Provisional Functional Classification System for Domestic Health Accounts of Hong Kong sar



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Provisional Functional Classification System

for

Domestic Health Accounts

of

Hong Kong SAR

People’s Republic of China


Submitted to Health and Welfare Bureau, Hong Kong SAR Government
August 1998

Institute of Policy Studies, Sri Lanka

under contract to Harvard University

Contents

Overview 2

Functional classification of health expenditures 2

CORE FUNCTIONS OF MEDICAL CARE 5

F1 Personal health services 5

F2 Distribution of medical goods 11

F3 Collective health services 13

F4 Health programme administration and health insurance 15

HEALTH RELATED FUNCTIONS 16

F5 Investment in medical facilities 16

F7 Health Research & Development 16

F8 Expenditure on environmental health 16

F9 Administration and provision of cash benefits 16

Review of International Practice 18

Core functions of medical care 18

Health related functions 39


Note on preparation
Prepared by Dr. Ravi P. Rannan-Eliya and Ms. Aparnaa Somanathan, Institute of Policy Studies, Sri Lanka (Consultants to Harvard University). The authors acknowledge the assistance during preparation of the international review of Manfred Huber of the OECD Secretariat in Paris, and of Dr. Peter Berman of Harvard University, and the inputs of the task groups appointed by the Health and Welfare Bureau of the Hong Kong SAR Government.

Overview

This document provides a set of classifications for use in Hong Kong DHA, developed through a process of review of international practice and deliberation by task groups appointed by the Hong Kong SAR Government Health and Welfare Bureau. Included is a review of current definitions and classifications used in NHA work by the Organisation of Economic Co-operation and Development (OECD) and four OECD member countries, USA, UK, Canada and Japan. The four countries were selected on the basis of feedback received from the DHA Team appointed by the Hong Kong government. On the basis of these approaches, a draft working paper was produced with recommendations as to options for the framework to be used in Hong Kong’s DHA and distributed among members of the DHA team. The paper was revised to incorporate comments made by the DHA team. This current paper is based on a previous paper by the same authors, Review of international NHA classifications and definitions for preparation of HK DHA, (March 1998).


Preparation of this document involved a systematic review of the current definitions used by the four countries concerned, the definitions used by the OECD secretariat in preparing its 1998 estimates of health spending in OECD member countries (to be published later in 1998, and referred to herein as OECD 1998), and a draft proposal for collecting international health statistics under preparation by the OECD secretariat in October 1997 (unpublished document made available to Institute of Policy Studies by OECD, referred to herein as OECD Proposal).
OECD 1998 is the most recent version of the set of definitions used by OECD in preparing its annual estimates of health spending in the OECD. It has been developed over several years in an ongoing attempt to standardise the available data reported by member countries, and therefore reflects substantially the structure of the health expenditure reporting systems in individual countries, in particular those of USA.
OECD Proposal (October,1997 version) is a new set of classifications and frameworks prepared by the OECD secretariat for measuring health expenditures in a manner consistent with other UN statistical reporting systems and the existing OECD database. It differs from OECD 1998 in that it proposes a different breakdown or classification of health expenditures, and in that it provides much more detailed sets of definitions for the various types of expenditures. Its functional classification of health expenditures, the ICHE (International Classification of Health Expenditures), is presented in four levels of disaggregation, each level of which is labelled according to a system of 1-4 digit codes. OECD plans to test this new approach during the next two years, and based on resulting modifications and feedback from non-OECD countries and experts to propose a revised version of the Proposal to Eurostat and other UN agencies as a global standard for health expenditure estimation. We have included the OECD Proposal in our review, as it is likely that it will lead eventually to a new international system of health expenditures estimation. However, the OECD Proposal is yet to be ratified by the OECD itself, and currently contains several major defects, which we believe will force major modifications. For this reason, we have focused on those elements in the OECD Proposal which are most useful and likely to stand the test of time.

Functional classification of health expenditures

OECD Proposal’s functional classification makes a basic distinction between core functions of health care and other health related functions. This same distinction is used in Hong Kong DHA, as it separates those expenditures for which there is universal agreement about their classification as health, from those for which there is considerable national variation and dispute. OECD Proposal then disaggregates core functions into four types at the first level (or one digit level of the ICHE):




  1. Personal medical services

  2. Distribution of medical goods

  3. Collective health services

  4. Health programme administration and health insurance

The draft functional classification used in Hong Kong DHA uses this same classification. At the next level of disaggregation, Hong Kong DHA deviates from that presented by the OECD Proposal (2 digit level in ICHE), and instead follow the general practice used in national NHA work by USA and that used in OECD 1998. The OECD Proposal presents a substantially different functional classification at its two digit level, which does not differentiate between inpatient and outpatient expenditures, and instead focuses on the clinical purpose of patient treatment expenditures. In our judgement, this new classification is unlikely to survive subsequent revisions, as most policy makers are actually interested firstly in knowing the inpatient/outpatient breakdown, and since most countries do not have the data to allow estimation of the categories proposed in OECD Proposal.


Table 1 gives the functional classification for health expenditures used in Hong Kong’s DHA. It includes the codes proposed for Hong Kong and the corresponding International Classification for Health Expenditures (ICHE) codes. ICHE is a standard developed by the proposed OECD manual. The remaining part of the document concentrates on presenting the definitions used by national agencies when reporting national statistics on health expenditures, or in their national health accounts, as well as those in use or proposed currently by OECD.
The format of this document is as follows. The definitions used in Hong Kong DHA for each item in the classification system are presented first. This is followed by a discussion of the relevant OECD and national definitions for those items. In many cases the only OECD definitions are those from OECD 1998. The definitions given for individual countries are the ones used in reporting national health expenditures through the OECD secretariat, where they deviate from the OECD 1998 definitions.
This document is a draft, and should be treated as a work in progress.
Table 1: Functional classification of health expenditures in Hong Kong

FUNCTION

CODE

ICHE CODE

Core functions of health care




HA.1-4

1. Personal health services

F1

HA.1

 Hospital services

F1.1

HA.1.1.4

 Acute hospital care

F1.1.1




 Psychiatric hospital care

F1.1.2




 Extended care

F1.1.3




 Ambulatory services

F1.2

HA.1.1

 Registered medical practitioners

F1.2.1




General Practitioners

F1.2.1.1




Medical specialists

F1.2.1.2




Other registered medical practitioners

F1.2.1.3




 Other registered medical care professionals

F1.2.2




 TCM providers

F1.2.3




 Unregistered medical care professionals

F1.2.4




 Laboratory services

F1.2.5

HA.1.1.2

 Diagnostic services

F1.2.6

HA.1.1.3

 Dental services

F1.2.7




 Psychological and socio-psychological services

F1.2.8

HA.1.1.7

 Residential nursing care/long term care for frail elderly people

F1.3

HA.1.1.5 - 6

 Home care

F1.4




 Patient transport and emergency rescue

F1.5

HA.1.3

2. Distribution of medical goods

F2

HA.2.

 Pharmaceuticals

F2.1

HA.2.1.1-2

 Therapeutic appliances and medical equipment

F2.2

HA.2.2.1-9

3. Collective health services

F3

HA.3

 Health promotion and disease prevention

F3.1

HA.3.1

 Maternal and child health

F3.1.1

HA3.1.1

 Family planning

F3.1.2

HA3.1.1

 Disease prevention

F3.1.3




Prevention of communicable diseases

F3.1.3.1

HA.3.1.2

 Prevention of non-communicable diseases

F3.1.3.2

HA.3.1.4

Health promotion

F3.1.4

HA.3.1.3

 School health services

F3.1.5

HA.3.1.5

 Food hygiene control

F3.1.6

HA.3.1.6

 Control of drinking water, environmental surveillance

F3.1.7

HA.3.1.7

 Other collective health services

F3.2

HA.3.2

 Occupational health care

F3.2.1

HA.3.2.1

4. Health programme administration and health insurance

F4

HA.4

 Health programme administration

F4.1

HA.4.1

 Administration of health insurance

F4.2

HA.4.2

Health related functions




HA.5 – 9

1. Investment into medical facilities

F5

HA.5

2. Education and training of health personnel

F6

HA.6

3. Research and development in health

F7

HA.7

4. Environmental health

F8

HA.8

5. Administration and provision of cash-benefits

F9

HA.9



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