A System of Health Accounts 2011

522 Pages·2017·4.889 MB·English

by  Organization for Economic Cooperation and Development

A System of Health
Accounts 2011
ReviSed edition
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A System
of Health Accounts
2011
REVISED EDITION
ThisworkispublishedundertheresponsibilityoftheSecretary-GeneraloftheOECD.Theopinionsexpressedand
argumentsemployedhereindonotnecessarilyreflecttheofficialviewsofOECDmembercountries,thoseofthe
WorldHealthOrganizationorthoseofEurostatortheEuropeanUnion.
Thisdocument,aswellasanydataandmapincludedherein,arewithoutprejudicetothestatusoforsovereignty
overanyterritory,tothedelimitationofinternationalfrontiersandboundariesandtothenameofanyterritory,city
orarea.
Pleasecitethispublicationas:
OECD,EurostatandWorldHealthOrganization(2017),ASystemofHealthAccounts2011:Revisededition,
OECDPublishing,Paris.
http://dx.doi.org/10.1787/9789264270985-en
ISBN978-92-64-27097-8(print)
ISBN978-92-64-27098-5(PDF)
EuropeanUnion
ISBN978-92-79-64619-5(print)
ISBN978-92-79-64620-1(PDF)
Cataloguenumber
No.:KS-05-19-103-EN-C(print)
No.:KS-05-19-103-EN-N(PDF)
Photocredits:Coverillustration:©AdamGault/OJOImages/GettyImages.
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FOREWORD
Foreword
H
ealthcaresystemsinallcountriescontinuetoevolveinresponsetochangingdemographicsand
diseasepatterns,rapidtechnologicaladvancesandmoreandmorecomplexfinancinganddelivery
mechanisms,tonamebutafewfactors.Instrivingtowardssomeofthecommonhealthcaresystem
goalsofequity,efficiencyandeffectivenessofcare,oneofthekeyquestionsforpolicymakersis“How
muchdowespendonhealthandisitmeasuredinacomparableway?”
To meet the increasing demands of analysts and policy makers for such health expenditure
information, A System of Health Accounts (SHA)proposes a framework for the systematic
descriptionofthefinancialflowsrelatedtohealthcare.TheaimofSHAistodescribethehealthcare
systemfromanexpenditureperspectivebothforinternationalandnationalpurposes.
Since the publication of the original A System of Health Accounts by OECD in 2000 and the
subsequentWHO/WB/USAIDProducersGuideforproducingnationalhealthaccountswithspecific
applicationsinlowandmiddleincomecountriesin2003,almosttenyearsofcountryexperiencein
healthaccountinghasbeengatheredtogether.Thispromptedtheneedforanupdatetorectifysome
oftheshortcomingsapparentintheoriginalmanualbutalsoprovidedanopportunitytotakeinto
accountsomeofthenewdevelopmentsinhealthcaresystems.Withthegoalofproducingaglobal
standardinhealthaccounting,aformalcollaborativeeffortbetweenOECD,EurostatandWHOwas
agreedin2006tooverseetherevisionoftheSHAManual.
ASystemofHealthAccounts2011istheresultofafour-yearextensiveandwide-reaching
consultationprocessgatheringinputsandcommentsfromamultitudeofnationalexpertsandother
international organisations around the world.All their contributions are gratefully acknowledged.
The Manual strives to reach a consensus while also reflecting different perspectives and priorities
withintheexpandingdomainofhealthaccounts.
The publication was prepared by the International HealthAccountsTeam (IHAT), comprising
the following health accounts experts from the three organisations: Roberto Astolfi, Rebecca
Bennetts, Hartmut Buchow, William Cave, Didier Dupré, Patricia Hernández, Sandra Hopkins,
DorotaKawiorska,LucaLorenzoni,NathalieVandeMaele,DavidMorgan,CornelisvanMosseveld,
EvaOrosz,MarkusSchneider,TessaTanTorresandJensWilkensaswellascommentsonthevarious
draftsfromothercolleagues.Appreciationalsogoestotheseniormanagementofthethreeco-ordinating
organisations including Anne Clemenceau, Marleen De Smedt, David Evans, Mark Pearson, and
PeterSchererfortheirassistanceinsteeringtheSHArevisionprocess.TheManualisaco-editionof
theOECD,theEuropeanUnionandtheWorldHealthOrganization.
ASYSTEMOFHEALTHACCOUNTS2011:REVISEDEDITION©OECD,EUROPEANUNION,WORLDHEALTHORGANIZATION2017 3

TABLEOFCONTENTS
Table of Contents
Acknowledgments ......................................................... 13
Acronyms ................................................................. 15
PartI
FoundationsoftheSystemofHealthAccounts
Chapter1.Introduction ...................................................... 19
Background ............................................................ 20
DifferencesandimprovementsbetweenSHA1.0andSHA2011 ............... 21
TheroleoftheManualanditsorganisation ............................... 21
Note .................................................................. 22
Chapter2.PurposesandPrinciplesofHealthAccounts .......................... 23
Introduction ........................................................... 24
Background ............................................................ 24
PurposesandobjectivesoftheSystemofHealthAccounts2011 ................. 25
PrinciplesoftheSystemofHealthAccounts2011 ............................. 25
Analyticaluses ......................................................... 28
Notes ................................................................. 31
Chapter3.AccountingConceptsandSHAAggregates ........................... 33
Introduction ........................................................... 34
AccountingandnationalaccountingasabasefortheSystem
ofHealthAccounts ....................................................... 34
Theconsumption,availabilityanduseofhealthcaregoodsandservices ...... 35
Mainaggregatesofhealthexpenditure .................................... 38
Restoftheworld ....................................................... 42
Timeofrecording ...................................................... 43
Themeasurementofconsumptionandoutput:market
andnon-marketproduction.............................................. 44
Thetreatmentofsubsidiesandothertransferstoproviderindustries ......... 45
Theproductionboundaryofhealthcareservices ........................... 46
TherelationshipbetweencurrentexpenditureonhealthandtheSNA
componentsofconsumption ............................................. 47
Notes ................................................................. 48
Chapter4.GlobalBoundariesofHealthCare ................................... 51
Introduction ........................................................... 52
Definingcurrenthealthcareexpenditures ................................. 52
ASYSTEMOFHEALTHACCOUNTS2011:REVISEDEDITION©OECD,EUROPEANUNION,WORLDHEALTHORGANIZATION2017 5
TABLEOFCONTENTS
Theboundaryofthecurrenthealthcareexpenditureaccount ............... 56
TheboundariesoftheadditionalexpenditureaccountsofSHA ............... 62
Notes ................................................................. 68
Chapter5.ClassificationofHealthCareFunctions(ICHA-HC)..................... 71
Introduction ........................................................... 72
Healthcareconsumptionbypurpose ..................................... 72
Usesofthefunctionalapproach .......................................... 73
FeaturesofSHA2011functionalclassification ............................. 73
Rationaleofthefunctionalclassification .................................. 75
ExplanatorynotestotheICHA-HCclassificationofhealthcarefunctions ...... 84
Notes ................................................................. 116
Chapter6.ClassificationofHealthCareProviders(ICHA-HP) ..................... 121
Introduction ........................................................... 122
Conceptoftheclassificationofhealthcareproviders ........................ 122
Descriptionandguidelinesforcompilers .................................. 127
ExplanatorynotestotheICHA-HPclassificationofhealthcareproviders ...... 131
Notes ................................................................. 151
Chapter7.ClassificationofHealthCareFinancingSchemes(ICHA-HF) ............ 153
Introduction ........................................................... 154
Mainconcept .......................................................... 156
Definitionofhealthcarefinancingschemes................................ 164
ExplanatorynotestotheICHA-HFclassificationofhealthcarefinancingschemes . 166
Specificconceptualissues ............................................... 181
MainstepsinadjustingSHA1.0orNHAProducersGuideofacountrytoSHA2011
accountingofhealthfinancing ........................................... 190
Notes ................................................................. 191
PartII
FurtherClassifications,ApplicationsandMethodology
ConcerningHealthAccounts
Chapter8.ClassificationofRevenuesofHealthCareFinancingSchemes(ICHA-FS) . 195
Introduction ........................................................... 196
Mainconcept .......................................................... 196
Definitionofrevenuesofhealthcarefinancingschemes ..................... 197
ExplanatorynotestotheICHA-FSclassificationofrevenues
ofhealthcarefinancingschemes ......................................... 198
Specificconceptualissues ............................................... 204
SHAtablesonrevenuecollection ......................................... 206
Additionaltools ........................................................ 208
Notes ................................................................. 210
Chapter9.ClassificationofFactorsofHealthCareProvision(ICHA-FP) ............ 211
Introduction ........................................................... 212
Mainconcept .......................................................... 212
6 ASYSTEMOFHEALTHACCOUNTS2011:REVISEDEDITION©OECD,EUROPEANUNION,WORLDHEALTHORGANIZATION2017
TABLEOFCONTENTS
Notesrelatedtotheclassificationandselectedtypesofclasses ............... 213
ExplanatorynotestotheICHA-FPclassificationoffactorsofhealthcare
provision .............................................................. 215
Notes ................................................................. 223
Chapter10.HealthSpendingbyBeneficiaryCharacteristics ...................... 225
Introduction ........................................................... 226
Background ............................................................ 226
Analyticaluses ......................................................... 228
Possibleframeworkforanalysingexpendituresbybeneficiaries .............. 230
Scopeofhealthexpendituresconsideredinanalyses
bybeneficiarycharacteristics ............................................ 231
LinkagetomainSHAestimates........................................... 233
Classificationsofbeneficiaries ........................................... 233
Possiblemethodologicalapproaches ...................................... 241
Notes ................................................................. 244
Chapter11.CapitalFormationinHealthSystems ............................... 247
Introduction ........................................................... 248
DefinitionofgrosscapitalformationinSHA................................ 248
Grossfixedcapitalformation ............................................ 248
Changesininventoriesandacquisitionslessdisposalsofvaluables ........... 259
Differentapproachestotheestimationofgrosscapitalformation ............ 260
TheconsumptionoffixedcapitalinSHA .................................. 262
Capitalaccount ........................................................ 263
Othermemorandumitems .............................................. 267
Notes ................................................................. 270
Chapter12.TradeinHealthCare.............................................. 273
Introduction ........................................................... 274
Backgroundandpolicyissues ............................................ 274
Basicconceptsanddefinitions ........................................... 277
ImportsandexportsundertheSystemofHealthAccounts ..................... 284
Datasourcesforestimatinginternationaltradeinhealthservices
underSHA ............................................................. 288
ReportingoftradeinhealthcaregoodsandservicesundertheSHAframework . 296
Notes ................................................................. 298
Chapter13.PriceandVolumeMeasures ....................................... 301
Introduction ........................................................... 302
MeasurementofchangesinpriceandvolumeintheSHAframework ......... 302
Inter-temporalindexesofpriceandvolume ................................ 304
Marketandnon-marketmeasuresforhealthcare........................... 306
Productsclassificationforpriceandvolumemeasures ...................... 307
Measurementbyproviderindustry ....................................... 309
Measurementofqualitychanges ......................................... 312
Inter-countryindexesofpriceandvolume ................................. 314
Notes ................................................................. 318
ASYSTEMOFHEALTHACCOUNTS2011:REVISEDEDITION©OECD,EUROPEANUNION,WORLDHEALTHORGANIZATION2017 7
TABLEOFCONTENTS
Chapter14.BasicAccountingandCompilationGuidance......................... 319
Introduction ........................................................... 320
Basicaccountingcriteria................................................. 320
SummaryintroductiontoSHAcompilationprocesses ....................... 321
Generalmeasurementissues............................................. 329
Measurementissuesinaspecialcase ..................................... 337
Notes ................................................................. 338
Chapter15.PresentationofResults,TablesandBasicIndicators.................. 339
Introduction ........................................................... 340
Thehealthaccountsreport .............................................. 341
HAtimeseries ......................................................... 346
UsingHAwithotherhealthsysteminformation ............................ 350
Countrybackground .................................................... 350
Metadataanddatasources .............................................. 350
Qualitychecks ......................................................... 351
National,regionalandinternationaldatabases ............................. 351
Theselectionoftablespresentedinthischapter ............................ 352
Notes ................................................................. 352
References................................................................. 371
AnnexA.RelationshipoftheICHAtoOtherClassifications....................... 380
AnnexB.TheRelationshipbetweenSHAandSNA .............................. 416
AnnexC.HealthandHealthAssociateProfessionalsandISCO-08................. 444
AnnexD.FinancingofHealthSystems–SupplementaryTools ................... 447
AnnexE.ClassifyingHealthCareProducts ..................................... 462
AnnexF.MedicalClassifications .............................................. 497
AnnexG.InternationalStandardsandClassificationsofTradeandTourism ....... 509
Tables
3.1. RelationshipbetweenSHAcurrentexpenditureonhealth
andSNAterminology ................................................ 48
4.1. SelectedborderlinecasesoftheSHAcoreaccountingframework .......... 66
5.1. Classificationofhealthcarefunctions ................................. 83
5.2. PreventiveandpublichealthcomponentsinSHA1.0andSHA2011 ........ 105
5.3. TCAMentriesasareportingitemclassHC.RI.2 .......................... 112
6.1. Classificationofactors/organisationsinhealthcareprovision
andhealthsystemdimensions........................................ 126
6.2. Classificationofhealthcareproviders ................................. 130
7.1. KeyhealthfinancingconceptsandclassificationsinSHA2011
andSHA1.0/ProducersGuide .......................................... 159
7.2. Maincriteriaofhealthcarefinancingschemes .......................... 163
7.3. Classificationofhealthcarefinancingschemes ......................... 165
7.4. ICHA-HFinSHA2011incomparisontoSHA1.0 ......................... 166
7.5. Expenditurebysocial,compulsoryprivateandprivatehealthcare
financingschemes .................................................. 182
8 ASYSTEMOFHEALTHACCOUNTS2011:REVISEDEDITION©OECD,EUROPEANUNION,WORLDHEALTHORGANIZATION2017