System of Health Accounts Seminar 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 Future development

Previous health expenditure data Limited number of variables reported Virtually no disaggregation of health spend totality Public Private Health insurance

Previous health expenditure data No breakdown by sector No breakdown by type of care Limited breakdown by financing type Limited use for policy purposes

Potential of System of Health Accounts Tri-axial nature of SHA Very flexible to new analyses More sophisticated comparisons with other countries New indicators on health expenditure Better insights into funding decisions

Potential of System of Health Accounts Powerful policy analysis tool Compare budget allocation decisions with where money was actually spent Compare distribution of spend with other countries Do we spend more in certain areas…why? Follow spend trends over time Does spend go in same direction as policy?

Potential of System of Health Accounts Some examples of enhanced analytic capability of SHA Analysing 2 key health accounting dimensions Filtering one dimension and analysing by another Filtering one dimension and analysing by another, internationally relativities Filtering both provider and financing scheme data to create an indicator by linking with other data

Example 1: Analysing 2 key health accounting dimensions

Example 1: Analysing 2 key health accounting dimensions Health care providers by financing schemes, Ireland and OECD average, 2014

Example 1: Analysing 2 key health accounting dimensions Health care providers by financing schemes, Ireland and OECD average, 2014

Example 1: Analysing 2 key health accounting dimensions Health care providers by financing schemes, Ireland and OECD average, 2014

Example 1: Analysing 2 key health accounting dimensions Health care providers by financing schemes, Ireland and OECD average, 2014 Ireland OECD Avg.

Example 2: Filtering one dimension and analysing by another

Example 2: Filtering one dimension and analysing by another Hospitals expenditure by type of care, Ireland and OECD average, 2014

Health Care Providers (HP) – HP.1 Hospitals Example 2: Filtering one dimension and analysing by another Hospitals expenditure by type of care, Ireland and OECD average, 2014 Filter by: Health Care Providers (HP) – HP.1 Hospitals

Health Care Functions (HF) – HC.1.1, 2.1 Inpatient HC.1.2, 2.2 Day Example 2: Filtering one dimension and analysing by another Hospitals expenditure by type of care, Ireland and OECD average, 2014 Analyse by: Health Care Functions (HF) – HC.1.1, 2.1 Inpatient HC.1.2, 2.2 Day HC.1.3, 2.3 Outpatient HC.1.4, 2.4 Home-based HC.3 Long-term care HC.4 Ancillary services HC.5 Medical goods Filter by: Health Care Providers (HP) – HP.1 Hospitals

Example 2: Filtering one dimension and analysing by another Hospitals expenditure by type of care, Ireland and OECD average, 2014

Example 3: Filtering one dimension and analysing by another, international relativities

Example 3: Filtering one dimension and analysing by another, international relativities Government funded health care by function of care, Ireland and OECD average, 2014

Health Care Financing Schemes (HF) – Example 3: Filtering one dimension and analysing by another, international relativities Government funded health care by function of care, Ireland and OECD average, 2014 Filter by: Health Care Financing Schemes (HF) – HF.1 Government schemes and compulsory contributory health care financing schemes

Health Care Functions (HC) Filter by: Example 3: Filtering one dimension and analysing by another, international relativities Government funded health care by function of care, Ireland and OECD average, 2014 Analyse by: Health Care Functions (HC) Filter by: Health Care Financing Schemes (HF) – HF.1 Government schemes and compulsory contributory health care financing schemes

Example 3: Filtering one dimension and analysing by another, international relativities Government funded health care by function of care, Ireland and OECD average, 2014

Example 4: Filtering both provider and financing scheme data to create an indicator by linking with other data

Example 4: Filtering both provider and financing scheme data to create an indicator by linking with other data Government funded expenditure per hospital bed, 2014

Health Care Financing Schemes (HF) – Example 4: Filtering both provider and financing scheme data to create an indicator by linking with other data Government funded expenditure per hospital bed, 2014 Filter by: Health Care Financing Schemes (HF) – HF.1 Government schemes and compulsory contributory health care financing schemes

Health Care Financing Schemes (HF) – Example 4: Filtering both provider and financing scheme data to create an indicator by linking with other data Government funded expenditure per hospital bed, 2014 Filter by: Health Care Financing Schemes (HF) – HF.1 Government schemes and compulsory contributory health care financing schemes Filter by: Health Care Providers (HP) – HP.1 Hospitals

Linking to data collected separately – Total beds in hospitals (HP.1) Example 4: Filtering both provider and financing scheme data to create an indicator by linking with other data Government funded expenditure per hospital bed, 2014 Linking to data collected separately – Total beds in hospitals (HP.1) Filter by: Health Care Financing Schemes (HF) – HF.1 Government schemes and compulsory contributory health care financing schemes Filter by: Health Care Providers (HP) – HP.1 Hospitals

Data collection on hospital beds uses SHA classifications: Example 4: Filtering both provider and financing scheme data to create an indicator by linking with other data Government funded expenditure per hospital bed, 2014 Data 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).

Example 4: Filtering both provider and financing scheme data to create an indicator by linking with other data – A developmental indicator for discussion Government funded expenditure per hospital bed, 2014

International indicators EC Social Protection Committee Joint Assessment Framework in the area of Health Several SHA based indicators used as contextual information on resources European Core Health Indicators DG Sante State of Health in the EU OECD Health at a Glance reports

Issues – Long-term care comparability * = 2013

Issues – Long-term care comparability Long recognised internationally as major issue affecting overall comparability Multiple interpretations have been applied to the definition and boundary of long-term care Need to review Irish long-term care boundary…a good opportunity

Issues – out-of-pocket spending Limitations for international comparisons due to Shortcomings associated with the recording of private funding Estimation methods for components of private expenditure on health

Future development – iterative SHA 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 approach Increase granularity of data over time Move from 2-digit reporting to 3-digit Focus on a small number of areas each year Quality of data should always be a priority

Future development – medium term Reporting items Total pharmaceutical spend Prevention and public health services

Future development – longer term Health expenditure by Disease Spending by disease (ICD) Inpatient Outpatient Medical goods Health spending by age Revenues of health care financing schemes

Thank you! Alan_cahill@health.gov.ie