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SHA Implementation. Louise Ogilvie Director Health Resources Information. CANADIAN HEALTH ACCOUNTS HISTORY. First systematic compilation by Health Canada in 1963. Expenditures on personal health care by private and public sector, from 1953 to 1961.

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sha implementation

SHA Implementation

Louise Ogilvie

Director

Health Resources Information

canadian health accounts history

CANADIAN HEALTH ACCOUNTSHISTORY

  • First systematic compilation by Health Canada in 1963.
  • Expenditures on personal health care by private and public sector, from 1953 to 1961.
  • Five categories: hospitals, prescribed drugs, physicians, dentists and other professionals.
canadian health accounts history4

CANADIAN HEALTH ACCOUNTSHISTORY

  • Health Canada maintained the National Health Accounts until 1995 when they were transferred to the new Canadian Institute for Health Information (CIHI).
  • CIHI was established in 1994 “To serve as the national mechanism to coordinate the development and maintenance of a comprehensive and integrated health information system in Canada”.
canadian health accounts

CANADIAN HEALTH ACCOUNTS

  • Reflect the structure of the Canadian Health Care System within its constitutional framework
canadian health accounts6

CANADIAN HEALTH ACCOUNTS

  • PROVINCIAL/TERRITORIAL GOVERNMENTS
  • Have primary responsibility in the health care area.

FEDERAL GOVERNMENT

  • National conditions/criteria
  • Fiscal Powers (Tax and Spending)
  • Direct responsibility for certain groups (Indians, Veterans, RCMP, Armed Forces, federal inmates).
canadian health accounts7

CANADIAN HEALTH ACCOUNTS

  • Historical series 1953–2003
  • Financial data
    • 5 sources of finance (sectors)
    • 42 uses of funds (categories)
  • Actual/estimates/forecasts
canadian health accounts total health expenditure by use of funds 1999
CANADIAN HEALTH ACCOUNTSTotal Health Expenditure by Use of Funds, 1999

Capital

3.5%

Hospitals

32.0%

Public Health

& Admin

5.7%

Drugs

15.0%

Other Health Spending

8.6%

Other

Institutions

9.5%

Physicians

13.6%

Other Professionals

12.1%

canadian health accounts mapping to icha hf

Public Sector

  • Good correspondence between the Canadian classification of sources of finance and the ICHA-HF.

Private Sector

  • Direct correspondence only for out-of-pocket expenditure.
  • No ICHA-HF category clearly corresponds to “non-consumption”.

CANADIAN HEALTH ACCOUNTS MAPPING TO ICHA-HF

total health expenditure by source of finance sha canada 1999

Central

government

3.0%

Total Health Expenditure by Source of Finance, (SHA), Canada,1999

State/provincial governments

65.2%

Non-

consumption

2.1%

Private household out-of-pocket

16.4%

Private social insurance 10.2%

Local/municipal governments 0.7%

Social security funds

1.3%

current health expenditure by major functional category sha canada 1999
Current Health Expenditure, by Major Functional Category, (SHA), Canada,1999

Undistributed

0.9%

Curative/rehabilitative care

48.9%

Health adm.

& insurance

2.0%

Prevention& public health

6.7%

Medical goods dispensed to out-patients

18.7%

Long-term nursing care

14.2%

Ancillary Services 8.6%

current health expenditure by mode of production sha canada 1999
Current Health Expenditure, by Mode of Production, (SHA), Canada,1999

Not applicable (ancillary services, medical goods, prevention & public health, health adm. & insurance) 36.0%

(

In-patient care

32.0%

Day care

2.9%

Out-patient care

26.2%

Home care

2.1%

Undistributed 0.9%

current health expenditure by major types of providers sha canada 1999
Current Health Expenditure, by Major Types of Providers, (SHA), Canada,1999

Undistributed 0.9%

(

Hospitals

35.6%

Nursing and residential care facilities

10.0%

All other industries 0.3%

Gen. Health adm.

2.0%

Provision and adm. of public health programmes

6.2%

Retail sale and other providers of medical goods 18.7%

Providers of ambulatory health care

26.4%

what went well

What went well…

Good correspondence between the Canadian classification of sources of finance for the public sector and the ICHA-HF.

Private insurance group plans meet the definition of HF.2.1 private social insurance.

Expenditures on drugs and capital could be directly mapped to the ICHA-HC.

what went well cont d

What went well (cont’d)…

About two thirds of hospital operating expenses could be directly allocated to as much as seventeen ICHA-HC categories.

Fee-for-service payments of physicians in private practice were allocated to seven ICHA-HC categories.

Good correspondence between some uses of funds and the ICHA-HP (e.g. Hospitals, Other Institutions, Other professionals).

conclusions
Conclusions
  • SHA implementation resulted in 3% reduction of THE relative to Canadian Accounts.
  • Furthermore, there are boundary differences between the Canadian Accounts and the SHA. Examples include:
    • Imports and exports are treated differently in the Canadian Accounts and the SHA
    • Auto Insurance is not included Canadian Acc’ts.
    • Non-medical care in residential facilities is included in the SHA, not in Canadian Acc’ts.
    • Alcohol-Drug Addiction facilities is included in Canadian Acc’ts, not in SHA.
    • No equivalent to Non-Consumption in the SHA.
conclusions cont d
Conclusions (cont’d)
  • Limitations to extent that most Uses of Funds in the Canadian Accounts could be mapped to ICHA-HC
  • The ICHA-HP is inconsistent with the way health care is financed in Canada.
  • The ICHA-HP is inconsistent with the way provider incomes are reported in Canada.