‫المجلس األعلى للصحة‬ Supreme Council Of Health

‫دولة قطر‬ State Of Qatar

Policy Affairs Directorate

Qatar National Health Accounts Report - 2011
A Trend with a New Classification

June - 2012

‫المجلس األعلى للصحة‬ Supreme Council Of Health

‫دولة قطر‬ State Of Qatar

Policy Affairs Directorate

Qatar National Health Accounts Report - 2011
A Trend with a New Classification

June - 2012

© 2012 General Secretariat, Supreme Council of Health, Qatar First published June - 2012 Supreme Council of Health, Qatar P.O. Box 42 Doha, Qatar www.sch.gov.qa
Qatar National Health Accounts - Report - 2011 The content of this publication may be freely reproduced for noncommercial purposes with attribution directed to the copyright holder.

 Contents
Tables And Figures ........................................................................................................................................................................................................................... II Qatar National Health Accounts Glossary ............................................................................................................................................................. III Abbreviations....................................................................................................................................................................................................................................... IV Foreword ..................................................................................................................................................................................................................................................... V Acknowlegdements ..................................................................................................................................................................................................................... VI Executive Summary ............................................................................................................................................................. 1 1 Introduction ........................................................................................................................................................................ 5 1.1 Qatar Health Accounts Report, 2010 ......................................................................................................................................................................... 5 1.2 SHA 2011 ............................................................................................................................................................................................................................................................ 6 1.3 Qatar’s Healthcare System ......................................................................................................................................................................................................... 6 2 Methodologies and Data Collection ................................................................................................................ 13 2.1 2.2 2.3 2.4 QHAR-2 Activities ............................................................................................................................................................................................................................... 13 QHAR-2 and SHA 2011 ............................................................................................................................................................................................................... 13 Data Sources, Strategy, and Assumptions Used ..................................................................................................................................... 14 Limitations.................................................................................................................................................................................................................................................... 16

3 QHA Results ...................................................................................................................................................................... 19 3.1 Financing Dimensions................................................................................................................................................................................................................. 19 3.2 3.3 3.4 3.5 Uses of Funds ........................................................................................................................................................................................................................................... 23 Factors of Healthcare Provision ...................................................................................................................................................................................... 32 Gross Capital Formation............................................................................................................................................................................................................ 34 Beneficiary Characteristics..................................................................................................................................................................................................... 34

4 Policy Implications ....................................................................................................................................................... 41 Annex 1: Second Online Health Survey ............................................................................................................... 43 1 Introduction ............................................................................................................................................................................................................................................... 45 1.1 Purpose ............................................................................................................................................................................................................................................................. 45 1.2 Methodology ........................................................................................................................................................................................................................................... 45 2 The Survey Results ............................................................................................................................................................................................................................ 47 2.1 Pattern of Participation............................................................................................................................................................................................................... 48 2.2 Sociodemographic Characteristics ........................................................................................................................................................................... 50 2.3 Household Structure and Health Expenditure ....................................................................................................50 Annex 2: NHA Tables ........................................................................................................................................................ 51 References ............................................................................................................................................................................... 62

 Tables and Figures
Table 1 Table 2 Table 3 Table 4 Table 5 Table 6 Table 7 Table 8 Table 9 Table 10 Table 11 Table 12

Selected Qatar indicators compared to regional and international countries. ..............................................10 Revenues of the financing schemes received by the financing schemes. .......................................................21 Health expenditure by type of financing schemes and type of providers.........................................................25 Health expenditure by type of financing schemes and health care functions. ..............................................28 Health care expenditure for the health care providers by health care functions...........................................32 Factors of health care provision. ..................................................................................................................................................33 Gross Capital Formation of government and other public organizations. .......................................................34 Current health expenditures by the beneficiaries’ characteristics. .........................................................................35 Sociodemographic characteristics of respondents. ........................................................................................................49 Detailed flow of funds from the financing sources to the financing agents. ..................................................53 Detailed health expenditure by type of financing schemes and type of providers. ..................................54 Detailed health expenditure by type of financing schemes and health care functions. .........................56 Detailed health care expenditure for the health care providers by health care functions. ....................60 Detailed gross Capital Formation of government and other public organizations. ...................................61

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Table 13 Table 14

Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13

Governance structure of the health care system in Qatar. ............................................................................................ 7 Actual and Adjusted Population, Qatar, 2010. ....................................................................................................................... 8 Medical equipment per million population, OECD and Qatar. ................................................................................11 Trend of current and capital health expenditure by financing sources, Qatar 2009 to 2011. ...............20 Distribution of current and capital health expenditure by revenue, Qatar and OECD. .............................22 Trend of current and capital health expenditure by health provider, 2009 to 2011. ..................................24 Distribution of current and capital health expenditure by provider, Qatar and OECD. ............................26 Trend of current and capital health expenditure by health care function, 2009 to 2011. .......................29 Distribution of current and capital health expenditure on healthcare functions, Qatar and OECD. .............30 Distribution of current health expenditure by age and gender, Qatar and selected countries. .........37 Participants’ number of completed by rounds and by nationality [N=2,472]. ................................................47 Participants’ distribution by nationality [N=2,472]. ..........................................................................................................50 Participants’ average household size, by nationality [N=2,472]. ..............................................................................50

 Qatar National Health Accounts Glossary
Ancillary services Capital formation (investment) Curative care A variety of services such as laboratory tests, diagnostic imaging and patient transport, mainly performed by paramedical or medical technical personnel with or without the direct supervision of a medical doctor. Investment in health care facilities and equipment that creates assets that are typically used over a long period of time. Medical and paramedical services delivered during an episode of curative care. An episode of curative care is when principal medical intent is to relieve the symptoms of injury or illness; to reduce severity of an illness or injury; or to protect against exacerbation and/or injury which could threaten life or normal function. Expenditure that arises out of the addition of investment expenditures to current health expenditures (CHE + investment). Comprises all services such as curative care, rehabilitative care, prevention and public health, and ancillary health care. It also includes expenditures made for the administration of these services and drugs, medical goods that are provided for the public, and salaries and fees of health personnel. It excludes investment expenditures. The types of inputs used in producing the goods and services consumed or the activities conducted in the health accounts boundary. Institutional units that manage health financing schemes. The revenues of the health financing schemes received or collected through specific contribution mechanisms. Components of a country’s health financial system that channel revenues received and use those funds to pay for, or purchase, the activities inside the health accounts boundary. Covers all general government entities to produce or purchase health care goods and services. the types of the assets that health providers have acquired during the accounting period and that are used repeatedly or continuously for more than one year in the production of health services. The value of all goods and services provided in a country by residents and non-residents without regard to their allocation among domestic and foreign claims. The types of goods and services provided and activities performed within the health accounts boundary. Entities that receive money in exchange for or in anticipation of producing the activities inside the health accounts boundary. Ongoing health and nursing care given to inpatients who need assistance on an ongoing basis because of chronic impairments that reduced their degree of independence and ability to perform daily activities. A category used to reflect those activities or transactions that fall within the boundaries of the health accounts but which cannot be definitively allocated to a specific category because of insufficient documentation. The direct outlays of households, including gratuities and payments in-kind, made to health practitioners and suppliers of pharmaceuticals, therapeutic appliances, and other goods and services whose primary intent is to contribute to the restoration or enhancement of the health status of individuals or population groups. Includes household payments to public services, nonprofit institutions or non-governmental organizations. A system developed by the OECD to provide international comparability for member and nonmember countries. Schemes that receive payments from the insuree or other institutional units on behalf of the insure, to secure entitlement to benefits of the voluntary health insurance schemes.
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Current and capital health expenditure Current health expenditure (CHE)

Factors of provision (FP) Financing agents (FA) Revenues of financing schemes (FS) Financing schemes (HF) General government expenditure on health (GGEH) Gross capital formation (HK) Gross domestic product (GDP) Health care functions (HC) Health care providers (HP)

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Long-term care

Not specified by kind (nsk)

Out-Of-Pocket (OOP) spending

System of Health Accounts (SHA) Voluntary prepayment schemes

 Abbreviations
CHE FP FS GCC GDP GGEH HC HF HMC HP MOEF MOI n.e.c. NHA NHS NSK Current Health Expenditure Factors of Provision Revenues of Financing Schemes Gulf Cooperation Council Gross Domestic Product General Government Expenditure on Health Health care functions Financing schemes Hamad Medical Corporation Healthcare Providers Ministry of Economy and Finance Ministry of Interior Not elsewhere classified National Health Accounts National Health Strategy 2011-2016 Not Specified by Kind Organization for Economic Co-operation and Development Other Government Organizations Online Health Survey Out-Of-Pocket Primary Health Care Corporation Private Health Insurance Qatar Armed Forces Qatari Riyal Qatar Foundation for Education, Science and Community Development Qatar Health Accounts Qatar National Health Accounts Report - 2009 - 2010 Qatar National Health Accounts Report - 2011 Qatar Petroleum Supreme Council of Health Initial System of Health Accounts, developed in 2000 First revision of System of Health Accounts, completed in 2011 Social Health Insurance Treatment Abroad United States Dollar World Health Organization World Health Survey

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OECD OGO OHS OOP PHCC PHI QAF QAR QF QHA QHAR-1 QHAR-2 QP SCH SHA 1.0 SHA 2011 SHI TA US$ WHO WHS

 Foreword

Following the successful release of Qatar’s first National Health Accounts 1st Report in June 2011, a first in the Gulf Cooperation Council region, it is my pleasure to release, the Qatar National Health Accounts 2nd Report– 2011,the first in the world to utilize the new classification system created by the Organization for Economic Cooperation and Development, Eurostat and the World Health Organization (WHO). Qatar’s decision to move to the new classification system is based on our fundamental belief that decision making should be based on evidence-based measures. The new classifications provide a refined conceptual framework for health accounting, and an extended set of classifications to describe the flow of funds within the health system. With these new classifications, Qatar’s policymakers and stakeholders will have a more precise description of the role of the health sector within the national economy. This report also adds new information about the granularity of health care financing in Qatar, by offering an enhanced opportunity to study the trend of health care expenditure in the last few years. This information helps us to answer three additional questions: “Who benefited from current health expenditures?”; “What was spent for investment on health?”; and “What resources were used to provide these services?”. Qatar is experiencing significant developments, particularly in the health sector. This report shows that the money spent on health increased by 27% from 2010 to 2011, and 84% of this increase was funded by the government. This increase illustrates the government commitment to advancing the health of its people. The Qatar National Health Accounts Report – 2011 is the realization of close collaboration between the Supreme Council of Health and its partners. I would like to thank the National Health Accounts team at the Supreme Council of Health – headed by Dr. Faleh Mohamed Hussain Ali, Assistant Secretary General for Policy Affairs – for their excellent work. This report would not have been possible without the contribution of various organizations, particularly the contribution of the Steering Committee member organizations. I also gratefully acknowledge the data and qualitative information provided by respondents to the online health survey, private health insurance companies, and health care providers. Lastly, and in our effort to institutionalize National Health Accounts in Qatar, I look forward to continuing support from all stakeholder organizations in the production of future reports.
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His Excellency Abdulla bin Khalid Al Qahtani Minister of Health, and Secretary General Supreme Council of Health

 Acknowledgements

Production of the Qatar National Health Accounts Report - 2011 was realized by the support of various individuals and organizations. This Report could not have been done without the support of His Excellency Mr. Abdulla bin Khalid Al Qahtani, Minister of Health, and Secretary General of the Supreme Council of Health. His Excellency Mr. Al Qahtani secured political support at the highest level, issued a Ministerial Decree to form the Steering Committee, and revised and approved the final version of this report. The National Health Accounts also benefited tremendously from the support and guidance of Dr. Faleh Mohamed Hussain Ali, Assistant Secretary General for Policy Affairs. He supervised the entire process, and participated in all revisions of this report. The execution of the National Health Accounts in Qatar was carried out by the following team of technical staff from the Supreme Council of Health – Policy Directorate: • Mr. Altijani Hussin managed the technical team, supervised the analysis, and led the development of this report. • Mrs. Eman Habib Sailani and Mrs. Fadlah Al-Mansouri provided the technical support and performed the data analysis. • Mrs. Lolwa Al-Kuwari provided the administrative support. • Mr. Husein Reka, Ms. Orsida Gjebrea, and Mr. Ahmad Fekri provided revisions to this report.
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Supreme Council Of Health

In addition to the team in the Supreme Council of Health, the following organizations provided valuable information and data, which were used in this report: • The World Health Organization, in particular Dr. Cornelis Van Mosseveld (HQ Office) and Dr. Awad Mataria (EMRO Office). • Hamad Medical Corporation, in particular Mr. Saeed Bawazeer and Mr. Giyab Alaamri. • Primary Health Care Corporation, in particular Dr. Mariyam Abdulmalik (A/Managing Director) and Mr. Amir Megahed. • Ministry of Economy and Finance, in particular Mr. Ahmad Bokshisha. • Qatar Statistics Authority, in particular Ms. Wadha Al-Jabor. • Ministry of Interior Medical Services, in particular Captain Sabt Al Kuwari. • Qatar Orthopedic and Sports Medicines Hospital (Aspetar), in particular Mr. Mouhamed Kayal and Mrs. Ailsa Lord. • Sidra Medical & Research Center, in particular Mr. Llew Werner. • Qatar Petroleum, in particular Mr. Saleem Kapoorwala. • The private hospitals (in alphabetical order): Al Ahli, Al Emadi, American, and Doha Clinics Hospitals. • The private health insurance companies (in alphabetical order): American Life Insurance, Al-Khaleej Takaful Group, Al Koot Insurance & Reinsurance, Doha Bank Assurance, Doha Insurance, LibanoSuisse Insurance, Qatar General Insurance and Reinsurance, Qatar Life And Medical Insurance Company, and SEIB Insurance and Reinsurance. • The respondents to the Online Health Survey 2011.

Executive Summary

 Executive Summary
With the first anniversary of the National Health Strategy 2011-2016 (NHS) that outlines 35 major health projects in Qatar, it is essential to observe and analyze the financial dimensions of health expenditure. The international tool used to monitor changes in the financial dimensions of healthcare systems is the National Health Accounts (NHA). The Supreme Council of Health (SCH), Qatar’s highest authority for health care, launched the Qatar National Health Accounts Report - 2009 - 2010 (QHAR-1), in June 2011, to help policy makers with several key objectives, such as giving a clear financial picture of the health system. Building on the same objectives, SCH produced Qatar National Health Accounts Report - 2011 (QHAR-2), with updated classifications that follow the newly published “A System of Health Accounts” (SHA 2011). These new classifications offer more complete coverage within the functional classification, a more concise picture of the universe of health care providers, and a precise approach for tracking financing in the health care sector. The key findings of QHAR-2 are summarized below, and are followed by the detailed findings and a list of policy implications. The report also includes two annexes. Annex 1 shows the methodology and main results of the second Online Health Survey (OHS-2). The responses from OHS-2 were used to estimate the household health expenditure used in this report. Annex 2 shows detailed NHA tables.

KEY FINDINGS
Current and capital health expenditure In 2011, Qatar spent a total of 12,088m QAR (3,320m US$) on healthcare, up by 27% from 2010 [9,530m QAR, (2,618m US$)]. The per capita expenditure, as a result, increased from 5,682 QAR to 7,028 QAR (1,920US$) in 2011. Of the total 12,088m QAR spent, 9,966m QAR (82%) was spent on current health expenditure (CHE), and 2,122m QAR (18%) was spent on gross capital formation (investment). Flow of funds from the original sources (where the funds came from?) The total 12,088m QAR spent was funded by the government schemes,9,307m QAR (77%), and by the voluntary prepayment schemes, 2,781m QAR (23%). The 9,966m QAR spent on CHE was funded by the public sector (72%), households (17%), and employers (11%)(1). Financing Schemes(HF) (which funds are used?) The public portion of CHE (7,186m) was mainly managed by SCH, 6,732m QAR (94%) and then by Other Government Organizations (OGO), 454m QAR (6%). The private portion of CHE (2,781m QAR) was managed by: Households, 1,665m QAR (60%); Voluntary health insurance schemes in Qatar, 629m QAR (23%); Enterprise schemes, 291m QAR (10%); The rest of the world, in form of services in Qatar paid by international health insurance plans, 195m QAR (7%); and • Zakat Fund, 15m QAR (1%). • • • •
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(1) Employers’ share was 9% direct services and enrollment in local private health insurance schemes, and 2% international health insurance plans.

Financing schemes to healthcare providers (HP) (which providers received the funds?) The 9,966mQAR spent on CHE was distributed to the following healthcare providers: • • • • • • Hospitals, 5,651m QAR (57%); Providers of ambulatory health care, 1,427m QAR (14%); Private providers of ancillary services and retailers of medical goods, 547m QAR (5%); Health care system administration, 770m QAR (8%); Rest of the world, in form of treatment abroad (TA), 907m QAR (9%); and Others not specified by kind (N.S.K.), 664m QAR (7%).

Healthcare functions (HC) (what services were received for these funds?) The 9,966m QAR spent on CHE was paid for the following services: • • • • Inpatient, long term, and rehabilitative care services, 4,016mQAR (40%); Outpatient and day care services, 3,031m QAR (30%); Ancillary services and medical goods, 1,851m QAR (19%); and Collective care, such as governance and preventive care, 1,032mQAR (10%).

Factors of provision used (FP) (what sources were used to provide these services?) The 9,966m QAR spent on CHE was paid for the following resources: • • • •
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Supreme Council Of Health

Compensation of employees and self-employed, 6,297m QAR (63%); Materials and services used, 2,562m QAR (26%); Treatment abroad, 907m QAR (9%); and Other items, 234m QAR (2%).

Beneficiary characteristics (who benefited from the CHE?) The 9,966m QAR spent on CHE was paid for services delivered to: • Males, 5,631m QAR (57%); and • Females, 4,335m QAR (43%). The age groups that benefited from these funds were as follows: • 0-14 years old, 1,751m QAR (18%); • Working age group 15-64 years old, 7,378m QAR (74%); and • Elderly population 65+, 836m QAR (8%). Gross capital formation (what was spent for investment on health?) The 2,122m QAR spent on gross capital formation was paid for infrastructure(74%), and machinery and equipment(26%).

Introduction

 1- Introduction
With the demand for advanced technologies in the health care systems increasing, the financial implications are increasing rapidly. Policy makers, analysts, and the general public have increased expectations about the costs associated with the advancement of their healthcare systems. NHA depicts the flow of the costs related to the consumption of health care goods and services. NHA is thus an analytical tool to provide measurable inputs to monitor and assess health system performance. In addition, NHA supplies reliable and timely data that is comparable both across countries and over time. The trend in spending for healthcare can be tracked by the NHA to find the factors driving it, such as change in demographics, and can be used to predict the future growth of the healthcare funds. Thus, NHA is used in two main ways: internationally, where the emphasis is on a selection of internationally comparable expenditure data, and nationally, with more detailed analyses of health care spending and a greater emphasis on comparisons over time. Health accounts are crucial for both of these uses (SHA 2011, 20).NHA allows countries to achieve these two uses by answering the following fundamental questions: • • • • • • How are revenues mobilized? Which schemes are used? Who is managing these schemes? Which healthcare providers do the health funds go to? Which healthcare services were bought for these funds? Who benefited from these funds, in terms of beneficiary characteristics such as age and gender?
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2012

1.1 Qatar Health Accounts Report, 2010
The SCH produced its QHAR-1 in June, 2011. The primary objective of the first report was to support the development and review of policies that are related to: • Identifying the revenues of financing schemes. • Reviewing the current allocation of resources to health services. • Identifying additional resources needed for healthcare. • Mobilizing funds and allocating them efficiently and effectively. The report was divided into two parts: the results of NHA in Qatar and the annexes which discuss the results of the OHS (used in several parts of the QHAR-1), and the methodological approach to adjust the population in Qatar. The results from QHAR-1 show the flow of funds in calendar years 2009 and 2010. In 2010, Qatar spent 9,530m QAR (USD 2,618m) on healthcare. The per capita health expenditure was QAR 5,683 (USD 1,561). Of the total 9,530m QAR spent on healthcare in 2010, 77.5% (QAR 7,382m) was funded by the public sector and 22.5% (QAR 2,148m) by the private sector. Other main findings include: • The public funds were exclusively managed by the public agents (SCH, 77%, Qatar Foundation QF, 14%, other government organizations and parastatal companies (2), 9%). • The private funds were mainly managed by the private agents (households, 17%, private health insurance companies (PHI), 28%, and charitable organizations, 1%). • Hospitals received the majority of the healthcare funds, 67%, followed by ambulatory providers, 11%, private retail sale and other providers of medical goods, 5%, public health programs and general health administration and insurance, 9%, and other non specified sources, 8%.
(2) Parastatal companies are state-owned companies that have a significant degree of autonomy from general government operations.

• The services received for these funds in 2010 were inpatient, long term, and rehabilitative care,26%, outpatient and daycare, 27%, ancillary services,12%, medical goods dispensed to outpatients, 9%, public health, and general administration and insurance, 9%, gross capital formation (investment) in health, 15%, and functions NSK, 1.5%. Cross-country comparisons were carried out for the main findings to show the relevant level of expenditure and utilization in Qatar compared to the region and countries of the Organization for Economic Cooperation and Development (OECD).The methodologies used in QHAR-1 were based on the international guidelines provided in the Guide to Producing National Health Accounts (WHO, 2003). This Producer’s Guide details the methodology to analyze the collected data, and the format for reporting the findings. In addition, the Qatar Health Accounts (QHA) team used the classification in A System of Health Accounts (OECD, 2000) (SHA 1.0).

1.2 SHA 2011
The healthcare systems around the globe have been developing rapidly since the production of SHA 1.0. Driving these changes are innovations in interventions, pharmaceuticals, and medical technologies. As a result, the cost of healthcare is also becoming increasingly a pressing subject of interest to policy makers, analysts, and the general public. There is an increased expectation for more sophisticated information that can be gained through the greater volume of health expenditure data now available. With this increased interest in healthcare financing, OECD, the European Union, and the World Health Organization (WHO) produced “A System of Health Accounts” in 2011 (SHA 2011). SHA 2011 built on SHA 1.0, but addressed the following issues in more details: • SHA 2011 develops the health care financing interface to allow for a systematic assessment of how finances are mobilized, managed and used, including the financing arrangements (Financing schemes), the institutional units (Financing agents) and the revenue-raising mechanisms (Revenues of financing schemes). • SHA 2011 delves into the cost structures of health care provision (Factors of provision) and provides a separate treatment of capital formation so as to avoid some of the past ambiguity regarding the links between current health spending and capital expenditure in health care systems. • SHA 2011 improves the study and further analysis of the functional dimension. • SHA 2011 improves the breakdown of health care expenditure according to beneficiary characteristics, such as disease, age, gender, region and socioeconomic status. In its effort to employ the improvements in the classification of the NHA, Qatar adopted SHA 2011 in the development of QHAR-2.

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1.3 Qatar’s Health Care System
Health care governance in Qatar is exercised through the SCH, which is mandated with a comprehensive range of powers for the administration and regulation of the health care system. The SCH supervises the two government owned organizations which are the country’s principal health care providers: Hamad Medical Corporation (HMC) and Primary Health Care Corporation (PHCC). The SCH also supervises all private health care institutions, including hospitals, clinics, pharmacies, laboratories and auxiliary medical practices. Figure 1 depicts the governance structure of the health care system in Qatar. Health care services, especially for the lower paid, are most commonly provided via HMC. The PHI market in Qatar is relatively new but rapidly expanding. Although not mandatory, employers may purchase PHI coverage to attract and retain qualified employees. Over the past decade, the private healthcare sector in Qatar has increased rapidly in size and services provided. Its role is expected to increase even further with the planned healthcare reforms.

Figure 1 Governance structure of the health care system in Qatar

SCH Board of Directors

SCH Executive Committee

SCH General Secretariat

Other Health Care Providers (Other gov’t organizations; Private hospitals, polyclinics, clinics, pharmacies, labs and imaging, etc.)

Hamad Medical Corporation

Primary Health Care Corporation

National Health Insurance Company

Supervision and oversight

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1.3.1 Population
Qatar’s infrastructure, including the health care system, continues to adjust for the significant increase in its population over the last 10 years. The population in Qatar increased by 176% between 2000 and 2010 (from 616,000 to 1,700,000). The high demand for oil and gas over the past 10 years, and the high cash revenues generated, resulted in a demand for labor, especially young expatriate males. The population in Qatar, as in other Gulf Cooperation Council (GCC) countries, of which Qatar is one of six member countries, is noted for its male composition. To cope with this rapid growth, laborers are brought in from other countries on short-term work visas. These laborers are mainly male, aged between 20 and 45, and screened for three communicable diseases upon entry to the country(3). Labor laws mandate employers to protect laborers against hazardous occupational health and work-related injuries. The laborers, which constitute about 54% of the population, have the lowest health utilization rates (due to their gender-age composition and selection based on screening), and, subsequently, the lowest health expenditure. Laborers live in large labor compounds located close to their working sites. The rest of the population in Qatar lives in standard household setups. This includes Qatari and non-Qatari household members and non-Qatari domestic workers. It is the regular household members (about 40% of the total population) who use the health care system the most and incur the highest share of health expenditure. Their health needs and utilization are comparable to those in other countries with a common gender-age distribution. Domestic workers, who receive their health care independently from their employers, are primarily covered by the HMC health cards. Although domestic workers are part of the household they live in, they have little impact on health care utilization and expenditure at the household level.
(3) HIV, and Tuberculosis for all, in addition to Hepatitis (B and C) for the food handlers.

To use comparable population denominators for Qatar, SCH used a statistical model, based on an imputation procedure, to estimate an adjusted male population aged 25 to 60 years. Population data from five regions were used (North Africa, Asia, Eastern Europe, Latin America, and the Caribbean). For more information see 56. The results are shown in Figure 2 below. The total population in 2010 was 1.7 million, while the adjusted population results show that the total population is only 950,000.
Figu 2 Actual and Adjusted Population, Qatar, 2010 ure d

Adjusted Males d
70+ yrs. 60 64 yrs. 0 50 54 yrs. 0 40 44 yrs. 0 30 34 yrs. 0 20 24 yrs 0 10 14 yrs. 0 0 4 yrs.

Actual Males

Actual Female A es

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250

200

150

100 50 0 Pop pulation in 1,0 000s

0

50

100

1.3.2 Key Indicators-Summary
Table 1 below shows selected key macroeconomic and health care resources indicators for Qatar and compares it with three groups of countries: I. Organization of Economic Cooperation and Development(4): a group of high income Western European countries; in addition to other non-European high income countries such as USA, Canada, Japan, and Australia. We chose this group of countries as our primary comparison throughout this report for two reasons. First, these countries have a comparable level of income to Qatar (both are high income countries). Second, these countries have updated and detailed health financing information.

II. Eastern Mediterranean Region (EMRO)(5), including Qatar. One of the six regions of the WHO. It includes a group of 22 countries, most of which are in the Middle East and North Africa. Because Qatar is part of the EMRO group, it is thus important to compare Qatar to these countries. III. Other GCC countries(6),not including Qatar. Qatar has the distinction of being part of this group of six, unique oil-rich countries. These countries share specific population structure, with the majority of the population consisting of expatriates, as well as specific economies with high dependency on oil and gas revenues.
(4) Australia, Austria, Belgium, Canada, Chile, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Japan, Korea, Luxembourg, Mexico, Netherlands, New Zealand, Norway, Poland, Portugal, Slovak Republic, Slovenia, Spain, Sweden, Switzerland, Turkey, United Kingdom, and United States. (5) Afghanistan, Bahrain, Djibouti, Egypt, Islamic Republic of Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syrian Arab Republic, Tunisia, United Arab Emirates, and Yemen. (6) Bahrain, Kuwait, Kingdom of Saudi Arabia, Oman, and United Arab Emirates.

Qatar’s Data
The economy in Qatar continued to increase in 2011. The Gross Domestic Product (GDP) per capita increased by 35% since 2010 (from 74,246 US$ to 100,300 US$). This dramatic growth is due to continuing increases in oil and gas prices worldwide. In the health sector, the government continues to play a major role in financing the services provided and the investment sought. Per capita current and capital health expenditure increased in 2011 by 23% since 2010 (from 1,561 US$ to 1,920 US$). The government’s share in this amount is 79% (1,518 US$ per capita, which is a 28% increase compared to 2010). The households’ share of the current and total health expenditure decreased from 16% in 2010, to 13.8% in 2011. As a result of the upward trend in health expenditure, healthcare resources indicators have continued to improve over the last three years. For example, hospital beds per 1,000 population edged up to 1.3, and is expected to reach 1.7 by the end of 2012.
Table 1: Selected Qatar indicators compared to regional and international countries Country Year
Population (Million) GDP per capita (US$) Per capita current and capital health expenditure (US$) Per capita public current and capital health expenditure (US$) Current and capital health expenditure, as% of GDP Public expenditure on health, as % of current and capital health expenditure OOP expenditure, as % of current and capital expenditure on health OOP expenditure, as % of CHE GGEH, as % of general government expenditure Hospital Beds per 1,000 population Radiation therapy equipment per million population Life expectancy at birth

OECD a 2009 1,220 33,320 3,233 2,250 9.6% 72.0%

EMRO b 2008 592 3,643 153 82 4.2% 53.2%

Other GCC b,c 2008 37 33,058 919 650 2.8% 71.4% 2009 1.6 59,683 1,580 1,233 2.6% 78%

QATAR 2010 1.7 74,246 1,561 1,183 2.1% 77% 2011 1.7 100,300 1,920 1,518 1.9% 79%
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9

20.0%

41.6%

19.0%

16.0% 19.4% 6.0% 1.2 NA 78.2

16.0% 18.7% 6.9% 1.2 NA 78.4

13.8% 16.7% 5.3% d 1.3 2.3 78.6

Not available in the old classifications

NA 5.1 6.7 79.3

6.9% 1.2 0.4 66.0

7.7% 1.9 0.8 75.0

a: Health at a Glance 2011 - OECD INDICATORS. All OECD monetary values are in US$ Purchasing Power Parity. b: World Health Statistics 2011 c: Other GCC countries excluding Qatar. d: Preliminary results

Cross-country comparison
Qatar’s GDP is the highest compared to the other countries in Table 1, with 2011 data showing 100,300 US$ per capita GDP. In the health care sector, Qatar’s per capita current and capital health expenditure was more than twice the average in Other GCC countries, and more than 12 times the average in the EMRO countries. When contrasted with OECD countries Qatar’s per capita current and capital health expenditure (1,920 US$) was lower than the average in OECD countries (3,233 US$)(7). However, when the expenditure was adjusted for population (results not shown in Table 1), Qatar’s per capita current and capital health expenditure (3,321 US$) exceeded OECD average. The same was true with per capita public current and capital expenditure on health. In addition, public funds were the highest source for health expenditure when comparing Qatar with the other groups of countries. The percentage share of households was the lowest in Qatar (13.8%) compared with the other groups of countries: about 20% in Other GCC and OECD countries, and 42% in EMRO. General government expenditure on health (GGEH) was relatively the same in Qatar (5.3%) to Other GCC (7.7%) and EMRO (6.9%) countries. Life expectancy at birth in Qatar (78.6 years) was very close to OECD (79.3 years), 3 years higher than Other GCC (75.0 years), and 12.6 years higher than EMRO (66.0). Figure 3 shows medical equipment per million population in Qatar, both at actual and adjusted population, compared with those in OECD. Qatar’s adjusted population MRI units per million populations are similar to OECD. However, the CT scanners and mammography units are lower in Qatar. Qatar’s results of lower than average OECD medical equipment, particularly radiation therapy and mammography units, should be interpreted with caution, and in context of Qatar’s population structure. Although these results appear to indicate lower ratios, this equipment is used primarily to detect breast cancers among women and to treat cancer patients, who are primarily over 60 years old. Qatar’s adjusted population is young and male biased.

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Figure 3 Medical equipment per million population, OECD and Qatar 2011 25.0 20.0 15.0 10.0 5.0 0.0 MRI units per million population CT Scanners per million population Mammograghs per million population

22.3

23.5

12.3 7.6

13.0 8.2

14.0 9.0 5.2

OECD, 2009

Qatar, 2011

Qatar, 2011 Adjusted population

(7)

Although the values for OECD are in US$ adjusted for Purchasing Power Parities (an economic method used to adjust for income and expenditure), these economies tend to have closer values between Purchasing Power Parities and US$ at exchange rates. For instance, the Purchasing Power Parities in national currencies per US$ in OECD was 1.06 for the GDP in 2008. In addition, the health expenditure data published for OECD - as a group - is only available in Purchasing Power Parity (Health at a Glance 2011).

Methodologies and Data Collection

 2- Methodologies and Data Collection
2.1 QHAR-2 Activities
Following the successful launch of QHAR-1, the NHA team organized a dissemination event that showed the main findings to the stakeholders (September, 2011). The objective of the dissemination event was to inform the stakeholders of the importance of their participation in providing the needed datasets, and to inform them that the NHA exercise will be part of the decision making process in Qatar’s health care system. Therefore, stakeholders were asked to provide periodic and detailed datasets to improve the accuracy of the NHA in Qatar. Soon after, the NHA team designed to capture the households’ health information for 2011. The survey was conducted with repeated sample of participants for four consecutive months (September to December, 2011). Annex-1 shows the details of OHS-2, and the key results. The team then designed various instruments to collect the needed information for QHAR-2. These instruments were built with SHA 2011 as the adopted set of classifications and methodologies. Section 2.3 below shows the targeted organizations and the requested information in these instruments. T-Accounts and NHA tables in Microsoft Excel 2007 were created to host the data. Once received, the information was entered in the relevant cells and the results were automated. Not all the needed information was received, and thus some assumptions were used to fill the missing information. These assumptions are also explained in Section 2.3 below.

2.2 QHAR-2 and SHA 2011
The data collected for QHAR-2 was analyzed in accordance with the international guidelines provided in SHA 2011 (OECD, Eurostat, WHO, 2011). Once the decision to adopt SHA 2011 in Qatar’s NHA was made, the technical team drafted the list of NHA tables that correspond to QHAR-1. The team also expanded the list of tables with the SHA 2011, based on the data availability and the policy needs. Thus, QHAR-2 repeats the following four tables reported in QHAR-1, but based on the new classifications. The first three of these tables are the following tri-axials: 1) Revenues of financing schemes BY Financing schemes [FSXHF] table. This table shows the revenues by type received by schemes and answers “ how are revenues mobilized, and which schemes are used”. 2) Financing schemes BY Health care providers [HFXHP] table. This table shows the flow of funds from the managing schemes to the health care providers, and answers “which schemes funds who?” The classification of the healthcare providers in SHA 2011 includes nine changes (see page 127-128, SHA 2011). Thus, adjustments were made in QHAR-2 to match the changes in SHA 2011. 3) Financing schemes BY Health care functions [HFXHC] table. This table shows the flow of funds from the financing schemes to the health care services purchased for these funds, and it answers “which schemes are used?” The healthcare functions in SHA 2011 were not significantly changed, with two exceptions. First, the public health services are separated from preventive services. Second, some of the health care related parts in SHA 1.0 are now inside the CHE in SHA 2011. Although major, these changes in classification caused limited adjustments in QHAR-2 to fit the new classification.

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4) Factors of provision BY Public and private provider group [FP] table, previously known as Resources Cost table in NHA Producer’s Guide. This table shows the cost of resources used to produce the health care functions purchased. It is a key monitoring tool in determining overall system performance, and it provides a basis for the analysis of the efficiency of production and resource use (SHA 2011, page 343). Due to the limited information available in 2010, QHAR-1 included only the public sector expenditure on the cost of resources. SHA 2011 classifications include small changes in the classification and definitions of this table’s items, and the team adjusted these changes in QHAR-2 to fit the new classifications. In addition, QHAR-2 includes the following new set of tables, which were not developed in QHAR-1: 5) Health care providers BY Health care Functions [HPXHC] table. This table is the final table in the tri-axial system of the NHA, and shows the CHE by type of provider and by function. It shows how expenditures on different health functions are channeled through the various types of providers, and answers “who provides what?” This table provides a summary perspective of the health market in a country, i.e. what is the structure of its health care needs and who are the providers involved. This table has been shown to be valuable for validating the supply side of the CHE estimate (SHA 2011, page 342). 6) Gross Capital Formation [HK] table. This table provides an overview of the finance of the capital goods in the health care system for the NHA year. It thus answers “which investment goods are acquired?” Because Qatar’s government is injecting significant amount of investment in the health care system, it is imperative to include this table in QHAR-2. However, this table only provides investment classifications financed by the government and other public organizations. Data was not available from the private sector to include in this table.
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7) Expenditure on health care by beneficiary characteristics: Gender and Age group. This table answers “which segments of the population benefited from the current health care spending?”With a unique population characteristics (see Section1.3.1), this table provides essential information on the uses of funds. It is thus considered one of the key outcomes of QHAR-2.

2.3 Data Sources, Strategy, and Assumptions Used
This section lists the data sources used in QHAR-2 matrices, the strategy used to collect the necessary data, and the assumptions used.

2.3.1 Government
MOEF MOEF provided the SCH with a breakdown of health expenditures paid by the government. Although the information received included all of the recipient organizations, the data only shows the expenditures at four categories: salaries and wages, operating expenses, capital expenses, and major projects. This breakdown was useful for the healthcare resources table, and was also useful to ensure consistency with reports from the recipients of the funds. SCH The SCH provided the breakdown of financial information based on the new budget classifications. Although the breakdown is more detailed than that received from MOEF, the allocation of funds was not given by programs. Assumptions were then used in allocating the expenditures to the healthcare function, health care resources, and health care providers’ tables. Because a significant amount of the public fund for health was spent on TA, an additional classification item was created in the health care functions’ table to allocate these expenditures: HC.1.1.M.

HMC A mapping exercise was conducted to improve the allocation of the HMC’s 570 cost centers to the various QHA matrices. Data for 2011 was available with the breakdown of the cost centers, and each cost center has further breakdowns of the various activities included, such as salaries and wages, equipment, etc. The QHA team allocated the administrative expenditure, proportionate to the size of the cost center, in consultation with the finance team from HMC. In addition, the team used HMC’s annual reports such as Annual Hospital Costs Report, 2011 in the factors of provision table. PHCC Similar breakdown to SCH expenditure was received from PHCC. Given the limited variety of services that PHCC provided, benchmarking was used to distribute the total expenditures into the needed QHA matrices. The benchmarking included the breakdown used in previous PHCC reports (FY 2007/08). Employer clinics The five Qatar Petroleum (QP) clinics provided detailed information which was used to allocate the funds into the necessary matrices. The other employer clinics, MOI and Qatar Armed Forces (QAF), did not provide new information. Thus, a simple trend was used to calculate their expenditures for 2011. Then, we benchmarked those expenditures to QP data to assert their health expenditures. Aspetar An instrument was sent and later filled by Aspetar. The instrument provided detailed information which allowed the mapping with QHA matrices with minimal assumptions. Sidra As Sidra does not yet provide services, all funds spent were placed into the capital formation sections of the QHA matrices.
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2.3.2 Private health insurance companies
Another instrument, tailored to PHI companies, was sent to the registered companies in Qatar. The instrument included four sections: 1) Person completing the instrument, and his position in the organization. 2) High level health insurance activities. For example, total number of enrollees, total amounts received in premiums, and total amounts paid in claims. 3) Details of total health expenditure for the services and goods provided to insured individuals. For example, inpatient care to public hospitals and inpatient care to private hospitals. 4) Details of the total health expenditure by beneficiary characteristics; i.e. age and gender.

2.3.3 Out-Of-Pocket spending
The SCH administered the second OHS in 2011 to evaluate the population’s health utilization and health expenditure, the current PHI market, and to assess attitudes toward the current health insurance market and expectations of the upcoming SHI scheme. The results from the OHS built on existing data in 2010 to help the SCH form an objective perspective on health financing issues pertaining to NHA and SHI projects, and to evaluate various economic and financial health care outcomes based on evidence-based methods. We added a new section in the survey about the children’s health utilization and expenditures.

An important section of the second OHS is the OOP expenses paid by individual respondents. The findings from that section were used to estimate the national average OOP expenses and were used in the QHA matrices. See Annex 1 for further details.

2.3.4 Private health care providers
A third instrument was sent to the four private hospitals operating in the country, with similar information to that requested from the private health insurance companies. Sources of income were classified as OOP, PHI, contracts, and others. The information received was then compared to that from the OHS and the PHI instruments. We found that the national PHI companies paid approximately 200m QAR to the private hospitals, while private hospitals received approximately 400m QAR from the PHI companies. Thus, we assumed that the difference, i.e. around 200m QAR, was received from the international PHI companies that operate in Qatar. These expenditures were then classified in the NHA tables as “other domestic revenues” in the financing sources classification, and as “rest of the world” in the financing schemes classifications.

2.3.5 Private firms
Private firms provide health coverage to their employees either by purchasing private health insurance, providing direct contracts with the private health providers, or reimbursing their employees for services received. The latest establishment survey conducted by QSA, which is the appropriate method to collect the private firms’ information, did not include health expenditures information.
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To address this limitation, the data received from the private hospitals included direct contracts with the private institutions. These amounts were then used in the appropriate classification of the NHA tables.

2.3.6 Charitable Organizations
Aggregate information was received from the not-for-profit Zakat Fund. Thus, the expenditures were allocated to “not specified by kind” categories of the QHA matrices. For the next rounds of QHA, it is highly recommended that the charitable organizations and the recipients of its funds report these amounts to the QHA team.

2.4 Limitations
The second report of the QHA addressed most of the limitations experienced in QHAR-1. However, few limitations remain to be addressed. First, the OOP estimate is derived from various sources, such as the OHS and the WHS, 2006, which may introduce bias. Efforts should be made to conduct a national health expenditure survey. Second, health expenditure data was not available for the private clinics and polyclinics. A limited survey should be carried out to estimate the amount spent at these providers. Third, the data received from the public and private providers, as well as the insurance companies, was not to the needed details. A proper and consistent mapping exercise should be adopted by the stakeholders, in collaboration with SCH, to ensure that future data needs are produced t the needed details.

QHA Results
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 3 - QHA Results
This section of the report shows the flow of funds in the following main NHA Tables: 1. Revenues of Financing Schemes (revenues) X Financing schemes [FSXHF]. 2. Financing schemes X Health care providers [HFXHP]. 3. Financing schemes X Health care functions [HFXHC]. 4. Health care providers X Health care functions [HPXHC]. 5. Factors of health care provisions [FP]. 6. Gross Capital Formation of government and other public organizations [HK]. 7. Beneficiary characteristics by gender, and by age group.

3.1 Financing Dimensions
Revenues of Financing Schemes (FS) are defined in the SHA 2011 (OECD, Eurostat, WHO, 2011: 341) as: “the revenues of the health financing schemes received or collected through specific contribution mechanisms.” Financing schemes (HF) are defined in the SHA 2011 (OECD, Eurostat, WHO, 2011: 341) as: “Components of a country’s health financial system that channel revenues received and use those funds to pay for, or purchase, the activities inside the health accounts boundary.” Financing agents (FA) are defined in SHA 2011 (OECD, Eurostat, WHO, 2011: 341) as: “Institutional units that manage health financing schemes”
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Main Findings: Where do the health funds come from?
Table 2 shows the revenues of the financing schemes received by the financing schemes in 2011: • The current and capital health expenditures were 12,088m QAR. Of this amount, CHE was 9,966m QAR (82%), and the gross fixed capital formation was 2,122m QAR (18%). • The gross fixed capital formation was exclusively funded by the government. • The total CHE (9,966m QAR) was funded by: i. The government, 72% ii. Households, 16.7% iii. Employers, 9.2% iv. Other domestic revenues not elsewhere classified (n.e.c), 2%. The other domestic revenues n.e.c. are the amounts received by the private hospitals from the international health insurance schemes (see Section 2.3.4). • The CHE from the public funds in 2011 were managed as follows: SCH, 94% (6,732m QAR), and other government organizations, 6% (454m QAR). • The CHE paid by voluntary prepayment schemes funded by the employers were managed as follows: voluntary health insurance schemes, 68% (629m QAR), and enterprise financing schemes, 32% (291m QAR). • Public entities continue to exclusively manage the public funds, and private entities exclusively managed the private funds.

Trend analysis
Figure 4 below shows the trend of the current and capital health expenditures by financing sources in Qatar for the last three years. The total current and capital expenditure increased by 27% (2,558m QAR) between 2010 and 2011 (from 9,530m QAR to 12,088m QAR). The increase was funded by: • Government, 84% (2,141m QAR). • Employers, 12% (302m QAR). • Households, 4.5% (115m QAR). However, a direct comparison should be interpreted with caution for two reasons. First, the difference in classifications between SHA 1.0 and SHA 2011. Second, the new detailed information that we received allowed a proper mapping of the schemes.

Figure 4 Trend of current and capital health expenditure by financing sources, Qatar 2009 to 2011 (Million QAR) 14,000

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12,088 9,376 711 1,507 7,158 (76%) 9,530 814 1,550 7,166 (75%) 9,307 (77%) 1,116 1,665

10,000 8,000 6,000 4,000 2,000 0

2009

2010

2011

Employers

Households

Government

Total Health Expenditures

Notes: Institutional units used in previous NHA classifications are not identical to the schemes Note:

used in the new classifications.

Table 2 : Revenues of the financing schemes received by the financing schemes, 2011 (Million QAR)
Financing Sources (revenues), Million QR FS.5 Voluntary Prepayment FS.1 Government * FS.5.1 From Households FS.5.2 From Employers 7,186 (72%) 6,732 (94%) 454 (6%) 6,732 (68%) 454 (5%) 935 (9%) 629 (68%) 15 (1%) 291 (32%) 1,650 (99%) 195 (100%) 7,186 (72.1%) 2,121 9,307 1,665 (16.7%) 2,586 920 (9.2%) 0.7 195 (2.0%) 195 629 (6%) 15 (0%) 291 (3%) 1,650 (17%) 195 (2%) 9,966 (100%) 2,122 12,088 FS.6 Other Domestic Revenues n.e.c. Total (% CHE)

Code

Financing Schemes

HF.1

Government Schemes

HF.1.1.1.1

SCH

HF.1.1.1.2

Other Government Organizations (MOI, AF, Aspetar)

HF.2

Voluntary Health Care Payment Schemes

HF.2.1

Voluntary Health Insurance Schemes

HF.2.2

NPISH (Zakat Fund)

HF.2.3

Enterprise Financing Schemes

HF.3

Household Out-of-pocket Payment

HF.4

Rest of the world

Total Current Health Expenditure **

(% from Total)

HK.1.1

Gross Fixed Capital formation

Current and Capital Health Expenditures

Notes: As the focus of the new system shifted into current spending, the percentages shown are from the CHE, i.e. from the columns totals.

* Revenue of the Government (FS.1) includes the household payments for enrollment in the public health system.

** Percentages shown are from total CHE, 9,966m QR.

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Cross-country comparison
Figure 5 shows the distribution of the current and capital health expenditure by revenue in Qatar in 2011, and compares it with advanced economies (OECD in 2009). The figure shows that the main source of revenues is the public funds both in Qatar and in OECD; however, the share is relatively higher in Qatar (77%). Households in Qatar contribute by 14%, compared to 19% in OECD, and employers have a higher share in Qatar (9%) compared to OECD (6%).

Figure 5 Distribution of curren and capital Figu 5 Distribution of current and capital ure nt health expendituure by revenue, Qatar and health expenditu by revenue, Qatar and ure OECD

OEC CD

Qatar, 20 011 9% 14% %
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77 7%

3% 6% 19%

OECD , 2009 O 9

72%

Public Se ector Employe ers

Households H

Others O

3.2 Use Of Funds 3.2.1 Health care providers
Health care providers are defined in SHA 2011 (OECD, Eurostat, WHO, 2011: 341) as: “Entities that receive money in exchange for or in anticipation of producing the activities inside the health accounts boundary.”

Main findings: Where do the health funds go to?
Table 3 shows the flow of funds from the financing schemes to the healthcare providers in 2011, as follows: • The amount of funds spent on CHE in 2011 was 9,966m QAR (last green column) and was distributed as follows: i. Hospitals received the lion’s share of the CHE, 57% (5,651m QAR). The ratio from the total current and capital expenditure is even higher: 64% (7,773m QAR, from 12,088m QAR). ii. Providers of ambulatory healthcare services, 14%, (1,427m QAR). iii. Providers of ancillary services, 2%, (183m QAR). iv. Retailers and other providers of medical goods, 4%, (364m QAR). v. Providers of health care system administration and financing, 8%, (770m QAR). vi. Rest of the world, TA, 9%, (907m QAR). vii. Providers NSK, 7% (664m QAR). • The public CHE (QAR 7,186m) was distributed to the following providers (first column): i. Hospitals, 68%, (4,914m QAR) mainly HMC. ii. Ambulatory health care, 12%, (845m QAR), which represents the expenditures on PHC and employer clinics. iii. Public health programs and government health administration, 8%, (553m QAR). iv. Rest of the world, TA, 12%, (874m QAR). • The funds for voluntary health care payment schemes (936m QAR) were distributed to the following providers (second two columns): i. Hospitals, 24%, (222m QAR). ii. Ambulatory healthcare, 40%, (375m QAR). iii. Private retail sale and other providers of medical goods, 8%, (53m QAR). iv. PHI administration, 23% (217m QAR), which includes profit and future payments, because of the difference between the accrual and cash methods. This share was initially reported as 54% in 2010, see SQHAR-1 Page 20, but now adjusted to (171m QAR 32%), where all future payments were liquidated. v. Rest of the world, TA, 4%, (33m QAR). vi. Providers n.s.k, the Zakat funds, 1.6%, (15m QAR). • The public funds continue to be exclusively spent on public providers, and the private funds continue to be mainly spent on private funds.
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Trend analysis
Figure 5 below shows the trend of the current and capital health expenditures by health provider in Qatar for the last three years. The total current and capital expenditure increased by 27% (2,558m QAR) between 2010 and 2011 (from 9,530m QAR to 12,088m QAR). The increase was received by: • Hospitals, 53%, (525m QAR in CHE and 740 in Gross Capital Formation). • Ambulatory care, 13% (333m QAR). • Ancillary, retailers and others, 36% (921m QAR). However, it is important to note that institutional units used in previous NHA classifications are not identical to the schemes used in the new classifications.

Figure 6 Trend of current and capital health expenditure by health provider, 2009 to 2011 (Million QAR) 14,000 12,000 10,000 8,000

12,088 9,376 1,161 1,044 4,754 (51%) 1,724
2009

9,530 1,196 1,094 5,036 (53%) 1,382
2010

2,117 (18%) 1,427 5,651 (47%) 2,122 (18%)
2011

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6,000 4,000 2,000 0

Adminstration and Financing Ambulatory Care Gross Capital Formation

Ancillary, Retailers, and Others Hospitals

Total Health Expenditures

Notes: Institutional units used in previous NHA classifications are not identical to the schemes Note:

used in the new classifications.

Table 3 : Health expenditure by type of financing schemes and type of providers, 2011 (Million QAR)
Financing Schemes, Million QR (% of CHE) HF.1 Government schemes and compulsory contributory health care HF.2.1Voluntary health insurance HF.2.3 Enterprises 38 (13%) 185 (11%) 5 (0%) 38 (13%) 254 (87%) 254 (87%) 130 (8%) 208 (13%) 112 (7%) 96 (6%) 163 (10%) 311 (19%) 195 (12%) 320 (19%) 195 (12%) 184 (29%) 106 (17%) 3 (0%) 75 (12%) 121 (19%) 75 (12%) 46 (7%) 20 (3%) 53 (8%) 553 (8%) 874 (12%) 33 (5%) 649 (39%) 7,186 (72%) 2,121 9,307 629 936 (6%) 291 1 1,650 (3%) 1,650 (17%) 195 195 (2%) 217 (35%) HF.4 Rest of the world 4,914 (68%) 2,843 (40%) 76 (1%) 1,995 (28%) 845 (12%) HF.2 Voluntary health care payment schemes (other than OOP) HF.3 Household out-of-pocket payment TOTAL (% of CHE)

Code

Providers

HP.1

Hospitals

5,651 (57%) 3,135 (31%) 83 (1%) 2,433 (24%) 1,427 (14%) 441 (4%) 142 (1%) 183 (2%) 364 (4%) 770 (8%) 907 (9%) 664 (7%) 9,966 (100%) 2,122 12,088

HP.1.1

General hospitals

HP.1.2

Mental health and substance abuse hospitals

HP.1.3

Specialty (other than mental and substance abuse) hospitals

HP.3

Providers of ambulatory health care

HP.3.1

Medical Practices

HP.3.2

Dental Practice

HP.4

Providers of ancillary services

HP.5

Retailers and other providers of medical goods

HP.7

Providers of health care system administration and financing

HP.9

Rest of the world (TA)

HP.nsk

Provider not specified by kind

Total Current Health Expenditures* (% from Total)

HK.1.1

Gross Fixed Capital formation

Total Current and Capital Health Expenditures

Note: As the focus of the new system shifted into current spending, the percentages shown are from the CHE, i.e. from the columns totals. HP.nsk Totals include Zakat Fund (not shown). * Percentages shown are from total CHE, 9,966m QAR..

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Cross-country comparison
Figure 7 shows the distribution of the current and capital health expenditure received by provider in Qatar in 2011, and compares it with advanced economies (OECD in 2009). The figure shows that the main recipients of the funds in Qatar were the tertiary care providers, mainly the public hospitals. For example, hospitals in Qatar received almost twice as much as in OECD countries (64% compared to 36%). As a result, the ambulatory care providers seem to have been the most affected by the domination of the tertiary care providers. Ambulatory care in Qatar received only 12%, while these providers in OECD countries received more than twice that percentage (28%). In addition, the ancillary services and retailers seem to be also affected by the concentration of the services in the hospitals. The share of the ancillary services and retailers in Qatar was only 6%, compared to 19% in OECD (figures not shown). To diversify the economy and to promote the consumer choice under the upcoming health insurance scheme, the Qatari health care system should support the ancillary services and retail sale at the private providers.

Fig ure 7 Distribution of curre and capita ent al alth ure er, hea expenditu by provide Qatar and OEC CD

Qatar , 2 2011 6%
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18% 12% 64%

OECD , 20 009 6% 30% 36%

28%
Hospital ls Ambulat tory Care Ancillary Retailers, a Others y, and

Admin. and Finan . ncing

3.2.3 Health Care Functions
Health care functions are defined in SHA 2011 (OECD, Eurostat, WHO, 2011: 341) as: “The types of goods and services provided and activities performed within the health accounts boundary.”

Main findings: What kinds of services and goods do health funds purchase?
Table 4 shows the flow of funds from the financing schemes to the various health care functions. • The 9,966m QAR spent on healthcare in 2011 (last green column) was paid for the following services: i. Inpatient, 38% (3,746m QAR) of which 907m QAR was spent on TA services. ii. Outpatient, 30% (3,007m QAR) of which 524m QAR was spent on dental care. Dental care, however low overall, constitutes 14% (234m QAR) of the OOP expenditures. iii. Ancillary services such as clinical laboratories and diagnostic imaging, 6% (636m QAR). iv. Medical goods non-specified by function, such as pharmaceuticals, medical equipment, and therapeutic appliances, 12% (1,215m QAR). v. Preventive care, and general administration and insurance, 11% (3% and 8%, respectively or 1,032m QAR). Although the preventive care seems to appear very low, the financial information received from SCH does not distinguish the preventive care provided by SCH and the governance expenses. Efforts should be made to allocate expenditures by services provided by SCH. vi. All others, including rehabilitative care, long-term care, and n.e.c., 3% (305m QAR). • The government financing schemes, 72% (7,186m QAR) of CHE, were paid for the following current health care functions (first column): i. Approximately 90% (6,352m QAR) was spent on personal care as follows: 2,348m QAR was spent on inpatient and long-term care inside Qatar; 874m QAR on TA; 2,084 QAR on outpatient and rehabilitative care; 672m QAR on medical goods; and 374m QAR on ancillary services. ii. About 10% (813m QAR) was spent on preventive care (260m QAR) and health care administration 553m QAR. • The voluntary schemes (936m QAR) were paid for the following services i. Approximately 75% (700m QAR) was spent on personal care as follows: 89m QAR was spent on inpatient care inside Qatar; 33m QAR on TA, 402m QAR on outpatient care; 81m QAR) on medical goods; 43m QAR on rehabilitative care; and 52m QAR on ancillary services. ii. About 24% (218m QAR) was spent on collective care, mainly PHI administration (217m QAR). • The details of the other two financing schemes, household OOP and rest of the world payments, are shown in columns HF.3 and HF.4 of Table 4.

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Table 4: Health expenditure by type of financing schemes and health care functions, 2011(Million QAR)
HF.1 Government financing schemes HF.4 Rest of the world TOTAL (% of CHE)

Code

Health care function

HC.1

Services of curative care

HC.1.1

Inpatient curative care

HC.1.1.1

General inpatient curative care

HC.1.1.2

Specialized inpatient curative care

151 (77%) 40 (21%) 0 (0%) 0 (0%) 0(0%)

HC.1.1.M

Treatment Abroad

HC.1.2

Day curative care

HC.1.3

Outpatient curative care

HC.1.3.1

General outpatient curative care

HC.1.3.2

Dental outpatient curative care

HC.1.3.3

Specialized outpatient curative care

1 (1%) 109 (56%) 52 (27%) 27 (14%) 30 (15%)

HC.2

Rehabilitative care

Financing Schemes, Million QR (% of CHE) HF.2 Voluntary health care payment schemes (other than OOP) HF.3 Household outHF.2.1Voluntary health HF.2.3 Enterprise of-pocket payment insurance financing 325 200 1,003 (52%) (69%) (61%) 111 11 398 (18%) (4%) (24%) 7 132 0(0%) (3%) (8%) 3 266 0(0%) (1%) (16%) 33 0(0%) 0(0%) (5%) 2 2 0(0%) (0%) (0%) 212 190 602 (34%) (65%) (37%) 101 158 99 (16%) (54%) (6%) 53 24 234 (8%) (8%) (14%) 58 8 269 (9%) (3%) (16%) 43 (15%)

HC.3

Long-term care (health)

HC.4

HC.5

Ancillary services (non-specified by function) Medical goods (non-specified by function)

20 (7%) 28 (10%)

193 (12%) 434 (26%)

HC.6

Preventive care

17 (8%) 27 (14%) 1 (0%)

HC.7

5,099 (71%) 3,185 (44%) 691 (10%) 1,620 (23%) 874 (12%) 19 (0%) 1,894 (26%) 765 (11%) 185 (3%) 944 (13%) 190 (3%) 37 (1%) 374 (5%) 672 (9%) 260 (4%) 553 (8%) 32 (5%) 53 (8%) 1 (0%) 217 (35%)

HC.9 7,186 (72%) 2,122 9,307

Governance, and health system and financing administration Other health care services not elsewhere classified (n.e.c.)

Total Current Health Expenditures (TCHE)*

629 (6%) 936

291 (3%) -

20 (1%) 1,650 (17%) 1,650

195 (2%) 195

6,777 (68%) 3,746 (38%) 831 (8%) 1,889 (19%) 907 (9%) 24 (0%) 3,007 (30%) 1,175 (12%) 524 (5%) 1,308 (13%) 233 (2%) 37 (0%) 636 (6%) 1,215 (12%) 262 (3%) 770 (8%) 35 (0%) 9,966 (100%) 2,122 12,088

HK.1.1

Capital formation for health care provider institutions

Total Current and Capital Health Expenditures

Note: As the focus of the new system shifted into current spending, the percentages shown are from the CHE, i.e. from the columns totals. * Percentages shown are from total CHE, 9,966m QAR.

Trend analysis
Figure 8 below shows the trend of the current and capital health expenditures by health care function in Qatar for the last three years. The total current and capital expenditure increased by 27% (2,558m QAR) between 2010 and 2011 (from 9,530m QAR to 12,088m QAR). The increase in the total current and capital expenditure in 2011 was distributed as follows: • Personal care, which includes all the items except governance and gross capital formation, increased by 23% (from 7,466m QAR to 9,196m QAR). • Health governance and gross capital formation increased by 40% (from 2,064m QAR to 2,892m QAR). Figure 8 also shows the share of each service provided from the total current and capital expenditures over the three-year period. However, a direct comparison should be interpreted with caution for two reasons. First, the difference in classifications between SHA 1.0 and SHA 2011. Second, the new detailed information that we received from HMC, which allowed a proper mapping of the services provided. Nevertheless, the trend between 2010 and 2011 shows that: • The share of the inpatient care increased from 23% to 31% (from 2,214m QAR to 3,746m QAR). • The share of the outpatient care decreased from 27% to 25% (from 2,553m QAR to 3,007m QAR). • The share of the ancillary services decreased from 22% to 15% (2,083m QAR to 1,851m QAR)(8). • The share of gross capital formation increased from 15% to 18% (1,382m QAR to 2,122m QAR). • The share of all other functions, including governance and administration, slightly decreased from 13% to 12% (1,299m QAR to 1,362m QAR).
Figure 8 Trend of current and capital health expenditure by health care function, 2009 to 2011 (Million QAR) 14,000

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12,088
12,000 10,000 8,000 6,000 4,000 2,000

All others Capital formation Governance & admin. Ancillary services & Medical goods Outpatient Inpatient

9,376 1,724 (18%) 550 2,015 (21%) 2,447 (26%) 2,097 (22%)
2009

9,530 1,382 (14%) 683 2,083 (22% ) 2,553 (27%) 2,214 (23%)
2010

2,122 (18%) 770 1,851 (15% ) 3,007 (25%) 3,746 (31%)
2011

Total

Notes: Institutional units used in previous NHA classifications are not identical to the schemes Note:

used in the new classifications.
(8) The data received from HMC for 2010 assigned all the ancillary services provided by HMC (whether for inpatients or outpatients) to one category. The data for 2011 was corrected for the ancillary services to include only outpatient care. Ancillary services received by patients admitted inside the hospital is classified as part of inpatient care expenditure.

Cross-country comparison
Figure 9 shows the percentage distribution of current and total health expenditures by health care function in Qatar, and compares it to the OECD average in 2009. The curative care (inpatient and outpatient care) is almost identical in Qatar and OECD, 63% and 62%, respectively. However, long term care in Qatar was almost non-existent (0.3%), and it was 12% in OECD. There are two explanations to the variation in the long-term care between Qatar and OECD. First, Qatar has a relatively young population. The expatriate population, comprising a vast majority, is repatriated to their home countries once they reach retirement age. Second, most of the elderly population, exclusively Qataris, is provided the long-term care by their families in forms of social care. Hence, this care will not appear in the NHA classifications, and can only be estimated through other studies. Medical goods and ancillary services were lower in Qatar (10%) compared to OECD (19%). However, collective care was relatively the same, 9% and 7%, respectively. Capital formation in Qatar constituted 18% of the total, but should also be interpreted with caution due to the variation in the classification. A more accurate comparison can be conducted once OECD produce their expenditure reports with the SHA 2011 classifications.
Fig ure 9 Distribution of curre and capita ent al alth ure ns, hea expenditu on health care function Qat and OECD tar D

Qatar, 20 011
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8% 18 9% 10% 31% 0% 0

32% 3

OECD, 20 009 7% 19% 12% 33% %
Inp patient care Ou utpatient car re Lo term car ong re Medical goods s Co ollective care e

29%

Ca apital form mation

3.2.3 Health Care Providers By Health Care Functions
Table 5 is the final table in the tri-axial system of the NHA, and it is an additional table the previous QHA Report. The purpose of adding this table is to allocate more accurately some of the non-specified items. For instance, 39% of the households’ health expenditure is not specified by provider. Due to the lack of information provided by the providers for the functions offered, we made some estimates to ensure that the data is matching the other tri-axial tables. A small survey of providers should be carried in the future to allocate the health expenditure by functions more accurately.

Main Findings: What services were produced by which providers?
Table 5 shows new information about health care expenditure for the health care providers by health care functions, which can be summarized as follows: • Hospitals received in total 7,707m QAR, and 5,651m QAR was spent on current services. About 74% (4,169m QAR) of the current expenditure was in curative care. Ancillary services cost the hospitals 7% (422m QAR), while medical goods cost the hospitals 10% (567m QAR). • HP 4, 5, and 6 have a very small share in the health care market in Qatar, because the majority of these services is provided in the hospitals. For instance, the expenditure on ancillary services, 636m QAR, was mainly provided by the hospitals, 66% (422m QAR), and only 34% (214m QAR) by the private providers of ancillary services. This concentration of services in hospitals is rarely experienced in more diversified health care system, such as the majority of the high income countries. • Due to the complexity of the table and the first time to produce it, the making of a trend analysis and cross-country comparison is not advised for the health care providers by health care functions table.
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Table 5: Health care expenditure for the health care providers by health care functions, 2011 (Million QAR)]
Health Care Providers HP.1 HP.3 HP.4 HP.5 Retailers and other providers of medical goods HP.6 HP.7 HP.nsk Provider not specified by kind/ balancing Item HP.9

Providers of ambulatory health care

Providers of health care system administration and financing

Providers of ancillary services

Providers of preventive care

HC.1 HC.2 HC.3 HC.4 HC.5

Services of curative care Rehabilitative care Long-term care (health) Ancillary services (nonspecified by function) Medical goods (non-specified by function) Preventive care Governance, and health system and financing administration

4,169 196 37 422 567 260

Hospitals

Code

Health Care Functions

Rest of the world (TA)

Total

1,147 3 278 -

183 -

364 -

-

-

554 35 31 7 2

907 -

6,777 233 37 636 1,215 262

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HC.6

HC.7

-

-

-

-

-

770

-

-

770

HC.9

Other health care services not elsewhere classified (n.e.c.)

-

-

-

-

-

-

35

-

35

Total Current Health Expenditures (CHE) Capital formation for health care provider institutions

5,651

1,427

183

364

-

770

664

907

9,966

HK.1.1

2,056

32

-

-

-

34

-

-

2,122

Total Current and Capital Health Expenditures

7,707

1,459

183

364

-

805

664

907

12,088

3.3 Factors of Health Care Provision
Factors of provision (FP) is defined in SHA 2011 (2011:341) as: “The types of inputs used in producing the goods and services or activities conducted inside the HA boundary.” Thus, this definition implies that only CHE should be evaluated in this section. Because TA is a major item in the cost of provision of care in Qatar, we added an import classification to the FP table: FP.M Table 6 shows the detailed factors of provision by the public and the private providers. The compensation of employees was not available for the private clinics. Thus, the self-employed estimate is based on PHCC data, and should be interpreted as the minimal estimates.

Main Findings: What resources used to provide these services?
• Compensation of employees was 61% of the public sector’s resource cost, while it was 69% of the private providers (18% compensation of employees and 51% self-employed remuneration). • TA was 12%, 874m QAR, of the public provision of care. • The share of health care goods, mainly pharmaceuticals, was 14% from the public provision, and 22% of the private provision of care.
Table 6 : Factors of health care provision, 2011 (Million QAR)
Code Description Public Provision 4,626 (61%) 0 (0%) 1,868 (25%) 1,035 (14%) 705 (9%) 127 (2%) 161 (2%) 48 (1%) 874 (12%) 7,576 (76%) Private Provision* 436 (18%) 1,212 (51%) 684 (29%) 518 (22%) 146 (6%) 20 (1%) 19 (1%) 6 (0%) 33 (1%) 2,390 (24%) Total (% of CHE) 5,062 (51%) 1,212 (12%) 2,552 (26%) 1,553 (16%) 851 (9%) 147 (1%) 180 (2%) 54 (1%) 907 (9%) 9,966 (100%)

FP.1

Compensation of employees

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FP.2.

Self-employed professional remuneration

FP.3

Materials and services used

FP.3.2

Health care goods

FP.3.3

Non-health care services

FP.3.4

Non-health care goods

FP.4

Consumption of fixed capital

FP.5

Other items of spending on inputs

FP.M

Treatment Abroad

Total Factors of Provision (% from Total)

Notes:
1) FP does not include the capital formation. Expenditures on investment and major projects do not yet produce health care services and is thus excluded. 2) The total cost in the public sector is paid for by MOEF and OOP. Public provision includes HMC, PHCC, SCH, and other government organizations (Aspetar, MOI, QP, QAF).

3.4 Gross Capital Formation
Qatar is experiencing major expansion projects in the health care system. The gross capital formation constituted 18% of the total current and capital expenditures in 2011 (2,122m QAR). Thus, it is very important to evaluate these expenditures using the NHA classifications. The information on capital expenditures was collected only from the public institutions. The private providers also underwent expansion projects in 2011, but to a much lesser extent. The data was not available from the private sector, and thus we only show the capital formation in the public sector.

Main Findings: what was spent for investment on health?
Table 7 shows the gross capital formation of government and other public organizations in 2011, and the results can be summarized as follows: • Infrastructure in total received 74% (1,574m QAR) of the investment amount. • Medical equipment received 18% (386m QAR) from the total, and the majority of this amount was received by HMC (338m QAR). These figures indicate that HMC is developing their technical capabilities faster than the other providers. • HMC received 27% of the total gross capital formation (578m QAR), while PHCC received only 2% (34m QAR). It is crucially important that PHCC increase their share of capital formation in future years, particularly in the medical equipment. • Other Government Organization received 70% of the gross capital formation (1,479m QAR), and the infrastructure is taking 99% of that amount (1،463m QAR), i.e., Sidra Project.
Table 7: Gross Capital Formation of government and other public organizations, 2011 (Million QAR)]
Code HK.1.1.1 Description Infrastructure Residential and non-residential buildings Other structures Machinery and equipment Medical equipment Transport equipment ICT equipment Machinery and equipment n.e.c. 52 (9%) 78 (14%) 578 (27%) HMC 110 (19%) 70 (12%) 40 (7%) 468 (81%) 338 (58%) 33 (97%) 12 (34%) 0.9 (3%) 8 (24%) 13 (37%) 34 (2%) 31 (100%) 24 (79%) 0.2 (1%) 4 (13%) 3 (8%) 31 91%) 16 (1%) 13 (1%) 0.1 (0%) 2 (0%) 1 (0%) 1,479 (70%) PHCC 0.9 (3%) 0.9 (3%) SCH OGO* 1,463 (99%) 1,463 (99%) Total (% CHE) 1,574 (74%) 1,534 (72%) 40 (2%) 548 (26%) 386 (18%) 1.1 (0%) 65 (3%) 95 (4%) 2,122 (100%)

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HK.1.1.1.1

HK.1.1.1.2 HK.1.1.2 HK.1.1.2.1 HK.1.1.2.2 HK.1.1.2.3 HK.1.1.2.4

HK.1.1 Gross Fixed Capital Formation (% from Total)**

Notes:

No information available on capital formation in the private sector. * Other Government Organizations include Sidra, Aspetar, QP, MOI, and QAF. As the focus of the new system shifted into current spending, the percentages shown are from the CHE, i.e. from the columns totals. ** Percentages shown are from total capital expenditure, i.e. 2,122m QAR.

3.5 Beneficiary Characteristics
Qatar has a unique structure of the gender and age characteristics (see section 1.3.1), and this structure is expected to influence the healthcare delivery. Therefore, the NHA team collected information from the providers on the characteristics of those who benefited from the services delivered. This breakdown enables the comparison of the health expenditures by gender and age groups of the beneficiaries.

Main Findings: Who benefited from the current health expenditures?
Table 8 shows the distribution of the CHE by the characteristics of the beneficiaries, as follows: • Gender: i. Males received 57% of CHE (5,631m QAR). ii. Females received 43% of CHE (4,335m QAR). • Age groups: i. Preschoolers, 0-4 years old, and school age, 5-14 years old, received 17% of CHE (815m QAR, and 935m QAR, respectively). ii. A significant share, 74%, of the CHE was spent on working age group, 15-64 years old (7,378m QAR). iii. Elderly age group, 65+ years old, received the lowest share of the CHE, 8% (836m QAR).
Table 8 : Current health expenditures by the beneficiaries’ characteristics, 2011 (Million QAR)
Characteristic Gender Males (all ages) Females (all ages) Totals Age 0 – 4 years old 5 – 14 years old 15 – 44 years old 45 – 64 years old 65+ years old Totals 815 (8%) 936 (9%) 5,182 (52%) 2,196 (22%) 836 (8%) 9,966 (100%) 5,631 (57%) 4,335 (43%) 9,966 (100%) Current Health Expenditure

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Cross-country comparison
Comparative data on health expenditures by beneficiary characteristics is quite scarce. Only few countries report the distribution of the health expenditure by age and gender. Thus, we only include three countries in this cross-country comparison: USA, 2004, Germany, 2008, and Austria, 2007. Although the data for the comparative countries are not overlapping in time, the trend of health care expenditure by the age and gender groups would not vary within a short period of time, particularly in these selected countries. Figure 10 shows the distribution of current health expenditures by gender, and by age groups. • Unlike the other countries, males in Qatar received higher CHE than females (57% in Qatar, compared to 43% in the comparative group of countries). However, the distribution is disproportionately higher than the actual population. Males in the comparative group constitute roughly 50% of the population. While in Qatar males constitute more than 76% (source QSA 2010). • The difference in distribution of CHE is even more pronounced by age groups in Qatar and the comparative countries. The age group 15-44 received 52% of CHE in Qatar, while this group received only 21% in the comparative group of countries. These differences do not come at a surprise, given the population pyramids in Qatar and in the comparative group of countries. As shown in Figure 10, the population in Qatar is skewed toward male. Census data from 2010 shows that 67% of the population was in the 20-44 age group in Qatar, while this age group composed only 42% of the population in Germany, for example. However, these findings further indicate that the per capita health indicators (including age and gender KPIs) must take into consideration the skewed distribution of the gender and age groups in Qatar. In addition, most of those males population reside in Qatar for short working contracts, and are screened upon their arrivals.

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Policy Implications

 4 - Policy Implications
Funds available for health care
Qatar’s health care expenditure increased by 27% between 2010 and 2011. This significant increase is one of the highest in the world, given that most of the countries are imposing austerity measures, including their health sectors. The increase was mainly funded by the government, which indicates the government’s commitment to improve health services in Qatar. Qatar’s health care expenditure totaled 12,088m QAR. The lion’s share of the health funds were secured through the government (77%), but the share funded privately is expected to increase with planned health care reforms, including the implementation of the SHI. A sizable share of the health funds (18%) was spent on capital formation (investment in health) to meet needed reforms, funded by the public sector. Public entities are exclusively responsible for managing the public funds, and private entities are exclusively responsible for managing the private funds. These exclusivities indicate that the health financing structure is fragmented, which may indicate duplication in efforts and services provided. It is expected that SHI will address these exclusivities, in order to improve the equity of the health care system in Qatar. 1st Implication The share of the capital formation will start to fade gradually, and use of these investments will increase once operational. To avoid misleading drops in future health expenditure, the current funds directed to investments should be properly allocated in future health consumptions, i.e. proper amortization and depreciation. 2nd Implication Although the OOP expenditure decreased in relative terms as a share of the total current and capital health expenditure between 2010 and 2011 (from 16% to 13.8%), the absolute share increased (from 1,550m QAR to 1,665m QAR). Until full implementation of SHI, the OOP may continue to increase. On the other hand, the opening of new public hospitals from this year, as well as an ongoing shift to a primary health care model of care should reduce unmet need, and OOP payments for alternative services (such as private or overseas services), particuarly in the secondary and tertiaty sectors. Nevertheless, short-term cost sharing adjustments should be studied and evaluated carefully.

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Uses of health care funds
The Qatari population is relatively young, and the non-Qatari population is mainly composed of young expatriate males. Nevertheless, the main recipients of the health care funds were tertiary care hospitals (57% of the total money spent on health), which is very high compared to advanced economies (36% in OECD countries). The amount spent on care delivered at hospitals increased by 12% from 2010 to 2011. This increase can be explained by the opening of . These hospitals provide outpatient care, as well as tertiary care. The share of the hospitals is only expected to increase for the next few years. There are currently five to six new hospitals scheduled to open in the next five years, which will double bed capacity. This concentration of services in hospitals is rarely experienced in more diversified health care system, such as the majority of the high income countries.

3rd Implication Policy interventions should be in place to ensure that the concentration of health services at the tertiary care facilities is robust, and the cost of these services is sustainable. In addition, health financing policies should foster the advancement of the primary health care model as specified in the NHS. The funding model should benefit from economies of scale. For instance, studies should be carried to measure the benefits of shifting more ancillary services and retail sales of pharmaceutical products to the private providers.Economies of scale are situations in which the average cost declines as quantities of health services purchased increases.

Beneficiaries of current funds
Because Qatar’s population structure is unique (75% male, and 82% in age-working group), analyzing health care funds by beneficiaries’ characteristics is paramount. The findings from this report show a potentially disproportionate distribution of funds: Males received only 57% of the current health funds, while the ageworking group received 75%. 4th Implication It is expected that health expenditure for males will be smaller than their population share in Qatar. The majority of males living in Qatar are young and healthy. However, further health economics studies should investigate whether the services delivered to each population group are equal to their health needs.

Future directions
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The QHAR-2 report is informative and reveals important findings, which can be used as the beginning of a trend to gauge health care expenditures to benchmark costs pre- and post the ambitious planned health care reforms. 5th Implication There are improvements in the data collection and data quality provided by the study’s stakeholders. However, further improvements need to be made. A number of assumptions were used in this report due to lack of data (incomplete or not provided in time). Efforts should be made to promote and mandate the collection of data for future Qatar National Health Accounts.

Annex 1: Second Online Health Survey

 1. Introduction
1.1 Purpose
The SCH conducted OHS-2 in 2011 as a follow up to the OHS-1 conducted in 2010. The main purpose of OHS-2 was to evaluate the population’s health utilization and health expenditure. The results from the OHS-2 will build on existing data to help the SCH form an objective perspective on health financing issues pertaining to the Health Insurance and this NHA report, and to evaluate various economic and financial health care outcomes based on evidence-based methods. The objectives of the OHS-2 are to: 1. Assess access to public and private health facilities by various subgroups of the population, and the common reason to visit these facilities. 2. Assess the health care system utilization of public and private health facilities, which include outpatient and inpatient visit ratios, the frequency of visits, and the reasons for the visits. In addition, assess patient satisfaction levels using international health satisfaction scales to identify areas for improvements in both the public and private sectors. 3. Obtain an updated OOP health expenditure for these households.

1.2 Methodology 1.2.1 Format
The technical team in SCH decided to conduct the second round of OHS-2 due to the delay in conducting a face-to-face survey within the calendar year 2011. Respondents to OHS-1 were asked to provide their contact information for future health surveys. About 3,200 respondents (of the total 6,250 completed responses) provided their email addresses. See for more details of the results. These respondents were contacted in 2011 to participate in OHS-2, conducted in four consecutive months September through December 2011. They were asked to record their household members’ health utilization and health expenditure. An invitation was sent to them at the beginning of each following month to complete the survey for the previous month. In addition to the participants from OHS-1, the team contacted additional organizations not approached in OHS-2, such as commercial banks and other major employers in the oil and gas industry. Each new recruited respondent was also asked to provide their contact information for future surveys. The same software used in 2010 was used to collect the information in 2011 (www.questionpro.com). Furthermore, all aspects of the survey (the invitations, the media campaign and the survey itself ) were in Arabic and English, the two most common languages of the target population.
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1.2.2 Sections of the survey
The surveys were composed of the following sections: 1) Demographics: This part of the survey included standard demographic questions, such as age, gender, nationality, educational attainment, work status, and household structure. To ensure proper calculations of the adjustment in the analyses stages, these questions were compulsory. To diminish respondents’ fatigue, these questions were only asked at the first round of participation.

2) Household health care expenditure: This section included a breakdown of total household health expenditure categories (primary, secondary and tertiary care, medicines, laboratory tests, medical devices, treatment abroad, etc.) during the 30 days prior to the survey. 3) Insurance coverage: This section included questions about the respondents’ health coverage. 4) Respondents’ health care: This section included questions about: i. The respondents’ general health status (presence of chronic diseases, etc.), and presence of a regular health care provider. ii. Health care utilization: Two sections solicited the respondents’ health care utilization (outpatient and inpatient care) in the 30 days and 12 months, respectively, prior to the survey. The respondents were also asked about the cost associated with each episode, and their satisfaction of the services delivered. iii. Children’s utilization: respondents were asked about the total number of children (16 years old or younger) that live in the household. They were then prompted to answer questions related to the youngest child only, if they have more than one child in the household. Two sections, similar to the adults’ sections, solicited the health care utilization and expenditure of that child. iv. Closing Section: In this section respondents were asked to keep records of the household’s health expenditure and utilization for the then current month.

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 2. Survey Results
2.1 Pattern Of Participation
Respondents were asked to participate in multiple rounds, during the four months of data collection. Figure 11 shows distribution of the participants by the number of completed rounds and by nationality. Above half of the Qatari respondents participated only once (54%), while less than half of the Non-Qataris participated only once (48%). Qataris, however, have a higher all-round participation than Non-Qataris (14% and 9%, respectively).

11 Fig ure 12 Partic cipants' numb of ber mpleted round and by nat ds tionality com [N= =2,472]

Qata aris 14% 1 15% 17% %

54%

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taris Non Qat 9% 19% 48% 23%

One round O Two rounds T s Three rounds T All rounds A

2.2 Sociodemographic Characteristics
Table 9 shows the sociodemographic characteristics of the respondents to OHS-2.

Gender
The gender distribution for the Qatari respondents is somewhat balanced (47% males and 53% females), but the non-Qatari respondents have higher male representation (69% male and 31% female). This reflects the actual gender distribution in the targeted population of the non-Qatari white-collar workers. The 2010 Census data show that this cohort is mainly male(9).

Age group
Respondents were asked to choose from one of five age groups (18-24, 25-34, 35-44, 45-54, and 55+). Qatari respondents are younger (43% between the age of 18-34) compared to non-Qatari respondents (27%). There were comparatively fewer respondents in the 55+ age group, particularly among Qatari respondents. Given the nature of the survey, this is to be expected: fewer elderly people are computer savvy.

Educational attainment
Given the age distribution discussed above, Qatari respondents are more concentrated in the lower educational attainment scale of the targeted sample for this survey (18% have attained high school or less). Non-Qatari respondents have a higher level of educational attainment (31% with a graduate degree) than their Qatari counterparts (18%). The distribution of college graduates possessing a bachelor’s degree is balanced between the two groups.

Occupational status
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Consistent with the respondents’ age group and educational attainment findings, the occupational status results show that Qatari respondents are more likely to be in senior (26%) and clerk (30%) positions compared to non-Qatari respondents (11% and 14%, respectively). Professionals, however, are highly represented by the non-Qatari respondents (54%).

Sector of employment
The government sector had the highest number of Qatari and non-Qatari respondents (67% and 59%, respectively).

Marital status
Most respondents are married. There were more single Qatari respondents (22%) than non-Qatari (11%).

Nationality
Figure 12 shows the respondents’ categorization into the five common nationality groups that live in Qatar. Qataris, who constitute a unique denomination both in health status and other socioeconomic characteristics, represent 27% of the total respondents. Non-Qataris from other Arab countries constitute the same number of respondents as Qataris (28%). The three other non- Qatari groups include those from Asian non-Arab countries (34%), Westerners – including Australians - (9%), and all other nationalities (2%).

(9) QSA Census 2010 Results, Table 1.9

Table 9 Sociodemographic characteristics of respondents
Qatari Gender [N=2,472] Male Female Age group [N=2,472] 18 – 24 25 – 34 35 - 44 45 - 54 55 + Educational attainment [N=2,173] Less than high school High school Diploma Bachelor Graduate Occupational status [N=2,202] Senior position Professional Technician Clerk Other Currently not working Employment sector [N=2,472] Government Private Other Currently not working Marital status [N=2,100] Never married Currently married Separated/divorced Widowed Note: Column results may not add up to 100% due to rounding.
2012

Non-Qatari

47% 53%

69% 31%

9% 34% 39% 16% 2%

2% 25% 40% 23% 10%

3% 15% 17% 47% 18%

1% 7% 17% 45% 31%

26% 23% 11% 30% 1% 9%

11% 54% 14% 14% 3% 4%

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National Health Accounts

67% 19% 19% 6%

59% 32% 32% 5%

22% 71% 6% 1%

11% 86% 2% 1%

Figure 12 Partic Fig ure 13 Participants’distribution byby cipants' distribution nationality [N=2,472] nationality [N=2 472] 2

2% % 9% 27% 34% % 28%

Qataris Arab coun ntries Asian non Arabs n Europe, North Americ and Aust N ca, tralia Other nat tionalities

2.3 Household Structure
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Supreme Council Of Health

An important component of health care financing is household structure. Figure 13 shows the results of the information provided on household members. The average Qatari households are larger than Non-Qatari households by one child (3.3 versus 2.0 children) and by two domestic workers (2.3 versus 0.2 workers).

Figu 13 Participants' numbe of complet rounds an ure 11 er ted nd by n nationality [N= =2,472]

Adults 1.9 s,
Qatari

Children, 3.3 3 Do omestic Work kers, 2.3 Others, 0.7 Adults, 1.7

Non Qatari

Children 2.0 n, Domestic Workers, 0. c .2 Others, 0.3
0 1 2 3 4

Average num A mber per ho ousehold

Annex 2: NHA Tables

Table 10 : Detailed Flow revenues of financing schemes received by the financing schemes, 2011 (Million QAR)
Financing Sources (revenues), Million QR Financing Schemes FS.1 Government FS.5.1 From Households 7,186 (72%) 6,732 (68%) 454 (5%) 935 (9%) 629 (6%) 15 (0%) 629 (6%) FS.5.2 From Employers FS.5 Voluntary Prepayment FS.6 Other Domestic Revenues n.e.c. Total

Code

HF.1

Government Schemes

HF.1.1.1.1

SCH

6,732 (68%)

HF.1.1.1.2

Other Gov. (MOI, AF, Aspetar)

454 (5%)

HF.2

Voluntary Health Care Payment Schemes

HF.2.1

Voluntary Health Insurance Schemes

HF.2.2

NPISH (Zakat Fund)

15 (0%) 291 291 (3%) (3%) 1,650

HF.2.3 1,650 (17%)

Enterprise Financing Schemes

HF.3

Household Out-Of-Pocket Payment

(17%) 195 (2%) 195 (2%) 1,665 (16.7%) 920 (9.2%) 195 (2.0%) 9,966 (100%)

HF.4 7,186 (72.1%0)

Rest of the world

Total Current Health Expenditure

Note: Percentages shown are from total CHE, i.e. 9,966m QAR.

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54
Financing Schemes, Million QR (% of CHE) HF.2 Voluntary health care payment schemes (other than OOP) HF.2.1Voluntary health insurance 184 (2%) 0 0 (0%) 0 (0%) (0%) 106 (1%) 0 (0%) 0 (0%) 38 (0%) 320 (3%) 185 (2%) 0 HF.2.2 NPISH financing HF.2.3 Enterprise financing HF.3 Household out-of-pocket payment TOTAL HF.4 Rest of the world 195 (2%) (0%) 5,651 (57%)

Supreme Council Of Health

Table 11 : Detailed health expenditure by type of financing schemes and type of providers, 2011 (Million QAR)

Code HF.1 Government schemes

Providers

HP.1

Hospitals

4,914 (49%) 2,843 (29%)

HP.1.1

General hospitals

3,134 (31%) 0 (0%)

HP.1.2 0 (0%)

Mental health and substance abuse hospitals

76 (1%)

3 (0%)

5 (0%)

84 (1%)

HP.1.3

Specialty (other than mental health and substance abuse) hospitals 845 (8%) 0 0 0 (0%) 75 (1%) 0 121 (1%) (0%) (0%)

1,995 (20%)

75 (1%)

38 (0%)

130 (1%)

195 (2%)

2,433 (24%)

HP.3

Providers of Ambulatory Health Care

254 (3%) 254 (3%) (0%)

208 (2%) 112 (1%)

0 0

(0%) (0%)

1,428 (14%)

HP.3.1 0 (0%)

Medical Practices

441 (4%) 0 (0%)

HP.3.1.1 0 (0%)

Offices of General Medical Practitioners

25 (0%)

254 (3%) 0 (0%) 0 (0%)

37 (0%)

316 (3%) 0 (0%)

HP.3.1.3 0 (0%)

Offices of Medical Specialists (Other than Mental Medical Specialists)

51 (1%)

75 (1%) 0 (0%) 0 (0%)

126 (1%) 0 (0%)

HP.3.2

Dental Practice

46 (0%)

96 (1%)

142 (1%)

HP.4 0

Providers of ancillary services

0

(0%) (0%) 0

20 (0%) (0%)

0 0

(0%) (0%)

0 0

(0%) (0%) 0

163 (2%) (0%)

0 0

(0%) (0%)

183 (2%)

HP.4.1 0

Providers of Patient Transportation and Emergency Rescue

0 (0%) (0%) 0 (0%) 0 (0%) 0 (0%)

HP.4.2

Medical and Diagnostic Laboratories

20 (0%)

163 (2%)

183 (2%)

Table 11 : Detailed health expenditure by type of financing schemes and type of providers, 2011 (Million QAR)
Financing Schemes, Million QR (% of CHE) HF.1 Government schemes HF.2.1Voluntary health insurance 53 (1%) 0 0 (0%) 0 (0%) (0%) 0 (0%) 46 (0%) 0 (0%) 0 (0%) 0 311 (3%) (0%) 311 (3%) 0 0 HF.2.2 NPISH financing HF.2.3 Enterprise financing HF.2 Voluntary health care payment schemes (other than OOP) HF.3 Household out-of-pocket payment

(Continue)
TOTAL HF.4 Rest of the world (0%) (0%) 364 (4%)

Code

Providers

HP.5 0 (0%)

Retailers and other providers of medical goods

0

(0%)

HP.5.1 0 (0%)

Pharmacies

357 (4%) 0 (0%)

HP.5.2

Retail Sellers and other Suppliers of Durable Medical Goods and Medical Appliances 0 (0%) 0 (0%) 0 (0%) 0 (0%)

7 (0%)

7 (0%)

HP.6

Providers of Preventive Care

0

(0%)

0

(0%)

0 (0%)

HP.7 0 (0%) 0 (0%)

Providers of Health Care System Administration and Financing 0 (0%) 0 0 553 (6%) 0 (0%) 0 (0%) 0

553 (6%)

217 (2%)

(0%) (0%)

0 0

(0%) (0%)

0 0

(0%) (0%)

770 (8%)

HP.7.1

Government health administration agencies

553 (6%) (0%) 0 (0%) 0 (0%) 0 (0%)

HP.7.2 0 (0%) 0

Social health insurance agencies

0 (0%) (0%) 0 (0%) 0 (0%) 0 (0%)

HP.7.3

Private Health Insurance Administration Agencies

217 (2%)

217 (2%)

HP.nsk

Provider not specified by kind/ Balancing Item

0

(0%)

15 (0%) 33 (0%) 629 (6%) 15 (0%)

0

(0%)

649 (7%) 0 (0%) 0 (0%)

0

(0%)

664 (7%)

HP.9

Rest of the world (TA)

874 (9%) 7,186 (72%)

0

(0%)

907 (9%)

Total Current Health Expenditure

291

(3%)

1,650 (17%)

195 (2%)

9,966 (100%)

Note: Percentages shown are from total CHE, i.e. 9,966m QAR.

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Financing Schemes, Million QR (% of CHE)

Supreme Council Of Health

Table 12 : Detailed health expenditure by type of financing schemes and health care functions, 2011(Million QAR)

HF.2 Voluntary health care payment schemes (other than OOP) HF.1 Government financing schemes HF.2.1Voluntary health insurance HF.2.2 NPISH financing HF.2.3 Enterprise financing HF.3 Household out-of-pocket payment HF.4 Rest of the world 151 (2%) 40 (0%) 132 (1%) 3 (0%) 0 (0%) 266 (3%) 0 (0%) 0 (0%) (0%) 0 (0%) (0%) 0 (0%) 0 212 (2%) 101 (1%) 185 (2%) 53 (1%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 2 (0%) 0 (0%) 0 (0%) 0 (0%) 2 (0%) 190 (2%) 158 (2%) 24 (0%) 602 (6%) 99 (1%) 234 (2%) 0 (0%) 0 (0%) 0 (0%) 1 (0%) 0 (0%) 0 (0%) 109 (1%) 52 (1%) 27 (0%) 1,003 (10%) 398 (4%)

Code

Health care function

TOTAL

HC.1

Services of curative care

5,099 (51%) 3,185 (32%) 691 (7%) 0 (0%) 1,620 (16%) 0 (0%) 874 (9%) 19 (0%) 2 (0%) 0 17 (0%) 1,894 (19%) 765 (8%) 2 (0%) 33 (0%) 0 (0%) 0 (0%) 0 (0%) 7 (0%) 111 (1%) 0 (0%) 11 (0%)

325 (3%)

0 (0%)

200 (2%)

6,777 (68%) 3,746 (38%) 830 (8%) 1,889 (19%) 907 (9%) 24 (0%) 3 (0%) 19 (0%) 3,007 (30%) 1,175 (12%) 523 (5%)

HC.1.1

Inpatient curative care

HC.1.1.1

General inpatient curative care

HC.1.1.2

Specialized inpatient curative care

HC.1.1.M

Treatment Abroad

HC.1.2

Day curative care

HC.1.2.1

General day curative care

HC.1.2.2

Specialized day curative care

HC.1.3

Outpatient curative care

HC.1.3.1

General outpatient curative care

HC.1.3.2

Dental outpatient curative care

Table 12 : Detailed health expenditure by type of financing schemes and health care functions, 2011(Million QAR) (Continue)
Financing Schemes, Million QR (% of CHE) HF.2 Voluntary health care payment schemes (other than OOP) HF.1 Government financing schemes HF.2.1Voluntary health insurance HF.2.2 NPISH financing HF.2.3 Enterprise financing HF.3 Household out-of-pocket payment HF.4 Rest of the world 30 (0%) 0 (0%) 0 (0%) 0 (0%) 4 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) (0%) (0%) 0 (0%) 0 32 (0%) 20 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 20 (0%) 2 (0%) 193 (2%) 94 (1%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 17 (0%) 10 (0%) 269 (3%) 0 (0%) (0%) 0 (0%) TOTAL

Code

Health care function

HC.1.3.3

Specialized outpatient curative care

944 (9%) 190 (2%) 0 (0%) 55 (1%) 0 (0%) 0 20 (0%) 0 (0%) 111 (1%) 0 (0%) 4 (0%) 0 (0%) 37 (0%) 0 (0%) 26 (0%) 0 11 (0%) 374 (4%) 141 (1%) 0 (0%) 0 (0%) 40 (0%) 0 (0%) 0 (0%) 43 (0%)

58 (1%)

0 (0%)

8 (0%)

1,309 (13%) 233 (2%) 55 (1%) 60 (1%) 114 (1%) 4 (0%) 37 (0%) 26 (0%) 11 (0%) 636 (6%) 267 (3%)

HC.2

Rehabilitative care

HC.2.1

Inpatient rehabilitative care

HC.2.2

Day rehabilitative care

HC.2.3

Outpatient rehabilitative care

HC.2.4

Home-based rehabilitative care

HC.3

Long-term care (health)

HC.3.1

Inpatient long-term care (health)

HC.3.4

Home-based long-term care (health)

HC.4

Ancillary services (non-specified by function)

HC.4.1

Laboratory services

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Financing Schemes, Million QR (% of CHE)

Supreme Council Of Health

Table 12: Detailed health expenditure by type of financing schemes and health care functions, 2011(Million QAR) (Continue)

HF.2 Voluntary health care payment schemes (other than OOP) HF.1 Government financing schemes HF.2.1Voluntary health insurance HF.2.2 NPISH financing HF.2.3 Enterprise financing HF.3 Household out-of-pocket payment HF.4 Rest of the world 6 (0%) 0 (0%) 434 (4%) 360 (4%) 28 (0%) 0 (0%) (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (0%) (0%) 0 (0%) 0 (0%) 0 (0%) 0 0 (0%) 360 (4%) 74 (1%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 27 (0%) 24 (0%) 24 (0%) 4 (0%) 0 (0%) 1 (0%) 0 (0%) 1 (0%) 0 (0%) 99 (1%) 0 (0%)

Code

Health care function

TOTAL

HC.4.2

Imaging services

41 (0%) 193 (2%) 0 (0%) 672 (7%) 672 (7%) 672 (7%) 0 (0%) 7 (0%) 0 46 (0%) 0 (0%) 46 (0%) 0 (0%) 28 (0%) 53 (1%) 0 (0%) 28 (0%) 0 (0%) 1 (0%)

12 (0%)

0 (0%)

17 (0%)

175 (2%) 194 (2%) 1,215 (12%) 1,130 (11%) 1,130 (11%) 85 (1%) 0 (0%) 262 (3%) 69 (1%) 21 (0%) 0 (0%)

HC.4.3

Patient transportation

HC.5

Medical goods (non-specified by function)

HC.5.1

Pharmaceuticals and other medical non-durable goods

HC.5.1.1

Prescribed medicines

HC.5.2

Therapeutic appliances and other medical durables 0 (0%)

HC.5.2.3

Other orthopedic appliances and prosthetics (excluding glasses and hearing aids 260 (3%) 69 (1%) 19 (0%) 1 (0%)

HC.6

Preventive care

HC.6.1

Information, education and counseling programs

HC.6.2

Immunization programs

HC.6.3

Early disease detection programs

Table 12: Detailed health expenditure by type of financing schemes and health care functions, 2011(Million QAR) (Continue)
Financing Schemes, Million QR (% of CHE) HF.2 Voluntary health care payment schemes (other than OOP) HF.1 Government financing schemes HF.2.1Voluntary health insurance HF.2.2 NPISH financing HF.2.3 Enterprise financing HF.3 Household out-of-pocket payment HF.4 Rest of the world 0 (0%) 0 (0%) 0 (0%) 0 (0%) (0%) (0%) 0 (0%) 0 0 (0%) 0 (0%) 0 (0%) (0%) 629 (6%) 15 (0%) 15 (0%) 0 291 (3%) (0%) 20 (0%) 1,650 (17%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 195 (2%) 0 (0%) 0 (0%) 0 (0%) TOTAL

Code

Health care function

HC.6.4

Healthy condition monitoring programs 0 (0%) 0 (0%) 553 (6%) 0 (0%) 553 (6%) 0 (0%) 0 (0%) 0 (0%) 217 (2%) 0 0 (0%) 0 (0%) 0 (0%) 0 (0%) 217 (2%) 0 (0%)

172 (2%)

0 (0%)

172 (2%) 770 (8%) 553 (6%) 217 (2%) 0 (0%) 217 (2%) 35 (0%) 9,966 (100%)

HC.7

Governance, and health system and financing administration

HC.7.1

Governance and Health system administration

HC.7.2

Administration of health financing

HC.7.2.1

Health administration and health insurance: social insurance 0 (0%) 0 (0%) 217 (2%) 0

HC.7.2.2

Health administration and health insurance: private insurance 0 7,186 (72%) (0%)

HC.9

Other health care services not elsewhere classified (n.e.c.)

Total Current Health Expenditure

Note: Percentages shown are from total CHE, i.e. 9,966m QAR.

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Healthcare Providers

Supreme Council Of Health

Table 13 : Detailed health care expenditure for the health care providers by health care functions, 2011 (Million QAR)

HP.1

HP.3

HP.4

HP.5

HP.6

HP.7

HP.nsk

HP.9

Hospitals

Providers of ancillary services

Providers of ambulatory health care

Retailers and other providers of medical goods

HC.1 196 (2%) 37 (0%) 422 (4%) 567 (6%) 260 (3%) 770 (8%) 278 (3%) 364 (4%) 183 (2%) 3 (0%)

Services of curative care

4,169 (42%)

1,147 (12%)

Providers of preventive care

Providers of health care system administration and financing

Provider not specified by kind/ balancing Item

554 (6%) 35 (0%)

907 (9%)

Rest of the world (TA)

Code

Healthcare functions

Total

6,777 (68%) 233 (2%) 37 (0%) 31 (0%) 7 (0%) 2 (0%) 636 (6%) 1,215 (12%) 262 (3%) 770 (8%) 35 (0%) 35 (0%)

HC.2

Rehabilitative care

HC.3

Long-term care (health)

HC.4

Ancillary services (non-specified by function)

HC.5

Medical goods (non-specified by function)

HC.6

Preventive care

HC.7

Governance, and health system and financing administration

HC.9 5,651 (57%) 1,427 (14%)

Other health care services not elsewhere classified (n.e.c.) 183 (2%) 364 (4%) 0 (0%) 770 (8%)

Total Current Health Expenditures

664 (7%)

907 (9%)

9,966 (100%)

Note: Percentages shown are from total CHE, i.e. 9,966m QAR.

Table 14 : Detailed gross Capital Formation of government and other public organizations, 2011 (Million QAR)
Description 110.2 (5%) 70.0 (3%) 40.2 (2%) 467.8 (22%) 70.0 (16%) 0.9 (0%) 51.5 (2%) 78.2 (4%) 578 (27%) 8.2 (0%) 12.8 (1%) 34 (2%) (1%) 11.6 24.2 (1%) 0.2 (0%) 3.9 (0%) 2.5 (0%) 31 (1%) (2%) (1%) 33.4 30.8 15.8 (1%) 12.6 (1%) 0.1 (0%) 1.9 (0%) 1.3 (0%) 1,479 (70%) (0%) (69%) 0.9 1,462.8 (0%) (69%) 0.9 1,462.8 1,574 (74%) 1,534 (72%) 40 (2%) 548 (26%) 386 (18%) 1.1 (0%) 65 (3%) 95 (4%) 2,122 (100%) HMC PHCC SCH OGO * Total

Code

HK.1.1.1

Infrastructure

HK.1.1.1.1

Residential and non-residential buildings

HK.1.1.1.2

Other structures

HK.1.1.2

Machinery and equipment

HK.1.1.2.1

Medical equipment

HK.1.1.2.2

Transport equipment

HK.1.1.2.3

ICT equipment

HK.1.1.2.4

Machinery and equipment n.e.c.

HK.1.1 Gross Fixed Capital Formation

Notes : No information available on capital formation in the private sector. * Other Government Organizations (including Sidra), and Public corporations (including QP). Percentages shown are from total capital expenditure, i.e.2,122m QAR.

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 References
2010. HMC.

1. HAMAD MEDICAL CORPORATION. June-2011. Annual Hospital Costs, Resources and Patient Activity

2. OECD, Eurostat, WHO (2011), A System of Health Accounts, OECD Publishing 3. OECD. 2000. A System of Health Accounts [Online]. OECD. Available at http://www.oecd.org/ health/sha [Accessed May 2011]. 4. OECD. 2011. Health at a Glance 2009 – OECD Indicators. OECD. 5. OECD. 2012. OECD Health Data 2010 [Online]. OECD. Available: www.ecosante.org/oecd.html [Accessed May 2012] 6. QATAR STATISTICS AUTHORITY. Census 2010 [Online]. QSA. Available at http://www.qsa.gov.qa/ QatarCensus/Default.aspx [Accessed May 2011]. 7. SUPREME COUNCIL OF HEALTH, QATAR. 2011. National Health Strategy 2011-2016. SCH. 8. SUPREME COUNCIL OF HEALTH, QATAR. 2011. Qatar National Health Accounts – 1st Report Years
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2009 & 2010. A baseline Analysis of Health Expenditure and Utilization. SCH. 9. WORLD HEALTH ORGANISATION. 2003. Guide to producing national health accounts – with special applications for low-income and middle-income countries. WHO. 10. WORLD HEALTH ORGANISATION. 2009. Country Profiles: Qatar [Online]. WHO. Available at: http:// www.emro.who.int/emrinfo/index.asp?Ctry=qat [Accessed 27 September 2009]. 11. WORLD HEALTH ORGANISATION 2011. World health statistics 2011. WHO.