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Analysis of trends in GDP
and Health Expenditure in
OECD countries, with a
focus on Health Insurance
Roberto ASTOLFI and Luca LORENZONI
Training Course on Social Health Insurance 2009
National Health Insurance Corporation
Seoul, 17 June 2009
Background
The System of Health Accounts
proposes an integrated system of
comprehensive and internationally
comparable accounts and provides a
uniform framework of basic
accounting rules and a set of standard
tables for reporting health
expenditure data
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Background (cont)
The goal of the collaboration between
OECD, EUROSTAT and WHO is to
reduce the burden of data collection
for the national authorities responsible
for the provision of statistical
information
This joint effort also increases the use of
international standards and definitions
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Methods
In 2005 the 3 organisations agreed to intensify
their collaborative actions through a joint
data collection based on:
– a functional classification of health care (HC)
– a classification of health care financing (HF)
– a classification of health care providers (HP)
– a classification of financing sources (FS)
– a classification of resources (RC)
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Methods (cont)
Core tables (minimum requirement to
countries):
HC x HP: CHE by function of care and provider
HC x HF: CHE by function of care and financing
agent
HP x HF: CHE by provider and financing agent
CHE: Current Health Expenditure
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Joint data collection 2009
Timing
• 2009 JHAQ sent to health contacts on
15 December 2008
• Completed by 31 March 2009 by 27
countries
• First validation by mid-May 2009
JHAQ: Joint Health Accounts Questionnaire
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Joint data collection 2009
Preliminary results - Indicators
• Health expenditure (HE) as a share of
GDP
–total; public; private
• Current HE as a share of actual final
consumption
• Private HE components analysis
• Population covered by private
insurance
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Preliminary results - one
• OECD countries devoted for the fifth consecutive
year about 8.9% of their GDP to health spending
• The share of health spending varies considerably
across OECD countries, ranging from less then
6% in Turkey and Mexico up to 16% in the
United States
• Also the share of public HE varies considerably
across OECD countries – more than three-fold
difference between France and Mexico
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Preliminary results - two
• Evidence of a positive association between GDP
per capita and HE per capita across OECD
countries
• Association is stronger among OECD countries
with a low GDP per capita
• However, there is a wide variation since GDP is
not the sole factor influencing HE levels
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Preliminary results - three
• The share of health goods and services to all
goods and services consumed by individuals in
the economy is more refined measure of relative
importance of health spending
• The average share of actual consumption
allocated to health in OECD countries is almost
13%, with 90% of countries devoting more than
10% of consumption to health
• Only Poland, Mexico, and Turkey are below the
10% threshold, while US, Switzerland,
Luxembourg, and Norway above 15%
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Preliminary results - four
• The average share of private health expenditure
to total health expenditure is stable over time for
the OECD countries and equals 27-28%
• In 2007, it ranges between 54% for United States
and 9% for Luxembourg
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Classification of sources of funding
ICHA Sources of funding
Code
HF.1 General government
HF.1.1 General government excluding social security funds
HF.1.1.1 Central government
HF.1.1.2 State/provincial government
HF.1.1.3 Local/municipal government
HF.1.2 Social security funds
HF.2 Private sector
HF.2.1 Private social insurance
HF.2.2 Private insurance enterprises (other than social insurance)
HF.2.3 Private household out-of-pocket expenditure
HF.2.4 Non-profit organisations serving households (other than social
insurance)
HF.2.5 Corporations (other than health insurance)
HF.3 Rest of the world
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Preliminary results - five
• Out-of-pocket expenditure is the most important
component of private health expenditure (PHE)
in almost all OECD member States
• However, in the US, France, and the Netherlands
the share of Private insurance expenditure to
PHE is the highest
• Non-profit institutions play an important role in
UK and Turkey, while corporations are
important in Australia and Slovak republic
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Private health insurance coverage, by type 2007
Netherlands
France (2006)
Belgium
Canada
United States
Luxembourg
Ireland
Australia
Austria
New Zealand
Switzerland
Germany
Portugal
Greece (2002)
Denmark
Spain (2006)
United Kingdom (2006)
Finland (2005)
Mexico
Turkey (2006)
Iceland
Primary
Complementary
Supplementary
Duplicate
Percentage of total population
0
10
20
30
40
50
60
70
80
20
90
100
Preliminary results - six
• The share of population covered by Private
Health Insurance (PHI) varies considerably
across OECD countries. Seven countries report
private coverage for over half of the population:
Netherlands; France; Belgium; Canada; US;
Luxembourg; and Ireland
• PHI plays a diversity of role in the health system.
Primary cover for certain population groups in
the United States and Germany
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Preliminary results - seven
• It offers to 88% of the French population
complementary insurance to cover cost sharing
applied in the social security system
• The Netherlands has largest supplementary
market, followed by Canada whereby PHI pays
for prescription drugs and dental care that are
not publicly reimbursed
• Duplicate markets providing faster private-sector
access to medical services where there are
waiting times in public systems are the largest
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Thank you for your
attention!
For further information, please visit our websites:
 System of Health Accounts:
www.oecd.org/health/sha
 Revison of the System of Health Accounts:
www.oecd.org/health/sha/revision
 OECD-Eurostat-WHO Joint SHA Data Collection:
www.oecd.org/health/sha/jointquestionnaire
 OECD Korea Policy Centre:
www.oecdkorea.org
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