National Health Accounts in the Czech Republic

1. OECD meeting of experts in NHA, 27-28 October 2003, Paris National Health Accounts in the Czech Republic Present state and implementation of the System of Health Accounts methodology Institute of Health Information and Statistics of the Czech Republic

2. Present information systems covering area of health • National Health Information System (IHIS) • Government Finance Statistics (Ministry of Finance) • International databases (OECD, WHO) • National Accounts (Czech Statistical Office) Institute of Health Information and Statistics of the Czech Republic

3. Activities related to implementation of SHA • Translation of SHA manual and conversion of national classifications to ICHA • Monitoring of available data sources • Modifications of statements of health insurance companies, collection and analysis of new data • Preparation of data collecting and methods of expendituresestimation from other sources Institute of Health Information and Statistics of the Czech Republic

4. Expenditures monitored by current sources Institute of Health Information and Statistics of the Czech Republic

5. Main data sources • Government expenditure • HF.1 → functions of budget (HP.x/HC.x) • Social security funds • HF.1.2 → segments of care (HP.x/HC.x) • Household out-of-pocket expenditure (Family Accounts Statistics) • HF.2.3 → COICOP (HC.x) Institute of Health Information and Statistics of the Czech Republic

6. Supplementary data sources • Economics of health establishments - assets and debts, costs (by type of care) and returns (by source) of health establishments HF.x → HP.x → type of care • Health employment: HP.x → occup.&wages • Economic data on pharmacies (revenues) HF.x → HP.4 → HC.5 • Drug consumption by ATC: HC.5 • Health care for foreigners: HF.x → HP.1 Institute of Health Information and Statistics of the Czech Republic

7. Potential data sources • Long-term nursing care in social establishments: HP.2 → HC.3 • National accounts - sector accounts and branches production accounts (HF.2.4) • Occupational health care financed by corporations: HF.2.5 → HC.6.5 • Private health insurance (HF.2.2) Institute of Health Information and Statistics of the Czech Republic

8. Problems and challenges Functions of health care • Determination of boundaries for health care, health-related care and non-health care. • included: education and research • excluded: long-term nursing care in social care establishments • Differences in definitions of functions • modes of production: day care not defined • types of episode of care:data not available or in different structure Institute of Health Information and Statistics of the Czech Republic

9. Problems and challenges Providers of health care • Boundaries for health care industries • problem ofdifferent sources of data • Type of provider reporting data • legal subjects (used at present) x units of homogenous production Institute of Health Information and Statistics of the Czech Republic

10. Problems and challenges Financiers of health care • Not all groups of financiers are included → involving other financiers • Real allocation of all resources (a concrete purpose of use)needn’t be known when collecting data from financiers → broader use of data from providers Institute of Health Information and Statistics of the Czech Republic

11. Forthcoming plans • To publish first estimates of health expenditures by SHA structure • To continually solve appropriate evaluation of types of health care according to ICHA-HC • To join expenditure data with non-monetary health data from other sources (e.g. length of stay and number of hospitalisations by age, sex and ICD) • To review ICHA consistency when combining data from different sources Institute of Health Information and Statistics of the Czech Republic

12. Contact Institute of Health Information and Statistics (www.uzis.cz) Jakub Hrkalhrkal@uzis.cz Czech Statistical Office (www.czso.cz) Jiří Papánekpapanek@gw.czso.cz Institute of Health Information and Statistics of the Czech Republic