National health accounts
- Total expenditure on health as a percentage of gross domestic product (GDP)
- General government expenditure on health as a percentage of total expenditure on health
- Private 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$)
- Per capita total expenditure on health (PPP int.$)
- Per capita government expenditure on health at average exchange rate (US$)
- Per capita total expenditure on health (PPP int.$)
- Per capita government expenditure on health (PPP int.$)
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 and agents to the distribution of funds between providers, and functions of health systems and benefits across geographical, demographic, socioeconomic and epidemiological dimensions.
Definition
The following are key indicators for which the data are available.
Level of total expenditure on health (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 the extent of social and private health insurance, the burden on households through out-of-pocket spending, and reliance on external resources in financing health care.
Associated terms
Total expenditure on health (THE) comprises the funds mobilized by the system, being the sum of General Government and Private Expenditure on Health.
General government expenditure (GGE) corresponds to the consolidated outlays of all levels of government: territorial authorities (Central/Federal Government, Provincial/Regional/State/District authorities, Municipal/ Local governments), social security institutions and extrabudgetary funds, including capital outlays. It is provided by the Central Bank/Ministry of Finance to the International Monetary Fund or by the United Nations Statistics Department.
Social security funds (SSHE) comprise the expenditure on health by social security institutions. Social security or national health insurance schemes are imposed and controlled by government units for the purpose of providing social benefits to members of the community as a whole or to particular segments of the community. They include direct outlays to medical care providers and to suppliers of medical goods as well as reimbursements to households and the supply of services in kind to the enrollees.
Rest of the world funds/external resources (ExtHE) are the sum of resources channelled towards health by all non-resident institutional units that enter into transactions with resident units or have other economic links with resident units, whether explicitly labelled for health or not, to be used to pay for health goods and services by financing agents in the government or private sectors. They include donations and loans, as both cash and in-kind resources.
Private expenditure on health (PvtHE) is the sum of outlays for health by private entities, such as commercial or mutual health insurance providers, non-profit institutions serving households, resident corporations and quasi-corporations not controlled by government with a health services delivery or financing, and direct household out-of-pocket payments.
Prepaid and risk-pooling plans (PrepaidHE) are the expenditure on health by private insurance institutions. Private insurance enrolment may be contractual or voluntary, and conditions and benefits or basket of benefits are agreed on a voluntary basis between the insurance agent and the beneficiaries. They are thus not controlled by government units for the purpose of providing social benefits to members.
Firm's expenditure on health is the outlay by private enterprises for medical care and health-enhancing benefits other than payment to social security or other prepaid schemes.
Non-profit institutions (nongovernmental organizations) serving mainly households (NGOs) are the outlays of those entities whose status does 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.
Out-of-pocket spending by private households (OOPs) is the direct outlay of households, including gratuities and payments in kind, made to health practitioners and suppliers of pharmaceuticals, therapeutic appliances and other goods and services, whose primary intent is to contribute to the restoration or to the enhancement of the health status of individuals or population groups. It includes household payments to public services, non-profit institutions and nongovernmental organizations. It includes non-reimbursable cost sharing, deductibles, co-payments and fee-for–service, but excludes payments made by companies that deliver medical and paramedical benefits, whether required by law or not, to their employees. It excludes payments for overseas treatment.
GDP (expenditure-based GDP) is total final expenditure at purchasers’ prices. It is provided by the United Nations Statistical Department, the International Monetary Fund or the World Bank.
General government expenditure on health (GGHE) is the sum of outlays for health maintenance, restoration or enhancement paid for in cash or supplied in kind by government entities, such as the Ministry of Health, other ministries, parastatal organizations or social security agencies (without double counting government transfers to social security and extrabudgetary funds). It includes transfer payments to households to offset medical care costs and extrabudgetary funds to finance health services and goods. The revenue base of these entities may comprise multiple sources, including external funds.
Exchange rate is the annual average or year-end number of units at which a currency is traded in the banking system.
International dollar rate is a common currency unit that takes into account differences in relative purchasing power annual average.
Total population is the de facto resident population and not the de jure population as supplied by the United Nations Population Division.
Data sources and methods of estimation
About 110 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. Ministries of health have responded to the draft updates sent for their input and comments.
The principal international references used are the International Monetary Fund (IMF), government financial 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.
For details on sources and methods see annex notes to The world health report or the NHA website (see below).
Disaggregation
By providers and functions: data are not available here but could be accessed from individual country NHA reports. Some data are also available on the NHA web site.
References
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The world health report 2006 – working together for health.
Geneva, World Health Organization, 2006
Database
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 expenditure for local government, nongovernmental organizations or insurance.