National Health Accounts (Expenditure on Health Care in Poland)

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National Health Accounts(Expenditure on Health
Care in Poland)
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National Health Account

• 2000-2002 - the first pilot national health
  account in Poland (data for 1999). It was drawn
  by a group of national and foreign experts on the
  basis of the OECD methodology
• Changes in the system of health care and in the
  national budget classification
• September 2004-June 2005 - the health account
  realised in cooperation with the ICON Institute
  (data for 2002, 2003).

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Health care financing sources (1)
Health care financing sources
Public expenditures
Private expenditures
Rest of the world
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Health care financing sources (2)public
expenditures
General government HF.1
Social security funds HF.1.2
Central government HF.1.1.1
National Health Fund
State and local government HF.1.1.2 and HF.1.1.3
Social insurance institutions
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Health care financing sources (3)
Central government HF.1.1.1
Ministry of Health
Ministry of Justice
Budgets of voivods
Ministry of Internal Affairs and Administration
Ministry of National Defence
Ministry of Social Policy
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Health care financing sources (4)
Private sector HF.2
Private social insurance HF.2.1
Households out-of-pocket payments HF.2.3
Corporations HF.2.5
Non-profit institutions HF.2.4
Quasi-insurance sector
Occupational health care
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Data sources (1)

• Public expenditures
• Reports
• Realisation of the state budget and budgets of
  local self-government units
• Realisation of the financial plan of the National
  Health Fund
• Social Insurance Institution
• Technical and financial plan of the Agricultural
  Social Insurance Fund

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Data sources (2)

• Private sector
• Private health care insurance - statistical
  report on insurance activity of insurance
  institutions
• Private household out-of-pocket payments
  households budgets survey/ modul survey Health
  care in households
• Non-profit organisations periodic survey
• Corporations experts estimations on the basis
  of available reports on occupational medicine and
  recognition of the quasi-insurance sector

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Data sources (3)

• Private health care insurance
• No private health insurance in the form of a
  separate kind
• Insurance institutions operating on the basis of
  the Law of 22 May 2003 on the Insurance
  Activities
• Quasi-insurance sector not included here
  (included in corporations group)

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Data sources (4)

• Private households out-of-pocket payments

HBS Modular survey
Sample size ca. 32 thous of households ca. 4 thous of households
Method filling in the diaries questions about the past
Periodicity continuous cyclical (every 3-5 years)
Classification COICOP/HBS ICHA
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Data sources (5)

• Non-profit organisations serving households
• fundations, associations, other social
  organisations
• cyclical survey carried out by the CSO
• last survey 2002 (data for 2001)
• estimations for 2003

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Data sources (6)

• Corporations
• Law on Occupational Medicine
• Organisational units of occupational medicine
  basic units and voivodship occupational medicine
  centres
• medical insurance packages quasi insurance
  institutions

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Analysis of results

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Figure 1. Expenditures on health care by
financing sector
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Figure 2 Total health expenditure by financing
agent (Total 100)
1999
2003
Public 71,2 Private 28,8
Public 70,0 Private 30,0
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Figure 3 Current health expenditure by provider
(Total current 100)
1999
2003
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Figure 4 Total health expenditure by function
(Total 100)
1999
2003
Public 97,3 Private 2,7
Public 82,0 Private 18,0
Public 39,9 Private 60,1
Public 34,3 Private 65,7
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Conclusions

• data availability - differences
• public expenditure almost complete data
• private expenditures problems (corporations,
  occupational medicine)
• rest of the world not well recognised

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Conclusions

• need for improving information sources
• public expenditures (health care in prisons,
  social welfare homes)
• private expenditures (corporations, insurance
  institutions)
• lower classification level