National Health Accounts in case of Latvia Dace Krievkalne Culture, Education, Science and Health Statistics Section Luxsembourg, 28-29 November 2016
Content 1. National SHA background and insights 2. Key principles of data collection: Data sources Approuch of data collection Pros and Cons Problems and Challenges 2
From 2005 to 2015 (1) Different working groups, seminars, TFs Experts visits and consultations Several projects (ICON-INSTITUT 2005, Grants 2007, 2014) Time constraints and doubts about the occuracy Data quality improvements and corrections Transition to the new SHA 2011 Good experience for creating and developing National Health Accounts 3
From 2005 to 2015 (2) 1600 000 1400 000 SHA1.0 1200 000 1000 000 800 000 600 000 400 000 200 000 - SHA2011 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Total health ependiture General governmebt expenditure Out-of-pocket expenditure MoH 4
Key principles Data sources Residual method for HF.3 Bottom-up approuch Provider side 5
Data sources (1) National Health Service covers approx. 80-85% of the whole budget of the Ministry of Health except functions HC.3.2; HC.4.3; HC.512; HC.6.1; HC.6.5-6.6, HC.7.1 and providers HP.2, HP.3.5; HP.4.1; HP.5.2; HP.5.9; HP.7.2-7.3; HP.8.1 Main partner for data collection not only for SHA but also for nonexpenditure data and other data request (for instance, PPP) During the Grant 2014 project, NHS improved IT solutions and introduced HP and HC classification into Management Information System that will help to keep the succession of data collection 6
Data sources (2) Central Statistical Bureau Integrated Statistical data Management system (including data on bugetary institutions, local government units, self-employed persons, Register of enterprises, quarterly and yearly questionnaires, questionnairies on investments HBS, LFS and other surveys other data sources for which we have an access (State Business register, home-pages, reports) 7
Data sources (3) State Agency of Medicines Summary on operation of pharmacies, wholesale medical companies and drug production companies Ministry of Welfare Long-term care services Therapeutic appliances and other medical durable goods Disability statistics Ministry of Health Programms that are not covered by NHS Centre for Disease Prevention and Control Non-expenditure data for calculations and estimates 8
Provider side approach (1) Health providers Number One common list of providers with NHS, Health Inspectorate and Centre for Disease Prevention and Control HP.1 66 Y HP.2 15 HP.3 3 998 Y HP.4 34 Y HP.5 848 HP.6 4 Y HP.7 11 Y HP.8 574 Partly TOTAL 5 550 9
Provider side approach (2) Structure of health providers HP.7 0.2% HP.6 0.1% HP.4 0.6% HP.8 10.3% HP.5 15.3% HP.3 [PERCENTAGE] HP.3.1 42.8% HP.3.2 14.8% HP.2 0.3% HP.1 1.2% HP.3.5 0.2% HP.3.4 2.7% HP.3.3 11.6% 10
Provider side (3) HP.6 0.7% HP.7 1.9% HP.4 10.3% HP.5 15.8% HP/HF.1 HP.8 0.8% HP.9 1.2% HP.1 45.4% HP.6 HP.7 0.1% 1.1% HP.5 51.0% HP/HF.3 HP.8 HP.9 0.0% 0.0% HP.1 15.8% HP.3 27.6% HP.2 1.7% HP.3 19.5% HP.2 4.4% HP.4 2.7%
Residual method (1) Residual method is used mainly for calculation private expenditure (PrE): The main variables that are taken from the CSB database are: Net turnover (according to the profit or loss statement); From net turnover - grants and subsidies (if they are included in net turnover) PrE = provider s turnover grants and subsidies CSB sub+g - NHS = 0 OK CSB sub+g - NHS > 0 OK CSB sub+g - NHS < 0! The main variables that are taken from the NHS database are: Total State funding per institution and functios
Prosp and cons (1) Common health providers list (HP) for all involved health data holders in the country Opportunity to calculate pure branch health and without weights Opportunity to use different sectors (for instance, government sector and private sector) Good platform for calculation tables on investments Opportunity to split HP into more detailed level, for instance, HP.3.1.1. GP practices or HP.3.1.2 psychiatrist medical practice Avoiding double counting 13
Prosp and cons (2) However... List of providers is sensitive to changes in the forms of enterprise activities and NACE classification Dependance on the accuracy of accountants filling in questionnaires For some providers (HP.21, HP.52 or HP.4 it is difficult to find providers using NACE and HA definitions Time consuming process. For NHS it takes 2 months, for CSB 3-4 months FTE. 14
Problems and Challenges (1) 1. Improvement of the data quality for household out-ofpocket payment by splitting private expenditure into HF.3.1 Out-of-pocket excluding cost-sharing and HF.3.2 Cost-sharing with third-party payers 2. The estimation of health services provided for nonresidents 3. Introduction of the additional SHA tables (HFxFS), (HPxFP) and HKxHP 15
Problems and Challenges (2) 4. Improvements to the main data tables by filling empty cells or supplementing them: Households as providers of home health care (HP.8.1) Patient transportation HC.4.3 Information, education and counselling programmes HC.6.1 5. Answers to the questions: Do we need in SHA medical professionals expenditure for professional certification and re-certification? How to deal with donations? SPA and welness services 16
Problems and Challenges (3) 6. How to reflect the expenditure of healthcare from different data sources? 7. Processes determined by health policy planning documents continue to take place in Latvia. Priorities are being set in health care, and they will certainly reflect in the collection of health care data (hospital reorganisation process, increase in the number of day hospital services, implementation of e- Health, EU funds for 2014 2020, etc.) 17
% Examples of different results reflect health spending 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Total health expenditure (according to SHA), % from GDP General Government expenditure (according to SHA), % from GDP Household out-of-pocket payments (according to SHA) Total health expenditure (according to SNA), % from GDP Health S14 (according to SNA), % from GDP HH expenditure for health from total HH expenditure
Thank you for your attention! 1 9