I MPROVING ESTIMATES OF INTERNATIONAL TRADE IN HEALTH SERVICES UNDER A S YSTEM OF H EALTH A CCOUNTS Working Party on International Trade in Goods and Trade in Services Statistics November 7-9, 2011, PARIS

B ACKGROUND Key definition of health expenditure in SHA: –Includes health care goods and services provided to residents by non-resident providers –Excludes goods and services provided to non-residents by resident providers Past experience – poorly reported, no explicit reporting of services provided to non-residents, insufficient guidelines, data sources Growing importance in recent years Significant for some countries Need to better define, measure and monitor 2

C ROSS - BORDER H EALTH C ARE IN THE EU EU Directive Respect patients rights to seek healthcare abroad while preserving rights for states to manage healthcare systems Reimbursed for treatment if entitled to in own country Prior authorisation only for hospital care Covers prescription and medical goods (excl. LTC and organ transplants) Information on safety, quality and tariffs Monitoring (flows and financing) - EC Regulation 1338/2008 3

OECD T RADE IN H EALTH PROJECT 2 year project supported by EU First phase 2009/2010 – review of concepts and boundaries – links to existing frameworks (BPM6, MSITS, TSA) – country case studies (regulations, sources, recommendations) – DEU, GRC, HUN, KOR, SVN, USA Second phase 2010/2011 –Draft framework, definitions, guidelines. –Workshop and feasibility testing –Final report Parallel with SHA Revision (Chapter 12 on Int. Trade) 4

B ASIC C ONCEPTS AND D EFINITIONS Balance of Payments (BPM6/SNA08) as basis: Economic territory – national, supra-national, sub-national Residence and non-residence – households and providers - Residence vs. covered population Valuation –Consistent with SHA basic concepts (Follow SNA) –Exporting vs. importing countries valuation (in kind) Timing –Accrual basis –Reporting delays 5

E XISTING C LASSIFICATIONS AND L INKS Mode of supply of trade in services (WTO/GATS) –(1) Cross-border supply, (2) consumption abroad, (3) commercial presence (outside SHA), (4) foreign persons (partial SHA) MSITS/EBOPs classification: –International statistics responding to BoP and GATS –Health-related travel and Health services close to SHA definitions Tourist Statistics/TSA –Consumption of visitors with health/medical purpose –Provides some common concepts and definitions/ sources 6

H EALTH S ERVICES UNDER EBOPS Travel 4.2Personal 4.2.1Health-related 4.2.2Education-related 4.2.3Other 11Personal, cultural and recreational services 11.2Other personal, cultural and recreational services Health services Alternative EBOPS groupings 8 Health services = health services in travel + health services in personal, cultural and recreational services Plus: Other direct insurance Business services Other personal, cultural and recreational services n.i.e. 7

SHA C ONCEPT OF T RADE 8 Health care provider in Country A Resident in Country A Health care provider in Country B Import for final use by resident Import for intermediate use by resident provider

I MPORTS AND E XPORTS UNDER SHA Health care goods and services classified according to health care functions Personal health care : –Medical goods internet pharmacies, mail order –Tele-medicine, e-health, etc –Patient mobility : planned, unplanned care (tourists, students, workers, etc) –Health professionals abroad Collective care : –Health care insurance –Outsourcing of governance, administration, etc 9

B ORDERLINE I SSUES Cosmetic surgery – for aesthetic purposes Well-being/Spas – health-related item Illegal / unethical treatments Transport and travel costs – accompanying persons/agency costs Health-y goods Health professionals (temporary) 10

G UIDELINES FOR E STIMATING T RADE Current reporting limited but improving Common sources with BoP/SNA/TSA – detail/ adjustments needed Improvement of measurement of mutual benefit Inventory of current/potential sources Weigh up investment in resources / new sources with perceived value of trade in health Review in light of national and international obligations 11

D ATA S OURCES Business surveys - administrative/ad hoc Government administrative data – budgetary, social security funds, liaison offices Private insurance records Household and tourist surveys Associations and other bodies – insurance, NGOs Other sources - mirror statistics, non-financial data, modelling. Other BoP data sources – ITS, ITRS, etc 12

R EPORTING AND S UPPLEMENTARY T ABLES Imports included - cross-classified by Function and Financing –non-resident providers of health goods and services (HP.9) Supplementary tables –Imports (HC.I.1-7) broken down by Financing scheme (HF) –Exports (HC.E.1-7) broken down by resident provider Memorandum items –TCAM, Spa/well-being (non-health), Non-health, etc Other country specific breakdowns –Mode of supply, trading partners, population groups, patient numbers, etc 13

SHA 2011: C HAPTER 12 Background and Policy Relevance Basic concepts and definitions Classifications of trade (in health) and links to other statistical systems Imports and exports under SHA Data sources and Guidelines Reporting and Supplementary tables 14

C URRENT R EPORTING : I MPORTS

C URRENT R EPORTING : E XPORTS

For further information: 17