Functions of healthcare expenditure
In the SHA, the functional classification of healthcare plays a major role in delineating the boundaries in the definition of healthcare activities and expenditure.
HC.1 Curative care
Curative care comprises healthcare contacts during which the principal intent is to relieve symptoms of illness or injury, to reduce the severity of an illness or injury.
Includes: all components of the curative care or treatment of the illness, that is, diagnostic and therapeutic procedures; and pharmaceutical products and other medical goods used.
HC.2 Rehabilitative care
Rehabilitation services are consumed by individuals experiencing functional difficulties associated with a broad range of health conditions (disease, disorder and injury), which may be acute or chronic, congenital or acquired, and affect people with disabilities of all ages, independent of, or in conjunction with, specialist healthcare services.
Excludes: rehabilitative services with a social, educational, leisure or labour purpose.
HC.3 Long-term healthcare
Long-term healthcare consists of a range of medical care services that are consumed with the primary goal of alleviating pain and suffering and reducing the deterioration in health status in patients with a degree of long-term dependency.
Within this category, HC.3.3 classifies the expenditure destined to the care of persons who are dependent as regards basic activities of daily life. There may be problems when it comes to quantifying this expenditure, as this service normally includes services associated with instrumental activities and personal care, which are not included in health expenditure. The SHA 2011 manual provides several guidelines and indications of the expenditure that should be included.
Each of the three functions described above is classified in accordance with criteria based upon the regime or way in which the service is provided. The following four modes of healthcare provision are distinguished:
Hospitalisation: involves the formal registration of the patient in the corresponding healthcare institution and that the patient spends at least one night there.
Day-care hospitalisation: includes those services where the patient is admitted and formally registered in the institution with the intention to discharge the patient on the same day.
Outpatient: : includes care for patients who are not formally admitted into establishment the (outpatient centres, doctors' and dental surgeries, etc.).
Home care: : includes all the healthcare received by the patient at home.
HC.4 Ancillary health services
Includes all ancillary activities linked to healthcare, which are not assigned to any specific function or mode of provision and which the patient consumes directly, such as clinical tests, diagnosis by imaging and the transport of patients.
HC.5 Medical goods (non-specified by function)
These include pharmaceutical products and non-durable medical goods intended for use in the diagnosis, cure, mitigation or treatment of disease, and which are not assigned to any specific function or mode of provision.
Includes: medical goods and products acquired by the beneficiary, whether as the result of a prescription, after contact with the health system or as a result of self-prescription and available over the counter.
Excludes: medical products consumed or provided during healthcare prescribed by a health professional.
This approach is coherent when it is taken into consideration that medical products constitute a part of the healthcare service that includes, as well as the good itself, an advisory service provided by the specialist regarding the need for the good in question and the way in which it is to be used. Thus, pharmaceutical products provided by the hospital are only part of the service offered by the hospital and, these same products, when they are acquired in pharmacies, constitute part of the service provided by the qualified professional working there.
HC.6 Preventive care
Prevention is any measure that aims to avoid or reduce the number or the severity of injuries and diseases, their sequelae and complications. It comprises activities that aim to maintain or improve the state of health of the population, but which do not constitute curative episodes.
Includes, among other things, the dissemination of information regarding health or healthy lifestyles; vaccination programmes, occupational healthcare.
HC.7 Governance and administration of the health system and healthcare financing
This comprises activities that direct and support the functioning of the health system, aimed at improving the effectiveness and efficiency of the health system, both public and private.
It includes the administration of health programmes; the setting of standards; the regulation, licensing or supervision of producers; the management of fund collection; and the administration, monitoring and evaluation of such resources.