Rolling out of SHA 2011 and related Issues

Rolling out of SHA 2011 and related Issues A proposed approach Chandika Indikadahena Department of Health governance & financing, WHO, Geneva indikadahenac@who. int 1| OECD (Korea), APNHAN September 2 -3, 2015 – Seoul, Korea

Health accounting Then and Now Then l Health accounting (SHA 1. 0) – Health expenditures only l Project approach – T-(2+) – ‘Rounds’ Now l Health Accounting and policy analysis (SHA 2011) – Health expenditures, more disaggregation (disease, inputs) and links with other data (macroeconomy and health) l Routine production – T-1 – Time trend analysis l NHA report – limited use l Annual Health Sector review and report l National Health Accounts + Subaccounts l Health accounts + Distribution by disease 2| OECD (Korea), APNHAN September 2 -3, 2015 – Seoul, Korea

Transitions I • THE CHE • aggregate adjustment to CHE and Capital spending • Easy transititons • Providers (HP) – Primary and secondary separated; detailed Ambulatory care • Functions (HC) – a separate Prevention class introduced • Factors of provision (FP) – Different perspective on Resource costs (SHA 1. 0); Capital excluded; CFC better defined • Beneficiaries – more detailed 3| OECD (Korea), APNHAN September 2 -3, 2015 – Seoul, Korea

Transitions II 4| New concepts / classifiactions • Financing schemes HF • ‘Public – Private’ replaced by ‘compulsary & voluntary’ • Revenues of Schemes (source Revenue of receiver); • More attention paid for external resources (Direct & Indirect) • Capital goods HK • Extended concept of HC. R. 1 (SHA 1. 0) • Closer to SNA concepts • E&T, R&D as Memorandom items OECD (Korea), APNHAN September 2 -3, 2015 – Seoul, Korea

Consequences for data collection l Some classes change their contents – HF, FS, HC. 6 l Some classes change their position – HP. 4 and higher, some FP classes l New variables introduced (HK details) 5| OECD (Korea), APNHAN September 2 -3, 2015 – Seoul, Korea

Target l Shifting to SHA 2011 should not mean losing SHA 1. 0 information available – SHA 1. 0 data can/should be converted to SHA 2011 data l Objective is to produce at least 15 year time series (2000 -2014) of key health financing information (FS, FS. RI, FA, HF) • WHY? to inform policy makers • • 6| sustainability and predictability of funding; government commitment; efforts towards pooling-mechanisms HOW? • by collecting data from the largest two financing actors (Mo. H and households) OECD (Korea), APNHAN September 2 -3, 2015 – Seoul, Korea

Challenges : Backcasting l Easy for existing classifications – Eg. recoding classes l Could be difficult: – For other classifications (or parts) • In case some small items are to be deleted; the data might be difficult to track for earlier years – For new classifications? • Lack of data (new variables were not collected in the past) • Time constraints (digging out data for the past is time consuming) 7| OECD (Korea), APNHAN September 2 -3, 2015 – Seoul, Korea

WHO recommendations l Use SHA 2011 – standard methodology (SHA 2011) – Preferably using HA tools (supports full disease distribution) l yearly health accounts production – data used for annual reviews and budget planning processes – Tools help producing reports l advantages – better data quality (limited human manipulation) – transparency – consistent & harmonized data: across time & countries; by disease l Migration of earlier years to SHA 2011 l 8| To have a 15 year time series OECD (Korea), APNHAN September 2 -3, 2015 – Seoul, Korea

EXPENDITURE BY DISEASE l technically more rigorous than tracking expenditure on one disease only: – standard way to allocate shared expenditures such as health facility expenditures where interventions are being delivered l ensures consistency with TOTAL health expenditure l minimizes multiple parallel data collection initiatives (Saves time/resources) => More value for money (more technically rigorous estimates, at a lower cost) 9| OECD (Korea), APNHAN September 2 -3, 2015 – Seoul, Korea

Why Production Tool (HAPT)? l built in SHA 2011 classifications and beyond – – Flexibility within the framework Supports expenditure by disease (ICD – GBD) Built-in survey questionnaires Promotes Transparency l systematic / qualitative approach – – setting up the accounts data collection mapping them consistency across the years Built-in QC Reduces human errors l sustainable approach – replication of health accounts studies (stability over time) - faster – Institutional memory (addresses staff turnover) – Promotes institutionalization of HA production 10 | OECD (Korea), APNHAN September 2 -3, 2015 – Seoul, Korea

Reports Graphs & tables facilitate checking of results 1) Possibility to sketch expenditure flow by • • data source to send to the data providers; disease to send to the programs; type of provider to send to health care facilities; financier to send institutions (health insurance) or associations (NGOs) • Involves programs focal points; supports access to their expenditure data; helps validate the results 2) Possibility to produce tables per disease/type of provider/ funder/purchaser crossed with inputs or functions etc. • QCs check the coding against knowledge of the system 11 | OECD (Korea), APNHAN September 2 -3, 2015 – Seoul, Korea

ADDITIONAL VALIDATION l Validate against previous years – Conversion of old SHA 1. 0 studies l Compare with averages of regions / income level HEALTH ACCOUNTS REPORTS l Reports are supported with outputs of M 6 of HAPT: – flow of funds chart + standard tables + metadata + QCs l We propose to reduce textual contents in traditional reports ; which sometimes are not policy relevant 12 | OECD (Korea), APNHAN September 2 -3, 2015 – Seoul, Korea

Our Aims are … 1. Improved methodology : including expenditure by disease 2. Improved production process : yearly & timely data 3. Improved quality of data : more systematized process 4. Improved use of results : integrated in policy process 13 | OECD (Korea), APNHAN September 2 -3, 2015 – Seoul, Korea