A System of Health Accounts 201 - OECD

Foreword
Table of Contents
Acknowledgments
Acronyms
Part I. Foundations of the System of Health Accounts
	Chapter 1. Introduction
		Background
		Differences and improvements between SHA 1.0 and SHA 2011
		The role of the Manual and its organisation
		Notes
	Chapter 2. Purposes and Principles of Health Accounts
		Introduction
		Background
		Purposes and objectives of the System of Health Accounts 2011
		Principles of the System of Health Accounts 2011
			Health systems and the System of Health Accounts
				Figure 2.1. Linkage between the frameworks of health systems and health accounts
		Analytical uses
			Uses of national health accounts and SHA data
		Notes
	Chapter 3. Accounting Concepts and SHA Aggregates
		Introduction
		Accounting and national accounting as a base for the System of Health Accounts
		The consumption, availability and use of health care goods and services
			Figure 3.1. The uses of health care goods and services
		Main aggregates of health expenditure
			Total expenditure on health (SHA 1.0)
			Current expenditure on health care
			Expenditure on gross capital formation in the health care system
			Capital transfers to health care providers
				Box 3.1. Layers of the core accounts and health financing
			Research and development
		Rest of the world
			Transactions in the health care sector
		Time of recording
		The measurement of consumption and output: market and non-market production
		The treatment of subsidies and other transfers to provider industries
		The production boundary of health care services
			Occupational health care
			Household provision of health care
			Health care as part of the informal sector
		The relationship between current expenditure on health and the SNA components of consumption
			Table 3.1. Relationship between SHA current expenditure on health and SNA terminology
		Notes
	Chapter 4. Global Boundaries of Health Care
		Introduction
		Defining current health care expenditures
			Health care boundary: Focus on functions
			The core and extended accounts of SHA
				Figure 4.1. The core and extended accounting framework of SHA 2011
			Criteria in boundary setting
		The boundary of the current health care expenditure account
			The consumption frame of health care goods and services
			Boundary criteria in operational terms
			Borderline cases
				Table 4.1. Selected borderline cases of the SHA core accounting framework
			Layers of the consumption frame
		The boundaries of the additional expenditure accounts of SHA
			Dimensions of extension
			Consumer health interface
			Provision interface
			Financing interface
		Notes
	Chapter 5. Classification of Health Care Functions (ICHA-HC)
		Introduction
		Health care consumption by purpose
		Uses of the functional approach
		Features of SHA 2011 functional classification
			Box 5.1. The classification of health care functions at the first-digit level
		Rationale of the functional classification
			Categories of health care consumption by purpose
				Figure 5.1. The natural history of disease and the purpose of health care goods and services
				Figure 5.2. Decision tree for the functional classification
			Mode-of-provision categories
			Further detailed functional groupings
			Health care goods and services non-specified by function
			Memorandum items
				Table 5.1. Classification of health care functions
		Explanatory notes to the ICHA-HC classification of health care functions
			HC.1. Curative care
			HC.2. Rehabilitative care
				Box 5.2. Examples of rehabilitation services
			HC.3. Long-term care (health)
				Figure 5.3. The health and social boundary of long-term care (LTC)
				Box 5.3. Assessing long-term care needs
			HC.4. Ancillary services (non-specified by function)
			HC.5 Medical goods (non-specified by function)
				Figure 5.4. Distribution mechanisms of medicines
			HC.6. Preventive care
				Table 5.2. Preventive and public health components in SHA 1.0 and SHA 2011
			HC.7. Governance, and health system and financing administration
			HC.9. Other health care services not elsewhere classified (n.e.c)
			HC.RI. Reporting items
				Table 5.3. TCAM entries as a reporting item class HC.RI.2
			HC.RI.3. Prevention and public health services (according to SHA 1.0)
			HCR. Health care-related classes
		Notes
	Chapter 6. Classification of Health Care Providers (ICHA-HP)
		Introduction
		Concept of the classification of health care providers
			Objectives
			The universe of health care providers
				Figure 6.1. Overview of primary and secondary providers encompassed by ICHA-HP
			The structure of health care providers
				Table 6.1. Classification of actors/organisations in health care provision and health system dimensions
		Description and guidelines for compilers
			Changes from SHA 1.0
			Specific compilation issues
				Table 6.2. Classification of health care providers
		Explanatory notes to the ICHA-HP classification of health care providers
			HP.1. Hospitals
			HP.2. Residential long-term care facilities
			HP.3. Providers of ambulatory health care
			HP.4. Providers of ancillary services
			HP.5. Retailers and other providers of medical goods
			HP.6. Providers of preventive care
			HP.7. Providers of health care system administration and financing
			HP.8. Rest of economy
			HP.9. Rest of the world
		Notes
	Chapter 7. Classification of Health Care Financing Schemes (ICHA-HF)
		Introduction
		Main concept
			Summary of the accounting framework for health care financing
			Key concepts
				Figure 7.1. A graphical representation of SHA 2011 financing framework
				Table 7.1. Key health financing concepts and classifications in SHA 2011 and SHA 1.0/Producers Guide
			The concept and main categories of health care financing schemes
				Table 7.2. Main criteria of health care financing schemes
				Figure 7.2. Criteria tree for health care financing schemes
		Definition of health care financing schemes
			Table 7.3. Classification of health care financing schemes
			Table 7.4. ICHA-HF in SHA 2011 in comparison to SHA 1.0
		Explanatory notes to the ICHA-HF classification of health care financing schemes
			HF.1. Government schemes and compulsory contributory health care financing schemes
			HF.2. Voluntary health care payment schemes (other than Household out-of-pocket payments)
			HF.3. Household out-of-pocket payment
			HF.4. Rest of the world financing schemes
		Specific conceptual issues
			The interpretation of “public” and “private”
				Table 7.5. Expenditure by social, compulsory private and private health care financing schemes
				Table 7.6. Health spending from public, compulsory private and private funds
			Treatment of cost-sharing
			Relationship between financing schemes and financing agents
				Table 7.7. Possible financing agents for the main categories of financing schemes
				Figure 7.3. The relationship between financing schemes and financing agents: one-to-one correspondence
				Figure 7.4. The relationship between financing schemes and financing agents: example of a more complex institutional setting
			Expenditure by health care financing schemes and financing agents
			The relationship between financing schemes and financing agents from a data collection viewpoint
			Distinguishing between government schemes and government as an institutional unit
				Figure 7.5. An example of the relationship between government schemes, government as a provider of financial resources and government as a financing agent
			Distinguishing between rest of the world financing schemes, foreign entities as providers of revenues and foreign entities as financing agents
				Figure 7.6. The possible roles of foreign resources and foreign (non-resident) institutional units in health financing
			The treatment of surplus funds or deficits under SHA 2011
			Relationship to other statistical systems
				Figure 7.7. Financing schemes in the context of SHA 2011 and SNA 2008
		Main steps in adjusting SHA 1.0 or NHA Producers Guide of a country to SHA 2011 accounting of health financing
		Notes
Part II. Further Classifications, Applications and Methodology Concerning Health Accounts
	Chapter 8. Classification of Revenues of Health Care Financing Schemes (ICHA-FS)
		Introduction
		Main concept
			Table 8.1. Comparison of FS in SHA 2011 with the Producers Guide
			Comparison of the concept of revenues of financing schemes with financing sources under the Producers Guide
		Definition of revenues of health care financing schemes
			Table 8.2. Classification of revenues of health care financing schemes
		Explanatory notes to the ICHA-FS classification of revenues of health care financing schemes
			FS.1. Transfers from government domestic revenues
			FS.2. Transfers distributed by government from foreign origin
			FS.3. Social insurance contributions
			FS.4. Compulsory prepayment (other than FS.3)
			FS.5. Voluntary prepayment
			FS.6. Other domestic revenues n.e.c.
			FS.7. Direct foreign transfers
			Memorandum items
				Table 8.3. Suggested reporting of loans as memorandum items to the FS classification
		Specific conceptual issues
			Transfers from government revenues
				Figure 8.1. A simplified display of transfers from government revenues to financing schemes
			FSR.1 Treatment of loans
			Valuation of in kind assistance and technical support
		SHA tables on revenue collection
			Revenues of health financing schemes by types of revenues (HFxFS table)
			Revenues of health financing schemes by institutional units and types of revenues
				Table 8.4. Revenues of health financing schemes by Institutional units and types of revenues
		Additional tools
			Sub-categories of government domestic revenue
				Table 8.5. Sub-categories of Transfers from government domestic revenue
			Tool for the analysis of the sources of household out-of-pocket payments
				Table 8.6. Accounting payments made by households for care under SHA 2011
			Further analysis of external resources distributed by governments
		Notes
	Chapter 9. Classification of Factors of Health Care Provision (ICHA-FP)
		Introduction
		Main concept
			The scope of the factor classification
		Notes related to the classification and selected types of classes
			The boundary of Factors of health care provision
				Table 9.1. Classification of factors of health care provision
		Explanatory notes to the ICHA-FP classification of factors of health care provision
			FP.1. Compensation of employees
			FP.2. Self-employed professional remuneration9
			FP.3. Materials and services used
				Box 9.1. Relevant facts related to intermediate consumption in the health system
				Table 9.2. Further breakdown of non-health care goods
			FP.4. Consumption of fixed capital
			FP.5. Other items of spending on inputs
			Cross-classification of functional and economic classifications of expenses (GFSM)
				Table 9.3. Cross-classification of functional and economic classifications of expenses
		Notes
	Chapter 10. Health Spending by Beneficiary Characteristics
		Introduction
		Background
			SHA 1.0 and the Producers Guide
			International comparisons
		Analytical uses
			Expenditure by disease
			Expenditures by socioeconomic categories
			Policy indicators for expenditure by beneficiary characteristics
		Possible framework for analysing expenditures by beneficiaries
			Concept and definition of beneficiaries
		Scope of health expenditures considered in analyses by beneficiary characteristics
		Linkage to main SHA estimates
		Classifications of beneficiaries
			Age and gender
			Disease
				Table 10.1. Classification of disease/condition by Global Burden of Disease (GBD) category
				Table 10.2. International statistical classification of diseases and related health problems (ICD-10) 10th revision
			Socioeconomic status
			Geographical region
		Possible methodological approaches
			Estimation of expenditure by disease
			Estimation of expenditure by geographical region
			Estimation of expenditure by socioeconomic status
		Notes
	Chapter 11. Capital Formation in Health Systems
		Introduction
		Definition of gross capital formation in SHA
		Gross fixed capital formation
			Boundaries
				Box 11.1. Terminology
			Type of asset
				Table 11.1. Classification of gross fixed capital formation in health systems by type of asset
				Box 11.2. Difference between gross capital formation (GCF) and intermediate consumption
			Treatment of specific cases
				Box 11.3. Owners and users of fixed assets
				Box 11.4. Cost of use, maintenance, consumption and return to capital
		Changes in inventories and acquisitions less disposals of valuables
			Changes in inventories
			Acquisitions less disposals of valuables
		Different approaches to the estimation of gross capital formation
			Three perspectives on the analysis of capital formation in health
				Figure 11.1. Current health expenditure and gross capital formation in SHA
			Estimation
		The consumption of fixed capital in SHA
			Figure 11.2. Consumption of fixed capital in SHA
		Capital account
			Net savings
			Capital transfers
			Investment grants
			Other capital transfers
			Net lending/borrowing
			Memorandum items: loans, accumulated savings and public-private partnerships
			Loans
				Table 11.2. Capital account
			Accumulated savings
			Public-private partnerships
		Other memorandum items
			Research and development in health
			Education and training of health personnel
		Notes
	Chapter 12. Trade in Health Care
		Introduction
		Background and policy issues
		Basic concepts and definitions
			Economic territory
			Residence
			Rest of the world and trade in health care
			Valuation
				Box 12.1. The CIF/FOB adjustment in trade statistics
			Timing
		Imports and exports under the System of Health Accounts
			Examples of trade in health care goods and services under SHA
			Borderline issues relevant to trade in health care goods and services
			Intermediate use versus final use of health care goods and services
				Figure 12.1. The treatment of imports under SHA
		Data sources for estimating international trade in health services under SHA
			Enterprise and business surveys
			Government administrative sources (liaison offices)
			Private health insurance
			Household and tourist surveys
			Other sources
		Reporting of trade in health care goods and services under the SHA framework
			Figure 12.2. Health care goods and services from non-resident providers in the HCxHP table
			Supplementary tables and reporting
				Table 12.1. Expenditure on health care imports by function and financing scheme
				Table 12.2. Expenditure on health care exports by function and provider
		Notes
	Chapter 13. Price and Volume Measures
		Introduction
		Measurement of changes in price and volume in the SHA framework
		Inter-temporal indexes of price and volume
			Box 13.1. Laspeyres and Paasche indexes
		Market and non-market measures for health care
		Products classification for price and volume measures
		Measurement by provider industry
			Hospitals
			Residential long-term care facilities
			Providers of ambulatory health care
			Offices of other health care practitioners
			Other health care providers
			Overview of measures
				Table 13.1. Overview of indicators for volume output of health service providers (HP.1-HP.3)
		Measurement of quality changes
		Inter-country indexes of price and volume
			Box 13.2. PPP indexes
			Box 13.3. The International Comparison Programme
		Notes
	Chapter 14. Basic Accounting and Compilation Guidance
		Introduction
		Basic accounting criteria
			Comprehensiveness of coverage
			Consistency and comparability of data
			International compatibility
			Timeliness and accuracy
			Relevance
		Summary introduction to SHA compilation processes
			Step I. Understanding the national health care system under study
			Step II. Setting the boundaries of NHA and clarifying any differences between the national boundaries of the health care system and SHA boundaries
			Step III. Investigating and evaluating data sources
			Step IV. Creating a health accounts database
				Table 14.1. Provider example: hospital activity information
				Table 14.2. Source of funding example: Ministry of Health budgetary information
				Table 14.3. Detailed representation of how data entries might be stored in a database
			Step V. Background calculations and filling the tables
			Step VI. Preparing a detailed documentation of the health accounts work
			Step VII. Quality check of the results
			Step VIII. Presentation of the results (output tables, key indicators, analysis for different audiences, etc.)
		General measurement issues
			Timing
			HC. The functional classification
				Table 14.4. Allocation of institutional care to mode of provision
				Table 14.5. Consumption of medical goods non-specified by function
			HP. The provider classification
			HF, FS and FA. The financing classifications
				Box 14.1. Other selected compilation issues
			Estimation using prorating
				Some examples of utilisation keys
		Measurement issues in a special case
			Private health expenditure
		Notes
	Chapter 15. Presentation of Results, Tables and Basic Indicators
		Introduction
		The health accounts report
			Health accounts tables
		HA. time series
			Table 15.1. Selected examples of indicators used in health care analysis
			Box 15.1. An example of an indicator on levels of care
				Expenditure on health care by financing schemes and a selection of providers of care and functions
		Using HA with other health system information
		Country background
		Metadata and data sources
		Quality checks
		National, regional and international databases
		The selection of tables presented in this chapter
			Notes
			Table 15.2. Expenditure on health care by financing schemes and functions of care
			Table 15.3. Expenditure on health care by health care providers and functions of care
			Table 15.4. Expenditure on health care by financing schemes and health care providers
			Table 15.5. Expenditure on health care by revenues of financing schemes and financing schemes
			Table 15.6. Expenditure on health care by financing agents and financing schemes
			Table 15.7. Expenditure on health care by factors of provision and health care providers
	References
	Annex A. Relationship of the ICHA to Other Classifications
		Figure A.1.1. Correspondence between classifications of the SNA/ESSPROS and SHA
		Table A.1.1. SNA and ESSPROS health care aggregates related to consumption
		Table A.1.2. Government outlays on health (COFOG) according to categories in Austria, 2009 (in million EUR)
		Table A.1.3. SNA Health care aggregates by provider industry
		Table A.1.4. SNA and ESSPROS health care aggregates related to financing
		Table A.1.5. Cross-check of the classification of health care functions (ICHA-HC) with SNA classifications
		Table A.1.6. Correspondence between classification of health care functions (ICHA-HC) and COFOG and COICOP-Households
		Table A.1.7. Correspondence between classification of health care functions (ICHA-HC) and CPC
		Table A.1.8. Definitions of the functions of social protection (ESSPROS)
		Table A.1.9. Correspondence between classification of health care functions (ICHA-HC) and ESSPROS
		Table A.1.10. Correspondence between classification of health care providers (ICHA-HP) and ISIC
		Table A.1.11. Correspondance between classification of financing schemes (ICHA-HF) and institutional sectors of SNA (examples)
		Table A.1.12. Correspondence between classification of health care providers (ICHA-HP) and institutional sectors of SNA (examples)
	Annex B. The Relationship between SHA and SNA
		Figure B.1.1. SHA 2011 information set
		Figure B.1.2. Links between the System of National Accounts (SNA) and the System of Health Accounts (SHA)
		Box B.1.1. Final consumption expenditure and actual final consumption of households
		Equation 1. Goods and services accounting identity
		Figure B.1.3. Health supply and use tables (H-SUT)
		Table B.1.1. Health supply table (H-ST)
		Table B.1.2. Health use table (H-UT)
		Box B.1.2. T-Account
		Box B.1.3. Interpreting expenditure by financing schemes as an aggregation of transactions
			Voluntary and mandatory insurance
		Box B.1.4. Intermediate consumption
		Table B.1.3. Production and generation of income account of health providers
		Table B.1.4. Secondary distribution and use of income accounts
	Annex C. Health and Health Associate Professionals and ISCO-08
		Table C.1.1. ISCO-08 structure for health professionals and health associate professionals
	Annex D. Financing of Health Systems – Supplementary Tools
		Table D.1.1. Classification of financing agents
		Table D.1.2. Revenues and expenses of governmental health financing schemes (HF.1.1)
		Table D.1.3. Revenues and expenses of governmental health financing schemes (HF.1.1)
		Table D.1.4. Total health-related revenues and expenses of government
		Table D.1.5. Account of households’ health-specific transfers and net financing out of own resources
		Table D.1.6. ICHA-HF classification of health care financing in SHA 1.0
	Annex E. Classifying Health Care Products
		Box E.1.1. An example of the possible level of detail in wound dressings and other medical non-durables
	Annex F. Medical Classifications
		Table F.1.1. International Classification of Primary Care (ICPC-2)
		Table F.1.2. Anatomical Therapeutic Chemical (ATC)
		Table F.1.3. International Shortlist for Hospital Morbidity Tabulation (ISHMT)
		Table F.1.4. Global Burden of Disease (GBD)
	Annex G. International Standards and Classifications of Trade and Tourism
		Figure G.1.1. The four modes of supply for trade in health services as defined by GATS
		Table G.1.1. Health services under the EBOPS 2010 classification