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Introduction to the System of Health Accounts 2011 Uvođenje u SISTEM ZDRAVSTVENIH RAČUNA 2011 Presentation by Eva Zver, NHA expert Meeting of the Work Group on National Health Accounts No.1 Sarajevo, 24th May 2012 Zašto je razvijen Nacionalni zdravstveni račun? __________________________________ Da bi se pružile standardne definicije zdravstvenih troškova i svih kategorija koje se koriste za indikatore troškova u zdravstvu – to znaći temelj za analiziranje glavnih međunarodno uporedivih indikatora Da bi se pružio standardni okvir (tabele) za organizovanje i prezentovanje informacija o troškovima u zdravstvu; ovaj okvir može, da se proširi za nacionalne potrebe Da bi se pratili svi tokovi finansija u zdravstvu u celom zdravstvenom sektoru (uključujući javni, privatni, kao i finansiranje i troškove u delu zdravstva koje finansiraju donatori) – treba odgovoriti na sledeće: Ko troši u zdravstvenom sektoru? – klasifikacija HP (Health Provider) Koliko troši? – klasifikacija HF (Health Financing Schemes) Kakve vrste zdravstvenih usluga se kupuju? – klasifikacija HC (Health Care Function) Da bi se pružili podaci o troškovima u zdravstvu u formi koju lako razumeju donosioci strategija i zakona Glavni problem: Šta zemlje uvrštavaju ili ne uvrštavaju u troškove zdravstvenog sistema? _____________________________________________________ Primjeri Direktni troškovi domaćinstava Privatno osiguranje Potrošnja privatnih firmi Vladine paralelne strukture Dugotrajna njega Kontinuirano obrazovanje Dodaci za njegu Preventiva Razlozi za neuvrštavanje određenih troškova: Nepoznavanje dijelova sistema Nezainteresiranost – nema izričite relevantnosti za politiku Nacionalne klasifikacije Ne postojanje podataka Aktivnosti SZO, Eurostata i OECD _____________________________________________ Prije 2000. godine: Podaci o troškovima u zdravstvu u bazi podataka SZO su prilagođeni u skladu sa nekim međunarodno dogovorenim pravilima 1996.-1999.: Eurostat, WHO and OECD počeli su proces razvoja međunarodnih standarda za izvještavanje o troškovima zdravstvene zaštite 2000.: Objavljen je priručnik: Sistem zdravstvenih računa, Verzija 1.0, OECD (The System of Health Accounts, 1.0) (postoji prevod u srpski jezik) 2003.: Svjetska banka, USAID i SZO su objavile Vodič za izradu nacionalnih zdravstvenih računa sa posebnom primjenom za zemlje sa niskim i srednjim prihodom (Guide to producing National Health Accounts in low and middle income countires, 2003) 2006.: Prvi zajednički upitnik OECD-EUROSTAT-a-SZO za prikupljanje podataka po metodologiji SHA 2007: Prvi podatki i zdravstveni finansijski indikatori po metodologji SHA objavljeni su na Eurostatu, OECD i WHO 2011: OECD-EUROSTAT-a-SZO objave novu revidiranu verziju priručnika The System of Health Accounts, 2011 Glavni doprinos revizije SHA 2011 ______________________________________________ Klasifikacije su prilagodili promjenama u zdravstvenih sistemih - da bi pojačali analitičku snagu SHA Uključena je jasna definicija za praćenje troškova dugotrajne njege Detaljno objašnjena veza i odstupanja sa sistemom nacionalnih računa (SNA 2008) i razvijene unakrsne klasifikacije sa ISIC, COFOG, COICOP, COPP – to je sa klasifikacijama koje se koristi u sistemu nacionalnih računa) Standardni okvir SHA 2011, ko ima tri dimenzije (isto kao SHA 1.0: HP, HF, HC) je proširen. Najvažnije dimenzije su: - Klasifikacija FS (Classification of Revenues of Financing Schemes) - Klasifikacija FA (Classification of Financing Agents) - Klasifikacija FP (Classification of Factors of Health Provision) - Troškovi za zdravstvo po karakteristikama pacienata - Kapitalski račun zdravstvenog sistema Dimeznije praćenja troškova za zdravstvo u SHA 2011 ______________________________________________ Zn ač iln o s ti b o ln ik o v ( s p o l, s tar o s t, b o lezen , d o h o d ek ) D im en zija zd r av s tv en e p o tr o šn je Zd r av s tv en i n am en i I C HA- HC O žji o k v ir S HA Vir i s r ed s tev I C HA- F S D im en zija f in an c ir an ja Br u to in v es tic ije Vir i f in an c ir an ja I C HA- HF Ag en ti f in an c ir an ja I C HA- F A I zv ajalc i I C HA- HP D im en zija p o n u d b e Vlo žk i v p r o izv o d n jo I C HA- F P Uv o z in izv o z System of Health Accounts, 2011 Definiranje troškova u zdravstvu ___________________________________ Nacionalni troškovi u zdravstvu obuhvataju sve troškove za aktivnosti čija je primarna uloga obnavljanje, poboljšanje i održavanje zdravlja nacije i pojedinaca tokom određenog vremenskog perioda Tekući troškovi na zdravstvo = konačna potrošnja residenta za robu i uslugu zdravstvene zaštite Glavni agregat SHA 1.0 (2000): Ukupni troškovi = tekući troškovi + burto kapitalne investicije u zdravstvo Glavni agregat SHA 2011: Tekući troškovi na zdravstvo (kapitalne investicije evidentiranju se u posebnom kapitalskom računu) Definiranje granice zdravstva ________________________________________ Definiranje granice zdravstva NHA ne uzima u obzir geografske granice Ona pokriva sve troškove građana i osoba sa rezidentskim statusom (čak i onih koji su privremeno u inostranstvu) za zdravstvenu zaštitu Ona uključuje i troškove za zdravstvo koje međunarodne organizacije daju za stanovništvo/stanovnike Ona ne uključuje troškove koje strani državljani naprave za zdravstvenu zaštitu u nekoj zemlji Definiranje vremenske granice NHA primjenjuje metodu evidentiranja troškova u momentu nastajanja troškova tj. izdavanja faktura a ne u momentu plaćanja tih faktura (accrual method) Dimenzije troškova u Zajedničkom upitniku (Joint OECD, Eurostat, WHO questionnaire) ____________________________________________ Izvori finansiranja (FS) Agenti finansiranja (HF) Davaoci usluga (HP) Funkcije u zdravstvu (HC) Ljudski resursi ICHA-HC Funkcionalna klasifikacija _______________________________________ ICHA kod Funkcije zdravstvene zaštite HC.1 – HC.7 Usluge i robe zdravstvene zaštite po funkcijama HC.1 - HC.5 Lične usluge i robe zdravstvene zaštite HC.1 HC.2 HC.3 HC.4 HC.5 Usluge kurativne njege Usluge rehabilitacijske njege Usluge dugoročne medicinske njege Pomoćne usluge zdravstvene zaštite Medicinska sredstva izdavana vanjskim pacijentima HC.6 – HC.7 HC.6 HC.7 Kolektivne usluge zdravstvene zaštite Prevencija i usluge javnog zdravstva Zdravstvena administracija i zdravstveno osiguranje HC.R Funkcije vezane za zdravstvo HC.R.1 HC.R.2 HC.R.3 HC.R.4 HC.R.5 Kapitalne investicije (osnivački kapital) za osnivanje institucija koje pružaju zdravstvenu zaštitu Obrazovanje i edukacija zdravstvenih radnika Istraživanja i razvoj u zdravstvu Kontrola namirnica, higijene i vode za piće Zdravlje i okoliš (zaštita životne sredine) HC.R.6 HC.R.7 Administracija i pružanje nenovčanih socijalnih usluga za pomoć života sa bolešću i hendikepom Administracija i pružanje novčanih beneficija vezanih za zdravstvo Izvor: ICHA-HC funkcionalna klasifikacija (jednoznamenkasti nivo) (pogledati SHA poglavlje 9) Klasifikacija funkcija (namjena) u zdravstvu – Classification of Health Care Functions (HC) SHA 1.0 (1st digit level) SHA 2011 (1st digit level) HC.1 Curative care HC.2 Rehabilitative care HC.3 Long-term care (health) HC.4 Ancillary services (non-specified by function) HC.1 Curative care HC.2 Rehabilitative care HC.3 Long-term care (health) HC.4 Ancillary services (non-specified by function) HC.5 Medical goods (non-specified by function) HC.5 Medical goods (non-specified by function) HC.6 Preventive care HC.7 Governance and health system and financing administration HC.9 Other health care services not elsewhere classified (n.e.c.) Total health expenditure: HC.1-HC.9 + HC.R.1 Health care related HC.R.1 Capital formation of health care providers HC.6 Preventive care HC.7 Governance and health system and financing administration HC.9 Other health care services not elsewhere classified (n.e.c.) Current health expenditure: HC.1-HC.9 Memorandum items: reporting items HC.RI.1 Total pharmaceutical expenditure HC.R.2 Education and training of health personnel HC.R. 4Food, hygiene and drinking water control HC.RI.2 Traditional complementary alternative medicines HC.RI.3 Prevention and public health services (according to SHA 1.0) Memorandum items: health care related HC.R.5 Environmental health HC.R. 6 Provision of social services in kind HCR.1 Long-term care (social) HCR.2 Health promotion with a multi-sectoral approach HC.R.3 Research and development in health HC.R.7 Administration and provision of cash-benefits System of Health Accounts, 2011, page 81-84 Klasifikacija funkcija (namjena) u zdravstvu – Classification of Health Care Functions (HC) SHA 1.0 (1st digit level) SHA 2011 (1st digit level) HC.1 Curative care HC.2 Rehabilitative care HC.3 Long-term care (health) HC.4 Ancillary services (non-specified by function) HC.1 Curative care HC.2 Rehabilitative care HC.3 Long-term care (health) HC.4 Ancillary services (non-specified by function) HC.5 Medical goods (non-specified by function) HC.5 Medical goods (non-specified by function) HC.6 Preventive care HC.7 Governance and health system and financing administration HC.9 Other health care services not elsewhere classified (n.e.c.) Total health expenditure: HC.1-HC.9 + HC.R.1 Health care related HC.R.1 Capital formation of health care providers HC.6 Preventive care HC.7 Governance and health system and financing administration HC.9 Other health care services not elsewhere classified (n.e.c.) Current health expenditure: HC.1-HC.9 Memorandum items: reporting items HC.RI.1 Total pharmaceutical expenditure HC.R.2 Education and training of health personnel HC.R. 4Food, hygiene and drinking water control HC.RI.2 Traditional complementary alternative medicines HC.RI.3 Prevention and public health services (according to SHA 1.0) Memorandum items: health care related HC.R.5 Environmental health HC.R. 6 Provision of social services in kind HCR.1 Long-term care (social) HCR.2 Health promotion with a multi-sectoral approach HC.R.3 Research and development in health HC.R.7 Administration and provision of cash-benefits System of Health Accounts, 2011, str. 81-84 Klasifikacija funkcija (namjena) u zdravstvu – Classification of Health Care Functions (HC) SHA 1.0 HP.1 Hospitals HP.1.1 General hospitals HP.1.2 Mental health hospitals HP.1.3 Specialised hospitals (other than mental health hospitals) HP.2 Residential long-term care facilities HP.2.1 Long-term nursing care facilities HP.2.2 Mental health and substance abuse facilities HP.2.9 Other residential long-term care facilities HP.3 Providers of ambulatory health care HP.3.1 Medical practices HP.3.2 Dental practice HP.3.3 Other health care practitioners HP.3.4 Ambulatory health care centres HP.3.4.1 Family planning centres HP.3.4.2 Ambulatory mental health and substance abuse centres HP.3.4.3 Free-standing ambulatory surgery centres HP.3.4.4 Dialysis care centres HP.3.4.9 All other ambulatory centres HP.3.5 Providers of home health care services HP.4 Providers of ancillary services HP.4.1 Providers of patient transportation and emergency rescue HP.4.2 Medical and diagnostic laboratories HP.4.9 Other providers of ancillary services System of Health Accounts, 2011, str. 130 SHA 2011 HP.1.0 HP.1.1 HP.1.2 HP.1.3 HP.2 HP.2.1 HP.2.2 HP.2.3, 2.9 HP.3 HP.3.1 HP.3.2 HP.3.3 HP.3.4 HP.3.4.1 HP.3.4.2 HP.3.4.3 HP.3.4.4 HP.3.4.5, 3.4.9 HP.3.6 HP.3.9.1 HP.3.5, 3.9.2 HP.3.9.9 Klasifikacija davaoca usluga u zdravstvu – Classification of Health Care Providers (HP) SHA 1.0 HP.1 Hospitals HP.1.1 General hospitals HP.1.2 Mental health hospitals HP.1.3 Specialised hospitals (other than mental health hospitals) HP.2 Residential long-term care facilities HP.2.1 Long-term nursing care facilities HP.2.2 Mental health and substance abuse facilities HP.2.9 Other residential long-term care facilities HP.3 Providers of ambulatory health care HP.3.1 Medical practices HP.3.2 Dental practice HP.3.3 Other health care practitioners HP.3.4 Ambulatory health care centres HP.3.4.1 Family planning centres HP.3.4.2 Ambulatory mental health and substance abuse centres HP.3.4.3 Free-standing ambulatory surgery centres HP.3.4.4 Dialysis care centres HP.3.4.9 All other ambulatory centres HP.3.5 Providers of home health care services HP.4 Providers of ancillary services HP.4.1 Providers of patient transportation and emergency rescue HP.4.2 Medical and diagnostic laboratories HP.4.9 Other providers of ancillary services System of Health Accounts, 2011, str. 130 SHA 2011 HP.1.0 HP.1.1 HP.1.2 HP.1.3 HP.2 HP.2.1 HP.2.2 HP.2.3, 2.9 HP.3 HP.3.1 HP.3.2 HP.3.3 HP.3.4 HP.3.4.1 HP.3.4.2 HP.3.4.3 HP.3.4.4 HP.3.4.5, 3.4.9 HP.3.6 HP.3.9.1 HP.3.5, 3.9.2 HP.3.9.9 Klasifikacija davaoca usluga u zdravstvu – Classification of Health Care Providers (HP) HP.5 Retailers and other providers of medical goods HP.4 HP.5.1 Pharmacies HP.4.1 HP.5.2 Retail sellers and other suppliers of durable medical goods and medical appliances HP.5.9 All other miscellaneous sellers and other suppliers of pharmaceuticals and medical goods HP.4.2, 4.3, 4.4 HP.6 Providers of preventive care HP.5 HP.7 Providers of health care system administration and financing HP.6 HP.7.1 Government health administration agencies HP.6.1 HP.7.2 Social health insurance agencies HP.6.2 HP.7.3 Private health insurance administration agencies HP.6.3, 6.4 HP.7.9 Other administration agencies HP.6.9 HP.8 Rest of economy HP.7 HP.8.1 Households as providers of home health care HP.7.2 HP.8.2 All other industries as secondary providers of health care HP.2.3, 2.9, 7.1, 7,9 HP.8.9 Other industries n.e.c. HP.9 Rest of the world HP.9 System of Health Accounts, 2011, str. 130 HP.4.9 Klasifikacija izvora financiranja zdravstva – Classification of Health Care Financing schemes System of Health Accounts, 2011, str. 166 Klasifikacija prihoda u izvore financiranja zdravstva – Classification of Health Care Financing schemes System of Health Accounts, 2011, str. 199 5. Basic set of cross-classification tables _________________________________ Three basic tables from SHA Manual: How are the different providers financed? (HP x HF) How are the different functions financed? (HC x HF) Who provides different kinds of services? (HC x HP) Additional table from Joint Questionnaire: How are the different financing agents financed? (HF X FS) Dissemination of health financing indicators based on the results from NHA data collection _____________________________________ Most important web pages for methodology: • • • WHO: http://www.who.int/nha/what/en/index.html OECD: http://www.oecd.org/health/sha Eurostat: http://ec.europa.eu/health/horiz_keydocs_en.htm Most important web pages for data: • • • OECD SHA: http://www.oecd.org/health/sha/implementation OECD Health Data: http://www.oecd.org/document/ Eurostat Portal: http://epp.eurostat.ec.europa.eu/portal/ WHOSIS: http://www.who.int/whosis/en