National Accounts Working Party 14-16 October 2008 Paris Towards measuring the volume of health and education services Draft OECD Handbook Paul Schreyer,
Post on 17-Jan-2016
214 Views
Preview:
Transcript
National Accounts Working Party14-16 October 2008
Paris
Towards measuring the volume of health and education services
Draft OECD Handbook
Paul Schreyer, OECD/STD
National Accounts Working Party14-16 October 2008
Paris
Towards measuring the volume of health and education services
Draft OECD Handbook
Paul Schreyer, OECD/STD
Contents
• Background
• General concepts
• Education
• Health
• Way forward
Background: OECD Project
• Strong and continued demand for output measures of education and health by policy-makers
• European Regulation• Project started in 2005, endorsement by CSTAT• Builds on previous work: Eurostat Handbook on
Volume and Prices, Atkinson Report, country experiences
• Workshops in London (2006) and Paris (2007)• Objectives:
– OECD Handbook– Data development
• First draft of handbook presented to WPNA 2007
Background: An old question – what is new?
1. Joint work with sector specialists
• Elaborated jointly with OECD’s specialised networks– Network of education experts– Network of health experts
• Both networks have strong interest in measuring appropriate volume output
Background: An old question – what is new?
2: Joint treatment of temporal and spatial dimensions
• Education and health PPPs are of great importance to analysts
• PPPs and national accounts have to be consistent
• Handbook deals with both dimensions in parallel
Concepts and terminology
• Distinction must be made between inputs, outputs, outcomes -
• Best explained by way of a graph
Inputs
Labour, capital, intermediate
inputs
Environmental factors
Information about outcome is a
possible tool for quality adjustment
Process without explicit quality
adjustment
Process with explicit quality
adjustment
Example education: number of
pupils/pupil hours by level of education
Example education: quality-adjusted number
of pupils/pupil hours by level of
education
Example health: number of complete
treatments by type of disease
Example health: quality-adjusted
number of complete
treatments by type of disease
Outputs
Information about outcome is a
possible tool for quality adjustment
Direct outcome
Indirect outcome
Knowledge and skills as measured by
scores
Health status of population
Future real earnings,
growth rate of GDP,
well-rounded citizens
etc.
Outcomes
Inhereted skills, socio-economic background, etc.
Hygene, lifestyle, infrastructure etc.
Inputs
Labour, capital, intermediate
inputs
Environmental factors
Information about outcome is a
possible tool for quality adjustment
Process without explicit quality
adjustment
Process with explicit quality
adjustment
Example education: number of
pupils/pupil hours by level of education
Example education: quality-adjusted number
of pupils/pupil hours by level of
education
Example health: number of complete
treatments by type of disease
Example health: quality-adjusted
number of complete
treatments by type of disease
Outputs
Information about outcome is a
possible tool for quality adjustment
Direct outcome
Indirect outcome
Knowledge and skills as measured by
scores
Health status of population
Future real earnings,
growth rate of GDP,
well-rounded citizens
etc.
Outcomes
Inhereted skills, socio-economic background, etc.
Hygene, lifestyle, infrastructure etc.
If outcome indicators are used for quality adjustment, they:
•Should control for any other factors that affect outcome for
consumers (e.g. socio-economic background of pupils,
environmental impact on health)
Quality adjustment
• First and important step towards capturing quality change is the correct stratification, i.e., the comparison of products with the same or at least similar characteristics.
• Explicit quality adjustment may make it necessary to invoke outcomes
• Handbook:– Health: discussion but no proposals for explicit quality
adjustment – Education: discussion and proposal for explicit quality
adjustment (exam scores) for secondary-level education
Values and weights
• Current price values of non-market production = sum of costs
• Volumes:
1.Direct volume index =volume change of items, aggregation with cost weights
2.Deflation: apply price index to values• (Quasi) price index = unit costs: costs per unit
of output • as opposed to costs per unit of input
Education – comparisons in time (1)
•Basic approach:
•Unit of output = (quality-adjusted) volume of teaching services delivered
•Broadly, measured as pupil (hours), the number of hours during which pupils receive teaching services
•But differentiation according to level of education important
Education – comparisons in time (2)Output-based methods
Pre-primary education Number of pupil-hours
Primary education
Number of pupils, adjusted for change in pupil attainmentNumber of pupil hours*Number of pupils*
Primary education: general
Primary education: special education, e.g., for disabled pupilsNote: The sub-stratification normal / special could be replaced by coefficients reflecting the extra costs for social services provided to disabled pupils
Secondary education
Lower secondary: general
Lower secondary: special classes, e.g. for disabled pupils
Upper secondary education: general + pre-technical or pre-vocational
Upper secondary education: vocational
Post-secondary non-tertiary education
Education – comparisons in time (3)
Tertiary education
Credits (ECTS) Full-time equivalent students*Enrolled students*
Tertiary education with practical and occupation-specific programmes
Tertiary education with more theoretically-based programmes Note: differentiation by field of education useful
•To be developed: measuring research output of tertiary education establishments•To be completed and corrected: annex table with country practices
Education – comparisons in space
•In the past, PPPs for education based on comparison of input prices (teacher’s wages etc.)
•Significant difficulties in measuring comparable input costs
•Eurostat/OECD Taskforce on PPPs for education:
•Examined output-based approach•Concluded that it yields more plausible results than input-based measures
Education – comparisons in space
Approach:
•Stratification by level of education
•Unit of output: pupil-hour (teaching received)
•Secondary education: explicit quality adjustment with PISA scores, corrected for socio-economic variables
Health – comparisons in time (1)•Disease-based approach
•Increasing number of countries use disease-based approach
•Reflects changes in administrative practice (e.g. shift to DRG system in Germany’s hospital administration)
•Unit of output = (complete) treatment
•But differentiation by type of activity important•Unit of output may vary between activities
Health – comparisons in time (2)ISIC rev 3.1 & 4 Output-based methods
Hospital activitiesAcute Hospitals 8511 & 8610 (Quasi) Price index based on DRGs (cost or
revenue-weighted)Direct volume index based on DRGs (cost or revenue-weighted)Direct volume index based on ICD categories (e.g., number of discharges by category with quantity-weights such as shares in hospital days)
Mental health and substance abuse hospitals
8511 & 810 (Quasi) Price index based on DRG-like categories (cost or revenue-weighted)Direct volume index based on DRG-like categories (cost or revenue-weighted)Direct volume index based on ICD categories (e.g., discharge numbers with quantity-weights such as shares in day care days)Number of discharges*Number of days of care*
Speciality (other than HP.1.2) hospital
8511 & 8610
Health – comparisons in time (3)
Health – comparisons in time (4)
Health – comparisons in time (5)ISIC rev 3.1 & 4 Output-based methods
Other human health activitiesNote: the list of services below is not exhaustive as other human health activities covers very heterogeneous activities Other health practitioner consultations
8519 & 8690
Direct volume index based on number of consultation by type of consultation (cost or revenue-weighted)
(Quasi) Price index based on average cost or revenue per consultation (cost or revenue-weighted)
Relevant component of Consumer Price Index if applicable**
Number of consultations*
Number of tests performed*
Number of cases treated*
Other outpatient visits 8519 & 8690Family Planning centres 8519 & 8690Outpatient mental health and substance abuse centres
8519 & 8690
Free-standing ambulatory surgery centres
8519 & 8690
Dialysis care centres 8519 & 8690Other outpatient multispecialty and cooperative service centres
8519/8531 & 8690
All other outpatient care centres 8519/8531 & 8690
Medical and diagnostic laboratories
8519 & 8690
Home health care services 8519/8531 & 8690
All other ambulatory health care services
8519 & 8690
Health – comparisons in time (3)
• Overview table of country practices•Based on country responses to Eurostat/OECD questionnaire in 2006•Attempt to describe practices in a common terminology difficult but potentially useful!•Countries’s help needed to complete
Health – comparisons in space
• Presentation by Luca Lorenzoni (OECD Health Division)
Way forward
•Health PPPs further developed in 2009•Completion of the chapter on health PPPs•Presentation of draft to health and education experts•Revision and final draft in 2009
•Delegates are asked to:•Comment on substance•Complete information on country practice
•Foreseen: written procedure
Thank you!
top related