HEDIC Health expenditures by diseases and conditions WG Public Health Statistics, December 17, 2014 Marian Craig, HEDIC Project Manager marian.craig@falconcraig.com; + 44 131 662 8837

Eurostat Contract No: 07154.2013.001-2013.239 HEDIC Background and context Why make international comparisons of health expenditure by diseases? - understand the determinants of health care expenditure (e.g. demography, epidemiology, health technology, pricing policy, organisational determinants of access); - predict trends in health care expenditure; - inform priority setting for health treatment and prevention activities; - understand indirect costs of illness (e.g. early retirement due to illness, incapacity to work). 23/11/2018 Eurostat Contract No: 07154.2013.001-2013.239

Eurostat Contract No: 07154.2013.001-2013.239 HEDIC Project aims and objectives to develop a methodology for systematically collecting information on transactions within health systems in relation to health outcomes, related to disease, age and sex applicable to as many European countries as possible within the overall goal of increasing the use of official public health data within the European Statistical System (ESS). 23/11/2018 Eurostat Contract No: 07154.2013.001-2013.239

Eurostat Contract No: 07154.2013.001-2013.329 HEDIC Distribution of health expenditure by condition and activity, Germany, 2008 (Source: BASYS) Eurostat Contract No: 07154.2013.001-2013.329

Holistic approach will lead to better results Example: Analysis of cancer related cost Eurostat Contract No: 07154.2013.001-2013.239

Consortium members – 17 countries HEDIC Consortium members – 17 countries Project Lead: Luxembourg * Active participants: Austria*, Bulgaria**, Czech Republic**, Germany BASYS, Greece Athens University, Hungary**, Lithuania SEC Consultancy, Latvia**, Netherlands**, Sweden*, Finland * Subcontractors: Netherlands Public Health Institute, Slovenia Stanislav Marn Consultant Observers: Austria Austrian Social Insurance Institutions, Switzerland **, Spain*, Germany**, Poland**, UK* * Ministry of Health/Social Security ** Central Statistical Office 23/11/2018 Eurostat Contract No: 07154.2013.001-2013.239

Eurostat Contract No: 07154.2013.001-2013.239 HEDIC Main tasks Task 1 Compile a data inventory Task 2 Prepare the HEDIC Manual Task 3 Pilot projects to test the methodology for compiling expenditure by disease Task 4 Analysis of pilot project data Task 5 3 workshops Stockholm (June 2014), The Hague (March 2015) , Budapest (Spring 2016) Task 6 Final report - Eurostat Working Paper (May 2016) 23/11/2018 Eurostat Contract No: 07154.2013.001-2013.239

Eurostat Contract No: 07154.2013.001-2013.239 HEDIC A. Current health expenditure by providers/functions/financing (with a decision to be taken about which years to use for the compilation) B. Allocation of current expenditure by disease, age and gender B.1 Expenditure B.2 Utilisation B.3 Unit cost B.4 Reproductive health B.5 Metadata C. Indirect costs D. Studies of cost of illness E. Data sources 23/11/2018 Eurostat Contract No: 07154.2013.001-2013.239

Eurostat Contract No: 07154.2013.001-2013.239 HEDIC Key challenges I Objective of HEDIC: develop a methodology for compiling data on cost of illness applicable in all European countries (EU and EFTA). Consortium carrying out the work currently consists of organisations from 17 European countries. 28 of 31 EU/EFTA countries have responded to our request for information about HEDIC data availability. 23/11/2018 Eurostat Contract No: 07154.2013.001-2013.239

Responses to data inventory questionnaire, 27/11/14 Country Completed questionnaire Need more time to complete questionnaire Interested in principle but no resources Referred to work already done No response Austria    Belgium Bulgaria Croatia Cyprus Await implementation of NHIS Czech Republic Denmark Estonia End 12/14 Finland France CNAMTS, Expenditure by major pathologies Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norway Poland   Portugal Romania Spain Slovak Republic Slovenia Sweden Switzerland Will support the project as observers UK DoH, Programme Budgets Total 16 5 2 3 23/11/2018 Eurostat Contract No: 07154.2013.001-2013.239

HEDIC Key challenges II Securing access to data on health expenditure by disease generated and controlled by social and commercial health insurance organisations, is arguably the biggest challenge for the work of HEDIC. In the absence of this data, the picture we develop of health expenditure by disease will be significantly incomplete. 23/11/2018 Eurostat Contract No: 07154.2013.001-2013.239

Eurostat Contract No: 07154.2013.001-2013.239 HEDIC Next steps Work to develop the HEDIC methodology: - countries with social insurance funded health systems to meet in Augsburg, January 2015: to develop the MDS from the publicly funded system on which the HEDIC compilation will be based; rules for further compilation; adding additional sources; reconciliation - revise the HEDIC manual (ATC-ICD mapping and allocation of primary care expenditure) - prepare first compilations of expenditure by disease, for analysis and discussion in The Hague in March 2015 23/11/2018 Eurostat Contract No: 07154.2013.001-2013.239