found that private hospitals revenues from the private health insurance exceeded the financing reported by the health insurance companies, and resulting 92 million QAR were allocated to the Rest of the World (RoW) utilization of Qatar healthcare system.
CAPITAL PROJECTS: PUBLIC WORKS AUTHORITY – ASHGHAL AND PRIVATE ENGINEERING OFFICE The QNHA 2013 surveyed the Ashghal and the PEO for the first time. At the time of writing this report, Ashghal provided the capital expenditure information at the high level of total capital expenditure. SCH used its database and knowledge of the Ashghal projects to allocate these capital expenditure to hospitals and ambulatory (medical centers) construction. The PEO has not provided the information on capital projects at the time of writing this report. QNHA team estimated the PEO capital expenditure based on SCH knowledge of the PEO projects.
HEALTHCARE PROVIDERS PUBLIC PROVIDERS: HMC AND PHCC Hamad Medical Corporation and Primary Health Care Corporation were extensively consulted with throughout the project. Two main types of information were provided: the general ledger for healthcare expenditure (HMC detailed, PHCC at higher level of aggregation); and patient revenues for the refinement of the OOP estimations. The general ledger data required careful approach to allocation of expenditure to the healthcare functions and was the most time-intensive part of the QNHA 2013 compilation. Both organizations reported information based on the calendar year.
PRIVATE CLINICS Largest private ambulatory healthcare centers were sent the requests for the information, with two returning the required information for the health accounts. While far from being complete, this nevertheless allowed for better understanding of the factors of provision in the private outpatient settings. QNHA team will continue working closely with the private healthcare sector in the coming QNHA rounds.
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Qatar National Health Accounts Report 2013
FINANCING AGENTS LANDSCAPE IN 2013 Consistent with QNHA 2011, HMC and PHCC were 20 not singled out as Financing Agents in QNHA 2013 . On one hand, these institutions – along with the Supreme Council of Health – prepare, submit and defend their budgets to the Ministry of Finance – which ultimately decides and approves funding for these institutions. On the other hand, all three organizations must receive the endorsement of budget proposals from the Minister of Health – the ultimate authority responsible for the healthcare quality and delivery in Qatar (see Section 2 for the detailed overview). Therefore on a higher level, one may assign the role of Financing Agent for the publicly provided care to the Ministry of Finance. On the function level, however, the decisions, monitoring and responsibility for healthcare delivery lies with the Minister of Health and the Supreme Council of Health. Therefore QNHA 2013 recognizes funding position of the SCH by integrating HMC and PHCC under SCH as a financing agent FA.1.1.1, which is equivalent to the Ministry of Health in other international reporting. Most of the expenditure exclusive to the SCH remained to be classified as HC.7 “Governance, Health System and Financing Administration” and HP.7 “Providers of Healthcare System Administration and Financing”. The expenditures of PHCC and HMC fit under the categories of HC.1 – HC.6 for the curative, preventative and rehabilitative care. The Aspire Zone Foundation, Ministry of Interior, Qatar Armed Forces, Amiri Guard and Qatar Petroleum remain classified as financing agents under appropriate FA codes. This is based on underlying arrangements where the entities receive financial resources from the state budget directly and manage those resources to finance provision of healthcare services by a wide range of relatively autonomous (managerially) clinics or hospitals under their control. In addition to the central government budget, both Aspetar and QP clinics derive their revenues from the private health insurance companies, and direct payments by the households.
Finally, following the establishment of the National Health Insurance Scheme, the National Health Insurance Company has entered the QNHA as a financing agent. During 2013 the role of NHIS was concentrated on providing healthcare coverage to the specific group of the beneficiaries – Qatari females aged 12 and above; for a specific set of healthcare functions and within an initial set of SEHA providers’ network. NHIC was pooling the funds for this set of the beneficiaries from a single source – the government (MoF) – as per the Law No. 7 of 2013 which assigns the role of the premium payer for the Qatari Nationals to the Government of Qatar. This is reflected in the appropriate tables of healthcare functions and financing sources. At the same time NHIC was preparing for the launch of Stage 1 and further building its capacities to be able to ramp up the operations during the Stage 2 in April 2014. These ‘built to initiate, maintain and ramp up’ costs are substantial and should be understood in the context of current and future operations of the NHIC.
EXPENDITURE ON TREATMENT ABROAD Qatar outlays substantial amounts on treatment abroad. This includes the following financing sources: • Government through the SCH TA program • Households through the OOP • Zakat Fund; and • Private Health Insurance The reflection of TA in QNHA 2013 follows a blend of QNHA 2011 and QNHA 2012: we maintained the classification FP.M for the factors of provision by the rest-of-the-world, and assumed highly specialized inpatient care HC.1.1.2 provided by overseas healthcare providers HP.9. SHA Matrix HF x HP is helpful to detect which financing scheme purchased services for TA.
3. Methodology
3.3 LIMITATIONS AND WAY FORWARD QNHAs are progressively providing more comprehensive and detailed information with increasing accuracy. Compared to the previous rounds, the current QNHA Report improves on representation of capital formation and household out-of-pocket expenditure. The remaining challenges – which will be the focus of QNHA 2014 – are: 1. Beneficiaries of healthcare expenditure with accurate reflection of age and gender composition; 2. Structure of healthcare expenditure by diseases; 21
3. Healthcare expenditure for medical research .
The roll out of NHIS-Seha and associated data accuracy and availability will be highly instrumental in addressing the first two challenges. Lastly, the international comparison is limited to the information available: GCC countries are currently in the 22 23 process of establishing SHA methodologies , some 24 OECD countries still maintain SHA 1.0 classification .
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Qatar National Health Accounts Report 2013
QATAR SYSTEM OF HEALTH ACCOUNTS 2013: FINDINGS
4. Qatar System of Health Accounts 2013: Findings
4.1 FINANCING DIMENSIONS MAJOR FINDINGS The healthcare system mobilized and spent 18.26 billion QAR in 2013. Current expenditure on health (CHE) at 15.11 billion of QAR accounted for more than eighty per cent of total health expenditure (82.7%); with gross capital formation (GCF) amount to 3.15 billion QAR (17.3%). Compared to the previous year 2012, the major increase in the healthcare spending was due to the current health expenditure, while capital formation remained at a relatively stable 3.15 billion QAR. An increase in the current health expenditure exceeded population growth of 9.3 per cent; with similar trend observed in 2012. Given that most of the population growth comes from the transitory population (dominated by young male migrant workers with lower healthcare utilization rates), it is important to understand the structural reasons driving the healthcare expenditure growth.
Qatar
2012 Billion QAR
2013 Billion QAR
Growth %
THE Total Health Expenditure
15.14
18.26
+ 20.6
CHE Current Health Expenditure
11.89
15.11
+ 27.1
GHF Gross Capital Formation
3.25
3.15
- 3.1
The Qatar SHA results for 2013 are summarized in this section by: • Financing dimensions. This outlines the structure of health care revenues and expenditure by financing schemes and financing agents, including analysis and cross country comparison. • Use of funds. This outlines the structure of health care expenditure by healthcare functions and healthcare providers, including analysis and cross country comparison • Factors of health care provision. This outlines the structure of health care expenditure by factors of provision. • Gross Capital Formation (GCF).
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Qatar National Health Accounts Report 2013
FINANCING ARRANGEMENTS Three financing arrangements were in charge of mobilizing, managing and/or spending of funds (Figures 4.1, 4.2 and 4.3) • Governmental financial arrangements (HF.1) accounted for 12.64 billion QAR of expenditure, which is 83.7% of CHE (an increase of 34.3 per cent). This is inclusive of Government Schemes (HF.1.1) and Compulsory contributory health insurance schemes (NHIS – Seha) (HF.1.2). • Household (HH) Out of Pocket (OOP) schemes (HF.3) accounted for 1.03 billion QAR (or 6.8% of CHE) (a decrease of 20.2 per cent) • Voluntary healthcare payment schemes (HF.2) contributed 1.34 billion QAR (8.9% of CHE) (an increase of 12.6 per cent)
0.6% HF.4 Rest of the world
6.8%
25
• Rest of the world (RoW) financed 0.09 billion (0.6%) of domestic healthcare provision. HF.3 Household OOP
Qatar
2012 Billion QAR
2013 Billion QAR
Growth %
HF.1 Government
9.41
12.64
+ 34.3
HF.2 Voluntary payments
1.19
1.34
+ 12.6
HF.3 Household OOP
1.29
1.03
- 20.2
8.9% HF.2 Voluntary healthcare payment
83.7% HF.1 Government HF.1.1 Government Schemes 83.1% HF.1.2 SEHA 0.5% Figure 4.1 Structure of Health Care financing by schemes
4. Qatar System of Health Accounts 2013: Findings
FINANCING REVENUES The Government was the major source of revenue (FS.1) contributing 12.6 billion (83.7%) to the CHE and 15.8 billion QAR (86.3%) to the overall funding. Similar to the previous years, almost all funds allocated to GCF came from the Government (3.1 billion QAR or 99%).
Revenues of schemes FS.5 Voluntary Prepayment
FS.1 Government Revenues of the financing scheme (HF) by financing sources (FS)
HF.1 Government HF.1.1 Government Schemes
HF.3 Household OOP
Share of (%)
FS.1.2 Transfers by Government on behalf of specific groups
FS.1.4 Other transfers from government domestic revenue
FS.5.9 Other Voluntary prepaid revenues
FS.6.1 Households
FS.6.2 Corporations
FS.7.3 Other direct foreign transfers
12,475.4
81.2
85.0
-
-
-
-
12,641.6
83.7%
12,475.4
-
85.0
-
-
-
-
12,560.4
83.1%
68.8%
-
-
-
-
-
81.2
0.5%
0.4%
-
1,028.1
4.8
311.6
-
1,344.5
8.9%
7.4%
76.5%
0.4%
23.2%
-
1,032.9
-
-
1,032.9
6.8%
5.7%
0.6%
0.5%
-
health insurance schemes (SEHA)
HF.2 Voluntary healthcare payment
FS.7 Direct Foreign Transfers
FS.1.1 Internal Transfers and Grants
99.3% HF.1.2 Compulsory contributory
FS.6 Other Domestic Revenues
Total CHE
THE
0.7% 81.2
100.0%
-
-
-
-
-
100.0% HF.4 Rest of the world
-
-
-
-
-
-
92.0
92.0
12,475.4
81.2
85.0
1,028.1
1,037.7
311.6
92.0
15,111.0
82.7%
82.6%
0.5%
0.6%
6.8%
6.9%
2.1%
0.6%
Gross capital formation (GCF)
3,121.7
-
-
-
28.4
-
3,150.1
17.3%
Total health expenditure (THE=CHE+GCF)
15,597.1
81.2
85.0
1,028.1
1,037.7
340.0
92.0
18,261.1
85.4%
0.4%
0.5%
5.6%
5.7%
1.9%
0.5%
100%
Current expenditure on health (CHE)
Figure 4.2 Health Care expenditure by revenues and financing schemes (in Million QAR)
100%
100%
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Qatar National Health Accounts Report 2013
FINANCING AGENTS LANDSCAPE Voluntary healthcare payment schemes (HF.2) 1.3 billion QAR contributed 8.9% of the CHE with revenues from: voluntary health insurance premiums (FS.5.9) at 1.03 billion QAR (76.5% of HF.2 or 6.8% of CHE); enterprise financing scheme (FS.6.2) 0.3 billion QAR (23.2% of HF.2 or 2.1% of CHE) and a marginal contribution from the Households (FS.6.1) channeled through the charity organizations.
The government revenues 12.6 billion QAR were managed by the SCH, HMC, PHCC, other Ministries and the NHIC. HMC was responsible for managing and delivering of 8.3 billion QAR (53.7% of CHE and 64.2% of the revenues from the Government). The second highest share of funding was managed by the SCH with 2.7 billion QAR (17.9% of CHE and 21.3% out of Government Schemes). PHCC managed 1.1 billion QAR (7.4% of CHE and 8.8% out of Government Schemes).
Household OOP (HF.3) were financed entirely by the households’ revenues (FS.6.1) at 1.0 billion, or 6.8% of the CHE. The Rest of the world (HF.4) contributed remaining 0.1 billion (0.6% of CHE).
During 2013, NHIC received the funds from the Government in a form of the premium as per the Social Health Insurance Law No.7 of 2013 which assigned the Government with the responsibility for the NHIS-Seha related premiums for all Qatari citizens (and residents of equal status). NHIC managed 0.08 billion QAR (0.5% of CHE)
SHA Matrix 1 (Annex) provides further details.
Private insurance companies (FA.2) managed 76.5% of the voluntary healthcare payment scheme (HF.2), with the remainder managed by Qatar Petroleum, other corporations and Zakat Fund. Figures 4.3, 4.4 and 4.5 show the detailed breakdown of financing agents.
14.2% Other Agents
100
4.6% Corporations
14.2% 0.2% Other Corporations
0.6% Rest of the world
4.6%
1.9% Qatar Petroleum
6.8% Comerc Ins Comp 6.8% Households 0.05% Non-profit (Zakat Fund)
81.1% General Government
1.6% Other Ministries 0.5% NHIC 7.4% PHCC
81.1% 0
General Government (FA1) Corporations (FA3) Other Agents (FA2, FA4, FA5, FA6)
Figure 4.3 Structure of the current healthcare expenditure (CHE) by financing agents
17.9% SCH
53.9% HMC
2.5% Aspire Zone Foundation
4. Qatar System of Health Accounts 2013: Findings
Revenues of schemes FS.5 Voluntary Prepayment
FS.1 Government Revenues of schemes (FS) and Financing Agents (FA)
FA.1 General Government FA.1.1 Central Government FA.1.1.1 SCH FA.1.1.2 Other Ministries and Public Units
FS.6 Other Domestic Revenues
FS.7 Direct Foreign Transfers
FS.1.1 Internal Transfers and Grants
FS.1.2 Transfers by Government on behalf of specific groups
FS.5.9 Other Voluntary prepaid revenues
FS.6.1 Households
FS.6.2 Corporations
FS.7.3 Other direct foreign transfers
12,176.4
81.2
-
-
-
-
12,176.4
81.2
-
-
-
11,939.2
-
-
-
237.3
-
-
-
Share of (%)
Total CHE
THE
12,257.6
81.1%
67.1%
-
12,257.6
81.1%
-
-
11,939.2
79.0%
-
-
237.3
1.6%
-
-
FA.1.1.2.1 Ministry of Finance FA.1.1.2.2 Ministry of Interior
127.3
-
-
-
-
-
127.3
0.8%
FA.1.1.2.3 Qatar Armed Forces and Amiri Guard
109.9
-
-
-
-
-
109.9
0.7%
FA.1.1.4 National Health Insurance Agency - NHIC
-
81.2
-
-
-
-
81.2
0.5%
FA.2 Insurance Corporations
-
-
1,028.1
-
-
-
1,028.1
6.8%
-
-
1,028.1
-
-
-
1,028.1
6.8%
383.9
-
-
-
309.2
-
693.2
4.6%
FA.3.1 Health Management and provider corporations
-
-
-
-
-
-
-
-
FA.3.2 Corporations (other than providers of health services)
383.9
-
-
-
309.2
-
693.2
4.6%
383.9
-
-
-
-
-
383.9
2.5%
FA.3.2.3 Qatar Petroleum
-
-
-
-
279.8
-
279.8
1.9%
FA.3.2.9 Other corporations
-
-
-
-
29.4
-
29.4
0.2%
FA.4 Non-Profit Institutions serving households (NPISHs)
-
-
-
4.8
2.4
-
7.2
0.05%
-
-
-
4.8
2.4
-
7.2
0.05%
FA.5 Households
-
-
-
1,032.9
-
-
1,032.9
6.8%
5.7%
FA.6 Rest of the World
-
-
-
-
-
92.0
92.0
0.6%
0.5%
12,560.4
81.2
1,028.1
1,037.7
311.6
92.0
15,111.0
100.0%
83.1%
0.5%
6.8%
6.9%
2.1%
0.6%
100.0%
Capital Formation
3,121.7
-
-
-
28.4
-
3,150.1
17.3%
Total Financing Schemes
15,682.0
81.2
1,028.1
1,037.7
340.0
92.0
18,261.1
100.0%
FA.2.1 Commercial Insurance Companies FA.3 Corporations (other than insurance corporations)
FA.3.2.1 Aspire Zone Foundation
FA.4.1 Zakat Fund
Current Financing Schemes
Figure 4.4 Healthcare revenues by revenues of schemes and agents (in million QAR)
5.6%
3.8%
0.05%
31
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Qatar National Health Accounts Report 2013
A breakdown of expenditure by financing agents and schemes explains the roles of key institutions in healthcare financing (Figure 4.5). In addition to already discussed, SCH, HMC and PHCC managed 0.6 billion QAR of capital formation. This is inclusive of IT, ICT, major medical equipment, major repairs and similar capital formation items.
The buildup of the major facilities infrastructure – hospitals and medical centers – estimated at 2.5 billion QAR during 2013 – was financed directly by the Ministry of Finance (FA.1.1.2.1) through two main construction developers: the Public Works Authority Ashghal and the Private Engineering Office. The direct financing of construction of SIDRA hospital by the MoF is also included in 2.5 billion.
Financing Schemes HF.1 Government HF.2 Voluntary healthcare payment
HF.3 Household OOP
HF.4 Rest of the world
Current expenditure on health
Gross capital formation
Total health expenditure
81.2
-
-
-
12,257.6
3,118.2
15,375.8
81.2
-
-
-
12,257.6
3,118.2
15,375.8
11,939.2
554.4
12,493.6
237.3
2,563.8
2,801.0
-
2,551.1
2,551.1
Financing Agents
FA.1 General Government FA.1.1 Central Government FA.1.1.1 SCH FA.1.1.2 Other Ministries and Public Units
HF.1.1 Government Schemes
HF.1.2 Compulsory Contributory Health Insurance Schemes
12,176.4 12,176.4 11,939.2 237.3
-
-
-
-
FA.1.1.2.1 Ministry of Finance FA.1.1.2.2 Ministry of Interior
127.3
127.3
5.7
133.0
FA.1.1.2.3 Qatar Armed Forces and Amiri Guard
109.9
109.9
7.1
117.0
81.2
-
81.2
1,028.1
-
1,028.1
1,028.1
-
1,028.1
693.2
31.9
725.1
-
27.2
27.2
693.2
4.7
697.9
383.9
3.5
387.4
1.2
281.0
FA.1.1.4 National Health Insurnace Agency - NHIC FA.2 Insurance Corporations
81.2 -
-
FA.2.1 Commercial Insurance Companies FA.3 Corporations (other than insurance corporations)
1,028.1
-
-
1,028.1 383.9
-
309.2
-
-
FA.3.1 Health Management and provider corporations FA.3.2 Corporations (other than providers of health services) FA.3.2.1 Aspire Zone Foundation
383.9
-
309.2
-
-
383.9
FA.3.2.3 Qatar Petroleum
-
279.8
279.8
FA.3.2.9 Other corporations
-
29.4
29.4
29.4
FA.4 Non-Profit Institutions serving households (NPISHs)
-
7.2
7.2
1,032.9
1,032.9
92.0
92.0
92.0
92.0
15,111.0
-
7.2
FA.4.1 Zakat Fund
-
7.2
FA.5 Households
1,032.9
FA.6 Rest of the World Total Financing Schemes
-
12,560.4
81.2
1,344.5
Figure 4.5 Healthcare expenditure by financing schemes and agents (in million QAR)
1,032.9
3,150.1
18,261.1
4. Qatar System of Health Accounts 2013: Findings
OBSERVED TREND Total health care financing increased by 20.6% from 15.14 billion QAR in 2012 to 18.26 billion QAR in 2013. Substantially higher growth rates were observed in 2012 (25.3% growth compared to 2011). Most of the growth in 2013 was due to the expansion of current health expenditure by 27.1% from 11.89 billion QAR in 2012, to 15.11 billion QAR in 2013. GCF remained stable at the level of 3 billion QAR (falling marginally by 3.7% from 3.25 billion in 2012 to 3.15 billion in 2013).
As explained earlier, the OOP expenditure in 2013 were estimated with greater accuracy, so any direct comparison between 2012 and 2013 should be exercised with caution. However, using the approach of estimating OOP based on 26 the HEUS 2014 and HEIS 2012-13 data also points to the reduction in the OOPs in the range of 1.1-1.2 billion for 2013. Therefore it appears that there is a genuine reduction in the household out-of-pocket expenditure.
While it appears that growth in healthcare expenditure is slowing down, detailed structural analysis requires further investigation. This is particularly important when healthcare expenditure growth is compared to the underlying population growth rates (10.6% in 2012 and 9.3% in 2013). The major contributor to the growth of healthcare financing was due to 24.5% increase in financing of government schemes from 12.66 billion QAR in 2012, to 15.76 billion QAR in 2013. This was partially offset by 20.2% reduction in HH OOP expenditure (from 1.29 billion QAR in 2012, to 1.03 billion QAR in 2013).
20,000 18,261 1,038 15,143
1,460
15,000 1,294 12,088
10,000
9,376
9,530
1,507
1,550
711
814
1,186
1,665 1,116
5,000
Government (FS.1) Others (FS.5, FS.6.2, FS.7) Households (FS.6.1) 7,158
7,166
9,307
12,663
15,763
2009
2010
2011
2012
2013
Figure 4.6 Comparison of healthcare financing by schemes and years (in million QAR)
Total health Expenditure (THE=CHE+GCF)
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Qatar National Health Accounts Report 2013
CROSS COUNTRY COMPARISON Qatar differs significantly from all OECD countries with a high share of GCF in total health expenditure (THE). The share of GCF varied between 0.9% (Japan) and 9.4% (Turkey) 27 with the average at 4.2% of the total health expenditure , compared to 17.3% in Qatar in 2013. Similar comparison was observed in 2012 [10]. As discussed above, all sectors in Qatar, including the healthcare, undergo a massive capital formation stage. We anticipate that this will be maintained throughout the next 5-10 years. More detailed structure of capital formation is discussed in Section 4.3. A comparative analysis of revenues by financing agents between Qatar and OECD countries is given in Figures 4.7 and 4.8. As in the previous years, the HH OOP payments in healthcare financing revenues in Qatar (6.8% of CHE) was much lower than average of lowest OECD countries (27.9%) for 2013. This is mainly due to two factors: (1) historically, most of the healthcare was provided at the expense 28 of the publicly funded healthcare , and (2) the current reform in the healthcare sector do not seek an increasing contribution of OOP expenditure as Qatar is committed to the universal health coverage at the lowest possible burden to the households.
Going forward, under NHIS-Seha cost-sharing mechanisms will be introduced with the purpose of demand management and not as a source of revenue. The share of private health insurance in Qatar is consistent with the average of OECD. The role of private health 29 insurance in OECD countries varies substantially, from 0.2% in Slovak Republic, to 34.8% in the United States. Starting from 2013, the operations of Private Health Insurers in Qatar are being brought in line with the Social Health Insurance Law (Law No.7 of 2013) which distinguishes between Basic and Additional benefits packages and outlines responsibilities of the NHIC and Private Health Insurers. The specific operational details to be put in place are currently being formulated. This will determine the future roles and contributions of the Private Health Insurance in Qatar healthcare system.
50.0
Household Out of Pocket
20
Private Insurance
44.4
40.0 15 30.0
27.9
10 20.0 16.0
14.2
5 10.0 6.8
0
17.3
1.4
4.2
6.7
Qatar
Lowest Quantile, OECD
Average, OECD
Highest Quantile, OECD
Figure 4.7 Gross Capital Formation (% THE): Qatar (2013) and OECD (2012-2013)
Source: Current report, OECD iLibrary [21]
6.8
6.6 1.4
0 Qatar
Lowest Quantile, OECD
Average, OECD
Figure 4.8 HH OOP payments and Private Insurance (% CHE): Qatar (2013) and OECD countries (2012-2013)
Highest Quantile, OECD Source: Current report, OECD iLibrary [21]
4. Qatar System of Health Accounts 2013: Findings
4.2 USES OF FUNDS HEALTHCARE FUNCTIONS Similar to previous years and as expected, the Curative care (HC.1) at 10.73 billion QAR comprises the bulk of CHE (71.0%). Medical goods (HC.5) at 1.56 billion QAR and Ancillary services (HC.4) at 1.47 billion QAR contributed another 10.3% and 9.7% respectively. The Governance and Financing Administration (HC.7) of the Healthcare system remained stable at 0.85 billion QAR. As expected, compared to the previous year, the expenditure on all healthcare functions across the system have increased. There were some methodological changes as well – explained below – which contributed to the relative structure of the functions. The inpatient curative care (HC.1.1) 6.77 billion QAR accounted for 44.8% of CHE and mostly concentrated on the provision of specialized inpatient curative care (37.4% of CHE). Outpatient curative care 3.76 billion QAR accounted for another quarter of the CHE.
Qatar
2012 Billion QAR
2013 Billion QAR
Growth %
HC.1 Curative Care
8.83
10.73
+ 20.3
HC.2 Rehabilitative Care
0.09
0.29
+ 32.2
HC.3 Long-term care
0.005
0.08
+ 1,500.0
HC.4 Ancillary services
1.43
1.47
+ 2.8
HC.5 Medical goods
0.52
1.56
+200.0
HC.6 Preventive care
0.05
0.14
+ 180.0
HC.7 Governance & Administration
0.854
0.847
- 0.83
The Government Schemes (HF.1.1) financed 12.64 billion of all healthcare functions (83.7% of CHE) including 9.36 billion of all curative care (HC.1) (87.2% of all curative care, or 61.9% of CHE). While the Curative care (HC.1) and Inpatient care (HC.1.1) in particular are the biggest spending items for the Government financing schemes (HF.1.1); Outpatient curative care (HC.1.3) and Medical goods (HC.5) are the biggest expenditure item for Households (HF.3), Private Health Insurers (HF.2.1.1.3) and Enterprises (HF.2.3.1).
35
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Qatar National Health Accounts Report 2013
Healthcare financing schemes (HF)
HF.2 Voluntary health care payment schemes
HF.3 Household out-of-pocket payment
HF.4 Rest of the world financing schemes (non resident)
HF.2.1.1.3 Other primary coverage scheme
HF.2.2.1 NPISH financing schemes (excluding HF.2.2.2)
HF.2.3.1 Enterprises (except Health care providers) financing schemes
HF.3.1 Out-of-pocket excluding cost sharing
HF.4.2.1 Voluntary health insurance schemes (non-resident)
30.5
521.0
7.1
142.5
629.3
6,354.2
20.8
153.5
7.1
9.4
895.0
17.8
52.9
-
5,453.1
3.0
54.2
6.2
-
HC.1.2 Day curative care
144.0
HC.1.3 Outpatient curative care
HF.1.1 Government schemes
HF.1.2 Compulsory contributory health insurance schemes
HF.1.1.1 Central governmental schemes
HF.1.2.1 Social health insurance schemes
9,329.5
HC.1.1 Inpatient curative care HC.1.1.1 General inpatient curative care
Healthcare Functions (HC) by Healtchare Financing Schemes (HF)
Total
Share in CHE (%)
69.1
10,729.0
71.0%
195.8
24.5
6,765.4
44.8%
4.9
58.3
12.1
1,041.0
6.9%
-
4.5
127.0
12.4
5,654.3
37.4%
46.4
7.1
-
10.5
-
70.2
0.5%
0.6
2.5
-
-
1.2
0.6
148.9
1.0%
2,776.1
9.0
365.0
-
133.1
432.3
44.0
3,759.5
24.9%
HC.1.3.1 General outpatient curative care
819.3
8.9
160.5
-
96.2
217.2
21.0
1,323.1
8.8%
HC.1.3.2 Dental outpatient curative care
347.4
-
83.9
-
31.6
40.2
2.2
505.3
3.3%
HC.1.3.3 Specialised outpatient curative care
1,609.4
0.1
120.6
-
5.2
153.3
20.8
1,909.5
12.6%
-
-
-
-
-
21.5
-
21.5
0.1%
HC.1.4 Home based curative care
55.1
-
-
-
-
-
-
55.1
0.4%
HC.2 Rehabilitative care
269.8
- a)
9.0
-
5.5
3.1
2.1
289.6
1.9%
HC.3 Long-term care (Health)
33.7
-
-
-
44.2
-
-
77.9
0.5%
HC.4 Ancillary services (not specified by function)
1,204.1
1.4
132.8
-
86.1
30.7
11.1
1,466.3
9.7%
HC.5 Medical goods (not specified by function)
1,002.3
0.2
158.0
0.1
27.1
359.7
9.7
1,556.9
10.3%
HC.6 Preventive care
116.0
-
14.4
0.1
-
6.5
-
137.0
0.9%
HC.7 Governance and health system and financing administration
604.9
49.1
192.9
-
-
-
-
846.9
5.6%
HC.9 Other health care services not elsewhere classified (n.e.c)
-
-
-
-
3.8
3.4
-
7.2
0.05%
12,560.4
81.2
1,028.1
7.2
309.2
1,032.9
92.0
15,111.0
83.1%
0.5%
6.8%
0.05%
2.0%
6.8%
0.6%
HC.1 Curative care
HC.1.1.2 Specialised inpatient curative care HC.1.1.9 Inpatient care not specified
HC.1.3.9 Outpatient care not specified
Current expenditure on health (CHE)
a) The estimated number is less than 100,000 QAR – refer to the SHA Matrix 5 in the Appendix for details Figure 4.9 Current healthcare expenditure by healthcare functions (HC) and healthcare financing schemes (HF) (in Million QAR)
100.0%
4. Qatar System of Health Accounts 2013: Findings
The distribution of healthcare functions by financing schemes shows that: • Almost three quarter (74.3%) of Government Scheme (HF.1.1) expenditure was directed towards the curative care 9.36 billion QAR, with half (50.6%) for inpatient care. Ancillary services (HC.4) 1.21 billion QAR and Medical goods (HC.5) 1.00 billion QAR were the next biggest spending items (9.5% and 7.9% respectively). • The largest item in the household OOPs is the expenditure on the Outpatient curative care (HC.1.3) 0.43 billion (47.9%) followed by Medical goods (HC.5) 0.36 billion QAR (34.8%).
• Similar to the households, private health insurers (HF.2.1.1.3) expenditure concentrated on the outpatient curative care 0.37 billion QAR (35.5%) and Medical goods (HC.5) 0.16 billion QAR (15.4%). The proportion of expenditure on HC.7 functions (health system and financing administration) was almost one fifth (18.8%) of the private health insurers. • Enterprise financing schemes (HF.2.3.1) spent 0.13 billion QAR on outpatient curative care (HF.1.3) (43.0%) and 0.09 billion on Ancillary services (HC.4).
71.0% Curative Care 100
3.3% 5.6%
HC.1.2 1.0% Day Curative care
10.3%
HC.1.3 24.9% Outpatient Curative care
80 9.7%
HC.1.4 0.4% Home based Curative care
60
3.3% Other Care
40 HC.1 Curative care HC.4 Ancillary services (not specified by function) 20
HC.6 0.9% Preventive Care HC.2 1.9% Rehabilitative care
HC.5 Medical goods (not specified by function) 71.0%
0
HC.1.1 44.8% Impatient Curative care
HC.7 Governance and health system and financing administration Other Care (HC.2, HC.3, HC.6, HC.9)
Figure 4.10: Current health expenditure structure by healthcare functions
HC.3 0.5% Long-term care
37
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Qatar National Health Accounts Report 2013
Qatar has spent 0.85 billion QAR to govern and administer the healthcare system (HC.7). This includes the administrative expenses of the SCH (0.60 billion QAR, or 71.4% of total governance expenditure), Private Health Insurers (0.19 billion, or 22.8%) and the NHIC (0.05 billion QAR or 5.8%). Seemingly high governance costs of the NHIC should be understood against the background of: - Building the capacities within NHIC and with the network of providers for the launch of the NHIS in 2013; - Ramping up the capacities to be able to expand the NHIS coverage and the providers network for the Stage 2 in early 2014 which in turn required accelerated investments in workforce and operations during 2013. The enrollment numbers for stage 2 were expected to be comparable with the total membership of all private health insurance market.
- Dealing with a substantially wider network of providers, including public health providers compared to the average private health insurer in Qatar; - As was discussed above, HMC was operating NHIS through the shadow-billing and not the actual claims. If HMC claims are considered, the share of the NHIC governance expenditure falls from 60.5% to 36.7%. Though the fixed costs of setting the governance and operational capacities underlying the efficient functioning of the NHIS-Seha were considerable, we anticipate to see a substantial reduction in the share of the governance and administrative costs during 2014 and further reduction as the NHIS rolls out to reach out to the remaining groups of the population.
4. Qatar System of Health Accounts 2013: Findings
HEALTHCARE PROVIDERS Hospitals (HP.1) financing historically dominated the healthcare landscape: in 2013, 9.05 billion (59.9% of CHE) was directed towards the hospital network with 8.05 billion (88.9% of total hospital financing) financed by the Government Schemes (HF.1.1).
HP.7 5.6% Administration and financing
HP.3 13.7% Ambulatory health care
HP.4 3.3% Ancillary Services
The expenditure at the providers of ambulatory care (HP.3) amounted to 2.07 billion QAR (13.7% of CHE) with 1.48 billion QAR financed by the Government Schemes (71.3% of total ambulatory care providers). Providers of Ancillary services (HP.4) and retailers and other providers of Medical goods (HP.5) utilized 0.496 (3.3% of CHE) and 0.37 billion QAR (2.4% of CHE) respectively. Treatment abroad (TA) is a very substantial item in Qatar healthcare expenditure: in 2013 total TA amounted to 2.22 billion QAR, or 14.7% of CHE; 2.02 billion QAR was financed by the Government Schemes (90.8% of total TA); and households contributed 0.16 billion QAR (or 7%).
HP.6 0.05% Preventive care
HP.5 2.4% Retailers medical goods HP.1 59.9% Hospitals
HP.9 14.7% Rest of the world HP.nsk 0.3% not specified by kind
Figure 4.11 Structure of current health care expenditure by healthcare providers
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Qatar National Health Accounts Report 2013
Figure 4.12 shows distribution of healthcare functions across healthcare providers and Figure 4.14 relates healthcare providers to the financing schemes.
Healthcare Providers
HP.1 Hospitals
HP.3 Providers of ambulatory health care
HP.4 Providers of ancillary services
HP.5 Retailers and other providers of medical goods
HP.6 Providers of preventive care
HP.7 Providers of health care system administration and financing
HP.9 Rest of the world
HP. Nsk Providers not specified by kind
Total
% of CHE
7,044.9
1,295.4
134.6
-
-
-
2,223.7
30.5
10,729.0
71.0%
HC.1.1 Inpatient curative care
4,612.8
-
-
-
-
-
2,143.6
8.9
6,765.4
44.8%
HC.1.1.1 General inpatient curative care
1,041.0
-
-
-
-
-
-
-
1,041.0
6.9%
HC.1.1.2 Specialised inpatient curative care
3,568.0
-
-
-
-
-
2,086.2
-
5,654.3
37.4%
3.8
-
-
-
-
-
57.4
8.9
70.2
0.5%
148.9
-
-
-
-
-
-
-
148.9
1.0%
HC.1.3 Outpatient curative care
2,270.8
1,252.5
134.6
-
-
-
80.1
21.5
3,759.5
24.9%
HC.1.3.1 General outpatient curative care
462.5
802.1
0.2
-
-
-
58.3
-
1,323.1
8.8%
HC.1.3.2 Dental outpatient curative care
276.8
228.5
-
-
-
-
-
-
505.3
3.3%
1,531.5
222.0
134.4
-
-
-
21.7
-
1,909.5
12.6%
-
-
-
-
-
-
-
21.5
21.5
0.1%
12.3
42.8
-
-
-
-
-
-
55.1
0.4%
HC.2 Rehabilitative care
277.7
11.9
-
-
-
-
-
-
289.6
1.9%
HC.3 Long-term care (Health)
33.7
44.2
-
-
-
-
-
-
77.9
0.5%
HC.4 Ancillary services (not specified by function)
938.6
162.2
361.7
-
-
-
-
3.9
1,466.3
9.7%
HC.5 Medical goods (not specified by function)
639.6
544.1
-
369.3
-
-
-
3.9
1,556.9
10.3%
HC.6 Preventive care
Healthcare Functions (HC) by Healthcare Providers (HP)
HC.1 Curative care
HC.1.1.9 Inpatient care not specified HC.1.2 Day curative care
HC.1.3.3 Specialised outpatient curative care HC.1.3.9 Outpatient care not specified HC.1.4 Home-based curative care
118.3
11.6
-
-
7.0
-
-
-
137.0
0.9%
HC.7 Governance and health system and financing administration
-
-
-
-
-
846.9
-
-
846.9
5.6%
HC.9 Other health care services not elsewhere classified (n.e.c)
-
3.8
-
-
-
-
-
3.4
7.2
0.05%
9,052.7
2,073.2
496.2
369.3
7.0
846.9
2,223.7
41.8
15,111.0
59.9%
13.7%
3.3%
2.4%
0.05%
5.6%
14.7%
0.3%
Current Health Expenditure (CHE)
Figure 4.12 Current health expenditure by healthcare functions (HC) and healthcare providers (HP) (in Million QAR)
100.0%
4. Qatar System of Health Accounts 2013: Findings
Hospitals in Qatar provide a full spectrum of healthcare functions. The inpatient curative care (HC.1.1) 4.61 billion represents just over a half (51%, or 30.5% of CHE) of total healthcare expenditure at the hospitals; outpatient (HC.1.3) and day care (HC.1.2) amounted to 2.42 billion QAR (26.7%, or 16% of CHE). The expenditure on inpatient and outpatient specialized curative care provided in hospital setting amounted to 5.10 billion QAR (56.3%, or 33.7% of CHE). Ancillary Services (HC.4) and Medical goods (HC.5) amounted to 0.94 and 0.64 billion respectively (see Figures 4.12 and 4.13). Government schemes (HF.1) financed 64.1% of revenues on hospitals (HP.1), 11.8% on providers of ambulatory care (HP.3) and 16.1% on providers abroad (HP.9). Households spent 0.4 billion (42.4%) on services from hospitals, and 0.1 billion (13.9%) on providers of ambulatory services. Combining with findings presented in Figure 4.9 where 0.4 billion QAR (41.9%) of expenditure under HH OOP scheme was allocated to outpatient curative care, suggests that households prefer to obtain outpatient services from hospitals rather than from ambulatory care providers. This was observed in QNHA 2012 and is also supported by the results of HUES 2012 and HUES 2014.
4.9% Other Care (HC.2, HC.3, HC.6) HC.5 7.1% Medical goods (not specified by function) HC.4 10.4% Ancillary services (not specified by function)
HC.1.3 25.1% Outpatient curative care
HC.1.1 51.0% Inpatient curative care HC.1.2 3.6% Day Curative care
Figure 4.13 Structure of expenditure of HP.1 Hospitals
41
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Qatar National Health Accounts Report 2013
Healthcare financing schemes (HF)
SHA CODES and Health Care Providers
HF.1.1 Government schemes
HF.1.2 Compulsory contributory health insurance schemes
HF.2 Voluntary health care payment schemes
HF.3 Household out-ofpocket payment
HF.4 Rest of the world financing schemes (non resident) HF.4.2.1 Voluntary health insurance schemes (nonresident)
Total
Share of (%) CHE
HF.1.1.1 Central governmental schemes
HF.1.2.1 Social health insurance schemes
HF.2.1.1.3 Other primary coverage scheme
HF.2.2.1 NPISH financing schemes (excluding HF.2.2.2)
HF.2.3.1 Enterprises (except Health care providers) financingschemes
HF.3.1 Out-ofpocket excluding cost sharing
8,047.2
32.1
410.0
3.9
29.4
438.1
92.0
9,052.7
59.9%
5,197.4
32.1
410.0
-
29.4
375.8
92.0
6,136.7
40.6%
-
-
-
-
-
-
-
-
2,849.8
-
-
-
-
62.3
-
2,912.1
19.3%
HP.1.9 Hospitals not specified
-
-
-
3.9
-
-
-
3.9
0.03%
HP.2 Residential long-term care facilities
-
-
-
-
-
-
-
-
-
1,477.8
-
172.2
-
279.8
143.4
-
2,073.2
13.7%
HP.3.1 Medical practice
85.0
-
-
-
-
5.9
-
90.8
0.6%
HP.3.2 Dental practice
-
-
74.4
-
-
0.1
-
74.4
0.5%
1,350.0
-
97.9
-
279.8
137.4
-
1,865.1
12.3%
42.8
-
-
-
-
-
-
42.8
0.3%
411.9
-
84.1
-
-
0.2
-
496.2
3.3%
HP.4.1 Providers of patient transportation and emergency rescue
411.9
-
-
-
-
-
-
411.9
2.7%
HP.4.2 Medical and diagnostic laboratories
-
-
84.1
-
-
0.2
-
84.3
0.6%
HP.5 Retailers and other providers of medical goods
-
-
115.4
0.1
-
253.9
-
369.3
2.4%
HP.6 Providers of preventive care
-
-
7.0
-
-
-
-
7.0
0.05%
604.9
49.1
192.9
-
-
-
-
846.9
5.6%
HP.9 Rest of the world
2,018.6
-
46.4
3.2
-
155.5
-
2,223.7
14.7%
HP. Nsk Providers not specified by kind
-
-
-
-
-
41.8
-
41.8
0.3%
Current expenditure on health (CHE)
12,560.4
81.2
1,028.1
7.2
309.2
1,032.9
92.0
15,111.0
100.0%
HP.1 Hospitals
HP.1.1 General hospitals
HP.1.2 Mental health hospitals HP.1.3 Specialised hospitals (other than mental health hospitals)
HP.3 Providers of ambulatory health care
HP.3.4 Ambulatory health care centres HP.3.5 Providers of home health care services HP.4 Providers of ancillary services
HP.7 Providers of health care system administration and financing
Figure 4.14 Current health expenditure by financing schemes (HF) and healthcare providers (HP) (in Million QAR)
4. Qatar System of Health Accounts 2013: Findings
OBSERVED TREND Figure 4.15 shows healthcare functions dimension of the overall health care financing growth. Prior discussing the results, the differences in the methodologies adopted in previous reports need to be outlined. As discussed in the Methodology Section 3, QNHA 2013 is more in line with the current costing standards being rolled out across Qatar healthcare system under the requirements of the NHIS. In this regard, the findings of QNHA 2013 are more aligned with the results of QNHA 2011 for the dynamic analysis of healthcare functions and providers. The proportionate to direct costs allocation of the overheads and indirect expenditure as adopted in QNHA 2013 30 affects two distributions : the relative weights of inpatient and outpatient healthcare functions; and hospital versus ambulatory care financing. Given consistency of QNHA 2013 with the costing standards and closer alignment with the 2011 results, the dynamics of the current health expenditure is assessed against QNHA 2011 findings.
• Over two years, the expenditure on inpatient curative care has grown on average at 34.4 per cent per annum from 3.75 billion QAR in 2011 to 6.75 billion QAR in 2013. • The expenditure growth on outpatient care was less pronounced at 11.8 per cent per annum from slightly over 3.0 billion QAR to 3.8 billion QAR. Ancillary services and Medical goods grew at the second highest rate of growth of 27.8 per cent per annum, from 1.9 billion QAR to slightly over 3.0 billion QAR.
20,000
1038 3,150
15,000
716 847 3,254
2,122
10,000 1,724 550 543
5,000
2,015
1,382 683 915
770 592
854 446
3,023
1,946
1,851
3,760
Inpatient (HC.1.1) Outpatient (HC.1.3)
4,092
2,083
Ancillary services & Medical goods (HC.4 & HC.5)
3,007 2,447
2,253
2,097
2,214
3,746
4,551
6,765
2009
2010
2011
2012
2013
Governance & administration (HC.7)
Figure 4.15 Comparison of healthcare financing by healthcare functions and years (in million QAR)
Rest of healthcare functions (HC.1.2, HC.2, HC.3, HC.6) Gross capital formation
43
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Qatar National Health Accounts Report 2013
Figure 4.16 illustrates changes in the structure of THE by healthcare functions between 2009 and 2013. Compared to 2011, the structure of the THE changed towards lower share of the outpatient expenditure and rising importance of the inpatient care. The share expenditure on the administrative functions is declining, while ancillary services and medical goods are relatively stable.
Figure 4.17 illustrates the trend in current health care expenditure by health care provider. Compared to 2011, the financing of all providers, except for the providers of administrative and governance functions was growing at a double digit rate: hospitals funding grew at 26.6 per cent per annum, ambulatory care providers at 20.5 per cent per annum and all other services at 21.8 per cent per annum. The financing of providers of healthcare administration and governance increased grew at a substantially moderate rate of 4.8 per cent per annum.
100% 14.5%
80%
18.4% 5.9% 5.8%
7.2% 9.6%
60% 21.5%
17.3%
17.6% 21.5% 6.4% 4.9%
5.6% 2.9%
15.3%
12.9%
24.9%
27.0%
4.6% 3.9%
16.6%
21.9%
40%
Inpatient (HC.1.1)
20.6%
26.1%
Outpatient (HC.1.3) Ancillary services & Medical goods (HC.4 & HC.5)
23.6%
20%
Governance & administration (HC.7)
22.4%
23.2%
31.0%
30.1%
37.0%
2009
2010
2011
2012
2013
Rest of healthcare functions (HC.1.2, HC.2, HC.3, HC.6) Gross capital formation
Figure 4.16 Structure of total healthcare expenditure by healthcare functions and years
20,000
15,000
847
775
10,000
3,138
2,073
771 3,239 693 1,161
5,000
1,044
822
2,117
1,196
1,427
1,094
3,122
Hospitals Ambulatory Ancillary, retailers and others 4,754
5,036
5,651
4,754
9,053
2009
2010
2011
2012
2013
Figure 4.17 Comparison of current healthcare expenditure by healthcare providers and years (in million QAR)
Administration and financing
4. Qatar System of Health Accounts 2013: Findings
CROSS COUNTRY COMPARISON Compared to the OECD countries, the relative financing of hospital providers versus ambulatory providers is clearly skewed toward in-hospital provision of all curative care, including inpatient and outpatient: hospitals in Qatar receive almost half of all funding (49.6% of total health expenditure) – compared to 37.1% average OECD, while providers of ambulatory care receive 14.1% (compared to average of 27.9% in OECD). More detailed analysis of the services provided by Hospitals shows that hospitals in Qatar spend 30.5% (of CHE) on inpatient care and 15.0% (of CHE) on outpatient care. This is compared to 25.0% and 6.7% to hospitals provision in OECD respectively (on average). This is also consistent with the hypothesis of population preferences for hospital provision of outpatient services in Qatar.
Payments to Hospitals
Inpatient
Payments to Ambulatory Care providers
Outpatient
49.6
50.0
35 33.0
47.0
30.5 30 40.0 37.1
38.5
25.0
25 30.0
27.9
20 16.9
22.7
15
20.0
15.0
17.7
12.3
14.1
10 6.7
10.0
5 1.3
0
0 Qatar
Lowest Quantile, OECD
Average, OECD
Figure 4.18 Payments to Hospitals and to Ambulatory care providers (% of THE): Qatar (2013) and OECD (2012-13)
Highest Quantile, OECD
Source: Source: Current report, OECD iLibrary [21]
Qatar
Lowest Quantile, OECD
Figure 4.19 Share of Inpatient and Outpatient services (% of CHE):Qatar (2013) and OECD (2012-13)
Average, OECD
Highest Quantile, OECD
Source: Source: Current report, OECD iLibrary [21]
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4.3 FACTORS OF HEALTH CARE PROVISION MAIN FINDINGS Expenditure by healthcare providers related to labour costs (FP.1) reached 8.1 billion QAR (62.9% of CHE internal to 31 Qatar healthcare system ), corresponding to 13.7% per annum growth rate compared to 2011 estimates and is 32 linked to the growing healthcare workforce .The growth in Materials and Services (FP.3) increased from 2.55 to 3.98 billion QAR (30.9% of domestic CHE and growth at 24.9% per annum). Consistent with previous years, estimated consumption of fixed capital is relatively small at 0.37 billion QAR. The accurate representation of fixed capital consumption still represents the challenge in composition of heath accounts: the approach to evaluating economic value of capital consumption is being developed.
2012 Billion QAR
2013 Billion QAR
Growth %
6.27
8.11
+13.7
and Services Used
2.55
3.98
+24.9
FP.4 Consumption of Fixed Capital
0.18
0.37
+43.5
FP.5 Other items
0.05
0.43
+180.8
Qatar
FP.1 & FP.2 Compensation of Employees and Self-Employed
2.9% FP.4 Consumption of fixed capital
3.3% FP.5 Other items of spending on inputs
FP.3 Materials
30.9% FP.3 Materials and services used
62.9% FP.1 Compensation of employees
Figure 4.20 Factors of Provision
4. Qatar System of Health Accounts 2013: Findings
HP.1 Hospitals
HP.3 Providers of ambulator health care
HP.4 Providers of ancillary services
HP.5 Retailers and other providers of medical goods
HP.6 Providers of preventive care
HP.7 Providers of health care system administration and financing
HP.9 Rest of the world
HP. Nsk Providers not specified by kind
Total
Share (%) of CHE
Share (%) of CHE FP.M
5,950.3
1,216.7
346.2
-
-
596.1
-
-
8,109.4
53.7%
62.9%
FP.1.1 Wages and salaries
3,386.0
983.5
217.2
-
-
466.7
-
-
5,053.4
33.4%
39.2%
FP.1.2 Social contributions
63.7
0.4
2.1
-
-
-
-
-
66.3
0.4%
0.5%
2,500.6
232.8
126.9
-
-
129.4
-
-
2,989.7
19.8%
23.2%
-
-
-
-
-
-
-
-
-
-
-
2,396.5
849.6
108.1
369.3
7.0
250.8
-
-
3,981.3
26.3%
30.9%
29.0
298.0
18.3
-
-
-
-
-
345.3
2.3%
2.7%
1,460.7
359.0
41.8
369.3
7.0
21.5
-
-
2,259.3
15.0%
17.5%
FP.3.2.1 Pharmaceuticals
695.6
351.6
23.8
100.6
-
21.5
-
-
1,193.1
7.9%
9.3%
FP.3.2.2 Other health care goods
765.1
7.4
18.0
268.7
7.0
-
-
-
1,066.2
7.1%
8.3%
FP.3.3 Non-health care services
420.5
177.6
30.4
-
-
177.3
-
-
805.8
5.3%
6.3%
FP.3.4 Non-health care goods
Factors of Provisions (FP) by Healthcare Providers (HP)
FP.1 Compensation of employees
FP.1.3 All other costs related to employees FP.2 Self-employed professional remuneration FP.3 Materials and services used FP.3.1 Health care services FP.3.2 Health care goods
486.3
15.0
17.6
-
-
52.1
-
-
571.0
3.8%
4.4%
FP.4 Consumption of fixed capital
346.8
4.1
19.9
-
-
-
-
-
370.9
2.5%
2.9%
FP.5 Other items of spending on inputs
359.1
2.7
22.0
0.1
-
0.04
-
41.8
425.7
2.8%
3.3%
-
-
-
-
-
-
2,223.7
-
2,223.7
14.7%
9,052.7
2,073.2
496.2
369.3
7.0
846.9
2,223.7
41.8
15,111.0
100.0%
FP.M Factors of provision by the RoW Current expenditure on health (CHE)
Figure 4.21 Expenditure of healthcare providers (in Qatar) by type of providers and factors of provision (in Million QAR)
100.0%
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Qatar National Health Accounts Report 2013
4.4 GROSS CAPITAL FORMATION MAIN FINDINGS GCF expenditure totaled 3.15 billion QAR in 2013, with 93.3% of this relating to investment in hospitals.
Healthcare providers (HP)
Gross Capital Formation (HK) by Healthcare Providers (HP)
HP.3 Providers of ambulatory health care
HP.1 Hospitals
HP.7 Providers of health care system administration and financing Total
Share (%) of GCF
HP.1.1 General hospitals
HP.1.3 Specialised hospitals (other than mental health hospitals)
HP.3.1.1 Offices of general medical practitioners
HP.3.4.9 All other ambulatory centres
HP.7.1 Government health administration agencies
1,716.6
1,221.6
23.5
170.5
18.0
3,150.1
1,716.4
1,221.6
23.5
170.5
18.0
3,149.9
100.0%
1,390.6
1,218.1
11.2
141.4
1.5
2,762.9
87.7%
HK.1.1.1.1 Residential and non-residential buildings
1,388.9
1,218.1
10.8
141.4
1.5
2,760.8
87.6%
HK.1.1.1.2 Other structures
1.7
-
0.3
-
-
2.1
0.1%
226.3
3.5
10.8
26.6
7.9
275.1
8.7%
HK.1.1.2.1 Medical equipment
158.2
3.5
9.0
15.2
4.3
190.2
6.0%
HK.1.1.2.2 Transport equipment
38.2
-
1.1
-
-
39.3
1.2%
HK.1.1.2.3 ICT equipment
0.4
-
0.2
8.2
0.01
8.8
0.3%
HK.1.1.2.4 Machinery and equipment n.e.c.
29.4
-
0.5
3.2
3.6
36.7
1.2%
99.6
-
1.5
2.4
8.6
112.0
3.6%
HK.1.1.3.1 Computer software and databases
99.6
-
1.3
2.4
8.6
111.8
3.6%
HK.1.1.3.2 Intellectual property products n.e.c.
-
-
0.1
-
-
0.1
0.005%
0.1
-
-
-
-
0.1
0.005%
54.5%
38.8%
0.7%
5.4%
0.6%
HK.1 Gross capital formation HK.1.1 Gross fixed capital formation HK.1.1.1 Infrastructure
HK.1.1.2 Machinery and equipment
HK.1.1.3 Intellectual property products
HK.1.2 Changes in inventories Gross capital formation (%)
Figure 4.22 Expenditure on gross capital formation by healthcare providers (in Million QAR)
100.0%
4. Qatar System of Health Accounts 2013: Findings
OBSERVED TREND Unlike Current Health Expenditure, Gross Capital Formation is driven by future healthcare demand. The first significant increase in capital formation was observed in 2012 (from 2.12 billion QAR in 2011 to 3.25 billion QAR). In 2013 Qatar invested a comparable amount of 3.15 billion QAR. Most of capital formation is focused on the buildup of infrastructure with 2.8 billion QAR (87.7% of GCF) being invested in building hospitals and medical centers. In 2013, the infrastructure of general - extension of Hamad General Hospital surgery expansion, among others - and specialized - naufar, TB unit at Rumailah Hospital among others - hospitals was extended by 1.7 billion and 1.2 billion respectively. The expenditure for capital formation for four medical centers was 0.17 billion QAR.
It is expected that Qatar will continue expanding its healthcare capital formation at the pace needed to meet the demand. According to the SCH Annual Report 2013 [4], between 2014 and 2022, additional four Medical Commission centers, 17 health centers, 7 hospitals and 13 other specialized healthcare facilities are planned to be put in place in order to meet the projected healthcare demand. The forthcoming SCH Annual Report 2014 [22] provides updated status of health infrastructure.
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Qatar National Health Accounts Report 2013
DISCUSSION AND POLICY IMPLICATIONS
5. Discussion and Policy Implications
NATIONAL HEALTH STRATEGY: GOAL 6 ‘EFFECTIVE AND AFFORDABLE HEALTH SERVICES’ The healthcare system in Qatar is in the stage of rapid transition. The health expenditure have been rising
The reporting year – 2013 – has witnessed the first stage of implementation of NHIS-Seha and put the
at high growth rates over the past two years. The growth in healthcare expenditure were due to a number of factors, including increasing population size and investments – both human and capital – required for the transitioning towards enhanced healthcare system. The Government of Qatar financed most of these healthcare expenditure to support the transition and to ensure the commitment to the universal health coverage of rapidly growing population.
foundations of future healthcare financing in Qatar in place.
The transition and future healthcare system will be supported by new financing mechanisms, including activity-based funding enhanced by quality incentives, and performance-based budgeting. These financing mechanisms will be able to align the healthcare providers’ behaviours and healthcare demand management with the national goals and priorities to achieve effective and affordable healthcare accessible to all residents.
This section discusses these major policy developments in the healthcare financing as of 2013, outlines further directions and potential challenges as relevant to the healthcare financing.
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Qatar National Health Accounts Report 2013
SUMMARY OF HEALTHCARE FINANCING INDICATORS Key health financing sector indicators are presented in Figure 5.1. Parameters and indicators
2012
2013
QAR
USD$
QAR
USD$
GDP (in millions of currency)
700,345
192,402
739,775
203,235
General government total expenditure (in millions of currency)
220,012
60,443
204,659
56,225
Current health expenditure (CHE) (in millions of currency)
11,889
3,266
15,111
4,151
Gross capital formation (GCF) (in millions of currency)
3,253
894
3,150
865
Total health expenditure (THE) (in millions of currency)
15,142
4,160
18,261
5,017
General Government expenditure on health (GGHE) (in millions of currency)
12,663
3,479
16,043
4,407
Private expenditure on health (PvtHE) (in millions of currency)
2,480
681
2,218
609
HH OOP healthcare expenditure (in millions of currency)
1,294
355
1,033
284
Population
1,832,903
2,003,700
Population Adjusted
1,024,610
1,120,087
Figure 5.1 Key expenditure indicators by currencies
Per capita indicators
OECD, 2012/13
GCC, 2012
Based on actual population estimates
QAR
US$
QAR
US$
US$, PPP
US$
Current health expenditure (CHE)
6,486
1,782
7,542
2,072
3,482
Gross capital formation (GCF)
1,775
488
1,572
432
37
Total health expenditure (THE)
8,261
2,270
9,114
2,504
3,519
1,276
General Government expenditure on health (GGHE)
6,909
1,898
8,007
2,200
2,516
1,002
Private expenditure on health (PvtHE)
1,353
372
1,107
304
1,003
274
759
208
515
142
590
170
Total health expenditure (THE)
14,779
4,060
16,303
4,479
Current health expenditure (CHE)
11,604
3,188
13,491
3,706
General Government expenditure on health (GGHE)
12,359
14,323
3,935 OECD
GCC
HH OOP Healthcare expenditure
Qatar, 2012
Qatar, 2013
Based on adjusted population estimates
Health expenditure ratios
3,395 Qatar, 2012
Qatar, 2013
Total health expenditure, as % of GDP
2.2%
2.5%
9.3%
2.9%
GGEH, as % of THE
83.6%
87.9%
72.3%
76.0%
GGEH as % of General government expenditure
5.8%
7.8%
HH OOP healthcare expenditure as % of THE
8.5%
5.7%
19.1%
HH OOP healthcare expenditure as % of CHE
10.9%
6.8%
19.8%
Figure 5.2 Key per capita indicators: Qatar, OECD and GCC
7.6% 14.8%
Source: WHO [20], OECD [21], MDPS [28]
5. Discussion and Policy Implications
During 2013, total health expenditure in Qatar increased by 20.6% from 15.14 to 18.26 billion QAR. In macroeconomic terms, this represents a rise from 2.2% of GDP in 2012 to 2.5% in 2013. Similar indicators for the GCC region and OECD in 2012 were 2.9% and 9.3% of GDP respectively. As with the GCC region overall, GDP does not necessarily represent the best indicator for Qatar due to its high levels of GDP (compared to the population base). The per capita indicators are more illustrative, especially once demographic structure of Qatar is accounted for. The unadjusted THE per capita expressed in current US$ was 2,504 in 2013 (up from 2,270 in 2012, or 10.3% growth), while THE per capita for the overall GCC was 1,276 US$. 34 The closest indicator for the OECD region evaluated at the purchasing-power parity (PPP) was 40.5% higher at 35 3,519 US PPP . Overall the healthcare expenditure have been increasing at a two-digit growth rates over the last two years (25% in 2012 and 20% in 2013). The statistics for the healthcare activity suggest that growth in all hospitals admissions increased by 36 37 9.7% and 8.3% (in 2012 and 2013 respectively), compared to the population growth rates of 5.8% and 9.3% [5].
During 2013, the growth in inpatient admission was also accompanied by the growth in the average length of stay (12.4%) and bed occupancy (17.4%). At the same time, the utilization of the outpatient services and primary healthcare have fallen by 1.5% and 13.4% respectively. These numbers point to an increasing pressure on the hospital inpatient services as well as the need to analyze the structural reasons for increasing demand for healthcare services and the role 38 of medical inflation . The healthcare sector of Qatar continues to be funded mostly by the Government, with General Government 39 Expenditure on Health increasing to 87.9% of the total health expenditure, or 7.8% of the total government budget. In turn, the role of household out-of-pocket expenditure appears to be lower compared to the previous 40 years , falling from 8.5% to 5.7% in 2013 (or 759 QAR to 515 QAR in per capita terms). Analysis of healthcare financing scheme revenue components by private sources (Figure 5.3) indicates that:
2,500 2,279 2,149
2,236 2,066
2,023 2,000
1,500
1,000
500 PHI 540
1,483
2009
623
1,526
2010
629
1,650
2011
Figure 5.3: Structure of healthcare financing scheme: private revenues (million QAR)
942
1,294
2012
1,028
1,038
2013
OOP Total
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Qatar National Health Accounts Report 2013
• The total amount of prepayments (to voluntary health insurance schemes) and household’s payments remained within a range of 2.00-2.30 billion QAR over the last 5 years with a slight downward trend
• Genuine reduction in OOPs: the results of the HUES 2012 and HUES 2014 show that healthcare coverage has been expanding in Qatar. This expansion comes from:
• Prepayments (pooled private financing) increased steadily from 0.54 billion QAR in 2009 to 1.03 billion QAR in 2013
- a greater utilization of medical cards (issued by HMC and PHCC for the access to the publicly funded healthcare at a nominal fee),
• By 2013, the roles of private health insurance financing and household out-of-pocket expenditure were approximately equal
- increasing coverage by the private healthcare insurance (according to the insurers reports collected for the QNHA 2013, an average 44 number of enrollees increased by 13.0% between 2012 and 2013)
The reduction in households OOP can be explained by a number of factors: • Consistent methodological improvements in OOP estimations: - in 2012 OOPs were estimated based on a comprehensive, representative of all population 41 groups, household survey , compared to internet42 based survey in 2011 which did not reach out to all population groups; - in 2013, the major bulk of the OOPs is estimated 43 based on the providers data , thus achieving a greater degree of accuracy. The expenditure at private outpatient clinics and pharmacies were approximated using HUES 2014, with the adjustment to 2013 calendar year.
- NHIS-Seha roll-out – which during 2013 covered all Qatari females aged 12 and above for the maternity and reproductive health and by May 2014 covered all Qatari Nationals for the comprehensive benefits package;
5. Discussion and Policy Implications
NATIONAL HEALTH INSURANCE SCHEME - SEHA
SEHA - FUNDING MECHANISMS
A major driver of reform in the Qatar health sector was and continues to be the provision of universal health coverage through the mandatory National Health Insurance Scheme.
ACTIVITY-BASED FUNDING
The first phase of the NHIS-Seha was launched in July 2013 and covered Qatari women 12 years and above for maternity and reproductive healthcare related services as well as newborns. The Scheme proved to be very popular and supported by the members: according to an 45 independent survey by the Qatar Statistics Authority , 84% of its participants responded that NHIS had fully met or exceeded their expectations. In addition to providing the curative care, Seha runs a 46 number of Disease Management Programs , including Maternity, Diabetes Programs and most recently Ischemic Heart Diseases. The Programs proved to be affective: 89% of members enrolled in Maternity DMP reported behavioural, dietary and awareness changes as a result of the Program.
HEALTHCARE EXPENDITURE NHIS-Seha was operational for just under six months during the reporting period. During that period, a range of healthcare services related to reproductive health, both inpatient and outpatient, were purchased from private providers and shadow-billed with the public providers. Even though the estimated results of the QNHA 2013 show a substantial proportion of actual expenditure of the NHIC being directed to the administrative costs, this cannot be taken out of context of building up, maintaining and ramping up the capacities for the initiation, implementation and expansion of Seha in both beneficiaries and providers dimensions. Over the period of July 2013 to April 2014, the NHIS-Seha has expanded its membership platform from zero to the member size comparable to the overall private health insurance market. Clearly, the QNHA 2014 will show further significance of the NHIS-Seha role in healthcare financing in Qatar.
Since the commencement of the National Health Insurance Scheme in July 2013, Qatar implemented an activity based funding model, joining over 30 countries worldwide. The first Fee Schedule was mainly based on a local bottomup costing methodology encompassing both public and private hospital providers. The country was also the first to introduce its own outpatient classification system (Qatar Outpatient Classification System) as part of the strategy towards establishing and implementing prospective reimbursement mechanisms. As emphasized in QNHA 2012 and many other documents, the activity based funding: • Provides transparency on current healthcare utilisation, efficiency, quality, safety and equity in provision of healthcare, and access to health services • Allows for robust projections built on solid healthcare fundaments (compared to line-item budgeting mechanisms) • Informs decision-making at the national level, and • Drives system improvement across the national health sector.
QUALITY ENHANCEMENT In the subsequent years, the activity-based budgeting will be further supported by the quality-enhancing incentives. Part of healthcare quality infrastructure is being implemented through the Health Service Performance Agreement (HSPA). The HSPA currently includes 25 and 15 key performance indicators for hospitals and primary healthcare. The financial incentives linked to the provision of high quality healthcare services will be introduced in the subsequent years. We anticipate that these incentives will be implemented first in areas of strategic importance (for example high burden of diseases), where there is a pressing need to improve the healthcare quality and reduce variation among the providers; and where the most accurate and complete data are available to assess the quality and its dynamics in unbiased manner.
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Qatar National Health Accounts Report 2013
HEALTHCARE EXPENDITURE
HEALTHCARE EXPENDITURE
The underlying standardized Fee Schedules allow for better understanding and control over medical inflation, assessment of and boost in productivity and efficiency, and alignment of financing incentives with the national healthcare goals and objectives. A move to the health insurance-based system also benefits tremendously to the accuracy, quality and timeliness of the healthcare data collection and standardization. We anticipate a swift improvement in data reporting and collection over the period 2014 and 2015.
Contrary to many countries in the world, especially the OECD countries which had been implementing austerity measures, including in the healthcare sector, the prime motivation behind the health sector reforms in Qatar was not for the cost containment, but achieving the valuefor-money in healthcare spending. The move towards activity-based funding and performance-based budgeting will allow to maximize healthcare outcomes with the costefficient provision of healthcare. In the years to come, the financing mechanisms will operate from the position of cost management, strongly supported by the Health Technology Assessment principles and guidelines.
The financing mechanisms underpinning the NHIS-Seha, together with the Performance-Based Budgeting will also lead to accurate, easily tractable and fast understanding of links between healthcare expenditure and health outcomes.
PERFORMANCE-BASED BUDGETING In another stream to ensure the financing mechanisms achieve effective and affordable care, the public healthcare sector is moving towards the performance-based budgeting with the pilot operations across SCH, HMC and PHCC scheduled for 2015. This development will shed a significant light on the performance of the healthcare sector in the public landscape and will show the paths for improvement by linking healthcare outcomes with the funding. Upon completion of this project and a full roll-out of the performance-based budgeting which is expected to coincide with the end of the transition, the funding of the public healthcare providers will be a combination of the activity-based funding with the performance based budgeting.
CAPITAL FORMATION The Qatar Healthcare Facilities Master Plan (QHFMP) will be a guiding plan to expand the healthcare facilities supported by the Qatar Certificate of Needs (QCON) program. The QHFMP and QCON are concerned with both physical infrastructure as well as large-scale medical equipment. The current infrastructure investment plans include construction of new hospitals dedicated to serve the needs of the expatriate labour population who work in high risk and physically demanding occupations. The opening of these new facilities is intended to coincide with the extension of Seha to cover this population group. In addition to hospitals, numerous medical centers (mostly with primary healthcare focus) are expected to be opened as well.
5. Discussion and Policy Implications
HEALTHCARE EXPENDITURE
CONCLUDING REMARKS
We anticipate that the investments in capital healthcare infrastructure will continue in the foreseeable future. To optimize the use of the capital investments, QHFMP and QCON will look and assess the need for new capital program in a holistic manner where both current and future projected capacities of the overall healthcare sector are scrutinized against the healthcare demand and long-term term objectives of the State of Qatar.
Overall the healthcare expenditure have been increasing at a two-digit growth rates over the last two years (25% in 2012 and 20% in 2013). Contrasting these numbers against the healthcare activity and efficiency indicators (see section 5.1 and forthcoming Qatar Health Report 2013) suggest an increasing pressures on hospital services, and the need to understand and resolve remaining challenges in the healthcare structure.
TREATMENT ABROAD
With prices for the providers participating in NHIS-Seha being regulated at the national levels as per the fee schedules, we do not anticipate an exaggerated pressure on medical inflation in the coming years. However SCH will continue a close monitoring and understanding of the underlying contributors to the medical inflation against the fee schedules, population growth, healthcare demand and utilization and expansion of NHIS-Seha coverage to all population groups.
Treatment abroad continues to be a substantial item in healthcare expenditure. It has risen from 0.5 billion QAR in 2009 to 2.2 billion QAR in 2013. We anticipate that the need for Treatment Abroad will be reduced in the long-run with the improvements in Qatar’s healthcare capacities, its healthcare workforce and substantial advancements in healthcare research where Qatar participates and actively contributes to.
SCH will continue enhancing the assessment of productivity and efficiency in the healthcare system.
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Qatar National Health Accounts Report 2013
REFERENCES OECD, Eurostat, WHO, A System of Health Accounts, OECD Publishing, 2011.
[12] Supreme Council of Health, "Qatar Health Report 2011," SCH, Doha, 2013.
[2] UNDP, "Human Development Index Trends," 2013. [Online]. Available: http://hdr.undp.org/ en/content/table-2-human-development-indextrends-1980-2013,. [Accessed 31 December 2014].
[13] Supreme Council of Health, "Qatar Health Report 2012," SCH, Doha, 2013.
[1]
[3] The World Bank, "GNI per capita, Atlas method (current US$)," 2014. [Online]. Available: http:// data.worldbank.org/indicator/NY.GNP.PCAP.CD/ countries/QA--XR-1W-OE?display=graph. [Accessed 29 December 2014]. [4] Supreme Council of Health, "SCH Annual Report 2013," Supreme Council of Health, Doha, 2014. [5] Ministry of Development, Planning and Statistics, "Population and Social Statistics," 2014. [Online]. Available: http://www.qsa.gov.qa/eng/publication/ annabs/2014/1_Population2013.pdf. [Accessed 31 December 2014]. [6] Ministry of Development, Planning and Statistics, Population Structure, Doha: MDPS, 2013. [7]
World Bank, "World Development Indicators," January 2015. [Online]. Available: http://data.worldbank.org/ indicator/SP.POP.DPND. [Accessed January 2015].
[8] Supreme Council of Health, "National Health Insurance Scheme (SEHA) report (Stage 1)," SCH, Doha, 2014, unpublished. [9]
Supreme Council of Health, "Qatar National Health Accounts 2009-2010," SCH, Doha, 2011.
[10] Supreme Council of Health, "Qatar National Health Accounts Report 2012," SCH, Doha, 2014. [11] Supreme Council of Health, Qatar, "SCH Annual Report 2012," General Secretariat, Supreme Council of Health, Doha, 2013.
[14] Supreme Council of Health, "Qatar Health Report 2013," SCH, Doha, forthcoming. [15] Supreme Council of Health, "Qatar Healthcare Facilities Master Plan 2013-2033," SCH, Doha, 2014. [16] Supreme Council of Health, "Social Health Insurance: Ensuring healthcare for all. An overview of the National Health Insurance Scheme of Qatar," SCH, Doha, forthcoming. [17] Supreme Council of Health, "Qatar Healthcare Facilities Master Plan 2013-2033," SCH, Doha, 2014. [18] Supreme Council of Health, "Qatar Certificate of Need: Policies and Procedure Use Manual," SCH, Doha, 2015 (forthcoming). [19] Organization for Economic Cooperation and Development, "OECD iLibrary," OECD, 2015. [Online]. Available: http://www.oecd-ilibrary.org/social-issuesmigration-health/data/oecd-health-statistics_healthdata-en;jsessionid=16rtx25wab0zs.x-oecd-live-02. [Accessed January 2015]. [20] World Health Organization, "Global Health Expenditure Database," 2015. [Online]. Available: http://apps.who.int/nha/database/Select/Indicators/ en. [Accessed January 2015]. [21] OECD, "OECD iLibrary Health Statistics," OECD iLIbrary, [Online]. Available: http://www.oecd-ilibrary. org/social-issues-migration-health/data/oecd-healthstatistics_health-data-en. [Accessed January 2015].
References
[22] Supreme Council of Health, "SCH Annual Report 2014," SCH, Doha, forthcoming. [23] UNDP, "The Rise of the South: Human Progress in a diverse World," 2014. [Online]. Available: http://hdr. undp.org/en/content/human-development-indexhdi-table. [Accessed 29 December 2014]. [24] Ministry of Development, Planning and Statistics, "Household Income and Expenditure Survey 201220163," MDPS, Doha, 2014. [25] R. P. Rannan-Eliya, "Estimating out-of-pocket spending for national health accounts," World Health Organization, Geneva, 2010. [26] Ministry of Development, Planning and Statistics, "Consumer Price Index (CPI), December 2013," 15 January 2014. [Online]. Available: http:// www.qsa.gov.qa/eng/News/2014/related/3/CPI_ Desember_2013_eng.pdf. [Accessed January 2015]. [27] Ministry of Development, Planning and Statistics, "Consumer Price Index (CPI), December 2012," 09 January 2013. [Online]. Available: http://www.qsa. gov.qa/eng/FrequentData/CPI/2012/Dec/CPI-DEC2012-Eng.pdf. [Accessed January 2015]. [28] Ministry of Development, Planning and Statistics, "Window on Economic Statistics of Qatar, 9th issue: Q2 2014" October 2014. [Online]. Available http://www.qsa.gov.qa/eng/publication/economic_ publication/WindowOnEconomicStatistics/ WindowOnEconomicStatistics-9th-Issue-Q2-2014. pdf. [Accessed December 2014].
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Qatar National Health Accounts Report 2013
NOTES 1
The healthcare expenditure for the organizations which have not provided the required information on time have been estimated using historical and projected data available at the SCH at the time of writing this report. 2
3
www.aspirezone.qa www.qf.org.qa
4
ee http://www.nhic.qa/schedule-of-benefits-seha. S html for the Stage 2 benefit package.
15
By the end of 2014, more than 160 providers formed part of Seha network, including public and private hospitals, dental and optical providers. This is compared with 2013 Seha coverage for maternal and women-related healthcare utilization in public (HMC) and three private hospitals only.
16
Ministry of Development, Planning and Statistics.
17
The 2013-14 fiscal year was 1st April 2013– 31 March 2014.
18
y the end of 2014, NHIS-Seha’s providers network B had more than 160 private providers and all HMC network.
The naufar – a specialized ambulatory care facility and also has inpatient facilities – is expected to be open and fully functioning in 2015. Ashghal is the main construction developer of this facility.
6
19
5
The performance-based budgeting framework will be piloted in 2015. The fee-for-service payment mechanisms dominate in the private healthcare providers system.
This holds for all Treatment Abroad cases, irrespective of financing schemes. The only exception is Treatment Abroad financed by the households’ out-of-pocket expenditure in case of emergency admissions overseas.
8
20
9
21
7
The QHR 2013 (forthcoming) provides more focused discussion on the performance of the healthcare system. QCON is expected to be in the readiness phase during 2015. 10
Conducted by the SCH and SESRI in April-May 2014.
QNHA 2012 deviated from this methodology and classified HMC and PHCC as individual Financing Agents. The Qatar Foundation and Hamad Medical Corporation are involved in the cutting-the-edge modern healthcare research.
22
Conducted by the MDPS over September 2012 – August 2013 [24].
To the best of our knowledge, only Dubai Emirate of the United Arab Emirates have established the System of Health Accounts.
12
23
11
Rannan-Eliya (2010) shows that the discrepancy between expenditure estimates based on the surveys and on national accounts for selected countries varies between 1% and 73% [25].
13
This approach was followed in QNHA 2011 as well.
Information for the GCC countries is sourced from the WHO Global Expenditure Database [20].
24
Data for OECD countries are sourced from the OECD iLibrary Health Statistics [19].
25
14
The targeted outpatient private providers were the first members of the Seha providers network which joined during 2014.
26
See section 3.2.2 for the definition and derivation.
The approach used for the QNHA 2012 household out-of-pocket expenditure estimate.
Notes
27
Subject to data availability: GCF is reported across OECD countries for 2013; with Germany, Italy, Korea and Norway reported for 2012. 28
The access to the publicly funded healthcare was regulated through the Medical cards (issued either through the HMC or PHCC at negligible costs of 100QAR for an annual access; in 2013 HMC raised a mere 53 million QAR, or 0.4% of CHE, through the medical cards renewal). Medical cards will continue to co-exist alongside the expansion of the NHIS-Seha.
29
Includes private social insurance.
30
This does not affect the total (THE), current (CHE) and/or capital (GCF) expenditure.
31
CHE includes both domestic expenditure (12.89 billion QAR) and expenditure on treatment abroad (2.23 billion). All proportions presented in this section refer to domestic provision of healthcare.
32
According to the SCH Annual Report 2013 [4], the public healthcare sector (SCH, HMC and PHCC) grew by 8.1 per cent during 2013.
33
Latest GCC estimates are for 2012.
34
Direct comparison should be taken with caution: Qatar expenditure are evaluated at the fixed exchange rate of 3.64QAR per 1 USD, while OECD indicators are presented at the PPP rates.
35
Reported numbers for OECD are a mix of 2013 and 2012 data.
36
For 2012 healthcare sector statistics see Qatar Health Report 2012 [13].
37
For 2013 healthcare sector statistics see forthcoming Qatar Health Report 2013 [14].
38
The consumer price index for the medical care and medical services remained stable at 2.2 [27] and 2.1 [26] per cent per annum in 2012 and 2013.
39
Includes both current and capital expenditure of government and parastatal organizations such as Qatar Petroleum.
40
See section 2 on important methodological improvements compared to 2011 and 2012 reports, which also explains a lower estimate of out-of pocket expenditure.
41
Health Utilization and Expenditure Survey 2012 – see QNHA 2012 for more details.
42
Online Health Survey 2011 – see QNHA 2011 for more details.
43
HMC, PHCC, Aspetar, QP, private hospitals, QRC. The approximations remain for private clinics and pharmacies. The estimates for the latter are consistent with QNHA 2012.
44
For the comparison purposes, Seha membership in 2014 is approximately equal to the total size of the private health insurance market in 2013.
45
Currently known as Ministry for Development, Planning an Statistics (MDPS).
46
Maternity program was introduced in 2013 to support the first stage of Seha, Diabetes program followed later in 2014 to support the second stage of Seha.
47
The implementation assumes grace period from April 2014 to March 2015.
61
62
Qatar National Health Accounts Report 2013
ANNEXES KEY SHA 2011 CONCEPTS Term
Definitions
Basic price
The amount receivable by the producer from purchaser for a unit of goods or services produced as output minus tax payable and plus any subsidy receivable on the produces as a consequence of its production or sale.
Consumption of fixed capital
The consumption of fixed capital is defined as the decline, during the accounting period, in the current value of the stock of fixed assets owned by health care providers. The consumption of fixed capital is the result of physical deterioration, normal obsolescence or normal accidental damage.
Current health expenditure
Final consumption expenditure of resident units on health care goods and services irrespective of where the consumption takes place: it implies the inclusion of imports (from non-resident providers) and the exclusion of exports (provided to non-residents).
Day care
Planned medical and paramedical services delivered to patients who have been formally admitted for diagnosis, treatment or other types of health care but with the intention to discharge the patient on the same day.
Exports (of health care goods and services)
Health care goods and services acquired by non-residents from resident providers.
Factors of provision (FP)
Inputs used by [health care] providers to produce the goods and services consumed or the activities conducted in the system. Health care goods or services produced and imported in the economic territory and used by a resident to satisfy an individual or collective need.
Final consumption (of health care goods and services)
Final consumption equals to the total uses of health goods and services minus intermediate consumption by health care providers (“factors of provision”), gross capital formation and exports (goods and services consumed by non-residents).
Annexes
Term
Definitions
Final consumption expenditure (FCE)
Same as Current health expenditure (CHE). Includes three type of expenditure: • Household final consumption expenditure • General government final consumption expenditure • NPISH final consumption expenditure
Financing agents (FA)
Institutional units that administer health financing schemes in practice: collect revenues and/or purchase services.
Financing scheme (HF)
Health care financing schemes are structural components of health care financing systems: they are the main types of financing arrangements through which people obtain health services. Health care financing schemes include direct payments by households for services and goods and third-party financing arrangements. Third party financing schemes are distinct bodies of rules that govern the mode of participation in the scheme, the basis for entitlement to health services and the rules on raising and then pooling the revenues of the given scheme.
Health Care Function (HC)
Relates to the type of need a transaction or group of transactions aims to satisfy or the kind of objective pursued; it explains the health purpose of transactions in health care.
Gross capital formation (in health care) (HK)
Acquisition of produced assets (assets intended for use in the production of other goods and services over a period of one year or more) by health care providers; measured by the total value of this assets that providers of health services have acquired during the accounting period (less the values of the disposals of assets of the same type). It includes the following three components: • Gross fixed capital formation • Changes in inventories • Acquisitions less disposal of valuables
63
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Qatar National Health Accounts Report 2013
Term
Definitions
Home based care
Comprises medical, ancillary and nursing services that are consumed by patients at their home and involve the provider’s physical presence.
Household final consumption expenditure
Expenditure incurred by resident households for the individual consumption of goods and services, including consumption of goods and services acquired abroad.
Inpatient care
Formal admission into a health care facility for treatment and/or care that is expected to constitute an overnight stay.
Intermediate consumption (of health care good and services)
Health care goods and services that are consumed (used-up or transformed) in the production process of other health care goods and services.
Long term care
A range of medical and personal care services that are consumed with the primary goal of alleviating pain and suffering or managing the deterioration in health status in patients with a degree of longterm dependency.
Mode-of-provision categories
Mode-of-provision refers to specific organizational and technological arrangements of the services consumed and consists of four categories: inpatient, day care, outpatient and home-based care.
Non-market providers
Entities that provide services (or goods) either for free of charge or at prices that are not economically significant (when prices cover less than half the full cost of production), opposite to market providers providing services at economically relevant prices.
Annexes
Term
Definitions
Out of Pocket
Out of Pocket Payments (OOP) show the direct burden of medical costs that households bear at the time of service use based on the willingness and ability to pay of the individual or household. It is a voluntary payment based on the decision of the household to use the services, and therefore to pay for them. A payment by the individual is not always accounted as OOP because it may be reimbursed by voluntary insurance or covered by the Government (conditional cash transfers) or a domestic or foreign NGO. In these cases, the payment for the healthcare is technically made by the household, but not from the households pocket.
Outpatient care
Any care offered to a non-admitted patient regardless of where it occurs except the patient’s place of residence (the outpatient serviced may be delivered in the outpatient ward of a hospital, a dedicated hospital outpatient center, an ambulatory care center, a physician’s private office, or a health care practice with a work place, school or prison, or even on the street).
Prevention (health boundaries)
The health boundary for preventive services is defined as having the primary purpose of risk avoidance, of acquiring diseases or suffering injuries, which can frequently involve a direct and active interaction of the consumer with the health care system.
Prevention, primary
Involves specific measures aimed at avoiding diseases and risk factors in order to reduce the onset of a disease, diminish the number of new cases, and anticipate the emergence and lessen the severity of disease.
Prevention, secondary
Involves specific interventions aimed at the detection of disease and then therapy as early as possible.
65
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Qatar National Health Accounts Report 2013
Term
Definitions
Prevention, tertiary
Specific measures aiming at reducing the negative impact of an already established disease or injury by an attempt to avid worsening and complication.
Providers (HP)
Health care providers encompass organizations and actors that deliver health care goods and services as their primary activity, as well as those for which health care provision is only one among a number of activities.
Providers, health care system administration and financing
Establishments that are primarily engaged in the regulation of the activities of agencies that provide health care and in the overall administration of the health care sector, including the administration of health financing.
Providers, primary
Primary providers are those whose principal activity is to deliver health care goods and services as defined in the core functional classification.
Providers, secondary
Those that deliver health care services in addition to their principal activities, which might be partially or not at all related to health.
Purchaser’s price
The amount payable by the purchaser, excluding any deductible VAT or similar deductible tax, in order to take delivery of a unit of good or service at the time and place required by the purchaser.
Revenues of financing schemes (RS)
Revenue is an increase in the funds of a health care financing scheme, through specific contribution mechanisms. The categories of the classification are the particular types of transaction through which the financing schemes obtain their revenues. The objective of this classification is to group types of revenues of health financing schemes into mutually exclusive classes.
Annexes
Term
Definitions
Social health insurance
Financing arrangement that ensures access to health care based on a payment of a non-risk-related contribution by or on behalf of the eligible person.
Social protection scheme
A distinct body of rules, supported by one or more institutional units, governing the provision of social protection benefits and their financing.
Total health expenditure
Total Health Expenditure (THE) can be defined as the sum of current health expenditure and the expenditure related to the acquisition (less disposals) on capital goods. In the report the term THE is used to depict the sum of these two aggregates. The term of THE was used in SHA 1.0 as well – representing the sum of "current expenditure on health" and "gross capital formation". While the term is not recommended any more in SHA 2011 but still is used in international databases used for comparison purposes (WB, WHO, etc.), QNHA 2013 maintained this terminology. Transactions are valued activities that take place between different actors or organizations. Economic flow of a kind of formalized relationship between various units acting in the health care sector, that is, between consumers and providers, providers and financing units, or consumers and financing units. The following types of transactions can be distinguished in SHA:
Transaction
• Transactions in products (i.e. final consumption of health care goods and services) • Distributive transactions (transfers granted to households for the specific purpose of providing health care services to family members) • Financial transactions (acquisitions and disposals in financial assets and liabilities) • Other flows related to the consumption of fixed capital and acquisitions (less disposals).
Transactions, valued
Transactions under which payments are made to providers in exchange for health care goods and services received by consumers.
67
-
HF.2.1.1.3 Other primary coverage schemes
-
HF.2.3.1 Enterprises (except Health care providers) financing schemes
HF.2.3.2 Health care providers financing schemes
-
-
HF.2.2.2 Resident foreign government development agencies schemes
HF.2.3 Enterprises financing schemes
-
HF.2.2.1 NPISH financing schemes (excluding HF.2.2.2)
-
-
HF.2.1.2.2 Other complementary/supplementary insurance
HF.2.2 NPISHs financing schemes
-
HF.2.1.2.1 Community-based insurance
-
-
HF.2.1.1.2 Government-based voluntary insurance
HF.2.1.2 Complementary/supplementary insurance schemes
-
-
HF.2.1.1.1 Employer-based insurance (other than enterprises schemes)
HF.2.1.1 Primary/substitutory health insurance schemes
-
HF.2.1 Voluntary health insurance schemes
-
HF.1.3 Compulsory Medical Saving Accounts (CMSA) -
-
HF.1.2.2 Compulsory private insurance schemes
HF.2 Voluntary health care payment schemes
-
-
HF.1.2 Compulsory contributory health insurance schemes
HF.1.2.1 Social health insurance schemes
-
12,475.4
12,475.4
12,475.4
FS.1.1 Internal transfers and grants
HF.1.1.2 State/regional/local governmental schemes
HF.1.1.1 Central governmental schemes
HF.1.1 Government schemes
HF.1 Government schemes and compulsory contributory health care financing schemes
Revenues of the financing scheme (HF) by financing sources (FS)
SHA MATRIX 1: FS X HF (IN QAR MILLION)
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
81.20
81.20
-
-
-
81.20
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
84.98
84.98
84.98
-
-
-
-
-
-
-
-
-
1,028.1
-
-
1,028.1
1,028.1
1,028.1
-
-
-
-
-
-
-
-
FS.5.9 Other voluntary prepaid revenues n.e.c
FS.1.2 Transfers by government on behalf of specific groups
FS.1.4 Other transfers from government domestic revenue
FS.5 Voluntary prepayment
FS.1 Government
-
-
-
-
4.8
4.8
-
-
-
-
-
-
-
-
4.8
-
-
-
-
-
-
-
-
FS.6.1 Other revenues from households n.e.c.
-
309.2
309.2
-
2.4
2.4
-
-
-
-
-
-
-
-
311.6
-
-
-
-
-
-
-
-
FS.6.2 Other revenues from corporations n.e.c.
FS.6 Other domestic revenues n.e.c.
Financing sources (FS)
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
FS.7.3 Other direct foreign transfers (n.e.c.)
FS.7 Direct foreign transfers
-
309.2
309.2
-
7.2
7.2
-
-
-
1,028.1
-
-
1,028.1
1,028.1
1,344.5
-
-
81.2
81.2
-
12,560.4
12,560.4
12,641.6
Total
3,121.7 15,597.1
Gross capital formation (GCF)
Total health expenditure (CHE + GCF)
-
HF.4.2.2.3 Enclaves (e.g., international organizations or embassies) 12,475.4
-
HF.4.2.2.2 Foreign Development agencies schemes
Current expenditure on health (CHE)
-
-
HF.4.2.2 Other schemes (non-resident)
HF.4.2.2.1 Philanthropy/ international NGOs’ schemes
-
HF.4.2.1 Voluntary health insurance schemes (non-resident)
-
-
HF.4.1.2 Other compulsory schemes (non-resident)
HF.4.2 Voluntary schemes (non-resident)
-
-
HF.4.1.1 Compulsory health insurance schemes (non-resident)
HF.4.1 Compulsory schemes (non-resident)
-
-
HF.3.2.2 Cost sharing with voluntary insurance schemes
HF.4 Rest of the world financing schemes (non resident)
-
-
HF.3.2 Cost sharing with third-party payers
HF.3.2.1 Cost sharing with government/ CCHI schemes
-
-
FS.1.1 Internal transfers and grants
HF.3.1 Out-of-pocket excluding cost sharing
HF.3 Household out-of-pocket payment
Revenues of the financing scheme (HF) by financing sources (FS)
SHA MATRIX 1: FS X HF (IN QAR MILLION) Continued
81.2
-
81.2
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
85.0
-
85.0
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
1,028.1
-
1,028.1
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
FS.5.9 Other voluntary prepaid revenues n.e.c
FS.1.2 Transfers by government on behalf of specific groups FS.1.4 Other transfers from government domestic revenue
FS.5 Voluntary prepayment
FS.1 Government
1,037.7
-
1,037.7
-
-
-
-
-
-
-
-
-
-
-
-
-
1,032.9
1,032.9
FS.6.1 Other revenues from households n.e.c.
340.0
28.4
311.6
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
FS.6.2 Other revenues from corporations n.e.c.
FS.6 Other domestic revenues n.e.c.
Financing sources (FS)
92.0
-
92.0
-
-
-
-
92.0
-
-
-
-
92.0
-
-
-
-
-
FS.7.3 Other direct foreign transfers (n.e.c.)
FS.7 Direct foreign transfers
18,261.1
3,150.1
15,111.0
-
-
-
-
92.0
-
-
-
-
92.0
-
-
-
1,032.9
1,032.9
Total
Annexes 69
1,118.9
PHCC
-
FA.2 Insurance corporations
-
-
FA.1.9 All other general government units
FA.2.2 Mutual and other nonprofit insurance organizations
-
FA.1.3.2 Other social insurance funds
-
-
FA.1.3.1 Sickness funds
FA.2.1 Commercial insurance companies
-
-
FA.1.1.4 National Health Insurance Agency - NHIC
FA.1.3 Social security agency
-
FA.1.1.3 National Health Service Agency
-
109.9
FA.1.1.2.3 Armed Force and Amiri Guard
FA.1.2 State/ Regional/ Local government
127.3
FA.1.1.2.2 Ministry of Interior
237.3
8,118.0
HMC
FA.1.1.2 Other Ministries and public units
2,702.3
11,939.2
12,176.4
12,176.4
FS.1.1 Internal transfers and grants
SCH
FA.1.1.1 Supreme Council of Health (SCH, HMC, PHCC)
FA.1.1 Central government
FA.1 General Government
Financing agents (FA) by Financing Sources (FS)
-
-
-
-
-
-
-
-
81.2
-
-
-
-
-
-
-
-
81.2
81.2
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
1,028.1
1,028.1
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
FS.5.9 Other voluntary prepaid revenues n.e.c
FS.1.2 Transfers by government on behalf of specific groups FS.1.4 Other transfers from government domestic revenue
FS.5 Voluntary prepayment
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
FS.6.2 Other revenues from corporations n.e.c.
FS.6 Other domestic revenues n.e.c.
FS.6.1 Other revenues from households n.e.c.
Financing sources (FS)
FS.1 Government
SHA MATRIX 2: FS X FA (IN QAR MILLION)
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
FS.7.3 Other direct foreign transfers (n.e.c.)
FS.7 Direct foreign transfers
-
1,028.1
1,028.1
-
-
-
-
-
81.2
-
109.9
127.3
237.3
1,118.9
8,118.0
2,702.3
11,939.2
12,257.6
12,257.6
Total
-
FA.3.2.9 Other Corporations
3,121.7
15,682.0
Gross capital formation (GCF)
Total health expenditure (CHE + GCF)
-
FA.6.3 Other foreign entities
12,560.4
-
FA.6.2 Foreign governments
Current expenditure on health (CHE)
-
-
FA.6 Rest of the World
FA.6.1 International organizations
-
-
FA.5 Households
FA.4.1 Zakat Fund
-
-
FA.3.2.2 Qatar Petroleum
FA.4 Non-profit Institutions serving households (NPISHs)
-
383.9
383.9
383.9
FS.1.1 Internal transfers and grants
FA.3.2 Corporations (other than providers of health services)
FA.3.1.1 Aspire Zone Foundation
FA.3.1 Health management and provider corporations
FA.3 Corporations (other than insurance corporations)
Financing agents (FA) by Financing Sources (FS)
81.2
-
81.2
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
1,028.1
-
1,028.1
-
-
-
-
-
-
-
-
-
-
-
-
-
FS.5.9 Other voluntary prepaid revenues n.e.c
FS.1.2 Transfers by government on behalf of specific groups FS.1.4 Other transfers from government domestic revenue
FS.5 Voluntary prepayment
1,037.7
-
1,037.7
-
-
-
-
1,032.9
4.8
4.8
-
-
-
-
-
-
340.0
28.4
311.6
-
-
-
-
-
2.4
2.4
29.4
279.8
309.2
-
-
309.2
FS.6.2 Other revenues from corporations n.e.c.
FS.6 Other domestic revenues n.e.c.
FS.6.1 Other revenues from households n.e.c.
Financing sources (FS)
FS.1 Government
SHA MATRIX 2: FS X FA (IN QAR MILLION) Continued
92.0
-
92.0
92.0
-
-
92.0
-
-
-
-
-
-
-
-
-
FS.7.3 Other direct foreign transfers (n.e.c.)
FS.7 Direct foreign transfers
18,261.1
3,150.1
15,111.0
92.0
-
-
92.0
1,032.9
7.2
7.2
29.4
279.8
309.2
383.9
383.9
693.2
Total
Annexes 71
-
-
-
HF.2.2.1 NPISH financing schemes (excluding HF.2.2.2)
HF.2.2.2 Resident foreign government development agencies schemes
-
-
HF.2.1.2.1 Community-based insurance
HF.2.1.2.2 Other complementary/ supplementary insurance
HF.2.2 NPISHs financing schemes
-
HF.2.1.2 Complementary/supplementary insurance schemes
-
-
HF.2.1.1.2 Government-based voluntary insurance
HF.2.1.1.3 Other primary coverage schemes
HF.2.1.1 Primary/substitutory health insurance schemes
-
-
HF.2.1 Voluntary health insurance schemes
HF.2.1.1.1 Employer-based insurance (other than enterprises schemes)
-
-
HF.2 Voluntary health care payment schemes
-
HF.1.3 Compulsory Medical Saving Accounts (CMSA)
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HF.1.2.1 Social health insurance schemes
-
-
-
-
-
FA.1.1.2.1 Ministry of Finance
-
-
11,939.2
11,939.2
11,939.2
FA.1.1.1 Supreme Council of Health
HF.1.2.2 Compulsory private insurance schemes
HF.1.2 Compulsory contributory health insurance schemes
HF.1.1.2 State/regional/local governmental schemes
HF.1.1.1 Central governmental schemes
HF.1.1 Government schemes
HF.1 Government schemes and compulsory contributory health care financing schemes
Financing Schemes (HF) by Financing Agents (FA)
FA.1.1.2.2 Ministry of Interior -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
127.3
127.3
127.3
FA.1.1.2.3 Armed Force and Amiri Guard -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
109.9
109.9
109.9
FA.1.1.4. National Health Insurance Agency - NHIC -
-
-
-
-
-
-
-
-
-
-
-
-
-
81.2
81.2
-
-
-
81.2
FA.2 Insurance corporations
FA.2.1 Commercial insurance companies -
-
-
-
-
-
1,028.1
-
-
1,028.1
1,028.1
1,028.1
-
-
-
-
-
-
-
-
FA.3.1.1 Aspire Zone Foundation -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
383.9
383.9
383.9
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
FA.3.1.4 Private Hospitals
FA.3.1 Health management and provider corporations
FA.3.2 Corporations (other than providers of health services)
-
-
-
-
-
-
-
-
-
-
-
279.8
-
-
-
-
-
-
-
-
FA.3.2.2 Qatar Petroleum
FA.1 General Government
-
-
-
-
-
-
-
-
-
-
-
29.4
-
-
-
-
-
-
-
-
FA.3.2.9 Other Corporations
Financing Agents (FA)
FA.4 Non-profit Institutions serving households (NPISHs)
-
7.2
7.2
-
-
-
-
-
-
-
-
7.2
-
-
-
-
-
-
-
-
FA.4.1 Zakat fund
SHA MATRIX 3: FA X HF (IN QAR MILLION)
FA.5 Households -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
FA.6 Rest of the World
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
FA.6.3 Other foreign entities
-
7.2
7.2
-
-
-
1,028.1
-
-
1,028.1
1,028.1
1,344.5
-
-
81.2
81.2
-
12,560.4
12,560.4
12,641.6
Total
-
-
HF.4.2.2.3 Enclaves (e.g., international organizations or embassies)
Total health expenditure (CHE + GCF)
Gross capital formation (GCF)
12,493.6
554.4
11,939.2
-
Current expenditure on health (CHE)
-
HF.4.2.2.2 Foreign Development agencies schemes
-
HF.4.2.2 Other schemes (non-resident)
HF.4.2.2.1 Philanthropy/ international NGOs’ schemes
-
HF.4.2.1 Voluntary health insurance schemes (non-resident)
-
HF.4.1.2 Other compulsory schemes (non-resident)
-
-
HF.4.1.1 Compulsory health insurance schemes (non-resident)
HF.4.2 Voluntary schemes (non-resident)
-
HF.4.1 Compulsory schemes (non-resident)
-
-
HF.3.2.2 Cost sharing with voluntary insurance schemes
HF.4 Rest of the world financing schemes (non resident)
-
HF.3.2.1 Cost sharing with government/CCHI schemes
-
-
HF.3.1 Out-of-pocket excluding cost sharing
HF.3.2 Cost sharing with third-party payers
-
HF.2.3.2 Health care providers financing schemes
HF.3 Household out-of-pocket payment
-
-
FA.1.1.1 Supreme Council of Health
HF.2.3.1 Enterprises (except Health care providers) financing schemes
HF.2.3 Enterprises financing schemes
Financing Schemes (HF) by Financing Agents (FA)
FA.1.1.2.1 Ministry of Finance
2,551.1
2,551.1
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
FA.1.1.2.2 Ministry of Interior 133.0
5.7
127.3
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
FA.1.1.2.3 Armed Force and Amiri Guard 117.0
7.1
109.9
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
FA.1.1.4. National Health Insurance Agency - NHIC 81.2
-
81.2
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
FA.2 Insurance corporations
FA.2.1 Commercial insurance companies 1,028.1
-
1,028.1
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
FA.3.1.1 Aspire Zone Foundation 387.4
3.5
383.9
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
27.2
27.2
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
FA.3.1.4 Private Hospitals
FA.3.2 Corporations (other than providers of health services)
281.0
1.2
279.8
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
279.8
279.8
FA.3.2.2 Qatar Petroleum
FA.3.1 Health management and provider corporations
29.4
-
29.4
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
29.4
29.4
FA.3.2.9 Other Corporations
FA.1 General Government
FA.4 Non-profit Institutions serving households (NPISHs)
7.2
-
7.2
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
FA.4.1 Zakat fund
Financing Agents (FA)
FA.5 Households 1,032.9
-
1,032.9
-
-
-
-
-
-
-
-
-
-
-
-
-
1,032.9
1,032.9
-
-
-
FA.6 Rest of the World
92.0
-
92.0
-
-
-
-
92.0
92.0
-
-
-
92.0
-
-
-
-
-
-
-
-
FA.6.3 Other foreign entities
SHA MATRIX 3: FA X HF (IN QAR MILLION) Continued
18,261.1
3,150.1
15,111.0
-
-
-
-
92.0
92.0
-
-
-
92.0
-
-
-
1,032.9
1,032.9
-
309.2
309.2
Total
Annexes 73
-
-
-
-
-
-
1,350.0
42.8
HP.3.4.3 Free-standing ambulatory surgery centres
HP.3.4.4 Dialysis care centres
HP.3.4.9 All other ambulatory centres
HP.3.5 Providers of home health care services
-
-
-
HP.3.4.1 Family planning centres
HP.3.4.2 Ambulatory mental health and substance abuse centres
HP.3.9 Other providers of ambulatory health care
-
1,350.0
HP.3.4 Ambulatory health care centres
-
-
-
-
-
-
HP.3.3 Other health care practitioners
-
-
HP.3.2 Dental practice
-
-
-
HP.3.1.2 Offices of mental medical specialists
HP.3.1.3 Offices of medical specialists (other than mental medical specialists)
-
-
-
85.0
-
-
-
85.0
HP.3.1.1 Offices of general medical practitioners
HP.3.1 Medical practice
1,477.8
-
-
HP.2.2 Mental health and substance abuse facilities
HP.2.9 Other residential long-term care facilities
HP.3 Providers of ambulatory health care
-
-
-
-
-
-
32.1
32.1
2,849.8
-
5,197.4
8,047.2
HF.1.1 Government schemes
HF.1.1.1 Central governmental schemes
HP.2.1 Long-term nursing care facilities
HP.2 Residential long-term care facilities
HP.1.9 Hospitals not specified
HP.1.3 Specialised hospitals (other than mental health hospitals)
HP.1.2 Mental health hospitals
HP.1.1 General hospitals
HP.1 Hospitals
Healthcare Providers (HP) by Healthcare Functions (HF)
HF.1.2 Compulsory contributory health insurance schemes
HF.1.2.1 Social health insurance schemes
HF.2.1.1.3 Other primary coverage scheme -
-
97.9
-
-
-
-
97.9
-
74.4
-
-
-
-
172.2
-
-
-
-
-
-
-
410.0
410.0
HF.2.2.1 NPISH financing schemes (excluding HF.2.2.2) -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
3.9
-
-
-
3.9
-
-
279.8
-
-
-
-
279.8
-
-
-
-
-
-
279.8
-
-
-
-
-
-
-
29.4
29.4
HF.2.3.1 Enterprises (except Health care providers) financing schemes
HF.2 Voluntary health care payment schemes
Healthcare financing schemes (HF)
HF.2.3.2 Health care providers financing schemes -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
137.4
-
-
-
-
137.4
-
0.1
-
-
5.9
5.9
143.4
-
-
-
-
-
62.3
-
375.8
438.1
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
92.0
92.0
HF.4 Rest of the world financing schemes (non resident)
HF.3 Household outof-pocket payment
HF.3.1 Out-of-pocket excluding cost sharing
SHA MATRIX 4: HF X HP (IN QAR MILLION)
HF.4.2.1 Voluntary health insurance schemes (non-resident)
-
42.8
1,865.1
-
-
-
-
1,865.1
-
74.4
-
-
90.8
90.8
2,073.2
-
-
-
-
3.9
2,912.1
-
6,136.7
9,052.7
Total
-
-
-
HP.5.9 All other miscellaneous sellers and other suppliers of pharmaceuticals and medical goods
-
HP.7.9 Other administration agencies
-
HP.8.3 Other industries n.e.c.
-
12,560.4
3,121.7
15,682.0
HP. Nsk Providers not specified by kind
Current expenditure on health (CHE)
Gross capital formation (GCF)
Total health expenditure (CHE + GCF)
2,018.6
-
HP.9 Rest of the world
-
HP.8.1 Households as providers of home health care
HP.8.2 All other industries as secondary providers of health care
-
-
HP.7.3 Private health insurance administration agencies
HP.8 Rest of economy
-
604.9
HP.7.2 Social health insurance agencies
HP.7.1 Government health administration agencies
HP.7 Providers of health care system administration and financing
604.9
-
-
HP.6 Providers of preventive care
-
-
HP.5.1 Pharmacies
HP.5.2 Retail sellers and other suppliers of durable medical goods and medical appliances
81.2
-
81.2
-
-
-
-
-
-
-
-
49.1
-
49.1
-
-
-
-
-
-
-
-
HP.5 Retailers and other providers of medical goods
-
HP.4.9 Other providers of ancillary services
411.9
411.9
HF.1.1.1 Central governmental schemes
HP.4.2 Medical and diagnostic laboratories
HP.4.1 Providers of patient transportation and emergency rescue
HP.4 Providers of ancillary services
Healthcare Providers (HP) by Healthcare Functions (HF)
HF.1.2 Compulsory contributory health insurance schemes
HF.1.2.1 Social health insurance schemes
HF.1.1 Government schemes
HF.2.1.1.3 Other primary coverage scheme 1,028.1
-
1,028.1
-
46.4
-
-
-
-
-
192.9
-
-
192.9
7.0
-
14.9
100.6
115.4
-
84.1
-
84.1
HF.2.2.1 NPISH financing schemes (excluding HF.2.2.2) 7.2
-
7.2
-
3.2
-
-
-
-
-
-
-
-
-
-
0.1
-
-
0.1
-
-
-
-
310.4
1.2
309.2
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HF.2.3.1 Enterprises (except Health care providers) financing schemes
HF.2 Voluntary health care payment schemes
HF.2.3.2 Health care providers financing schemes 27.2
27.2
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
1,032.9
-
1,032.9
41.8
155.5
-
-
-
-
-
-
-
-
-
-
-
253.9
-
253.9
-
0.2
-
0.2
92.0
-
92.0
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HF.4 Rest of the world financing schemes (non resident)
HF.3 Household outof-pocket payment
HF.3.1 Out-of-pocket excluding cost sharing
Healthcare financing schemes (HF)
HF.4.2.1 Voluntary health insurance schemes (non-resident)
SHA MATRIX 4: HF X HP (IN QAR MILLION) Continued
18,261.1
3,150.1
15,111.0
41.8
2,223.7
-
-
-
-
-
192.9
49.1
604.9
846.9
7.0
0.1
268.7
100.6
369.3
-
84.3
411.9
496.2
Total
Annexes 75
-
1,609.4
HC.1.3.3 Specialised outpatient curative care
-
-
HC.3.4 Home-based long-term care (health)
HC.3.5 Long-term health care - LTHC n.e.c.
342.3
277.6
HC.4.3 Patient transportation
-
HC.4.1.9 Laboratory services not specified
HC.4.2 Imaging services
-
584.3
584.3
HC.4.1.2 Blood, sperm and organ bank services
HC.4.1.1 Laboratory diagnostics
HC.4.1 Laboratory services
1,204.1
-
HC.3.3 Outpatient long-term care (health)
HC.4 Ancillary services (not specified by function)
-
33.7
33.7
HC.3.2 Day long-term care (health)
HC.3.1 Inpatient long-term care (health)
HC.3 Long-term care (Health)
-
2.5
HC.2.4 Home-based rehabilitative care
HC.2.5 Rehabilitative care n.e.c.
131.8
-
135.6
269.8
-
55.1
HC.2.3 Outpatient rehabilitative care
HC.2.2 Day rehabilitative care
HC.2.1 Inpatient rehabilitative care
HC.2 Rehabilitative care
HC.1.5 Curative care n.e.c.
HC.1.4 Home-based curative care
-
347.4
HC.1.3.9 Outpatient care not specified
819.3
HC.1.3.2 Dental outpatient curative care
2,776.1
HC.1.3.1 General outpatient curative care
HC.1.3 Outpatient curative care
HC.1.2.9 Day care not specified
24.3
119.7
HC.1.2.2 Specialised day curative care
144.0
HC.1.2.1 General day curative care
HC.1.2 Day curative care
6.2
5,453.1
HC.1.1.2 Specialised inpatient curative care
HC.1.1.9 Inpatient care not specified
895.0
6,354.2
9,329.5
-
0.5
-
-
1.0
1.0
1.4
-
-
-
-
-
-
-
-
0.002
-
-
0.002
-
-
-
0.1
-
8.9
9.0
-
0.5
0.1
0.6
-
3.0
17.8
20.8
30.5
HF.1.2 Compulsory contributory health insurance schemes
HF.1.1 Government schemes
HF.1.1.1 Central governmental schemes
HC.1.1.1 General inpatient curative care
HC.1.1 Inpatient curative care
HC.1 Curative care
Health Care Functions (HC) by Healtchare Financing Schemes (HF) HF.1.2.1 Social health i nsurance schemes
HF.2.1.1.3 Other primary coverage scheme 0.002
43.5
-
-
89.3
89.3
132.8
-
-
-
-
-
-
-
-
9.0
-
0.032
9.0
-
-
-
120.6
83.9
160.5
365.0
-
2.0
0.5
2.5
46.4
54.2
52.9
153.5
521.0
HF.2 Voluntary health care payment schemes
Healthcare financing schemes (HF)
HF.2.2.1 NPISH financing schemes (excluding HF.2.2.2) -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
7.1
-
-
7.1
7.1
HF.2.3.1 Enterprises (except Health care providers) financing schemes 69.9
15.2
-
-
1.0
1.0
86.1
-
-
44.2
-
-
44.2
-
-
5.5
-
0.012
5.5
-
-
-
5.2
31.6
96.2
133.1
-
-
-
-
-
4.5
4.9
9.4
142.5
-
HF.2.3.2 Health care providers financing schemes -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HF.3 Household outof-pocket payment
0.006
10.5
-
-
20.3
20.3
30.7
-
-
-
-
-
-
-
-
3.1
-
0.1
3.1
-
-
21.5
153.3
40.2
217.2
432.3
-
1.0
0.2
1.2
10.5
127.0
58.3
195.8
629.3
HF.3.1 Out-ofpocket excluding cost sharing
SHA MATRIX 5: HF X HC (IN QAR MILLION)
HF.4 Rest of the world financing schemes (non resident)
0.001
4.3
-
-
6.9
6.9
11.1
-
-
-
-
-
-
-
-
2.1
-
0.007
2.1
-
-
-
20.8
2.2
21.0
44.0
-
0.5
0.1
0.6
-
12.4
12.1
24.5
69.1
HF.4.2.1 Voluntary health insurance schemes (non-resident)
347.5
416.2
-
-
702.6
702.6
42,135.0
-
-
44.2
-
33.7
77.9
-
2.5
151.4
-
135.7
289.6
-
55.1
21.5
1,909.5
505.3
1,323.1
3,759.5
-
123.7
25.2
148.9
70.2
5,654.3
1,041.0
6,765.4
10,729.0
Total
-
-
-
-
HC.5.2.3 Other orthopaedic appliances and prosthetics (excluding glasses and hearing aids)
HC.5.2.9 All other medical durables, including medical technical devices
1.8
3.0
49.7
0.4
HC.6.3 Early disease detection programmes
HC.6.4 Healthy condition monitoring programmes
HC.6.5 Epidemiological surveillance and risk and disease control programmes
3,121.7
15,682.0
Gross capital formation (GCF)
Total health expenditure (CHE + GCF)
-
12,560.4
Current expenditure on health (HC)
HC.9 Other health care services not elsewhere classified (n.e.c)
-
-
HC.7.3 Other administrative costs not specified by kind (n.s.k.)
-
81.2
-
81.2
-
-
-
49.1
-
HC.7.2.2 Health administration and health insuracne. Private insurance
49.1
604.9
HC.7.2.1 Health administration and health insuracne. Social insurance
HC.7.2 Administration of health financing
HC.7.1 Governance and health system administration
-
-
604.9
HC.6.9 Preventive care not specified
HC.7 Governance and health system and financing administration 49.1
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
0.2
0.2
-
HC.6.6 Preparing for disaster and emergency response programmes
61.2
HC.6.2 Immunisation programmes
116.0
HC.6.1 Information, education and counseling programmes
HC.6 Preventive care
-
-
HC.5.3 medical goods non specified by function n.e.c.
-
HC.5.2.2 Hearing aids
-
4.7
-
997.6
1,002.3
0.2
HF.1.1 Government schemes
HF.1.1.1 Central governmental schemes
1,002.3
HF.1.2 Compulsory contributory health insurance schemes HF.1.2.1 Social health i nsurance schemes
HC.5.2.1 Glasses and other vision products
HC.5.2 Therapeutic appliances and other medical goods
HC.5.1.3 Other medical non-durable goods
HC.5.1.2 Over the counter medicines
HC.5.1.1 Prescribed medicines
HC.5.1 Pharmaceuticals and other non durable goods
HC.5 Medical goods (not specified by function)
HC.4.4 Ancillary services non specified by function n.e.c.
Health Care Functions (HC) by Healtchare Financing Schemes (HF)
-
HF.2.1.1.3 Other primary coverage scheme 1,028.1
-
1,028.1
-
-
192.9
-
192.9
-
192.9
-
-
-
7.0
-
7.3
-
14.4
-
14.9
-
-
-
14.9
-
-
143.1
143.1
158.0
HF.2 Voluntary health care payment schemes
-
HF.2.2.1 NPISH financing schemes (excluding HF.2.2.2) 7.2
-
7.2
-
-
-
-
-
-
-
0.1
-
-
-
-
-
-
0.1
-
-
-
-
-
-
-
-
0.1
0.1
0.1
-
HF.2.3.1 Enterprises (except Health care providers) financing schemes 310.4
1.2
309.2
3.8
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
27.1
27.1
27.1
-
HF.2.3.2 Health care providers financing schemes 27.2
27.2
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HF.3 Household outof-pocket payment
1,032.9
-
1,032.9
3.4
-
-
-
-
-
-
-
-
-
0.027
0.1
1.4
5.0
6.5
-
134.5
-
6.0
78.8
219.3
-
34.5
105.8
140.3
359.7
-
HF.3.1 Out-ofpocket excluding cost sharing
Healthcare financing schemes (HF) HF.4 Rest of the world financing schemes (non resident)
92.0
-
92.0
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
9.7
9.7
9.7
-
HF.4.2.1 Voluntary health insurance schemes (non-resident)
SHA MATRIX 5: HF X HC (IN QAR MILLION) Continued
18,261.1
3,150.1
15,111.0
7.2
-
192.9
49.1
242.0
604.9
846.9
0.1
-
0.4
56.8
3.1
10.5
66.2
137.0
-
149.3
-
6.0
78.8
234.2
4.7
34.5
1,283.6
1,322.7
1,556.9
-
Total
Annexes 77
60.2
HC.1.2.2 Specialised day curative care
1,206.5
HC.1.3.3 Specialised outpatient curative care
HC.1.4 Home-based curative care
0.003
15.4
-
-
HC.2.3 Outpatient rehabilitative care
HC.2.4 Home-based rehabilitative care
HC.2.5 Rehabilitative care n.e.c.
4.2
19.6
-
2.0
HC.2.2 Day rehabilitative care
HC.2.1 Inpatient rehabilitative care
HC.2 Rehabilitative care
HC.1.5 Curative care n.e.c.
-
63.0
HC.1.3.2 Dental outpatient curative care
HC.1.3.9 Outpatient care not specified
453.0
1,722.4
HC.1.3.1 General outpatient curative care
HC.1.3 Outpatient curative care
-
25.2
HC.1.2.1 General day curative care
HC.1.2.9 Day care not specified
85.4
HC.1.2 Day curative care
1,902.9
HC.1.1.2 Specialised inpatient curative care
-
949.0
HC.1.1.1 General inpatient curative care
HC.1.1.9 Inpatient care not specified
2,851.9
4,661.8
HP.1.1 General hospitals
HC.1.1 Inpatient curative care
HC.1 Curative care
Health Care Functions (HC) by Healtchare Providers (HP)
HP.1.3 Specialised hospitals (other than mental health hospitals)
-
2.5
124.2
-
131.5
258.1
-
10.3
-
325.0
213.8
9.5
548.4
-
63.5
-
63.5
-
1,665.1
92.0
1,757.1
2,379.2
HP.1.9 Hospitals not specified
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
3.8
-
-
3.8
3.8
-
HP.2.1 Long-term nursing care facilities
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.2.9 Other residential long-term care facilities
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.3.1 Medical practice
HP.3.1.1 Offices of general medical practitioners
-
-
-
-
-
-
-
-
-
16.5
2.1
34.7
53.3
-
-
-
-
-
-
-
-
53.3
-
HP.3.1.3 Offices of medical specialists (other than mental medical specialists)
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.3.2 Dental practice
-
-
-
-
-
-
-
-
-
-
74.4
-
74.4
-
-
-
-
-
-
-
-
74.4
-
HP.3.4.1 Family planning centres
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.3.4.2 Ambulatory mental health and substance abuse centres
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
11.9
-
-
11.9
-
-
-
205.4
152.0
767.4
1,124.9
-
-
-
-
-
-
-
-
1,124.9
HP.3.4.9 All other ambulatory centres
HP.3.4 Ambulatory health care centres
HP.3.5 Providers of home health care services
-
-
-
-
-
-
-
42.8
-
-
-
-
-
-
-
-
-
-
-
-
-
42.8
HP.4.1 Providers of patient transportation and emergency rescue
-
-
-
-
-
-
-
-
-
134.4
-
-
134.4
-
-
-
-
-
-
-
-
134.4
-
-
-
-
-
-
-
-
-
-
-
0.2
0.2
-
-
-
-
-
-
-
-
0.2
HP.4.2 Medical and diagnostic laboratories
-
HP.4.9 Other providers of ancillary services
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.5 Retailers and other providers of medical goods
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.5.1 Pharmacies
HP.4 Providers of ancillary services
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.5.2 Retail sellers and other suppliers of durable medical goods and medical appliances
HP.3 Providers of ambulatory health care
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.5.9 All other miscellaneous sellers and other suppliers of pharmaceuticals and medical goods
HP.1 Hospitals
-
HP.6 Providers of preventive care
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.7 Providers of health care system administration and financing
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.7.1 Government health administration agencies
Healthcare providers (HP)
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.7.2 Social health insurance agencies
HP.2 Residential long-term are facilities
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.7.3 Private health insurance administration agencies
SHA MATRIX 6: HP X HC (IN QAR MILLION)
-
HP.7.9 Other administration agencies
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.9 Rest of the world
-
-
-
-
-
-
-
-
-
21.7
-
58.3
80.1
-
-
-
-
57.4
2,086.2
-
2,143.6
2,223.7
HP. Nsk Providers not specified by kind
-
-
-
-
-
-
-
-
21.5
-
-
-
21.5
-
-
-
-
8.9
-
-
8.9
30.5
-
2.5
151.4
0.003
135.7
289.6
-
55.1
21.5
1,909.5
505.3
1,323.1
3,759.5
-
123.7
25.2
148.9
70.2
5,654.3
1,041.0
6,765.4
10,729.0
Total
-
895.7
HC.3.5 Long-term health care - LTHC n.e.c.
HC.4 Ancillary services (not specified by function)
-
HC.4.4 Ancillary services non specified by function n.e.c.
-
HC.5.2.1 Glasses and other vision products
-
-
HC.5.2 Therapeutic appliances and other medical goods
HC.5.2.3 Other orthopaedic appliances and prosthetics (excluding glasses and hearing aids)
-
HC.5.1.3 Other medical non-durable goods
-
-
-
-
-
199.1
-
440.4
HC.5.1.1 Prescribed medicines
HC.5.1.2 Over the counter medicines
199.1
440.4
199.1
-
HC.5.1 Pharmaceuticals and other non durable goods
440.4
0.01
HC.5 Medical goods (not specified by function)
26.3
322.8
HC.4.2 Imaging services
HC.4.3 Patient transportation
-
-
-
HC.4.1.9 Laboratory services not specified
-
16.5
-
572.9
16.5
42.8
-
-
-
-
9.5
9.5
HP.1.3 Specialised hospitals (other than mental health hospitals)
HC.4.1.2 Blood, sperm and organ bank services
HC.4.1.1 Laboratory diagnostics
572.9
-
HC.3.4 Home-based longterm care (health)
HC.4.1 Laboratory services
-
-
HC.3.2 Day long-term care (health)
24.2
HC.3.3 Outpatient longterm care (health)
24.2
HC.3.1 Inpatient longterm care (health)
HP.1.1 General hospitals
HC.3 Long-term care (Health)
Health Care Functions (HC) by Healtchare Providers (HP)
HP.1.9 Hospitals not specified
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.2.1 Long-term nursing care facilities
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.2.9 Other residential long-term care facilities
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.3.1 Medical practice
HP.3.1.1 Offices of general medical practitioners
-
-
-
4.7
-
32.0
36.6
36.6
-
-
-
-
-
0.9
0.9
0.9
-
-
-
-
-
-
HP.3.1.3 Offices of medical specialists (other than mental medical specialists)
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.3.2 Dental practice
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.3.4.1 Family planning centres
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.3.4.2 Ambulatory mental health and substance abuse centres
-
-
-
-
-
-
-
-
-
-
-
-
-
507.5
507.5
507.5
-
69.9
-
42.3
-
-
-
49.0
49.0
161.3
-
-
44.2
-
-
44.2
-
-
-
-
-
-
-
-
-
-
-
-
HP.3.4.9 All other ambulatory centres
HP.3.4 Ambulatory health care centres
HP.3.5 Providers of home health care services
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.4.1 Providers of patient transportation and emergency rescue
-
-
-
-
-
-
-
-
-
277.6
-
-
-
-
-
277.6
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
24.8
-
-
59.3
59.3
84.1
-
-
-
-
-
-
HP.4.2 Medical and diagnostic laboratories
HP.4.9 Other providers of ancillary services
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.5 Retailers and other providers of medical goods
-
-
-
-
-
100.6
100.6
100.6
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.5.1 Pharmacies
HP.4 Providers of ancillary services
6.0
78.8
234.2
-
34.5
-
34.5
268.7
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.5.2 Retail sellers and other suppliers of durable medical goods and medical appliances
HP.3 Providers of ambulatory health care
-
-
-
-
-
0.1
0.1
0.1
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.5.9 All other miscellaneous sellers and other suppliers of pharmaceuticals and medical goods
HP.2 Residential long-term are facilities HP.6 Providers of preventive care
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.7 Providers of health care system administration and financing
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.7.1 Government health administration agencies
HP.1 Hospitals
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.7.2 Social health insurance agencies
Healthcare providers (HP)
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.7.3 Private health insurance administration agencies
SHA MATRIX 6: HP X HC (IN QAR MILLION) Continued
HP.7.9 Other administration agencies
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.9 Rest of the world
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP. Nsk Providers not specified by kind
-
-
-
-
-
3.9
3.9
3.9
-
-
-
-
-
3.9
3.9
3.9
-
-
-
-
-
-
Total
6.0
78.8
234.2
4.7
34.5
1,283.6
1,322.7
1,556.9
-
347.5
416.2
-
-
702.6
702.6
1,466.3
-
-
44.2
-
33.7
77.9
Annexes 79
-
HC.5.3 medical goods non specified by function n.e.c.
-
HC.7 Governance and health system and financing administration
6,136.7
6,136.7
1,716.6
Current expenditure on health (CHE)
Gross capital formation (GCF)
Total health expenditure (CHE + GCF)
-
HC.7.3 Other administrative costs not specified by kind (n.s.k.)
-
-
HC.7.2.2 Health administration and health insuracne. Private insurance
HC.9 Other health care services not elsewhere classified (n.e.c)
-
HC.7.2.1 Health administration and health insuracne. Social insurance
-
-
HC.6.9 Preventive care not specified
HC.7.2 Administration of health financing
-
HC.6.6 Preparing for disaster and emergency response programmes
-
0.4
HC.6.5 Epidemiological surveillance and risk and disease control programmes
HC.7.1 Governance and health system administration
48.1
HC.6.4 Healthy condition monitoring programmes
-
8.6
HC.6.2 Immunisation programmes
HC.6.3 Early disease detection programmes
37.8
HC.6.1 Information, education and counseling programmes
94.9
-
HC.5.2.9 All other medical durables, including medical technical devices
HC.6 Preventive care
-
HP.1.1 General hospitals
HC.5.2.3 Other orthopaedic appliances and prosthetics (excluding glasses and hearing aids)
Health Care Functions (HC) by Healtchare Providers (HP)
HP.1.3 Specialised hospitals (other than mental health hospitals)
1,221.6
2,912.1
2,912.1
-
-
-
-
-
-
-
-
-
-
-
-
-
23.3
23.3
-
-
-
HP.1.9 Hospitals not specified
-
3.9
3.9
-
-
-
-
-
-
-
0.1
-
-
-
-
-
-
0.1
-
-
-
HP.2.1 Long-term nursing care facilities
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.2.9 Other residential long-term care facilities
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.3.1 Medical practice
HP.3.1.1 Offices of general medical practitioners
23.5
90.8
90.8
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.3.1.3 Offices of medical specialists (other than mental medical specialists)
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.3.2 Dental practice
-
74.4
74.4
-
-
-
-
-
-
-
-
-
-
-
-
-
0.1
0.1
-
-
-
HP.3.4.1 Family planning centres
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.3.4 Ambulatory health care centres
HP.3.4.2 Ambulatory mental health and substance abuse centres
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.3.4.9 All other ambulatory centres
170.5
1,865.1
1,865.1
3.8
-
-
-
-
-
-
-
-
-
1.7
3.1
1.9
5.0
11.5
-
-
-
HP.3.5 Providers of home health care services
-
42.8
42.8
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.4.1 Providers of patient transportation and emergency rescue
-
411.9
411.9
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
84.3
84.3
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.4.2 Medical and diagnostic laboratories
HP.4.9 Other providers of ancillary services
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.5 Retailers and other providers of medical goods
-
100.6
100.6
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.5.1 Pharmacies
HP.4 Providers of ancillary services
-
268.7
268.7
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
149.3
-
HP.5.2 Retail sellers and other suppliers of durable medical goods and medical appliances
HP.3 Providers of ambulatory health care
-
0.1
0.1
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.5.9 All other miscellaneous sellers and other suppliers of pharmaceuticals and medical goods
HP.1 Hospitals
HP.6 Providers of preventive care
-
7.0
7.0
-
-
-
-
-
-
-
-
-
-
7.0
-
-
-
7.0
-
-
-
HP.7 Providers of health care system administration and financing
18.0
604.9
604.9
-
-
-
-
-
604.9
604.9
-
-
-
-
-
-
-
-
-
-
-
HP.7.1 Government health administration agencies
Healthcare providers (HP)
-
49.1
49.1
-
-
-
49.1
49.1
-
49.1
-
-
-
-
-
-
-
-
-
-
-
HP.7.2 Social health insurance agencies
HP.2 Residential long-term are facilities
-
192.9
192.9
-
-
192.9
-
192.9
-
192.9
-
-
-
-
-
-
-
-
-
-
-
HP.7.3 Private health insurance administration agencies
SHA MATRIX 6: HP X HC (IN QAR MILLION) Continued
HP.7.9 Other administration agencies
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.9 Rest of the world
-
2,223.7
2,223.7
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP. Nsk Providers not specified by kind
-
41.8
3.4
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
3,150.1
15,111.0
15,069.2
7.2
-
192.9
49.1
242.0
604.9
846.9
0.1
-
0.4
56.8
3.1
10.5
66.2
137.0
-
149.3
-
Total
231.9
240.0
FP.4 Consumption of fixed capital
FP.5 Other items of spending on inputs
2,912.1
3.9
-
3.9
-
3.9
-
-
-
-
-
-
-
-
-
-
-
-
HP.2.1 Long-term nursing care facilities
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.2.9 Other residential long-term care facilities -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.3.1.1 Offices of general medical practitioners 90.8
-
-
-
-
2.6
-
-
4.7
32.0
36.6
23.3
60.0
-
-
-
28.2
28.2
-
HP.3.1.3 Offices of medical specialists -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.3.2 Dental practice 74.4
-
-
-
-
-
1.1
4.5
0.3
13.5
13.8
4.6
24.0
-
3.4
-
47.1
50.5
-
HP.3.4.1 Family planning centres -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.3.4.2 Ambulatory mental health and substance abuse centres -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.3.4.9 All other ambulatory centres 1,865.1
-
0.7
-
0.7
-
12.5
171.2
0.9
305.4
306.3
270.0
760.0
-
215.5
-
888.9
1,104.4
HP.3.5 Providers of home health care services 42.8
-
2.0
-
2.0
1.5
1.4
1.9
1.5
0.8
2.3
0.0
5.7
-
13.9
0.4
19.3
33.6
HP.4.1 Providers of patient transportation and emergency rescue 411.9
-
22.0
-
22.0
19.9
16.4
25.4
17.6
8.6
26.2
13.0
81.0
-
123.1
2.1
163.8
289.0
84.3
-
-
-
-
-
1.2
5.1
0.4
15.2
15.6
5.2
27.1
-
3.8
-
53.3
57.2
HP.4.2 Medical and diagnostic laboratories
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
100.6
-
-
-
-
-
-
-
-
100.6
100.6
-
100.6
-
-
-
-
-
268.7
-
-
-
-
-
-
-
268.7
-
268.7
-
268.7
-
-
-
-
-
0.1
-
0.1
-
0.1
-
-
-
-
-
-
-
-
-
-
-
-
-
7.0
-
-
-
-
-
-
-
7.0
-
7.0
-
7.0
-
-
-
-
604.9
-
0.04
-
0.04
-
3.8
177.3
-
21.5
21.5
-
202.6
-
129.1
-
273.2
402.3
49.1
-
-
-
-
-
48.2
-
-
-
-
-
48.2
-
0.3
-
0.6
0.9
192.9
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
192.9
192.9
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
2,223.7
Current expenditure on health (CHE)
6,136.7
-
HP.1.9 Hospitals not specified
-
HP.5.1 Pharmacies
Total factors of provision
-
115.1
-
115.1
114.9
160.6
135.3
181.6
171.2
352.8
0.9
649.6
-
771.5
22.4
1,238.5
HP.6 Providers of preventive care miscellaneous sellers and other suppliers of pharmaceuticals and medical goods
2,223.7
-
FP.nsk Other items not classified
HP.1.3 Specialised hospitals (other than mental health hospitals)
2,032.5
HP.7 Providers of health care system administration and financing
HP.9 Rest of the world
FP.M Factors of provision by the RoW
240.0
FP.5.2 Other items of spending
-
325.7
FP.5.1 Taxes
285.2
FP.3.4 Non-health care goods
583.4
FP.3.3 Non-health care services
524.5
FP.3.2.2 Other health care goods
1,107.9
FP.3.2 Health care goods
FP.3.2.1 Pharmaceuticals
28.1
FP.3.1 Health care services
1,746.9
-
FP.2 Self-employed professional remuneration
FP.3 Materials and services used
1,729.1
41.3
FP.1.2 Social contributions
FP.1.3 All other costs related to employees
2,147.5
3,917.8
HP.1.1 General hospitals
FP.1.1 Wages and salaries
FP.1 Compensation of employees
Factors of provision (FP) by Healthcare Providers (HP) HP.4.9 Other providers of ancillary services
HP.5 Retailers and other providers of medical goods
HP.5.2 Retail sellers and other suppliers of durable medical goods and medical appliances
HP.4 Providers of ancillary services
HP.5.9 All other miscellaneous sellers and other suppliers of pharmaceuticals and medical goods
HP.3 Providers of ambulatory health care
HP.7.1 Government health administration agencies
HP.2 Residentiallongterm care facilities Providers of ambulatory health care
HP.7.2 Social health insurance agencies
HP.1 Hospitals
HP.7.3 Private health insurance administration agencies
Healthcare providers (HP)
HP.7.9 Other administration agencies
SHA MATRIX 7: HP X FP (IN QAR MILLION)
-
HP. Nsk Providers not specified by kind 41.8
41.8
-
-
41.8
-
-
-
-
-
-
-
-
-
-
-
-
Total 15,111.0
2,223.7
41.8
383.9
-
425.7
370.9
571.0
805.8
1,066.2
1,193.1
2,259.3
345.3
3,981.3
-
2,989.7
66.3
5,053.4
8,109.4
Annexes 81
0.4
29.4
HK.1.1.2.3 ICT equipment
HK.1.1.2.4 Machinery and equipment n.e.c.
-
-
-
-
HKF.2 Capital transfers
HKF.2r Receivable
HKF.2p Payable
Gross Capital Formation
1,716.6
-
HKF.1 Saving, net
Net lending (+)/ net borrowing (–)
-
-
Changes in net worth
HK.2.2 Other non-produced non-financial assets
-
-
HK.2.1 Land
HK.2 Non-produced non-financial assets
-
HK.1.1.n Net capital formation
-
-
HK.1.1.c Consumption of fixed capital
HK.1.9 Capital Formation
-
HK.1.3 Acquisitions less disposals of valuables
0.1
HK.1.1.3.2 Intellectual property products n.e.c.
HK.1.2 Changes in inventories
99.6
HK.1.1.3.1 Computer software and databases
99.6
38.2
HK.1.1.2.2 Transport equipment
HK.1.1.3 Intellectual property products
158.2
HK.1.1.2.1 Medical equipment
-
1,221.6
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
3.5
3.5
1.7
226.3
1,218.1
1,218.1
1,221.6
1,221.6
HP.1.3 Specialised hospitals (other than mental health hospitals)
1,388.9
1,390.6
1,716.4
1,716.6
HP.1.1 General hospitals
HK.1.1.2 Machinery and equipment
HK.1.1.1.2 Other structures
HK.1.1.1.1 Residential and nonresidential buildings
HK.1.1.1 Infrastructure
HK.1.1 Gross fixed capital formation
HK.1 Gross capital formation
Changes in Acquisition less disposals of capital goods
SHA CODES and Categories
HP.1 Hospitals
HP.1.9 Hospitals not specified -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.2 Residential long-term care facilities -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.3.1.1 Offices of general medical practitioners 23.5
-
-
-
-
-
-
-
-
-
-
-
-
-
0.1
1.3
1.5
0.5
0.2
1.1
9.0
10.8
0.3
10.8
11.2
23.5
23.5
HP.3.2 Dental practice -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.3.4.9 All other ambulatory centres 170.5
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.3.5 Providers of home health care services
-
-
-
-
-
2.4
2.4
3.2
8.2
-
15.2
26.6
-
141.4
141.4
170.5
170.5
HP.4.1 Providers of patient transportation and emergency rescue -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.4.2 Medical and diagnostic laboratories -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.4.9 Other providers of ancillary services
HP.4 Providers of ancillary services
HP.5 Retailers and other providers of medical goods -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.6 Providers of preventive care -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.7 Providers of health care system administration and financing
18.0
-
-
-
-
-
-
-
-
-
-
-
-
-
-
8.6
8.6
3.6
0.01
-
4.3
7.9
-
1.5
1.5
18.0
18.0
HP.7.1 Government health administration agencies
HP.3 Providers of ambulatory health care
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.7.2 Social health insurance agencies
Healthcare providers (HP)
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP.7.9 Other administration agencies
SHA MATRIX 8: CAPITAL ACCOUNT (IN QAR MILLION)
HP.9 Rest of the world -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
HP. Nsk Providers not specified by kind
3,150.1
-
-
-
-
-
-
-
-
-
-
-
-
0.1
0.1
111.8
112.0
36.7
8.8
39.3
190.2
275.1
2.1
2,760.8
2,762.9
3,149.9
3,150.1
Total
