Draft Guidelines for the SHA 2011 Framework for Accounting Health Care Financing

Transcription

1 Draft Guidelines for the SHA 2011 Framework for Accounting Health Care Financing 13th Meeting of Health Accounts Experts, OECD, Paris 4-5 October 2011 Eva Orosz, head of Health Policy and Health Economics Department, ELTE University, Faculty of Social Sciences, Budapest

2 Overview Purposes of the Financing Guidelines Preparation of the Guidelines: a collaborative effort The structure and some key issues Further steps Issues for discussion

3 The Interim Report presents a framework of the SHA 2011 Financing Guidelines; a draft of their main elements; and proposals for further work.

4 Financing Guidelines intend to provide a more detailed explanation of the changes in concepts related to health care financing in SHA 2011; general approaches for the preparation of SHA tables relevant to health care financing; and possible tools (e.g., working tables) useful in the case of complex financing arrangements.

5 Development of Financing Guidelines is a collaborative effort The Interim Report will be discussed by a peer review group; participants of the 2011 OECD Meeting of Health Accounts Experts; countries already pilot tested SHA The Financing Guidelines (selected elements) are to be tested. New elements can be added in a step-wise approach.

6 How to use the SHA Financing Guidelines Financing Guidelines complement the relevant chapters of the SHA 2011 Manual. On the other hand, the guidelines are a stand-alone document. It is not expected that countries will implement all elements of the Financing Guidelines. Factors influencing a country s choice among the various tools are: differences in the complexity of health financing systems, health policy issues of interest, data availability and available resources.

7 Structure of the Financing Guidelines 1. The overview of the accounting of health care financing under SHA Description of the health care financing system from a health accounting point of view 3. Accounting the government s involvement in the health sector 4. The interpretation of public and private under SHA Accounting foreign aid 6. Transition from SHA 1.0 to SHA 2011 regarding the classifications of health care financing 7. Preparation of SHA 2011-based health accounts tables relevant to health care financing 8. Accounting health care financing from the perspective of the individual schemes and institutional units

8 Key issues of the Guidelines From a health policy perspective Information on health financing functions and performance of the financing system Role of the government Role of foreign aid Information on changes in institutional arrangements of health care finance Interpretation of public and private From a health accounting perspective Identification and relationships between providers of financial resources financing schemes financing agents Accounting of the basic flows: (i) revenue-raising by the financing schemes; and (ii) allocation of resources Transition from SHA 1.0 to SHA 2011 Accounting health financing from the perspective of the individual schemes and institutional units

9 The overview of the accounting of health care financing under SHA 2011 PROVIDERS EMPLOYERS CENTRAL GOV SCHEMES MINISTRY OF HEALTH OTHER MINISTRIES NGOs HOUSEHOLDS GOVERNMENT STATE/LOCAL GOV SCHEMES COMPULSORY HEALTH INSURANCE LOCAL GOV NGOs HEALTH INSURANCE FUNDS OTHER SOCIAL INSURANCE FUNDS INSURANCE COMPANIES NGO VOLUNTARY HEALTH INSURANCE HEALTH INSURANCE FUNDS INSURANCE COMPANIES HOUSEHOLDS ROW HOUSEHOLD OOP NPISH FINANCING SCHEME ENTERPRISES FINANCING SCHEMES HOUSEHOLDS NGOs HOUSEHOLDS ENTERPRISES (1) ENTERPRISES (2) All lines represent financial or in-kind resource flow ROW FINANCING SCHEMES GOV UNIT FOREIGN NGOs LOCAL NGOs

10 Description of the health care financing system from a health accounting point of view Identification of the health financing schemes Description of the functional and institutional structure of the health financing system (HF and FAs) Identification of the basic flows: (i) revenue-raising (ii) allocation of resources Identifying problem cases Clarifying the most important differences between classifications of health financing of COUNTRY (A) under SHA1.0 and SHA 2011

11 HF Identification of the health financing schemes in COUNTRY(A) (Table 2.1) ICHA-HF Social health insurance schemes Health financing schemes in COUNTRY(A) Statutory social health insurance Other health-related insurance schemes (operated by the retirement funds) Statutory long-term care insurance scheme * Participation and benefit entitlement Benefit package LTC HF Compulsory private insurance schemes Compulsory private health insurance schemes Statutory long-term care insurance scheme * Individuals with an income above a threshold can opt out of the SHI LTC

12 ICHA -HF HF.1.1 HF HF Description of the functional and institutional structure of the health financing system (Table 2.4) Health financing schemes in COUNTRY(A) Governmental schemes Central governmental schemes Special scheme for the army Special scheme for the police A national cancer prevention programme State/ regional / local governmental schemes Main financing agents in COUNTRY(A) Ministry of Health (P)* Ministry of Defence (P) Ministry of Interior (P) National Tax Authority (C)* NPISH(a) (C) State governments (C&P) FA code FA. 1.1 FA FA FA FA.4 SHA2011 Financing Agent Central government Ministry of Health Other Ministries and public units Other Ministries and public units NPISHs FA.1.2 State/ regional / local government DATA SOUR CES Data problems

13 Identification of the basic flows: revenue-raising (Table 2.5) FS.1 Government domestic revenues FS.1.1 FS.1.2 FS.1.3. FS.1. 4 FS.2 FS.3 FS.3.1 FS.3.2 FS.3.3 FS.3.4 FS.4 FS.4.1. FS.4.2. FS.4.3. FS.5 Internal transfers and Grants Transfers on behalf of specific groups Subsidies Other transfers from government domestic revenues Transfers by government from foreign origin Social insurance contributions Employee social insurance contribution Employer social insurance contribution Self-employed social insurance contribution Other social insurance contribution Compulsory prepayment (other than FS.3) Compulsory prepayment from households Compulsory prepayment from employers Other Compulsory prepayment Voluntary prepayment Voluntary prepayment from households employers FS.5 Other Voluntary prepayment FS.6 Other domestic revenues n.e.c. FS.6 Other revenues from households n.e.c. Other revenues from corporations FS.7 Other revenues from NPISHs n.e.c. Direct Foreign transfers All revenues of financing schema Total current expenditure and capital transfers by financing Operating balance HF.1 Governmental schemes x and compulsory private schemes HF.1.1 Governmental schemes x x x x x HF.1.2. Social health insurance x x x x x 1 x x x x HF.1.2. Compulsory private health x x x x x 2 insurance HF.2 Voluntary health care payment schemes x HF.2.1 Voluntary insurance x x x x x x x HF.2.2 NPISH financing schemes x x x x x x x HF.2.3 Enterprises financing x x schemes HF.3 Households out-ofpocket x x payment HF.4 Rest of the world financing schemes x x

14 Accounting the government s involvement in the health sector Functions of the government Regulation Accounting categories Governmental schemes (HF) Accounting tools (tables) HC.7xHF.1.1 HP.7.1xHF.1.1 Revenue-raising Provider of revenues FS.1xHF.1.1 FS.1xHF.1.2 FS.1xHF.2 Financing agent collecting revenues HF.1.1xFA.1 xhc.7 Pooling Purchasing Provision of services Financing agent pooling revenues Financing agent paying for services Owner of providers HF.1.1xFA.1 xhc.7 HF.1.1xHC HF.1.1xHP

15 Accounting the government s involvement in the health sector (2) Transactions by governmental financing schemes (HF.1.1) Transactions related to government health-related functions (HCR.1, HCR.2) Transactions related to resource-generation (human and physical capital and technology) Providing revenues by the government to HF.1.1. and other financing schemes (FS.1, FS.2) Transactions made as an intermediary institution (e.g., between foreign NGO and local NGOs) Non-health spending by the government units acting as financing agent

16 Interpretation of public and private under SHA 2011 Revenues from compulsory payment Revenues from voluntary payment Public financing agents (FA) HF.1. Governmental and compulsory contributory schemes HF.1 managed by public FA HF.2. Voluntary health care payment schemes HF.2 managed by public FA Private financing agents (FA) HF.1 managed by private FA HF.2 managed by private FA Public providers Private providers

17 Refinement of the categories of public and private (1) Would have been categori zed as private under SHA1.0 HF.1 HF.1.1 HF HF HF.1.3 HF.2 HF.2.1 HF.2. 2 HF.2. 3 HF.3 Financing schemes Governmental financing schemes and compulsory contributory health financing schemes Governmental financing schemes Social health insurance Compulsory private health insurance Compulsory Medical Saving Accounts (CMSA) Voluntary health care payment schemes (other than OOP) Voluntary health insurance NPISHs-financing schemes Enterprises financing schemes Households out-of-pocket payment Major expenditure aggregates Expenditure by government schemes and compulsory contributory health financing schemes (instead of public expenditure ) Expenditure by voluntary health financing schemes (instead of private expenditure) HF.4 Rest of the World financing programmes Expenditure by RoW schemes 17

18 Refinement of the categories of public and private (2) Previously, according to WHO guidelines categorized as private fund FS.1 FS.1.1 FS.1.2 FS.1.3 FS.1.4 FS.3 FS.4 FS.2; FS.7.1.1; 7.1.2; ; FS 5. FS 6 FS.7.1.3; FS ; Revenue of financing schemes Transfers from government domestic revenue Internal transfers and grants Transfers by government on behalf of specific groups Subsidies; Other transfers from government domestic revenue Social insurance contributions Compulsory prepayment (other than FS.2) Bilateral and Multilateral financial transfers and aid in kind Voluntary prepayment Other domestic revenues n.e.c Other foreign financial transfers and aid in kind Major expenditure aggregates Public and compulsory private funds spent on health care Voluntary private funds spent on health care 18

19 Accounting foreign aid Domestic resources Foreign resources GOVERNMENT NGO Domestic financing agents RoW financing agents Governmental and compulsory contributory scheme Voluntary health care payment schemes RoW financing scheme Flows of domestic resources Domestic health care provders Flows of foreign resources Foreign health care providers Flows from NGOs

20 Accounting foreign aid (2) intends to track as much as possible the route of the total foreign resource flows in the domestic health care system, includes not only health-specific aid, but an estimation (imputation) of the part of general budget aid; and other health-specific flows (without aid purposes), allows for developing a correspondence to the DAC statistics, distinguishes different types of foreign involvement (types of flows and types of institutional units, types of providers

21 Issues to be discussed: To what extent can / should SHA based NHAs use the OECD DAC database?

22 Transition from SHA 1.0 to SHA 2011: HF Distinguishing analytical units and statistical units: The categories of health financing schemes are the key analytical units of SHA 2011, concerning which data are collected from financing agents or providers including institutional units collecting the funds, if they are different from agents paying the providers

23 Transition from SHA 1.0 to SHA 2011: HF Table 6.2. Mapping HF(SHA 1.0) to Classification of Financing Schemes under SHA 2011 HF.1 HF.1.1 HF HF HF HF.1.2 SHA 1.0 SHA 2011 Default financing scheme General government General government excluding social security funds Central government HF (A) HF (B) State/provincial government Local/municipal government Social security funds HF.1.2 (A) HF.1.2 (B) HF.1.2 (C) HF.1 HF. 1.1 HF HF HF HF. 1.2 HF HF Governmental schemes and compulsory contributory health financing schemes Governmental schemes Central governmental schemes Central governmental schemes State/regional/local governmental schemes Compulsory contributory health insurance schemes Social health insurance Social health insurance HF HF. 2.1 Other financing scheme Compulsory private insurance Voluntary health insurance schemes FS 1.4 Revenues of HF Other transfers from government domestic revenue

24 Transition from SHA 1.0 to SHA 2011: FS Transfers from Government domestic revenue Internal transfers and grants Transfers by government on behalf of specific Subsidies Other transfers from government domestic revenue Transfers distributed by Government from Direct Foreign transfers Table 6.4 Mapping the FS (PG / JHAQ) categories to the categories of Classification of Revenues of Health Financing Schemes FS.1 FS.2 FS.7 FS.1.1 FS.1.2 FS.1.3 FS.1.4 FS(PG/JHAQ) FS.1 FS.1.1 FS.1.2 General government units Territorial governments All otrher public units ΣGOV ΣGOV - (GOV 5+ GOV6) GOV1 GOV2 GOV3 GOV4 GOV5 GOV6 FS.2.1; FS.2.3 FS.2.2 FS.3 Corporations and NPISHs Households Rest of the world

25 Preparation of SHA 2011-based health accounts tables relevant to health care financing Three-dimensional tables can be prepared for the following purposes: as working tables (i.e. only for technical reason) to produce HC x HF, HP x HF and HF x FS tables; analysis of the information gathered: completeness, consistency; as output tables, for analytical purpose also

26 Preparation of SHA 2011-based health accounts tables relevant to health care financing The following three-dimensional tables are proposed to prepare: Expenditure on health care by financing schemes, financing agents and providers (HF x FA x HP) Expenditure on health care by financing schemes, financing agents and health care function (HF x FA x HC) Revenues of financing schemes, by types of revenues and financing agents (FS x HF x FA)

27 Compilation tasks under different types of HF FA relationship Types of HF FA relationship One-to-one correspondence between HF(x) and FA(a) FA(a) manages two different financing schemes: HF(x) and HF(y) Compilation tasks Data collected from FA(a) can be directly filled into HFxFAxHC or HC x HF table Data on expenditure should be collected (or estimated) separately for the financing schemes managed by FA(a) (See Table 7.4). The allocation of administrative costs of FA(a) according to the financing schemes may require a specific estimation. FA(a) manages HF(x), and in addition an other social welfare scheme (e.g., in-cash benefits, such as sick leave or family allowance, etc.) Data on HF(x) should be separated from the other activities of FA(a) The HF(x)-related administrative costs of FA(a) should be estimated.

28 Accounting health care financing from the perspective of the individual schemes and institutional units Chapter 8 provides two related tools : a possible way to show the relationships between FS, HF and FA in the case of a particular financing scheme sectoral accounts (expenses and revenues for individual financing schemes, as well as individual institutional units)

29 Table 8.1 Central governmental schemes: types of revenues and FS.1 FS.1.1 FS.2 FS.6 FS.6.1 FS.6.2 FS.6.3 FS.7 Revenues of HF Transfers from Government domestic revenue (allocated to health purposes) Internal transfers and grants Transfers distributed by Government from foreign origin Other domestic revenues n.e.c. Other revenues from households n.e.c. Other revenues from corporations n.e.c. Other revenues from NPISH n.e.c. Direct Foreign transfers relevant financing agents Financing agents administering HF NCU HF FA Ministry of Health NCU Central governmental schemes FA FA FA.1.2 FA.1.9 FA.3.1 FA.4 Other Ministries and public units (belonging to central government) National Health Service Agency State /Regional / Local government other general government units Health management and provider corporations Non-profit Institutions serving households (NPISHs

30 Table 8.5 Sectoral accounts of Social health insurance schemes (HF.1.2.1) Background tables to sectoral account of HF HF related Revenues HF related Revenues Revenues and expenses of HF Social health insurance and expenses of National and expenses of Insurance schemes (Md NCU) Health Insurance Agency corporations (FA.2) Expenses Revenues Expenses Revenues Expenses Revenues Transfers from government domestic HP.1 to HP 6 FS.1 revenue (allocated to health purposes) HP.1 to HP 6 FS.1 HP.1 to HP 6 FS.1 HP. 7 Providers of health care system administration and financing FS.3 Social insurance contributions HP. 7 FS.3 HP. 7 FS.3 HP.7.1 Government health administration agencies FS.6 Other revenues n.e.c. HP.7.1 FS.6 HP.7.1 FS.6 HP.7.2 HP.7.3 Social health insurance agencies Private health insurance administration agencies Other HP.7 administration.9 agencies Net/Gross operating balance FS.7.1 Direct foreign financial transfers HP.7.2 FS.7.1 HP.7.3 HP.7.9 HP.7.2 FS.7.1 HP.7.3 HP.7.9

31 Further steps (1) Financing Guidelines will be finalised based on the discussion of this Interim Report by a peer review group and participants of the 2011 OECD Meeting of Health Accounts Experts. The revised version will contain a summary of conclusions and/or recommendations in each chapter

32 Further steps (2) Preparation of specific country studies implementing some of the tools provided in this interim report (testing the advantages and feasibility of the given tools). Based on the country studies, the SHA 2011 Financing Guidelines will be further developed. Separate guidelines will be developed for the presentation of results from the implementation of the SHA 2011 accounting tools for health financing

33 Participating experts are invited to: COMMENT on the general approaches presented in the Interim report; COMMENT on the set of tools presented in the Interim report; PROPOSE further issues that need to be addressed under the Guidelines; EXPRESS an interest to participate in testing some of the tools proposed in the Guidelines.