A System of Health Accounts
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«A System of Health Accounts HEALTH OECD, 2000. Software: 1987-1996, Acrobat is a trademark of ADOBE. All rights reserved. OECD grants you the right to use one copy of this Program for your personal use only. Unauthorised reproduction, lending, hiring, transmission or distribution of any data or software is prohibited. You must treat the Program and associated materials and any elements thereof like any other copyrighted material. All requests should be made to: Head of Publications Service, OECD Publications Service, 2, rue Andr´e-Pascal, 75775 Paris Cedex 16, France. A System of Health Accounts Version 1.0 ORGANISATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT ORGANISATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT Pursuant to Article 1 of the Convention signed in Paris on 14th December 1960, and which came into force on 30th September 1961, the Organisation for Economic Co-operation and Development (OECD) shall promote policies designed: – to achieve the highest sustainable economic growth and employment and a rising standard of living in Member countries, while maintaining financial stability, and thus to contribute to the development of the world economy; – to contribute to sound economic expansion in Member as well as non-member countries in the process of economic development; and – to contribute to the expansion of world trade on a multilateral, non-discriminatory basis in accordance with international obligations. The original Member countries of the OECD are Austria, Belgium, Canada, Denmark, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland, Turkey, the United Kingdom and the United States. The following countries became Members subsequently through accession at the dates indicated hereafter: Japan (28th April 1964), Finland (28th January 1969), Australia (7th June 1971), New Zealand (29th May 1973), Mexico (18th May 1994), the Czech Republic (21st December 1995), Hungary (7th May 1996), Poland (22nd November 1996) and Korea (12th December 1996). The Commission of the European Communities takes part in the work of the OECD (Article 13 of the OECD Convention). Publié en français sous le titre : Systèmes de comptes de la santé © OECD 2000 Permission to reproduce a portion of this work for non-commercial purposes or classroom use should be obtained through the Centre français d’exploitation du droit de copie (CFC), 20, rue des Grands-Augustins, 75006 Paris, France, Tel. (33-1) 44 07 47 70, Fax (33-1) 46 34 67 19, for every country except the United States. In the United States permission should be obtained through the Copyright Clearance Center, Customer Service, (508)750-8400, 222 Rosewood Drive, Danvers, MA 01923 USA, or CCC Online: http://www.copyright.com/. All other applications for permission to reproduce or translate all or part of this book should be made to OECD Publications, 2, rue André-Pascal, 75775 Paris Cedex 16, France. FOREWORD Health care has become one of the largest industries in OECD countries and one of the most dynamic in terms of job creation and innovation. There have been impressive achievements in improved health status of populations and in universal coverage for most OECD countries. There remains, however, a recurrent concern regarding the adequacy of resources and the way they are currently used, and how best to increase the equity, efficiency and effectiveness of health care. The challenges of rapid technological change, growing patient expectations and ageing populations reinforced the appeal for further reforms. Consequently, there is a rising demand for a core set of financial data provided by National Health Accounts as well as by international comparisons of health care spending. This manual of A System of Health Accounts (SHA) provides a set of comprehensive, consistent and flexible ac- counts. It establishes a conceptual basis of statistical reporting rules and proposes a newly devel- oped International Classification for Health Accounts (ICHA) which covers three dimensions: health care by functions of care; providers of health care services; and sources of funding. The proposed accounts are designed to meet the needs of analysts of health care systems and policy-makers. They provide a common framework for enhancing the comparability of data over time and across countries. They are intended for use in international comparisons that include a broad range of countries with different ways of organising health care and its financing. This manual builds on more than fifteen years of work of the OECD Secretariat on international comparisons of health care data in support of economic analysis of health policy. A number of experts in OECD countries and from other international organisations have assisted in producing this manual by commenting on various draft versions. Their contributions are gratefully acknowledged. The manual was prepared by Manfred Huber, an administrator in the Directorate for Education, Employment, Labour and Social Affairs and is published on the responsibility of the Secretary-General of the OECD. National statistical agencies and other users of the manual may contact the SHA Hotline at [email protected] for questions and queries. Additional information on the SHA and further practical guidelines are available at http://www.oecd.org/els/health/sha.htm. All users of this manual are invited to take an active part in its further development. © OECD 2000 3 A SYSTEM OF HEALTH ACCOUNTS ACKNOWLEDGEMENTS Comments, which influenced the final round of redrafting, were provided by Jean-Pierre Poullier (WHO Geneva), who had initiated the project of the System of Health Accounts at the OECD Secretariat and commented on each draft version over the last three years. Various draft versions of the SHA were discussed with the members of the Eurostat Task Force on Health Care Statistics. Comments from experts in non-Member countries and from other international organisations document the interest of a wider range of countries in the draft manual. Ms. Ann Chadeau, and Mr. Hermann T. Sarrazin have assisted in the drafting of parts of the manual. A particular debt of gratitude is owed to the United States Health Care Financing Administration whose financial support contributed to the development of this manual. 4 © OECD 2000 TABLE OF CONTENTS 1. Principles of the System of Health Accounts............................................................ 11 Introduction ........................................................................................................................... 11 Purposes of the System of Health Accounts ............................................................................ 13 Background ............................................................................................................................ 13 Looking ahead: pilot implementations and further development of the manual...................... 15 The organisation of the manual: a reader’s guide .................................................................... 16 Basic criteria for the System of Health Accounts..................................................................... 17 The System of Health Accounts and health satellite analysis and accounts.............................. 19 PART I CONCEPTS AND METHODS FOR HEALTH ACCOUNTS 2. A Set of Standard Tables .......................................................................................... 23 Estimation strategies and flows of information in health accounting ...................................... 24 Standard tables 1 to 10 ..................................................................................................... 26-40 3. Basic Functions and Global Boundaries of Health Care ........................................... 41 Introduction ........................................................................................................................... 41 The functional boundaries of health care................................................................................ 41 Health care and health-related functions ................................................................................ 42 Modes of production .............................................................................................................. 43 Further dimensions for classifying personal health care services .............................................. 45 Health-related functions ......................................................................................................... 47 Applying the functional classification ..................................................................................... 48 4. Health Care Provider Industries............................................................................... 51 Introduction ........................................................................................................................... 51 Industries of health care providers within the economy .......................................................... 52 The classification of health care provider industries ................................................................ 53 Additional institutional classifications .................................................................................... 53 Applying the ICHA-HP health care provider classification ..................................................... 55 © OECD 2000 5 A SYSTEM OF HEALTH ACCOUNTS 5. Measurement of Expenditure on Health Care .........................................................