National health accounts

What are national health accounts (NHA)?

NHA is a tool designed to assist policy-makers in their efforts to understand their health systems and to improve health system performance.
NHA constitute a systematic, comprehensive and consistent monitoring of resource flows in a country’s health system for a given period and reflect the main functions of health care financing: resource mobilization & allocation, pooling and insurance, purchasing of care and the distribution of benefits.
They address a basic set 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?

Boundaries

National health expenditure encompasses all expenditures for activities whose primary purpose is to restore, improve and maintain health 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 the above, NHA have boundaries in terms of space and time.

NHA classifications

The classification schemes are designed to be compatible with those practiced internationally; most importantly, the System of national accounts (SNA), to make cross-national comparisons possible.
The International Classification for Health Accounts (ICHA) is a comprehensive system which classifies NHA into four dimensions: Financing sources (FS)-contributions by different actors; Financing agents (HF)-entities who manage health expenditures; Providers (HP)-entities that provide health care services and goods; and Functions (HC)-types of health care activities.
Beside these, classifications by resource cost (human resources, pharmaceuticals, investment etc.), beneficiary groups, such as : disease specific, socio-demographic, geopolitical are also becoming important.

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/matrices are presented; (FS x HF, HF x HP, HP x HC, HF x HC). The strength of the NHA methodology is that the construction of NHA tables in different classification methods give the same for total expenditures on health. By convention, NHA tables are called by column by row which reflect the flow of resources from the origin to the use.

New

News

System of Health Accounts 2011 (SHA 2011)

Key documents

This Guide is now available in Arabic, French and Spanish also and in draft form in Chinese and Russian .

Guide to producing Reproductive health subaccounts