The Norwegian System of Health Accounts

1. The Norwegian System of Health Accounts Ann-Kristin Brændvang Division for National Accounts AKB@SSB.no

2. Background • The planning started in 2000 • Established as a satellite account system to the National Accounts • SHA finalised at the end of 2004 and • time series for the period 1997-2004 • constant price estimates for the same period

3. The implementation • Planning • Adjustments in the NA-system and the need for improving data sources (2-3 years) • Mapping

4. National accounts • Comprehensive accounting framework • Satellite accounts; • flexible tool • consistent with the NA • designed for the purpose of economic analysis • Supply and use including more than 1200 products. The core variable is the product, more than 50 health products.

5. The NA product = data carrier • The classification was implemented by coding products in a specific way • A six digit-code that contents data on provider, type of goods and service and (in most cases) source of funding • Combination of ‘product – user- purpose’ in the core accounts of NA = platform for mapping to ICHA

6. The NA product, an example; • XXXXXX • 85XX • 85116 • 85111 • 85117 • 851161 = Curative care provided in hospitals, funded by the state. • 851390 = Dental service provided by dentists and funded by households

7. Sources • The National Accounts • Public accounts • Statistics from public and private hospitals (specialist nursing homes, convalescence and rehabilitation institutions and hospitals) • The Household Budget Survey. • Other sources

8. Local government accounts (KOSTRA) • Better information about the local authorities • Coherent system • Comparability • Timeliness • More efficient reporting • No data redundancy • Electronic data reporting

9. KOSTRA and Hospital accounts • Unique data source (covers around 75 per cent of the total health expenditure) • Accounting regulations • Classification by Types of Expenditure • Classification by ‘Function’

10. KOSTRA and Hospital accounts accounting regulations cont…. Classification by Types of Expenditure: • Separating between: • Services produced by the municipalities / institutions • Services bought from others (private companies, municipalities or the state) • Transfers • Consumption of fixed capital

11. KOSTRA and Hospital accountsaccounting regulations cont…. Classification by ’Functions’, examples: • Maternal and child health; family planning and counselling • Dental care • Basic medical and diagnostic services • Activation of elderly and disabled • Nursing and care, help in institutions • Nursing and care, help at home • Service of curative care • Rehabilitative care • Patient transport etc. • The costs are also classified according too ICHA-HP for the services produced by the institutions.

12. Health versus Social care • Old age homes (no health personnel are required), are classified as social care • Nursing homes are classifies as health • The share is annually estimated • Figures indicate that about 90 per cent of the cost is related to health in 2002

13. Home care • We have information on man year by education/profession for ”Nursing and care, help at home” in addition to the total costs • The share is annually estimated, 65 per cent in 2002 • Tendency towards more health less social care

14. Results – increased health expenditures • The health expenditures compiled in the new system increased nearly 10 per cent compared to the “old” system • The total health expenditures resulting from the new system is estimated to nearly 170 billion Norwegian kroner or • about 10 per cent of GDP • From 1997 to 2004 the health expenditures at constant prices has increased by 4,1 per cent per year on average, while the current expenditures have increased by 8,6 per cent per year

17. Health expenditure by function. 1997 and 2004 in per cent of total

18. More information • http://www.ssb.no