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7. ICHA-HC FUNCTIONAL CLASSIFICATION HEALTH CARE
Principles and analytical use
Decision-making involves the allocation and the use of resources by type of function. The health spending profile by function allows to extend and to refine the planning process and to define outputs by function. Health functions have as their primary purpose to restore and maintain and to improve the health status of populations and individuals, or perhaps, secondarily, to support this primary purpose. Intrinsically, they constitute and define the boundaries of the system. The appropriate classification of function, when summed should result in the definition and measure of health expenditure. Therefore, the boundaries of the health system are set by the sum of the HC classes. The community of nations has an interest in standardising the health boundaries and so do individual countries regardless of their policy objectives and their financing or delivery arrangements.
Key issues:
The functional classification, (ICHA-HC), should as much as possible be purpose-defined, neutral of mode of production and /or mode-of-financing. Redefined definitions of the object and scope of subclasses will result in an expanded or restricted total boundary. An example of an expansion is HC.2 long-term care; another is public health, which presently host subcomponents of several HC and HCR classes. An example of retraction might be the removal of non-health functions from the SHA 1.0 definition.
The classification of functions is expected to reflect a continuum of the health care content from health promotion to prevention to maintenance to repair to palliative care
Some issues identified as requiring discussion include:
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Construction of classes independently of mode-of-production
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Disaggregation of HC.1 into the various products of the hospitals
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Review of HC.2: as a class of its own or possibly merge with another
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Definition of HC.3 to reflect the health - social care distinction (based on OECD advances)
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HC.4 to be analysed regardless of mode-of-production (presently accounts only for out patient care)
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HC.5 to be analysed regardless of mode-of-production (presently accounts only for out patient care). Consider the inclusion of traditional, alternative and complementary medical goods in the framework
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HC.6 to be redefined: inclusion of a genuine public health services (currently below the line as in some environmental interventions like testing potability of water for drinking) and explicit accounting of personal prevention services (e.g. immunization which is currently accounted as curative care in HC.1)
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HC.7 to be discussed as it is not a genuine health function, but only supports health functions
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HC.R.1 to be accounted in a separate classification as it is not a genuine health function
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