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OECD Health Data: future directions of work. OECD World Forum on Key Indicators 10 th November 2004 Manfred Huber, OECD Social Policy Division, Directorate for Employment, Labour and Social Affairs. Outline of presentation. Background to OECD data collection on health

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Oecd health data future directions of work

OECD Health Data: future directions of work

OECD World Forum on Key Indicators

10th November 2004

Manfred Huber, OECD

Social Policy Division, Directorate for Employment, Labour and Social Affairs


Outline of presentation
Outline of presentation

  • Background to OECD data collection on health

  • Structure and guiding principles of OECD Health Data

  • Challenges of future data development work at the OECD Secretariat

  • Role of the OECD manual A System of Health Accounts

  • Other priority areas for future work

  • International co-operation

  • Conclusions


Background 1 challenges to health care systems common in oecd countries
Background (1) : Challenges to health care systems, common in OECD countries

  • Affordable cost today and sustainable financing tomorrow

  • Population access to health care services and adequate coverage of services

  • Increasing value for money in health care systems

  • Improving quality and safety

  • Strengthening of prevention and health promotion


Background 2 rising demand for health data
Background (2): rising demand for health data in OECD countries

  • Health care high on the agenda of public spending policy (and a key concern for citizens, - as are health issues in general)

  • More than 25 years of data collection and analysis at OECD on health and other social spending (e.g. “The Welfare State in Crisis” 1980)

  • International statistical guidance has long been lacking behind other social and economic fields.

  • Regular annual collection of OECD Health Data since 1991.


The structure of oecd health data
The structure of in OECD countriesOECD Health Data

  • 1. Health status

  • 2. Health care resources

  • 3. Health care utilisation

  • 4 Health expenditure

  • 5. Health care financing

  • 6. Social Protection

  • 7. Pharmaceutical market

  • 8. Non-medical determinants of ehalth

  • 9. Demographic References

  • 10. Economic References


A model for understanding in OECD countriesOECD Health Data

Non-medical Determinants (Part 8)

The Production of Health -Related Welfare

Health Status (Part 1)

Inputs to Health Services (Part 2)

Utilization of Services (Part 3)

Social Welfare and Individual Utility

Budgeting Decisions

Purchasing Decisions

Purchasing Decisions

Demographic (Part 9)

& Economic (Part 10)

References

The Flow of Health Expenditure

Overall social protection (Part 6)

Health Expenditure(Input volumes X prices)

Health Expenditure and Financing (Taxes, Insurance, Out-of-Pocket) (Part 4, 5)

Health Expenditure (Utilization volumes X prices)


Main challenges for a system of international health care statistics 1
Main challenges for a system of international health care statistics (1)

  • Degree of international harmonisation of health care statistics (resources, activities, outcome measures) still low..

  • ..and there are important gaps on national level

  • E.g. health care data can be difficult for: private sector activity; devolved health care systems (different information systems across regions)

  • Uneven coverage between hospital activity and ambulatory activity


Main challenges for a system of international health care statistics 2
Main challenges for a system of international health care statistics (2)

  • Better integrated system on national and international level need to be developed in parallel

  • Examples of national “stock-taking” exercises: Australia, Canada, Germany

  • Major challenge: where are the limits of aggregate data versus comparable sets of micro data?

  • Which role should harmonised population surveys play in the future? (not currently on OECD agenda)


Tobacco consumption 1985 and incidence of lung cancer 2000
Tobacco Consumption, 1985 and Incidence of Lung Cancer, 2000 statistics (2)

Source: OECD Health Data 2004, 3rd edition


Focus for future work on sha and health care statistics
Focus for future work on SHA and health care statistics statistics (2)

(1) Health Accounts and Health Care Activity Data

  • Expenditure classifications: refinements and addendums to current classifications

  • Indicators connecting health expenditure and non-monetary data

  • Output and price measurement

  • Long-term care expenditure and beneficiaries

    (2) Indicators of quality of health care


What is the oecd system of health accounts sha
What is the OECD statistics (2)System of Health Accounts (SHA)?

  • Framework for accounting rules and classifications

  • ICHA: International Classification for Health Accounting:

    • Functions (ICHA-HC)

    • Providers (ICHA-HP)

    • Financing agents (ICHA-HF)

  • Proposed set of two-dimensional standard tables

  • ICHA-HC and ICHA-HP provide interface for linking with (non-monetary) resource and activity data


Main objectives of the sha from a health policy perspective
Main objectives of the SHA - from a health policy perspective

  • To provide a framework for analysing health systems

    • overall level of spending on health care

    • changes in the composition of spending

    • monitoring factors of growth in health spending

    • differences across countries in expenditure growth and composition of expenditure

  • To provide a tool to monitor effects of health care reforms


Trend in out of pocket spending 1990 2002
Trend in Out-of-pocket Spending, 1990-2002 perspective

Source: OECD Health Data 2004, 3rd edition


Sha and health accounting practice
SHA and health accounting practice perspective

  • Pilot implementations of the SHA started in 1998-2000; ongoing iterative process to harmonise data reporting to OECD Health Data

  • SHA working and technical papers documenting results

  • Several European Union projects related to SHA have been launched or are planned

  • WHO/World Bank/USAID Guide to producing health accounts

  • SHA now serves as an international “quasi-standard”



Overall assessment of pilot implementations
Overall Assessment of Pilot Implementations perspective

  • The implementation of the SHA is feasible: major challenge is resource constraints in countries

  • The SHA framework contributed to substantial improvement in the comprehensiveness and consistency of health expenditure estimates

  • Current pilot implementations still have smaller or greater departures from the recommendations of the OECD SHA Manual, which themselves need be backed by further guidance and more detail in several cases


Hospital and in patient curative rehabilitative expenditure
Hospital and In-patient perspectiveCurative-rehabilitative Expenditure


Major challenges of implementing sha i estimating total expenditure
Major challenges of implementing SHA (I) - Estimating total expenditure

  • Boundary of health care (ICHA-HC) in an internationally harmonised way (e.g. long-term-care)

  • Accounting for expenditure by all the financing agents defined by the SHA (e.g. non-profit organisations, out-of-pocket)

  • To include all primary and secondary providers of health care (e.g. army, companies, schools)

  • Application of standard methods for valuation of health services


Major challenges of implementing sha ii applying the functional classification
Major challenges of implementing SHA (II) - Applying the functional classification

  • Defining more precisely the boundary between health and health related functions (e.g. public health)

  • Separating health - health related and non-health activities in the case of complex institutions (e.g. university clinics, public health centres)

  • Applying functional classification in the case of multi-functional health care organisations (e.g., in patient care, day care, out patient care within hospitals)


Other priority areas for future work i
Other Priority Areas for Future Work (I) functional classification

Statistics on health employment: next steps

  • Improve data collection on key professions: physicians and nurses

  • Analyse feasibility of comprehensive estimates of employment in health care (from national examples)

  • Co-operation with Eurostat project “Health labour accounts”, linking employment data to SHA provider classification (ICHA)

  • Conceptual work on utilising ISCO; estimation of part-time employment


Other priority areas for future work ii
Other Priority Areas for Future Work (II) functional classification

Remuneration of health professions

  • Previously collected; was among the most frequently demanded indicators

  • Data collection will resume in 2005

  • Physicians: both salaried and self-employed; general practice and specialists

  • Nurses: start with data from hospital setting


Other priority areas for future work iii
Other Priority Areas for Future Work (III) functional classification

Statistics on health resources and utilisation

  • Further develop set of medical technology indicators (move towards joint list with Eurostat and WHO?)

  • Focus on statistics on surgical procedures (in patient and day cases) for shortlist of procedures

  • Co-operation with Eurostat and WHO project on “Hospital data” (activity data, resources, and hospital financing)

  • Major challenge: international harmonisation of procedure statistics and their common use in countries (not in OECD portfolio)


Other priority areas for future work iv
Other Priority Areas for Future Work (IV) functional classification

Data on long-term care services and expenditure

  • Basis data set on expenditure and recipients from the OECD Study on Long-term Care (under OECD Health Project)

  • Work will continue in 2005 on methodological framework and basic data set

  • Expected outcome:

    Improved guidelines for health accounting

    Better comparable health expenditure estimates

    Routine data collection on services and expenditure to monitor health and social policies for ageing societies


Expenditure on long term care 2000
Expenditure on long-term care, 2000 functional classification

Source:OECD Long term Care Policies for Older People (forthcoming)


Initiatives to strengthen international co operation
Initiatives to strengthen international co-operation functional classification

  • Exchange of letters with Eurostat to intensify co-operation on health statistics

  • Ultimate goal of joint data collection instruments with Eurostat and WHO in the future based on successful models in other areas (e.g. education, energy)

  • This will contribute to better harmonised data reporting with non-OECD countries as well (e.g. health accounts in World Health Report and World Bank databases)

    Dissemination strategies -- and needs for additional data modules -- may differ across organisations


Sha influence on revision of international statistical systems
SHA influence on revision of international statistical systems

  • 2007 revision of ISIC: move health industry from Group level to Division level (for which international comparability is required)

  • Current revision of Central Product Classification (CPC): improve definition and breakdown of services with the help of the ICHA-HC and ICHA-HP classifications

  • Health professions in ISCO: advocate use of ISCO for estimating human resources for health care

  • Missing link: up-to-date internationally agreed system of procedure classifications for health interventions


Conclusions
Conclusions systems

  • Improvements in international health care statistics involve substantial investments at national level

  • Harmonised reporting to international data collections driver to identify and fill information gaps in countries

  • There are clear limits to “ex-post harmonisation” of data in the health care arena due to large differences in the structure of health care systems and reporting mechanism

  • Development of new data initially restricted to subset of countries; broad coverage of countries can take many years


Data dissemination
Data dissemination systems

  • Annual electronic publication on CD-ROM (in collaboration with IRDES, a French research institute in health economics)

  • Available for download via SourceOECD

  • “Health at a Glance” (2003; third edition next Oct. 2005)

  • OECD Health Data on the Internet: www.oecd.org/health/healthdata

    • Access to frequently asked data, all Sources and Methods, etc.

    • Interim updates (two per edition)


An invitation to explore oecd health data 2004
An invitation to explore systemsOECD Health Data 2004


For more information
For more information.. systems

  • www.oecd.org/health

  • www.oecd.org/health/healthdata

  • www.oecd.org/health/sha

  • www.oecd.org/healthmin2004


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