Strategies for a BEA Satellite Health Care Account: Summary of a Workshop (2009)

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Appendix B Workshop Agenda and Participants WORKSHOP AGENDA Friday, March 14, 2008 8:30 a.m. Introduction/Overview of Day’s Agenda Joseph Newhouse, Steering Committee Chair 8:45 Plans for a Satellite Health Care Account. Goals of BEA’s health care accounting program; progress to date on producing a detailed proposal by the end of 2009; summary of BEA’s strategies for deal- ing with key measurement issues; and data needs. Ana Aizcorbe, BEA Discussants: Dale Jorgenson, Matthew Shapiro Open Discussion 10:00 Constructing Nominal Expenditures by Disease. Overview of Altarum Institute’s work developing time-series estimates of national expenditures by medical condition. These estimates are benchmarked to government estimates of personal health expendi- tures from the National Health Expenditure Accounts. Thus, they cover spending by the civilian noninstitutional population as well as some institutionalized populations and the military. Charles Roehrig, Altarum Institute Discussants: David Cutler, Allison Rosen Open Discussion 84 

appendix B 85 11:15 Coffee Break 11:30 Price Indexes and Volume Measures. Discuss BLS’s plans to research and generate price indexes organized by broad disease category. The PPI program currently publishes provider based price indexes aggregated by broad disease category for payers other than Medicare and Medicaid in general hospitals and for pharmaceutical manufacturing. Because similar data will be available in the future for other industries such as physician services, medical laboratories, and diagnostic imaging centers, the PPI is researching the develop- ment of an alternative price index organized by disease categories rather than provider. Currently collected item data captured monthly and priced at the point of service (the provider) will be used in the proposed index, and procedures have been developed that allow price change caused by substitution of treatments across providers to be reflected. Additionally, PPI has developed a method to quality adjust its current hospital indexes by using quality indicators con- tained in the CMS Hospital Compare database. The CPI program is generating experimental price indexes, also organized by major disease category, by merging medical expenditure and utilization data from the Medical Expenditure Panel Survey with the BLS CPI production database. Both the PPI quality adjustment proposal and the CPI generation of experimental price indexes use existing data- bases with no additional expenditure from BLS. Bonnie Murphy, BLS Ralph Bradley, BLS Discussants: Jack Triplett, Patricia Danzon Open Discussion 12:45 p.m. Lunch Topic Discussion: Measuring Treatment Outcomes. Dis- cuss the difficulties when constructing measures of treatment out- comes and assess the current state of knowledge. Discuss the role of clinical data to inform performance measures; offer views on merging clinical data to claims data, and on the availability of HMO encounter data. Mark McClellan, Brookings Institution Open Discussion 2:00 National Accounting Issues. Discuss national accounting issues that must be resolved in order to produce a satellite account for health care. Among these is how to construct measures of real expenditures for health care industries, define disease and product classes, and make the spending and industry sides of the account 

86 Strategies for a BEA Satellite Health CARE Account add up (or provide a reason why they do not). Also discuss the need for a set of deflators for industries (at least doctors, hospitals and drugs); the importance of data on sources of payment, and the role of government subsidies; the domain for goods and services, including a time consideration—at what point do we draw the line for treatment; what to include in gross output or final demand; and how to deal with nonmarket health inputs. Brian Moyer, BEA Discussants: Barbara Fraumeni, Sherry Glied Open Discussion 3:15 Summary and Perspective, Prospects for Moving Forward. Wrap-up comments on (1) BEA’s plans for the NIPAs and for the satellite health care accounts, (2) hurdles and priorities, and (3) next steps. Gail Wilensky, Project HOPE Open Discussion 4:00 p.m. Adjourn LIST OF PARTICIPANTS Ana Aizcorbe, BEA Bruce Baker, BEA Jessica Banthin, AHRQ Linda Bilheimer, NCHS Ralph Bradley, BLS LeRoynda Brooks, BEA Elaine Cardenas, BLS Aaron Catlin, CMS Constance Citro, CNSTAT Staff Steve Cohen, AHRQ Frank Congelio, BLS Cathy Cowan, CMS David Cutler, Harvard University Patricia Danzon, University of Pennsylvania Dennis Fixler, BEA Barbara Fraumeni, University of Southern Maine Mark Freeland, CMS Alan Garber, Stanford University Daniel Ginsburg, BLS Sherry Glied, Columbia University Micah Hartman, CMS 

appendix B 87 Steven Heffler, CMS Michael Horrigan, BLS Dale Jorgenson, Harvard University Richard Kane, BEA Emmett Keeler, RAND James Kim, BEA Steven Landefeld, BEA Katharine Levit, Thomson Healthcare John Lucier, BLS Erin Ludlow, BEA Christopher Mackie, CNSTAT Staff William Marder, Thomson Healthcare Tami Mark, Thomson Healthcare Mark McClellan, Brookings Institution Robert McClelland, BLS Brent Moulton, BEA Brian Moyer, BEA Bonnie Murphy, BLS Joseph Newhouse, Harvard University Sarah Pack, BEA Bonnie Retus, BEA Charles Roehrig, Altarum Institute Allison Rosen, University of Michigan Arthur Sensenig, CMS Matthew Shapiro, University of Michigan Michael Siri, CNSTAT Staff Shelly Smith, BEA Edward Sondik, NCHS Jack Triplett, Brookings Institution Frank Velez, BLS Gail Wilensky, Project HOPE