Health Accounts Methods

The following table illustrates the available health accounting methods and some of their advantages and disadvantages. To access the relevant manuals and guidelines, please see the Standard Methods page.

Methodology (origin)

Implementing Countries

Data Requirements

Advantages

Operational Challenges

Executing Organization

United Nations SNA 1993 (Satellite Accounts) (1950s)

Argentina

Brazil

Canada

Chile

Costa Rica

EUROSTAT

France

Peru

Spain

Sri Lanka

United States

- Highly detailed data on uses of resources and production

- Intermediate production

- Input/output matrices

- Production for auto-consumption, including registry of costs and quantities

- Uniform values listed under categories of production of individual health units

- Mature, coherent, internally consistent statistical system

- Fully developed and detailed classification of sectors and activities

- Takes into account links between the health sector and the macroeconomy

- Permits international comparisons

- Allows to evaluate the efficiency of the health sector and measure its value added

- Allows to investigate the primary sources of the resources, such as taxes or the national treasury

- Permits the analysis of equity of the patterns of spending

- Lacks sectoral focus

- Rigid structure not adaptable to the manner used by public or private health entities to maintain records

- Satellite accounts are open to various interpretations, making comparisons between countries more difficult

- Production and resource use data available in many countries usually lack sufficient detail

- Decision-makers may have difficulty understanding data and results presented under categories of consumption, capital formation, and transfers

- Necessity to tightly link satellite accounts with the central framework of SNA limits the relevance of this methodology to the concerns of health sector managers

- Central Banks

- National statistical agencies

Sponsors:

- PAHO

National Health Expenditure Accounts of the USA (Administrative Accounts) (1960s)

United States

- Economic censuses

- Business taxation system

- Annual surveys of the American Hospital Association

- Pharmaceuticals sales data

- Demographic data

- Employer salaries and expenditures data

- Medicare and Medicaid national program data

- Permits the counting and integration of data produced by distinct public and private institutions

- Measures expenditures on health without considering the production or purchasing efficiency

- Uses terminology, classification, and format of reports produced by private health management organizations and providers of health services

- Possibility of double counting of economic and financial records

- Does not distinguish clearly between capital and recurrent expenditures

- Does not include research and development expenses of the pharmaceutical industry, or of the producers of medical equipment and supplies

- Ministry of Health

- Centre for Medicare and Medicaid Services (before 1999 the Health Care Financing Administration)

Sponsors:

- United States Congress

Harvard National Health Accounts (based on Administrative Accounts) (1980s)

Mexico

Colombia

El Salvador

Bolivia

Ecuador

Guatemala

Honduras

Peru

Dominican Republic

Nicaragua

(also Egypt, Jordan, Zambia, Philippines, Sri Lanka, India, Bangladesh, Japan, Hong Kong, Thailand, China, Poland,

Czech Republic)

- All types of expenditure data

- Executed government budget

- Employers´ records on social expenditures

- Households goods and services expenditure surveys

- Social expenditures of NGOs and their sources

- Expenditures of international and foreign aid organizations

- Records of insurance companies

- Records of health care providers

- Social, demographic, economic and health data of the beneficiaries of the health system

- Knowledge of the value of the purchase unit not required

- Value of the providers´ or insurers´ capital not required

- Describes the flow of funds in a system from funders to providers

- Flexible and adaptable to the needs of the Ministries of Health

- Data organized in a manner relevant to health sector managers

- Reflects national priorities

- Allows the inclusion of expenditures peripheral to the health system (education, environment, sanitation)

- Appropriate for multiple payer systems

- Broad disaggregation by sources of funding

- Broader definition of health includes al activities that promote, restore, or maintain health

- Requires a modest-sized team and 6-12 months to produce the first round of estimations

- Examines only expenditures, which does permit evaluation of the efficiency of the sector or its economic valorization

- Not standardized, reflecting mainly national concerns, making difficult international comparisons

- Lacks internal consistency

- Mixes production and financing perspectives

- Does not distinguish clearly between capital and recurrent expenditures

- Does not distinguish between intermediate and final consumption

- Comparability with SNA 1993 unknown, but significant differences exist in the treatment of certain expenditure categories

- Institutionalization as difficult as for the other methodologies

- Ministries of Health

- Technical teams not linked with the government

- Universities

- Central Banks

- National income offices

Sponsors:

- USAID (PHRplus)

- World Bank

- World Health Organization

- PAHO

- IDB

OECD System of Health Accounts (2000)

Argentina

All OECD countries

- Public administrative records

- Records of private insurance companies

- Records of service providers

- Specialized surveys of direct private payments, charity works, import and export of goods and services

- Compromise between the NHEA and the SNA 1993 methodology

- Seeks international comparability

- Recognizes only two categories of sources of funding: private and public

- Classification system mixes providers, functions, and line items in a single list

- Restricted to "activities of individuals or institutions through the application of medical, paramedic, or nursing knowledge and technology

- Ministries of Health

- National statistical agencies

- National planning agencies

Sponsors:

- IDB

- PAHO

Documents

Satellite Health Account Manual This manual was launched by PAHO in july 2005. It was written by international experts in National Accounts, Magda Ascues, Markela Castro S. and Carmen Reyes, with the support of Amparo Gordillo-Tobar of PAHO. Presently it is only available in Spanish.

SHA-Based National Health Accounts in Thirteen OECD Countries: A Comparative Analysis (other papers of the health series can be found here) 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 methodological documentation. The authors describe where further harmonization of national classifications with the SHA International Classification for Health Accounts should be pursued.

OECD's A System of Health Accounts Manual 1.25 MB, PDF This manual was developed at OECD and published in 2000, and is also available here. For description of the health accounts system it proposes, please see the OECD webpage.

SHA Guidelines: Practical Guidance for Implementing A System of Health Accounts in the EU (Working Draft 2003) 895 KB, PDF This manual was written by the UK Office for National Statistics and co-financed by EUROSTAT as part of the "Support Package for Applying the Manual of Health Accounts in the EU". For a practical application of the manual please see the Experimental UK Health Accounts webpage of the Office for National Statistics.

Cuentas de Salud y Cuentas Nacionales de Salud: Experiencias Regionales 558 KB, PDF This presentation, prepared by Rubén M. Suárez-Berenguela, the PAHO Regional Advisor on Health Economics and Financing, for the International Workshop on Health and Gender Accounts in Santiago de Chile, 2001, provides an overview of the various methodologies, how they arose, and which countries have utilized them.

National Health Accounts Training Manual 4.28 MB, PDF The manual - a toolkit containing lectures, PowerPoint presentations, interactive exercises, and supplemental readings - was produced in 2003 by the NHA team of USAID-funded PHRplus project and follows closely the methodology presented in the Guide to Producing National Health Accounts. Other PHRplus publications about NHA can be found here.

National Health Accounts in Developing Countries: Appropriate Methods and Recent Applications 425 KB, PDF This 1996 paper by Harvard's Peter Berman describes the Harvard National Health Accounts methodology and its application in developing countries.

Organizations

Introduction to the United Nations System of National Accounts 1993 (SNA 1993) The 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.

UN System of National Accounts CD-ROM The System of National Accounts (SNA) on CD-ROM can be purchased on this website. It is a complete electronic version of the System of National Accounts 1993 book publication, with a wealth of new electronic functions made possible by this new medium.

NHEA 2001 National Health Accounts: Definitions, Sources, and Methods Since 1964, the United States Department of Health and Human Services has published an annual series of statistics presenting total national health expenditures. The basic aim of these statistics, termed National Health Accounts (NHA), is to "identify all goods and services that can be characterized as relating to health care in the nation, and determine the amount of money used for the purchase of these goods and services".

International Health Systems Program Harvard’s IHSP has developed software for implementing the National Health Accounts methodology. It can be obtained by contacting them directly.

OECD System of Health Accounts (SHA)
The OECD tool for the preparation of health accounts.

PAHO Methodologies PAHO methodological documents on Health Expenditure Estimations made using the PAHO database. Includes calculations of public and private expenditures in health, as well as expenditures on social security.