OECD Health Data: future directions of work

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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
1
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
2
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
3
Background (2): rising
demand for health data




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.
4
The structure of OECD
Health Data

1. Health status

6. Social Protection

2. Health care resources

7. Pharmaceutical market

3. Health care utilisation


4 Health expenditure
8. Non-medical
determinants of ehalth

9. Demographic References

10. Economic References

5. Health care financing
5
A model for understanding OECD
Health Data
Non-medical
Determinants (Part 8)
The
Production
of Health Related
Welfare
Social Welfare
and Individual
Utility
Budgeting
Decisions
The Flow
of Health
Expenditure
Health
Expenditure and
Financing (Taxes,
Insurance, Out-ofPocket) (Part 4, 5)
Health
Status
(Part 1)
Demographic (Part 9)
& Economic (Part 10)
References
Overall social
protection (Part 6)
Utilization of
Services
(Part 3)
Inputs to
Health
Services
(Part 2)
Purchasing
Decisions
Purchasing
Decisions
Health
Expenditure
(Utilization
volumes X
prices)
Health
Expenditure
(Input
volumes X
prices)
6
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
7
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)
8
Tobacco Consumption, 1985 and
Incidence of Lung Cancer, 2000
Aged standardised incidence rate of lung cancer
70
HUN
60
NLD
50
CAN
40
USA
DNK
GBR
FRA
IRL
30
NOR
FIN
AUS
AUT
NZL
JPN
20
SUE
10
0
1000
1500
2000
2500
3000
3500
Tobacco consum ption in gram s per capita
Source: OECD Health Data 2004, 3rd edition
9
Focus for future work on
SHA and health care
statistics
(1) Health Accounts and Health Care Activity Data

Expenditure classifications: refinements and addendums
to current classifications

Indicators connecting health expenditure and nonmonetary data

Output and price measurement

Long-term care expenditure and beneficiaries
(2) Indicators of quality of health care
10
What is the OECD 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
11
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
12
Source: OECD Health Data 2004, 3rd edition
1990
a
re
Ko
o
1)
00
(2
n
ry
ga
un
ly
ai
Ita
M
ex
ic
H
)
nd
la
Sp
Fi
n
01
(2
0
d
nd
la
Ze
a
an
k
a
m
ar
ad
an
Ic
el
lia
st
ra
Au
es
nd
y
w
ay
or
en
C
D
la
St
at
N
te
d
ew
ni
N
U
Ire
an
nc
e
m
er
G
Fr
a
OoP payments as Percent of Total Health Expenditure
Trend in Out-of-pocket
Spending, 1990-2002
70
60
50
40
30
20
10
0
2002
13
SHA and health accounting
practice

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”
14
Status of SHA implementation
SHA-based health accounts
regularly produced/ or pilot
study undertaken (16)
Australia
Canada
Denmark
Finland
Germany
Hungary
Japan
Korea
Mexico
Netherlands
Poland
Spain
Switzerland
Turkey
United Kingdom
United States
SHA study or
preparatory
work under
way (10)
Austria
Czech Republic
France
Ireland
Luxembourg
Norway
Portugal
Slovak Republic
Sweden
Considering
implementation;
resources not
yet allocated (2)
Greece
Iceland
No immediate
plans for SHA
implementation
(2)
Italy
New Zealand
15
Overall Assessment of Pilot
Implementations

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
16
Hospital and In-patient
Curative-rehabilitative
Expenditure
% current exp. on health
60
Hospital Expenditure
Curative-rehabilitative (in-patient)
50
40
30
20
10
Australia
Canada
Denmark
Germany
Hungary
Japan
Poland
Spain
Switzerland
Turkey
Source: “SHA-Based National Health Accounts in Thirteen OECD Countries: A Comparative Analysis” (OECD Health Working Papers No. 16)
17
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-ofpocket)

To include all primary and secondary providers of health
care (e.g. army, companies, schools)

Application of standard methods for valuation of health
services
18
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 multifunctional health care organisations (e.g., in patient care, day
care, out patient care within hospitals)
19
Other Priority Areas for
Future Work (I)
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 parttime employment
20
Other Priority Areas for
Future Work (II)
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
21
Other Priority Areas for
Future Work (III)
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)
22
Other Priority Areas for
Future Work (IV)
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
23
3.50
3.00
2.50
2.00
Private
Public
1.50
1.00
0.50
ed
Sw
w
or
N
en
ay
s
rla
nd
m
he
et
N
U
ni
te
d
G
Ki
er
m
at
St
ni
te
d
ng
do
an
y
es
a
ad
an
U
C
st
ra
lia
n
Au
Ja
pa
d
Ze
al
an
la
nd
N
ew
Sp
Ire
n
0.00
ai
Expenditure on long-term care as percentage of GDP
Expenditure on long-term
care, 2000
Source: OECD Long term Care Policies for Older People (forthcoming)
24
Initiatives to strengthen
international co-operation

Exchange of letters with Eurostat to intensify cooperation 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
25
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
26
Conclusions




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
27
Data dissemination

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)
28
An invitation to explore OECD
Health Data 2004
29
For more information..

www.oecd.org/health

www.oecd.org/health/healthdata

www.oecd.org/health/sha

www.oecd.org/healthmin2004
30
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