Deriving expenditures by disease under the System of Health Accounts (SHA) 2011 framework: a systematic analysis

Abstract

BackgroundConsistent and internationally comparable data on spending by disease can help answer important policy questions related to technical efficiency, sustainability, and equity, as well as tracking and examining the relation between disease-specific targeted expenditures (eg, reproductive, child, and maternal health, HIV/AIDS) and outcomes. The recently released global standard, A System of Health Accounts 2011, provides a framework to develop such estimates. A significant input came from an Organisation for Economic Cooperation and Development project that developed and successfully tested guidelines under differing health-care system characteristics. The current project seeks to develop efficient methodologies to expand the availability of comparable health expenditure by disease in the absence of explicit expenditure data. MethodsThe absence of detailed expenditure data can hinder the production of disease accounts. In this case, the development of allocation keys in a top–down approach is proposed. In an initial step, the focus has been on acute hospital care, where reliable administrative data (discharge data and average length of stay data by diagnostic category) are available for a majority of countries. Econometric models have been developed to determine if administrative data can be used to derive reliable expenditure by disease data for countries that do not produce explicit expenditure by disease data. FindingsInitial results have been promising. Data from countries that are able to produce reliable hospital expenditure data can be further employed to derive average resource intensity weights that can be applied to hospital utilisation data in order to estimate the expenditures by disease. InterpretationThe regular and expanded collection of expenditure by disease data will be extremely useful in the development of future disease-specific expenditure and cost-of-illness studies. Research is ongoing to derive disease-specific expenditures also in the areas of pharmaceutical spending and primary care. FundingEuropean Union.