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What are national health accounts?
National health accounts (NHA) constitute a systematic, comprehensive, and consistent monitoring of resource flows in a country’s health system for a given period. They are designed to capture the full range of information contained in these resource flows and to reflect the main functions of health care financing: resource mobilization and allocation, pooling and insurance, purchasing of care, and the distribution of benefits. NHA address some basic sets of questions:
- Where do the resources come from?
- Where do the resources go?
- What kinds of services and goods do they purchase?
- Who provides what services?
- What inputs are used for providing services?
- Whom do they benefit?
National health accounts is a tool designed specifically to assist policy-makers in their efforts to understand their health systems and to improve health system performance.
Boundaries
For the purposes of NHA, the boundary is set as follows: national health expenditure encompasses all expenditures for activities whose primary purpose is to restore, improve and maintain health for the nation and for individuals during a defined period of time. This definition applies regardless of the type of the institution or entity providing or paying for the health activity.
In addition to a boundary stated in terms of the types of activities considered, NHA have boundaries in terms of space and time.
NHA classifications
The classification schemes are at the heart of the NHA methodology and group transactions that share common characteristics.
To make cross-national comparisons of health expenditure possible, it is recommended to use international classification schemes. The International Classification for Health Accounts (ICHA) is a comprehensive classification system in four important NHA dimensions: financing sources (which track contributions by different actors), financing agents (entities who manage health expenditures), providers (entities that provide health care services and goods), and functions (types of health care activities performed by health system).
Besides these, other classification becoming important are resource cost (health spending by inputs such as human resources, pharmaceuticals, investment etc.), classification by beneficiaries groups, such as : disease specific, socio-demographic, geopolitical.
Classification schemes were designed to be compatible with a number of existing classification schemes and practices in international economic statistics–most importantly, with the system of national accounts.
(SNA)
NHA matrices
The classifications constitute the main families that can be used to cross-tabulate spending along two dimensions, the procedure by which health accounting tables or matrices are formed or presented. (Financing sources by Financing Agents, Financing Agents by Providers, Providers by Functions, Financing Agents by Functions ).
NHA tables are matrices that array expenditure on health following the flow of funds between two dimensions (for example, financing sources by financing agents). The strength of the NHA methodology is that the construction of NHA tables that triangulates data from different sources and at different classification levels and gives the same common total for total expenditures on health.
In a departure from the mathematical convention that matrices are called by their row and column, NHA tables are called by column and row: this convention reflects the flow of resources from the origin to the use.
Producing NHA
The production of National Health Accounts is a
process
of collecting the data, organizing the data, analyzing the results for health policy, and disseminating the information to the stakeholders.
A System of Health Accounts – manual available in English, French, and Spanish. OECD, 2000.
Understanding National Health Accounts: The Methodology and Implementation Process_[pdf, 546kb]. PHRplus, 2003.
National Health Accounts: Concepts, Data Sources and Methodology_[pdf, 687kb]. WHO, 2002.
National Health Accounts: Where are we today?_[pdf, 5489kb]. SIDA, 2001.
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