SHA based SHA based National Health AccountNational Health Account

Hiroyuki SAKAMAKI, MBAInstitute for Health Economics and Policy (IHEP)

Tokyo, Japan

Meeting of Experts in National Health AccountsOrganisation for Economic Co-operation and Development (OECD)

Directorate for Employment, Labour and Social AffairsChateau de la Muette, Paris, 27-28 October 2003

Japan

SHA MemberManabu YAMAZAKIKoki HAYAMIZUSumie IKEZAKIMasahiro TASHIMA

Outline of PresentationOutline of Presentation

Overview of the NHA estimates in

2000

LTC System and Estimating

Expenditure of LTC

Key Issues

Trend of National Medical Trend of National Medical Expenditure (NME)Expenditure (NME)

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

19901991199219931994199519961997199819992000

Bio Yen

Shifted to LTC

The Structure of The Structure of National Health AccountsNational Health Accounts

(Billion Yen, 2000)(Billion Yen, 2000)

Total Expend. on Health

39,534

Total Expend. on Health

39,534

Current Expend.

37,306

Current Expend.

37,306

Investment

2,227

Investment

2,227

Personal Expend.

35,283

Personal Expend.

35,283

Collective Expend.

2,022

Collective Expend.

2,022

Prevent. & Public Health

1,165

Prevent. & Public Health

1,165

Admin. &Insurance

875

Admin. &Insurance

875

Medical Services

27,724

Medical Services

27,724

Medical Goods

7,559

Medical Goods

7,559

LTC Welfare services

NMENME as currently defined. as currently defined.

HC.7 Indirect NME as currently defined.Administration of health insurance system

HCR.1 Public expenditures on medical institutions.

Subsidies, Public payments, etc.

Spending on medical-related services•HC 6 Preventive health and health Promotion

•Medical servicesOTC drugs,Private-duty nursing,etc.

•Medical-related servicesPersonal dental services, Special meals,etc.

HCR.Sub-systems supporting the medical

system

education, R&D, etc

Structure of SHAStructure of SHAPersonal Personal

ExpenditureExpenditure

12,296 12,964 13,363 13,870 14,445 14,848 15,126

9,62010,487

10,76511,449

12,143 12,230 12,595

161150

10581

5940

21

247212

207198

193

190

247

7,9407,559

7,213

7,2727,7347,949

7,823

31,32330,35830,934

29,82529,065

28,52126,958

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

1995 1996 1997 1998 1999 2000 2001

In Patient Care

Out Patient Care

Home Care

Ancillary Services

Medical Goods

National Medical Expend29,950

32,119

32,87934,118

35,034

36,068

31,633

Bio　Yen

Estimation in 2001 is tentative data

Trend of Personal Health Trend of Personal Health Expenditure and NMEExpenditure and NME

Current Expenditure by FunctionCurrent Expenditure by Function

247 (0.7%)

269 (0.7%)

343 (0.9%)

857 (2.3%)

1,165 (3.1%)

3,517 (9.4%)

7,216

(19.3%)

23,691

(63.5%)

- 5,000 10,000 15,000 20,000 25,000

HC.4 Ancillary services

to health care

HC.2 Services of rehabilitative

care

HC.5.2 Therapeutic appliances

and other medical durables

HC.7 Health administration

and health insurance

HC.6 Prevention and

public health services

HC.3 Services of long-term

nursing care

HC.5.1 Pharmaceuticals and

other medical non-durables

HC.1 Services of curative care

Bil Yen2000

Current Expenditure by FinancingCurrent Expenditure by Financing

124(0.3%)

593(1.6%)

4,518(12.1%)

6,570(17.6%)

25,501(68.4%)

- 5,000 10,000 15,000 20,000 25,000 30,000

HF.2.2 Private insurance enterprises

HF.2.5 Corporations

HF.1.1 General government excluding social security funds

HF.2.3 Private household out-of-pocket expenditure

HF.1.2 Social security funds

(Billion Yen, 2000)

Current Expenditure by ProviderCurrent Expenditure by Provider

93 (0.3%)

247 (0.7%)

247 (0.7%)

857 (2.3%)

1,088 (2.9%)

1,165 (3.1%)

2,559 (6.9%)

4,566(12.2%)

7,860(21.1%)

18,871(50.6%)

- 5,000 10,000 15,000 20,000

HP.3.6 Providers of homehealth care services

HP.3.9 Other providers ofambulatory health care

HP.3.9.1 Ambulance services

HP.6 General health administration and insurance

HP.2 Nursing and residentialcare facilities

HP.5 Provision and administrationof public health programmes

HP.3.2 Offices of dentists

HP.4 Retail sale and otherproviders of medical goods

HP.3.1 Offices of physicians

HP.1 Hospitals

Bil Yen, 2000

LTC System and LTC System and Estimating Estimating Expenditure of LTCExpenditure of LTC-Long Term Care--Long Term Care-

Public Long Term Care Insurance ActPublic Long Term Care Insurance Act

In effect since April 1, 2000.

To allow those in need of care and support to lead their daily lives as independently as possible making use of the capabilities.

To provide long term care by integrating health, medical care and welfare services as select by the user.

Medical insurers

Mechanism of LTC Insurance SystemMechanism of LTC Insurance System

No.1 Insured (65 and over)

No.2 Insured (from 40 to 64)

municipalities

Deducted frompension

Social InsuranceMedical Care Fee

Payment Fund

Premiumsof elderly

(17%)

Premiumsof

non-elderly(33%)

Publicexpenditure

State(25%)

Prefecture(12.5%)

Municipality(12.5%)

Pref

ectu

reFe

dera

tion

of N

atio

nal H

ealth

Insu

ranc

e A

ssoc

iatio

ns

Premiums

Lump-sum payment National pool

Transfer

Premiums

30%

70%

Aid to municipality

Examinations,payments,etc.

Domiciliary ServiceDomiciliary Service

Home-visit servicesHome-visit servicesHome help service / Bathing service / Nursing / Home rehabilitation

Short-term stay servicesShort-term stay servicesDay service (at day care center) / Outpatient rehabilitation (at medical care facility) / Short stay therapy / Group therapy to counter dementia (home for senile dementia patients) / Long term care for residents of special facilities

OthersOthersHome treatment management and guidance / Leasing of welfare appliances/Provision for purchase of home care welfare appliances / Provision for home improvements associated with care / Home help service support

Facility ServicesFacility Services

Long Term Care Welfare Facilities for the Elderly

(Special Nursing Homes for the Elderly)

Long Term Care Health Facilities for the Elderly

(Facilities of Health Care Services for the Elderly)

Long Term Care Medical Treatment Facility

Medical treatment beds

Beds for treatment of senile dementia

Long Term Care strength building hospital

LTC Services include SHA and LTC Services include SHA and Categories by ICHA-HCCategories by ICHA-HC

home-visit nursing HC.3.3HC.3.3 long-term nursing home care

home-visit rehabilitation HC2.4HC2.4 rehabilitative home care

commuting rehabilitation services

HC.2.2HC.2.2 rehabilitative day care

medical care service through a short-term stay

HC.3.1HC.3.1 long-term nursing in-patient care

management guidance for in-home care

HC2.4HC2.4 rehabilitative home care

health care facility services for the elderly requiring long-term care

HC.3.1HC.3.1 long-term nursing in-patient care

sanatorium type medical care facility services for the elderly requiring care

HC.3.1HC.3.1 long-term nursing in-patient care

Types of Institutes providing LTC and Types of Institutes providing LTC and SHA categories by ICHA-HPSHA categories by ICHA-HP

Long term care welfare facilities for the Aged [ LTCW ] Not AppreciableNot Appreciable

Long term care health facilities for the Aged [LTCH]

HP.2HP.2 nursing and residential care facilities

Long term care medical treatment facilities [LTCM]

Medical treatment beds HP.1HP.1 Hospital

Beds for treatment of senile dementia HP.1HP.1 Hospital

LTC strength building Hospital HP.1HP.1 Hospital

GP Clinic HP.3HP.3 ambulatory health care providers

Dental Clinic HP.3HP.3 ambulatory health care providers

Home visiting nurse station HP.3HP.3 ambulatory health care providers

LTC Services by LTC Services by Function and ProvidersFunction and Providers

HP.1Hospital

HP.2Long

term care health

facilities

HP.3

Clinic Home visiting nurse

station

HC2.2

commuting rehabilitation services HC2.4

home-visit rehabilitation HC2.4

management guidance for in-home care

HC3.1

medical care service through a short-term stay

HC3.1

health care facility services for the elderly requiring long-term care

HC3.1

sanatorium type medical care facility services for the elderly requiring care

HC3.3

home-visit nursing

LTC fundingLTC funding

HF.1.1.3HF.1.1.3Municipalities

(12.5%)

HF.1.1.2HF.1.1.2Prefecture(12.5%) HF.1.1.1HF.1.1.1

State(25%)

HF.1.2HF.1.2Social Security Funds

(50%)

HF.2.3HF.2.3Out of Pocket

Public Expenditure

Insurance Premium

Personal Expenditures for MedicaPersonal Expenditures for Medical Care and LTCsl Care and LTCs

MedicalCare

LTC Total

HC.1 Services of curative care 23,691 - 23,691

HC.2 Services of rehabilitative care - 269 269

HC.2.1 In-patient rehabilitative care - - -

HC.2.2 Day cases of rehabilitative care - 249 249

HC.2.3 Out-patient rehabilitative care - - -

HC.2.4 Services of rehabilitative home care - 20 20

HC.3 Services of long-term nursing care 1,900 1,618 3,517

HC.3.1 In-patient long-term nursing care 1,882 1,516 3,399

HC.3.2 Day cases of long-term nursing care - - -

HC.3.3 Long-term nursing care: home care 17 101 119

HC.4+HC.5 Ancillary services + Medical goods 7,806 - 7,806

33,396 1,887 35,283Total expenditure on personal health care

Billion Yen, 2000

LTC Expenditure by ProvidersLTC Expenditure by Providers

547

102

951

138

3

5

0

0

99

15

10

19

0 200 400 600 800 1,000 1,200 1,400 1,600

HC.3.1long-term nursing

in-patient care

HC.2.2rehabilitative day care

HC.2.4rehabilitative home

care

HC.3.3long-term nursing

home care

HP.1hospitals

HP.2 nursing and residential care facilitiesHP.3 ambulatory health care providers

1,516

99

20

249

Billion Yen, 2000

LTC Expenditure by financingLTC Expenditure by financing

1,306

224

210

18

91

2

11

25

0 400 800 1,200 1,600

HC.3.1long-term nursing

in-patient care

HC.2.2rehabilitative day

care

HC.2.4rehabilitative home

care

HC.3.3long-term nursing

home carepublic private

1,516

20

249

101

Billion Yen, 2000

Key Issues.Key Issues.

Expenditure for amenities, advanced med care (ie. ESWL)

HC.2.3 Non-Insured Acupuncture and JUDO reposition.

HC.6 Educational interventions for health promotion.

Expenditure for the public health center admin.

HC.7 Expenditure for the general government admin.

HCR.1 Capital investment for specialized hospitals.

HCR.2,4-7 Not available.

Items those are not counted in the National Expenditure on Health by SHA definition due to lack of data.

Following data are NOT available, therefore cause for underestimation:

ConclusionConclusion The total expenditure on health in Japan 2000 is about

700 billions of Yen (22%) higher than the value based on the National Medical Care Expenditure

In 2000, 293,916 Yen per capita – that is 7.3 % of GDP – were spent on total expenditure on health. Public funds financed 80% of the total expenditure.

Between 1996 and 2000, the growth of total expenditure on health varied between 1.5% (1996/1997) and 4.4% (1999/2000) per year.

Thank you Thank you for your for your

attentionattention

Tea Ceremony Kimono

Kinkaku-Ji:The Golden Temple