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Standard Methods
Standard methodological approaches are those based on existing internationally
agreed-upon concepts, definitions, classifications and accounting
procedures. They were developed by the United Nations
Statistical Commission over the last 60 years and through an extensive
process of consultations and consensus-building.
The advantages of using standard methods such as the SNA
1993, include:
- Uniform definitions for the boundaries of the
health sector
- Standard classifications of inputs and services
- Valid comparisons across countries and over
time
Most importantly, application of standard methods
allows direct comparison of health system financial indicators with
macroeconomic indicators used by the Ministries of Finance and Central
Banks.
Standard
national accounts have the following structure (the potential applications
for analysis are listed in brackets):
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I. Production accounts*
- Income generation (employment,
productivity, value added)
- Economic impact (direct and
indirect, of health service production activities)
II. Intermediate and final utilization
accounts
- Welfare (optimization,
efficiency, collective/public goods, consumption of private
goods and services)
- Consumption vs. investment
- Human resources formation
(national accounts of human resources)
- Final consumption (inequalities
and inequities in the final consumption of health goods and
services)
III. Expenditure and financing
accounts
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Non-Standard Methods
The main disadvantage of the standard methods is their relative
rigidity. For this reason, non-standard approaches were developed
that are based on extensions and
modifications of the standard concepts and classifications, and/or
on newly proposed sets of concepts, classifications, and accounting
procedures. These permit greater flexibility in terms of data
sources, health sector boundaries, and classifications, and for this
reason allow more timely reporting of results and tend to present data
in a manner more relevant to the needs of decision makers in the
health sector.
The following
table presents the approaches used in health
accounts estimations classified into four general categories, and provides links to
key documents about them. For a brief analysis of advantages and weaknesses of each of the approaches,
please visit the Health
Accounts Methods page.
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Standard Approaches |
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Approach |
Main Features |
Documentation and Manuals |
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PAHO's SNA National Health Expenditures
Accounts
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-
Health Sector Satellite
Accounts
UN Social Accounting Matrices
& Extensions |
The United Nations System
of National Accounts (SNA) consists of a coherent, consistent, and
integrated set of macroeconomic accounts, balance sheets and tables
based on a set of internationally agreed concepts, definitions,
classifications and accounting rules. It provides a comprehensive
accounting framework, within which economic data can be compiled and
presented in a format that is designed for purposes of economic
analysis, decision taking and policy-making. It also serves as a
point of reference in establishing standards for related statistics.
SNA 1993, the most recent
update of SNA, describes the SNA conceptual system applicable to
economies around the world. It does not attempt to provide guidance
on how to make estimates, on the priority with which different
accounts should be implemented, or on the frequency and format of
their presentation. Practical guidance can be found in the handbooks
of national accounting prepared by the United Nations Statistics
Division and other international agencies.
The other
approaches listed here are based on, or on the extensions of, the definitions, concepts,
classifications and accounting procedures of SNA 1993 and the UN
Family of Social and Economic Classifications (including the
estimation of NHEA and NHA indicators)
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Introduction to the United Nations System of National Accounts 1993
(SNA 1993)
National
Accounts: A Practical Introduction (the PDF
file, an XLS work sheet, and an example
are available)
PAHO's
Work
Bureau of Economic
Analysis: National Accounts Methodologies
Satellite Analysis
and Accounts of the SNA 1993
 Satellite
Health Account Manual (published by PAHO) [Spanish]
United Nations
Statistics Newsletter
(published in five languages, subscription available here)
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Government
Finance Statistics Manual (GFSM 2001) of the International
Monetary Fund
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The 2001 edition of
the GFS Manual, which updates the first edition published by
the International Monetary Fund (IMF) in 1986, describes an
integrated statistical system for government finances that is
harmonized, to the extent possible, with the 1993 SNA
described above. The Manual is a major advance in the
standards for compilation and presentation of fiscal
statistics and part of a worldwide trend toward greater
accountability and transparency in government finances,
operations, and oversight. It covers concepts, definitions,
classifications, and accounting rules, and it provides a
comprehensive analytic framework within which the statistics
can be summarized and presented in a form appropriate for
analysis, planning, and policy determination.
The use and
interpretation of government finance statistics, however, is
beyond the scope of the GFSM 2001, and practical guidance on
the compilation of the statistics is reserved for the GFSM
2001 companion
material. Government finance statistics are a key to
fiscal analysis, and they play a vital role both in developing
and monitoring sound financial programs and in conducting
surveillance of economic policies.
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The
complete Government Finance Statistics Manual (GFSM 2001) |
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International
Family of Economic and Social Classifications
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The international
family of economic and social classifications is comprised of
reference classifications that have been registered into the United
Nations Inventory of Classifications, reviewed and
approved as guidelines by the United Nations Statistical
Commission or other competent intergovernmental board on such
matters as economics, demographics, labor, health, education,
social welfare, geography, environment and tourism. It also
includes those classifications on similar subjects that are
registered into the Inventory and are derived or related to
the reference classifications and are primarily, but not
solely, used for regional or national purposes.
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International Family of
Economic and Social Classifications
Classifications
Newsletter
- No. 13, December 2003
2007
Revision of the Central Product Classification (CPC)
ECLAC
webpage on International Classifications [Spanish]
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Non-Standard Approaches |
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Approach |
Main Features |
Documentation and Manuals |
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USA
HCFA/CMS National Health Expenditure Accounts (NHEA)/National Health Accounts (NHAª)
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Country
studies
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Developed in the USA, this approach is based on business administrative definitions, concepts, classification and
procedures used in business accounting.
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NHEA
2001 National Health Accounts: Definitions, Sources, and Methods
System of National and State Health
Accounts of Mexico |
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OECD
- A System of Health Accounts:
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System of Health Accounts (OECD-SHA)
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OECD International Classification
for Health Accounts (Functions, Providers, Financing
agents)
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OECD Health Data
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The
OECD system
of health accounts (OECD-SHA) provides a standard
framework for producing internationally comparable accounts to
meet the needs of public and private sector health analysts
and policy-makers. The SHA manual establishes a conceptual
basis of statistical reporting rules that are compatible with
other economic and social statistics, and provides basic
concepts and definitions underlying the annual data collection
of OECD
Health Data, as well as standard tables for reporting
on health resource flows. This approach combines the economic and financial indicators from
administrative (NHEA) and national
accounts (SNA), and is defined as a quasi-satellite
accounts system.
The SHA Manual proposes a new and distinct classification system,
the International
Classification for Health Accounts (ICHA), which covers
three dimensions of health care: functions of care, health care
providers, and sources of funding. Although still in its pilot
stages, the standards of the system have been adopted as basis for
their accounts by many OECD and non-OECD countries.
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OECD
- A System of Health Accounts (SHA) Website The
OECD SHA Manual in Spanish
(for purchase) and English
(download)
OECD
ICHA - Health Care Functions
OECD ICHA - Health Care
Providers
OECD ICHA - Health Care
Financing
OECD
Health Data 2005
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The World Health
Organization, the World Bank, the United States Agency for
International Development, and other partners sponsored
publication of the "Guide to Producing National Health
Accounts with Special Applications for Low-Income and
Middle-Income Countries". This guide adapts the OECD-SHA and the
HCFA/CMS-NHEA/NHA
approaches described above, aiming to provide a resource for
teams of health accountants in pursuit of international
standards for measuring health expenditure.
The Guide is the
result of a consensus among experts on national health
accounting. However,, but the authors acknowledge that, as for
any new set of NHA procedures, it will give rise to questions
about the right way to account for specific expenditures.
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National Health
Accounts, also known as the "Harvard Method"
Producer's
Guide to
National Health
Accounts with Special Applications for Low-Income and
Middle-Income Countries
Instructor
Manual - Producer's Guide to NHA
Participant
Manual - Producer's Guide to NHA |
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HCFA/CMS: In
2001 the Health
Care Financing Administration (HCFA) was renamed the Centers for Medicare and
Medicaid Services (CMS).
ªNHA: The term NHA is used to refer to the
estimation of National Health Expenditure Accounts indicators, not to be
confused with the United Nations SNA national health accounts. The NHA expenditure indicators include:
estimates of intermediate and final consumption of health services
and pharmaceutical products; gross capital
formation, and exports and imports; gross value of production and the value
added of health care services industries; employment; they may include
indicators for the pharmaceutical industry.
NHEA: Indicators
include estimates of national health care expenditures, composition
according to economic and/or functional classifications, matrices of
flows of funds, and matrices of sources of funding or
financing.
PHRplus: The Partners for Health Reform
plus (PHRplus) project is
funded by the U.S. Agency for International Development, and is aimed to provide technical assistance and to help maintain
the worldwide leadership role of USAID in health care reform,
health policy, and health systems management. It is implemented by
the private for profit consulting firm Abt Associates Inc. based in
Maryland, USA.
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Documents |
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SHA-Based
National Health Accounts in Thirteen OECD Countries: A
Comparative Analysis (other
papers of the health series can be found here)
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An OECD Working Paper No. 16 by Eva
Orosz and David Morgan was published in August of 2004. It
analyses the financing and provision of the main types of
health services in 13 member countries (Australia, Canada,
Denmark, Germany, Hungary, Japan, Korea, Mexico, the
Netherlands, Poland, Spain, Switzerland and Turkey). Thirteen
technical papers present key results a on a country-by-country
basis, providing supporting detailed methodological
documentation. The authors describe where further
harmonization of national classifications with the SHA
International Classification for Health Accounts should be
pursued.
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SHA
Guidelines: Practical Guidance for Implementing A System of
Health Accounts in the EU (Working Draft 2003)
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This Working Draft document was
completed in 2003 by the UK Office of National Statistics as
part of work commissioned by EUROSTAT. Its purpose is to
provide practical guidance to European Union countries wishing
to implement the OECD manual A System of Health Accounts
(SHA), and it was written for those who are only beginning the
process as well as for those who seek clarification of certain
concepts. It is hoped that the information made
available to those wishing to compile Health Accounts will
reduce the resource requirements and increase sharing of best
practices. |
| El
Concepto de Cuenta Satélite y la Generación de Normas y
Orientaciones por los Organismos Internacionales |
This overview of satellite accounts
was written by Marcelo Ortúzar Ruiz, the Chief of National
Accounts, Statistics Division, ECLAC, for the October 2001 International
Workshop on Health and Gender Accounts. The workshop
was sponsored by PAHO and FONASA (Fundación Nacional de Salud,
Chile). [Spanish] |
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Expenditure on Health and Their Financing in OECD Health Data 2002
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This presentation and attached
annexes were prepared by M. Huber, E. Orosz, and U. J. Ploug
of the OECD Health Policy Unit, for the October 2002 Meeting
of Experts in National Health Accounts, of the Working Party
on Social Policy/Health Policy Statistics. It describes the
structure of health expenditure reporting, gaps in data
availability, and the state of harmonization across countries.
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| Health
Accounts and National Health Accounts in the Americas
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Executive summary brochure of PAHO's
work on health accounts in Latin America and the Caribbean,
published in July 2003 by the Health Economics Group of the
Health Systems and Policies Unit, housed in the Area of
Strategic Health Development
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| Health
Accounts Approaches |
A PDF file for download from the PAHO website,
summarizing the Health Accounts Approaches table presented
above
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| The State of
Implementation of the OECD Manual: A System of Health Accounts
(SHA) in OECD Member Countries, 2001
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This OECD paper, published in June
of 2001, provides an overview of the current state of
implementation of A System of Health Accounts pilot
methodology in OECD countries. In addition, it
summarizes the background of the OECD SHA manual and provides
an overview of the latest developments in international
cooperation in the area of health accounts.
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WHO Discussion
Paper No. 47: National Health Accounts: Concepts, Data
Sources, and Methodology 687
KB, PDF |
This paper was written by
Jean-Pierre Poullier, Patricia Hernandez, and Kei Kawabata of
the WHO in 2002. It defines health accounts and outlines
their purpose, basic principles, and provides examples of
selected uses. Finally, in addition to presenting a
methodological overview of national health accounting, the
paper lists data sources used to produce WHO estimates of
health expenditures and provides 1998 data tables for 191
countries.
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Organizations |
| Centers
for Medicare and Medicaid Services |
The Centres for
Medicare and Medicaid Services (CMS) is a United States
federal agency within the Department of Human and Health
Services, which develops Health Accounts of that country.
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| Economic
Commission for Latin America and the Caribbean - Statistical
Conference of the Americas (ECLAC-SCA) |
The
ECLAC-SCA first Progress Report on the Activities of the
Program of International Statistical Work for Latin America
and the Caribbean, June 2001-June 2003 can be found here
(50 KB, PDF).
The
Programme of International Statistical Work for Latin America
and the Caribbean, July 2003-June 2005, can be found here
(115 KB, PDF).
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| PAHO
Methodological Documents on the Estimation of Health
Expenditure for the NHEX Database |
A
list of methodological documents on Health Expenditure Estimations
based on PAHO's database. The database includes calculations of public
and private expenditures in health, as well as expenditures on
social security. [Spanish]
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| Partners
for Health Reformplus (PHRplus)
PHRplus
National Health Accounts |
The PHRplus
is a flagship project of the USAID
for in the area of strengthening health policies and systems.
Through this project, USAID provides technical assistance and
maintains its leadership role in the areas of health reform,
health policies, management, health financing, and system
strengthening. PHRplus is implemented by Abt
Associates Inc., a private for-profit company.
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| World
Health Organization - National Health Accounts |
The WHO webpage on
National Health Accounts provides information on health
expenditure, contact information in the countries, key
documents and publications on the topic. In addition it
facilitates contacts with health accounts experts.
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