Transcript IMPROVING ESTIMATES OF INTERNATIONAL TRADE IN HEALTH SERVICES UNDER A SYSTEM OF HEALTH ACCOUNTS Working Party on International Trade in Goods and Trade in Services.

IMPROVING ESTIMATES OF
INTERNATIONAL TRADE IN HEALTH
SERVICES UNDER
A SYSTEM OF HEALTH ACCOUNTS
Working Party on International Trade in
Goods and Trade in Services Statistics
November 7-9, 2011, PARIS
BACKGROUND
Key definition of health expenditure in SHA:
– Includes health care goods and services provided to
residents by non-resident providers
– Excludes goods and services provided to non-residents by
resident providers
• Past experience – poorly reported, no explicit
reporting of services provided to non-residents,
insufficient guidelines, data sources
• Growing importance in recent years
• Significant for some countries
 Need to better define, measure and monitor
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CROSS-BORDER HEALTH CARE IN THE EU
EU Directive
• Respect patients’ rights to seek healthcare abroad while
preserving rights for states to manage healthcare
systems
• Reimbursed for treatment if entitled to in own country
• Prior authorisation only for ‘hospital’ care
• Covers prescription and medical goods (excl. LTC and
organ transplants)
• Information on safety, quality and tariffs
• Monitoring (flows and financing) - EC Regulation
1338/2008
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OECD TRADE IN HEALTH PROJECT
• 2 year project supported by EU
• First phase 2009/2010
– review of concepts and boundaries
– links to existing frameworks (BPM6, MSITS, TSA)
– country case studies (regulations, sources, recommendations) –
DEU, GRC, HUN, KOR, SVN, USA
• Second phase 2010/2011
– Draft framework, definitions, guidelines.
– Workshop and feasibility testing
– Final report
• Parallel with SHA Revision (Chapter 12 on Int. Trade)
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BASIC CONCEPTS AND DEFINITIONS
Balance of Payments (BPM6/SNA08) as basis:
• Economic territory – national, supra-national, sub-national
• Residence and non-residence – households and
providers - Residence vs. covered population
• Valuation
– Consistent with SHA basic concepts (Follow SNA)
– Exporting vs. importing countries valuation (in kind)
• Timing
– Accrual basis
– Reporting delays
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EXISTING CLASSIFICATIONS AND LINKS
• Mode of supply of trade in services (WTO/GATS)
– (1) Cross-border supply , (2) consumption abroad, (3)
commercial presence (outside SHA), (4) foreign persons
(partial SHA)
• MSITS/EBOPs classification:
– International statistics responding to BoP and GATS
– ‘Health-related travel’ and ‘Health services’ close to SHA
definitions
• Tourist Statistics/TSA
– Consumption of visitors with ‘health/medical’ purpose
– Provides some common concepts and definitions/ sources
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HEALTH SERVICES UNDER EBOPS 2010
4 Travel
• 4.2 Personal
•
4.2.1
Health-related
•
4.2.2
Education-related
•
4.2.3
Other
•
11 Personal, cultural and recreational services
•
11.2
Other personal, cultural and recreational services
•
11.2.1
Health services
Alternative EBOPS groupings
8 Health services = health services in travel + health services in personal,
cultural and recreational services
Plus:
Other direct insurance
Business services
Other personal, cultural and recreational services n.i.e.
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SHA CONCEPT OF TRADE
Import for
‘intermediate use ’ by
resident provider
Health care
provider in
Country A
Health care
provider in
Country B
Import for ‘final use’
by resident
Resident in
Country A
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IMPORTS AND EXPORTS UNDER SHA
Health care goods and services classified according to
health care functions
• Personal health care :
– Medical goods
• internet pharmacies, mail order
– Tele-medicine, e-health, etc
– Patient mobility : planned, unplanned care
(tourists, students, workers, etc)
– Health professionals abroad
• Collective care :
– Health care insurance
– Outsourcing of governance, administration, etc
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BORDERLINE ISSUES
Cosmetic surgery – for aesthetic purposes
Well-being/Spas – health-related item
Illegal / unethical treatments
Transport and travel costs – accompanying
persons/agency costs
• ‘Health-y’ goods
• Health professionals (temporary)
•
•
•
•
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GUIDELINES FOR ESTIMATING TRADE
• Current reporting limited but improving
• Common sources with BoP/SNA/TSA – detail/
adjustments needed
• Improvement of measurement of mutual benefit
• Inventory of current/potential sources
• Weigh up investment in resources / new sources
with perceived value of trade in health
• Review in light of national and international
obligations
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DATA SOURCES
• Business surveys - administrative/ad hoc
• Government administrative data – budgetary,
social security funds, liaison offices
• Private insurance records
• Household and tourist surveys
• Associations and other bodies – insurance, NGOs
• Other sources - mirror statistics, non-financial
data, modelling.
• Other BoP data sources – ITS, ITRS, etc
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REPORTING AND SUPPLEMENTARY TABLES
• Imports included - cross-classified by Function and
Financing
– non-resident providers of health goods and services (HP.9)
• Supplementary tables
– ‘Imports’ (HC.I.1-7) broken down by Financing scheme (HF)
– ‘Exports’ (HC.E.1-7) broken down by resident provider
• Memorandum items
– TCAM, Spa/well-being (non-health), Non-health, etc
• Other country specific breakdowns
– Mode of supply, trading partners, population groups, patient
numbers, etc
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SHA 2011: CHAPTER 12
• Background and Policy Relevance
• Basic concepts and definitions
• Classifications of trade (in health)
and links to other statistical systems
• Imports and exports under SHA
• Data sources and Guidelines
• Reporting and Supplementary
tables
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CURRENT REPORTING: IMPORTS
2009
2004-2009
Luxembourg
Iceland
Portugal
Netherlands
Belgium ¹
Germany
Turkey ¹
Hungary
Canada ¹
Czech Republic
Slovak Republic
Austria
Korea
Sw eden
Norw ay
Estonia
France ¹
Italy ¹
Slovenia
Mexico ¹
Denmark
Ireland ¹
Poland
Greece ¹
United Kingdom ¹
United States ¹
9.49
1.11
1.02
0.89
0.59
0.47
0.44
0.30
0.24
0.21
0.20
0.20
0.18
0.16
0.14
0.14
0.14
0.14
0.13
0.10
0.08
0.07
0.06
0.06
0.05
0.04
2.0
1.5
1.0
0.5
% of total health expenditure
0.0
-6.8
12.2
5.5
1.7
-3.9
7.3
23.5
40.0
1.0
48.6
6.2
13.2
4.6
19.7
-6.4
58.1
2.0
23.6
-4.4
-10.0
-5.4
3.0
-4.0
-14.0
8.4
13.0
-20
0
20
40
60
Annual grow th rate (%)
80
1. Refers to balance-of-payments concept of health-related travel.
Source: OECD Health Data 2011 and OECD-Eurostat Trade in Services Database.
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CURRENT REPORTING: EXPORTS
2009
2004-2009
Czech Republic
Hungary
Poland
Luxembourg
Turkey
Belgium
Estonia
Mexico
Slovenia
Greece
France
Korea
Israel
United States
Italy
Canada
United Kingdom
New Zealand
Austria
Iceland
3.58
2.08
1.62
1.15
0.98
0.84
0.67
0.48
0.20
0.19
0.15
0.15
0.13
0.11
0.08
0.08
0.06
0.06
0.03
0.02
4
3
2
1
% of total health expenditure
0
27.8
-3.6
41.9
35.7
3.5
-2.0
9.9
-1.3
-13.5
-7.7
0.6
8.9
-5.2
6.9
0.7
5.2
2.4
-1.7
5.7
-6.0
-20
0
20
40
Annual growth rate (%)
60
Note: Health-related travel exports occur w hen domestic providers supply medical services to non-residents travelling for
medical reasons.
Source: OECD-Eurostat Trade in Services Database.
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For further information:
www.oecd.org/health/sha
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