Frequently asked questions
Public facilities
Should ‘user charges’ at government facilities be included?
(See PG 10.15) User charges at government facilities definitely should be included in the accounts to the extent that they support and maintain health facilities or programmes. The question is which entity to credit as the financing agent. In many countries, user charges for health services delivered by publicly funded health facilities are retained by the facility concerned or considered part of that facility’s budget (for example, most cost recovery programmes implemented in Africa and in Latin America in the 1980s and 1990s). In other countries, the fees are returned to the central ministry and are included in that budget. Regardless of the arrangement, where the fees have been paid by consumers in return for delivery of services, the household is the appropriate financing agent (for the amount of the fees). Expenditures by government as a financing agent should be net of those fees.
For example, suppose that the ministry of health operates a hospital at a cost of 2500, and that the hospital collects 150 in user charges from households. In the accounts, households would be the financing agent for 150 and the ministry of health would be the financing agent for 2350, for a total of 2500. If user fees are returned to the ministry of health, the ministry’s books will show a figure of 2500; it is essential that the user charges not be included in the ministry’s outlays in order to avoid double counting those expenditures. However, if the fees are retained as additional resources by providers, i.e. they supplement ministry of health spending, the ministry’s books will show a figure of 2350 and the user charges do not need to be subtracted from the ministry total.
Where should I include user fees paid to public facilities?
What people pay at public facilities is part of household activity as a financing agent. Therefore, these copayments appear in the NHA as FS.2.2xHF2.3, not as FS.2.2xHF.1.1 or FS.2.2xHF.1.2 (see PG pages 36 and 42 and paragraph 10.15).
User charges at government facilities definitely should be included in the accounts to the extent that they support and maintain health facilities or programmes. The question is which entity to credit as the financing agent. In many countries, user charges for health services delivered by publicly funded health facilities are retained by the facility concerned or considered part of that facility's budget (for example, most cost recovery programmes implemented in Africa and in Latin America in the 1980s and 1990s). In other countries, the fees are returned to the central ministry and are included in that budget. Regardless of the arrangement, where the fees have been paid by consumers in return for delivery of services, the household is the appropriate financing agent (for the amount of the fees). Expenditures by government as a financing agent should be net of those fees. For example, suppose that the ministry of health operates a hospital at a cost of 2500, and that the hospital collects 150 in user charges from households. In the accounts, households would be the financing agent for 150 and the ministry of health would be the financing agent for 2350, for a total of 2500. If user fees are returned to the ministry of health, the ministry's books will show a figure of 2500; it is essential that the user charges not be included in the ministry's outlays in order to avoid double counting those expenditures. However, if the fees are retained as additional resources by providers, i.e. they supplement ministry of health spending, the ministry's books will show a figure of 2350 and the user charges do not need to be subtracted from the ministry total.