1. System of Health Accounts Seminar
Health Policy and Service Provider Perspective
Alan Cahill

2. Agenda Previous health expenditure data
Potential of System of Health Accounts
Additional reporting items
International indicators
Issues
Future development

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

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

5. 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

6. 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?

7. 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

8. Example 1: Analysing 2 key health accounting dimensions

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

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

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

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

13. Example 2: Filtering one dimension and analysing by another

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

15. 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

16. 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

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

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

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

20. 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

21. 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

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

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

24. 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

25. 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

26. 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

27. 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

28. 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).

29. 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

30. 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

31. Issues – Long-term care comparability
* = 2013

32. 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

33. 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

34. 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

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

36. 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

37. Thank you! Alan_cahill@health.gov.ie