ppt

Report
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

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