03/10/2006francis malherbe, eurostat, unit c1 and alain gallais, oecd, std/nafs review of european...

03/10/2006 Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS

Review of European and OECD countries experiences

Health output methods

Measurement of non-market output in education and health

OECD/ONS workshopLondon, 3-5 October 2006


The availability of price and volume measures of GDP is essential for:

1. Monitoring economic development in the EU

2. The monetary policy of the euro area3. The implementation of the Stability and

Growth Pact

Importance of price and volume measures for the European Union


Commission Decisions 98/715 and 2002/990 clarified the principles for the measurement of prices and volumes.

This Commission legislation has identified the most appropriate estimation methods to be applied (A and B methods) and the methods which shall not to be used (C methods).

The old Member States were asked to remove the C methods by end 2006.

Some legal aspects in the EU


In June 2006 Eurostat sent to all Member States a list of questions on price and volume measurement in the fields of non market health and education services.

The main objective was to assess and monitor Member States progress towards removing C methods by end 2006.

In this context, the sharing of experience between countries is of utmost importance.

During the same month of June 2006, the OECD launched a similar questionnaire to OECD non-EU members, in the perspective of its „non-market project“ (best practices).

Aims of the list of questions


The list covers solely the output methods currently used or being developed by the countries.

24 out of 27 EU countries (including Iceland and Norway) replied to the list.

7 OECD non-EU countries replied to the similar OECD questionnaire, but only 2 (AU, NZ) currently apply output methods and 1 (US) studies a project. Japan and Korea are „all market“.

Scope of the list


The list covers five aspects:1. Stratification

2. Quantity indicators

3. Weighting

4. Quality indicators

5. Availability of the data

Structure of the list


A and B methods require stratification for, at least, the following categories:

1. Hospital services2. Medical practice services3. Dental practice services4. Other human health services

Stratification (1)


Hospital services must be broken down in:

1. Services to in-patients by general and specialised hospitals.

2. Hospital psychiatric services3. Rehabilitation services in rehabilitation

centers / hospitals4. Nursing services

Medical practice services must be broken down in:

1. Services by medical specialists2. Services by general practitioners

Stratification (2)


The basic stratification is generally applied

11 EU countries use complementary stratifications (by region and subject)

AU and NZ use a specific ANZICS classification (developed for specialists).

Stratification (3)


Eurostat handbook indicates: “The quantity of health care received by patients should be measured in terms of complete treatments“.

For hospital services Eurostat recommends to measure the treatments on the basis of DRG (Diagnosis Related Groups).

For nursing services Eurostat recommends occupant days by level of care.

Quantity indicators (1)


For services by general practitioners Eurostat recommends to use the number of consultations by type of treatment.

For services by medical specialists Eurostat recommends to use the number of first visits.

For dental practice services Eurostat recommends to use the number of consultations by type of treatment.



For services to inpatients by general and specialised hospitals we had 20 EU replies:

o 8 countries use DRG methods.o 6 countries use mixed methods.o 3 countries use the number of occupant

days.o 3 countries use other methods.

AU, NZ use DRG too (+ US in project)



For hospital psychiatric services we had 15 EU replies:

o 2 countries use DRG methods.o 6 countries use the number of occupant

days.o 3 countries use mixed methods.o 4 countries use other methods.

AU uses number of occupant days by level of care, NZ a composite index.



For rehabilitation services we had 12 EU replies:


days.o 2 countries use the number of treatments.o 3 countries use mixed methods.



For nursing services we had 13 EU replies:


days.o 1 country uses the number of treatments.o 3 countries use mixed methods.



For services by general practitioners we had 15 EU replies:

o 5 countries use the number of consultations.

o 3 countries use the number of treatments.o 5 countries use mixed methods.o 2 countries use other methods.

AU uses the number of treatments and NZ the CPI (idem for other medical services).



For services by medical specialists we had 13 EU replies:


o 4 countries use the number of treatments.o 4 countries use mixed methods.o 2 countries use other methods.



For dental services we had 14 EU replies:


o 3 countries use the number of treatments.

o 4 countries use mixed methods.o 3 countries use other methods.



For other human health services we had 8 EU replies:

o 2 countries use the number of treatments.

o 2 countries use mixed methods.o 4 countries use other methods.



Nearly all countries apply weightings based on costs as required in the regulation.

They mainly use administrative sources.

Weighting


Eurostat recommends the use of adjustments for quality but an output indicator method can be acceptable (B method) without quality adjutment.

6 European countries use adjustments for quality and these adjusments are mainly based on DRG.

The US envisage to use QALY.

Quality indicators (1)


For example, Italy and Austria use fully quality-adjusted indicators based on the DRG for each class of hospital services.

Italy uses also indicators based on high-technology diagnostic equipment.



The issue of quality is, indeed, a very difficult one, both conceptually and in terms of implementation.

Eurostat is interested to learn some ideas from this workshop and will continue discussions at EU level.



Health is a particulary difficult area, more difficult than education, certainly due to the great heterogenity of health systems across countries.

Eurostat has to continue discussions with EU MS on the difficulties mentioned and try to find appropriate solutions on the various aspects of price and volume measurement.

Conclusion (1)


It is important to work on administrative sources, in particular, to help to reduce response burden.

Further discussions are needed on the issue of quality adjusment.

In next OECD workshop in Paris, in June 2007 ?

Conclusion (2)

03/10/2006francis malherbe, eurostat, unit c1 and alain gallais, oecd, std/nafs review of european...

Documents

hospital services eurostat

nursing services eurostat

unit c1

alain gallais

francis malherbe

stdnafs hospital services

stdnafs eurostat handbook

rehabilitation services