Transcript Good practice examples of SHA

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
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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%