The creation of Health Accounts (HA) implies
estimation of the following standard national accounts indicators
for health-related activities:
- Expenditures
and financing
- Production of goods and services
- Consumption or utilization of goods and
services
The national health accounting framework should be...
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Comprehensive –
covers the
whole health system and all the entities that act in it or benefit from
it
Consistent –
employs the same
definitions, concepts, and principles for each
entity and each transaction measured
Comparable across time and
space – allows evaluation of changes in economic indicators of a health
system over the years and of across geographical regions
Compatible – with other
national
aggregate economic measurement systems
Timely, accurate, and sensitive
– provides reliable information at the appropriate level of detail when policy-makers need
it
Transparent
and replicable –
allows users to assess the
validity of measurements to update and extend the estimates
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In an ideal situation, HA should form part of a
comprehensive health information system, in this manner permitting
the evaluation of expenditure, financing, and production in context
of health outcomes of the population obtained with these
investments. Today, however, few countries can boast adequately
comprehensive and integrated health sector information systems.
If
you have questions about how to develop HA in your country, please write
to our experts or contact one of the professionals belonging to our Network.
Steps
to create health accounts
Determine funding requirements and obtain resources
National governments—typically
policy units within the Ministry of Health, Planning, or Finance—devote staff time
and materials to estimate the economic value of health-related
activities, and usually begin with estimates of health expenditures
only. In some cases institutions such as Central Banks and
Statistical Offices are also involved.
Often health accounts estimation exercises are sponsored through externally-financed projects and programs.
Over the past 10 years PAHO, IADB, USAID/PHRplus, and the World Bank have all financed health accounts exercises in Latin
American and Caribbean countries in
collaboration with national governments.
The cost of preparing health accounts
varies depending on the quantity and quality of data sources, and on the number of
staff involved. Availability of accurate and recent estimates of private spending from existing
household surveys is the
most important determinant of the cost.
If quality information on household spending can be obtained, a typical first-time health expenditure
exercise in the Latin America and Caribbean region can be completed
for under US$100,000. If a household survey
has to be conducted, costs can rise beyond US$2 million.
Assemble a team to collect and
analyze information
Health accounts are
usually conducted by a multi-sectoral and multi-disciplinary team that
includes accountants, economists, public health specialists, and
policymakers. While inter-institutional coordination may
present a challenge, the involvement of
several institutions renders
health accounts results more accurate.
It may be useful for the team members to
participate in training activities and workshops before and during
the process of generating health accounts estimates. PAHO,
IDB, USAID, and World Bank have in the past sponsored
capacity-building workshops on health accounts. For announcements
about future training events go to the Events
section.
Select appropriate health accounts methods
Choosing a
standard method (such as the United Nations SNA 1993 satellite
accounts) or a non-standard method (such as the Harvard/NHA
approach) for collecting, classifying, and tabulating data, depends on the scope of the
estimates to be conducted, as well as on the specific policy
application for these estimates.
Subsequent documenting of local
adaptations to the method, whether dictated by data availability or by the particularities
of a given health system, is
essential in order to compare the results with national
macroeconomic indicators or with financial health indicators of other
countries.
Links to documents and
websites containing information about standard and non-standard
approaches can be found on the Standard
Methods page in this section. A table on the Health
Accounts Methods page illustrates the advantages and
disadvantages of the various approaches.
Communicate results to
users
In order to make health accounts results
useful, they must be presented to the policy-makers, other users,
and the public in a manner relevant to their needs and easily
related to the decisions they make. Results can be
communicated by highlighting key indicators and using graphs to
convey quantitative information.
PARIS21
website provides some useful advice on how to foster effective dialogue
between those who produce development statistics and those who use
them. The OECD A System of Health Accounts manual and the Producers’
Guide for Low- and Middle-Income Countries (see Standard
Methods page) provide ways to assemble,
organize, and present health accounts estimates.
Institutionalize health accounts
To date, 36 of the 46 Latin America and Caribbean countries have conducted health accounts
estimations at least once. None however have incorporated
them into the
routine “business” of the health, statistics or finance
departments.
Efforts are under way to identify the ways in which health
accounts can be institutionalized as a basic function of the state,
and thereby provide ongoing monitoring of the impact of reforms and specific
policies on health expenditures, financing and health services
production. Helping countries
to institutionalize health accounts activities is the main objective of the
IDB-PAHO-WB-USAID partnership.
