DRAFT GUIDELINES FOR THE
SHA 2011 FRAMEWORK FOR
ACCOUNTING HEALTH CARE
FINANCING
14th Meeting of Health Accounts Experts, OECD
Paris 10-11 October 2012
David Morgan , Health Division, OECD
Eva Orosz, Head of Health Policy and Health Economics
Department, ELTE University,
Faculty of Social Sciences, Budapest
• Purposes of the Financing Guidelines
• Preparation of the Guidelines: a collaborative effort
• The structure and some key issues
• Further steps
• Issues for discussion
Overview
• 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.
Aim of Financing Guidelines
• 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 (9th October)
A collaborative effort
• 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.
How to use the SHA Financing Guidelines
1. 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. Mapping from SHA 1.0 to SHA 2011
4. Accounting the government’s involvement in health care financing
5. Interpretation of “public” and “private” under SHA 2011
6. Accounting foreign aid
7. Further analysis of health care financing from the perspective of types of schemes and institutional units
Structure of the Financing 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”
1. Key concepts and definitions
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
The financing framework under SHA 2011
Financing
agent
(FA)
Financing
agent
(FA)
Institutional units of
the economy
providing revenues
Financing
agent
(FA)
Providers
(HP)
Functions
(HC)
Financing
scheme
(HF)
Financing
scheme
(HF)
Basic structural relationships
of health financing
Money flow
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)
2. Relationship between Financing schemes (HF) and Financing agents (FA)
Financing schemes
Financing Agents (institutional units)
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.1.2.1
Voluntary health
insurance
HF.2.1
Out-of-pocket
payments
HF.3
Foreign aid
programmes
HF.4
10
2. Describing the HF-FA relationship
Description HF code HF description Purchasing agent
FA code FA description Data source(s)
Central govt. financing of public health activities
HF.1.1.1 Central governmental schemes
Ministry of Health
FA.1.1.1 Ministry of Health
MoH
Statutory social health insurance (SHI)
HF.1.2.1 Social health insurance schemes
General regional funds
FA.1.3.1 Social Health Insurance Agency
NHF
Industrial branch-based sickness funds
FA.2.2
Mutual and other non-profit insurance organisations
NHF
Sickness funds for farmers
FA.2.2
Mutual and other non-profit insurance organisations
NHF
Sickness funds for miners
FA.2.2
Mutual and other non-profit insurance organisations
NHF
Retirement funds
FA.1.3.2 Other social security agency
NHF
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
Gov
ern
men
t d
omes
tic
reve
nu
es
Inte
rnal
tra
nsfe
rs a
nd G
rant
s
Tra
nsfe
rs o
n be
half
of
spec
ific
grou
ps
Sub
sidi
es
Oth
er t
rans
fers
fro
m g
over
nmen
t
dom
esti
c re
venu
es
Tra
nsf
ers
by
gove
rnm
ent
from
fore
ign
ori
gin
S
ocia
l i
nsu
ran
ce c
ontr
ibu
tion
s
Em
ploy
ee s
ocia
l in
sura
nce
cont
ribu
tion
E
mpl
oyer
soc
ial
insu
ranc
e
cont
ribu
tion
Sel
f-em
ploy
ed s
ocia
l in
sura
nce
cont
ribu
tion
Oth
er s
ocia
l in
sura
nce
cont
ribu
tion
Com
pu
lsor
y p
rep
aym
ent
(oth
er
than
FS
.3)
Com
puls
ory
prep
aym
ent
from
hous
ehol
ds
Com
puls
ory
prep
aym
ent
from
empl
oyer
s O
ther
Com
puls
ory
prep
aym
ent
Vol
un
tary
pre
pay
men
t
Vol
unta
ry p
repa
ymen
t fr
om
hous
ehol
ds
Vol
unta
ry p
repa
ymen
t fr
om
empl
oyer
s
Oth
er V
olun
tary
pre
paym
ent
Oth
er d
omes
tic
reve
nu
es n
.e.c
.
Oth
er
reve
nues
fro
m h
ouse
hold
s
n.e.
c.
Oth
er
reve
nues
fro
m c
orpo
rati
ons
Oth
er
reve
nues
fro
m N
PIS
Hs
n.e.
c.
Dir
ect
For
eign
tra
nsf
ers
All
rev
enu
es o
f fi
nan
cin
g sc
hem
a
Tot
al c
urr
ent
exp
end
itu
re a
nd
cap
ital
tra
nsf
ers
by
fin
anci
ng
sch
emes
O
per
atin
g b
alan
ce
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
3. Identifying the flows: revenue-raising
2. An example of a health financing system
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
3. Default approach - SHA 1.0 to SHA 2011
Main options to decide:
• mapping to the “default” scheme. For example, HF.1.1.1 is mapped by “default” to HF.1.1.1 Central governmental schemes
• mapping to a different (non-default) scheme. For example, (part of) HF.2.2 may be mapped to HF.1.2.2. Compulsory private insurance. (See Table 3.1)
• the value accounted as spending by HF (under SHA1.0) should be accounted as revenue. (HF.1.1.1 Central governmental scheme versus FS.1.4 Other transfers from government)
• 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
4. The government’s role in the health sector
4. Role of the government
Main role of the government’s involvement
Health accounting terms
Regulation Administrative activities of Governmental schemes (HF)
Revenue-raising Provider of revenues
Collecting and pooling Financing agents/schemes collecting and pooling revenues
Purchasing Financing schemes paying for services
Provision of services Owner of providers
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?
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.
5. “Public” and “Private”
• 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
6. Accounting foreign aid
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)
7. Individual schemes and institutional units
• 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.
Final steps
• COMMENT on the general approaches and content presented in the Interim report;
• PROPOSE any further issues that need to be addressed under the Guidelines
Participating experts are invited to: