1. Analysis of trends in GDP and Health Expenditure in OECD countries, with a focus on Health Insurance
Roberto ASTOLFI and Luca LORENZONI
Training Course on Social Health Insurance 2009
National Health Insurance Corporation
Seoul, 17 June 2009

2. Background
The System of Health Accounts proposes an integrated system of comprehensive and internationally comparable accounts and provides a uniform framework of basic accounting rules and a set of standard tables for reporting health expenditure data

3. Background (cont)
The goal of the collaboration between OECD, EUROSTAT and WHO is to reduce the burden of data collection for the national authorities responsible for the provision of statistical information
This joint effort also increases the use of international standards and definitions

4. Methods
In 2005 the 3 organisations agreed to intensify their collaborative actions through a joint data collection based on:
a functional classification of health care (HC)
a classification of health care financing (HF)
a classification of health care providers (HP)
a classification of financing sources (FS)
a classification of resources (RC)

5. Methods (cont) Core tables (minimum requirement to countries):
HC x HP: CHE by function of care and provider
HC x HF: CHE by function of care and financing agent
HP x HF: CHE by provider and financing agent
CHE: Current Health Expenditure

6. Joint data collection 2009 Timing
2009 JHAQ sent to health contacts on 15 December 2008
Completed by 31 March 2009 by 27 countries
First validation by mid-May 2009
JHAQ: Joint Health Accounts Questionnaire

7. Joint data collection 2009 Preliminary results - Indicators
Health expenditure (HE) as a share of GDP
total; public; private
Current HE as a share of actual final consumption
Private HE components analysis
Population covered by private insurance

9. Preliminary results - one
OECD countries devoted for the fifth consecutive year about 8.9% of their GDP to health spending
The share of health spending varies considerably across OECD countries, ranging from less then 6% in Turkey and Mexico up to 16% in the United States
Also the share of public HE varies considerably across OECD countries – more than three-fold difference between France and Mexico

12. Preliminary results - two
Evidence of a positive association between GDP per capita and HE per capita across OECD countries
Association is stronger among OECD countries with a low GDP per capita
However, there is a wide variation since GDP is not the sole factor influencing HE levels

14. Preliminary results - three
The share of health goods and services to all goods and services consumed by individuals in the economy is more refined measure of relative importance of health spending
The average share of actual consumption allocated to health in OECD countries is almost 13%, with 90% of countries devoting more than 10% of consumption to health
Only Poland, Mexico, and Turkey are below the 10% threshold, while US, Switzerland, Luxembourg, and Norway above 15%

16. Preliminary results - four
The average share of private health expenditure to total health expenditure is stable over time for the OECD countries and equals 27-28%
In 2007, it ranges between 54% for United States and 9% for Luxembourg

17. Classification of sources of funding
ICHA Code
Sources of funding
HF.1
General government
HF.1.1
General government excluding social security funds
HF.1.1.1
Central government
HF.1.1.2
State/provincial government
HF.1.1.3
Local/municipal government
HF.1.2
Social security funds
HF.2
Private sector
HF.2.1
Private social insurance
HF.2.2
Private insurance enterprises (other than social insurance)
HF.2.3
Private household out-of-pocket expenditure
HF.2.4
Non-profit organisations serving households (other than social insurance)
HF.2.5
Corporations (other than health insurance)
HF.3
Rest of the world

19. Preliminary results - five
Out-of-pocket expenditure is the most important component of private health expenditure (PHE) in almost all OECD member States
However, in the US, France, and the Netherlands the share of Private insurance expenditure to PHE is the highest
Non-profit institutions play an important role in UK and Turkey, while corporations are important in Australia and Slovak republic

20. Private health insurance coverage, by type 2007
Primary
Complementary
Supplementary
Duplicate

21. Preliminary results - six
The share of population covered by Private Health Insurance (PHI) varies considerably across OECD countries. Seven countries report private coverage for over half of the population: Netherlands; France; Belgium; Canada; US; Luxembourg; and Ireland
PHI plays a diversity of role in the health system. Primary cover for certain population groups in the United States and Germany

22. Preliminary results - seven
It offers to 88% of the French population complementary insurance to cover cost sharing applied in the social security system
The Netherlands has largest supplementary market, followed by Canada whereby PHI pays for prescription drugs and dental care that are not publicly reimbursed
Duplicate markets providing faster private-sector access to medical services where there are waiting times in public systems are the largest

23. Thank you for your attention!
For further information, please visit our websites:
System of Health Accounts:
Revison of the System of Health Accounts:
OECD-Eurostat-WHO Joint SHA Data Collection:
OECD Korea Policy Centre: