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Slide1: 

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

Slide2: 

SHA Member Manabu YAMAZAKI Koki HAYAMIZU Sumie IKEZAKI Masahiro TASHIMA

Outline of Presentation: 

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): 

Trend of National Medical Expenditure (NME) Shifted to LTC

Slide5: 

The Structure of National Health Accounts (Billion Yen, 2000)

Structure of SHA: 

LTC Welfare services 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. Spending on medical-related services HC 6 Preventive health and health Promotion Medical services OTC drugs,Private-duty nursing,etc. Medical-related services Personal dental services, Special meals,etc. HCR. Sub-systems supporting the medical system education, R&D, etc Structure of SHA

Trend of Personal Health Expenditure and NME: 

Estimation in 2001 is tentative data Trend of Personal Health Expenditure and NME

Current Expenditure by Function: 

Current Expenditure by Function

Current Expenditure by Financing: 

Current Expenditure by Financing (Billion Yen, 2000)

Current Expenditure by Provider: 

Current Expenditure by Provider

LTC System and Estimating Expenditure of LTC-Long Term Care-: 

LTC System and Estimating Expenditure of LTC -Long Term Care-

Public Long Term Care Insurance Act: 

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: 

Medical insurers Mechanism of LTC Insurance System No.1 Insured (65 and over) No.2 Insured (from 40 to 64) municipalities Deducted from pension Social Insurance Medical Care Fee Payment Fund Premiums of elderly (17%) Premiums of non-elderly (33%) Public expenditure State (25%) Prefecture (12.5%) Municipality (12.5%) Prefecture Federation of National Health Insurance Associations Premiums Lump-sum payment National pool Transfer Premiums 30% 70% Aid to municipality Examinations, payments,etc.

Domiciliary Service: 

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: 

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: 

LTC Services include SHA and Categories by ICHA-HC

Types of Institutes providing LTC and SHA categories by ICHA-HP: 

Types of Institutes providing LTC and SHA categories by ICHA-HP

LTC Services by Function and Providers: 

LTC Services by Function and Providers

LTC funding: 

LTC funding

Personal Expenditures for Medical Care and LTCs: 

Personal Expenditures for Medical Care and LTCs Billion Yen, 2000

LTC Expenditure by Providers: 

LTC Expenditure by Providers Billion Yen, 2000

LTC Expenditure by financing: 

LTC Expenditure by financing Billion Yen, 2000

Key Issues.: 

Key Issues. 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. 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:

Conclusion: 

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.

Slide25: 

Thank you for your attention Tea Ceremony Kimono Kinkaku-Ji:The Golden Temple