1. 1 Developing a System of Health Accounts in an Industrialized Economy: Progresses & Challenges Chung-Fu Lan, DrPH, FICD, FPFA, FRAI Associate Dean, School of Medicine National Yang-Ming University Fourth OECD/Korea RCHSP-ASNHAN Meeting of Regional Health Accounts Experts July 10, 2008

2. 2 Contents Introduction Progresses in the First Year of the SHA- Based NHA Study Project Revealed from the National Health Account 2006 Inquiry of Health Data/Metrics & Related Information for Taiwan’s SHA Project Conclusion

3. 3 The State of NHE/NHA Development in Taiwan 1 Taiwan has begun the development of national incomes/national accounts in mid- 1970’s. Since the earlier 1990’s, the DOH & the academic have gradually developed & published the NHE/NHA followed the above-mentioned statistical methods and experiences.

4. 4 The State of NHE/NHA Development in Taiwan 2 After the implementation of the NHI in 1995, healthcare budgets/funds have increased tremendously, & the contents of the flow of funds have changed significantly (the total expenditure on health as % of GDP is 6.1% in 2007). Taiwan has facing several important health policy issues such as very rapid demographic transition, the emergence of public health problems, shifting health paradigm, & great impacts of NHI’s global budget on health care delivery modules & providers’ behaviors.

5. 5 The State of NHE/NHA Development in Taiwan 3 Calls for more efficient use of resources and/or more resources are also facilitate the interests & tasks on embarking a better national health accounting exercises. Keeping the path with methodological advancement & a series of standardized internationally classification for health accounts by the OECD, World Bank, WHO, USAID, the literature, & personal communications, the DOH & the scholars in Taiwan have worked on improving the contents & measurements, & continuing the updates of NHE/NHA.

6. 6 Progresses in the First Year of the SHA-Based NHA Study Project

7. 7 Progresses in Year 2007’s Study 1 Literature reviews Reviews of international SHA experiences Conceptual, methodological & administrative considerations Compiling the existing database & information Discussions on strategies for meeting the items that data currently unavailable

8. 8 Progresses in Year 2007’s Study 2 SHA tables (year 2005) preparation –Current expenditure on health by function of care, provider & source of funding –Current expenditure on health by function of care & provider industry –Current expenditure on health by provider industry & source of funding –Current expenditure on health by function of care & source of funding

9. 9 Revealed from the National Health Account 2006

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19. 19 Inquiry of Health Data/Metrics & Related Information for Taiwan’s SHA Project

20. 20 General Economic Indicators 1 Total Output, Income, & Spending –Gross Domestic Product (GDP) –Real GDP –Implicit Price Deflators for GDP, (or Price Deflators) –GDP & Related Price Measures: Indexes & Percent Changes –National Income –Real Personal Consumption Expenditure –Sources of Personal Income –Disposition of Personal Income –Business Investment (Capital Expenditure) by Industry

21. 21 General Economic Indicators 2 Employment, Unemployment, & Wages –Status of Labor Force –Selected Unemployment Rates –Nonagricultural Employment –Average Weekly Hours, Hourly Earnings, & Weekly Earnings – Private Nonagricultural Industries –Employment cost Index – Private Industry –Productivity & Related Data, Business Sector

22. 22 General Economic Indicators 3 Production & Business Activity –Industrial Production & Capacity Utilization –Industrial Production – Major Market Groups & Selected Manufactures –New Construction Prices –Producer Prices –Consumer Prices – All Urban Consumers –Changes in Producer Prices for Finished Goods –Changes in Consumer Prices – All Urban Consumers

23. 23 General Economic Indicators 4 Government Finance –Government Receipts, Outlays, & Debt –Government Receipts by Source & Outlays by Function –Government Sectors, National Income Account Basis International Trade –International Trade in Goods & Services –International Transactions

24. 24 Health Economic Indicators 1 Total Health Care Output, Income, & Spending –Gross Health Care Output –Adjusted Health Care Output –Health Care Related Price Measures: Indexes & Percent Changes –Real Personal Consumption Expenditure in Health Care –Real Personal Out-of-Pocket Expenditure in Health Care –Health Care Capital Investment Health Care Employment, Unemployment, & Wages –Status of Health Care Labor Force –Selected Health Care Professionals’ Nonhealth Employment & Unemployment (including Inactive) Rates –Average Weekly Hours, Hourly Earnings, & Weekly Earnings – Private Nonagricultural Industries –Health Care Employment cost Index – Private & Public Health Care Sectors –Productivity & Related Data, Health Care Sector

25. 25 Health Economic Indicators 2 Health Care Production & Related Activities –Health Care Industrial Production –Health Care Resources’ Capacity Utilization –New Construction in Health Care Health Care Prices –Health Care Producer Prices –Health Care Consumer Prices – Rural & Urban Consumers –Medical Consumer Price Index (MCPI) & –Changes in Health Care Producer Prices by Service Category –Changes in Health Care Consumer Prices – Rural & Urban Consumers

26. 26 Health Economic Indicators 3 Central & Local Governments’ Finance in Health Care –Government Receipts, Outlays, & Debt in Health Care –Government Receipts in Health Care by Source & Outlays by Function –Government Sectors, National Health Account Basis International Health Care Statistics –International Trade in Medical Equipments & Service –International Trade in Pharmaceuticals & Services –International Trade in Health-related Commercial Insurance Programs –International Trade in Medical Care Services –International Trade in Long-Term Care & Social Assistive Services –International Trade in Other Health Care Related Services –International Health Care Transactions

27. 27 National Household Health Expenditures Survey Especially on the out-of-pocket (OOP) expenditures Defining health & healthcare broadly; including traditional medical-related practices Examples: –Long-term care –Complementary & alternative medicine –Over-the-counter (OTC) pharmaceuticals –Private health insurances

28. 28 Building a Better Health System with the Basis of a Better Health Information

29. 29 Health System Reform & National Health Account Essentially, structural reform in pricing & cost control as well as regulations of providers In details: –improving cost efficiency, –assuring quality, –promoting competition, –equitabling access, –decentralizing administration, & –responding to aging.

30. 30 Many Thanks !!