a satellite account of u.s. health care spending: plans and progress brian c. moyer associate...
TRANSCRIPT
A Satellite Account of U.S. Health Care Spending: Plans
and progress
Brian C. MoyerAssociate Director for Industry Accounts
12th OECD-NBS Workshop on National Accounts
Paris, FranceOctober 27-31, 2008
www.bea.gov 2
Health care spending as a percent of GDP
13%
14%
15%
16%
17%
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Source: U.S. Bureau of Economic Analysis
www.bea.gov 3
Health care spending in BEA’s accounts
National income and product accounts Consumer spending on health care Investment in health care equipment Contribution of health care to real GDP
growth
Industry accounts Input-output accounts—detailed
transactions for the health care industries GDP-by-industry accounts—real value
added for the health care industries
www.bea.gov 4
Conceptual model of a national health account
Inputs Outputs Medical Care Market labor/capital Volunteer labor Time invested in own health Other consumption items Research and development Quality of the environment
Health status
Longevity Quality of life Financial externalities
Source: Beyond the Market: Designing Nonmarket Accounts for the United States (National Research Council, 2005)
www.bea.gov 5
BEA’s Health Care Spending Satellite Account
Focuses on three primary areas:
Reconcile National Health Expenditure Accounts and National Income and Product Account measures
Develop disease-based statistics for health care spending
Develop disease-based price indexes for health care spending
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Treatment substitution: An example
Assumptions:
•No price change for either type of treatment
•No change in number of patients
Problem: As patients use outpatient services,
•Nominal expenditures fall
•Treatment prices show no change
•“Real” spending falls, even though quantities did not
Previous studies suggest this issue is numerically important.
price
time
In patient
Out patient
Cost of Cataract Surgery
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Disease-based price indexes: Early research
0.9
1.0
1.1
1.2
1.3
2003q1 2004q1 2005q1
Features of index:
•Constructed using large claims database for HMO patients
•Price = revenue from all sources
•Price is defined as price per patient treated for a homogeneous condition
•Dollars are allocated to conditions using “episode groupers”
•“Providers” are identified using “place of service” variable
Source: Aizcorbe and Nestoriak (2008)
Comparison of disease- and provider-based indexes
Disease-based
Provider-based
www.bea.gov 8
Accounting framework: Initial thoughts
Consumer spending organized by type of disease
Primary caregiving industry provides health care services using inputs from other health care industries, such as hospitals, laboratories, and pharmacies
Productivity gains allocated across industries
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Routing of industry transactions
Other industries provide Intermediate
inputs
Employee Health Insurance
PrimaryCaregiver
Employer
Hospital Clinic Laboratory Pharmacy
Industry that provides health care