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10 – Implementation around the world

10.1 Health care output

Following publication of the current SNA, the System of national accounts 1993 (UN 1993), a number of countries put in place work programmes to implement the changed guidance on the measurement of non-market output in the National Accounts. Whereas the previous SNA had recommended that non-market output in both current price as well as volume terms should be on the basis of the sum of the inputs, SNA 1993 recommended that the volume measure of non-market output should, where possible, be estimated directly as actual change in output (the guidance on current price estimates remains the same).

Thus, towards the end of the 1990s, some countries introduced direct measures of non-market output into their National Accounts. New Zealand, Australia, and the UK were amongst the countries that have had direct measures of health care output incorporated in their National Accounts since then.

Following publication of the Handbook on price and volume measures for the national accounts, the European Commission embodied its recommendations into law: implementation for all EU countries but Denmark (which has a derogation until 2012) was required for National Accounts data relating to the year 2006 and onwards.

This legal requirement, along with growing interest in understanding the performance of the non-market sector (perhaps generated by the Atkinson review and the fact that OECD is currently drafting a manual on the measurement of health and education production for the National Accounts), has acted as a spur to European countries to ensure that their National Accounts methods were consistent with the recommendations in the Handbook.

Table 44 sets out the current state of play in OECD countries with measures of change in the volume of health care output.

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Table 44 State of play in OECD countries’ National Accounts practices for measuring change in the volume of health care output volumes

State of play in measurement practice Countries
Quality adjusted quantity measure for both primary and secondary care None
Quantity measure only for either primary and secondary care, no quality adjustment Australia, Czech Republic, Finland, Sweden, UK
Quantity measure only for secondary care, no quality adjustment; ‘output=inputs’ for primary care Austria, France, Germany, Greece, Hungary, Italy, Netherlands, New Zealand, Norway, Slovak Republic
‘Output=inputs’ for primary and secondary care Belgium, Canada, Denmark, Iceland, Ireland, Japan, Korea, Luxembourg, Poland, Portugal, Switzerland, US

Source: Joint Eurostat/OECD survey, 2006

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The rest of this section briefly reviews the state of play in measurement of health care output estimates in a number of OECD countries: New Zealand, the United Kingdom, Australia, Germany, and Denmark. For each country, information is given on: output quantity change; output quality change; and output weights.

10.2.1 New Zealand

See section 2.3.3 for a description of current National Accounts practice in measuring volume change in health care output.

10.2.2 United Kingdom

The United Kingdom’s ‘second generation’ methods for measuring change in the volume of health care output, inputs, and productivity are the direct result of work driven by the recommendations and principles set out in the Atkinson review. Of the many improvements made, the most significant have been:

  • a great increase in the level of disaggregation, from 16 types of health care output to, nowadays, some 2,000 different types;
  • increase in coverage of health care activities provided to patients, from 63 percent in 1994/95 to around 80 percent in 2005 (in terms of expenditure);
  • incorporation of information on Northern Ireland (previously, only English data were used. Work continues on incorporation of data specific to Scotland and Wales);
  • better cost weights based on health service accounting systems; and
  • measurement of general practice (GP) contacts using GP databases rather than household survey (with much improved accuracy).

Table 45 provides a brief overview of the current state of play in the methods used for measuring change in the volume of health care output in the UK.

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Table 45 Overview of health care output measures in the UK

Component of method State of play in latest estimates
Output quantity Activity, rather than health care pathway, based80 per cent coverageDistinction between 2,500 types of activity Classification used is DRG
Output quality For the National Accounts:No quality change adjustment (although the level of disaggregation captures some aspects of quality change)For productivity analyses:Measures are included of change in survival, health benefits from treatment, health effects from shorter waiting times; improved management of some chronic conditions in Primary Care, and patient satisfaction.The model used to combine quantity and quality measures is simple: it assumes growth in the separate indicators of quality and quantity change are equally valuable.
Output weights Costs available from health service accounting systemsSome work carried out to illustrate difference between cost and value weights for a few activities

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10.2.3 Australia

Australia’s methods for measuring change in the volume of health care output were implemented in the late 1990s, after publication of SNA 1993. Currently, the Australian Bureau of Statistics is looking into ways of improving its measures, drawing on the recent improvements made in other countries and the forthcoming OECD manual.

Table 46 provides a brief overview of the current state of play in the methods used for measuring change in the volume of health care output in Australia.

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Table 46 Overview of health care output measures in Australia

Component of method State of play in latest estimates
Output quantity Activity, rather than health care pathway, basedCovers primary, secondary, and residential careClassification used is DRG
Output quality None
Output weights Cost weights are a mix of DRG costs, subsidy rates and fees


10.2.4 Germany

Table 47 provides a brief overview of the current state of play in the methods used for measuring change in the volume of health care output in Germany.

10.2.5 Denmark

Table 48 provides a brief overview of the current state of play in the methods used for measuring change in the volume of health care output in Denmark.

Table 48 Overview of health care output measures in Denmark

Component of method State of play in latest estimates
Output quantity Current: Deflation with input price indexPlanned for 2012: Deflation using unit costs per treatmentClassification is DRG
Output quality None
Output weights Unit costs


10.2 Health care inputs

As with government health care and education productivity studies, the measurement of inputs into production of government health care and education is in its infancy, and few countries have published specific studies and estimates. While the measurement of government output in volume terms is required for the National Accounts, there is no similar requirement for the measurement of government inputs in volume terms. There are few countries, therefore, which have published studies or estimates of the volume of inputs used in producing government health care or education.

The UK has published a sequence of articles on the productivity of a number of different functions of government, including health care and education.

10.1.1 New Zealand

See sections 3.2.2 (labour) and 3.3.2 (capital services) for a description of Statistics NZ’s current practice in measuring volume change in inputs (although neither health care nor education).

10.1.2 United Kingdom

The United Kingdom’s methods for measuring change in the volume of health care inputs are the direct result of work driven by the recommendations and principles set out in the Atkinson review.

Table 49 provides a brief overview of the current state of play in the methods used for measuring change in the volume of health care output in the UK.

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Table 49 Overview of health care inputs measures in the UK

Component of method

State of play in latest estimates

Labour

Measured as change in the number of full time equivalents

Full time equivalents calculated according to contracted hours

Distinction made between different types of staff

Weights used are wages & salaries

Capital

Measured using capital consumption as a proxy

Weights used are current price capital consumption

Intermediate consumption

Measured by deflating expenditure

Expenditure and price information used at a detailed level

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10.3 Education output

This section briefly reviews the state of play in measurement of health care output estimates in a number of OECD countries: New Zealand, the United Kingdom, Australia, Finland, and Italy. For each country, information is given on: output quantity change; output quality change; and output weights.

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Table 50 State of play in OECD countries’ National Accounts practices for measuring change in the volume of education output volumes

State of play in measurement practice Countries
Quality adjusted quantity measure for ECE, schooling and tertiary education Sweden
Quantity measure only for secondary and tertiary education, with quality adjustment Austria, France, Hungary, Italy, Latvia, Lithuania, Malta, Norway, Spain, UK
Quantity measure only for schooling and tertiary education, no quality adjustment Australia, Belgium, Finland, Germany, Greece, New Zealand
Quantity measure only for schooling, no quality adjustment; ‘output=inputs’ for tertiary education Czech Republic, Netherlands, Slovakia
‘Output=inputs’ for all education Canada, Denmark, Japan, Korea, Luxembourg, Switzerland, US.

Source: Joint Eurostat/OECD survey, 2006

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The rest of this section briefly reviews the state of play in measurement of education output estimates in a number of OECD countries: New Zealand, the United Kingdom, Australia, Germany, and Denmark. For each country, information on is given on: output quantity change; output quality change; and output weights.

10.2.1 New Zealand

See section 7.2.2 for a description of current National Accounts practice in measuring volume change in education output.

10.2.2 United Kingdom

The United Kingdom’s ‘second generation’ methods for measuring change in the volume of education output, inputs and productivity are the direct result of work driven by the recommendations and principles set out in the Atkinson review. Significant improvements include:

  • Output definition changed from pupil numbers to pupil attendance;
  • increase in coverage of education services to include initial teacher training, health professional courses, government-funded pre-school, and City Technical Colleges;
  • introduction of cost weights for different levels of education services;
  • increase in coverage to include Scotland and Northern Ireland, and the introduction of country weights that allow the production of chain-linked output indices for England, Scotland, Wales, and Northern Ireland;
  • introduction of a ‘multiplicative model’ which assumes that pupils’ progress through school each year is a multiple of previous progress (rather than an addition to).

Table 51 provides a brief overview of the current state of play in the methods used for measuring change in the volume of education output in the UK.

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Table 51 Overview of health care output measures in the UK

Component of method State of play in latest estimates
Output quantity Based on pupil attendance where possible, else numbers.Covers: government-funded ECE child FTEs; attendance-adjusted pupil numbers at government-maintained primary, secondary and special schools; student numbers in initial teacher training and health professional training. (Excludes other post-secondary education)
Output quality For the National Accounts:An explicit annual quality adjustment of 0.25 percent is made, based on the historical rate of improvement in GCSE results from the mid-1990sFor productivity analyses:Adjusted by change in uncapped average point scores of GSCE exams relating to the attainment of pupils at end of Year 11.The model used to combine quantity and quality measures is multiplicative and assumes that pupils’ progress through school each year is a multiple of previous progress (rather than an addition to)
Output weights Expenditure shares by level of education

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10.2.3 Australia

Australia’s methods for measuring change in the volume of education output were implemented in the late 1990s, after publication of SNA 1993. Currently, the Australian Bureau of Statistics is looking into ways of improving its measures, drawing on the recent improvements made in other countries and the forthcoming OECD manual.

Table 52 provides a brief overview of the current state of play in the methods used for measuring change in the volume of education output in Australia.

Table 52 Overview of education output measures in Australia

Component of method State of play in latest estimates
Output quantity Based on pupil numbers and number of research publicationsStratified by level of education and field of tertiary studyCovers ECE through tertiaryClassification used ANZSIC
Output quality None
Output weights Expenditure.

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10.2.4 Finland

Table 53 provides a brief overview of the current state of play in the methods used for measuring change in the volume of education output in Finland.

Table 53 Overview of education output measures in Finland

Component of method State of play in latest estimates
Output quantity Based on student numbers, taught hours, number of credits and student-years, depending on the stratumVery detailed stratification that separates upper and lower secondary, separates vocational from general curricula, and specifies field of tertiary educationFocuses on economic unit, rather than product; university research estimated by number of publicationsCovers ECE through tertiary, and adult education
Output quality None
Output weights Cost weights.
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10.2.5 Italy

Table 54 provides a brief overview of the current state of play in the methods used for measuring change in the volume of education output in Italy.

Table 54 Overview of education output measures in Italy

Component of method State of play in latest estimates
Output quantity Based on enrolment numbers Detailed stratification that separates upper and lower secondary, specifies type of upper secondary institute and field of tertiary educationActivity based: Separates university activity into separate education and research activities, includes subsidiary services to education like meals and dormitoriesCovers ECE through tertiary
Output quality Coefficient based on class size for schooling, degrees per enrolment for tertiary faculties
Output weights Cost weights

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10.4 Education inputs

10.1.1 New Zealand

See sections 6.3.2 (labour) and 6.3.7 (capital services) for a description of current Statistics NZ’s current practice in measuring volume change in inputs.

10.1.2 United Kingdom

The United Kingdom’s methods for measuring change in the volume of education inputs are the direct result of work driven by the recommendations and principles set out in the Atkinson review.

Table 55 provides a brief overview of the current state of play in the methods used for measuring change in the volume of education inputs in the UK.

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Table 55 Overview of education inputs measures in the UK

Component of method State of play in latest estimates
Labour Measured as change in the number of full time equivalents for 94 percent of education labour and deflated current price labour expenditure for the remaining 6 percentFull time equivalents calculated according to contracted hoursDistinction made between teaching and support staffTeaching staff adjusted for actual hours workedWeights used are average wages
Capital Measured using capital consumption as a proxyWeights used are current price capital consumption
Intermediate consumption Measured by deflating expenditureExpenditure and price information used at a detailed level.

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10.1.2 Australia

Table 56 provides a brief overview of the current state of play in the methods used for measuring change in the volume of education inputs in Australia.

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Table 56 Overview of education inputs measures in Australia

Component of method State of play in latest estimates
Labour Total hours worked estimated by multiplying employee counts by average hours worked
Capital Measured using capital consumption as a proxyProductive capital stock estimated with a perpetual inventory modelWeights used are derived user cost of capital by asset
Intermediate consumption Measured by deflating expenditureExpenditure and price information used at a detailed level

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