PARIS 2005PARIS 2005 Central Statistical Office of PolandCentral Statistical Office of Poland 11

National Health National Health AccountAccountss

(Expenditure on Health Care in (Expenditure on Health Care in Poland)Poland)

PARIS 2005PARIS 2005 Central Statistical Office of PolandCentral Statistical Office of Poland 22

National Health AccountNational Health Account

• 2000-2002 - the first pilot national health account in Poland (data for 1999). It was drawn by a group of national and foreign experts on the basis of the OECD methodology

• Changes in the system of health care and in the national budget classification

• September 2004-June 2005 - the health account realised in cooperation with the ICON Institute (data for 2002, 2003).

PARIS 2005PARIS 2005 Central Statistical Office of PolandCentral Statistical Office of Poland 33

Health care financing Health care financing sourcessources (1) (1)

Health care financing sources

Public expenditures Private expenditures

Rest of the world

PARIS 2005PARIS 2005 Central Statistical Office of PolandCentral Statistical Office of Poland 44

Health care financing sourcesHealth care financing sources (2)(2)

public expenditurespublic expenditures

General governmentHF.1

Central governmentHF.1.1.1

State and local government

HF.1.1.2 and HF.1.1.3

Social insurance

institutions

National Health Fund

Social security funds HF.1.2

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Health care financing Health care financing sourcessources (3) (3)Central government

HF.1.1.1

Ministry of Social Policy

Ministry of Health

Ministry of Internal Affairs and Administration

Budgets of voivods

Ministry of National Defence

Ministry of Justice

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Health care financing sourcesHealth care financing sources ((44))Private sectorHF.2

Households’ out-of-pocket payments

HF.2.3

Occupational health care

Non-profit institutionsHF.2.4

Private social insuranceHF.2.1

Quasi-insurance sector

CorporationsHF.2.5

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Data sourcesData sources (1) (1)

Public expendituresPublic expendituresReports:Reports:– Realisation of the state budget and Realisation of the state budget and

budgets of local self-government unitsbudgets of local self-government units– Realisation of the financial plan of the Realisation of the financial plan of the

National Health FundNational Health Fund– Social Insurance InstitutionSocial Insurance Institution– Technical and financial plan of the Technical and financial plan of the

Agricultural Social Insurance FundAgricultural Social Insurance Fund

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Data sourcesData sources (2) (2)

Private sectorPrivate sector1.1. Private health care insurance Private health care insurance - - statistical report statistical report

on insurance activity of insurance institutionson insurance activity of insurance institutions

2.2. Private household outPrivate household out--ofof--pocket payments –pocket payments – households’ budgets households’ budgets survey/ survey/ modul survey modul survey „Health care in households” „Health care in households”

3.3. Non-profit Non-profit organisations organisations –– periodic surveyperiodic survey

4.4. CorporationCorporations s – experts estimations on the basis – experts estimations on the basis of available reports on occupational medicine of available reports on occupational medicine and recognition of the quasi-insurance sectorand recognition of the quasi-insurance sector

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Data sourcesData sources (3) (3)

Private health care insurancePrivate health care insurance- No private health insurance in the form No private health insurance in the form

of a separate kind of a separate kind - Insurance institutions operating on the Insurance institutions operating on the

basis of the Law of 22 May 2003 on the basis of the Law of 22 May 2003 on the Insurance ActivitiesInsurance Activities

- Quasi-insurance sector not included Quasi-insurance sector not included here (included in „corporations” group) here (included in „corporations” group)

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Data sourcesData sources (4) (4)Private hPrivate households out-of-pocket ouseholds out-of-pocket

paymentspaymentsHBSHBS Modular Modular

surveysurvey

Sample sizeSample size ca. 32 thous ca. 32 thous of householdsof households

ca. 4 thous of ca. 4 thous of householdshouseholds

MethodMethod filling in the filling in the diariesdiaries

questions questions about the about the pastpast

PeriodicityPeriodicity continuouscontinuous cyclical cyclical (every 3-5 (every 3-5 years)years)

ClassificationClassification COICOP/HBSCOICOP/HBS ICHAICHA

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Data sourcesData sources (5) (5)

Non-profit organisations serving Non-profit organisations serving householdshouseholds

- fundations, associations, other social fundations, associations, other social organisationsorganisations

- cyclical survey carried out by the CSOcyclical survey carried out by the CSO- last survey 2002 (data for 2001)last survey 2002 (data for 2001)- estimations for 2003estimations for 2003

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Data sourcesData sources (6) (6)

CorporationsCorporations

– Law on Occupational MedicineLaw on Occupational Medicine– Organisational units of occupational Organisational units of occupational

medicine: basic units and voivodship medicine: basic units and voivodship occupational medicine centresoccupational medicine centres

– „„medical insurance packages” – quasi medical insurance packages” – quasi insurance institutionsinsurance institutions

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Analysis of resultsAnalysis of results

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Figure Figure 1. 1. Expenditures Expenditures on on health care health care by financing sectorby financing sector

0

5 000

10 000

15 000

20 000

25 000

30 000

35 000

40 000

(in th

ou

s. PL

N)

Public expenditure Private expenditure Rest of the world

199920022003

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Social security 57,6%

Private insurance

0,4%

Corporations1,0% General

government (excl.social

security)13,6%

NPISHs0,8%

Rest of the world0,0%

out-of-pocket payments

26,6%

Figure 2 Total health expenditure Figure 2 Total health expenditure by financing agent (Total = 100)by financing agent (Total = 100)

Public 71,2%

Private 28,8%

1999

Social security 60,2%

Private insurance

0,6%

Corporations2,3%

General government (excl.social

security)9,8%

NPISHs0,7%

Rest of the world0,0%

out-of-pocket payments

26,4%

Public 70,0%

Private 30,0%

2003

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Rest of the world0,1%

Nursing and residential

care 1,3%

Providers of ambulatory health care

26,9%

Health adm. and

insurance1,4%

Hospitals28,1%

Providers of public health

programmes2,9%

All other industries

6,2%

Retail of medical goods33,1%

Unspecified2,3% Rest of the

world0,1%

Nursing and residential

care 1,8%

Providers of ambulatory health care

25,7%

Health adm. and insurance

4,3%

Hospitals29,8%

Providers of public health programmes

2,6%

All other industries

6,3%

Retail of medical goods27,1%

Figure 3 Current health Figure 3 Current health expenditure by provider (Total expenditure by provider (Total current = 100)current = 100)1999 2003

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Long-term nursing care:

4,9%

Ancillary services

3,0%

Health adm. and insurance

1,4%

Curative and rehabilitive care

50,8%

Prevention and public health

3,3%

Gross capital formation

4,2%

Medical goods 32,4%

Gross capital formation

3,7%

Long-term nursing care:

6,0%

Ancillary services

3,0%

Prevention and public

health 3,6%

Curative and rehabilitive

care51,3%

non-classified2,2%

Health adm. and

insurance4,1%

Medical goods 26,1%

Figure 4 Total health Figure 4 Total health expenditure by function (Total expenditure by function (Total = 100)= 100)

1999 2003

Public 97,3% Private 2,7%

Public 34,3% Private 65,7%

Public 82,0% Private 18,0%Public 39,9%

Private 60,1%

Central Statistical Office of PolandCentral Statistical Office of Poland 1818PARIS 2005PARIS 2005

ConclusionsConclusions

• data availability - differencesdata availability - differences– public expenditure – almost public expenditure – almost complete datacomplete data– private expenditures – problems private expenditures – problems (corporations, occupational (corporations, occupational medicine)medicine)– rest of the world – not well rest of the world – not well recognisedrecognised

Central Statistical Office of PolandCentral Statistical Office of Poland 1919PARIS 2005PARIS 2005

ConclusionsConclusions

• need for improving information need for improving information sourcessources

– public expenditures (health care in public expenditures (health care in prisons, social welfare homes)prisons, social welfare homes)– private expenditures (corporations, private expenditures (corporations, insurance institutions) insurance institutions) – lower classification levellower classification level