1 DRAFT GUIDELINES TO IMPROVE LONG-TERM CARE EXPENDITURE IN OECD HEALTH DATA 2006/2007 7 th Meeting of Health Accounts Experts and Correspondents for Health Expenditure Data Paris, 29 - 30 September 2005
Mar 21, 2016
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DRAFT GUIDELINES TO IMPROVE LONG-TERM CARE EXPENDITURE IN
OECD HEALTH DATA 2006/2007
7th Meeting of Health Accounts Experts and Correspondents for Health Expenditure Data
Paris, 29 - 30 September 2005
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Components of OECD work on LTC expenditure
Long-term Care Study – provided the definition for HC.3 Follow-up on the Long-term Care Study: data collection on
recipients of LTC Data collection complementary to OECD Health Data
2005 on expenditure on health and social care for the elderly and people with physical and mental impairments – pointed out the need for reporting Total LTC expenditure (HC.3+HC.R.6)
Preparation of guidelines on LTC expenditure for OECD Health Data 2006 and SHA data collection
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Requirements for LTC expenditure data
Availability of data Reliability of data Timeliness Comprehensiveness of estimating total spending Consistency of hierarchy of sub-aggregates Comparability across countries and over time Transparency (estimation methods and deviations) Policy-relevant indicators
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Total health and social expenditure (including cash benefits) for the elderly and people with physical and mental impairmentsLong-term health and social expenditure
Other in-kind benefits
Cash benefits
Long term nursing and personal care [HC.3]
Social services of LTC [HC.R.6]
Other in-kind benefits (e.g., free use of public transport)
Related to sickness and disability [HC.R.7]
All other cash benefits
Long term “health” care (according to national definitions)
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HC1 & HC2 Services of curative and rehabilitative care
HC3 Long-term nursing and personal care
HC4 Ancillary services
HC5 Medical goods
HC 6 Prevention and public health
HC7 Health administration and health insurance
HC1-2, HC4-7 EXPENDITURE ON PREVENTIVE-CURATIVE HEALTH CARE
HC 1-7 TOTAL CURRENT HEALTH EXPENDITURE
HC 1-7; HC.R.1 TOTAL HEALTH EXPENDITURE
Memorandum items
HC.R.6.1 Long-term care other than HC3
HC3 + HC.R.6.1 Total LTC EXPENDITURE
HC 1-7, HC.R.6.1 TOTAL CURRENT HEALTH AND LONG TERM CARE EXPENDITURE
Proposed way of presenting categories of LTC in OECD Health Data 2006
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Policy relevance of different categories of LTC expenditure
From the point of view of public budgets, it is desirable to provide information concerning the total spending on services provided to the elderly and people with physical and mental impairments (with ADL and/or IADL restrictions).
Expenditure on LTC services provided to persons with ADL restrictions distinguish between severe and minor disabilities
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Requirement of comprehensiveness
SHA Manual: “In accordance to the functional approach, all programmes designed to provide health care … should be included, whether labelled “health care” or not in national statistics.”
It is desirable to apply this requirement for health and social care for people who are limited in their ability to function independently on a daily basis over a relatively long period of time – regardless whether it is labelled “health” or “social” in national statistics
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HC.3 Services of long-term nursing and personal care
Definition – developed by the LTC Study Long-term nursing and personal care comprises a range of
services required by persons with a reduced degree of functional capacity, either physical or cognitive, who are consequently dependent on help with basic activities of daily living (ADL), such as bathing, dressing, eating, getting in and out of bed or chair, moving, around and using the bathroom. This physical or mental disability can be the consequence of chronic illness, frailty in old age, mental retardation or other limitations of mental functioning and/or cognitive capacity. In addition, help with monitoring status of patients in order to avoid further worsening of ADL status
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HC.R.6. Health-related LTC social services (Long term care other than HC.3)
This item comprises services of home help and residential care services: care assistance which are predominantly aimed at providing help with IADL restrictions to persons with functional limitations and a limited ability to perform these tasks on their own without substantial assistance, including supporting residential services (in assisted living facilities and the like).
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Total long term care (including HC.R.6)
The term ‘long-term care services’ encompasses the organisation and delivery of a broad range of services and assistance to people who are limited in their ability to function independently on a daily basis over an extended period of time. Functional dependency can result from either physical or mental limitations and is defined in terms of the inability to perform essential activities of daily living (ADLs), such as eating, bathing, dressing, using the toilet, getting into and out of bed, and moving about the house, or activities necessary to remain independent, known as instrumental activities of daily living (IADLs) such as shopping, cooking, doing laundry, managing household finances, and housekeeping.
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Components of LTC spending
Palliative care (end-of-life care) Long-term nursing care Personal care services (assistance with ADL
restrictions)
Services in support of informal (family) care– Care allowances– Support to informal care givers
Home help; care assistance (help with IADL restrictions)
Supported living arrangements: residential (care) services Other social services provided in a long-term care context
– Special types of transportation– Case management / coordination
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Initial comments on LTC Guidelines
Alternative proposals Home care Home help; care assistance (help with IADL restrictions) Meals on wheels Services in support of informal (family) care
– Care allowances– Support to informal care givers
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HOME CARE: alternative proposals
Option A HC.3.3 Long-term nursing and personal care: home care Includes: personal services, nursing services delivered at
home; lower-care services (home help), if provided by the same person that also provides help with ADL restrictions at the same time.
Option B HC.3.3 Long-term nursing and personal care: home care Includes: nursing and personal care services delivered at
home; and services in support of informal (family) care related to ADL restrictions
Excludes: all other types of LTC services
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HOME HELP: alternative proposals
Option ARecommendation: Home help and other help with IADL restrictions -
where delivered as separately identifiable services should be included only in HC.R.6: Health-related social services of LTC
Include expenditure on help with IADL restrictions in HC.3, if provided as part of nursing or personal care services provided by the same care giver
Option BHome help, care assistance and other help with IADL restrictions
should be included only in HC.R.6: social services of LTC (Long-term care other than HC.3). If home help provided together with HC.3.3. LTC home care, these services should be separately accounted under HC.3.3 (home care) and HC.R.6 (home help). If the separation is not possible, all expenditure should be reported under HC.R.6.
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Meals on wheels: alternative proposals
Option A Meals on wheels included in HC.R.6
Option B Meals on wheels is excluded from all types of LTC
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Programmes of personal budgets and consumer-choice, care-allowances etc.
Option A All expenditure on programmes of care allowances and
other direct payment schemes should be included in health accounts
Option B If it is possible to distinguish whether the eligibility is due
to ADL restrictions or IADL restrictions, the expenditure should be accounted as HC.3 or HC.R.6, respectively. If it is not possible to make this distinction, all payments should be reported under HC.R.6 financed by HF.1
Note: special attention should be paid to avoid double counting (not to report the expenditure as financed by households).
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Further comments (not included in alternative proposals)
Personal care services (assistance with ADL restrictions) should be excluded from HC.3 and only included in HC.R.6
HC.3 Long-term nursing care Palliative care (end-of-life care) Long-term nursing care
HC.R.6. Health-related LTC social services Personal care services (assistance with ADL restrictions) Services in support of informal (family) care Home help; care assistance (help with IADL restrictions) Supported living arrangements: residential (care) services Other social services provided in a long-term care context
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Treatment of complex provider organisations
Recommendation on estimating the boundary between HC.3 and HC.R.6 (when data on actual spending is not available separately)
To estimate the number of three types of persons: – (i) those who receive nursing and personal care (HC.3)– (ii) those who receive only social support services due to
IADL restrictions (HC.R.6); and – (iii) those who basically live in mixed institutions to avoid
social isolation
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Treatment of complex provider organisations (cont.)
Estimation methods surveys expert opinions dominant profile of the institution
Proposed general rules Account as HC.R.6, if not possible to decide between
HC.3. and HC.R.6 Exclude if not possible to decide between HC.R.6 and
other non-LTC
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Alternative labels for HC.R.6.1
Health-related LTC social services
Social services of LTC
LTC other than HC.3
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HC.R.6 Administration and provision of social services in kind to assist living with
disease and impairmentHC.R.6.1 Health-related LTC social services (LTC
other than HC.3)
HC.R.6.9 All other HC.R.6 expenditure
HC.R.7 Administration and provision of health related cash-benefits
Categories for health-related expenditure (relevant to LTC) in the joint OECD- Eurostat and WHO SHA
questionnaire
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Next steps
Decision about the alternative proposals– Assessment of the discussion at the Meeting of Health
Accounts Experts– Discussion with experts at EUROSTAT and WHO
Finalising the LTC Guidelines for OECD Health Data 2006/2007 (and joint SHA data collection)
Establishing SHA Electronic Discussion Group
Issues beyond 2006-07 Starting a wider discussion about rationality and
feasibility of Health and Long-term Care Accounts and harmonisation with ISIC Rev4
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ISIC Rev4
86 Human health activities861 Hospital activities862 Medical and dental practices869 Other human health activities (includes
paramedic activities and medical testing)87 Residential care services
871 Nursing care facilities 872 Residential care activities for mental retardation, mental health and substance abuse 873 Residential care activities for the elderly and disabled879 Other Residential care activities
88 Social work activities without accommodation 881 Social work activities without accommodation
for the elderly and disabled 889 Other Social work activities without
accommodation
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Issues for discussion
Alternative proposals based on comments received on the Draft LTC Guidelines
Appropriateness and feasibility of the proposed guidelines
Possible difficulties in implementation in 2006 and 2007