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Health Accounts Methods
The following table illustrates
some of the advantages and disadvantages of the available standard
and non-standard health accounts methods:
|
Methodology
(origin)
|
Implementing
Countries
|
Data
Requirements
|
Advantages
|
Operational
Challenges
|
Executing
Organization
|
| United Nations SNA 1993 (Satellite Accounts) (1950s) |
Argentina
Brazil
Canada
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)
|
|
- 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
|
| OECD System of Health Accounts
(2000) |
Argentina
All OECD countries |
|
- 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 |
For more information and documents about the different
methodologies, please visit the Standard
Methods page.
|
|
|
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 detailed methodological
documentation. The authors describe where further
harmonization of national classifications with the SHA
International Classification for Health Accounts should be
pursued.
|
|
SHA
Guidelines: Practical Guidance for Implementing A System of
Health Accounts in the EU (Working Draft 2003)
|
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,
21 KB, PDF |
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). |
|
Expenditure on Health and Their Financing in OECD Health Data 2002
203 KB, PDF
|
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.
|
| Health
Accounts and National Health Accounts in the Americas
180 KB, PDF
|
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
|
| Health
Accounts Approaches 28 KB, PDF |
A PDF file for download from the PAHO website,
summarizing the Health Accounts Approaches table presented
above
|
| The State of
Implementation of the OECD Manual: A System of Health Accounts
(SHA) in OECD Member Countries, 2001
31 KB, PDF
|
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.
|
|
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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