Developing a System of Health Accounts in an

Developing a System of Health Accounts in an Industrialized Economy: Progresses & Challenges Chung-Fu Lan, Dr. PH, FICD, FPFA, FRAI Associate Dean, School of Medicine National Yang-Ming University Fourth OECD/Korea RCHSP-ASNHAN Meeting of Regional Health Accounts Experts July 10, 2008 1

Contents • Introduction • Progresses in the First Year of the SHABased NHA Study Project • Revealed from the National Health Account 2006 • Inquiry of Health Data/Metrics & Related Information for Taiwan’s SHA Project • Conclusion 2

The State of NHE/NHA Development in Taiwan 1 • Taiwan has begun the development of national incomes/national accounts in mid 1970’s. • Since the earlier 1990’s, the DOH & the academic have gradually developed & published the NHE/NHA followed the above-mentioned statistical methods and experiences. 3

The State of NHE/NHA Development in Taiwan 2 • After the implementation of the NHI in 1995, healthcare budgets/funds have increased tremendously, & the contents of the flow of funds have changed significantly (the total expenditure on health as % of GDP is 6. 1% in 2007). • Taiwan has facing several important health policy issues such as very rapid demographic transition, the emergence of public health problems, shifting health paradigm, & great impacts of NHI’s global budget on health care delivery modules & providers’ behaviors. 4

The State of NHE/NHA Development in Taiwan 3 • Calls for more efficient use of resources and/or more resources are also facilitate the interests & tasks on embarking a better national health accounting exercises. • Keeping the path with methodological advancement & a series of standardized internationally classification for health accounts by the OECD, World Bank, WHO, USAID, the literature, & personal communications, the DOH & the scholars in Taiwan have worked on improving the contents & measurements, & continuing the updates of NHE/NHA. 5

Progresses in the First Year of the SHA-Based NHA Study Project 6

Progresses in Year 2007’s Study 1 • Literature reviews • Reviews of international SHA experiences • Conceptual, methodological & administrative considerations • Compiling the existing database & information • Discussions on strategies for meeting the items that data currently unavailable 7

Progresses in Year 2007’s Study 2 • SHA tables (year 2005) preparation – Current expenditure on health by function of care, provider & source of funding – Current expenditure on health by function of care & provider industry – Current expenditure on health by provider industry & source of funding – Current expenditure on health by function of care & source of funding 8

Revealed from the National Health Account 2006 9

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Inquiry of Health Data/Metrics & Related Information for Taiwan’s SHA Project 19

General Economic Indicators 1 • Total Output, Income, & Spending – – – – – Gross Domestic Product (GDP) Real GDP Implicit Price Deflators for GDP, (or Price Deflators) GDP & Related Price Measures: Indexes & Percent Changes National Income Real Personal Consumption Expenditure Sources of Personal Income Disposition of Personal Income Business Investment (Capital Expenditure) by Industry 20

General Economic Indicators 2 • Employment, Unemployment, & Wages – Status of Labor Force – Selected Unemployment Rates – Nonagricultural Employment – Average Weekly Hours, Hourly Earnings, & Weekly Earnings – Private Nonagricultural Industries – Employment cost Index – Private Industry – Productivity & Related Data, Business Sector 21

General Economic Indicators 3 • Production & Business Activity – Industrial Production & Capacity Utilization – Industrial Production – Major Market Groups & Selected Manufactures – New Construction • Prices – – Producer Prices Consumer Prices – All Urban Consumers Changes in Producer Prices for Finished Goods Changes in Consumer Prices – All Urban Consumers 22

General Economic Indicators 4 • Government Finance – Government Receipts, Outlays, & Debt – Government Receipts by Source & Outlays by Function – Government Sectors, National Income Account Basis • International Trade – International Trade in Goods & Services – International Transactions 23

Health Economic Indicators 1 • Total Health Care Output, Income, & Spending – – – Gross Health Care Output Adjusted Health Care Output Health Care Related Price Measures: Indexes & Percent Changes Real Personal Consumption Expenditure in Health Care Real Personal Out-of-Pocket Expenditure in Health Care Capital Investment • Health Care Employment, Unemployment, & Wages – Status of Health Care Labor Force – Selected Health Care Professionals’ Nonhealth Employment & Unemployment (including Inactive) Rates – Average Weekly Hours, Hourly Earnings, & Weekly Earnings – Private Nonagricultural Industries – Health Care Employment cost Index – Private & Public Health Care Sectors – Productivity & Related Data, Health Care Sector 24

Health Economic Indicators 2 • Health Care Production & Related Activities – Health Care Industrial Production – Health Care Resources’ Capacity Utilization – New Construction in Health Care • Health Care Prices – – – Health Care Producer Prices Health Care Consumer Prices – Rural & Urban Consumers Medical Consumer Price Index (MCPI) & Changes in Health Care Producer Prices by Service Category Changes in Health Care Consumer Prices – Rural & Urban Consumers 25

Health Economic Indicators 3 • Central & Local Governments’ Finance in Health Care – Government Receipts, Outlays, & Debt in Health Care – Government Receipts in Health Care by Source & Outlays by Function – Government Sectors, National Health Account Basis • International Health Care Statistics – International Trade in Medical Equipments & Service – International Trade in Pharmaceuticals & Services – International Trade in Health-related Commercial Insurance Programs – International Trade in Medical Care Services – International Trade in Long-Term Care & Social Assistive Services – International Trade in Other Health Care Related Services – International Health Care Transactions 26

National Household Health Expenditures Survey • Especially on the out-of-pocket (OOP) expenditures • Defining health & healthcare broadly; including traditional medical-related practices • Examples: – – Long-term care Complementary & alternative medicine Over-the-counter (OTC) pharmaceuticals Private health insurances 27

Building a Better Health System with the Basis of a Better Health Information 28

Health System Reform & National Health Account • Essentially, structural reform in pricing & cost control as well as regulations of providers • In details: – – – improving cost efficiency, assuring quality, promoting competition, equitabling access, decentralizing administration, & responding to aging. 29

Many Thanks !! 30