September 21 COSA: Health Accounts in Belgium 1

State of play at the international level and ambitions of EUROSTAT

C. van Mosseveld, PhDEUROSTAT

Unit F5: Health and Food Safety statistics

September 21 2

Content

EUROSTAT Health statistics OECD-WHO-EUROSTAT Joint Questionnaire on Health

Expenditure SHA Revision Process Problems and Comparability

September 21 3

Health statistics in Eurostat

Unit F5 Food safety Health and safety at work

Public healthNon-expenditure Physical data of

economic units

Manpower dataExpenditure

Joint Questionnaire

SHA Revision

COD HIS

Morb

September 21 COSA: Health Accounts in Belgium 4

Joint OECD-WHO-EUROSTAT Questionnaire

September 21 5

Background & Goals

Need for data on SHA: WGPH decided to have SHA implemented

SHA data are important for OECD, EUROSTAT and WHO-HQ

Co-operation and co-ordination required Result: Joint Questionnaire SHA created in 2005

Reducing the burden for suppliers Increase the possibilities of national and international

analysis of data Facilitate the use of the data by stakeholders

September 21 6

Process

Starting point: tables based on the classifications of the manual (OECD, WHO PG)

Each organisation informs its national counterparts Nomination of one focal point per country Only one data set to be returned Installation of IHAT responsible for communication with data

suppliers

Validation by either of the 3 organisations within 2 months Information exchange on all steps of the validation process Dissemination free to chose by each of the 3 organisations

September 21 7

Validation process

For all 5 tables: internal consistency checked at all digit levels

For all 5 tables the consistency is checked between identical variables at all levels of detail

For every table the relative shares are presented Growth rates between 2 years can be checked Finally all data can be checked against the methodological

information

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Date of extraction: Thu, 20 Sep 07 04:13:27Last update: Tue Aug 14 11:51:54 MEST 2007

Copyright © Eurostat. All Rights Reserved.

table hlth_sha2Expenditure of selected health care functions (HC; types of goods and services produced) by financing agents in health care (HF; entities paying for the purchase)

hf_sha hf1hf3All financing agents

time 2003a00

unit mio-eurMillions of euro (from 1.1.1999)/ECU (up to 31.12.1998)

geo be es fr nlBelgium Spain France Netherlands

hc_shahc1hc9hcr1 Health care expenditure 26730.6 61396.9 173676.8 43580.9hc1hc9 Current health care expenditure 26730.6 59437.4 169051.6 41360.9hc1 Services of curative care 13447.6 : 0 20877.7hc5 Medical goods dispensed to out-patients 5076.4 15517.6 36071.1 7568.8

hf_sha hf12Social security funds

time 2003a00

unit mio-eurMillions of euro (from 1.1.1999)/ECU (up to 31.12.1998)

geo be es fr nlBelgium Spain France Netherlands

hc_shahc1hc9hcr1 Health care expenditure 16224.6 3311.4 129335.7 :hc1hc9 Current health care expenditure 16224.6 3200.4 124710.5 26226.1hc1 Services of curative care 9246.1 : 0 13940.3hc5 Medical goods dispensed to out-patients 2594 465.7 22199.9 3914.1

hf_sha hf23Private household out-of-pocket expenditure

time 2003a00

unit mio-eurMillions of euro (from 1.1.1999)/ECU (up to 31.12.1998)

geo be es fr nlBelgium Spain France Netherlands

hc_shahc1hc9hcr1 Health care expenditure 6541.1 14112.3 12747.1 :hc1hc9 Current health care expenditure 6541.1 14112.3 12747.1 3415.2hc1 Services of curative care 2447.5 : 0 1218.6hc5 Medical goods dispensed to out-patients 2343.5 5280.4 6096.1 1974.8

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September 21 COSA: Health Accounts in Belgium 9

SHA Revision

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Background

2006 OECD, WHO and EUROSTAT: work together in SHA revision

Goal is global SHA standard, manual For this:

– IHAT (created for JQ) mandate revised– Consultation process to be created– Programme of work to be set up

Membership: OECD, WHO and EUROSTAT Secretariat: OECD

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Reasons behind revision process

SHA Manual is “pilot”, first draft– Implementation started around 1999– Now around 100 country experiences available

Problems identified (consistency, boundary, etc.) Need for more flexibility and policy relevance

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First step: Problem Inventory

WGPH 2006 requested EUROSTAT to take stock of the problems MS face in the implementation of SHA and the use of the manual

OECD and WHO conducted similar processes

All answers are used in the revision process

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Summary of Results of Problem Inventory

Definitions and descriptions in manual are not clear leading to misinterpretations– Also requests for more examples

Boundary problems e.g.:– Production, financing, final use (functions)

Additional classifications may be necessary e.g. for policy needs

More flexibility to respond to changes in data requests Links between SHA and SNA appreciated

September 21 14

IHAT: responsibilities

Set up programme of work for SHA revision Distribute the subjects into units Provide the rationale behind each unit Propose the key issues to be addressed in each unit Facilitate and co-ordinate the consultation process

IHAT decides based on consensus IHAT has to warrant overall consistency

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IHAT: steps in the Revision Process

Invitation to produce “Input papers” and comments on these

Co-ordinating organisation produces “proposal for 1st IHAT draft”

IHAT discusses and produces “1st IHAT draft” Invite comments from the international community IHAT discusses and produces “2nd IHAT draft” in case of

consensus Lacking consensus: selected experts opinion and back to

IHAT: accepting or rejecting of proposal IHAT (at senior level) submits “Draft Manual” to decision

making bodies in three organisations

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Possible involvement, information provided

Heads of statistical authorities of all OECD and EU member and candidate and acceding countries.

Ministries of Health. Experts serving as focal points for the Joint OECD-WHO-

EUROSTAT Health Accounts data collection. Health accounts networks. European Commission. UNSD, OECD Statistics Directorate. World Bank, Regional Development Banks, IMF.

Private experts, ………., etc.

September 21 17

Facilitation of Participation

A tri-party website is introduced A tri-party EDG is installed

Each of the 3 organisations adds its own formal and informal processes:– OECD: e.g. Health expert meeting– WHO: e.g. regional networks in the world– EUROSTAT: e.g. SHA Revision Development Group

September 21 18

Expected results

Solutions for identified statistical problems A sound statistical system Backward comparability Better links to SNA/ESA and its classifications Possibilities to link to national classification systems

Improved cross-country comparability Improved usability in framework of policy relevance

September 21 19

Proposed work programme

Introduction

Part I:

Principles & Concepts

Reasons for revision, new elements, overview

Unit 1: Purposes & principles Unit 2: Global boundaries Unit 3: Key concepts &

definitions Unit 4: Expenditure dimensions Unit 5: Types of HA Unit 6: Relationships to other

statistical systems

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Proposed work programme (2)

Part II:

ICHA

Unit 7: ICHA-HC health care functional classification

Unit 8: ICHA-HP health care provider classification

Unit 9: ICHA-FS financing sources classification

Unit 10: ICHA-HF financing schemes classification

Unit 11: ICHA-HB beneficiaries classification

Unit 12: ICHA-RC resources mobilised in the production of health goods and services

Unit 13: ICHA-P health care products classification

Unit 14: Human resources

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Proposed work programme (3)

Part III:

Indicators, tables &

compilation

Unit 15: Presentation of results Unit 16: Basic accounting rules and guidelines Unit 17: Possible compilation processes Unit 18: Policy use

Glossary

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Time frame & remarks

Proposes finalisation date: End of 2009 The new Manual should provide clear guidance for

migration from SHA 1.0 to SHA 2.0

SHA revision should not discourage countries from developing NHA based on current methodologies

September 21 COSA: Health Accounts in Belgium 23

Comparability

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Problems & solutions

Problems in cross-country comparability:– 10-20 years ago already known that providers, products and

financing agents NOT comparable (even having the same name).

– New approaches were needed For comparability goals the Functional Classification

was invented, evolved as a natural solution All problems solved? No, but much more comparability is reached by using the

ICHA; and much more expected by SHA II.