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This
document provides a set of classifications for use in Hong
Kong DHA, developed through a process of review of international
practice and deliberation by task groups appointed by the
Hong Kong SAR Government Health and Welfare Bureau. Included
is a review of current definitions and classifications used
in NHA work by the Organisations of Economic Co-operation
and Development (OECD) and four OECD member countries, USA,
UK, Canada and Japan. The four countries were selected on
the basis of feedback received from the DHA Team appointed
by the Hong Kong government. On the basis of these approaches,
a draft working paper was produced with recommendations
as to options for the framework to be used in Hong Kong’s
DHA and distributed among members of the DHA team. The paper
was revised to incorporate comments made by the DHA team.
This current paper is based on a previous paper by the same
authors, Review of international NHA classifications and
definitions for preparation of HK DHA, (March, 1998).
Preparation of this document involved a
systematic review of the current definitions used by the
four countries concerned, the definitions used y the OECD
secretariat in preparing its 1998 estimates of health spending
in OECD member countries (to be published later in 1998,
and referred to herein as OECD 1998), and a draft proposal
for collecting international health statistics under preparation
by the OECD secretariat in October 1997 (unpublished document
made available to Institute of Policy Studies by OECD, referred
to herein as OECD Proposal).
OECD 1998 is the most recent version of
the set of definitions used by OECD in preparing its annual
estimates of health spending in the OECD. It has been developed
over several years in an ongoing attempt to standardise
the available data reported by member countries, and therefore
reflects substantially the structure of the health expenditure
reporting system in individual countries, in particular
those of USA.
OECD Proposal (October, 1997 version) is
a new set of classifications and frameworks prepared by
the OECD secretariat for measuring health expenditures in
a manner consistent with other UN statistical reporting
systems and the existing OECD database. It differs from
OECD 1998 in that it proposes a different breakdown or classification
of health expenditures, and in that it provides much more
detailed sets of definitions for the various types of expenditures.
Its functional classification of health expenditures, the
ICHE (International Classification of Health Expenditures),
is presented in four levels of desegregation, each level
of which is labelled according to a system of 1-4 digit
codes. OECD plans to test this new approach during the next
two years, and based on resulting modifications and feedback
from non-OECD countries and experts to propose a revised
version of the Proposal to Eurostat and other UN agencies
as a global standard for health expenditure estimation.
We have included the OECD Proposal in our review, as it
is likely that it will lead eventually to a new international
system of health expenditures estimation. However, the OECD
Proposal is yet to be ratified by the OECD itself, and currently
contains several major defects, which we believe will force
major modifications. For this reason, we have focused on
those elements in the OECD Proposal which are most useful
and likely to stand the test of time.
Table of Contents:
- Overview
- Functional Classification of Health Expenditures
- Core Functions of Medical Care
- Health Related Functions
- Review of International Practice
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