Novel indicators for the NCDs impact surveillance and health systems response: results from a pilot study in Chile.

Affiliations 1)Programa de Políticas, Sistemas y Gestión en Salud. Escuela de Salud Pública, Universidad de Chile 2)Ministry of Health, Chile. 3)ECLAC 4)PAHO/WHO Contact: [email protected] Acknowledgements Ministry of Health and differential governmental agencies for their contribution in the data collection and validation. PAHO/WHO and ECLAC teams for their support and technical advice.

Funding source PAHO/WHO (CH/CNT/1400048.001)

Central government expenditure on NCD prevention 100% 80% 60% 40% 20%

Access to a Quality Food Basket in Chile Population by income deciles 11.0

Social Dev.

75.0 97.8

100.0

100.0

100.0

100.0

100.0

84.7 65.8

25.0

The quality food basket cost 36% more than the basic food basket defined in Chile. 27,1% of the population could not afford to purchase a healthy diet based on national dietary recommendations, highly concentrated within the lower income groups.

2

3

4

5

No access

6

7

8

9

Internal Affairs

Enviroment

National Assets

Transports

Health

Proportion of budget allocated to prevention Proportion of total governemental expenditure in prevention

2.2

1

Sports

15.3 34.2

89.0

Education

10

Access

Yearly, 1,47% of the household suffer from catastrophic health expenditures attributable to NCDs every year, accounting for nearly 36% of all catastrophic health expenditures. For in-patient care, 51% of the catastrophic health expenditures are attributable to NCDs, while in-patient care represent an increasing proportion of out-of-pocket expenditures in households suffering catastrophic health expenditures. At least an 18% of pharmaceutical expenditure is attributable to NCD, the main driver of catastrophic health expenditures.

Distribution of household out-of-pocket expenditures Distribution of health expenditures 0 20 40 60 80 100

The study was designed as an exploratory case-study based in Chile. Three indicators of the economic and multi-sectorial aspects of non-communicable diseases (cardiovascular, cancer, diabetes and chronic respiratory) and its main risk factors (nutrition, alcohol, tobacco and physical inactivity) developed by a regional expert committee were designed to address different levels of NCD impact and policy response (2). The indicators focus on: (A) public sector investment in NCD prevention and health promotion; (B) the affordability of a healthy diet; and (C) catastrophic health expenditures (CHE) due to NCDs. Indicator A is estimated using a bottom-up approach using national health accounts and governmental financial reports for 2013 fiscal year, after gathering information of primary prevention and health promotion governmental programs from key informants from 8 Ministries of central government. Indicator B is estimated trough a normative adaptation of the basic food basket defined for poverty line purposes (3), adapting it composition to meet the national recommended nutritional guidelines(4). Indicator C is estimated using household level expenditure data from a national representative survey and national registries of catastrophic health expenditures based on WHO methods(5,6) and using a 30% threshold in terms of the capacity to pay. Expert consultation had been used to validate both methods and results for each indicator during the process.

100

Health systems are facing an increasing burden of disease associated with non-communicable diseases (NCDs), causing 82 percent of premature deaths in the low and middle-income countries (1). The impact of NCDs and the complexity of its causes and consequences brings new challenges for health systems. PAHO had proposed new indicators in the framework of regional NCD surveillance (2), bringing novel possibilities for the countries to address the consequences and actions taken by the governments on this complex problem. This study aims to explore the feasibility of implementing and estimating these novel indicators within the Americas region.

Methods

0

Background

The three indicators were feasible to estimate within the Chilean context in a limited timeframe. Results shows that 0.7% of Chilean public sector spending was devoted to NCD prevention and health promotion. This represented 4.1% of total public health care spending and two-tenths of one percent of GDP (0.19%) mainly related with health expenditures (86% of total prevention). Ministries of Sports and Environment invest a higher proportion of their budgets in activities of health promotion and primary prevention.

% of population access 20 40 60 80

Authors: Cuadrado C.1, García JL.1, Palacios A.2 ,Miller T.3 & Legetic B.4

Results

9.0 3.5 9.8 2.4

18.0 0.7 10.0 7.5

19.2

8.2 10.1

13.3

25.9 37.6 19.6 5.4

No CHE

CHE

In-patient care Diagnostic test Out-patient procedures Other

Discussion & conclusions While administrative data and registries have not been developed for the production of these indicators, installed capacities and data available in Chile allowed to approach the estimation with different levels of certainty. The results are mixed. Investment on health promotion and prevention activities are concordant with other publications. Nevertheless, a significant percentage of the Chilean population has limited access to a food basket with minimum quality standards, underlining the impact of the food system in the populations health. The impact on NCD is evident after considering the catastrophic impact in Chilean households. The utility of such indicators is clear, but new institutional capacities and intersectorial collaboration are needed to advance in more complex surveillance systems.

1. 2. 3. 4. 5. 6.

References

Pharmaceuticals Out-patient visit Medical devices Dental care

World Health Organization. Global status report on noncommunicable diseases. Alwan A, editor. Geneva: WHO Library Cataloguing; 2010. 176 p. Panamerican Health Organization. Informe del Grupo de Estudio sobre planificación estratégica de las enfermedades no transmisibles en las Américas. 2013. Ministerio de Desarrollo Social. Canasta Básica de Alimentos. Observatorio Social. 2014. Ministerio de Salud. Guías Alimentarias para la población chilena. 2014. Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJL. Household catastrophic health expenditure: a multicountry analysis. Lancet. 2003 Jul;362(9378):111–7. Xu K. Distribución del gasto en salud y gastos catastróficos: metodología. Geneva; 2005. Report No.: 2.

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