# **OUTLINE**

|**A. INTRODUCTION ................................................................................................................................... 3**|
|---|
|**B. GEOGRAPHICAL SCOPE, DATA SOURCES AND LIMITATIONS............................................. 3**|
|_B1 Geographical scope......................................................................................................................... 3_|
|_B2 Data sources.................................................................................................................................... 4_|
|_B3 Data limitations............................................................................................................................... 4_|
|**C. ENSURING SUFFICIENT REVENUES .............................................................................................. 5**|
|C1. SOURCES OF HEALTHCARE REVENUES.................................................................................................. 6|
|C2. CHALLENGES AHEAD......................................................................................................................... 10|
|_C2.1 Limited formal employment growth and high levels of informal employment............................ 11_|
|_C2.2 Limited scope to raise social health insurance contributions .................................................... 12_|
|_C2.3 Widespread formal exemptions from the payment of social insurance contributions ................ 12_|
|_C2.4 Evasion of contribution payments .............................................................................................. 13_|
|_C2.5 Co-payment policies: widespread exemptions, low levels of co-payments and poor collection. 14_|
|**D. ENCOURAGING EFFICIENT EXPENDITURES............................................................................ 14**|
|D1 ALARGE SHARE OF NATIONAL RESOURCES ARE ALLOCATED TO HEALTHCARE EXPENDITURE............ 15|
|_D1.1 Current expenditure levels as share of GDP are aligned with EU countries............................. 15_|
|_D1.2 The share of resources spent on health has not increased over the past decade ....................... 17_|
|_D1.3 The fiscal space to increase expenditures is extremely limited.................................................. 18_|
|_D1.4 The functional composition of public expenditure is marked by inefficiencies .......................... 19_|
|_D1.5 Expenditures have to be better managed to avoid the accumulation of deficits......................... 20_|
|D2 DRIVERS OF HEALTH EXPENDITURE.................................................................................................... 21|
|_D2.1 Pharmaceutical procurement and pricing systems .................................................................... 21_|
|_D2.2 Generous benefit packages and increasingly expensive medical technology............................. 24_|
|_D2.3 Salaries ...................................................................................................................................... 25_|
|_D2.4. Excess medical capacity in the hospital sector ......................................................................... 27_|
|<br>_D2.5. Line budgeting........................................................................................................................... 29_|
|**E. MOVING FORWARD.......................................................................................................................... 29**|
|**REFERENCES ........................................................................................................................................... 33**|
|**APPENDIX ................................................................................................................................................. 34**|