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SHA based National Health Account Hiroyuki SAKAMAKI, MBA

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

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SHA based National Health Account Hiroyuki SAKAMAKI, MBA

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  1. 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

  2. Japan SHA Member Manabu YAMAZAKI Koki HAYAMIZU Sumie IKEZAKI Masahiro TASHIMA

  3. Outline of Presentation • Overview of the NHA estimates in 2000 • LTC System and Estimating Expenditure of LTC • Key Issues

  4. Bio Yen 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Trend of National Medical Expenditure (NME) Shifted to LTC

  5. 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 Medical Services 27,724 Medical Goods 7,559 Prevent. & Public Health 1,165 Admin. &Insurance 875

  6. Personal Expenditure 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, R&D, etc LTC Welfare services NME as currently defined. HC.7 Indirect NME as currently defined. Administration of health insurance system HCR.1 Public expenditures on medical institutions. Subsidies, Public payments, etc.

  7. BioYen 40,000 36,068 35,034 35,000 34,118 7,940 Medical Goods 32,879 7,559 7,213 32,119 31,633 National Medical Expend 7,272 7,734 29,950 7,949 30,000 31,323 30,934 30,358 7,823 247 Ancillary Services 29,825 247 212 29,065 Home Care 28,521 161 207 150 26,958 105 198 25,000 81 193 59 190 40 12,595 12,230 Out Patient Care 21 12,143 20,000 11,449 10,765 10,487 9,620 15,000 In Patient Care 10,000 15,126 14,848 14,445 13,870 13,363 12,964 12,296 5,000 0 1995 1996 1997 1998 1999 2000 2001 Trend of Personal Health Expenditure and NME Estimation in 2001 is tentative data

  8. 23,691 HC.1 Services of curative care (63.5%) 7,216 HC.5.1 Pharmaceuticals and (19.3%) other medical non-durables HC.3 Services of long-term 3,517 (9.4%) nursing care HC.6 Prevention and 1,165 (3.1%) public health services HC.7 Health administration 857 (2.3%) and health insurance HC.5.2 Therapeutic appliances 343 (0.9%) and other medical durables HC.2 Services of rehabilitative 269 (0.7%) care Bil Yen 2000 HC.4 Ancillary services 247 (0.7%) to health care - 5,000 10,000 15,000 20,000 25,000 Current Expenditure by Function

  9. 25,501 HF.1.2 Social security funds (68.4%) HF.2.3 Private household out 6,570 -of-pocket expenditure (17.6%) HF.1.1 General government excluding 4,518 social security funds (12.1%) 593 HF.2.5 Corporations (1.6%) 124 HF.2.2 Private insurance enterprises (0.3%) - 5,000 10,000 15,000 20,000 25,000 30,000 Current Expenditure by Financing (Billion Yen, 2000)

  10. 18,871 HP.1 Hospitals (50.6%) 7,860 HP.3.1 Offices of physicians (21.1%) HP.4 Retail sale and other 4,566 providers of medical goods (12.2%) HP.3.2 Offices of dentists 2,559 (6.9%) HP.5 Provision and administration 1,165 (3.1%) of public health programmes HP.2 Nursing and residential 1,088 (2.9%) care facilities HP.6 General health 857 (2.3%) administration and insurance 247 (0.7%) HP.3.9.1 Ambulance services HP.3.9 Other providers of 247 (0.7%) Bil Yen, 2000 ambulatory health care HP.3.6 Providers of home 93 (0.3%) health care services - 5,000 10,000 15,000 20,000 Current Expenditure by Provider

  11. LTC System and Estimating Expenditure of LTC-Long Term Care-

  12. 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.

  13. 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%) Premiums Medical insurers No.2 Insured (from 40 to 64) Prefecture (12.5%) Federation of National Health Insurance Associations Lump-sum payment National pool Examinations,payments,etc. Municipality (12.5%) Social Insurance Medical Care Fee Payment Fund Transfer

  14. 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

  15. 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

  16. LTC Services include SHA and Categories by ICHA-HC

  17. Types of Institutes providing LTC and SHA categories by ICHA-HP

  18. LTC Services by Function and Providers

  19. HF.2.3Out of Pocket HF.1.1.2Prefecture (12.5%) HF.1.1.1 State (25%) Public Expenditure HF.1.1.3 Municipalities (12.5%) HF.1.2 Social Security Funds (50%) Insurance Premium LTC funding

  20. Personal Expenditures for Medical Care and LTCs Billion Yen, 2000

  21. LTC Expenditure by Providers Billion Yen, 2000

  22. LTC Expenditure by financing Billion Yen, 2000

  23. 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.

  24. 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 – that is 7.3 % of GDP – were spent on total expenditure on health. Public funds financed 80% of the total expenditure. • Between 1996 and 2000, the growth of total expenditure on health varied between 1.5% (1996/1997) and 4.4% (1999/2000) per year.

  25. Kinkaku-Ji:The Golden Temple Thank you for your attention Kimono Tea Ceremony

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