OECD/NBS Workshop on national
accounts
27-31 October 2008
Paris
Towards measuring the volume of
health and education services
Draft OECD Handbook
Paul Schreyer, OECD/STD
Contents
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•
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•
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Background
General concepts
Education
Health
Way forward
Background: OECD Project
• Strong and continued demand for output measures
of education and health by policy-makers
• European Regulation
• Project started in 2005, endorsement by CSTAT
• Builds on previous work: Eurostat Handbook on
Volume and Prices, Atkinson Report, country
experiences
• Workshops in London (2006) and Paris (2007)
• Objectives:
– OECD Handbook
– Data development
Background: An old question – what is new?
1. Joint work with sector specialists
• Elaborated jointly with OECD’s specialised
networks
– Network of education experts
– Network of health experts
• Both networks have strong interest in
measuring appropriate volume output
Background: An old question – what is new?
2: Joint treatment of temporal and spatial
dimensions
• Education and health PPPs are of great
importance to analysts
• PPPs and national accounts have to be
consistent
• Handbook deals with both dimensions in parallel
Concepts and terminology
• Distinction must be made between inputs, outputs,
outcomes • Best explained by way of a graph
Inputs
Outputs
Process without
explicit quality
adjustment
Labour, capital,
intermediate
inputs
Environmental
factors
Information about
outcome is a
possible tool for
quality adjustment
Process with
explicit quality
adjustment
Information about
outcome is a
possible tool for
quality adjustment
Outcomes
Direct
outcome
Example
Example
education:
education: qualitynumber of
adjusted number
pupils/pupil hours
of pupils/pupil
by level of
hours by level of
education
education
Knowledge
and skills as
measured by
scores
Example health:
Example health:
quality-adjusted
number of
number of
complete
complete
treatments by
treatments by type
type of disease
of disease
Health status
of population
Indirect
outcome
Future real
earnings,
growth rate
of GDP,
wellrounded
citizens
etc.
Inhereted skills, socio-economic
background, etc.
Hygene, lifestyle, infrastructure
etc.
Inputs
Outputs
Process without
explicit quality
adjustment
Labour, capital,
intermediate
inputs
Environmental
factors
Information about
outcome is a
possible tool for
quality adjustment
Process with
explicit quality
adjustment
Information about
outcome is a
possible tool for
quality adjustment
Outcomes
Direct
outcome
If outcome indicators are used for
quality adjustment, they:
•ShouldExample
control for any other
Example
Knowledge
education:
education: qualityfactors
that
affect
outcome
for
and
skills as
number of
adjusted number
measured by
pupils/pupil
hours
of pupils/pupil
consumers
(e.g. socio-economic
scores
by level of
hours by level of
background
of
pupils,
education
education
environmental impact on health)
Example health:
Example health:
quality-adjusted
number of
number of
complete
complete
treatments by
treatments by type
type of disease
of disease
Health status
of population
Indirect
outcome
Future real
earnings,
growth rate
of GDP,
wellrounded
citizens
etc.
Inhereted skills, socio-economic
background, etc.
Hygene, lifestyle, infrastructure
etc.
Quality adjustment
• First and important step towards capturing quality
change is the correct stratification, i.e., the comparison
of products with the same or at least similar
characteristics.
• Explicit quality adjustment may make it necessary to
invoke outcomes
• Handbook:
– Health: discussion but no proposals for explicit quality
adjustment
– Education: discussion and proposal for explicit quality
adjustment (exam scores) for secondary-level education
Values and weights
• Current price values of non-market
production = sum of costs
• Volumes:
1.Direct volume index =volume change of
items, aggregation with cost weights
2.Deflation: apply price index to values
• (Quasi) price index = unit costs: costs per
unit of output
• as opposed to costs per unit of input
Education – comparisons in time (1)
•Basic approach:
•Unit of output = (quality-adjusted) volume of
teaching services delivered
•Broadly, measured as pupil (hours), the number
of hours during which pupils receive teaching
services
•But differentiation according to level of education
important
Education – comparisons in time (2)
Output-based methods
Pre-primary education
Number of pupil-hours
Primary education
Primary education: general
Primary education: special education, e.g., for
disabled pupils
Note: The sub-stratification normal / special could be
replaced by coefficients reflecting the extra costs for
social services provided to disabled pupils
Number of pupils, adjusted for change in
pupil attainment
Number of pupil hours*
Secondary education
Number of pupils*
Lower secondary: general
Lower secondary: special classes, e.g. for
disabled pupils
Upper secondary education: general + pretechnical or pre-vocational
Upper secondary education: vocational
Post-secondary non-tertiary education
Education – comparisons in time (3)
Tertiary education
Tertiary education with
occupation-specific programmes
practical
and
Credits (ECTS)
Full-time equivalent students*
Tertiary education with more theoreticallyEnrolled students*
based programmes
Note: differentiation by field of education useful
•To be developed: measuring research output of tertiary
education establishments
Education – comparisons in time (3)
Volume output measures of non-market education services, France
7%
6%
5%
4%
3%
2%
1%
0%
-1%
-2%
-3%
2000
2001
2002
Output method
2003
2004
Number of pupils / students
2005
Input method
2006
Health – comparisons in time (1)
•Disease-based approach
•Increasing number of countries use diseasebased approach
•Reflects changes in administrative practice (e.g.
shift to DRG system in Germany’s hospital
administration)
•Unit of output = (complete) treatment
•But differentiation by type of activity important
•Unit of output may vary between activities
Health – comparisons in time (2)
ISIC rev 3.1 & 4
Hospital activities
Acute Hospitals
8511 & 8610
Mental health and substance 8511 & 810
abuse hospitals
Speciality (other than HP.1.2) 8511 & 8610
hospital
Output-based methods
(Quasi) Price index based on DRGs (cost or
revenue-weighted)
Direct volume index based on DRGs (cost or
revenue-weighted)
Direct volume index based on ICD categories
(e.g., number of discharges by category with
quantity-weights such as shares in hospital
days)
(Quasi) Price index based on DRG-like
categories (cost or revenue-weighted)
Direct volume index based on DRG-like
categories (cost or revenue-weighted)
Direct volume index based on ICD categories
(e.g., discharge numbers with quantityweights such as shares in day care days)
Number of discharges*
Number of days of care*
Health – comparisons in time (3)
Residential care activities
Nursing care facilities
8519/8531
Note: RUGS are only used for 8710
nursing care
Residential mental retardation, 8519/8531
mental health and substance 8720
abuse facilities
Community care facilities for 8519/8531
the elderly
8730
All other
facilities
residential
care 8519/8531
8790
& (Quasi) Price or unit cost index based on
Resource Utilisation Groups (RUGs) or
equivalent (cost-weighted)
Direct volume index based on RUGs or
equivalents (cost-weighted)
&
Direct volume index based on number of
days of care by level of care (cost weighted)
Direct volume index based on number of
cases by level of care (cost weighted)
& Number of days of care*
Number of cases/discharges*
&
Health – comparisons in time (4)
Medical and dental practice
activities
Doctor services
8512 & 8620
Note: services are defined as
consultation/visit/treatment
depending on the typology of the
country
Dental services
8512 &8620
Note: ‘number of services’ refers
to units such as consultations,
visits or treatments, depending
on the typology of the country
(Quasi) Price index based on number and
type of service (cost or revenue-weighted)
Direct volume index based on number and
type of service (cost or revenue-weighted)
Relevant component of Consumer Price
Index if applicable**
(Quasi) Price index based on average
costs/revenues per service (cost or revenueweighted)
Direct volume index based on number of
services
(cost
or
revenue-weighted)
Number of services*
Relevant component of Consumer Price
Index if applicable**
Direct volume index based on number of
services (cost or revenue-weighted)
Number of services*
Health – comparisons in time (5)
ISIC rev 3.1 & 4
Other human health activities
Note: the list of services below
heterogeneous activities
Other
health
practitioner
consultations
Other outpatient visits
Family Planning centres
Outpatient mental health and
substance abuse centres
Free-standing
ambulatory
surgery centres
Dialysis care centres
Other outpatient multispecialty
and cooperative service centres
All other outpatient care centres
is not exhaustive as other human health activities covers very
8519 & 8690
8519 & 8690
8519 & 8690
8519 & 8690
Direct volume index based on number of
consultation by type of consultation (cost or
revenue-weighted)
8519 & 8690
(Quasi) Price index based on average cost or
revenue per consultation (cost or revenueweighted)
8519 & 8690
8519/8531
8690
8519/8531
8690
diagnostic 8519 & 8690
Medical
and
laboratories
Home health care services
Output-based methods
8519/8531
8690
All other ambulatory health care 8519 & 8690
services
&
Relevant component of Consumer Price
& Index if applicable**
Number of consultations*
& Number of tests performed*
Number of cases treated*
Health – comparisons in time (6)
Input price index and output-based price index
for acute hospital services in Denmark
120.0
115.0
110.0
105.0
Input based
Output based
100.0
95.0
90.0
2000
2001
2002
2003
2004
2005
Overall effects - France
Impact of output and input-based methods on total value-added, France
4,5%
4,0%
3,5%
3,0%
2,5%
2,0%
1,5%
1,0%
0,5%
+0.1 %
-0.2 %
2005
Impact of the output method for NM education and health on the evolution of value-added for all industries
in volume
Output method for NM education and health
Input method for NM education and health
-0.0 %
2006
-0.1 %
2004
-0.3 %
2002
-0.2 %
2001
-1,0%
-0.3 %
2000
-0,5%
2003
0,0%
Way forward
•Health PPPs further developed in 2009
•Completion of the chapter on health PPPs
•Presentation of draft to health and education
experts
•Revision and final draft in 2009
Thank you!