A framework for international comparisons of volume and prices in health care Interim Report

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A framework for international comparisons of
volume and prices in health care Interim Report
7th Meeting of HA Experts and Correspondents for
Health Expenditure Data

• Manfred Huber

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Overview 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

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The 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)

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Basic 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

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Expenditure classifications for price
comparisons ICHA
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Expenditure classifications for price
comparisons ICHA (cont)
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Four estimation methods and their data
requirements
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Method 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)?

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Expenditure classification ICHA modified
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Which are the shortcuts used for health in
current PPPs?
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Current 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

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Example of detailed specification pharmaceutical
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Example of detailed specification home care
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Example of detailed specification dental care
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How 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

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Potential 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?

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Calculation 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
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Linking countries with (minimum) spanning trees
Examples of spanning trees
Source Hill (2002) Linking Countries and Regions
using Chaining Methods and Spanning Trees
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Example of spanning tree
Source Hill (2002) Linking Countries and Regions
using Chaining Methods and Spanning Trees
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Which 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

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Conclusions 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

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Points 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