SHA based

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• SHA based
• National Health Account
• Hiroyuki SAKAMAKI, MBA
• Institute for Health Economics and Policy (IHEP)
  Tokyo, Japan
• Meeting of Experts in National Health Accounts
• Organisation for Economic Co-operation and
  Development (OECD)
• Directorate for Employment, Labour and Social
  Affairs
• Chateau de la Muette, Paris, 27-28 October 2003

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SHA Member Manabu YAMAZAKI Koki HAYAMIZU Sumie
IKEZAKI Masahiro TASHIMA
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Outline of Presentation

• Overview of the NHA estimates in 2000
• LTC System and Estimating Expenditure of LTC
• Key Issues

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Trend of National Medical Expenditure (NME)
Shifted to LTC
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The Structure of National Health Accounts
(Billion Yen, 2000)
Total Expend. on Health 39,534
Current Expend. 37,306
Investment 2,227
Personal Expend. 35,283
Collective Expend. 2,022
Prevent. Public Health 1,165
Admin. Insurance 875
Medical Services 27,724
Medical Goods 7,559
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Structure of SHA

• Spending on medical-related services
• HC 6 Preventive health and health
  Promotion
• Medical services
• OTC drugs,Private-duty nursing,etc.
• Medical-related services
• Personal dental services, Special meals,etc.

HCR. Sub-systems supporting the medical
system education, RD, etc
LTC Welfare services
NME as currently defined.
HC.7 Indirect NME as currently defined. Administra
tion of health insurance system
HCR.1 Public expenditures on medical
institutions. Subsidies, Public payments, etc.
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Trend of Personal Health Expenditure and NME
Estimation in 2001 is tentative data
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Current Expenditure by Function
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Current Expenditure by Financing
(Billion Yen, 2000)
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Current Expenditure by Provider
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LTC System and Estimating Expenditure of
LTC-Long Term Care-
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Public Long Term Care Insurance Act

• In effect since April 1, 2000.
• To allow those in need of care and support to
  lead their daily lives as independently as
  possible making use of the capabilities.
• To provide long term care by integrating health,
  medical care and welfare services as select by
  the user.

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Mechanism of LTC Insurance System
municipalities
30
Premiums of elderly (17)
Premiums
Aid to municipality
Prefecture
No.1 Insured (65 and over)
Public expenditure
70
Deducted from pension
Premiums of non-elderly (33)
State (25)
Medical insurers
Premiums
No.2 Insured (from 40 to 64)
Prefecture (12.5)
Federation of National Health Insurance
Associations
Lump-sum payment
National pool
Municipality (12.5)
Examinations,payments,etc.
Social Insurance Medical Care Fee Payment Fund
Transfer
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Domiciliary Service

• Home-visit services
• Home help service / Bathing service / Nursing /
  Home rehabilitation
• Short-term stay services
• Day service (at day care center) / Outpatient
  rehabilitation (at medical care facility) / Short
  stay therapy / Group therapy to counter dementia
  (home for senile dementia patients) / Long term
  care for residents of special facilities
• Others
• Home treatment management and guidance / Leasing
  of welfare appliances/Provision for purchase of
  home care welfare appliances / Provision for home
  improvements associated with care / Home help
  service support

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Facility Services

• Long Term Care Welfare Facilities for the Elderly
  (Special Nursing Homes for the Elderly)
• Long Term Care Health Facilities for the Elderly
  (Facilities of Health Care Services for the
  Elderly)
• Long Term Care Medical Treatment Facility
• Medical treatment beds
• Beds for treatment of senile dementia
• Long Term Care strength building hospital

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LTC Services include SHA and Categories by ICHA-HC
home-visit nursing HC.3.3 long-term nursing home care
home-visit rehabilitation HC2.4 rehabilitative home care
commuting rehabilitation services HC.2.2 rehabilitative day care
medical care service through a short-term stay HC.3.1 long-term nursing in-patient care
management guidance for in-home care HC2.4 rehabilitative home care
health care facility services for the elderly requiring long-term care HC.3.1 long-term nursing in-patient care
sanatorium type medical care facility services for the elderly requiring care HC.3.1 long-term nursing in-patient care
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Types of Institutes providing LTC and SHA
categories by ICHA-HP
Long term care welfare facilities for the Aged LTCW Not Appreciable
Long term care health facilities for the Aged LTCH HP.2 nursing and residential care facilities
Long term care medical treatment facilities LTCM
Medical treatment beds HP.1 Hospital
Beds for treatment of senile dementia HP.1 Hospital
LTC strength building Hospital HP.1 Hospital
GP Clinic HP.3 ambulatory health care providers
Dental Clinic HP.3 ambulatory health care providers
Home visiting nurse station HP.3 ambulatory health care providers
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LTC Services by Function and Providers
HP.1 Hospital HP.2 Long term care health facilities HP.3 HP.3
HP.1 Hospital HP.2 Long term care health facilities Clinic Home visiting nurse station
HC2.2 commuting rehabilitation services ? ? ?
HC2.4 home-visit rehabilitation ? ?
HC2.4 management guidance for in-home care ? ?
HC3.1 medical care service through a short-term stay ? ? ?
HC3.1 health care facility services for the elderly requiring long-term care ?
HC3.1 sanatorium type medical care facility services for the elderly requiring care ? ?
HC3.3 home-visit nursing ? ? ?
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LTC funding
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Personal Expenditures for Medical Care and LTCs
Billion Yen, 2000
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LTC Expenditure by Providers
Billion Yen, 2000
22
LTC Expenditure by financing
Billion Yen, 2000
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Key Issues.
Items those are not counted in the National
Expenditure on Health by SHA definition due to
lack of data. Following data are NOT available,
therefore cause for underestimation

• Expenditure for amenities, advanced med care (ie.
  ESWL)
• HC.2.3 Non-Insured Acupuncture and JUDO
  reposition.
• HC.6 Educational interventions for health
  promotion. Expenditure for the public health
  center admin.
• HC.7 Expenditure for the general government
  admin.
• HCR.1 Capital investment for specialized
  hospitals.
• HCR.2,4-7 Not available.

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Conclusion

• The total expenditure on health in Japan 2000 is
  about 700 billions of Yen (22) higher than the
  value based on the National Medical Care
  Expenditure
• In 2000, 293,916 Yen per capita