SHA Implementation Louise Ogilvie Director Health Resources Information

CANADIAN HEALTH ACCOUNTS HISTORY First systematic compilation by Health Canada in Expenditures on personal health care by private and public sector, from 1953 to Five categories: hospitals, prescribed drugs, physicians, dentists and other professionals.

CANADIAN HEALTH ACCOUNTS HISTORY Health Canada maintained the National Health Accounts until 1995 when they were transferred to the new Canadian Institute for Health Information (CIHI). CIHI was established in 1994 “To serve as the national mechanism to coordinate the development and maintenance of a comprehensive and integrated health information system in Canada”.

CANADIAN HEALTH ACCOUNTS Reflect the structure of the Canadian Health Care System within its constitutional framework

CANADIAN HEALTH ACCOUNTS PROVINCIAL/TERRITORIAL GOVERNMENTS Have primary responsibility in the health care area. FEDERAL GOVERNMENT National conditions/criteria Fiscal Powers (Tax and Spending) Direct responsibility for certain groups (Indians, Veterans, RCMP, Armed Forces, federal inmates).

CANADIAN HEALTH ACCOUNTS Historical series 1953–2003 Financial data – 5 sources of finance (sectors) – 42 uses of funds (categories) Actual/estimates/forecasts

CANADIAN HEALTH ACCOUNTS Sources of Finance

CANADIAN HEALTH ACCOUNTS Total Health Expenditure by Use of Funds, 1999 Capital 3.5% Public Health & Admin 5.7% Other Health Spending 8.6% Other Institutions 9.5% Other Professionals 12.1% Physicians 13.6% Drugs 15.0% Hospitals 32.0%

CANADIAN HEALTH ACCOUNTS MAPPING TO ICHA-HF Public Sector Good correspondence between the Canadian classification of sources of finance and the ICHA-HF. Private Sector Direct correspondence only for out-of- pocket expenditure. No ICHA-HF category clearly corresponds to “non-consumption”.

CANADIAN HEALTH ACCOUNTS MAPPING TO ICHA-HF: Public Sector

CANADIAN HEALTH ACCOUNTS MAPPING TO ICHA-HF: Private Sector

Total Health Expenditure by Source of Finance, (SHA), Canada,1999 State/provincial governments 65.2% Local/municipal governments 0.7% Private social insurance 10.2% Social security funds 1.3% Private household out-of-pocket 16.4% Central government 3.0% Non- consumption 2.1%

CANADIAN HEALTH ACCOUNTS MAPPING TO ICHA-HC Eight Broad Uses of Funds Were Mapped to ICHA-HC Uses of Funds in Canadian Health Accounts ICHA-HC Hospitals17 categories Other Institutions2 categories Physicians7 categories Other Professionals3 categories Drugs3 categories Capital1 category Public Health and Administration 1 category Other Health Spending9 categories

CANADIAN HEALTH ACCOUNTS Hospitals: MAPPING TO ICHA-HC

CANADIAN HEALTH ACCOUNTS Other Institutions: MAPPING TO ICHA-HC

CANADIAN HEALTH ACCOUNTS Physicians: MAPPING TO ICHA-HC

CANADIAN HEALTH ACCOUNTS Other Professionals: MAPPING TO ICHA-HC

CANADIAN HEALTH ACCOUNTS Drugs, Capital, Public Health and Administration : MAPPING TO ICHA-HC

Current Health Expenditure, by Major Functional Category, (SHA), Canada,1999 Undistributed 0.9% Health adm. & insurance 2.0% Prevention & public health 6.7% Medical goods dispensed to out-patients 18.7% Ancillary Services 8.6% Long-term nursing care 14.2% Curative/rehabilitative care 48.9%

Uses of Funds in Canadian Health Accounts Broken Down by Mode of Production

Current Health Expenditure, by Mode of Production, (SHA), Canada,1999 Out-patient care 26.2% In-patient care 32.0% Not applicable (ancillary services, medical goods, prevention & public health, health adm. & insurance) 36.0% ( Home care 2.1% Day care 2.9% Undistributed 0.9%

CANADIAN HEALTH ACCOUNTS Institutions and Professional Services: MAPPING TO ICHA-HP

CANADIAN HEALTH ACCOUNTS Drugs, Public Health/Admin, Other Health Spending: MAPPING TO ICHA-HP

Current Health Expenditure, by Major Types of Providers, (SHA), Canada,1999 Nursing and residential care facilities 10.0% Hospitals 35.6% Undistributed 0.9% ( Providers of ambulatory health care 26.4% Provision and adm. of public health programmes 6.2% Retail sale and other providers of medical goods 18.7% All other industries 0.3% Gen. Health adm. 2.0%

What went well…  Good correspondence between the Canadian classification of sources of finance for the public sector and the ICHA-HF.  Private insurance group plans meet the definition of HF.2.1 private social insurance.  Expenditures on drugs and capital could be directly mapped to the ICHA-HC.

What went well (cont’d)…  About two thirds of hospital operating expenses could be directly allocated to as much as seventeen ICHA-HC categories.  Fee-for-service payments of physicians in private practice were allocated to seven ICHA-HC categories.  Good correspondence between some uses of funds and the ICHA-HP (e.g. Hospitals, Other Institutions, Other professionals).

Conclusions  SHA implementation resulted in 3% reduction of THE relative to Canadian Accounts.  Furthermore, there are boundary differences between the Canadian Accounts and the SHA. Examples include:  Imports and exports are treated differently in the Canadian Accounts and the SHA  Auto Insurance is not included Canadian Acc’ts.  Non-medical care in residential facilities is included in the SHA, not in Canadian Acc’ts.  Alcohol-Drug Addiction facilities is included in Canadian Acc’ts, not in SHA.  No equivalent to Non-Consumption in the SHA.

Conclusions (cont’d)  Limitations to extent that most Uses of Funds in the Canadian Accounts could be mapped to ICHA-HC  The ICHA-HP is inconsistent with the way health care is financed in Canada.  The ICHA-HP is inconsistent with the way provider incomes are reported in Canada.