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13: CLASSIFICATION OF HEALTH CARE PRODUCTS
Principles and analytical use
This unit proposes a new classification for ICHA SHA 2.0 The definition of health care products will determine the classification. Products need to be defined to enable definition across countries. The physical properties and intrinsic nature of products are distinguishing characteristics of the products themselves. These include, for example, the raw materials of which goods are made, the stage of production or the way in which goods are produced or services rendered, the purpose or user category for which products are intended and the prices at which they are sold (CPC classification). In the health sector, just as in the product classification for national accounts, the products can be classified as goods, services or mixed (where goods in form of equipments or drugs are provided during a treatment service).
The major challenge in the health sector is the definition of the unit of measurement of the product and specifically for complex services sold at non market prices. The key challenge is to define a product, specifically a service which is homogenous in its characteristic. At the same time we do not want to fragment services and need a more homogenous unit of output which can be compared over time and space and which may be able to capture changes fostered by technological advances or delivered with different technologies in different countries. We need classifications along a dimension which are feasible to define and measure.
The traditional approach to measure output is days of inpatient care, number of outpatient consultations, etc. Recent approaches to measure products are treatment of episode of illness, which take into account patients’ age, sex, disorder, severity of case, and interventions used; or diagnosis related groups systems for output indicator for inpatient care. It would be worthwhile to assess whether the treatment of disease can be associated with the provider and functions classifications of SHA2.0 to define a quality adjusted product.
There are a number of approaches which may be considered for the definition of products. First, the World Bank has standard product descriptions for PPP purposes of hospital services, medical care services, dental services, paramedical services, pharmaceutical goods, and therapeutic appliances and equipments in which they take into account patient characteristics, mode and type of treatment
procedures, quantity and packaging and several other characteristics to define a service or good. A second possibility is the WHO health care technology package tool which links health care interventions to health technologies (defined by using different mix of medical equipment, human resources, drugs and facilities) to define a particular output. On the other side, health care interventions are defined by linking international classification of diseases (ICD) to clinical procedures terminology (CPT). Standard data bases are available for such linkages and could be explored. This may be specifically useful as some of the interventions are performed without identifying underlying disease and can be linked directly to the CPT classifications such as integrated management of child illness (IMCI), Adult lung health initiative (ALHI) etc. Further interventions can also be defined for personal, preventive, promotion, rehabilitative and self care (The essential Health care technology package- A new tool for planning and managing resources for
health interventions: P. A. Heimann and A. Issakov)
The Product classification is important to define the output or volume of goods and services produced in a country and see how much is spent on that output. This in turn enables an examination of whether country is achieving better indicators because of differences in volumes or just expenditures. It is important to take technology into account in product definition as it is a significant contributor of costs but also helps the provider to provide services more effectively and efficiently. Products defined according to technology can help health care providers to know if cost effective methods are being used for providing better quality health care. Additionally, there is a need to classify health care products to construct a comparable basket of goods and services and determine their prices. The development of a product classification would assist in the construction of healthspecific Purchasing Power Parities (PPPs).
Key Issues:
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The classification list of products should be exhaustive and should be representative of current health expenditure in the country and also exclusive so as not to double count goods that are included as part of mixed services.
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The classification list should take account of broader list of health goods and services on which the value, quantity, quality and prices can be determined and similar characteristics can be defined across the countries. Using quality indicators to define similar products is a key challenge. E.g. Can an outpatient consultation in a health centre in a wealthy urban setting be treated the same as the outpatient consultation in a health centre in rural area which does not have comparable facilities? Measuring differences within and across countries is a key challenge.
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The classification list should be based on country experiences of defining products, especially for public health.
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Classification should be based on possibilities for collecting the data and needs clear guidance on the estimation methods.
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