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4. DIMENSIONS OF HEALTH EXPENDITURE
Principles and analytical use
The International Classification for Health Accounts (ICHA) is a key element of SHA. As a starting point for extending and amending ICHA, clarification is needed on what SHA intends to measure and to what extent the current version of ICHA can fulfil those requirements. ICHA should provide adequate categories to describe the basic characteristics of the key functions of the health care system, such as financing, provision of services and goods and their consumption by different population groups. SHA 2.0 intends to put more emphasis on how services are used by different population groups by introducing age, gender and disease as dimensions of health expenditure. In order to provide a better picture of the flow of financial resources, the revision of classifications of financing sources and financing schemes will be a key issue. Better methods of output measurement and development of health-specific PPPs require a product classification. To provide better information for assessing efficiency, a classification for resources for production of health goods and services is required.
Key issues
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This chapter intends to provide an overview of the structure of the ICHA and the relationships between the dimensions of ICHA2. It will briefly explain and exemplify the importance of the dimensions of ICHA from a health policy point of view.
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Implication of dimensions of health expenditure will also be discussed from a statistical point of view, including the implication for data collection. A clear definition of the statistical units for SHA should also be developed.
Health services and goods
Under the proposal, two classifications refer to the activities, services and goods provided by health care providers. The work should clarify the relationship between ICHA-HC (Functional Classification Health Care) and Classification of Health care products. The question whether a more detailed Functional Classification or a separate Classification of Health care products would be more appropriate is to be considered.
Dimensions (components) of the ICHA
The following classifications – and their relevant cross-classification - serve to describe the characteristics of final consumption of health services:
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Classification of Beneficiary/recipient' characteristics;
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ICHA-HP Classification of Health Care Provider Industries;
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ICHA-HC Functional Classification Health Care, and
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ICHA-HF Classification of financing schemes.
The following classifications serve to describe the characteristics of production and
provision of health goods and services:
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ICHA-HP Classification of Health Care Provider Industries
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ICHA-HC Functional Classification Health Care;
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Classification of health care products;
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Classification of Resources for production.
The following classifications serve to describe the characteristics of health financing systems:
During the consultation process proposals for additional dimensions may emerge. Australia has already proposed to consider "Economic type framework categories". It will be included as an issue for discussion in the relevant paper to be produced for the international consultation process related to SHA revision.
Requirements for the revised SHA framework for health financing
The financing system of a country consists of several schemes (sub-systems): e.g., social security, private insurance, out-of-pocket payments, etc. These schemes, in turn, have different characteristics of revenue-raising, pooling and purchasing. Health Accounts (in particular, ICHA-HF and ICHA-FS classifications and the tables and T-accounts displaying the relationship between financial sources and financing schemes) should provide a clear and transparent picture regarding the structure of the health financing system of a country, as well as how each financing scheme raises and utilises their financial resources; as well as the balance of revenues and expenditure
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