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Methodological improvements of SHA: Examples of good practice Markus Schneider Bruxelles, ONSS, Place Victor Horta, 20-21 septembre 2007 Organisé par Service public fédéral Sécurité sociale SPP Politique scientifique - HIVA Katholieke Universiteit Leuven Outline • • • • • Concept of SHA1.0 + PG Criteria of good practice and improvements Examples: NL, PT, D, CZ, F Tools Requests on SHA2.0 Concept of SHA1.0 Patient characteristics: Age, Gender, Diseases Consumers Financing Agent characteristics: ICHA-HF Financing Agents** Providers* Provider characteristics: ICHA-HP Expenditures: ICHA-HC Prices, Volumes TCHE(HF)=TCHE(HC)=TCHE(HP) under certain conditions below the line: Health related functions ICHA-HC.R * incl. consumers, financing agents as providers ** incl. consumers, providers as financing agent Health personnel Concept of SHA1.0+PG Patient characteristics: Age, Gender, Diseases Consumers Financing Agent characteristics: ICHA-HF Financing Sources FS Financing Agents** Providers* Provider characteristics: ICHA-HP Expenditures: ICHA-HC Prices, Volumes TCHE(FS)=TCHE(HF)=TCHE(HC)=TCHE(HP)=RC under certain conditions below the line: Health related functions ICHA-HC.R * incl. consumers, financing agents as providers ** incl. consumers, providers as financing agent Resource Cost RC Health Personnel Actors, Activities, Inputs SHA1.0+PG Actors Providers: ICHA-HP Financing agents: ICHA-HF, FS Consumers: Age, Gender, Diseases, BOD Activities Expenditures: ICHA-HC, ICHA-HC.R Volumes Prices Inputs Health personnel (Health, Non-Health), Resources Costs (RC) Criteria of good practice • SHA1.0 Principles: – Comprehensiveness, Consistency (internal, over-time), Compatibility • Organisation of statistical process: Input, Throughput, Output (Metainformation, National Manual) • Transparency (Metainformation, Reporting Standards, National Manuals) • International comparability (external consistency) Methodological Improvements • Related to the compilation of the SHA Cube Health care and non health care production (Netherlands) Integration of human resources and cost of illness (Germany, Czech Republic) • Related to the compatibility of SHA Co-ordination with sectors of SNA (Portugal) • Related to international comparability Concept of relative unit cost, EUCOMP AC/CC, TOSHA • Related to the concept of SHA Value-added concept, Health-added concept, Financing concept Example: NL • Objectives: internal consistency with other accounts SNA, ESSPROS, multiple use, • Responsibility: CBS, Health Statistics • Approach: Provider side (HC, HCR, NHC), reconsiliation with financing side, Including Social Care • Comprehensiveness: SHA Cube, Pilot compilations of Health personnel and Prices, Cost of Illness accounts (RIVM) • Timeliness: 1998-2005 • Issues: International comparability HF2.3, HC.3, HC5.2, Transparency (Non-health care), Example: PT • Objectives: internal consistency with SNA, • Responsibility: INE, SNA department • Approach: Reconsiliation SNA + Provider side + reconsiliation financing side • Comprehensiveness: SHA Cube, Pilot compilations of Prices • Timeliness: 2000-2005 • Issues: International comparability: Outpatient care, Transparency of private provision, health consumption of tourists PT: Consolidation with SNA 3 Unit: 10 € Transitional Matrix I (Output side) - HP.1 - Hospitals Sources of information Providers (ICHA-HP) HP.1 HP.1.1 HP.1.2 HP.1.3 Total Output Public and private social Corporations insurance subsystems General Government sector Providers belonging to NPIS Total 3.001 3.001 331 1 27 78 3.001 436 1 332 27 78 3.438 3 Unit: 10 € Transitional Matrix II (Financing side) - HP.1 - Hospitals Sources of information Providers (ICHA-HP) HP.1 HP.1.1 HP.1.2 HP.1.3 Total HF.1.1 IGIF – other state institutions Source: INE 2006 3 1 0 4 Total 965 2.055 57 210 3.287 HF. 2.1 SAMS - Co-financed expenditure (social benefits in kind) + production 11 0 3 13 Total 24 1 4 29 HF. 2.2 SAMS – Financing of Total insurance companies 3 0 0 3 45 0 2 46 HF. 2.3 IGIF – Health fees 18 0 1 19 Total 66 3 7 76 Total 965 2.190 61 223 3.438 Example: DE • Objectives: indepence of other accounts, limited links with other accounts SNA, ESSPROS, • Responsibility: StBA, Health Statistics • Approach: Financing side + reconsiliation providers side • Comprehensiveness: SHA Cube, HLA account incl. Health Industries, Cost of Illness accounts, • Timeliness: SHA 1992-2005, HLA 1995-2005, COI 2000, 2002, 2004 • Issues: International comparability HF2.3, Transparency (press brochures instead comprehensive tables) DE: Linking German Health Accounting Systems NHA HLA COIA Providers CFHMS-HP international national ICHA-HP EuComp (Actors) WZ03 Source: Cordes 2004, StBA Example: CZ • Objectives: indepence of other accounts, limited links with SNA, • Responsibility: CZSU, Health Statistics • Approach: Financing side (Individual accounts) + reconsiliation providers side • Comprehensiveness: SHA Cube and Cost of Illness accounts, • Timeliness: SHA 2000-2005, COI 2000-2005 • Issues: International comparability HF2.3, HC.3; Transparency ? Results page - database Summary of examples NL SHA Cube y Health Personnel y Prices y Cost of Illness y Financing Sources PT y DE CZ y y y (y) y (y) y Tools • Inventories: Actors, Activities and costing, Prices, Data • Software Metadata: EUCOMP: HP Actors, HLA 1 Accounts (linked to EUCOMP) • Software Accounts: TOSHA: SHA Cube, HLA 2 Accounts (linked to EUCOMP) • COI: Disease List, Age classification TOSHA Output TOSHA Throughput TOSHA Input National Database Flexibility, Confidentiality, Interfaces SHA 1.0 Software, License IHAT Common Questionnaire Key assignment page Compilation page EUCOMP-ACC: International reconciliation International Reconciliation: Relative unit costs Health Expenditure = Health Expenditure _________________ GDP Expenditure ratio = Patients * Price per patient Patients Price per Patient ________________ Inhabitants Prevalence * __________________ GDP/ Inhabitants Relative unit cost International Reconciliation: Relative unit costs of hospital care Hospital Expenditure _________________ GDP 3% Hospital Patients = ________________ Inhabitants 20% Price per Patient * __________________ GDP/ Inhabitants 15%