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 14th Meeting of Health Accounts Experts, OECD Paris October 2012 David Morgan, Health Division, OECD 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 Aim of Financing Guidelines a more detailed explanation of the changes in concepts related to health care financing in SHA 2011; general approaches for the preparation of SHA data relevant to health care financing; and possible methodologies and approaches useful in the case of complex financing arrangements.

4 A collaborative effort The first draft presented in 2011 has undergone substantial review and revision: 2011 OECD Meeting of Health Accounts Experts; a peer review group, WHO NHA Team; Selective in-house testing of feasibility of elements of the guidelines Workshop (9 th October)

5 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. Not all parts of the Guidelines are relevant or appropriate to countries: differences in the complexity of health financing systems, health policy issues of interest, data availability and available resources.

6 Structure of the Financing Guidelines 1. The accounting of health care financing under SHA Description of the health care financing system from a health accounting point of view 3. Mapping from SHA 1.0 to SHA Accounting the government s involvement in health care financing 5. Interpretation of public and private under SHA Accounting foreign aid 7. Further analysis of health care financing from the perspective of types of schemes and institutional units

7 1. Key concepts and definitions 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

8 The financing framework under SHA 2011 Financing agent (FA) Financing scheme (HF) Functions (HC) Institutional units of the economy providing revenues Financing agent (FA) Financing scheme (HF) Providers (HP) Basic structural relationships of health financing Money flow Financing agent (FA)

9 2. Describing health financing systems Task 1: Identifying the national health care financing arrangements preparing an inventory of financing arrangements Classifying according to ICHA-HF in SHA 2011 Task 2: Describing the structure of the health financing system identification of related financing agents for each financing scheme Task 3: Identifying the basic flows in health financing (i) revenue-raising by the financing schemes; and (ii) allocation of resources by the financing schemes (according to functions, providers and beneficiaries)

10 2. Relationship between Financing schemes (HF) and Financing agents (FA) Financing Agents (institutional units) Financing schemes Government units FA.1.1, FA.1.2 Social insurance funds FA.1.3 Insurance corporations FA.2 Households FA.5 Rest of the World FA.6 Government schemes HF.1.1 Compulsory social health insurance HF Voluntary health insurance HF.2.1 Out-of-pocket payments HF.3 Foreign aid programmes HF.4 10

11 2. Describing the HF-FA relationship Description HF code HF description Purchasing agent Central govt. Central financing of Ministry of HF governmental public health Health schemes activities General regional Statutory social health insurance (SHI) HF Social health insurance schemes funds Industrial branchbased sickness funds Sickness funds for farmers Sickness funds for miners Retirement funds FA code FA description Data source(s) FA FA FA.2.2 FA.2.2 FA.2.2 FA Ministry of Health Social Health Insurance Agency Mutual and other non-profit insurance organisations Mutual and other non-profit insurance organisations Mutual and other non-profit insurance organisations Other social security agency MoH NHF NHF NHF NHF NHF

12 Government domestic revenues Internal transfers and Grants Transfers on behalf of specific Subsidies Other transfers from government domestic revenues Transfers by government from foreign origin Social insurance contributions Employee social insurance 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 Other Compulsory prepayment FS.1 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 Identifying the flows: revenue-raising HF.1 Governmental schemes and compulsory private schemes HF.1.1 Governmental schemes x x x HF.1.2. Social health insurance 1 x x x x HF.1.2. Compulsory private health 2 insurance HF.2 Voluntary health care payment schemes HF.2.1 Voluntary insurance x x HF.2.2 NPISH financing schemes x x HF.2.3 Enterprises financing x x x x x x x x

13 2. An example of a health financing system

14 3. Mapping SHA 1.0 to SHA 2011 Suggested method: For the latest data: Describing health financing systems (as Ch. 1) i.e. defining financing schemes independently from the previously used categories of SHA1.0 For previous years data: Mapping SHA 1.0 to SHA 2011 Connecting SHA 1.0 and SHA 2011

15 3. Default approach - SHA 1.0 to SHA 2011 Main options to decide: mapping to the default scheme. For example, HF is mapped by default to HF Central governmental schemes mapping to a different (non-default) scheme. For example, (part of) HF.2.2 may be mapped to HF Compulsory private insurance. (See Table 3.1) the value accounted as spending by HF (under SHA1.0) should be accounted as revenue. (HF Central governmental scheme versus FS.1.4 Other transfers from government)

16 4. The government s role in the health sector Transactions by governmental financing schemes (HF.1.1) related to health (HC) 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) Transactions related to government health-related functions (HCR.1, HCR.2) Transactions related to resource-generation (human and physical capital and technology) Non-health spending by the government units acting as financing agent

17 4. Role of the government Main role of the government s involvement Health accounting terms Regulation Revenue-raising Collecting and pooling Purchasing Provision of services Administrative activities of Governmental schemes (HF) Provider of revenues Financing agents/schemes collecting and pooling revenues Financing schemes paying for services Owner of providers

18 5. Interpreting public and private Shall we calculate expenditure by financial scheme, revenue of financial scheme, or agent? SHA 1.0 defined the private sector as follows:.. all resident institutional units which do not belong to the government sector. Then: compulsory private insurance and social insurance schemes executed by private insurance companies would be reported under private expenditure, together with voluntary insurance and OOP. Do we really care about ownership from the policy perspective?

19 5. Public and Private SHA 2011 adopts two approaches: From the perspective of financing schemes, the main distinguishing criterion is whether the participation in a scheme is compulsory or voluntary; From the perspective of the types of revenues, the key distinguishing criterion is whether the payment or contribution is compulsory or not.

20 6. Accounting foreign aid 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 7. Individual schemes and institutional units Two related methodologies: a possible way to show detailed 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)

22 Final steps Financing Guidelines will be finalised based on the discussion of this Interim Report by Workshop on Implementation participants of the 2011 OECD Meeting of Health Accounts Experts and more widely Comments by November 9, 2012 Finalise the guidelines and make available by end 2012.

23 Participating experts are invited to: COMMENT on the general approaches and content presented in the Interim report; PROPOSE any further issues that need to be addressed under the Guidelines