Pilot Study Mapping Health Expenditures from SHA 1.0 to SHA 2011

Transcription

1 EUROPEAN COMMISSION EUROSTAT Directorate F: Social statistics Unit F5: Education, health and social protection DOC 2013PH06 Annex 2 Pilot Study Mapping Health Expenditures from to Item of the Agenda Meeting of the Public Health Statistics Working Group Luxembourg, 23 December 2013 Bech Building Room Quetelet

2 EUROPEAN COMMISSION EUROSTAT Directorate F: Social Statistics Unit F5: Education, health and social protection statistics 2013TFSHA02 Pilot Study Mapping Health Expenditures from to Luxembourg, 24 September 2013 Bech Building Room B3/404 1

3 1. INTRODUCTION 1.1. Background Revision of SHA v1.0 the manual Since 2007 Eurostat, OECD and WHO, the so called International Health Accounts Team (IHAT), coordinated the work on the revision of the SHA 1.0 manual in order to complete/improve methodological issues and to provide a refined conceptual framework for better comparability of health expenditure data across countries. This process was finished in March The new manual was endorsed by the WG PH in June 2011 and subsequently published. However, at the same time the WG PH emphasised the need to continue the expenditure data collection with the current JQ based on the manual for another 23 years Feasibility of shifting from SHA v1.0 to At the WG PH meeting in 2011 the Core Group CARE presented the results of a feasibility study that aimed at mapping the data for the three main classifications on health function, providers and financing following the new manual onto categories. The results indicated that indeed a data collection following the manual would be feasible, given some further investigations, such as a pilot project for preventive ; an adjustment of the Joint Questionnaire to the requirements could be less of a problem than expected. As a result, a Commission Regulation (CR) could be developed. In June 2012 TG CARE, a decision was made to use the methodology as the basis of a possible CR. At the Working Group Public Health (WFPH) meeting held on 2526 September 2012, participants welcomed Eurostat's proposal for a draft CR on health expenditure and financing, including a set of 3 crosstabulations according to. Member States proposed some improvements to the draft CR and were invited to participate in a pilot testing of those tables that are strictly based on the manual. The results of the pilot exercise would be analysed by a newly created Task Force that would meet in Pilot testing of the data collection based on the draft Commission Regulation In January 2013, the OECD, in the name of IHAT, circulated the SHA2011 based Joint Questionnaire (JQ) for pilot collections. These pilot collections would be done in addition to the regular (annual) data collection activity based on. On the 13 th of February 2013, Eurostat invited the members of the Technical Group CARE through to participate in the pilot testing of the draft CR variables and cross tabulations with data for the reference year 2011 covering at least the CR variables. Variables included in the draft CR are a subset of the variables of the SHA2011based JQ. 2

4 2. COMMISSION REGULATION (CR) TABLES 2.1. Crossclassification of current health expenditure: health functions (HC) by financing schemes (HF) Financing schemes HF.1.1 HF.1.2 HF.1.3 HF.2.1 HF.2.2 HF2.3 HF.3 HF.4 Health functions Government schemes Compulsory contributory health insurance schemes comp.. medical savings accounts Voluntary health insurance schemes Nonprofit institutions financing schemes Enterprises financing schemes Household outofpocket payment Rest of the world financing schemes (nonresident) Current expenditure HF.1.1HF.4 HC.1.1;HC.2.1 Inpatient HC.1.2;HC.2.2 Day HC.1.3;HC.2.3 Outpatient HC.1.4;HC.2.4 Homebased HC.3.1 Inpatient longterm (health) HC.3.2 Day longterm (health) HC 3.3 Outpatient longterm (health) HC.3.4 Homebased longterm (health) HC.4 Ancillary services (nonspecified by function) HC.5.1 Pharmaceuticals and other medical nondurable goods HC.5.2 Therapeutic appliances and other medical goods HC.6 Preventive HC.7 Governance and health system and financing administration HC.9 Other health services not elsewhere classified (n.e.c.). Meeting of the Public Health Statistics Working Group Luxembourg, 23 December 2013 Bech Building Room Quetelet

5 Current expenditure on health HC.1.1HC Crossclassification of current health expenditure: health functions (HC) by health providers (HP) Health providers HP.1 HP.2 HP.3 HP.4 HP.5 HP.6 HP.7 HP.8 HP.9 Health functions Hospitals Residential longterm facilities Providers of ambulatory health Providers of ancillary services Retailers and other providers of medical goods Providers of preventive Providers of health system administration and financing Rest of the economy Rest of the world Current health expenditure HP.1HP.9 HC.1.1;HC.2.1 Inpatient HC.1.2;HC.2.2 HC.1.3;HC.2.3 HC.1.4;HC.2.4 HC.3.1 HC.3.2 HC 3.3 HC.3.4 HC.4 HC.5.1 HC.5.2 HC.6 HC.7 HC.9 Day cases of Outpatient Homebased Inpatient longterm (health) Day longterm (health) Outpatient longterm (health) Homebased longterm (health) Ancillary services (nonspecified by function) Pharmaceuticals and other medical nondurable goods Therapeutic appliances and other medical goods Preventive Governance and health system and financing administration Other health services not elsewhere classified (n.e.c.) Current health expenditure HC.1.1HC.8 4

6 2.3. Crossclassification of current health expenditure: health providers (HP) by financing schemes (HF) Financing schemes HF.1.1 HF.1.2 HF1.3 HF.2.1 HF.2.2 HF.2.3 HF.3 HF.4 Health providers Government schemes Compulsory contributory health insurance schemes comp.. medical savings accounts Voluntary health insurance schemes Nonprofit institutions financing schemes Enterprises financing schemes Household outofpocket payment Rest of the world financing schemes (nonresident) Current expenditure HF.1..1HF.4 HP.1 HP.2 HP.3 HP.4 HP.5 HP.6 HP.7 HP.8 HP.9 Hospitals Residential longterm facilities Providers of ambulatory health Providers of ancillary services Retailers and other providers of medical goods Providers of preventive Providers of health system administration and financing Rest of the economy Rest of the world Current health expenditure HP.1HP.9 5

7 3. MAIN CHANGES SHAV1.0 SHA2011 introduced a number of changes and improvements compared with SHA 1.0. First and foremost, it reinforced the triaxial relationship that is at the root of the System of Health Accounts and its description of health and longterm expenditure that is, what is consumed has been provided and financed. This triangulation maintained the guiding principles of and the Producers Guide. offered more complete coverage within the functional classification in areas such as prevention and longterm ; a more concise picture of the universe of health providers, with closer links to standard industry classifications; and a precise approach for tracking financing in the health sector using the new classification of financing schemes Health Care Functions (HC) In, several refinements have been introduced into the classification of health functions. First, an effort has been made to enhance the functional approach both in the labels and definitions of the firstlevel purpose categories. Second, in order to refocus the measurement to that of final consumption, the expenditure associated with capital formation has been moved to a specific capital account. Third, more precise boundary criteria have been applied to better differentiate health prevention from the health related categories (HC.R) of and to better differentiate the health component of longterm from the social one. Last, new memorandum items have been created to allow further analysis of policy and resource allocation, while some health related classes in are now a memorandum item of the capital account in. A detailed overview of the refinements introduced by into the functional classification is provided in pp of the manual Indicative Mapping Table of Health Care Functions (HC) code SHA v1.0 code HC.1.1;HC.2.1 Inpatient Curative and Rehabilitative HC.1.1;HC.2.1 HC.1.2;HC.2.2 Day cases of HC.1.2;HC.2.2 HC.1.3;HC.2.3 Outpatient HC.1.3;HC.2.3 HC.1.4;HC.2.4 Homebased HC.1.4;HC.2.4 HC.3 Longterm (health) HC.3 HC.3.1 Inpatient longterm (health) HC.3.1 HC.3.2 Day longterm (health) HC.3.2 HC.3.3 Outpatient longterm (health) part of HC.3 HC.3.4 Homebased longterm (health) HC.3.3 HC.4 Ancillary services (nonspecified by function) HC.4 HC.5 Medical goods (nonspecified by function) HC.5 HC.5.1 Pharmaceuticals and other medical nondurable goods HC.5.1 HC.5.2 Therapeutic appliances and other medical goods HC.5.2 HC.6 Preventive HC.6, part of HC.R.4, HC.R.5 HC.7 Governance, and health system and financing administration HC.7 Meeting of the Public Health Statistics Working Group Luxembourg, 23 December 2013 Bech Building Room Quetelet

8 code SHA v1.0 code HC.9 Other health services not elsewhere classified (n.e.c.) Table 3.1 Classification of health functions 3.2. Health Care Providers (HP) The provider classification under follows that of, though there are certain modifications that have been driven by countries experiences with SHA implementation, on the one hand, and the recommendations of the International Standard Industrial Classification (ISIC Rev. 4) 1, on the other. Both factors reflect trends in health provision, contribute to greater comparability with other national and international classifications, and preserve continuity with the previous SHA version. Therefore, for almost all provider categories at both the firstdigit level and seconddigit level, the HP classification of keeps continuity with that of. The majority of categories are retained, although partly under different codes. In pp of the SHA2011 manual, a detailed list of changes from is provided Indicative Mapping Table of Health Care Providers (HP) Code SHA v1.0 code HP.1 Hospitals HP.1 HP.2 Residential longterm facilities HP.2 HP.3 Providers of ambulatory health HP.3 HP.4 Providers of ancillary services HP HP.3.9 HP.4.1 Providers of patient transportation and emergency rescue HP HP.4.2 Medical and diagnostic laboratories HP.3.5, HP.4.9 Other providers of ancillary services HP HP.5 Retailers and other providers of medical goods HP.4 HP.5.1 Pharmacies HP.4.1 HP.5.2 Retail sellers and other suppliers of durable medical goods HP.4.2, HP.4.3, and medical appliances HP.4.4 HP.5.9 All other miscellaneous sellers and other suppliers of pharmaceuticals and medical goods HP.4.9 HP.6 Providers of preventive HP.5 HP.7 Providers of health system administration and financing HP.6 HP.8 Rest of economy HP.7 HP.9 Rest of the world HP.9 Table 3.2 Classification of health providers 1 The International Standard Industrial Classification of All Economic Activities is a United Nations system for classifying economic data. The Statistical Classification of Economic Activities in the European Community (in French: Nomenclature statistique des activités économiques dans la Communauté européenne), commonly referred to as NACE, is a European industry standard classification system consisting of a 6 digit code. 7

9 3.3. Health Care Financing Schemes (HF) The financing axis of the health system is associated with a major change in ; while in SHA1.0 it was measured by financing agents, in SHA 2011 it is measured by financing schemes. The concept of health financing schemes is an application and extension of the concept of social protection schemes defined by the European System of Integrated Social Protection Statistics (ESSPROS). The use of health financing as the general term in proved to be too vague, as in a wider sense it may include financing schemes and their revenues, as well as financing agents. Based on the relevant health policy literature, the SNA and ESSPROS, health financing schemes is regarded as a more suitable concept for SHA data collection. In a simple health financing system, there may be onetoone correspondence among revenues of schemes, financing schemes and financing agents. However, neither theoretically nor in practice is this a typical case. A financing scheme may raise its revenues from several sources, and it can be operated by more than one type of institutional unit (financing agents). Furthermore, a social health insurance scheme (a body of rules) may be operated by a government unit and private insurance companies at the same time. Therefore, the following Table compares HF classification under with that of. It is emphasised again that there is a difference between and concerning the concept of HF: the HF categories under are types of financing schemes, while the HF categories under were a mixture of schemes (such as private social insurance) and institutional units (such as private insurance enterprises) Indicative Mapping Table of Health Care Financing Schemes (HF) Code SHA v1.0 code HF.1 Government schemes and compulsory contributory health HF.1 financing schemes HF.1.1 Government schemes HF.1.1 HF.1.2 Compulsory contributory health insurance schemes HF.1.2 HF.1.3 Compulsory Medical Saving Accounts (CMSA) HF.2 Voluntary health payment schemes HF.2.1;HF HF HF.2.4 HF.2.1 Voluntary health insurance schemes HF.2.1;HF.2.2 HF.2.2 NPISH financing schemes HF.2.4 HF.2.3 Enterprise financing schemes HF.2.5 HF.3 Household outofpocket payment HF.2.3 HF.4 Rest of the world financing schemes (nonresident) HF.3 Table 3.3 Classification of health financing schemes 8

10 4. PILOT STUDY ANALYSIS Based on the data submitted by countries participating in the pilot testing of the CR variables, we aim at analysing the feasibility of mapping health expenditures from SHA1.0 to. Our focus is primarily put on the mapping of categories into CR variables. However, since CR variables refer only to 1 st digit categories and to a limited number of 2 nd digit categories of SHA2011, we should note that the feasibility of such a mapping may be affected by a country s ability to implement a mapping at a lower level (i.e. 2 nd digit and 3 rd digit categories). For example, while the total health expenditures recorded under HC.6 Preventive in and SHA 1.0 may not differ significantly, it is anticipated that the mapping at the 2 nd digit level will not be a straightforward procedure due to the reclassification that SHA2011 brought with regard to this health function. Notwithstanding the importance of every category in the manual, we limit our attention only to CR variables. Four countries (i.e., France (FR), Hungary (HU), Netherlands (NL) and Switzerland (CH)) sent the CR variables directly, while in the case of Latvia (LV) they were extracted from the corresponding SHA2011based JQ. To facilitate the analysis of the feasibility of mapping Health Expenditures from to, we take as a basis the mapping Tables that were presented in Section 3. These Tables should be considered as indicative, in the sense that specific specialities of health systems in different countries, technicalities in the data compilation procedure, and, in many cases, availability of sources may lead to deviations from the provided mapping schemes. However, they can serve as a starting point for revealing the major challenges in compiling health expenditure data based on the SHA2011 manual. It should be noted that 2 nd digit categories of health providers: HP.4.1 Providers of patient transportation and emergency rescue, HP.4.2 Medical and diagnostic laboratories and HP.4.9 Other providers of ancillary services are not part of the CR variables. However, their comparison to the corresponding categories is also presented, since HP.4 is a new category in. The methodology for analysing the transition from to and assessing the feasibility of deriving a mapping scheme is summarized as follows: 1. Countries reported their health expenditure data based on the methodology using the Tables listed in Section Based on the indicative mapping Tables provided in Section 3, the expenditures reported during the standard () 2013 data collection were transferred to the Tables. 3. The difference between each entry in the two Tables (i.e the Table containing data and the Table containing data) was calculated, so as to highlight the deviation from the indicative mapping schemes provided in Section 3. The unit used for all figures in the Tables presented hereinafter is of national currency (m). 9

11 4.1. France HC.1;HC.2 Services of curative and rehabilitative HC.1.1;HC.2.1 Inpatient curative and rehabilitative HC.1.2;HC.2.2 Day cases of curative and rehabilitative HC.1.3;HC.2.3 Outpatient curative and rehabilitative HC.1.4;HC.2.4 Services of home curative & rehabilitative HC.3 Services of longterm nursing HC.3.1 Inpatient longterm nursing HC.3.2 Day cases of longterm nursing HC.3.3 Longterm nursing : home HC.4 Ancillary services to health HC.5 Medical goods dispensed to outpatients HC.5.1 Pharmaceutical and other medical nondurables HC.5.2 Therapeutic appliances and other medical durables HC.6 Prevention and public health services, part of HC.R.4, HC.R.5 The total amount of Current Health Expenditure (CHE) reported using the methodology was 25m less than the CHE under methodology. This is due to the fact that expenditures recorded under HC.6 Preventive using the SHA2011 methodology are 25m less than the corresponding expenditures recorded under HC.6 Prevention and public health services in. France noted that this is the result of a misclassification (wrong choice between HC.3 and HC.6) which will be corrected Health Care Functions (HC) Difference (m) SHA ,53 53,77 53, , ,82 30,84 30, , ,59 6,48 6, , ,12 16,45 16, , ,95 11,17 11, , ,54 7,66 7, , ,41 3,51 3, , ,51 5,14 5, , ,45 20,93 20, , ,58 16,15 16, , ,87 4,79 4, ,87 HC.1;HC.2 Curative and Rehabilitative HC.1.1;HC.2.1 Inpatient Curative and Rehabilitative HC.1.2;HC.2.2 Day cases of HC.1.3;HC.2.3 Outpatient HC.1.4;HC.2.4 Homebased curative and rehabilitative HC.3 Longterm (health) HC.3.1 Inpatient longterm (health) HC.3.2 Day longterm (health) HC.3.3 Outpatient longterm (health) HC.3.4 Homebased longterm (health) HC.4 Ancillary services (nonspecified by function) HC.5 Medical goods (nonspecified by function) HC.5.1 Pharmaceuticals and other medical nondurable goods HC.5.2 Therapeutic appliances and other medical goods 4.487,94 2,00 24,87 1, ,06 HC.6 Preventive

12 HC.7 Health administration and health insurance HC.9 Not specified by kind Difference (m) SHA ,72 6,98 6, ,72 Total CHE , , ,22 Total CHE HC.7 Governance, and health system and financing administration HC.9 Other health services not elsewhere classified (n.e.c.) A direct mapping of health expenditures from to was feasible for almost all categories of health functions. However, France does not report HC.1.4;HC.2.4 Homebased curative and rehabilitative and HC.3.2 Day longterm (health), as they lack data upon homebased at the moment. France is currently trying to collect this information, but the distinction between HC.1.4 and HC.2.4 might be difficult. As far as HC.3.2 Day longterm (health) and HC.3.3 Outpatient longterm (health) are concerned, France does not have any data available. 11

13 Health Care Providers (HP) Difference (m) SHA2011 HP.1 Hospitals ,41 35,50 35, ,41 HP.1 Hospitals HP.2 Nursing and HP.2 Residential longterm facilities ,71 6,39 6, ,71 residential facilities HP.3 Providers of HP.3 Providers of ,26 28, ,74 24, ,52 ambulatory health ambulatory health HP HP ,08 4,23 753,42 3,89 HP.4 Providers of ancillary 8.714,66 services HP Ambulance HP.4.1 Providers of services 2.517,42 1, ,20 1, ,62 patient transportation and emergency rescue HP.3.5 Medical and diagnostic laboratories, Blood and organ banks 4.815,03 2,15 2, ,03 HP.4.2 Medical and diagnostic laboratories HP Providers of all other ambulatory health services 2.135,62 0, ,62 HP.4.9 Other providers of ancillary services HP.4 Retail sale and other providers of medical goods HP.5 Provision and administration of public health programs HP.6 General health administration and insurance ,67 21,51 21, , ,35 0, ,16 1, , ,72 6,98 470,03 7, ,74 HP.5 Retailers and other providers of medical goods HP.6 Providers of preventive HP.7 Providers of health system administration and financing HP.7 Other industries (rest of the economy) 2.006,98 0, ,98 HP.8 Rest of economy HP.9 Rest of the world HP.9 Rest of the world Total CHE , , ,22 Total CHE According to the indicative mapping Table of categories of health providers, 2 nd digit categories HP.2.3 Community facilities for the elderly and HP.2.9 All other residential facilities in are expected to be reported under HP.2.9 Other residential longterm facilities using the methodology, as it is in the case of the France. However, a part of expenditures under HP.2.3, HP.2.9 in were expected to be recorded under HP.8 Rest of the economy in. France has isolated the health expenditure in homes for elderly without onsite nursing (315 m), which will be reclassified accordingly in the future update of the tables. 12

14 Moreover, 2 nd digit categories HP.3.5 and HP.3.9 in are expected to be reported under HP.4 Providers of ancillary services in SHA2011. For France this is applicable for HC.1.1;HC.2.1 Inpatient curative and rehabilitative x HP.3.5; HP.3.9 and HC.4 Ancillary services (nonspecified by function) x HP.3.5; HP.3.9. However, this mapping does not apply in the case of HC.6 Preventive x HP.3.5; HP.3.9. France reported 753 m under HC.6 x HP.3.9 in. As far as the transition to is concerned, 436m are still reported under HC.6 x HP.3, 292 m are reported under either HC.6 x HP.6 or HC.6 x HP.7 and 25m are not reported at all, which is due to a misclassification as noted in the introduction. France did not report any expenditure under HP.8 Rest of the economy which is mapped onto category HP.7 Other industries (rest of the economy) of. In the JQ2013, France reported m under HP.7. This amount covered surveillance of employee health (1537 m) and school health services (470 m). As far as the transition to is concerned, surveillance of employee health (1537 m) was reported under HC.6 x HP.6, and school health services were reported under HC.6 x HP.7.1. However, France has revised this classification and both categories will be reported under HC.6 x HP.8.2 in the forthcoming update of the Tables. According to the indicative mapping Table for health providers, category HP.6 Providers of preventive in is mapped onto HP.5 Provision and administration of public health programs in. However, expenditures recorded under HP.6 in SHA2011 are 1829 m more than those recorded under HP.5 in SHAv1.0. This deviation from the indicative mapping scheme is due to: (a) 1537 m that were classified under HC.6 x HP.6, as explained above and (b) expenditures reported under HP in for which France made the choice of HP.6 according to the SHA2011 manual. According to the indicative mapping scheme, category HP.7 Providers of health system administration and financing in is mapped onto HP.6 General Health administration and insurance in. However, expenditures recorded under HP.7 in SHA2011 are 470 m more than those recorded under HP.6 in SHAv1.0. This deviation is explained by the 470 m of school health services which are reported under HP.7.1 and should rather be reported under HP

15 HF.1 General government HF.1.1 General government (excl. social security) HF.1.2 Social security funds HF.2.1;HF HF HF.2.4 HF.2.1;HF.2.2 Private insurance HF.2.4 Nonprofit institutions serving households HF.2.5 Corporations (other than health insurance) HF.2.3 Private households outofpocket expenditure Health Care Financing Schemes (HF) Difference (m) SHA ,79 77,20 24,88 77, , ,40 3,74 657,83 3, , ,39 73,46 632,95 73, ,34 HF.3 Rest of the world ,68 15,07 15, , ,40 14,40 14, ,40 26,80 0,01 19,50 0,00 7, ,48 0,66 19,50 0, , ,62 7,73 0,01 7, ,63 HF.1 Government schemes and compulsory contributory health financing schemes HF.1.1 Government schemes HF.1.2 Compulsory contributory health insurance schemes HF.1.3 Compulsory Medical Saving Accounts (CMSA) HF.2 Voluntary health payment schemes HF.2.1 Voluntary health insurance schemes HF.2.2 NPISH financing schemes HF.2.3 Enterprise financing schemes Total CHE , , ,22 Total CHE HF.3 Household outofpocket payment HF.4 Rest of the world financing schemes (nonresident) The total health expenditure reported under HF.1 Government schemes and compulsory contributory health financing schemes in is equal to HF.1 General government in, with the exception of 25 m that were misclassified as already explained in previous sections. However, 632,95 m which were reported under HF.1.1 General government (excl. social security) in are now reported under HF.1.2 Compulsory contributory health insurance schemes The expenditures recorded under HF.2 Voluntary health payment schemes in is equal to the sum of HF.2.1;HF.2.2 Private insurance, HF.2.4 Nonprofit institutions serving households, HF.2.5 Corporations (other than health insurance) in. According to the indicative mapping scheme of financing agents in and financing schemes in, a total of 26.8 m under HC.7.2 x HF.2.4 in were expected to be reported under HC.7.2 x HF.2.2 in. Instead, they were reported under HC.7.2 x HF.2.3 in SHA 14

16 2011. This is due to a misclassification in as this expenditure should have been reported under HC.7.2 x HF.2.5. On the contrary, 7.3 m recorded under HC.6 x HF.2.5 in were expected to be reported under HC.6 x HF.2.3 in following the indicative mapping Table. Instead they are reported under HC.6 x HF.2.2. This is due to a misclassification in as this expenditure should have been reported under HC.6 x HF.2.4. The total health expenditure reported under HF.3 Household outofpocket payment in is equal to HF.2.3 Private households outofpocket expenditure in. 15

17 4.2. Hungary HC.1;HC.2 Services of curative and rehabilitative HC.1.1;HC.2.1 Inpatient curative and rehabilitative HC.1.2;HC.2.2 Day cases of curative and rehabilitative HC.1.3;HC.2.3 Outpatient curative and rehabilitative HC.1.4;HC.2.4 Services of curative home and rehabilitative home HC.3 Services of longterm nursing HC.3.1 Inpatient longterm nursing HC.3.2 Day cases of longterm nursing HC.3.3 Longterm nursing : home HC.4 Ancillary services to health HC.5 Medical goods dispensed to outpatients HC.5.1 Pharmaceutical and other medical nondurables HC.5.2 Therapeutic appliances and other medical durables HC.6 Prevention and public health services, part of HC.R.4, HC.R.5 HC.7 Health administration and health insurance HC.9 Not specified by kind Health Care Functions (HC) Difference (m) SHA ,33 48,06 48, , ,44 24,21 24, , ,19 1,12 1, , ,40 22,48 22, , ,31 0,25 0, , ,42 3,79 3, , ,50 3,52 3, , ,72 0,09 0, , ,20 0,18 0, , ,61 5,04 5, , ,33 36,84 36, , ,12 34,40 34, , ,21 2,44 2, ,21 HC.1;HC.2 Curative and Rehabilitative HC.1.1;HC.2.1 Inpatient Curative and Rehabilitative HC.1.2;HC.2.2 Day cases of curative and rehabilitative HC.1.3;HC.2.3 Outpatient curative and rehabilitative HC.1.4;HC.2.4 Homebased curative and rehabilitative HC.3 Longterm (health) HC.3.1 Inpatient longterm (health) HC.3.2 Day longterm (health) HC.3.3 Outpatient longterm (health) HC.3.4 Homebased longterm (health) HC.4 Ancillary services (nonspecified by function) HC.5 Medical goods (nonspecified by function) HC.5.1 Pharmaceuticals and other medical nondurable goods HC.5.2 Therapeutic appliances and other medical goods ,68 4,46 4, ,68 HC.6 Preventive ,16 1,62 1, , ,93 0,20 0, ,93 Total CHE , ,46 Total CHE HC.7 Governance, and health system and financing administration HC.9 Other health services not elsewhere classified (n.e.c.) 16

18 Hungary is still in the beginning of implementing the methodology. The total amount of CHE reported by Hungary using the SHA2011 methodology was the same as the CHE under. A onetoone mapping between and was feasible for CR variables related to health functions, which is presented in the Table above. However, no expenditures are reported under the 2 nd digit category HC.3.3 Outpatient Longterm Care due to the difficulty of separating HC3.3 from other HC.3 2 nd digit categories. Hungary has already started working towards a methodology for separating this figure by organising meetings with the main data providers; yet, separating HC3.3 from other HC.3 2 nd digit categories, but also from HC.1.3;HC.2.3 Outpatient curative and rehabilitative is currently infeasible. 17

19 Health Care Providers (HP) Difference (m) SHA HP.1 Hospitals ,59 30,24 30, ,59 HP.1 Hospitals HP.2 Nursing and HP.2 Residential longterm facilities ,82 2, ,14 1, ,68 residential facilities HP.3 Providers of HP.3 Providers of ,84 23, ,20 18, ,64 ambulatory health ambulatory health HP.4 Providers of HP HP ,60 5,34 0,40 5, ,20 ancillary services HP.4.1 Providers of HP Ambulance patient transportation services and emergency rescue HP.3.5 Medical and diagnostic laboratories, Blood and organ banks HP Providers of all other ambulatory health services HP.4 Retail sale and other providers of medical goods HP.5 Provision and administration of public health programs HP.6 General health administration and insurance ,33 36,84 36, , ,60 2,82 2, , ,14 1,36 1, ,14 HP.4.2 Medical and diagnostic laboratories HP.4.9 Other providers of ancillary services HP.5 Retailers and other providers of medical goods HP.6 Providers of preventive HP.7 Providers of health system administration and financing HP.7 Other industries (rest of the economy) ,22 2, ,14 3, ,36 HP.8 Rest of economy HP.9 Rest of the world 4.208,93 0,20 0, ,93 HP.9 Rest of the world Total CHE , ,46 Total CHE The mapping between and variables was clear for certain categories of health providers: HP.1 Hospitals, HP.5 Retailers and other providers of medical goods, HP.6 Providers of preventive, HP.7 Providers of health system administration and financing and HP.9 Rest of the world. A total of ,20 m is recorded under HP.4 Providers of ancillary services which was subtracted from HP.3 Providers of ambulatory health in and is equal to the sum of expenditures reported in categories HP.3.5 and HP.3.9 in. The expenditure reported under HP.8 Rest of economy is ,14 m higher than the expenditures recorded under HP.7 Other industries (rest of the economy) in. This amount was subtracted from HP.2 Nursing and residential facilities in and it corresponds to institutions whose main activity is the social according to the classification based on the data provided by the National Institute for Quality

20 and Organizational Development in Health and Medicines (GYEMSZI), which is the organization that classifies the health providers in Hungary. 19

21 HF.1 General government HF.1.1 General government (excl. social security) HF.1.2 Social security funds HF.2.1;HF HF HF.2.4 HF.2.1;HF.2.2 Private insurance HF.2.4 Nonprofit institutions serving households HF.2.5 Corporations (other than health insurance) HF.2.3 Private households outofpocket expenditure Health Care Financing Schemes (HF) Difference (m) SHA ,97 64, ,47 64, , ,48 8, ,47 8, , ,49 56,05 56, , ,55 8, ,47 8, , ,35 2,67 2, , ,90 1, ,47 1, , ,29 4,15 4, , ,95 26,81 26, ,95 HF.1 Government schemes and compulsory contributory health financing schemes HF.1.1 Government schemes HF.1.2 Compulsory contributory health insurance schemes HF.1.3 Compulsory Medical Saving Accounts (CMSA) HF.2 Voluntary health payment schemes HF.2.1 Voluntary health insurance schemes HF.2.2 NPISH financing schemes HF.2.3 Enterprise financing schemes HF.3 Household outofpocket payment HF.3 Rest of the world HF.4 Rest of the world financing schemes (nonresident) Total CHE , ,46 Total CHE A clear mapping between 1 st and 2 nd digit categories of health financing agents/schemes under SHAv1.0 and SHA2011 was feasible, based on the indicative mapping Tables provided in the manual. However, according to that Table, 2 nd digit category HF.2.2 NPISH financing schemes in is mapped onto HF.2.4 NPISH (other than social insurance) in SHAv1.0, with the latter accounting for 39,934 m. On the other hand, the expenditures recorded under HF.2.2 in SHA2011 account for 34,541 m. This difference of 5392 m, which is instead reported under HF.1.1 Government schemes in SHA2011, accounts for hospitals that from administrative approach are nonprofit institutions and according to the manual are classified in the HF.2.4 NPISH but in the new interpretation of the financing schemes should be classified as part of Government scheme. 20

22 4.3. Latvia The total amount of CHE reported by Latvia using the SHA2011 methodology was the same as the CHE under methodology Health Care Functions (HC) HC.1;HC.2 Services of HC.1.1;HC.2.1 Inpatient HC.1.2;HC.2.2 Day cases of HC.1.3;HC.2.3 Outpatient HC.1.4;HC.2.4 Services of curative home and rehabilitative home HC.3 Services of longterm nursing HC.3.1 Inpatient longterm nursing HC.3.2 Day cases of longterm nursing HC.3.3 Longterm nursing : home HC.4 Ancillary services to health HC.5 Medical goods dispensed to outpatients HC.5.1 Pharmaceutical and other medical nondurables HC.5.2 Therapeutic appliances and other medical durables HC.6 Prevention and public health services, part of HC.R.4, HC.R.5 HC.7 Health administration and health insurance Difference (m) SHA2011 HC.9 Not specified by kind 241,25 63,09 1,56 63,49 242,81 135,60 35,46 35,46 135,60 29,14 7,62 7,62 29,14 75,63 19,78 1,56 20,19 77,19 0,89 0,23 0,23 0,89 6,71 1,76 1,76 6,71 4,44 1,16 1,16 4,44 2,28 0,60 0,60 2,28 39,36 10,29 1,85 9,81 37,51 84,61 22,13 0,08 22,15 84,68 84,57 22,11 0,08 22,13 84,65 0,04 0,01 0,01 0,04 HC.1;HC.2 Curative and Rehabilitative HC.1.1;HC.2.1 Inpatient Curative and Rehabilitative HC.1.2;HC.2.2 Day cases of HC.1.3;HC.2.3 Outpatient HC.1.4;HC.2.4 Homebased HC.3 Longterm (health) HC.3.1 Inpatient longterm (health) HC.3.2 Day longterm (health) HC.3.3 Outpatient longterm (health) HC.3.4 Homebased longterm (health) HC.4 Ancillary services (nonspecified by function) HC.5 Medical goods (nonspecified by function) HC.5.1 Pharmaceuticals and other medical nondurable goods HC.5.2 Therapeutic appliances and other medical goods 6,36 1,66 0,22 1,72 6,57 HC.6 Preventive 4,12 1,08 1,08 4,12 Total CHE 382, ,41 Total CHE HC.7 Governance, and health system and financing administration HC.9 Other health services not elsewhere classified (n.e.c.) 21

23 A clear mapping for the following categories of health functions was feasible: HC.1.1;HC.2.1 Inpatient Curative and Rehabilitative, HC.1.2;HC.2.2 Day cases of, HC.1.4;HC.2.4 Homebased, HC.3.1 Inpatient longterm (health), HC.3.4 Homebased longterm (health), HC.5.2 Therapeutic appliances and other medical goods, HC.7 Governance, and health system and financing administration. Expenditures recorded under HC.4 Ancillary services (nonspecified by function) in are 1.85 m less than those recorded under HC.4 in. This amount has been distributed to categories: 1.56m to HC.1.3;HC.2.3 Outpatient, 0.08m to HC.5.1 Pharmaceuticals and other medical nondurable goods and 0.22m to HC.6 Preventive. There are currently, no expenditures are reported under HC3.3 Outpatient Longterm Care in. This specific category was not separately reported in SHA v1.0, but was rather part of HC.3. The reason behind the lack of data is not a difficulty in breaking down the expenditure for categories Day longterm (health) or Outpatient longterm (health) from HC.3, but the fact that the National Health Service is managing the budget of the Ministry of Health and, in this case, the MoH is not paying for these services. The Ministry of Welfare could possibly identify some expenditure to be filled in this category by the Central Statistical Bureau of Latvia. 22

24 Health Care Providers (HP) Difference (m) SHA HP.1 Hospitals 195,98 51,25 0,38 51,15 195,60 HP.1 Hospitals HP.2 Nursing and HP.2 Residential longterm 0,03 0,01 0,01 0,03 residential facilities facilities HP.3 Providers of HP.3 Providers of 89,24 23,34 5,34 21,94 83,90 ambulatory health ambulatory health HP.4 Providers of ancillary HP HP.3.9 6,19 1,62 0,09 1,60 6,11 services HP.4.1 Providers of HP Ambulance patient transportation and services emergency rescue HP.3.5 Medical and diagnostic laboratories, Blood and organ banks HP Providers of all other ambulatory health services HP.4 Retail sale and other providers of medical goods HP.5 Provision and administration of public health programs HP.6 General health administration and insurance HP.7 Other industries (rest of the economy) 6,08 1,59 0,03 1,60 6,11 0,12 0,03 0,12 90,29 23,61 0,39 23,51 89,90 4,12 1,08 1,08 4,12 HP.4.2 Medical and diagnostic laboratories HP.4.9 Other providers of ancillary services HP.5 Retailers and other providers of medical goods HP.6 Providers of preventive HP.7 Providers of health system administration and financing 0,05 0,01 0,01 0,05 HP.8 Rest of economy HP.9 Rest of the world 2,69 0,70 0,70 2,69 HP.9 Rest of the world Total CHE 382, ,41 Total CHE The mapping between and variables was clear for certain categories of health providers: HP.2 Residential longterm facilities, HP.7 Providers of health system administration and financing, HP.8 Rest of economy and HP.9 Rest of the world. According to the indicative mapping Table between SHA2011 and categories of health providers provided in the manual, 2 nd digit categories HP.3.5 Medical and diagnostic laboratories and HP.3.9 Other providers of ambulatory health in, which account for 6,195 m in total, are expected to be reported under HP.4 Providers of ancillary services in. Latvia reported 6,107 m under HP.4 in. This amount corresponds to: 5,336 m which were reported under HP.3 Providers of ambulatory health in SHAv1.0, corresponding to a 0,859 m difference with the sum of HP.3.5 and HP.3.9 in. 0,379 m which were reported under HP.1 in and were expected to be reported under HP.1 in SHA2011 according to the indicative mapping Table

25 0,392m which were reported under HP.4 Retail sale and other providers of medical goods in and were expected to be reported under HP.5 Retailers and other providers of medical goods in SHA2011 according to the indicative mapping Table. Latvia is currently working towards the methodological analysis of the expenditures reported under health providers categories which will shed light in the deviations that are observed with regard to the provided mapping Table Health Care Financing Schemes (HF) Difference (m) SHA2011 HF.1 General government 382,41 100,00 100,00 382,41 HF.1.1 General government (excl. social security) HF.1.2 Social security funds 382,41 100,00 382,41 HF.1 Government schemes and compulsory contributory health financing schemes HF.1.1 Government schemes HF.1.2 Compulsory contributory health insurance schemes HF.1.3 Compulsory Medical Saving Accounts (CMSA) HF.2 Voluntary health payment schemes HF.2.1 Voluntary health insurance schemes HF.2.1;HF HF HF.2.4 HF.2.1;HF.2.2 Private insurance HF.2.4 Nonprofit HF.2.2 NPISH financing institutions serving schemes households HF.2.5 Corporations HF.2.3 Enterprise (other than health financing schemes insurance) HF.2.3 Private households HF.3 Household outofpocket payment outofpocket expenditure HF.4 Rest of the world HF.3 Rest of the world financing schemes (nonresident) Total CHE 382, ,41 Total CHE 24

26 4.4. Netherlands The Netherlands have already achieved a considerable progress in the implementation of the methodology, as they currently construct figures out of figures in order to fill the tables of the annual Joint Health Account Questionnaire. However, there still remain steps to be taken, before a full implementation of is realised. The total Current Health Expenditure reported by the Netherlands is the same both under and methodology. The following Tables provide a comparison of the figures recorded under the CR variables using both the first and the second version of the SHA methodology Health Care Functions (HC) HC.1;HC.2 Services of HC.1.1;HC.2.1 Inpatient HC.1.2;HC.2.2 Day cases of HC.1.3;HC.2.3 Outpatient HC.1.4;HC.2.4 Services of curative home and rehabilitative home HC.3 Services of longterm nursing HC.3.1 Inpatient longterm nursing HC.3.2 Day cases of longterm nursing HC.3.3 Longterm nursing : home HC.4 Ancillary services to health HC.5 Medical goods dispensed to outpatients HC.5.1 Pharmaceutical and other medical nondurables HC.5.2 Therapeutic appliances and other medical durables HC.6 Prevention and public health services, part of HC.R.4, HC.R.5 Difference (m) SHA ,51 50,09 50, , ,79 29,75 29, , ,79 19,77 19, ,79 381,93 0,57 0,57 381, ,34 24,21 24, , ,53 20,25 499,37 19, ,15 499,37 0,75 499, ,81 3,96 3, , ,24 1,89 1, , ,34 14,71 14, , ,00 10,12 10, , ,34 4,59 4, ,34 HC.1;HC.2 Curative and Rehabilitative HC.1.1;HC.2.1 Inpatient Curative and Rehabilitative HC.1.2;HC.2.2 Day cases of HC.1.3;HC.2.3 Outpatient HC.1.4;HC.2.4 Homebased HC.3 Longterm (health) HC.3.1 Inpatient longterm (health) HC.3.2 Day longterm (health) HC.3.3 Outpatient longterm (health) HC.3.4 Homebased longterm (health) HC.4 Ancillary services (nonspecified by function) HC.5 Medical goods (nonspecified by function) HC.5.1 Pharmaceuticals and other medical nondurable goods HC.5.2 Therapeutic appliances and other medical goods 2.542,40 3,81 3, ,40 HC.6 Preventive

27 HC.7 Health administration and health insurance Difference (m) SHA ,01 4,20 4, ,01 HC.9 Not specified by kind 729,02 1,09 1,09 729,02 Total CHE , ,86 Total CHE HC.7 Governance, and health system and financing administration HC.9 Other health services not elsewhere classified (n.e.c.) A direct mapping of and variables was feasible for HC.1;HC.2 Curative and Rehabilitative, as well for 2 nd digit categories under HC.1;HC.2. However, the Netherlands did not report any figures under HC.1.2 Day Curative Care, HC.2.2 Day Rehabilitative Care and HC.3.2 Day longterm, as it is the case for. In the Netherlands, inpatient, day, outpatient and home are provided by integrated organisations. These large integrated organisations do report on different kinds of expenditures, and therefore, from the financing side, there is available information to separate inpatient+day vs. outpatient or home. However, the split between inpatient and day is difficult to make in expenditure, despite the fact that in cases or days it is feasible. The Netherlands will investigate this issue more thoroughly in 2014 and in 2015, so as to devise an appropriate methodology for splitting the figures. The direct mapping of HC.3 Longterm (health) variable in SHA 2011 with the HC.3 Services of longterm nursing category in SHA 1.0 was also feasible. This was mainly due to the redefinition of long term (health), which constitutes the most important, i.e. quantitatively, adjustment that the Netherlands have made in the last years. During the CR variable pilot study, the Netherlands recorded 499,37 m under HC.3.3 Outpatient longterm (health), which was correspondingly subtracted from HC.3.1 Inpatient longterm (health). While such a splitting of inpatient and outpatient longterm seems straightforward, the Netherlands faced a number of challenges which they successfully addressed, also by incorporating the different viewpoints on longterm expenditures allocation of a number of stakeholders/experts. All the important aspects of the applied approach will be illuminated by the Netherlands during the Task Force meeting. A mapping between SHA2011 categories: HC.4 Ancillary services (nonspecified by function), HC.5 Medical goods (nonspecified by function), 2 nd digit categories HC5.1 and HC.5.2, HC.7 Governance, and health system and financing administration, HC.9 Other health services not elsewhere classified (n.e.c.) and their corresponding categories was feasible as well. 26

28 The expenditure recorded under HC.6 Preventive is equal to the one reported under HC.6 Prevention and public health services in. Nevertheless, the Netherlands faced difficulties in its reporting. This is ascribed to the fact that several items are allocated to the classes of prevention, but some of the second digit classes could not be filled, or hardly be filled. 27

29 Health Care Providers (HP) Difference (m) SHA2011 HP.1 Hospitals ,66 33,55 33, ,66 HP.1 Hospitals HP.2 Nursing and HP.2 Residential longterm ,45 24,05 24, ,45 residential facilities facilities HP.3 Providers of HP.3 Providers of ,56 19, ,12 17, ,44 ambulatory health ambulatory health HP.4 Providers of ancillary HP HP ,12 2,07 2, ,12 services HP.4.1 Providers of HP Ambulance 317,97 0,48 0,48 317,97 patient transportation and services emergency rescue HP.3.5 Medical and diagnostic laboratories, Blood and organ banks HP Providers of all other ambulatory health services HP.4 Retail sale and other providers of medical goods HP.5 Provision and administration of public health programs HP.6 General health administration and insurance HP.7 Other industries (rest of the economy) 1.040,25 1,56 1, ,25 24,90 0,04 0,04 24, ,03 14,09 14, ,03 848,66 1,27 592,32 2, , ,00 4,77 4, ,00 HP.4.2 Medical and diagnostic laboratories HP.4.9 Other providers of ancillary services HP.5 Retailers and other providers of medical goods HP.6 Providers of preventive HP.7 Providers of health system administration and financing 1.333,49 2,00 592,32 1,11 741,17 HP.8 Rest of economy HP.9 Rest of the world 624,00 0,93 0,93 624,00 HP.9 Rest of the world Total CHE , ,86 Total CHE The mapping of and variables seems to be clear for certain categories of health providers: HP.1 Hospitals, HP.2 Residential longterm facilities, HP.5 Retailers and other providers of medical goods, HP.7 Providers of health system administration and financing, HP.9 Rest of the world. However, the Netherlands reported that, as far as the allocation of expenditures among health providers under is concerned, the same caveats as for apply. For example, since inpatient, day, outpatient and home are provided by integrated organizations, it is not feasible to report separate figures for home health providers anymore; although the activity can be distinguished, it cannot be equated to a provider. The amount of 1, m which is reported under HP.4 Providers of ancillary services in accounts for the sum of 2 nd digit categories HP.3.5 Medical and diagnostic laboratories and HP.3.9 Other providers of ambulatory health in. 28

30 A total of 592m, which were reported under HP.7 Other industries (rest of the economy in and which were expected to be reported under HP.8 Rest of economy in according to the indicative mapping scheme, are reported under HP.6 Providers of preventive. This expenditure refers to occupational health, while the in house occupational health component is in HP.8. The Netherlands noted that, these specific providers (enterprises) are difficult to allocate to HP.3; given their purpose, they qualify better for HP.6. 29

31 Health Care Financing Schemes (HF) Difference (m) SHA2011 HF.1 General government ,20 85,60 85, ,20 HF.1.1 General government (excl. social security) HF.1.2 Social security funds 5.429,64 8,13 8, , ,55 77,47 77, ,55 HF.1 Government schemes and compulsory contributory health financing schemes HF.1.1 Government schemes HF.1.2 Compulsory contributory health insurance schemes HF.1.3 Compulsory Medical Saving Accounts (CMSA) HF.2 Voluntary health payment schemes HF.2.1 Voluntary health insurance schemes HF.2.1;HF HF HF ,38 8,44 8, ,38 HF.2.1;HF.2.2 Private insurance 3.723,02 5,58 5, ,02 HF.2.4 Nonprofit HF.2.2 NPISH financing institutions serving 803,22 1,20 1,20 803,22 schemes households HF.2.5 Corporations HF.2.3 Enterprise (other than health 1.106,14 1,66 1, ,14 financing schemes insurance) HF.2.3 Private households HF.3 Household outofpocket payment 3.980,29 5,96 5, ,29 outofpocket expenditure HF.4 Rest of the world HF.3 Rest of the world financing schemes (nonresident) Total CHE , ,86 Total CHE A clear mapping between and categories of health financing schemes was feasible, according to the indicative mapping Table. This is the result of the fact that the Netherlands already split the financing according to schemes, so there is not any difference between and. However, the same remarks regarding the financing agents in apply for data as well: private OOP expenditure does not cover deductibles of the compulsory health insurance or copayments for the exceptional medical expenses act; these are to be found in HF