OECD Health Data: future directions of work

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OECD Health Data future directions of work

• OECD World Forum on Key Indicators
• 10th November 2004
• Manfred Huber, OECD
• Social Policy Division, Directorate for
  Employment, Labour and Social Affairs

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Outline of presentation

• Background to OECD data collection on health
• Structure and guiding principles of OECD Health
  Data
• Challenges of future data development work at the
  OECD Secretariat
• Role of the OECD manual A System of Health
  Accounts
• Other priority areas for future work
• International co-operation
• Conclusions

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Background (1) Challenges to health care
systems, common in OECD countries

• Affordable cost today and sustainable financing
  tomorrow
• Population access to health care services and
  adequate coverage of services
• Increasing value for money in health care systems
• Improving quality and safety
• Strengthening of prevention and health promotion

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Background (2) rising demand for health data

• Health care high on the agenda of public spending
  policy (and a key concern for citizens, - as are
  health issues in general)
• More than 25 years of data collection and
  analysis at OECD on health and other social
  spending (e.g. The Welfare State in Crisis
  1980)
• International statistical guidance has long been
  lacking behind other social and economic fields.
• Regular annual collection of OECD Health Data
  since 1991.

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The structure of OECD Health Data

• 6. Social Protection
• 7. Pharmaceutical market
• 8. Non-medical determinants of ehalth
• 9. Demographic References
• 10. Economic References

• 1. Health status
• 2. Health care resources
• 3. Health care utilisation
• 4 Health expenditure
• 5. Health care financing

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A model for understanding OECD Health Data
Non-medical Determinants (Part 8)
The Production of Health -Related Welfare
Health Status (Part 1)
Inputs to Health Services (Part 2)
Utilization of Services (Part 3)
Social Welfare and Individual Utility
Budgeting Decisions
Purchasing Decisions
Purchasing Decisions
Demographic (Part 9) Economic (Part
10) References
The Flow of Health Expenditure
Overall social protection (Part 6)
Health Expenditure(Input volumes X prices)
Health Expenditure and Financing (Taxes,
Insurance, Out-of-Pocket) (Part 4, 5)
Health Expenditure (Utilization volumes X prices)
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Main challenges for a system of international
health care statistics (1)

• Degree of international harmonisation of health
  care statistics (resources, activities, outcome
  measures) still low..
• ..and there are important gaps on national level
• E.g. health care data can be difficult for
  private sector activity devolved health care
  systems (different information systems across
  regions)
• Uneven coverage between hospital activity and
  ambulatory activity

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Main challenges for a system of international
health care statistics (2)

• Better integrated system on national and
  international level need to be developed in
  parallel
• Examples of national stock-taking exercises
  Australia, Canada, Germany
• Major challenge where are the limits of
  aggregate data versus comparable sets of micro
  data?
• Which role should harmonised population surveys
  play in the future? (not currently on OECD
  agenda)

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Tobacco Consumption, 1985 and Incidence of Lung
Cancer, 2000
Source OECD Health Data 2004, 3rd edition
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Focus for future work on SHA and health care
statistics

• (1) Health Accounts and Health Care Activity Data
• Expenditure classifications refinements and
  addendums to current classifications
• Indicators connecting health expenditure and
  non-monetary data
• Output and price measurement
• Long-term care expenditure and beneficiaries
• (2) Indicators of quality of health care

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What is the OECD System of Health Accounts (SHA)?

• Framework for accounting rules and
  classifications
• ICHA International Classification for Health
  Accounting
• Functions (ICHA-HC)
• Providers (ICHA-HP)
• Financing agents (ICHA-HF)
• Proposed set of two-dimensional standard tables
• ICHA-HC and ICHA-HP provide interface for linking
  with (non-monetary) resource and activity data

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Main objectives of the SHA - from a health
policy perspective

• To provide a framework for analysing health
  systems
• overall level of spending on health care
• changes in the composition of spending
• monitoring factors of growth in health spending
• differences across countries in expenditure
  growth and composition of expenditure
• To provide a tool to monitor effects of health
  care reforms

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Trend in Out-of-pocket Spending, 1990-2002
Source OECD Health Data 2004, 3rd edition
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SHA and health accounting practice

• Pilot implementations of the SHA started in
  1998-2000 ongoing iterative process to
  harmonise data reporting to OECD Health Data
• SHA working and technical papers documenting
  results
• Several European Union projects related to SHA
  have been launched or are planned
• WHO/World Bank/USAID Guide to producing health
  accounts
• SHA now serves as an international
  quasi-standard

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Status of SHA implementation
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Overall Assessment of Pilot Implementations

• The implementation of the SHA is feasible major
  challenge is resource constraints in countries
• The SHA framework contributed to substantial
  improvement in the comprehensiveness and
  consistency of health expenditure estimates
• Current pilot implementations still have smaller
  or greater departures from the recommendations of
  the OECD SHA Manual, which themselves need be
  backed by further guidance and more detail in
  several cases

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Hospital and In-patient Curative-rehabilitative
Expenditure
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Major challenges of implementing SHA (I) -
Estimating total expenditure

• Boundary of health care (ICHA-HC) in an
  internationally harmonised way (e.g.
  long-term-care)
• Accounting for expenditure by all the financing
  agents defined by the SHA (e.g. non-profit
  organisations, out-of-pocket)
• To include all primary and secondary providers of
  health care (e.g. army, companies, schools)
• Application of standard methods for valuation of
  health services

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Major challenges of implementing SHA (II) -
Applying the functional classification

• Defining more precisely the boundary between
  health and health related functions (e.g. public
  health)
• Separating health - health related and non-health
  activities in the case of complex institutions
  (e.g. university clinics, public health centres)
• Applying functional classification in the case of
  multi-functional health care organisations (e.g.,
  in patient care, day care, out patient care
  within hospitals)

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Other Priority Areas for Future Work (I)

• Statistics on health employment next steps
• Improve data collection on key professions
  physicians and nurses
• Analyse feasibility of comprehensive estimates of
  employment in health care (from national
  examples)
• Co-operation with Eurostat project Health labour
  accounts, linking employment data to SHA
  provider classification (ICHA)
• Conceptual work on utilising ISCO estimation of
  part-time employment

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Other Priority Areas for Future Work (II)

• Remuneration of health professions
• Previously collected was among the most
  frequently demanded indicators
• Data collection will resume in 2005
• Physicians both salaried and self-employed
  general practice and specialists
• Nurses start with data from hospital setting

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Other Priority Areas for Future Work (III)

• Statistics on health resources and utilisation
• Further develop set of medical technology
  indicators (move towards joint list with Eurostat
  and WHO?)
• Focus on statistics on surgical procedures (in
  patient and day cases) for shortlist of
  procedures
• Co-operation with Eurostat and WHO project on
  Hospital data (activity data, resources, and
  hospital financing)
• Major challenge international harmonisation of
  procedure statistics and their common use in
  countries (not in OECD portfolio)

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Other Priority Areas for Future Work (IV)

• Data on long-term care services and expenditure
• Basis data set on expenditure and recipients from
  the OECD Study on Long-term Care (under OECD
  Health Project)
• Work will continue in 2005 on methodological
  framework and basic data set
• Expected outcome
• Improved guidelines for health accounting
• Better comparable health expenditure estimates
• Routine data collection on services and
  expenditure to monitor health and social policies
  for ageing societies

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Expenditure on long-term care, 2000
Source OECD Long term Care Policies for Older
People (forthcoming)
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Initiatives to strengthen international
co-operation

• Exchange of letters with Eurostat to intensify
  co-operation on health statistics
• Ultimate goal of joint data collection
  instruments with Eurostat and WHO in the future
  based on successful models in other areas (e.g.
  education, energy)
• This will contribute to better harmonised data
  reporting with non-OECD countries as well (e.g.
  health accounts in World Health Report and World
  Bank databases)
• Dissemination strategies -- and needs for
  additional data modules -- may differ across
  organisations

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SHA influence on revision of international
statistical systems

• 2007 revision of ISIC move health industry from
  Group level to Division level (for which
  international comparability is required)
• Current revision of Central Product
  Classification (CPC) improve definition and
  breakdown of services with the help of the
  ICHA-HC and ICHA-HP classifications
• Health professions in ISCO advocate use of ISCO
  for estimating human resources for health care
• Missing link up-to-date internationally agreed
  system of procedure classifications for health
  interventions

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Conclusions

• Improvements in international health care
  statistics involve substantial investments at
  national level
• Harmonised reporting to international data
  collections driver to identify and fill
  information gaps in countries
• There are clear limits to ex-post harmonisation
  of data in the health care arena due to large
  differences in the structure of health care
  systems and reporting mechanism
• Development of new data initially restricted to
  subset of countries broad coverage of countries
  can take many years

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Data dissemination

• Annual electronic publication on CD-ROM (in
  collaboration with IRDES, a French research
  institute in health economics)
• Available for download via SourceOECD
• Health at a Glance (2003 third edition next
  Oct. 2005)
• OECD Health Data on the Internet
  www.oecd.org/health/healthdata
• Access to frequently asked data, all Sources and
  Methods, etc.
• Interim updates (two per edition)

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An invitation to explore OECD Health Data 2004
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For more information..

• www.oecd.org/health
• www.oecd.org/health/healthdata
• www.oecd.org/health/sha
• www.oecd.org/healthmin2004