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National Health Accounts

How can national health accounts and reports be used and what sort of data can you gain from them?
PETER ANNEAR: We’re going to talk here about national health accounts. So making decisions about health care and health care financing requires access to sufficient, good quality data. And here we will look at one of the main sources of data for health care financing– that is the national health accounts. Not every country has national health accounts. The NHA process is often quite complex and it’s sometimes quite difficult and itself– it relies on access to good quality, routine data about the many different forms of health care spending. But where the information is available, NHAs can answer a number of important questions, especially how much is spent, where do the funds come from, and where are they used?
There are two concepts to grasp here. One is the system of health accounts, which, in fact, is the international template for defining the standard health financing or health expenditure categories. The national health accounts are what countries themselves produce based on the system of health accounts– that is based on the same classifications. The system of health accounts provides a template for a set of interlinked accounts covering all aspects– that is the general and very detailed aspects of health care expenditure. They do this by function, by service provider, and by funding source. You’ll see that the tables appear as a two dimensional spreadsheet with function, provider, and source on the vertical axis, and health services of different types on the horizontal axis.
This is an example of one of the many tables from the system of health accounts– listing classifications you might like to look at more closely when you have the time. Total health expenditure, which we derive from the national health accounts, is simply the sum of all the money spent nationally from every source of revenue on health services– services being promotive, preventive, curative, and rehabilitative right across the care spectrum. So remember this when you look at the NHAs, which are often complex and quite often not very clearly presented– remember this as a guiding principle in making judgments about health care financing– with the information provided by national health accounts, we can then map and illustrate the national health financing situation.
Here, using NHA data, we can illustrate the main sources of financing for health care across many different countries. Here, again, the pattern of increasing government participation and at the same time falling out-of-pocket costs is well illustrated. You can see as government spending rises out-of-pocket will fall. It’s a useful formula to keep in mind. The NHA tables can, therefore, be used to produce a set of reproductive health accounts, which are illustrated here in this example from WHO. You can access health financing data in different places. Generally, access to national data is essential– not so easy to retrieve. You can also retrieve summary data and with varying degrees of reliability– we must say from the WHO and the World Bank website databases.
I hope then that this has been a useful introduction to national health accounts and data for health financing. Reproducing the NHA is a time consuming task, but it can provide valuable national information.

It’s helpful to look at real-life examples of national health accounts and reports to understand how they can be used. A good starting place is A System of Health Accounts which lays out a standard used in OECD countries. As an example of the way in which the SHA are presented, take a look at ‘Table 1. Current expenditure on health by function of care, provider and source of funding’ on page 26, which categorises current health expenditure by function of care, provider and source of funding according to the ICHA classifications.

In general, the SHA tables appear as two-dimensional spreadsheets with function, provider, and source on the horizontal axis, and health services of different types on the vertical axis.

The WHO guide to producing national health accounts also has some good examples and guidelines, if you want to explore this further.

The NHA detail the flow of funds from the sources of financing, through the agents that allocate the funding, to the many different providers who deliver health care to the population. National Health Accounts can also be produced also for different sectors within the health system. Like the general NHA, NHA sub-analysis for reproductive health (for example) captures and organises information on health expenditures in the standard table format, from financing sources to end uses, but does so only for reproductive health.

To see an illustration of this process, have a look at the USAID and PHR Plus case study.

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