Strategies for a BEA Satellite Health Care Account Summary of a Workshop (2009) / Chapter Skim
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1 Introduction
1 Introduction
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with next steps as it develops plans to produce a satellite health care account designed to improve its measurement of economic activity in the medical care sector and to be useful for health care policy. The ultimate objectives of the BEA program are to compile medical care spending information by type of disease that is more directly useful for measuring health care inputs, outputs, and productivity than are current estimates of spending by type of provider; produce a comprehensive set of accounts for health care–sector income, expenditure, and product; develop medical care price and real output measures that better break out changes in the delivery of health care from changes in the prices of that care; and coordinate BEA and Centers for Medicare and Medicaid Services (CMS)
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program is generating experimental price indexes, also orga nized by major disease category, by merging medical expenditure and utilization data from the Medical Expenditure Panel Survey with the CPI production database of the Bureau of Labor Statistics (BLS)
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Matthew Shapiro agreed, observing that the statistical system appears poised to make major progress on health accounting issues, and added that the workshop occurred at a pivotal time. Both the BLS and BEA are currently engaged in innovative research that will enhance their ability to provide comprehensive data for measuring activity in the medical care sector of the economy.
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Compared with work by academic health economists on data systems designed to track changes in population health alongside the investment of inputs to health, she described the BEA initiative as modest. BEA is most concerned with one input to health -- medical care -- because it is the piece that is most relevant to the market-oriented national accounts; it is also numerically important (medical care accounts for a large and growing portion of GDP)
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The history of economic accounting includes forays by statistical agencies into such projects with broader scope. One example is the satellite accounts that have been developed in various countries, including the United States, to estimate the economic contributions to society of the environment (or parts thereof)
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It is not something that BEA could, given the current state of the art, fruitfully think of as part of its satellite system now under development; but, he advised, these ideas and goals -- particularly as they relate to measurement of the changing quality of medical care -- should be kept in mind at all times as part of the long-run objective. The BEA Medical Care Account: Experimental Work to Improve the Market-Oriented NIPAs Jorgenson suggested that perhaps the satellite account concept was not quite the way to think about BEA's project.
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Every time a better price index is introduced, it changes the deflator used to calculate real GDP, even if it does not change the categories or the scope of the accounts. Landefeld cited BEA's travel and transportation satellite account as an example of work that takes place within the scope of the existing accounts but that breaks out additional detail for what is already covered.
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In Chapter 2, we describe characteristics of a system, as envisioned by workshop participants, for defining expenditure categories or "buckets" in which to allocate dollars spent in the economy on medical care. One of the most difficult issue that arises is comorbidity; when patients require medical care for multiple conditions, it becomes much more complicated to assign expenditures to predefined categories accurately.
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Collaborative research is under way at CMS and BEA to further this objective. Price Indexes: Calculating Real GDP for Medical Care Many of the difficult tasks required for developing a satellite health care ccount relate to the calculation of price indexes needed to deflate nominal expenditure estimates for the measurement of real GDP.
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BEA has also done research and commissioned outside work using a different episode grouper that found significant variation as well. Measuring Quality Change in Medical Care Ideally, medical care price indexes used to deflate the economic accounts would be capable of reflecting changes in the quality of medical goods and services.
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Here, the concern is not with the business of providing medical service, but the role of businesses as buyers of health insurance; the data must allow users to distinguish the health insurance industry and its activities from those of the medical care sector itself. When thinking about payments for treatments generated by providers, J orgenson noted that those have to be segregated, as they are in the national health expenditure accounts, by sources of payment, so that links can be made to the other sectors in the economy.
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