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2. GLOBAL BOUNDARIES OF HEALTH CARE
Principles and analytical use
The global boundaries of the health (care) system need to be determined to make a solid clear description possible of the subjects to be included, to determine the areas related to the consumption, production, and financing.
Common functional boundaries of health care have been already proposed in the framework of SHA 1.0. The list of activities of health care, such as disease prevention, health promotion, treatment, rehabilitation and long- term, strengthened by the application of medical, paramedical and nursing knowledge and technology was chosen as a basis for the delineation of the health care sector. However, the implementations of SHA in various countries made it evident that some areas within the existing borderlines need further and more detailed clarification and guidance, while some others require discussion on their inclusion or exclusion.
Taking into consideration a comprehensive notion of health both with respect to health of individual persons and of population, determinants such as life style, environment, social or economic factors and health care itself it becomes evident that health encompasses a very wide area. However, common global boundaries of health care sector to be the subject of international comparison, even if generally agreed, are of little value unless there is a realistic possibility of collecting the data that are fit for such boundaries. Therefore, when designing the health care boundaries for the purpose of international comparisons the necessity of compromising between academic and research theories and the possibility of its practical implementation has to be kept in mind. This may imply the introduction of borderlines created for the purpose of international comparison. This however, does not exclude the possibilities that for national policy purposes the health care boundaries of individual countries may be designed and reported differently.
Several areas need special attention in SHA revision due to its policy relevancies and the experience with SHA implementation in various countries. A growing interest for indicators that could be used for social protection policy, including social inclusion and exclusion indicators, may lead to verification of existing SHA borderlines between health and social care. LTC services due to their
economic significance are of great importance. Furthermore information on health care and LTC expenditure are needed for running a short and long term projections relating to population aging and sustainability of health / social care system that ensure cross-generation security. The switch from institutional care of dependant people into home care requires the decision on inclusion /exclusion of certain health and social services provided by household (as health care providers) as well as detailed guidance on how to estimate this expenditure in case of shortage of information sources. Free movement of goods and services among EU members leads to cross-border mobility of patients both with respect to the use of services and the flow of related funds.
Potential differences between SHA 1.0 and SHA 2.0
Majority of changes may refer to SHA internal boundaries: personal health vs. public health, health vs health related goods and services.
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