Choosing the Methodology

Español

Acronyms

Glossary

Home

About This Website

What Are Health Accounts?

Key Topics

Estimation Methods
Data

Creating Health Accounts

Obtaining Funding
Identifying Country Team
Choosing the

Methodology
Identifying Data Sources
Disseminating Results
Sustaining Health Accounts

Events and Research

Events

Research Findings

Using Health Accounts

For Policy-Making

To Assess Equity

To Assess Efficiency

To Understand Patterns of Spending

Select a Country

Library

Links

Q&A

LAC HA Newsletter

Professionals Network

Contact Us

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):*

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

Economic-financial planning for the Health Sector
Fiscal issues: financial viability/sustainability
Distributive impact of public spending
Financial management of resources

The 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.

The following table presents methodological 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.

*adapted from presentation by R. Suárez, the Regional Advisor on Health Economics and Financing, PAHO.

Standard Approaches
Approach	Main Features	Documentation and Manuals
United Nations System of National Accounts (SNA 1993): PAHO's SNA National Health Expenditures Accounts WHO's NHA Approach BEA-US NIPA Approach 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)	National Accounts: A Practical Introduction (the PDF file, an XLS work sheet, and an example are available) Introduction to the United Nations System of National Accounts 1993 (SNA 1993) Satellite Analysis and Accounts of the SNA 1993 United Nations Statistics Newsletter (published in five languages, subscription available here) Bureau of Economic Analysis: National Accounts Methodologies
Government Finance Statistics Manual (GFSM 2001)	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.	The complete Government Finance Statistics Manual (GFSM 2001)
International Family of Economic and Social Classifications	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.	International Family of Economic and Social Classifications
Non-Standard Approaches
Approach	Main Features	Documentation and Manuals
Administrative: USA HCFA/CMS National Health Expenditure Accounts (NHEA)/National Health Accounts (NHAª) Country studies	Developed in the USA, this approach is based on business administrative definitions, concepts, classification and procedures used in business accounting.	NHEA 2001 National Health Accounts: Definitions, Sources, and Methods System of National and State Health Accounts of Mexico
OECD - A System of Health Accounts: System of Health Accounts (OECD-SHA) OECD International Classification for Health Accounts (Functions, Providers, Financing) OECD Health Data	The OECD system of health accounts (OECD-SHA) system 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.	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 2004
USAID/World Bank/WHO/PHRplus/Harvard- NHA: National Health Accounts for Developing Countries (NHA) Guide to Producing National Health Accounts	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.	National Health Accounts, also known as the "Harvard Method" Guide to Producing National Health Accounts with Special Applications for Low-Income and Middle-Income Countries

BEA: Bureau of Economic Analysis of the US Department of Commerce.

Harvard: School of Public Health, Harvard University.

HCFA/CMS: The Health Care Financing Administration (HCFA) is 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 System of National Accounts satellite 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 level, composition according to economic and/or functional classifications, and matrices of flows of funds and matrices of sources of funding or financing.

OECD: Organization for Economic Cooperation and Development, based in Paris, France.

PHRplus: The Partners for Health Reformplus (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 Associattes Inc. based in Maryland, USA.

USAID: United States Agency for International Development

WB: The World Bank

WHO: World Health Organization, based in Geneva, Switzerland

Documents
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 1.2 MB, PDF	This manual was developed at OECD and published in 2000. 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".
OECD System of Health Accounts (SHA)	The OECD tool for the preparation of health accounts. The final version is available here (1.25 MB, PDF).
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.