Summary of the National Health Accounts of Suriname 2006

Summary of the Final report on the National Health Accounts of

Suriname 2006

The National Health Accounts of Suriname over 2006 were conducted by T&H
Groep and Bright International Consultants in the first half of 2008.

The basic data used for this study are presented in TABLE 1, and include a
population of 504,257, a GDP of 1,916,423,273 USD (incl. the informal sector),
resulting in an income per capita of USD 3,800. TABLE 1 also presents the number of
employees in government, private and informal sector.

The Total Health Expenditures (THE) in 2006 were USD 163,508,436. Of the THE 42.6%
was spent by the public sector, 53.5% by the private sector, and 3.9% by non-
governmental organizations (NGO’s).

Per capita USD 324.26 was spent on health, with House Hold out Of Pocket (HH-
OOP) expenditures of USD 64.18, of which USD 26.77 was spent on premiums for
health insurance and USD 37.41 as direct OOP expenses for health services.

The three main identified groups that constitute the description of the flow of funds
in the NHA study are de Sources of Funds, The Financing Intermediaries, and the
Health Services Providers.

The main source for funds in the Health Sector was the Ministry of Finance (37.5%),
followed by the private firms with 34.1%, and the Household Out Of Pocket
expenditures (HH-OOP) with 20%.

Of the Financing Intermediaries the firms’ own health services and direct cost were
good for 25.7%, the State Health Foundation (SZF) 18%, Ministry of Social Affairs
16.5%, the Ministry of Health 14.4%, direct Out Of Pocket 11.7%, and the private
health insurers 8.3%. The Ministry of Social Affairs processes more funds in health
than the Ministry of Health itself.

The expenses of the Total Health Expenditures to Health Services Providers

demonstrates that the largest expenses are for to the hospitals 27.3%, followed by
private general practitioners with 12.6%, pharmaceuticals 11.5%, medical
specialists 9.2%, laboratory services 4.8%, dentists 3.9% and the RGD 3.3%.

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 Summary of the National Health Accounts of Suriname 2006

Analyses of the Total Health Expenditures to health functions learned that 35% was
spent on secondary care (hospital services, blood and blood products, and kidney
dialyses).

The other expenditures were for prevention and primary care 27.2%,
pharmaceuticals 11.5%, laboratory services 4.8%, dental care 4.6%, mental health
4.5%, health administration 4.3%, optical care 1.9% and diagnostic imaging 1.7%.
The percentage of THE spent on hospital services is reasonable compared to other
developing countries and lower than most developed countries. However, it is still a
significant part of the THE and likely will not decrease with the more specialized
procedures that are introduced in Suriname with an aging population.

Comparing the NHA of 2000 with 2006 (TABLE 2) learns that the GDP, the income
per capita and the Total Health Expenditures almost doubled. The Out Of Pocket
(OOP) expenses increased with 77.7% and people relatively spent much more on
health insurance premiums than direct OOP payments. Obvious and surprising is
the decline of 6.5% of spending on primary health care and prevention, the
cornerstone of the health system.

Laboratory and diagnostic imaging expenses, together, increased with 4.0%. Other
significant increases were documented for pharmaceuticals, medical specialists
and private GP’s.

Health administration cost stayed nearly constant but concerning was the decline
of 0.2% in the expenses for education and training.

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 Summary of the National Health Accounts of Suriname 2006

Basic Information for the Context of the NHA 2006

Basic National information for the context of the NHA 2006 was collected along the
specific data from the questionnaires. The basic data is presented in TABLE 1.

Table 1; Basic National data for the NHA 2006*

Population 2004 492,829

Population 2006 504,257

Number of families 129,296

Average family size 3.9

SRD USD

GDP 2006 4,483,517,000 1,630,369,818

GDP 2006, including the informal sector 5,270,164,000 1,916,423,273

Percentage of the informal sector in GDP 14.9%

National Income per capita 2006 8,891 3,233

National Income per capita 2006 including informal sector 10,451 3,800
Percentage of total
Number of Employees employment
positions

government employees 39,008 28.6%

private sector employees 57,102 41.8%

informal sector employees 23,667 17.3%

unemployed 16,769 12.3%

Total employment positions 136,546 100.0%

Ministry of Social Affairs

Registered Card Holders (families) poor and near poor 66,236

Total beneficiaries for health services poor and near poor,
December 2006 163,780

* Source; Algemeen Bureau voor Statistiek (ABS) and Ministry of Labour, Technology and
Environment (ATM)

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 Summary of the National Health Accounts of Suriname 2006

Comparing the NHA 2000 to the NHA 2006

Table 2; Comparison of data between the NHA in 2000 and 2006 in USD and in percentages

NATIONAL HEALTH ACCOUNTS

2000 2006 Difference

Population 436,775 504,257 15,5%

GDP (USD) 836,133,524 1,916,423,273 129.2%

Income per capita 1,914 3,800 98.5%

THE 78,763,778 163,508,436 107.6%

THE per capita 180.33 324.26 79.8%

THE as % of GDP 9.4% 8.5% -0.9%

Total OOP as % of THE 20.0% 19.8% -0.2%

Total OOP expenditure per capita 36.11 64.18 77.7%

9.97 26.77 168.5%

OOP for insurance premium per capita
Direct OOP per capita 26.14 37.41 43.1%

HE public sector as % of THE 45.2% 42.6% -2.6%

HE private sector as % of THE 40.0% 53.5% 13.5%

Health expenditures to services and

providers as % of THE
Prevention and primary care 33.7% 27.2% -6.5%

Hospitals 36.3% 35.1% -1.2%

Mental Health 4.5%

Laboratory 4.8%
2.5% 4.0%
Diagnostic Imaging 1.7%

Pharmaceuticals 7.2% 11.5% 4.3%

medical specialists 5.0% 9.3% 4.3%

Private GP's 7.5% 12.6% 5.1%

Administration 4.7% 4.3% -0.4%

Education and Training 0.6% 0.4% -0.2%

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 Summary of the National Health Accounts of Suriname 2006

In TABLE 2 a comparison is made between data from the NHA in 2000 and 2006.

Obvious is the 129.2% increase in GDP with a population increase of 15.5%. This
resulted in an increase in income per capita of 98.5%.

The Total Health Expenditures, USD 163,508,436, increased with 107.6% and
decreased as a percentage of GDP with 9.4% to 8.5% of GDP. The health
expenditures per capita increased from USD 180.33 to 324.26, an increase of 79.8%.

The total OOP expenditures were kept at a percentage of around the 20% of the
THE, to be in line with the OOP in 2000 that were based on a household study. The
OOP expenditures per capita were USD 64.18, a 77.7% increase compared to the
year 2000.

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 Summary of the National Health Accounts of Suriname 2006

Comparison of health expenditures in the Caribbean Region

Table 3: Health expenditures of Caribbean countries. Averages in the period 1997-2001*

Indicators Ant Bah Bdos Bel. Dom. Gren. Gya Jca SKN SL SVG Sur TT

THE%GDP
5.4 5.6 6.1 5.0 5.9 4.9 5.0 6.4 48 4.3 6.1 9.8 4.3

PHE%THE
39 43 34 51 27 31 17 49 34 36 37 41 55

GHE%THE
61 57 66 49 73 69 83 51 66 64 63 59 45

GHE%TGE
14 15 12 5.5 12 12 9.3 6.2 11 8.5 9.1 17.7 6.6

4
ERH%THE 3 -- 4 4 2 -- 4 3 7 0.6 1.5 12

SSHE%GHE -- -- -- -- -- -- -- -- -- 24 -- 30 --

OOP%THE 39 43 26 51 27 31 17 34 34 36 37 16 48

THE pc US$ 487 798 562 147 200 223 48 178 344 188 167 169 239

THE pc $PPP 540 1029 844 251 292 372 191 229 515 257 324 396 367

* WHO World Health Report 2004

THE----Total Health Expenditure PHE---Private Health Expenditure

GHE—Government (Public) Health Expenditure ERH—External Resources for Health

OOP—Out of Pocket Expenditure SSHE—Social Security Health Expenditure

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 Summary of the National Health Accounts of Suriname 2006

Suriname’s per capita spending is one of the lowest, while it has the highest
percentage of GDP spending in health. Life expectancy ranks 10/14 while IMR 3/14
ranks high and CDR 6/14 ranks in the middle group. This indicates that Suriname
can perform well in health with fewer funds than the other countries.

For more and detailed information about the National Health Accounts of
Suriname 2006 please look in the “Final report on the National Health Accounts of
Suriname 2006”.