Using Health Accounts...To Assess Efficiency

Health accounts permit to estimate indicators for public expenditure on health services, whether community-level public health interventions or specialized hospital care.  With this type of information, policy makers and researchers can evaluate if the system is "purchasing" the appropriate combination of services to achieve its sanitary and management objectives (allocative efficiency).  

On the other hand, out-of-pocket expenditure indicators calculated using health accounts estimates allow to evaluate if these resources might be channeled more efficiently via health insurance plans.

Health accounts, when estimated using international standards, classifications, and definitions, also permit making international comparisons of expenditure in health.  Through them, countries can learn from experiences and experiments of others, and can avoid repeating common mistakes.  For example, international comparisons allow to ask if the sector expenditure would increase or lower according to:

  • The public-private composition of the sector
  • Payment mechanisms: fee-for-service or salary
  • The use of primary care physicians as gatekeepers of the system
  • The number of doctors or nurses
  • The proportion of ensured in the population
  • The use of technology-intensive procedures
  • The level of public production of health services
  • The proportion of hospital-to-ambulatory health services

Related Links and Articles

Documents
Financiamento público e privado em saúde na América Latina e Caribe: uma breve análise dos anos noventa PDF The objective of this 2005 article, written by Andre C. Medici of the IDB, is to evaluate the financing of the public and private forms of organizing the Latin American and Caribbean health sector, and its behavior in the 1990s. It is available in Portuguese.
Child Mortality and Public Spending on Health: How Much Does Money Matter? 114 KB, PDF The authors use cross-national data to examine the impact of both non-health factors (economic, educational, cultural) and public spending, on health in determining child (under 5) and infant mortality.
Cost Analysis and Efficiency Indicators for Health Care: Report No. 4 100 KB, PDF Summary output for 19 primary health care facilities in Alexandria, Bani Suef, and Suez, Egypt, in 1993 and 1994
Cost Effectiveness of HIV Prevention in Developing Countries 75 KB, PDF This document posits that HIV prevention interventions in developing countries can reduce the incidence of HIV infection and save financial resources in the process.
Cost-Effectiveness and Health Sector Reform Website This Working Paper by World Bank's Philip Musgrove, originally prepared for the Seminar on Health Sector Reform in Latin America (Buenos Aires, Argentina, March 14-16 1994), clarifies efficiency concepts used in the World Health Report 1993.
Health and Labor Productivity: Economic Impact of Onchocercal Skin Disease (OSD) 31 KB, PDF This paper examines the economic impact of health status on productivity and income in general, and, more specifically, the existence and magnitude of the adverse economic impact of onchocercal skin disease (OSD) on the labor force at a coffee plantation in southwest Ethiopia.
Selecting an Essential Package of Health Services Using Cost Effectiveness Analysis: A Manual for Professionals in Developing Countries 690 KB PDF This manual provides practical guidelines for estimating the burden of disease at national or regional level, and for calculating the cost-effectiveness of alternative packages of health interventions.
Workshop on Using Cost-Effectiveness Analysis to Identify a Package of Priority Health Interventions 1994 56 KB, PDF This USAID-sponsored workshop introduces the methodology of cost-effectiveness analysis and its use in health planning to Egyptian health officials at the central and governorate levels.
Workshop on Using Cost-Effectiveness Analysis to Identify a Package of Priority Health Interventions 1995 67 KB, PDF In this six-day workshop organized by the Directorate of Planning of the Ministry of Health and Harvard University, with the support of USAID, teams from the governorates of Beni Suef, Alexandria, and Suez in Egypt presented preliminary data from costing studies at a dozen health facilities and four hospitals.
The Value of Preventing Malaria in Tembien, Ethiopia 183 KB, PDF This study conducted by PHRplus, measures the monetary value households place on preventing malaria in Tigray, Ethiopia.
Public Spending in a Market Context: The Efficiency Issue Public Expenditure Analysis by the World Bank presents an overview of efficiency and market failure issues.
Financing Reproductive and Family Planning Services 432 KB, PDF This 2000 study assesses the financing of Family Planning and Reproductive Health (FP/RH) services in Egypt and Sri Lanka, two countries with similar levels of income and public health spending, but very different FP/RH outcomes and levels of access to FP/RH services. Other publications and links on Planning and Finance are available from the Policy Project.
Valuing Mortality Reductions in India: A Study of Compensating Wage Differentials 69 KB, PDF This paper looks at the issue of Values of a Statistical Life (VSL) by conducting a compensation wage study in India to obtain estimates of the VSL that reflect Indian risk preferences.
Organizations
The Policy Project The POLICY Project works with host-country governments and civil society groups to achieve a more supportive policy environment for family planning/reproductive health, HIV/AIDS, and maternal health.
Partners IADB logo IADB PAHO logo PAHO USAID logo USAID World Bank logo World Bank

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