Methodological improvements of SHA: Examples of good practice

Markus Schneider

Bruxelles, ONSS, Place Victor Horta, 20-21 septembre 2007

Organisé par Service public fédéral Sécurité sociale - SPP Politique scientifique - HIVA Katholieke Universiteit Leuven

Outline

• Concept of SHA1.0 + PG

• Criteria of good practice and improvements

• Examples: NL, PT, D, CZ, F

• Tools

• Requests on SHA2.0

Concept of SHA1.0

Consumers

Providers* Financing Agents**

Patient characteristics: Age, Gender, Diseases

Provider characteristics:

ICHA-HP

Financing Agent characteristics:

ICHA-HF

Expenditures: ICHA-HC Prices, Volumes

TCHE(HF)=TCHE(HC)=TCHE(HP) under certain conditions

Health personnel

* incl. consumers, financing agents as providers ** incl. consumers, providers as financing agent

below the line: Health related functions ICHA-HC.R

Concept of SHA1.0+PG

Consumers

Providers* Financing Agents**

Patient characteristics: Age, Gender, Diseases

Provider characteristics:

ICHA-HP

Financing Agent characteristics:

ICHA-HF

Expenditures: ICHA-HC Prices, Volumes

TCHE(FS)=TCHE(HF)=TCHE(HC)=TCHE(HP)=RC under certain conditions

Resource Cost RC Health

Personnel

* incl. consumers, financing agents as providers ** incl. consumers, providers as financing agent

Financing Sources FS

below the line: Health related functions ICHA-HC.R

Actors, Activities, Inputs SHA1.0+PG

Actors Providers: ICHA-HP

Financing agents: ICHA-HF, FS

Consumers: Age, Gender, Diseases, BOD

Activities Expenditures: ICHA-HC, ICHA-HC.R

Volumes

Prices

Inputs Health personnel (Health, Non-Health),

Resources Costs (RC)

Criteria of good practice

• SHA1.0 Principles:– Comprehensiveness, Consistency (internal, over-time),

Compatibility

• Organisation of statistical process: Input, Throughput, Output (Metainformation, National Manual)

• Transparency (Metainformation, Reporting Standards, National Manuals)

• International comparability (external consistency)

Methodological Improvements

• Related to the compilation of the SHA Cube Health care and non health care production (Netherlands)Integration of human resources and cost of illness (Germany, Czech Republic)

• Related to the compatibility of SHACo-ordination with sectors of SNA (Portugal)

• Related to international comparabilityConcept of relative unit cost, EUCOMP AC/CC, TOSHA

• Related to the concept of SHAValue-added concept, Health-added concept, Financing concept

Example: NL• Objectives: internal consistency with other accounts SNA,

ESSPROS, multiple use,

• Responsibility: CBS, Health Statistics

• Approach: Provider side (HC, HCR, NHC), reconsiliation with financing side, Including Social Care

• Comprehensiveness: SHA Cube, Pilot compilations of Health personnel and Prices, Cost of Illness accounts (RIVM)

• Timeliness: 1998-2005

• Issues: International comparability HF2.3, HC.3, HC5.2, Transparency (Non-health care),

Example: PT• Objectives: internal consistency with SNA, • Responsibility: INE, SNA department • Approach: Reconsiliation SNA + Provider side +

reconsiliation financing side• Comprehensiveness: SHA Cube, Pilot

compilations of Prices • Timeliness: 2000-2005• Issues: International comparability: Outpatient

care, Transparency of private provision, health consumption of tourists

PT: Consolidation with SNATransitional Matrix I (Output side) - HP.1 - Hospitals Unit: 103 €

Providers (ICHA-HP)

General Government

sectorCorporations

Public and private social

insurance subsystems

Providers belonging to NPIS

Total

3.001 3.001331 27 78 436

1 1

3.001 332 27 78 3.438Total

Output

HP.1HP.1.1HP.1.2HP.1.3

Sources of information

Unit: 103 €

Providers (ICHA-HP)

IGIF – other state

institutionsTotal

SAMS - Co-financed expenditure (social benefits in kind) +

production

Total

SAMS – Financing of

insurance companies

TotalIGIF – Health

feesTotal

965 9653 2.055 11 24 3 45 18 66 2.1901 57 0 1 0 0 0 3 610 210 3 4 0 2 1 7 2234 3.287 13 29 3 46 19 76 3.438

HF. 2.2 HF. 2.3

Total

HP.1.3Total

Transitional Matrix II (Financing side) - HP.1 - Hospitals

HP.1HP.1.1HP.1.2

HF.1.1 HF. 2.1Sources of information

Source: INE 2006

Example: DE• Objectives: indepence of other accounts, limited links with

other accounts SNA, ESSPROS,

• Responsibility: StBA, Health Statistics

• Approach: Financing side + reconsiliation providers side

• Comprehensiveness: SHA Cube, HLA account incl. Health Industries, Cost of Illness accounts,

• Timeliness: SHA 1992-2005, HLA 1995-2005, COI 2000, 2002, 2004

• Issues: International comparability HF2.3, Transparency (press brochures instead comprehensive tables)

DE: Linking German Health Accounting Systems

NHA HLA COIA

ProvidersCFHMS-HP

international

ICHA-HP

EuComp(Actors)

national

WZ03

Source: Cordes 2004, StBA

Example: CZ• Objectives: indepence of other accounts, limited links

with SNA, • Responsibility: CZSU, Health Statistics• Approach: Financing side (Individual accounts) +

reconsiliation providers side• Comprehensiveness: SHA Cube and Cost of Illness

accounts, • Timeliness: SHA 2000-2005, COI 2000-2005• Issues: International comparability HF2.3, HC.3;

Transparency ?

Results page - database

Summary of examples

NL PT DE CZ

SHA Cube y y y y

Health Personnel y y

Prices y (y)

Cost of Illness y y y

Financing Sources (y)

Tools

• Inventories: Actors, Activities and costing, Prices, Data

• Software Metadata: EUCOMP: HP Actors, HLA 1 Accounts (linked to EUCOMP)

• Software Accounts: TOSHA: SHA Cube, HLA 2 Accounts (linked to EUCOMP)

• COI: Disease List, Age classification

IHAT Common Questionnaire

TOSHA Output

TOSHA Throughput

TOSHA Input

National DatabaseFlexibility, Confidentiality, Interfaces

SH

A 1.0

So

ftw

are,

Lic

ense

Key assignment page

Compilation page

EUCOMP-ACC: International reconciliation

Health Expenditure

= Patients * Price per patient

Health Expenditure

Patients Price per Patient

_________________ = ________________ * __________________

GDP Inhabitants GDP/ Inhabitants

Expenditure ratio

Prevalence Relative unit cost

International Reconciliation: Relative unit costs

Hospital Expenditure

Hospital Patients

Price per Patient

_________________ = ________________ * __________________

GDP Inhabitants GDP/ Inhabitants

3% 20% 15%

International Reconciliation: Relative unit costs of hospital care