1 OECD Health Data: future directions of work OECD World Forum on Key Indicators 10 th November 2004 Manfred Huber, OECD Social Policy Division, Directorate for Employment, Labour and Social Affairs

2 Outline of presentation Background to OECD data collection on health Structure and guiding principles of OECD Health Data Challenges of future data development work at the OECD Secretariat Role of the OECD manual A System of Health Accounts Other priority areas for future work International co-operation Conclusions

3 Background (1) : Challenges to health care systems, common in OECD countries Affordable cost today and sustainable financing tomorrow Population access to health care services and adequate coverage of services Increasing value for money in health care systems Improving quality and safety Strengthening of prevention and health promotion

4 Background (2): rising demand for health data Health care high on the agenda of public spending policy (and a key concern for citizens, - as are health issues in general) More than 25 years of data collection and analysis at OECD on health and other social spending (e.g. “The Welfare State in Crisis” 1980) International statistical guidance has long been lacking behind other social and economic fields. Regular annual collection of OECD Health Data since 1991.

5 The structure of OECD Health Data 1. Health status 2. Health care resources 3. Health care utilisation 4 Health expenditure 5. Health care financing 6. Social Protection 7. Pharmaceutical market 8. Non-medical determinants of ehalth 9. Demographic References 10. Economic References

6 Inputs to Health Services (Part 2) Health Expenditure (Input volumes X prices) Utilization of Services (Part 3) Health Status (Part 1) Social Welfare and Individual Utility Non-medical Determinants (Part 8) The Production of Health - Related Welfare The Flow of Health Expenditure Health Expenditure and Financing (Taxes, Insurance, Out-of- Pocket) (Part 4, 5) Health Expenditure (Utilization volumes X prices) A model for understanding OECD Health Data Budgeting Decisions Purchasing Decisions Demographic (Part 9) & Economic (Part 10) References Overall social protection (Part 6)

7 Main challenges for a system of international health care statistics (1) Degree of international harmonisation of health care statistics (resources, activities, outcome measures) still low....and there are important gaps on national level E.g. health care data can be difficult for: private sector activity; devolved health care systems (different information systems across regions) Uneven coverage between hospital activity and ambulatory activity

8 Main challenges for a system of international health care statistics (2) Better integrated system on national and international level need to be developed in parallel Examples of national “stock-taking” exercises: Australia, Canada, Germany Major challenge: where are the limits of aggregate data versus comparable sets of micro data? Which role should harmonised population surveys play in the future? (not currently on OECD agenda)

9 Tobacco Consumption, 1985 and Incidence of Lung Cancer, 2000 Source: OECD Health Data 2004, 3rd edition

10 Focus for future work on SHA and health care statistics (1) Health Accounts and Health Care Activity Data Expenditure classifications: refinements and addendums to current classifications Indicators connecting health expenditure and non- monetary data Output and price measurement Long-term care expenditure and beneficiaries (2) Indicators of quality of health care

11 What is the OECD System of Health Accounts (SHA)? Framework for accounting rules and classifications ICHA: International Classification for Health Accounting: –Functions (ICHA-HC) –Providers (ICHA-HP) –Financing agents (ICHA-HF) Proposed set of two-dimensional standard tables ICHA-HC and ICHA-HP provide interface for linking with (non-monetary) resource and activity data

12 Main objectives of the SHA - from a health policy perspective To provide a framework for analysing health systems –overall level of spending on health care –changes in the composition of spending –monitoring factors of growth in health spending –differences across countries in expenditure growth and composition of expenditure To provide a tool to monitor effects of health care reforms

13 Trend in Out-of-pocket Spending, Source: OECD Health Data 2004, 3rd edition

14 SHA and health accounting practice Pilot implementations of the SHA started in ; ongoing iterative process to harmonise data reporting to OECD Health Data SHA working and technical papers documenting results Several European Union projects related to SHA have been launched or are planned WHO/World Bank/USAID Guide to producing health accounts SHA now serves as an international “quasi-standard”

15 Status of SHA implementation

16 Overall Assessment of Pilot Implementations The implementation of the SHA is feasible: major challenge is resource constraints in countries The SHA framework contributed to substantial improvement in the comprehensiveness and consistency of health expenditure estimates Current pilot implementations still have smaller or greater departures from the recommendations of the OECD SHA Manual, which themselves need be backed by further guidance and more detail in several cases

17 Hospital and In-patient Curative-rehabilitative Expenditure

18 Major challenges of implementing SHA (I) - Estimating total expenditure Boundary of health care (ICHA-HC) in an internationally harmonised way (e.g. long-term-care) Accounting for expenditure by all the financing agents defined by the SHA (e.g. non-profit organisations, out-of- pocket) To include all primary and secondary providers of health care (e.g. army, companies, schools) Application of standard methods for valuation of health services

19 Major challenges of implementing SHA (II) - Applying the functional classification Defining more precisely the boundary between health and health related functions (e.g. public health) Separating health - health related and non-health activities in the case of complex institutions (e.g. university clinics, public health centres) Applying functional classification in the case of multi- functional health care organisations (e.g., in patient care, day care, out patient care within hospitals)

20 Other Priority Areas for Future Work (I) Statistics on health employment: next steps Improve data collection on key professions: physicians and nurses Analyse feasibility of comprehensive estimates of employment in health care (from national examples) Co-operation with Eurostat project “Health labour accounts”, linking employment data to SHA provider classification (ICHA) Conceptual work on utilising ISCO; estimation of part- time employment

21 Other Priority Areas for Future Work (II) Remuneration of health professions Previously collected; was among the most frequently demanded indicators Data collection will resume in 2005 Physicians: both salaried and self-employed; general practice and specialists Nurses: start with data from hospital setting

22 Other Priority Areas for Future Work (III) Statistics on health resources and utilisation Further develop set of medical technology indicators (move towards joint list with Eurostat and WHO?) Focus on statistics on surgical procedures (in patient and day cases) for shortlist of procedures Co-operation with Eurostat and WHO project on “Hospital data” (activity data, resources, and hospital financing) Major challenge: international harmonisation of procedure statistics and their common use in countries (not in OECD portfolio)

23 Other Priority Areas for Future Work (IV) Data on long-term care services and expenditure Basis data set on expenditure and recipients from the OECD Study on Long-term Care (under OECD Health Project) Work will continue in 2005 on methodological framework and basic data set Expected outcome: Improved guidelines for health accounting Better comparable health expenditure estimates Routine data collection on services and expenditure to monitor health and social policies for ageing societies

24 Expenditure on long-term care, 2000 Source: OECD Long term Care Policies for Older People (forthcoming)

25 Initiatives to strengthen international co-operation Exchange of letters with Eurostat to intensify co- operation on health statistics Exchange of letters with Eurostat to intensify co- operation on health statistics Ultimate goal of joint data collection instruments with Eurostat and WHO in the future based on successful models in other areas (e.g. education, energy) This will contribute to better harmonised data reporting with non-OECD countries as well (e.g. health accounts in World Health Report and World Bank databases) Dissemination strategies -- and needs for additional data modules -- may differ across organisations

26 SHA influence on revision of international statistical systems 2007 revision of ISIC: move health industry from Group level to Division level (for which international comparability is required) Current revision of Central Product Classification (CPC): improve definition and breakdown of services with the help of the ICHA-HC and ICHA-HP classifications Health professions in ISCO: advocate use of ISCO for estimating human resources for health care Missing link: up-to-date internationally agreed system of procedure classifications for health interventions

27 Conclusions Improvements in international health care statistics involve substantial investments at national level Harmonised reporting to international data collections driver to identify and fill information gaps in countries There are clear limits to “ex-post harmonisation” of data in the health care arena due to large differences in the structure of health care systems and reporting mechanism Development of new data initially restricted to subset of countries; broad coverage of countries can take many years

28 Data dissemination Annual electronic publication on CD-ROM (in collaboration with IRDES, a French research institute in health economics) Available for download via SourceOECD “Health at a Glance” (2003; third edition next Oct. 2005) OECD Health Data on the Internet: –Access to frequently asked data, all Sources and Methods, etc. –Interim updates (two per edition)

29 An invitation to explore OECD Health Data 2004

30 For more information