Hun gar ian National Health Accounts, 1998 - 2000

1. HungarianNational Health Accounts, 1998 - 2000 Separation of expenditure by function within hospitals Maria GoschiMANNO Maria MihalyneHAJDU OECD Paris

2. Hungarian National Health Accounts, 1998 - 2000 • Topics • Completed SHA and other tables • Raw databases • SHA: Table 2. calculations • Estimations • Importance of Sector of Hospital • Problems to be solved in the future OECD Paris

3. Hungarian National Health Accounts, 1998 - 2000 • Completed SHA tables • SHA Table 2. (= HNHA table 5) Total current health expenditures by functions ofhealth care and types of service providers • SHA Table 3. (= HNHA table 9) Total current health expenditures by types of service providers and financing agents • SHA Table 4. (= HNHA table 7) Total current health expenditures by functions of health care and financing agents OECD Paris

4. Hungarian National Health Accounts, 1998 - 2000 • Completed other tables • HNHA Table 1: Health expenditures by financing agents • HNHA Table 2: Development of health expenditures as percentage of GDP • HNHA Table 3: Real value of health expenditures • HNHA Table 4: Current health expenditures by functions of health care andtypes of service providers • HNHA Table 6: Current health public expenditures by functions of health care and types of service providers • HNHA Table 8: National Health Insurance expenditures by functions of health care • HNHA Table 10: Total current health expenditures by type and form of service providers and by financing agents OECD Paris

5. Hungarian National Health Accounts, 1998 - 2000 • Raw databases • Annual reports of the budgetary institutions • Financing data of the National Health Insurance Fund • Hungarian Central Statistical Office (HCSO): Household statistics • HCSO: Non-profit organisations • HCSO: National Accounts • HCSO: Investment statistics • Tax Finance and Control Office (TFCO): Self-employed • TFCO: Enterprises • Private Health Insurance Fund - surveying • Enterprises: - at an estimations OECD Paris

6. Sort of the budgetary institutions Sort of functions of budgetary institutions Individual classification to four groups by three Hungarian legal rules. Breakdown to eight main categories on the basis of codes of so-called „special tasks”. The first main group is the group of healthcare functions. Within the healthcare group the functions were primarily collated with the SHA functions. Hungarian National Health Accounts, 1998 - 2000 SHA: Table 2. calculations – Step 1 • Results: • Separation of non-health care functions of healthcare institutions. • Elaboration of SHA table of the budgetary institutions (Version 1). OECD Paris

7. Hungarian National Health Accounts, 1998 - 2000 SHA: Table 2. calculations – Step 1 Breakdown of current health expenditures by functions Summary of breakdown of current expenditures OECD Paris

8. Functional separation Separation of one-day care from inpatient care Separation from inpatient service Clinical laboratory services Diagnostic imaging services Kidney dialysis Home special care Result: a functional classifications is identical with of OECD SHA (Version 2) NHIF payments to private institutions All cells in the SHA 2. (Version 2) table were increased by NHIF payments to private sector Result:SHA 2. (Version 3) SHA 2. (Version 3) = SHA 2. (Version 2) + NHIF to private Hungarian National Health Accounts, 1998 - 2000 SHA: Table 2. calculations – Step 2 - 3 Correction with financing data of the National Health Insurance Fund OECD Paris

9. Hungarian National Health Accounts, 1998 - 2000 SHA: Table 2. calculations – Step 4 Correction with data of private sector • Incomes of private hospitals from private sector • The value of paying from private sector is decreased by item to budgetary institutions. • These results were added to the data of the SHA 2. (Version 3) Supposition: the total expenditure of private hospitals are allocated to inpatient services. • Result:Final SHA 2. • SHA 2 = SHA 2 (Version 3) + privatesector OECD Paris

10. Hungarian National Health Accounts, 1998 - 2000 SHA: Table 2. calculations - outcome OECD Paris

11. Representative collection of „unspecified” income data of the budgetary hospitals „Unspecified” income amounted to 10% of the total revenues of the hospitals Result: Elimination of cumulated data About 30% of the „unspecified” income was eliminated Hungarian National Health Accounts, 1998 - 2000 Estimations – 1 (Screening overlaps) OECD Paris

12. The three main tasks of Universities of medical sciences Education Research Health care services Integration of Universities In 1998 and 1999 years: independent institutions From 2000 year: integrated institutions Separation of Universities of medical sciences „Clinical” institution This data appears in SHA tables „Education and research” institution SHA tables were not included. Hungarian National Health Accounts, 1998 - 2000 Estimations -2 (Universities of medical sciences) OECD Paris

13. Hungarian National Health Accounts, 1998 - 2000 Estimations -2 (Universities of medical sciences) Distribution of expenditures of universities of medical sciences OECD Paris

14. Hungarian National Health Accounts, 1998 - 2000 Role and weight of the hospital sector - 1 Breakdown of total current health expenditure by types of service providers • Almost 40% of health care expenditures is dedicated to hospitals activities. • The objective of healthcare policy: decrease the rate. OECD Paris

15. Hungarian National Health Accounts, 1998 - 2000 Role and weight of the hospital sector - 2 • The total health expenditures realised • 31 % to inpatient care • 39 % to medical goods • 16 % to outpatient care Breakdown the total health expenditures by functions health care OECD Paris

16. Hungarian National Health Accounts, 1998 - 2000 Role and weight of the hospital sector– 3 (general hospitals) Breakdown of health expenditures of general hospitals by functions of health care • General hospitals • General hospitals • „Clinical” institutions • Out of hospitals’ health expenditures almost 80 % is dedicatedto inpatient services. • The diagnostic services rendered to inpatients are recorded under inpatient function. (These expenses are included in DRG.) OECD Paris

17. Hungarian National Health Accounts, 1998 - 2000 Role and weight of the hospital sector– 4 (The hospitals in outpatient services) Breakdown ofexpenditures of outpatient services by types of service providers Within outpatient services hospitals represent a significant proportion. • The expenditures realised at the hospitals: • 73% of the total outpatient rehabilitative care • 59 % of the total specialised outpatient care (HC.1.3.3) • 28 % of the total outpatient care OECD Paris

18. Hungarian National Health Accounts, 1998 - 2000 Problems to be solved in the future • Studying of functional structure of healthcare expenditure in private sector. • Completion of the Non-profit statistics. • Indirect calculation from data of the Household statistics. • Elaboration the rest SHA tables. • Development of IT system. • Elaboration of regional accounts. OECD Paris

19. Hungarian National Health Accounts, 1998 - 2000 Thank you for all your attention. Lunch break OECD Paris