SHA based
National Health Account
Hiroyuki SAKAMAKI, MBA
Institute for Health Economics and Policy (IHEP)
Tokyo, Japan
Meeting of Experts in National Health Accounts
Organisation for Economic Co-operation and Development (OECD)
Directorate for Employment, Labour and Social Affairs
Chateau de la Muette, Paris, 27-28 October 2003
Japan
SHA Member
Manabu YAMAZAKI
Koki HAYAMIZU
Sumie IKEZAKI
Masahiro TASHIMA
Outline of Presentation
Overview of the NHA estimates in 2000
 LTC System and Estimating
Expenditure of LTC
Key Issues
Trend of National Medical
Expenditure (NME)
Bio Yen
35,000
Shifted
to LTC
30,000
25,000
20,000
15,000
10,000
5,000
0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
The Structure of
National Health Accounts
Total Expend. on
Health
39,534
(Billion Yen, 2000)
Current Expend.
Investment
37,306
2,227
Collective
Expend.
Personal Expend.
35,283
2,022
Medical
Services
Medical Goods
Prevent. &
Public Health
Admin.
&Insurance
27,724
7,559
1,165
875
Structure of SHA
Spending on medical-related services
•HC 6 Preventive health and health
Promotion
•Medical services
OTC drugs,Private-duty nursing,etc.
LTC
Welfare
services
•Medical-related services
Personal dental services, Special meals,etc.
NME as currently defined.
HC.7 Indirect NME as currently defined.
Administration of health insurance system
HCR.1 Public expenditures on medical
institutions.
Subsidies, Public payments, etc.
Personal
Expenditure
HCR.
Sub-systems
supporting
the medical
system
education, R&D,
etc
Trend of Personal Health
Expenditure and NME
Bio Yen
40,000
35,000
34,118
32,879
29,950
30,000
7,823
26,958
25,000
207
40
31,323
247
247
212
105
161
150
Ancillary Services
Home Care
59
21
12,143
10,487
30,358
81
193
190
29,825
29,065
198
Medical Goods
National Medical Expend
30,934
28,521
7,940
7,272
7,734
7,949
7,559
7,213
32,119
31,633
20,000
36,068
35,034
10,765
12,230
12,595
Out Patient Care
11,449
9,620
15,000
In Patient Care
10,000
13,870
14,445
15,126
12,296
13,363
14,848
12,964
1995
1996
1997
1998
1999
2000
2001
5,000
0
Estimation in 2001 is tentative data
Current Expenditure by Function
23,691
(63.5%)
HC.1 Services of curative care
7,216
(19.3%)
HC.5.1 Pharmaceuticals and
other medical non-durables
HC.3 Services of long-term
nursing care
3,517 (9.4%)
HC.6 Prevention and
public health services
1,165 (3.1%)
HC.7 Health administration
and health insurance
857 (2.3%)
HC.5.2 Therapeutic appliances
and other medical durables
343 (0.9%)
HC.2 Services of rehabilitative
care
269 (0.7%)
HC.4 Ancillary services
to health care
Bil Yen
2000
247 (0.7%)
-
5,000
10,000
15,000
20,000
25,000
Current Expenditure by Financing
25,501
(68.4%)
HF.1.2 Social security funds
HF.2.3 Private household out
-of-pocket expenditure
6,570
(17.6%)
HF.1.1 General government excluding
social security funds
4,518
(12.1%)
593
(1.6%)
HF.2.5 Corporations
124
(0.3%)
HF.2.2 Private insurance enterprises
-
5,000 10,000 15,000 20,000 25,000 30,000
(Billion Yen, 2000)
Current Expenditure by Provider
18,871
(50.6%)
HP.1 Hospitals
7,860
(21.1%)
HP.3.1 Offices of physicians
HP.4 Retail sale and other
providers of medical goods
4,566
(12.2%)
HP.3.2 Offices of dentists
2,559 (6.9%)
HP.5 Provision and administration
of public health programmes
1,165 (3.1%)
HP.2 Nursing and residential
care facilities
1,088 (2.9%)
HP.6 General health
administration and insurance
857 (2.3%)
HP.3.9.1 Ambulance services
247 (0.7%)
HP.3.9 Other providers of
ambulatory health care
247 (0.7%)
HP.3.6 Providers of home
health care services
93 (0.3%)
-
Bil Yen,
2000
5,000
10,000
15,000
20,000
LTC System and
Estimating Expenditure
of LTC
-Long Term Care-
Public Long Term Care Insurance Act
In effect since April 1, 2000.
To allow those in need of care and
support to lead their daily lives as
independently as possible making use of
the capabilities.
To provide long term care by integrating
health, medical care and welfare services
as select by the user.
Mechanism of LTC Insurance System
municipalities
No.1 Insured
(65 and over)
Deducted from
pension
Premiums
of elderly
(17%)
70%
Premiums
No.2 Insured
(from 40 to 64)
Medical insurers
Lump-sum payment
Public
expenditure
Aid to
municipality
National pool
Social Insurance
Medical Care Fee
Payment Fund Transfer
State
(25%)
Premiums
of
Prefecture
non-elderly (12.5%)
(33%)
Municipality Examinations,
(12.5%) payments,etc.
Federation of National Health
Insurance Associations
Premiums
Prefecture
30%
Domiciliary Service
Home-visit services
Home help service / Bathing service / Nursing /
Home rehabilitation
Short-term stay services
Day service (at day care center) / Outpatient
rehabilitation (at medical care facility) / Short stay
therapy / Group therapy to counter dementia (home
for senile dementia patients) / Long term care for
residents of special facilities
Others
Home treatment management and guidance /
Leasing of welfare appliances/Provision for
purchase of home care welfare appliances /
Provision for home improvements associated with
care / Home help service support
Facility Services
 Long Term Care Welfare Facilities for the Elderly
(Special Nursing Homes for the Elderly)
 Long Term Care Health Facilities for the Elderly
(Facilities of Health Care Services for the Elderly)
 Long Term Care Medical Treatment Facility
 Medical treatment beds
 Beds for treatment of senile dementia
 Long Term Care strength building hospital
LTC Services include SHA and
Categories by ICHA-HC
home-visit nursing
home-visit rehabilitation
HC.3.3
long-term nursing home care
HC2.4
rehabilitative home care
commuting rehabilitation
services
HC.2.2
rehabilitative day care
medical care service through a
short-term stay
HC.3.1
long-term nursing in-patient care
management guidance for inhome care
HC2.4
rehabilitative home care
health care facility services for
the elderly requiring long-term
care
sanatorium type medical care
facility services for the elderly
requiring care
HC.3.1
long-term nursing in-patient care
HC.3.1
long-term nursing in-patient care
Types of Institutes providing LTC and
SHA categories by ICHA-HP
Long term care welfare facilities for the
Aged [ LTCW ]
Long term care health facilities for the Aged
[LTCH]
Not Appreciable
HP.2 nursing and residential
care facilities
Long term care medical treatment facilities
[LTCM]
Medical treatment beds
Beds for treatment of senile dementia
LTC strength building Hospital
GP Clinic
HP.1 Hospital
HP.1 Hospital
HP.1 Hospital
Dental Clinic
HP.3 ambulatory health care
providers
Home visiting nurse station
HP.3 ambulatory health care
providers
HP.3 ambulatory health care
providers
LTC Services by
Function and Providers
HC commuting rehabilitation services
2.2
HC home-visit rehabilitation
2.4
HC management guidance for in-home
2.4 care
HC medical care service through a
3.1 short-term stay
HP.1
Hospital
HP.2
Long
term care
health
facilities





HC health care facility services for the
3.1 elderly requiring long-term care


HP.3
Clinic
Home
visiting
nurse
station




HC sanatorium type medical care
3.1 facility services for the elderly
requiring care


HC home-visit nursing
3.3



LTC funding
HF.2.3
Out of Pocket
HF.1.1.2
Prefecture
(12.5%)
HF.1.1.1
HF.1.1.3
Municipalities
(12.5%)
State
(25%)
HF.1.2
Social Security Funds
(50%)
Public
Expenditure
Insurance
Premium
Personal Expenditures for
Medical Care and LTCs
HC.1
Services of curative care
HC.2
Services of rehabilitative care
Medical
Care
23,691
LTC
Total
-
23,691
-
269
269
HC.2.1
In-patient rehabilitative care
-
-
-
HC.2.2
Day cases of rehabilitative care
-
249
249
HC.2.3
Out-patient rehabilitative care
-
-
-
HC.2.4
Services of rehabilitative hom e care
-
20
20
1,900
1,618
3,517
1,882
1,516
3,399
HC.3
Services of long-term nursing care
HC.3.1
In-patient long-term nursing care
HC.3.2
Day cases of long-term nursing care
-
-
-
HC.3.3
Long-term nursing care: hom e care
17
101
119
7,806
-
7,806
33,396
1,887
35,283
HC.4+HC.5 Ancillary services + Medical goods
Total expenditure on personal health care
Billion Yen, 2000
LTC Expenditure by Providers
HC.3.1
long-term nursing
in-patient care
547
951
1,516
19
HC.2.2
102 138
rehabilitative day care
249
10
HC.2.4
20
rehabilitative home
care
5 0 15
HC.3.3
long-term nursing
home care
HP.1hospitals
HP.2 nursing and residential care facilities
HP.3 ambulatory health care providers
99
3
0 99
0
200
400
600
800
1,000 1,200
1,400 1,600
Billion Yen, 2000
LTC Expenditure by financing
HC.3.1
long-term nursing
in-patient care
1,306
1,516
25
HC.2.2
rehabilitative day
care
HC.2.4
rehabilitative home
care
210
249
224
18 2
20
91 11
HC.3.3
long-term nursing
home care
101
0
public
400
800
1,200
private
1,600
Billion Yen, 2000
Key Issues.
Items those are not counted in the National
Expenditure on Health by SHA definition due to
lack of data.
Following data are NOT available, therefore cause
for underestimation:
 Expenditure for amenities, advanced med care (ie. ESWL)
 HC.2.3
Non-Insured Acupuncture and JUDO reposition.
 HC.6
Educational interventions for health promotion.
Expenditure for the public health center admin.
 HC.7
Expenditure for the general government admin.
 HCR.1
Capital investment for specialized hospitals.
 HCR.2,4-7
Not available.
Conclusion
 The total expenditure on health in Japan 2000 is about
700 billions of Yen (22%) higher than the value based
on the National Medical Care Expenditure
 In 2000, 293,916 Yen per capita – that is 7.3 % of GDP
– were spent on total expenditure on health. Public
funds financed 80% of the total expenditure.
 Between 1996 and 2000, the growth of total
expenditure on health varied between 1.5%
(1996/1997) and 4.4% (1999/2000) per year.
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Thank you for
your attention
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