1. September 21 COSA: Health Accounts in Belgium 1 State of play at the international level and ambitions of EUROSTAT C. van Mosseveld, PhD EUROSTAT Unit F5: Health and Food Safety statistics

2. September 21 2 Content EUROSTAT Health statistics OECD-WHO-EUROSTAT Joint Questionnaire on Health Expenditure SHA Revision Process Problems and Comparability

3. September 21 3 Health statistics in Eurostat Unit F5 Food safety Health and safety at work Public health Non-expenditure Physical data of economic units Manpower data Expenditure Joint Questionnaire SHA Revision CODHIS Morb

4. September 21 COSA: Health Accounts in Belgium 4 Joint OECD-WHO-EUROSTAT Questionnaire

5. September 21 5 Background & Goals Need for data on SHA: WGPH decided to have SHA implemented SHA data are important for OECD, EUROSTAT and WHO-HQ Co-operation and co-ordination required Result: Joint Questionnaire SHA created in 2005 Reducing the burden for suppliers Increase the possibilities of national and international analysis of data Facilitate the use of the data by stakeholders

6. September 21 6 Process Starting point: tables based on the classifications of the manual (OECD, WHO PG) Each organisation informs its national counterparts Nomination of one focal point per country Only one data set to be returned Installation of IHAT responsible for communication with data suppliers Validation by either of the 3 organisations within 2 months Information exchange on all steps of the validation process Dissemination free to chose by each of the 3 organisations

7. September 21 7 Validation process For all 5 tables: internal consistency checked at all digit levels For all 5 tables the consistency is checked between identical variables at all levels of detail For every table the relative shares are presented Growth rates between 2 years can be checked Finally all data can be checked against the methodological information

8. September 21 8

9. COSA: Health Accounts in Belgium 9 SHA Revision

10. September 21 10 Background 2006 OECD, WHO and EUROSTAT: work together in SHA revision Goal is global SHA standard, manual For this: –IHAT (created for JQ) mandate revised –Consultation process to be created –Programme of work to be set up Membership: OECD, WHO and EUROSTAT Secretariat: OECD

11. September 21 11 Reasons behind revision process SHA Manual is “pilot”, first draft –Implementation started around 1999 –Now around 100 country experiences available Problems identified (consistency, boundary, etc.) Need for more flexibility and policy relevance

12. September 21 12 First step: Problem Inventory WGPH 2006 requested EUROSTAT to take stock of the problems MS face in the implementation of SHA and the use of the manual OECD and WHO conducted similar processes All answers are used in the revision process

13. September 21 13 Summary of Results of Problem Inventory Definitions and descriptions in manual are not clear leading to misinterpretations –Also requests for more examples Boundary problems e.g.: –Production, financing, final use (functions) Additional classifications may be necessary e.g. for policy needs More flexibility to respond to changes in data requests Links between SHA and SNA appreciated

14. September 21 14 IHAT: responsibilities Set up programme of work for SHA revision Distribute the subjects into units Provide the rationale behind each unit Propose the key issues to be addressed in each unit Facilitate and co-ordinate the consultation process IHAT decides based on consensus IHAT has to warrant overall consistency

15. September 21 15 IHAT: steps in the Revision Process Invitation to produce “Input papers” and comments on these Co-ordinating organisation produces “proposal for 1st IHAT draft” IHAT discusses and produces “1st IHAT draft” Invite comments from the international community IHAT discusses and produces “2nd IHAT draft” in case of consensus Lacking consensus: selected experts opinion and back to IHAT: accepting or rejecting of proposal IHAT (at senior level) submits “Draft Manual” to decision making bodies in three organisations

16. September 21 16 Possible involvement, information provided Heads of statistical authorities of all OECD and EU member and candidate and acceding countries. Ministries of Health. Experts serving as focal points for the Joint OECD-WHO- EUROSTAT Health Accounts data collection. Health accounts networks. European Commission. UNSD, OECD Statistics Directorate. World Bank, Regional Development Banks, IMF. Private experts, ………., etc.

17. September 21 17 Facilitation of Participation A tri-party website is introduced A tri-party EDG is installed Each of the 3 organisations adds its own formal and informal processes: –OECD: e.g. Health expert meeting –WHO: e.g. regional networks in the world –EUROSTAT: e.g. SHA Revision Development Group

18. September 21 18 Expected results Solutions for identified statistical problems A sound statistical system Backward comparability Better links to SNA/ESA and its classifications Possibilities to link to national classification systems Improved cross-country comparability Improved usability in framework of policy relevance

19. September 21 19 Proposed work programme Introduction Part I: Principles & Concepts Reasons for revision, new elements, overview Unit 1: Purposes & principles Unit 2: Global boundaries Unit 3: Key concepts & definitions Unit 4: Expenditure dimensions Unit 5: Types of HA Unit 6: Relationships to other statistical systems

20. September 21 20 Proposed work programme (2) Part II: ICHA Unit 7: ICHA-HC health care functional classification Unit 8: ICHA-HP health care provider classification Unit 9: ICHA-FS financing sources classification Unit 10: ICHA-HF financing schemes classification Unit 11: ICHA-HB beneficiaries classification Unit 12: ICHA-RC resources mobilised in the production of health goods and services Unit 13: ICHA-P health care products classification Unit 14: Human resources

21. September 21 21 Proposed work programme (3) Part III: Indicators, tables & compilation Unit 15: Presentation of results Unit 16: Basic accounting rules and guidelines Unit 17: Possible compilation processes Unit 18: Policy use Glossary

22. September 21 22 Time frame & remarks Proposes finalisation date: End of 2009 The new Manual should provide clear guidance for migration from SHA 1.0 to SHA 2.0 SHA revision should not discourage countries from developing NHA based on current methodologies

23. September 21 COSA: Health Accounts in Belgium 23 Comparability

24. September 21 24 Problems & solutions Problems in cross-country comparability: –10-20 years ago already known that providers, products and financing agents NOT comparable (even having the same name). –New approaches were needed For comparability goals the Functional Classification was invented, evolved as a natural solution All problems solved? No, but much more comparability is reached by using the ICHA; and much more expected by SHA II.