Title: A framework for international comparisons of volume and prices in health care Interim Report
1A framework for international comparisons of
volume and prices in health care Interim Report
7th Meeting of HA Experts and Correspondents for
Health Expenditure Data
2Overview of presentation
- Objectives of the project of health specific PPPs
(H-PPPs) - Expenditure classifications for price comparisons
- Potential data sources Where are we? Whats
missing? - Aggregation strategies for multilateral
comparisons - Which role for quality adjustment?
- Conclusions Next steps
3The project of price and volume comparisons
objectives
- Set of comparative indicators at different levels
of aggregation (ICHA-HC three/two/one digit
level) - Indicators for bilateral comparisons
- Simple comparisons of volume measures with
unweighted OECD averages - But also aggregation to Indicators for
multilateral comparisons.. - ..for Improved purchasing power parities for
health (H-PPPs) (health-specific PPPs)
4Basic definitions (SNA terminology)
- Expenditure price x volume
- Value synonym to expenditure
- Quantity units for homogenous, individual goods
or services - Volume weighted average of quantities of
individual products or groups of products - Output volume of well-defined bundle of goods
5Expenditure classifications for price
comparisons ICHA
6Expenditure classifications for price
comparisons ICHA (cont)
7Four estimation methods and their data
requirements
8Method of choice ?
- Unit prices for market services (in particular
for medical goods) - Indirect comparison for non-market services via
output measures from (secondary) administrative
data sources ? suggested for the H-PPP project - Input price method for non-market services
(Eurostat-OECD, 2002 PPPs) - But non-market/market distinction in SHA-based
health accounts not available.. - ..and what about expenditure corresponding to
transaction prices for mixed public-private
payment (cost-sharing)?
9Expenditure classification ICHA modified
10Which are the shortcuts used for health in
current PPPs?
11Current specification of health in PPPs
- Detailed list of market prices for medical goods
and selected ambulatory/outpatient services (540
of which 85 are pharmaceuticals - Advantages questionnaire with very detailed
specifications, tested in the field - Potential to complement list of ambulatory
services (e.g. put in more services which
correspond to current/latest technology more
expensive treatment) - E.g. complement unit-prices for long-term care
12Example of detailed specification pharmaceutical
13Example of detailed specification home care
14Example of detailed specification dental care
15How to improve PPPs and move to H-PPPs?
- Focus on comparative resistant item of hospital
care - Big spending item, not covered well in current
PPPs - Select inpatient care items high spending items
dynamic spending development (ageing/chronic
conditions) e.g. surgery like hip/knee
replacement - Complement ambulatory care list with high volume
surgical procedures (cataract etc.) - Further develop indicators for long-term care
16Potential data sources
- Use of secondary data sources survey too costly?
- Design hospital data set with a view to provide
relevant data for H-PPP purposes - Same for long-term care
- Health care quality indicators project many
indicators refer to volumes (often measuring
times, right thing is done) - Co-operate with main PPPs project to improve
available items in questionnaire and for quality
checking?
17Calculation and aggregation standard methods of
linking countries
Complete system of bilateral comparisons
Comparison of four countries with a multilateral
average
Source Hill (2002) Linking Countries and Regions
using Chaining Methods and Spanning Trees
18Linking countries with (minimum) spanning trees
Examples of spanning trees
Source Hill (2002) Linking Countries and Regions
using Chaining Methods and Spanning Trees
19Example of spanning tree
Source Hill (2002) Linking Countries and Regions
using Chaining Methods and Spanning Trees
20Which role for quality adjustment?
- Quality differences important issue that needs to
be addressed - Direct adjustment versus post-adjustment/analysis?
- Suggestion to keep volume/output/quality separate
for the first phases of the project - Later on, test regression models before
adjustments can be justified - Hedonic regression technique for PPPs available,
but seldom used so far should be tested once
more data available
21Conclusions and next steps
- Project of H-PPPs major undertaking, potentially
resource intensive - Better linking of SHA to SNA becomes a concern
- Synergy with overall PPP project?
- Break project down in manageable parts
- Get countries involved in bilateral comparisons
to improve quality, commitment and save cost? - Need to write down the math on index formulas to
be tested and do first tests with hospital data
22Points for discussion
- Comments on conceptual framework
- Data availability and feasiblity from national
sources - Interest to participate in further methodological
work and work with test data