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