Measuring Expenditure on Health-Related R&D

212 Pages·2001·1.022 MB·English

by  Oecd

«
HEALTH
Measuring Expenditure on Health-related R&D Measuring Expenditure
Science and technology improves human health but the pressure for faster and larger improvements on Health-related R&D
is building with the continued ageing of the population of many OECD countries and the associated
increased demands for health care. A fundamental starting point for better understanding of the
impact of innovation on health is the measurement of R&D.
This publication addresses this issue by looking in detail at measurement practices across ten OECD
Member countries as well as the main international sources. A number of new insights are gained
including the growing importance of clinical trials, the contribution of hospitals and the role
of provincial and local government. The book also identifies a number of issues that need to
be considered when making comparisons based on the most obvious health-related R&D series
in international publications.
FURTHER READING HEALTH
OECD Health Data.
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ISBN 92-64-18678-6
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Measuring Expenditure
on Health-related R&D
ORGANISATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT
ORGANISATION FOR ECONOMIC CO-OPERATION
AND DEVELOPMENT
Pursuant to Article 1 of the Convention signed in Paris on 14th December 1960, and which came into
force on 30th September 1961, the Organisation for Economic Co-operation and Development (OECD)
shall promote policies designed:
– to achieve the highest sustainable economic growth and employment and a rising standard of
living in Member countries, while maintaining financial stability, and thus to contribute to the
development of the world economy;
– to contribute to sound economic expansion in Member as well as non-member countries in the
process of economic development; and
– to contribute to the expansion of world trade on a multilateral, non-discriminatory basis in
accordance with international obligations.
The original Member countries of the OECD are Austria, Belgium, Canada, Denmark, France,
Germany, Greece, Iceland, Ireland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain,
Sweden, Switzerland, Turkey, the United Kingdom and the United States. The following countries
became Members subsequently through accession at the dates indicated hereafter: Japan
(28thApril1964), Finland (28th January 1969), Australia (7th June 1971), New Zealand (29th May 1973),
Mexico (18th May 1994), the Czech Republic (21st December 1995), Hungary (7th May 1996), Poland
(22ndNovember 1996), Korea (12th December 1996) and the Slovak Republic (14th December 2000). The
Commission of the European Communities takes part in the work of the OECD (Article 13 of the OECD
Convention).
© OECD 2001
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FOREWORD
This book originates from an exercise undertaken in co-operation between Statistics Canada and
the OECD Working Party of National Experts on Science and Technology Indicators. Its objective
was to build on the existing work at the OECD, supported by the Frascati Manual, to improve the
coverage, quality and comparability of data available on health R&D for international comparison. As
part of this exercise ten countries [Australia, Austria, Canada, Denmark, France, Israel, Norway,
Spain, the United Kingdom (England) and the United States] provided papers on their national health
R&D systems and funding data and a review of the main international sources was undertaken. An
informal workshop was held on 10 March 2000 to discuss the main measurement issues revealed by
these papers including:
• Identifying and comparing health-related R&D in government R&D budgets.
• Measuring the resources devoted to R&D in hospitals.
• Identifying the borderline issues of R&D associated with clinical trials.
• Measuring and comparing health-related R&D in the government, private non-profit and
higher education sectors.
• Identifying and comparing health-related R&D in the business enterprise sector.
• Other classifications of health R&D.
The first part of the book identifies and illustrates the main problems of international
comparability of the data on health-related R&D currently available from OECD and other
international R&D and health data sources. It incorporates the discussion papers and gives many
illustrations from national sources.
Part II covers the national papers which reveal some common preoccupations (notably measuring
R&D in hospitals, and measuring R&D by persons with multiple activities spread over very long
hours) and others caused by national specificities, such as employment practices or complex relations
between the institutions and teams which make up the respective national health science and
innovation systems.
The report is published on the responsibility of the Secretary-General of the OECD. Support from
the Government of Canada through Statistics Canada is gratefully acknowledged.
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TABLE OF CONTENTS
Part I
AN ASSESSMENT OF NATIONAL AND INTERNATIONAL PRACTICES FOR COMPILING
DATA ON HEALTH-RELATED RESEARCH AND DEVELOPMENT
Chapter 1. Identifying and Comparing Health-related R&D in Government Budget
Appropriations and Outlays for R&D: GBAORD
Alison Young...........................................................................................................11
Chapter 2. Compiling Performer-reported Health GERD
Alison Young...........................................................................................................23
Chapter 3. Improving National Surveys and Their International Comparability:
Clinical Trials and R&D in Hospitals
Alison Young...........................................................................................................43
Chapter 4. Other Views and Classifications of Health-related R&D
Alison Young...........................................................................................................49
Part II
NATIONAL EFFORTS TO MEASURE RESOURCES FOR HEALTH-RELATED R&D
Chapter 5. Health Research and Experimental Development in Australia
Derek Byars............................................................................................................79
Chapter 6. Measuring Health R&D in Austria
Karl Messmann.....................................................................................................103
Chapter 7. Estimates of Gross Expenditures on R&D in the Health Field in Canada
Paul McPhie.........................................................................................................121
Chapter 8. R&D in the Danish Health Sector
Henrik Troelsen and Karen Siune.........................................................................127
Chapter 9. Estimating Health-related R&D Expenditure in France
Monique Bonneau.................................................................................................169
Chapter 10. Measuring Resources Devoted to Health-related R&D in Israel
Soli Peleg and Nava Brenner................................................................................175
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Chapter 11. Measuring Health R&D in Norway
Susanne Lehmann Sundnes...................................................................................193
Chapter 12. Research in the Spanish Health Services
Carlos Angulo.......................................................................................................205
Chapter 13. Measuring Health-related R&D in the United Kingdom
Fiona Russell and Derek Gardiner.......................................................................207
Chapter 14. Estimates of Health R&D Expenditures in the United States: An Exploratory
Data Compilation
John E. Jankowski.................................................................................................213
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Part I
AN ASSESSMENT OF NATIONAL AND INTERNATIONAL PRACTICES
FOR COMPILING DATA ON HEALTH-RELATED RESEARCH AND
DEVELOPMENT
by
Alison Young
Consultant to Statistics Canada
Introduction
The demand for information
The importance of the contribution of science and technology to improving human health is widely
accepted.
Science, technology and human health
Half of all the gains in human life expectancy of the past several thousand years have occurred in this
century. Some of these gains have resulted directly from the improvements in economic and educational
standards that have recently transformed the material lives of most - but far from all of the world’s
population. Improvements in income and education account, however, for only part of this century’s
remarkable improvements in health. At the turn of the century the people of a country with an income level
of USD 5 000 per capita (in purchasing power adjusted for inflation) would have had a life expectancy of
under 50 years; today the number is close to 75. Why this enormous difference after controlling for
income? Important as income and education undoubtedly are, another factor - advance in scientific
knowledge and its application both in creating powerful interventions and in guiding behaviour - has,
perhaps, become more important.
Source: WHO (1996), Investing in Health Research and Development.
The advance in scientific knowledge mentioned above results from R&D activities. To date, there is
not an established set of internationally comparable health-related R&D data, which can be used to
describe and understand this phenomenon and to aid policy makers in priority setting. This first part of the
book reviews the existing international sources and ongoing plans in order to identify what information on
R&D is already available or in the pipeline and examines the main problems of international comparability
with illustrations for selected countries.
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It reviews three frameworks and sources of data on spending on health-related R&D:1
• Science and technology policy, indicators and underlying survey.
• Health policy, indicators and underlying survey.
• Special studies of health research.
In the first two cases the most that can be expected is to get a general picture of the level and structure
of health-related R&D within the statistical framework concerned. In the third case a greater attempt may
be made to obtain full coverage and to use specific classifications.
A framework for international comparisons
Since the review is of existing national and international surveys and sources one cannot begin with
firm definitions of health R&D and its main components. What are needed are gauges for measuring the
coverage and comparability of the data available.
The National Health Science and Innovation System
First it is useful to start with an overall view of the way health R&D is organised. Each country may
be said to have a National Health Science and Innovation System (NHSIS), i.e. the set of institutions, teams
and individuals who, jointly and individually, create, store and transfer the knowledge, skills and artefacts
which define new and improved health products and interventions and more efficient ways of delivering
them.2 This system operates at two levels, the distinct institutions and major programmes and below them a
complex network of topics, teams and projects which are the actual “elements in a collective system of
creation, transfer, and use”3 of health related knowledge.
The same “core” types of institutions (medical research councils4, medical faculties, hospitals,
pharmaceutical companies, health-related charities etc.) exist in most countries. However, the way they are
organised and their relative importance varies from country to country. Furthermore there are other
institutions which fund or perform some health R&D although this is not their main activity. These
“peripheral health R&D institutions” may be mainly involved in healthcare and do (or are expected to do)
relatively little R&D (non-university hospitals). They may do some health related R&D in connection with
their main activity (health and safety at nuclear establishments, military medicine by the armed forces) or
do basic research which may have health applications (general research councils). R&D surveys may cover
only the core institutions, or also the peripheral ones. Some very detailed ones may reach “topics, teams
and projects”.

1. There are other international sources and frameworks. This paper does not examine data on biotechnology
R&D which is the topic of another Statistics Canada/OECD activity.
2. Based on Metcalfe (1995) as quoted in OECD (1999a) and Global Forum for Health Research (1999).
3. Smith (1996) as quoted in OECD (1999a).
4. Given recent changes “Health Research Councils” would be more appropriate. For example, since 1992 the
Australian Health Research Council, and in 2000 the Canadian Institutes of Health.
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Distinguishing between R&D and non-R&D activities
Different sources place the borders of health R&D at different points. The first boundary is between
R&D and other activities.
The definition of R&D for survey purposes dates back to the United States in the mid 1950’s. It has
changed little since5. The version used by OECD/Eurostat/UNESCO is as follows:
Research and experimental development comprise creative work undertaken on a systematic base in
order to increase the stock of knowledge, including knowledge about man, culture and society, and the use
of this knowledge to devise new applications
Virtually all the sources examined in this paper use this definition or something very like it as a point
of departure. R&D can be distinguished from other activities carried out in the Health Science and
Innovation System. These other activities include: education and training; other scientific and
technological activities, (scientific and technical information services; general purpose data-collection;
testing and standardisation; feasibility studies; patent and licence work; policy-related studies; routine
software development); other industrial activities leading to technological innovation and administration
and other supporting activities. In the case of health-related R&D it must also be distinguished from
regular medical care activities. Sources may attempt to distinguish R&D from all these activities, may
identify R&D only where it is an independent activity, or may cover both R&D proper and those related
S&T activities which are needed to build up the national capacity to undertake health-related R&D.
Distinguishing between health-related R&D and other R&D
In the widest sense we are interested in all R&D which is relevant to human health. Here there are no
generally accepted international definitions or guidelines on coverage. “There are few (if any) areas of
investigations which can “logically” be excluded from possible relevance to health – perhaps cosmology”
(Wilk, 1996). Coverage differs between sources, depending on the aims of the designers/users and also on
the type of survey approach adopted. The term “relevance” can be defined using different criteria and its
coverage can be extended along several axes.
• How far “back” up the chain the source concerned goes for long term research, which may have
health applications, notably in the field of biology.
• How far it includes R&D on the risk factors for ill-health (smoking, diet, social exclusion, etc.)
• How far it includes R&D on methods of managing and delivering new and improved health
products and interventions and the associated government policies.
Apparent and actual expenditure on health-related R&D
Given the lack of an agreed set of high quality health R&D data to underpin international
comparisons, those seeking for such data have to compile them from various international sources. In
doing so they are reduced to picking out the immediately available and obvious health-related R&D series
and treating them as proxies for the health R&D indicators they would really like to compare between
countries. This report examines whether these “apparent health R&D expenditure” series are, in fact,

5. This general definition first appeared in the second version of the Frascati Manual published in 1970.
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