Discussion of OECD Health Data

1
Discussion of OECD Health Data

• major progress with SHA and indicators
• importance of Ministerial endorsement
• appreciating broader determinants of health and
  what works versus primacy of costs and
  sustainable financing
• caution re over reliance on SNA concepts

• Michael Wolfson
• Statistics Canada

2
Hospital and In-patient Curative-rehabilitative
Expenditure
previous uncertainty
3
Per Capita Health Care Costs over Time by Use
(Current )
(1.3 billion aggregate drop)

(CIHI)
4
A model for looking at data availability in OECD
Health Data
Non-medical Determinants (Part 8)
The Production of Health -Related Welfare
Health Status (Part 1)
Inputs to Health Services (Part 2)
Utilization of Services (Part 3)
Social Welfare and Individual Utility
Budgeting Decisions
Purchasing Decisions
Purchasing Decisions
Demographic (Part 9) Economic (Part
10) References
The Flow of Health Expenditure
Overall social protection (Part 6)
Health Expenditure(Input volumes X prices)
Health Expenditure and Financing (Taxes,
Insurance, Out-of-Pocket) (Part 4, 5)
Health Expenditure (Utilization volumes X prices)
Pharma Market (Part 7)
5
The Evans and Stoddart Plumbing Diagram
6
top quintile
7
One year mortality rate vs. revascularized
within 14 days, AMI patients in health regions
with populations over 100,000, 4 provinces,
1995/96
30
25
20
15
revascularized within 14 days
better
10
5
0
0
5
10
15
20
25
30
Adjusted 1 year mortality rate ()
(Johansen et. al., Stats Can, 2001)
8
(with virtually no differences in one year
survival but what about differences in
health-related QoL?)
9
Changes in Life Expectancy (LE) and
Health-Adjusted Life Expectancy (HALE) by Cause
HALE
LE
Source Manuel et al, ICES and Health Canada, NPHS
10
ONS, Atkinson, and Productivity

• mandate (from ONS National Statistician)
• To advance methodologies for the measurement of
  government output and productivity (OK)
• in the context of the National Accounts
• BUT why not pose issue first in general, and
  then ask whether SNA is an appropriate framework
  for this, and if not, what would be?
• Caution OECD should be careful about entering
  this domain