SHA Implementation

2. SHA Implementation Louise Ogilvie Director Health Resources Information

3. CANADIAN HEALTH ACCOUNTSHISTORY • 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.

4. CANADIAN HEALTH ACCOUNTSHISTORY • 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”.

5. CANADIAN HEALTH ACCOUNTS • Reflect the structure of the Canadian Health Care System within its constitutional framework

6. 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).

7. CANADIAN HEALTH ACCOUNTS • Historical series 1953–2003 • Financial data • 5 sources of finance (sectors) • 42 uses of funds (categories) • Actual/estimates/forecasts

8. CANADIAN HEALTH ACCOUNTSSources of Finance

9. 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%

10. 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”. CANADIAN HEALTH ACCOUNTS MAPPING TO ICHA-HF

11. CANADIAN HEALTH ACCOUNTS MAPPING TO ICHA-HF: Public Sector

12. CANADIAN HEALTH ACCOUNTS MAPPING TO ICHA-HF: Private Sector

13. Central government 3.0% Total Health Expenditure by Source of Finance, (SHA), Canada,1999 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%

14. CANADIAN HEALTH ACCOUNTS MAPPING TO ICHA-HC

15. CANADIAN HEALTH ACCOUNTSHospitals: MAPPING TO ICHA-HC

16. CANADIAN HEALTH ACCOUNTSOther Institutions: MAPPING TO ICHA-HC

17. CANADIAN HEALTH ACCOUNTSPhysicians: MAPPING TO ICHA-HC

18. CANADIAN HEALTH ACCOUNTSOther Professionals: MAPPING TO ICHA-HC

19. CANADIAN HEALTH ACCOUNTSDrugs, Capital, Public Health and Administration: MAPPING TO ICHA-HC

20. 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%

21. Uses of Funds in Canadian Health Accounts Broken Down by Mode of Production

22. 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%

23. CANADIAN HEALTH ACCOUNTSInstitutions and Professional Services: MAPPING TO ICHA-HP

24. CANADIAN HEALTH ACCOUNTSDrugs, Public Health/Admin, Other Health Spending: MAPPING TO ICHA-HP

25. 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%

26. 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.

27. What went well (cont’d)… 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).

28. 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 Acc’ts. • Non-medical care in residential facilities is included in the SHA, not in Canadian Acc’ts. • Alcohol-Drug Addiction facilities is included in Canadian Acc’ts, not in SHA. • No equivalent to Non-Consumption in the SHA.

29. Conclusions (cont’d) • 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.