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National Accounts Working Party14-16 October 2008
Paris
Towards measuring the volume of health and education services
Draft OECD Handbook
Paul Schreyer, OECD/STD
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National Accounts Working Party14-16 October 2008
Paris
Towards measuring the volume of health and education services
Draft OECD Handbook
Paul Schreyer, OECD/STD
![Page 3: National Accounts Working Party 14-16 October 2008 Paris Towards measuring the volume of health and education services Draft OECD Handbook Paul Schreyer,](https://reader036.vdocuments.us/reader036/viewer/2022062518/56649f3e5503460f94c5f34e/html5/thumbnails/3.jpg)
Contents
• Background
• General concepts
• Education
• Health
• Way forward
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Background: OECD Project
• Strong and continued demand for output measures of education and health by policy-makers
• European Regulation• Project started in 2005, endorsement by CSTAT• Builds on previous work: Eurostat Handbook on
Volume and Prices, Atkinson Report, country experiences
• Workshops in London (2006) and Paris (2007)• Objectives:
– OECD Handbook– Data development
• First draft of handbook presented to WPNA 2007
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Background: An old question – what is new?
1. Joint work with sector specialists
• Elaborated jointly with OECD’s specialised networks– Network of education experts– Network of health experts
• Both networks have strong interest in measuring appropriate volume output
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Background: An old question – what is new?
2: Joint treatment of temporal and spatial dimensions
• Education and health PPPs are of great importance to analysts
• PPPs and national accounts have to be consistent
• Handbook deals with both dimensions in parallel
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Concepts and terminology
• Distinction must be made between inputs, outputs, outcomes -
• Best explained by way of a graph
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Inputs
Labour, capital, intermediate
inputs
Environmental factors
Information about outcome is a
possible tool for quality adjustment
Process without explicit quality
adjustment
Process with explicit quality
adjustment
Example education: number of
pupils/pupil hours by level of education
Example education: quality-adjusted number
of pupils/pupil hours by level of
education
Example health: number of complete
treatments by type of disease
Example health: quality-adjusted
number of complete
treatments by type of disease
Outputs
Information about outcome is a
possible tool for quality adjustment
Direct outcome
Indirect outcome
Knowledge and skills as measured by
scores
Health status of population
Future real earnings,
growth rate of GDP,
well-rounded citizens
etc.
Outcomes
Inhereted skills, socio-economic background, etc.
Hygene, lifestyle, infrastructure etc.
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Inputs
Labour, capital, intermediate
inputs
Environmental factors
Information about outcome is a
possible tool for quality adjustment
Process without explicit quality
adjustment
Process with explicit quality
adjustment
Example education: number of
pupils/pupil hours by level of education
Example education: quality-adjusted number
of pupils/pupil hours by level of
education
Example health: number of complete
treatments by type of disease
Example health: quality-adjusted
number of complete
treatments by type of disease
Outputs
Information about outcome is a
possible tool for quality adjustment
Direct outcome
Indirect outcome
Knowledge and skills as measured by
scores
Health status of population
Future real earnings,
growth rate of GDP,
well-rounded citizens
etc.
Outcomes
Inhereted skills, socio-economic background, etc.
Hygene, lifestyle, infrastructure etc.
If outcome indicators are used for quality adjustment, they:
•Should control for any other factors that affect outcome for
consumers (e.g. socio-economic background of pupils,
environmental impact on health)
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Quality adjustment
• First and important step towards capturing quality change is the correct stratification, i.e., the comparison of products with the same or at least similar characteristics.
• Explicit quality adjustment may make it necessary to invoke outcomes
• Handbook:– Health: discussion but no proposals for explicit quality
adjustment – Education: discussion and proposal for explicit quality
adjustment (exam scores) for secondary-level education
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Values and weights
• Current price values of non-market production = sum of costs
• Volumes:
1.Direct volume index =volume change of items, aggregation with cost weights
2.Deflation: apply price index to values• (Quasi) price index = unit costs: costs per unit
of output • as opposed to costs per unit of input
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Education – comparisons in time (1)
•Basic approach:
•Unit of output = (quality-adjusted) volume of teaching services delivered
•Broadly, measured as pupil (hours), the number of hours during which pupils receive teaching services
•But differentiation according to level of education important
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Education – comparisons in time (2)Output-based methods
Pre-primary education Number of pupil-hours
Primary education
Number of pupils, adjusted for change in pupil attainmentNumber of pupil hours*Number of pupils*
Primary education: general
Primary education: special education, e.g., for disabled pupilsNote: The sub-stratification normal / special could be replaced by coefficients reflecting the extra costs for social services provided to disabled pupils
Secondary education
Lower secondary: general
Lower secondary: special classes, e.g. for disabled pupils
Upper secondary education: general + pre-technical or pre-vocational
Upper secondary education: vocational
Post-secondary non-tertiary education
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Education – comparisons in time (3)
Tertiary education
Credits (ECTS) Full-time equivalent students*Enrolled students*
Tertiary education with practical and occupation-specific programmes
Tertiary education with more theoretically-based programmes Note: differentiation by field of education useful
•To be developed: measuring research output of tertiary education establishments•To be completed and corrected: annex table with country practices
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Education – comparisons in space
•In the past, PPPs for education based on comparison of input prices (teacher’s wages etc.)
•Significant difficulties in measuring comparable input costs
•Eurostat/OECD Taskforce on PPPs for education:
•Examined output-based approach•Concluded that it yields more plausible results than input-based measures
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Education – comparisons in space
Approach:
•Stratification by level of education
•Unit of output: pupil-hour (teaching received)
•Secondary education: explicit quality adjustment with PISA scores, corrected for socio-economic variables
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Health – comparisons in time (1)•Disease-based approach
•Increasing number of countries use disease-based approach
•Reflects changes in administrative practice (e.g. shift to DRG system in Germany’s hospital administration)
•Unit of output = (complete) treatment
•But differentiation by type of activity important•Unit of output may vary between activities
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Health – comparisons in time (2)ISIC rev 3.1 & 4 Output-based methods
Hospital activitiesAcute Hospitals 8511 & 8610 (Quasi) Price index based on DRGs (cost or
revenue-weighted)Direct volume index based on DRGs (cost or revenue-weighted)Direct volume index based on ICD categories (e.g., number of discharges by category with quantity-weights such as shares in hospital days)
Mental health and substance abuse hospitals
8511 & 810 (Quasi) Price index based on DRG-like categories (cost or revenue-weighted)Direct volume index based on DRG-like categories (cost or revenue-weighted)Direct volume index based on ICD categories (e.g., discharge numbers with quantity-weights such as shares in day care days)Number of discharges*Number of days of care*
Speciality (other than HP.1.2) hospital
8511 & 8610
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Health – comparisons in time (3)
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Health – comparisons in time (4)
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Health – comparisons in time (5)ISIC rev 3.1 & 4 Output-based methods
Other human health activitiesNote: the list of services below is not exhaustive as other human health activities covers very heterogeneous activities Other health practitioner consultations
8519 & 8690
Direct volume index based on number of consultation by type of consultation (cost or revenue-weighted)
(Quasi) Price index based on average cost or revenue per consultation (cost or revenue-weighted)
Relevant component of Consumer Price Index if applicable**
Number of consultations*
Number of tests performed*
Number of cases treated*
Other outpatient visits 8519 & 8690Family Planning centres 8519 & 8690Outpatient mental health and substance abuse centres
8519 & 8690
Free-standing ambulatory surgery centres
8519 & 8690
Dialysis care centres 8519 & 8690Other outpatient multispecialty and cooperative service centres
8519/8531 & 8690
All other outpatient care centres 8519/8531 & 8690
Medical and diagnostic laboratories
8519 & 8690
Home health care services 8519/8531 & 8690
All other ambulatory health care services
8519 & 8690
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Health – comparisons in time (3)
• Overview table of country practices•Based on country responses to Eurostat/OECD questionnaire in 2006•Attempt to describe practices in a common terminology difficult but potentially useful!•Countries’s help needed to complete
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Health – comparisons in space
• Presentation by Luca Lorenzoni (OECD Health Division)
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Way forward
•Health PPPs further developed in 2009•Completion of the chapter on health PPPs•Presentation of draft to health and education experts•Revision and final draft in 2009
•Delegates are asked to:•Comment on substance•Complete information on country practice
•Foreseen: written procedure
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Thank you!