From%20Vision%20to%20Action:%20CIHI

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SHA Implementation

• Louise Ogilvie
• Director
• Health Resources Information

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CANADIAN HEALTH ACCOUNTS HISTORY

• First systematic compilation by Health Canada in
  1963.
• Expenditures on personal health care by private
  and public sector, from 1953 to 1961.
• Five categories hospitals, prescribed drugs,
  physicians, dentists and other professionals.

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CANADIAN HEALTH ACCOUNTS HISTORY

• Health Canada maintained the National Health
  Accounts until 1995 when they were transferred to
  the new Canadian Institute for Health Information
  (CIHI).
• CIHI was established in 1994 To serve as the
  national mechanism to coordinate the development
  and maintenance of a comprehensive and integrated
  health information system in Canada.

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CANADIAN HEALTH ACCOUNTS

• Reflect the structure of the Canadian Health
  Care System within its constitutional framework

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CANADIAN HEALTH ACCOUNTS

• PROVINCIAL/TERRITORIAL GOVERNMENTS
• Have primary responsibility in the health care
  area.
• FEDERAL GOVERNMENT
• National conditions/criteria
• Fiscal Powers (Tax and Spending)
• Direct responsibility for certain groups
  (Indians, Veterans, RCMP, Armed Forces, federal
  inmates).

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CANADIAN HEALTH ACCOUNTS

• Historical series 19532003
• Financial data
• 5 sources of finance (sectors)
• 42 uses of funds (categories)
• Actual/estimates/forecasts

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CANADIAN HEALTH ACCOUNTSSources of Finance

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CANADIAN HEALTH ACCOUNTSTotal Health
Expenditure by Use of Funds, 1999
Capital 3.5
Hospitals 32.0
Public Health Admin 5.7
Drugs 15.0
Other Health Spending 8.6
Other Institutions 9.5
Physicians 13.6
Other Professionals 12.1
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CANADIAN HEALTH ACCOUNTS MAPPING TO ICHA-HF

• Public Sector
• Good correspondence between the Canadian
  classification of sources of finance and the
  ICHA-HF.
• Private Sector
• Direct correspondence only for out-of-pocket
  expenditure.
• No ICHA-HF category clearly corresponds to
  non-consumption.

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CANADIAN HEALTH ACCOUNTS MAPPING TO ICHA-HF
Public Sector
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CANADIAN HEALTH ACCOUNTS MAPPING TO ICHA-HF
Private Sector
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Total Health Expenditure by Source of Finance,
(SHA), Canada,1999
Central government 3.0
State/provincial governments 65.2
Non- consumption 2.1
Private household out-of-pocket 16.4
Private social insurance 10.2
Local/municipal governments 0.7
Social security funds 1.3
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CANADIAN HEALTH ACCOUNTS MAPPING TO ICHA-HC
Eight Broad Uses of Funds Were Mapped to ICHA-HC Eight Broad Uses of Funds Were Mapped to ICHA-HC
Uses of Funds in Canadian Health Accounts ICHA-HC
Hospitals 17 categories
Other Institutions 2 categories
Physicians 7 categories
Other Professionals 3 categories
Drugs 3 categories
Capital 1 category
Public Health and Administration 1 category
Other Health Spending 9 categories
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CANADIAN HEALTH ACCOUNTS Hospitals MAPPING TO
ICHA-HC
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CANADIAN HEALTH ACCOUNTS Other Institutions
MAPPING TO ICHA-HC
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CANADIAN HEALTH ACCOUNTS Physicians MAPPING TO
ICHA-HC
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CANADIAN HEALTH ACCOUNTS Other
Professionals MAPPING TO ICHA-HC
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CANADIAN HEALTH ACCOUNTS Drugs, Capital, Public
Health and Administration MAPPING TO ICHA-HC
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Current Health Expenditure, by Major Functional
Category, (SHA), Canada,1999
Undistributed 0.9
Curative/rehabilitative care 48.9
Health adm. insurance 2.0
Prevention public health 6.7
Medical goods dispensed to out-patients 18.7
Long-term nursing care 14.2
Ancillary Services 8.6
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Uses of Funds in Canadian Health Accounts Broken
Down by Mode of Production
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Current Health Expenditure, by Mode of
Production, (SHA), Canada,1999
Not applicable (ancillary services, medical
goods, prevention public health, health adm.
insurance) 36.0 (
In-patient care 32.0
Day care 2.9
Out-patient care 26.2
Home care 2.1
Undistributed 0.9
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CANADIAN HEALTH ACCOUNTS Institutions and
Professional Services MAPPING TO ICHA-HP
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CANADIAN HEALTH ACCOUNTS Drugs, Public
Health/Admin, Other Health Spending MAPPING TO
ICHA-HP
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Current Health Expenditure, by Major Types of
Providers, (SHA), Canada,1999
Undistributed 0.9 (
Hospitals 35.6
Nursing and residential care facilities 10.0
All other industries 0.3
Gen. Health adm. 2.0
Provision and adm. of public health
programmes 6.2
Retail sale and other providers of medical goods
18.7
Providers of ambulatory health care 26.4
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What went well

• Good correspondence between the Canadian
  classification of sources of finance for the
  public sector and the ICHA-HF.
• Private insurance group plans meet the definition
  of HF.2.1 private social insurance.
• Expenditures on drugs and capital could be
  directly mapped to the ICHA-HC.

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What went well (contd)

• About two thirds of hospital operating expenses
  could be directly allocated to as much as
  seventeen ICHA-HC categories.
• Fee-for-service payments of physicians in private
  practice were allocated to seven ICHA-HC
  categories.
• Good correspondence between some uses of funds
  and the ICHA-HP (e.g. Hospitals, Other
  Institutions, Other professionals).

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Conclusions

• SHA implementation resulted in 3 reduction of
  THE relative to Canadian Accounts.
• Furthermore, there are boundary differences
  between the Canadian Accounts and the SHA.
  Examples include
• Imports and exports are treated differently in
  the Canadian Accounts and the SHA
• Auto Insurance is not included Canadian Accts.
• Non-medical care in residential facilities is
  included in the SHA, not in Canadian Accts.
• Alcohol-Drug Addiction facilities is included in
  Canadian Accts, not in SHA.
• No equivalent to Non-Consumption in the SHA.

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Conclusions (contd)

• Limitations to extent that most Uses of Funds in
  the Canadian Accounts could be mapped to ICHA-HC
• The ICHA-HP is inconsistent with the way health
  care is financed in Canada.
• The ICHA-HP is inconsistent with the way provider
  incomes are reported in Canada.