Accounting for Health and Health Care Approaches to Measuring the Sources and Costs of Their Improvement (2010) / Chapter Skim
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2 Medical Care Accounts and Health Accounts: Structure and Data
2 Medical Care Accounts and Health Accounts: Structure and Data
Pages 27-70
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From page 27... ...
This is not an account, as that term is normally used in the national accounts literature, but rather a research database. The rationale for recommending the research database on the determinants of health over a full-fledged health account is presented in section 2.2.3.
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From page 28... ...
2.2. MEDICAL CARE AND HEALTH ACCOUNTS CONTRASTED Any economic account incorporates an economic framework.
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From page 29... ...
In section 2.4, we discuss the inputs to the medical care account; in section 2.5, we turn to the output. A health account, similarly, records the relationships between an output -- in this case, a measure of health, which is multidimensional -- and the inputs that produce it (or, alternatively, the determinants of population health)
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From page 30... ...
R&D in the medical care account consists of, for example, development of new pharmaceuticals or new medical procedures; 4 R&D in the health account includes research that demonstrates the effects of smoking cessation, of healthy diets, or of exercise on health. In the familiar para digm, R&D in the medical care account augments the inputs to medical care; the additional, and different, R&D in the health account augments the nonmedical determinants of health.
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From page 31... ...
sector 62) between 1987 and 2001 was negative, at a rate of about 1 percent per year.8 They attributed the improbable negative productivity growth in the sector to data inadequacies in the measurement of medical care output and also to mismeasurement of several inputs, particularly the high-tech portions of medical equipment.
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From page 32... ...
growth in the medical care sector9 can be expressed as: LP (medical care) = ∂ (medical services)
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From page 33... ...
For policy purposes, the most pressing needs are to measure properly medical care expenditures and outputs, to improve measures of medical inflation, and to determine what part of increasing medical care costs are attrib utable to increases in medical services, as opposed to price change. In addition, accurate expenditure and output data on medical care, developed and presented by a detailed cost-of-disease metric, are essential for a "health" account.
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From page 34... ...
suggests constructing a health account that would provide a welfare-oriented measure as a counterpart to the market-oriented measures of the NIPA. Thus, it would be structured by analogy to the familiar national accounts that record economic activity but would be built around the functional relation and the variables in equation 2.2.
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From page 35... ...
It may, however, be premature to recommend that statistical agencies organize health data to accommodate a health account of the welfare-oriented NIPAs type. As was true of the development of national economic accounts in the 1930s, health accounts have not yet evolved very far, but the situation should change as more work on their conceptual underpinnings and practical needs is undertaken.
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From page 36... ...
. Thus, the current industry accounts provide a good starting place for producing a medical care production account.
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From page 37... ...
In the 2002 Economic Census, the three subsectors accounted for the following proportions of the total receipts of NAICS 62 less social services (U.S. Census Bureau, 2002 Economic Census Geographic Area Series summary statistics, see http://factfinder.census.gov)
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From page 38... ...
One would not want the development of a medical care sector to wait on its lagging component. Nonetheless, a medical care account without drugs, devices, and durable medical equipment that are purchased at retail by households will not be as useful as one with a broader definition that matches the national expenditure total for medical care.
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From page 39... ...
To this core, a household production sector that will account for other spending on medical care, such as on pharmaceuticals and medical equipment, should be added. In constructing a medical care account that extends beyond NAICS 62, BEA would undoubtedly also keep a NAICS 62 aggregate.
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From page 40... ...
Similar tabulations appear in the BEA industry accounts for NAICS subsectors 621, 622, and 623, described above. With the provisos that elements of household production should be included and that social services need to be removed from NAICS 62, as noted above, these data serve 13 However, we note that if the output of custodial activities were removed from medical care as an input to the production of health, then the partial productivity measure discussed in equation 2.6, above, cannot be computed when industry data are used in the analysis, even though the MFP measure in equation 2.4 is defined.
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From page 41... ...
This is (NAICS 62) System of National Accounts language for compensation of capital, essentially an expanded notion of profits and other returns to capital.
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From page 42... ...
The National Health Expenditure Accounts (NHEAs) have long contained data on investment in medical structures and now use BEA medical equipment data.16 The NHEAs have traditionally also included investment in education in their accounts.
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From page 43... ...
lists, in addition to payroll, 12 classes of inputs, identified by Census Bureau material codes, for which expenditure information was collected. 17 Hospitals, of course, are in services; electromedical equipment is in the manufacturing sector.
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From page 44... ...
Recommendation 2.4: The Census Bureau, Bureau of Economic Analysis, and Bureau of Labor Statistics should work jointly to harmonize the clas sifications and structure of their published data on electromedical equipment and to reduce, so far as practical, the share of shipments falling into the "all other" categories in the Current Industrial Reports. Deflators for equipment are the third major problem in medical capital data.
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From page 45... ...
As a result of both the scarcity of PPI indexes and the fact that they do not match Census Bureau data on shipments, BEA does not actually deflate medi cal equipment at the lowest level of PPI detail available, falling back instead to undesirable higher levels of aggregation. Historically, the more difficult-to-measure commodities have had less PPI coverage, and medical equipment bears out this historical regularity.
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From page 46... ...
Producing PPI indexes that do not match the Census Bureau's detailed data on shipments of medical equipment, or expendi tures on them as investment goods, will bring little advantage. Therefore, expanding PPI detail should accompany and coordinate with the interagency task force suggested in Recommendation 2.4.
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From page 47... ...
Methods for incorporating labor quality, or human capital, have been developed for use in industry accounts (Jorgenson, Gollop, and Fraumeni, 1987) , and BLS includes a labor quality adjustment in its published MFP measures.
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From page 48... ...
, looking at three separate published measures of industry employment -- two from BLS and one based on Census Bureau data -- show that the three present surprisingly divergent information on industry employment trends. For all indus try accounts, including those for medical care, divergences on the order found by Triplett and Bosworth suggest errors in existing labor productivity growth estimates as well as in other studies based on industry accounts.
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From page 49... ...
BEA has already done so in its accounting for intermediate inputs in its industry accounts (Moyer, 2008) , and there are no obvious special considerations with respect to the medical care sector's consumption of energy.
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From page 50... ...
The PPI, however, contains an index for scanning, which does not differ greatly from the relevant index for electromedical equipment (see section 2.4.2, above)
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From page 51... ...
Adding R&D to investment in national accounts has been proposed, and BEA has produced a satellite account that capitalizes R&D in the economy as a whole. If R&D is counted among capital assets, then the capital services provided by R&D would go into industry accounts as an input.
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From page 52... ...
, new German output measures for medical care (Organisation for Economic Co-operation and Development, 2009) , and the Organisation for Economic Co-operation and Development manual on measuring education and medical care output (Schreyer, 2009)
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From page 53... ...
Thus, the output of the medical care sector is its incremental contribution to health when a medical treatment or other procedure, including preventive interventions, is undertaken. The only effective way to measure a medical intervention is through a disease-based metric.
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From page 54... ...
As well, much other medical information, which an analyst would use in conjunction with medical care data and health accounts, is collected, tabulated, and organized on a similar principle. Scientific advances also fit into the system: research on new treatments takes place at the level of a specific disease, so it can be fitted naturally into the ICD.
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From page 55... ...
. PPI indexes for hospitals have been constructed for many years using the same classification system, and BLS has proposed new PPI indexes for doc tors' offices and medical labs that would mesh with the new Census Bureau data collections.
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From page 56... ...
. For data collected from providers (via the Census Bureau–BLS mode)
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From page 57... ...
Alternatively, they can be collected from establishments that provide the services (the collection framework for Census Bureau collections of health care sector data and for BLS in the PPI)
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From page 58... ...
2.5.3. Measuring Spending on Nondisease-Specific Health Care Goods and Services The treatment of diseases represents a large part of the activity of the health care sector.
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From page 59... ...
Some patients in long-term care are frail in many ways: their entry into a nursing home may be triggered by a disease -- for example, disability due to a stroke -- but their medical conditions are not tied to a single disease or health condition. In addition, nursing homes provide rehabilitation and convalescent care in many episodes of disease.
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From page 60... ...
Equation 2.8 suggests that medical care interventions are valued by their incremental contributions to health -- that is, the output of each intervention is its medical outcome measure. If so, why not measure medical outcomes directly, disease-by-disease, and combine them into a weighted measure, rather than forming measures of treatments?
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From page 61... ...
, they are outputs of the medical care sector. Determining whether or not medical sector output arising from inappropri ate treatments contributes to welfare is a task for the compilers of the health account, particularly since they are more likely than national accountants to have the expertise to determine when treatments are not effective.
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From page 62... ...
If the output of the medical care sector were measured as a health outcome, and that measure then used as an input in the health account, the pos sibility of productivity change in the health account is largely eliminated by con vention. One of the things that a health account should be designed to reveal is the productivity of the medical care sector in the production of health.
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From page 63... ...
-- are not well integrated and can be confusing, so we present a brief summary of their data on medical equipment. Data for Medical Care Capital equipment As explained in the text, the Census Bureau, in the Economic Census, still does not collect the range of input data for services industries that it has long collected for manufacturing and other goods-producing industries.
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From page 64... ...
ASM distinguish as the main product of NAICS 33451 "diagnostic and therapeutic" equipment, presumably the same "electromedical and electro therapeutic equipment" products that are collected in ACES. No detail beyond this aggregate is published in ASM.32 The 2007 Economic Census form for the industry "Electromedical and Electrotherapeutic Apparatus" gathered information on receipts from "electromedical equipment including diagnostic, therapeutic and patient monitoring equipment." This is the same level of fairly gross aggregation as in ASM, and the Census Bureau form specifies that it is the same aggregate as on CIR.
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From page 65... ...
Some years ago, government data on computers and related equipment were as seriously undeveloped as medical equipment data are today. A multipronged effort by all three major statistical agencies (BEA, Census Bureau, Bureau of Labor Statistics [BLS]
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From page 66... ...
: • 1100 electromedical equipment, including diagnostic, therapeutic, and patient monitoring equipment; • 1103 magnetic resonance imaging equipment (MRI) ; • 1106 ultrasound scanning devices; • 1109 electrocardiograp; • 1112 electroencephalograph and electromyograph; • 1115 audiological equipment; • 1118 endoscopic equipment; • 1121 respiratory analysis equipment; • 1124 all other medical diagnostic equipment; and • 3100 electronic hearing aids.
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From page 67... ...
CIR's second disaggregation is by product. But even though CIR presents much more product detail than the ASM or the Economic Census, the CIR pub lished product detail does not map exactly into the Census Bureau 10-digit prod uct list.
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From page 68... ...
, CIR electromedical equipment contains a whole first-level category labeled "other electromedical and electrotherapeutic apparatus." Accordingly, almost half of the total shipments of electromedical equipment falls into "all other" classifications. Substantial government funding and a substantial amount of respondent burden are costs of the CIR medical equipment survey.
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From page 69... ...
MeDICAL CAre ACCOUNTS AND HeALTH ACCOUNTS equipment by hospitals and other medical sector units presents no disclosure possibilities and so obviates the difficulty in collecting information from domestic producers. In medical care analysis, the investment data -- that is to say, information from the buyers -- are more crucial than domestic production data (information from the sellers)
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