Draft Guidelines for the SHA 2011 Framework for …Draft Guidelines for the SHA 2011 Framework for...
Transcript of Draft Guidelines for the SHA 2011 Framework for …Draft Guidelines for the SHA 2011 Framework for...
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
Overview
• Purposes of the Financing Guidelines
• Preparation of the Guidelines: a collaborative effort
• The structure and some key issues
• Further steps
• Issues for discussion
The Interim Report presents
• a framework of the SHA 2011 Financing Guidelines;
• a draft of their main elements; and
• proposals for further work.
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.
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 2011.
• The Financing Guidelines (selected elements) are to be tested.
• New elements can be added in a step-wise
approach.
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.
Structure of the Financing Guidelines
1. The overview of the accounting of health care financing under SHA 2011
2. 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 2011
5. 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
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
HOUSEHOLDS
EMPLOYERS
ROW
NGO
GOVERNMENT
CENTRAL GOV
SCHEMES
STATE/LOCAL
GOV SCHEMES
COMPULSORY
HEALTH
INSURANCE
VOLUNTARY
HEALTH
INSURANCE
HOUSEHOLD OOP
NPISH FINANCING
SCHEME
ENTERPRISES
FINANCING
SCHEMES
ROW FINANCING
SCHEMES
MINISTRY OF HEALTH
OTHER MINISTRIES
NGOs
LOCAL GOV
NGOs
HEALTH INSURANCE FUNDS
OTHER SOCIAL INSURANCE FUNDS
INSURANCE COMPANIES
HEALTH INSURANCE FUNDS
INSURANCE COMPANIES
HOUSEHOLDS
HOUSEHOLDS
NGOs
HOUSEHOLDS
ENTERPRISES (1)
ENTERPRISES (2)
GOV UNIT
FOREIGN NGOs
LOCAL NGOs
PR
OV
IDE
RS
All lines represent financial or in-kind resource flow
The overview of the accounting of health care financing
under SHA 2011
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
ICHA-HF Health financing
schemes in
COUNTRY(A)
Participation and
benefit entitlement
Benefit
package
Statutory social health
insurance
Other health-related
insurance schemes
(operated by the
retirement funds)
HF.
1.2.1
Social health insurance
schemes
Statutory long-term
care insurance scheme
*
LTC
Compulsory private
health insurance
schemes
Individuals with an
income above a
threshold can opt
out of the SHI
HF.
1.2.2
Compulsory private
insurance schemes Statutory long-term
care insurance scheme
*
LTC
Identification of the health financing schemes in
COUNTRY(A) (Table 2.1)
ICHA
-HF
Health financing
schemes in
COUNTRY(A)
Main financing
agents in
COUNTRY(A)
FA
code
SHA2011
Financing
Agent
DATA
SOUR
CES
Data
problems
HF.1.1
Governmental
schemes
HF.
1.1.1
Central
governmental
schemes
FA.
1.1 Central
government
Ministry of
Health (P)*
FA.
1.1.1 Ministry of
Health
Special scheme for
the army
Ministry of
Defence (P)
FA.
1.1.2 Other
Ministries and
public units
Special scheme for
the police
Ministry of
Interior (P)
FA
1.1.2 Other
Ministries and
public units
National Tax
Authority (C)*
A national cancer
prevention
programme
NPISH(a) (C)
FA.4 NPISHs
HF.
1.1.2
State/ regional /
local governmental
schemes
State
governments
(C&P)
FA.1.2 State/ regional
/ local
government
Description of the functional and institutional structure of
the health financing system (Table 2.4)
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
.4.3
. FS
.5
FS
.5
FS
.6
FS
.6
FS
.7
Go
ver
nm
ent
do
mes
tic
rev
enu
es
Inte
rnal
tra
nsf
ers
and
Gra
nts
Tra
nsf
ers
on
beh
alf
of
spec
ific
gro
up
s S
ub
sid
ies
Oth
er t
ran
sfer
s fr
om
gov
ernm
ent
do
mes
tic
rev
enu
es
Tra
nsf
ers
by
go
ver
nm
ent
fro
m
fore
ign
ori
gin
S
oci
al
in
sura
nce
co
ntr
ibu
tio
ns
Em
plo
yee
so
cial
in
sura
nce
con
trib
uti
on
E
mp
loy
er
soci
al i
nsu
ran
ce
con
trib
uti
on
Sel
f-em
plo
yed
so
cial
in
sura
nce
con
trib
uti
on
Oth
er s
oci
al i
nsu
ran
ce c
on
trib
uti
on
Co
mp
uls
ory
p
rep
ay
men
t (o
ther
tha
n F
S.3
)
Co
mp
uls
ory
pre
pay
men
t fr
om
ho
use
ho
lds
Co
mp
uls
ory
pre
pay
men
t fr
om
emp
loy
ers
Oth
er C
om
pu
lso
ry p
rep
aym
ent
Vo
lun
tary
p
rep
ay
men
t
Vo
lun
tary
p
rep
aym
ent
fro
m
ho
use
ho
lds
Vo
lun
tary
p
rep
aym
ent
fro
m
emp
loy
ers
Oth
er V
olu
nta
ry
pre
pay
men
t
Oth
er
do
mes
tic
rev
enu
es n
.e.c
.
Oth
er
rev
enu
es f
rom
ho
use
ho
lds
n.e
.c.
Oth
er
rev
enu
es f
rom
co
rpo
rati
on
s
Oth
er
rev
enu
es f
rom
NP
ISH
s n
.e.c
.
Dir
ect
Fo
reig
n t
ran
sfer
s
All
rev
enu
es o
f fi
na
nci
ng
sch
ema
To
tal
cu
rren
t ex
pen
dit
ure
an
d
cap
ita
l tr
an
sfer
s b
y f
ina
nci
ng
sch
emes
Op
era
tin
g b
ala
nce
HF.1 Governmental schemes
and compulsory private
schemes
x
HF.1.1 Governmental schemes x x x x x
HF.1.2.
1
Social health insurance
x x x x
x x x x
x
HF.1.2.
2
Compulsory private health
insurance
x x x x x
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
schemes
x x
HF.3 Households out-of-
pocket payment
x x
HF.4 Rest of the world
financing schemes
x x
Identification of the basic flows: revenue-raising (Table 2.5)
Functions of the government
Accounting categories
Accounting tools (tables)
Regulation Governmental schemes (HF)
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 Financing agent pooling revenues
HF.1.1xFA.1 xHC.7
Purchasing Financing agent paying for services
HF.1.1xHC HF.1.1xHP
Provision of services Owner of providers
Accounting the government’s involvement in the
health sector
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
Interpretation of “public” and “private” under SHA 2011
Revenues from
compulsory
payment
Revenues from
voluntary payment
HF.1. Governmental
and compulsory
contributory schemes
HF.2. Voluntary
health care
payment
schemes
Public financing
agents (FA)
Private
financing
agents (FA)
Public providers Private providers
HF.1 managed by
public FA
HF.1 managed
by private FA
HF.2
managed by
public FA
HF.2
managed by
private FA
17
Financing schemes Major expenditure aggregates
HF.1 Governmental financing schemes and compulsory contributory health financing schemes
Expenditure by government schemes and compulsory contributory health financing schemes (instead of „public expenditure”)
HF.1.1 Governmental financing schemes
HF.1.2.1
Social health insurance
HF.1.2.2
Compulsory private health insurance
HF.1.3 Compulsory Medical Saving Accounts (CMSA)
HF.2 Voluntary health care payment schemes (other than OOP)
Expenditure by voluntary health financing schemes (instead of „private” expenditure)
HF.2.1 Voluntary health insurance
HF.2.2
NPISHs-financing schemes
HF.2.3
Enterprises financing schemes
HF.3 Households out-of-pocket payment
HF.4 Rest of the World financing
programmes
Expenditure by RoW schemes
Refinement of the categories of „public” and „private” (1)
Would
have
been
categori
zed as
private
under
SHA1.0
18
Revenue of financing schemes
Major expenditure aggregates
FS.1
Transfers from government domestic revenue
Public and compulsory private funds spent on health care
FS.1.1 Internal transfers and grants
FS.1.2
Transfers by government on behalf of specific groups
FS.1.3 FS.1.4
Subsidies; Other transfers from government domestic revenue
FS.3 Social insurance contributions
FS.4
Compulsory prepayment (other than FS.2)
FS.2; FS.7.1.1; 7.1.2; 7.2.1.;
Bilateral and Multilateral financial transfers and aid in kind
FS 5. Voluntary prepayment Voluntary private funds spent on health care
FS 6 Other domestic revenues n.e.c
FS.7.1.3; FS.7.2.1.3;
Other foreign financial transfers and aid in kind
Refinement of the categories of „public” and „private” (2)
Previously,
according to
WHO
guidelines
categorized
as private
fund
RoW financing
agents
Domestic
financing agents
RoW financing
scheme
Voluntary health
care payment
schemes
Governmental and
compulsory
contributory
scheme
Foreign
resources
Domestic
health care
provders
Foreign
health care
providers
GOVERNMENT
Flows of domestic resources
Flows of foreign resources
Domestic
resources
NGO
Flows from NGOs
Accounting foreign aid
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
Issues to be discussed:
• To what extent can / should SHA 2011-based NHAs use the OECD DAC database?
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
Table 6.2. Mapping HF(SHA 1.0) to Classification of Financing Schemes under SHA 2011
SHA 1.0 SHA 2011
“Default” financing scheme Other financing
scheme
Revenues of HF
HF.1 General government
HF.1 Governmental schemes
and compulsory
contributory health
financing schemes
HF.1.1
General government
excluding social
security funds
HF.
1.1 Governmental schemes
HF.
1.1.1 Central government
HF.
1.1.1
Central governmental
schemes
HF.1.1.1 (A) HF.1.
1.1
Central governmental
schemes
HF.1.1.1 (B)
FS
1.4
Other transfers from
government
domestic revenue
HF.
1.1.2
HF.
1.1.2
State/regional/local
governmental schemes
HF.
1.1.3
State/provincial
government
Local/municipal
government
HF.
1.2
Compulsory contributory
health insurance schemes
HF.1.2 Social security funds HF.
1.2.1 Social health insurance
HF.1.2 (A)
HF.
1.2.1 Social health insurance
HF.1.2 (B)
HF.
1.2.2 Compulsory
private insurance
HF.1.2 (C)
HF.
2.1 Voluntary health
insurance
schemes
Transition from SHA 1.0 to SHA 2011: HF
FS.1 FS.2 FS.7
FS.1.1 FS.1.2 FS.1.3 FS.1.4
Tra
ns
fers
fro
m
Go
ve
rnm
en
t
do
me
sti
c r
ev
en
ue
Inte
rna
l tra
nsf
ers
an
d g
ran
tsT
ran
sfe
rs b
y
go
vern
me
nt
on
be
ha
lf o
f sp
eci
fic
Su
bsi
die
sO
the
r tr
an
sfe
rs
fro
m g
ove
rnm
en
t
do
me
stic
re
ven
ue
Tra
ns
fers
dis
trib
ute
d b
y
Go
ve
rnm
en
t fr
om
Dir
ec
t F
ore
ign
tra
ns
fers
FS.1General
government units
FS.1.1 Territorial
governments ΣGOV
ΣGOV -
(GOV 5+
GOV6) GOV1 GOV2 GOV3 GOV4 GOV5 GOV6
FS.1.2All otrher public
units
FS.2.1;
FS.2.3 Corporations and
NPISHs
FS.2.2 Households
FS.3 Rest of the world
Table 6.4 Mapping the FS (PG / JHAQ) categories to the categories of
Classification of Revenues of Health Financing Schemes
FS(PG/JHAQ)
Transition from SHA 1.0 to SHA 2011: FS
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
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)
Types of HF–FA relationship Compilation tasks
One-to-one correspondence
between HF(x) and FA(a) Data collected from FA(a) can be directly
filled into HFxFAxHC or HC x HF table
FA(a) manages two different
financing schemes: HF(x) and
HF(y)
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.
Compilation tasks under different types of HF–FA
relationship
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)
Revenues of HF.1.1.1
Financing agents administering HF.1.1.1
FS.1
Transfers from Government domestic revenue (allocated to health purposes)
NCU FA.1.1.1 Ministry of Health NCU
FS.1.1 Internal transfers and grants
FA.1.1.2 Other Ministries and public units (belonging to central government)
FS.2
Transfers distributed by Government from foreign origin
FA.1.1.3 National Health Service Agency
FS.6 Other domestic revenues n.e.c.
FA.1.2 State /Regional / Local government
FS.6.1 Other revenues from households n.e.c.
FA.1.9 other general government units
FS.6.2 Other revenues from corporations n.e.c.
FA.3.1 Health management and provider corporations
FS.6.3 Other revenues from NPISH n.e.c.
FA.4 Non-profit Institutions serving households (NPISHs
FS.7 Direct Foreign transfers
HF.1.1.1. Central governmental schemes
Table 8.1 Central governmental schemes: types of revenues and
relevant financing agents
FS.1
Transfers from
government domestic
revenue (allocated to
health purposes) FS.1 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
Social health
insurance agencies FS.7.1
Direct foreign financial
transfers
HP.7
.2 FS.7.1
HP.7
.2 FS.7.1
HP.7
.3
Private health
insurance
administration
agencies
HP.7
.3
HP.7
.3
HP.7
.9
Other
administration
agencies
HP.7
.9
HP.7
.9
RevenuesExpenses Expenses Revenues Expenses
Net/Gross operating
balance
Table 8.5 Sectoral accounts of Social health insurance schemes
(HF.1.2.1) Background tables to sectoral account of HF.1.2.1
Revenues and expenses of HF.1.2.1 Social health insurance
schemes (Md NCU)
HF.1.2.1 related Revenues
and expenses of National
Health Insurance Agency
HF.1.2.1 related Revenues
and expenses of Insurance
corporations (FA.2)
HP.1 to HP 6 HP.1 to HP 6
HP.1 to
HP 6
Revenues
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
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
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.