National health acounts
- General government expenditure on health as a percentage of total expenditure on health
- General government expenditure on health as a percentage of total government expenditure
- External resources for health as a percentage of total expenditure on health
- Social security expenditure on health as a percentage of general government expenditure on health
- Out-of-pocket expenditure as a percentage of private expenditure on health
- Private prepaid plans as a percentage of private expenditure on health
- Per-capita total expenditure on health at average exchange rate (US$)
- Per-capita government expenditure on health at average exchange rate (US$)
- Per-capita government expenditure on health at international dollar rate
Rationale for use
Health financing is a critical component of health systems. National health accounts (NHA) provide a large set of indicators on the basis of expenditure information collected within a internationally recognized framework. NHA are a synthesis of the financing and spending flows recorded in the operation of a health system, from funding sources to the distribution of funds between providers, and functions of health systems and benefits across geographical, demographic, socioeconomic and epidemiological dimensions.
Definition
Key indicators for which the data are available:
Level of total health expenditure (THE) as a percentage of gross domestic product (GDP), and per-capita health expenditures in US dollars and in international dollars.
Distribution of public and private sectors in financing health and their main components, such as: extent of social and private health insurance; burden on households through out-of-pocket spending; and reliance on external resources in financing health care.
Associated terms
GDP is the value of all goods and services provided in a country by residents and non-residents. This corresponds to the total sum of expenditure (consumption and investment) of the private and government agents of the economy during the reference year.
General government expenditure (GGE) includes consolidated direct outlays and indirect outlays, such as subsidies and transfers, including capital, of all levels of government social security institutions, autonomous bodies, and other extrabudgetary funds.
Total expenditure on health ((THE) is the sum of general government health expenditure and private health expenditure in a given year, calculated in national currency units in current prices. It comprises the outlays earmarked for health maintenance, restoration or enhancement of the health status of the population, paid for in cash or in kind.
General government expenditure on health (GGHE) is the sum of outlays by government entities to purchase health-care services and goods. It comprises the outlays on health by all levels of government, social-security agencies, and direct expenditure by parastatals and public firms. Expenditures on health include final consumption, subsidies to producers, and transfers to households (chiefly reimbursements for medical and pharmaceutical bills). It includes both recurrent and investment expenditures (including capital transfers) made during the year. Besides domestic funds it also includes external resources (mainly as grants passing through the government or loans channelled through the national budget).
Social security expenditure on health (SSHE) includes outlays for purchases of health goods and services by schemes that are mandatory and controlled by government. Such social-security schemes that apply only to a selected group of the population, such as public sector employees only, are also included here.
External resources (ExtHE) includes all grants and loans for health goods and services, passing through governments or private entities, in cash or in kind.
Private health expenditure (PvtHE) is defined as the sum of expenditures on health by the following entities:
Prepaid plans and risk-pooling arrangements (prepaidHE): the outlays of private insurance schemes and private social insurance schemes (with no government control over payment rates and participating providers but with broad guidelines from government)
Firms’ expenditure on health: the outlays by private enterprises for medical care and health-enhancing benefits other than payment to social security or other pre-paid schemes.
Non-profit institutions serving mainly households (NGOs): outlays of those entities whose status do not permit them to be a source of financial gain for the units that establish, control or finance them. This includes funding from internal and external sources.
Household out-of-pocket spending (OOPs): the direct outlays of households, including gratuities and in-kind payments made to health practitioners and to suppliers of pharmaceuticals, therapeutic appliances and other goods and services. This includes household direct payments to public and private providers of health-care services, non-profit institutions, and non-reimbursable cost-sharing, such as deductibles, copayments and fees for services.
Exchange rate: the annual average or year-end number of units at which a currency is traded in the banking system
International dollars are derived by dividing local currency units by an estimate of their purchasing power parity (PPP) compared with US dollars, i.e. the measure that minimizes the consequences of differences in prices between countries.
Data sources and methods of estimation
About 100 countries have either produced full national health accounts or report expenditure on health to the Organisation for Economic Co-operation and Development (OECD). Standard accounting estimation and extrapolation techniques have been used to provide time series (1998–2004). Ministries of health have responded to the draft updates sent for their inputs and comments.
The principal international references used are the International Monetary Fund (IMF), government finance statistics and international financial statistics; OECD health data; and the United Nations national accounts statistics. National sources include: national health accounts reports, public expenditure reports, statistical yearbooks and other periodicals, budgetary documents, national accounts reports, central bank reports, nongovernmental organization reports, academic studies, reports and data provided by central statistical offices and ministries and statistical data on official web sites.
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The world health report 2006—working together for health
For details on sources and methods see annex notes to the World health report on the World Health Report website.
Disaggregation
By providers and functions: data are not available here but could be accessed from individual NHA reports of the countries.
References
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The world health report 2006—working together for health
WHO. The world health report 2006—working together for health. Geneva, World Health Organization, 2006.
Database
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National health accounts, World Health Organization
National health accounts, WHO
Comments
Data on estimated health expenditure are collected by triangulating information from several sources to ensure that the outlays constitute the bulk of the government/private expenditure on health. Some figures may be underestimated when it is not possible to obtain data on expenditures for local governments, nongovernmental organizations or insurance.