1. OECD/NBS Workshop on national accounts 27-31 October 2008 Paris Towards measuring the volume of health and education services Draft OECD Handbook Paul Schreyer, OECD/STD

2. Contents Background General concepts Education Health Way forward

3. Background: OECD Project Strong and continued demand for output measures of education and health by policy-makers European Regulation Project started in 2005, endorsement by CSTAT Builds on previous work: Eurostat Handbook on Volume and Prices, Atkinson Report, country experiences Workshops in London (2006) and Paris (2007) Objectives: –OECD Handbook – Data development

4. Background: An old question – what is new? 1. Joint work with sector specialists Elaborated jointly with OECDs specialised networks –Network of education experts –Network of health experts Both networks have strong interest in measuring appropriate volume output

5. Background: An old question – what is new? 2: Joint treatment of temporal and spatial dimensions Education and health PPPs are of great importance to analysts PPPs and national accounts have to be consistent Handbook deals with both dimensions in parallel

6. Concepts and terminology Distinction must be made between inputs, outputs, outcomes - Best explained by way of a graph

8. If outcome indicators are used for quality adjustment, they: Should control for any other factors that affect outcome for consumers (e.g. socio-economic background of pupils, environmental impact on health)

9. Quality adjustment First and important step towards capturing quality change is the correct stratification, i.e., the comparison of products with the same or at least similar characteristics. Explicit quality adjustment may make it necessary to invoke outcomes Handbook: –Health: discussion but no proposals for explicit quality adjustment –Education: discussion and proposal for explicit quality adjustment (exam scores) for secondary-level education

10. Values and weights Current price values of non-market production = sum of costs Volumes: 1.Direct volume index =volume change of items, aggregation with cost weights 2.Deflation: apply price index to values (Quasi) price index = unit costs: costs per unit of output as opposed to costs per unit of input

11. Education – comparisons in time (1) Basic approach: Unit of output = (quality-adjusted) volume of teaching services delivered Broadly, measured as pupil (hours), the number of hours during which pupils receive teaching services But differentiation according to level of education important

12. Education – comparisons in time (2) Output-based methods Pre-primary educationNumber of pupil-hours Primary education Number of pupils, adjusted for change in pupil attainment Number of pupil hours* Number of pupils* Primary education: general Primary education: special education, e.g., for disabled pupils Note: The sub-stratification normal / special could be replaced by coefficients reflecting the extra costs for social services provided to disabled pupils Secondary education Lower secondary: general Lower secondary: special classes, e.g. for disabled pupils Upper secondary education: general + pre- technical or pre-vocational Upper secondary education: vocational Post-secondary non-tertiary education

13. Education – comparisons in time (3) Tertiary education Credits (ECTS) Full-time equivalent students* Enrolled students* Tertiary education with practical and occupation-specific programmes Tertiary education with more theoretically- based programmes Note: differentiation by field of education useful To be developed: measuring research output of tertiary education establishments

14. Education – comparisons in time (3) Volume output measures of non-market education services, France

15. Health – comparisons in time (1) Disease-based approach Increasing number of countries use disease- based approach Reflects changes in administrative practice (e.g. shift to DRG system in Germanys hospital administration) Unit of output = (complete) treatment But differentiation by type of activity important Unit of output may vary between activities

16. Health – comparisons in time (2) ISIC rev 3.1 & 4Output-based methods Hospital activities Acute Hospitals8511 & 8610(Quasi) Price index based on DRGs (cost or revenue-weighted) Direct volume index based on DRGs (cost or revenue-weighted) Direct volume index based on ICD categories (e.g., number of discharges by category with quantity-weights such as shares in hospital days) Mental health and substance abuse hospitals 8511 & 810(Quasi) Price index based on DRG-like categories (cost or revenue-weighted) Direct volume index based on DRG-like categories (cost or revenue-weighted) Direct volume index based on ICD categories (e.g., discharge numbers with quantity- weights such as shares in day care days) Number of discharges* Number of days of care* Speciality (other than HP.1.2) hospital 8511 & 8610

17. Health – comparisons in time (3) Residential care activities Nursing care facilities Note: RUGS are only used for nursing care 8519/8531 & 8710 (Quasi) Price or unit cost index based on Resource Utilisation Groups (RUGs) or equivalent (cost-weighted) Direct volume index based on RUGs or equivalents (cost-weighted) Direct volume index based on number of days of care by level of care (cost weighted) Direct volume index based on number of cases by level of care (cost weighted) Number of days of care* Number of cases/discharges* Residential mental retardation, mental health and substance abuse facilities 8519/8531 & 8720 Community care facilities for the elderly 8519/8531 & 8730 All other residential care facilities 8519/8531 & 8790

18. Health – comparisons in time (4) Medical and dental practice activities Doctor services Note: services are defined as consultation/visit/treatment depending on the typology of the country 8512 & 8620(Quasi) Price index based on number and type of service (cost or revenue-weighted) Direct volume index based on number and type of service (cost or revenue-weighted) Relevant component of Consumer Price Index if applicable** (Quasi) Price index based on average costs/revenues per service (cost or revenue- weighted) Direct volume index based on number of services (cost or revenue-weighted) Number of services* Dental services Note: number of services refers to units such as consultations, visits or treatments, depending on the typology of the country 8512 &8620Relevant component of Consumer Price Index if applicable** Direct volume index based on number of services (cost or revenue-weighted) Number of services*

19. Health – comparisons in time (5) ISIC rev 3.1 & 4Output-based methods Other human health activities Note: the list of services below is not exhaustive as other human health activities covers very heterogeneous activities Other health practitioner consultations 8519 & 8690 Direct volume index based on number of consultation by type of consultation (cost or revenue-weighted) (Quasi) Price index based on average cost or revenue per consultation (cost or revenue- weighted) Relevant component of Consumer Price Index if applicable** Number of consultations* Number of tests performed* Number of cases treated* Other outpatient visits8519 & 8690 Family Planning centres8519 & 8690 Outpatient mental health and substance abuse centres 8519 & 8690 Free-standing ambulatory surgery centres 8519 & 8690 Dialysis care centres8519 & 8690 Other outpatient multispecialty and cooperative service centres 8519/8531 & 8690 All other outpatient care centres8519/8531 & 8690 Medical and diagnostic laboratories 8519 & 8690 Home health care services8519/8531 & 8690 All other ambulatory health care services 8519 & 8690

20. Health – comparisons in time (6) Input price index and output-based price index for acute hospital services in Denmark

21. Overall effects - France Impact of output and input-based methods on total value-added, France

22. Way forward Health PPPs further developed in 2009 Completion of the chapter on health PPPs Presentation of draft to health and education experts Revision and final draft in 2009

23. Thank you!