Health Policy and Service Provider Perspective Alan Cahill Agenda Previous health expenditure data Potential of System of Health Accounts Additional reporting items International indicators Issues ID: 1041702
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1. System of Health Accounts SeminarHealth Policy and Service Provider PerspectiveAlan Cahill
2. AgendaPrevious health expenditure dataPotential of System of Health AccountsAdditional reporting itemsInternational indicatorsIssuesFuture development
3. Previous health expenditure dataLimited number of variables reportedVirtually no disaggregation of health spend totalityPublicPrivateHealth insurance
4. Previous health expenditure dataNo breakdown by sectorNo breakdown by type of careLimited breakdown by financing typeLimited use for policy purposes
5. Potential of System of Health AccountsTri-axial nature of SHAVery flexible to new analysesMore sophisticated comparisons with other countriesNew indicators on health expenditureBetter insights into funding decisions
6. Potential of System of Health AccountsPowerful policy analysis toolCompare budget allocation decisions with where money was actually spentCompare distribution of spend with other countriesDo we spend more in certain areas…why?Follow spend trends over time Does spend go in same direction as policy?
7. Potential of System of Health AccountsSome examples of enhanced analytic capability of SHAAnalysing 2 key health accounting dimensionsFiltering one dimension and analysing by anotherFiltering one dimension and analysing by another, internationally relativitiesFiltering both provider and financing scheme data to create an indicator by linking with other data
8. Example 1: Analysing 2 key health accounting dimensions
9. Example 1: Analysing 2 key health accounting dimensionsHealth care providers by financing schemes, Ireland and OECD average, 2014
10. Example 1: Analysing 2 key health accounting dimensionsHealth care providers by financing schemes, Ireland and OECD average, 2014
11. Example 1: Analysing 2 key health accounting dimensionsHealth care providers by financing schemes, Ireland and OECD average, 2014
12. Example 1: Analysing 2 key health accounting dimensionsHealth care providers by financing schemes, Ireland and OECD average, 2014IrelandOECD Avg.
13. Example 2: Filtering one dimension and analysing by another
14. Example 2: Filtering one dimension and analysing by anotherHospitals expenditure by type of care, Ireland and OECD average, 2014
15. Example 2: Filtering one dimension and analysing by anotherHospitals expenditure by type of care, Ireland and OECD average, 2014Filter by:Health Care Providers (HP) – HP.1 Hospitals
16. Example 2: Filtering one dimension and analysing by anotherHospitals expenditure by type of care, Ireland and OECD average, 2014Filter by:Health Care Providers (HP) – HP.1 HospitalsAnalyse by:Health Care Functions (HF) – HC.1.1, 2.1 InpatientHC.1.2, 2.2 DayHC.1.3, 2.3 OutpatientHC.1.4, 2.4 Home-basedHC.3 Long-term careHC.4 Ancillary services HC.5 Medical goods
17. Example 2: Filtering one dimension and analysing by anotherHospitals expenditure by type of care, Ireland and OECD average, 2014
18. Example 3: Filtering one dimension and analysing by another, international relativities
19. Example 3: Filtering one dimension and analysing by another, international relativitiesGovernment funded health care by function of care, Ireland and OECD average, 2014
20. Example 3: Filtering one dimension and analysing by another, international relativitiesGovernment funded health care by function of care, Ireland and OECD average, 2014Filter by:Health Care Financing Schemes (HF) – HF.1 Government schemes and compulsorycontributory health care financing schemes
21. Example 3: Filtering one dimension and analysing by another, international relativitiesGovernment funded health care by function of care, Ireland and OECD average, 2014Filter by:Health Care Financing Schemes (HF) – HF.1 Government schemes and compulsorycontributory health care financing schemesAnalyse by:Health Care Functions (HC)
22. Example 3: Filtering one dimension and analysing by another, international relativitiesGovernment funded health care by function of care, Ireland and OECD average, 2014
23. Example 4: Filtering both provider and financing scheme data to create an indicator by linking with other data
24. Example 4: Filtering both provider and financing scheme data to create an indicator by linking with other dataGovernment funded expenditure per hospital bed, 2014
25. Example 4: Filtering both provider and financing scheme data to create an indicator by linking with other dataGovernment funded expenditure per hospital bed, 2014Filter by:Health Care Financing Schemes (HF) – HF.1 Government schemes and compulsorycontributory health care financing schemes
26. Example 4: Filtering both provider and financing scheme data to create an indicator by linking with other dataGovernment funded expenditure per hospital bed, 2014Filter by:Health Care Financing Schemes (HF) – HF.1 Government schemes and compulsorycontributory health care financing schemesFilter by:Health Care Providers (HP) – HP.1 Hospitals
27. Example 4: Filtering both provider and financing scheme data to create an indicator by linking with other dataGovernment funded expenditure per hospital bed, 2014Filter by:Health Care Financing Schemes (HF) – HF.1 Government schemes and compulsorycontributory health care financing schemesFilter by:Health Care Providers (HP) – HP.1 HospitalsLinking to data collected separately – Total beds in hospitals (HP.1)
28. Example 4: Filtering both provider and financing scheme data to create an indicator by linking with other dataGovernment funded expenditure per hospital bed, 2014Data collection on hospital beds uses SHA classifications:Curative care (acute care) beds in hospitals (HP.1) are hospital beds that are available for curative care (HC.1 in the SHA classification).Rehabilitative care beds in hospitals (HP.1) are hospital beds that are available for rehabilitative care (HC.2 in the SHA classification).Long-term care beds in hospitals (HP.1) are hospital beds accommodating patients requiring long-term care (HC.3 in the SHA classification).
29. Example 4: Filtering both provider and financing scheme data to create an indicator by linking with other data – A developmental indicator for discussionGovernment funded expenditure per hospital bed, 2014
30. International indicatorsEC Social Protection CommitteeJoint Assessment Framework in the area of HealthSeveral SHA based indicators used as contextual information on resourcesEuropean Core Health IndicatorsDG SanteState of Health in the EUOECD Health at a Glance reports
31. Issues – Long-term care comparability* = 2013
32. Issues – Long-term care comparabilityLong recognised internationally as major issue affecting overall comparabilityMultiple interpretations have been applied to the definition and boundary of long-term careNeed to review Irish long-term care boundary…a good opportunity
33. Issues – out-of-pocket spendingLimitations for international comparisons due toShortcomings associated with the recording of private fundingEstimation methods for components of private expenditure on health
34. Future development – iterativeSHA should be considered to be an evolving standard“It should be seen as a staging post…can be considered a work in progress.”Nationally, we should take an iterative approachIncrease granularity of data over timeMove from 2-digit reporting to 3-digitFocus on a small number of areas each yearQuality of data should always be a priority
35. Future development – medium termReporting itemsTotal pharmaceutical spendPrevention and public health services
36. Future development – longer termHealth expenditure by DiseaseSpending by disease (ICD)InpatientOutpatientMedical goodsHealth spending by ageRevenues of health care financing schemes
37. Thank you!Alan_cahill@health.gov.ie