1 INTERIM REPORT ON SHA DEVELOPMENTAL WORK 7 th Meeting of Health Accounts Experts and Correspondents for Health Expenditure Data Paris, September 2005

2 Overview Health accounting in OECD Work program, General goals for SHA developmental work Progress in SHA developmental work since the 2004 Meeting of Health Accounts Experts Draft project proposals for SHA developmental work in 2006 and in the budget period Questions for discussion

3 Health accounting in OECD Work program, Major tasks Encourage and assist SHA implementation and harmonisation of health accounting practices OECD, EUROSTAT and WHO joint SHA data collection Build up an SHA database Analysis and publication of SHA-based national health accounts Developmental work - Depending on availability of additional resources –Refinement and extension of International Classification for Health Accounts (ICHA) – proposal discussed at the 2004 Meeting of Health Accounts Experts

4 General goals for SHA developmental work OECD SHA serves as an international “quasi-standard” – no need for fundamental changes Second edition of the SHA Manual with ICHA Version 1.1 is expected to better fulfil the requirements of international comparability to enhance the analytical power of the SHA framework to better accommodate different national health systems be based on consensus amongst the international organisations concerned

5 Progress in SHA developmental work since the 6th Meeting Guidelines for estimating long-term care expenditure [HA(2005)3] A review of the current categories of ICHA - in connection to the joint OECD – EUROSTAT- WHO SHA data collection - has started [HA(2005)1] Draft project proposals for SHA developmental work [HA(2005)2] Of the proposed projects, work has already started on –International comparison of volumes and prices in health care [HA(2005)5] –Refinement of the SHA framework for health financing

6 Project proposals for SHA developmental work in 2006 and in the budget period A need for methodological developmental work in order to enhance the SHA framework Increasing expectation for health accounts to provide information (indicators) suitable to assess health system performance (sustainable financing, efficiency, productivity and equity) at system level The SHA in its current state is not a performance indicator framework in itself, but rather a framework for reporting expenditure data that can serve as one (of multiple) inputs to generate performance indicators

7 Project proposals for SHA developmental work in 2006 and in the budget period (cont.) I. Refinement of the SHA framework for health financing II. Estimating expenditure by disease, age and gender under the SHA framework III. Incorporating input, output and productivity measurement into the SHA framework IV. Study on strengthening the connection between SHA and SNA

8 I. Refinement of the SHA framework for health financing Problems with the current framework and data Current categories of the ICHA-HF classification are not able to adequately reflect the new developments in health financing in OECD countries SHA Manual does not adequately distinguish between important elements of health care financing: ultimate sources of funding, financing schemes and institutions executing financing schemes Feasibility of data reporting (e.g., subcategories of private household out-of-pocket expenditure are too detailed) Reliability and comparability of private expenditure on health requires improvement

9 I. Refinement of the SHA framework for health financing (cont.) Main tasks to refine the conceptual framework to revise and extend the ICHA-HF classification (new dimensions with appropriate structure) and the current definitions to design the ways of appropriate presentation of the relationship between the components of health financing (tables, T-accounts) to provide proposals for improving data sources and estimation methods for components of private expenditure

10 II. Estimating Expenditure by Disease, Age And Gender under the SHA Framework Main tasks A concept paper on theoretical and practical challenges to produce internationally comparable estimates on expenditure by disease categories, age and gender groups –E.g., to find a way for including information on co-morbidity; and define the desirable modifications to the main ICD groups Revision of the tables on expenditure by disease categories and age and gender groups in the SHA Manual, and preparation of Guidelines for producing the tables The project intends to avoid the duplication of the WHO project on disease specific chapter of the Guide

11 III. Incorporating Input, Output and Productivity Measurement into the SHA Framework Main tasks A systematic review of current national practices in producing price indices for health care A review of the results from relevant latest/ongoing research projects A proposal to develop health-specific purchasing power parities to be used in OECD Health Data (in co-operation with OECD STD). Starting point: [HA(2005)5] A detailed concept paper on Incorporating Input, Output and Productivity Measurement into the SHA Framework.

12 Possible further development of International Classification for Health Accounts (ICHA) Final source of funding Financing agents / schemes Inputs Service providers Regions Disease / Age & gender Functions Products/Activities?

13 IV. Strengthening the Connection between the SHA and the SNA A more transparent link between the two systems could improve each of them The aim of the project: a systematic comparison of basic approaches (theoretical frameworks) to health care classifications and definitions used for the health sector valuation rules data sources, and methodologies applied for estimation of specific items

14 Questions for discussion Do you agree with the priorities proposed in [HA(2005)2]? How would you prioritize the proposed projects from your national point of view? Would you propose further issues to be addressed? Your interests and possibilities to participate