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					 Measurement of non-market
output in education and health
    OECD/ONS workshop
                   London, 3-5 October 2006

                Review of European and OECD
                     countries experiences

             Health output methods


03/10/2006   Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS
         Importance of price and
          volume measures for
           the European Union
 The availability of price and volume
  measures of GDP is essential for:

  1. Monitoring economic development in the
     EU
  2. The monetary policy of the euro area
  3. The implementation of the Stability and
     Growth Pact

 03/10/2006   Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS
Some legal aspects in the EU

 Commission      Decisions    98/715   and
  2002/990 clarified the principles for the
  measurement of prices and volumes.
 This     Commission     legislation   has
  identified the most appropriate estimation
  methods to be applied (A and B methods)
  and the methods which shall not to be
  used (C methods).
 The old Member States were asked to
  remove the C methods by end 2006.


03/10/2006   Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS
    Aims of the list of questions
 In June 2006 Eurostat sent to all Member
  States a list of questions on price and volume
  measurement in the fields of non market
  health and education services.
 The main objective was to assess and monitor
  Member States progress towards removing C
  methods by end 2006.
 In this context, the sharing of experience
  between countries is of utmost importance.
 During the same month of June 2006, the
  OECD launched a similar questionnaire to
  OECD non-EU members, in the perspective of
  its „non-market project“ (best practices).
  03/10/2006   Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS
                   Scope of the list

 The list covers solely the output
  methods currently used or being
  developed by the countries.
 24 out of 27 EU countries (including
  Iceland and Norway) replied to the
  list.
 7 OECD non-EU countries replied to
  the similar OECD questionnaire, but
  only 2 (AU, NZ) currently apply output
  methods and 1 (US) studies a project.
  Japan and Korea are „all market“.
03/10/2006   Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS
               Structure of the list

 The list covers five aspects:
   1.    Stratification
   2.    Quantity indicators
   3.    Weighting
   4.    Quality indicators
   5.    Availability of the data


03/10/2006   Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS
                    Stratification (1)

 A and B methods require
  stratification for, at least, the
  following categories:

    1.       Hospital services
    2.       Medical practice services
    3.       Dental practice services
    4.       Other human health services

03/10/2006    Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS
                   Stratification (2)

 Hospital services must be broken
  down in:
        1. Services to in-patients by                             general        and
           specialised hospitals.
        2. Hospital psychiatric services
        3. Rehabilitation services in                             rehabilitation
           centers / hospitals
        4. Nursing services
 Medical practice services must be
  broken down in:
        1. Services by medical specialists
        2. Services by general practitioners
03/10/2006   Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS
                   Stratification (3)

 The basic stratification is generally
  applied
 11 EU countries use complementary
  stratifications (by region and subject)
 AU and NZ use a specific ANZICS
  classification       (developed     for
  specialists).

03/10/2006   Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS
             Quantity indicators (1)

 Eurostat    handbook      indicates:   “The
  quantity of health care received by patients
  should be measured in terms of complete
  treatments“.
 For     hospital      services      Eurostat
  recommends to measure the treatments on
  the basis of DRG (Diagnosis Related
  Groups).
 For      nursing      services     Eurostat
  recommends occupant days by level of
  care.
03/10/2006   Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS
               Quantity indicators (2)
 For services by general practitioners
  Eurostat recommends to use the number of
  consultations by type of treatment.
 For services by medical specialists Eurostat
  recommends to use the number of first
  visits.
 For dental practice services Eurostat
  recommends to use the number of
  consultations by type of treatment.


  03/10/2006   Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS
              Quantity indicators (3)

 For services to inpatients by general
  and specialised hospitals we had 20 EU
  replies:
  o 8 countries use DRG methods.
  o 6 countries use mixed methods.
  o 3 countries use the number of occupant
    days.
  o 3 countries use other methods.
 AU, NZ use DRG too (+ US in project)
 03/10/2006   Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS
             Quantity indicators (4)

 For hospital psychiatric services we
  had 15 EU replies:
    o 2 countries use DRG methods.
    o 6 countries use the number of occupant
      days.
    o 3 countries use mixed methods.
    o 4 countries use other methods.
 AU uses number of occupant days by
  level of care, NZ a composite index.
03/10/2006   Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS
              Quantity indicators (5)

 For rehabilitation services we had 12
  EU replies:
  o 2 countries use DRG methods.
  o 5 countries use the number of occupant
    days.
  o 2 countries use the number of treatments.
  o 3 countries use mixed methods.


 03/10/2006   Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS
              Quantity indicators (6)

 For nursing services we had 13 EU
  replies:
 o 2 countries use DRG methods.
 o 8 countries use the number of occupant
   days.
 o 1 country uses the number of treatments.
 o 3 countries use mixed methods.



 03/10/2006   Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS
             Quantity indicators (7)

 For services by general practitioners
  we had 15 EU replies:
    o 5 countries use the number of
      consultations.
    o 3 countries use the number of treatments.
    o 5 countries use mixed methods.
    o 2 countries use other methods.
 AU uses the number of treatments and
  NZ the CPI (idem for other medical
  services).
03/10/2006   Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS
              Quantity indicators (8)

 For services by medical specialists we
  had 13 EU replies:
  o 3 countries use the number of
    consultations.
  o 4 countries use the number of treatments.
  o 4 countries use mixed methods.
  o 2 countries use other methods.


 03/10/2006   Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS
             Quantity indicators (9)

 For dental services we had 14 EU
  replies:
   o 4 countries use the number                                                      of
     consultations.
   o 3 countries use the number                                                      of
     treatments.
   o 4 countries use mixed methods.
   o 3 countries use other methods.

03/10/2006   Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS
        Quantity indicators (10)

 For other human health services we
  had 8 EU replies:
    o 2 countries use the number                                                     of
      treatments.
    o 2 countries use mixed methods.
    o 4 countries use other methods.




03/10/2006   Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS
                            Weighting

 Nearly    all   countries   apply
  weightings based on costs as
  required in the regulation.
 They mainly use administrative
  sources.



03/10/2006   Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS
             Quality indicators (1)

 Eurostat recommends the use of
  adjustments for quality but an output
  indicator method can be acceptable
  (B method) without quality adjutment.
 6     European      countries     use
  adjustments for quality and these
  adjusments are mainly based on DRG.
 The US envisage to use QALY.
03/10/2006   Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS
              Quality indicators (2)

 For example, Italy and Austria use
  fully quality-adjusted indicators based
  on the DRG for each class of hospital
  services.
 Italy uses also indicators based on
  high-technology              diagnostic
  equipment.


 03/10/2006   Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS
             Quality indicators (3)

 The issue of quality is, indeed, a very
  difficult one, both conceptually and
  in terms of implementation.
 Eurostat is interested to learn some
  ideas from this workshop and will
  continue discussions at EU level.


03/10/2006   Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS
                      Conclusion (1)

 Health is a particulary difficult area,
  more     difficult   than    education,
  certainly due to the great heterogenity
  of health systems across countries.
 Eurostat has to continue discussions
  with EU MS on the difficulties
  mentioned and try to find appropriate
  solutions on the various aspects of
  price and volume measurement.

03/10/2006   Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS
                       Conclusion (2)

 It   is   important    to   work      on
  administrative sources, in particular, to
  help to reduce response burden.
 Further discussions are needed on the
  issue of quality adjusment.
 In next OECD workshop in Paris, in
  June 2007 ?


 03/10/2006   Francis MALHERBE, Eurostat, unit C1 and Alain GALLAIS, OECD, STD/NAFS

				
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