Health systems across the globe are continuing to evolve in response to a multitude of factors, including improvements in medical technology and knowledge, increased information about health and health services and greater access to it, changes in health policy priorities to meet shifting disease and demographic patterns, new organisational methods and more complex financing mechanisms. Health accounts also need to adapt to deal with these developments and to anticipate foreseeable future trends.

A System of Health Accounts 2011 reflects a desire to make health accounts more adaptable to rapidly evolving health systems around the world by further enhancing the cross-country comparability of health expenditure and financing data and thereby increasing the information base for its analytical use. Moreover, it is hoped that the new version of the SHA will make it more useful as a tool in the assessment and monitoring of health systems and in the analysis of the importance of health expenditures from a consumption perspective in the economy as a whole.

This chapter presents an overview of the main accounting concepts and aggregates used throughout the Manual. While each aggregate is considered in further detail in the following chapters, here the focus is on the relationship between the consumption of health care goods and services and all the other possible uses of health care goods and services in the economy. The range of possible uses includes intermediate consumption (or factors of provision), analysed in Chapter 9, capital formation, presented in Chapter 11, and exports, examined in Chapter 12 together with imports. This chapter examines the central concept of consumption, considering the distinction between final consumption expenditure and actual final consumption and discusses the role of capital transfers. Various issues concerning the valuation of market and non-market transactions are also explored.

Achieving consensus on a common boundary of health care activities is crucial for the complex task of international comparisons. In pursuing this objective, SHA refers to a functional approach based on selected health care activities that can be captured by transactions. Transactions are valued activities that take place between different actors or organisations. The transactions recorded in the SHA accounting framework relate to health care goods and services provided and consumed to improve the health status of individuals and of the population as a whole.

Within the health accounting framework, the underlying principle may be formulated as “what is consumed has been provided and financed”. Clearly, there is no one-to-one relationship between health care functions and the provision and financing categories. The same type of health care goods and services can be consumed from different types of providers and at the same time purchased using various types of financing schemes. But to achieve the tri-axial perspective (consumption-provisionfinancing), the starting point is to measure consumption (see Chapter 4), which in a health functional approach describes the direct consumption by the population according to the type of health purpose. The boundaries of health care are set based on this consumption purpose. It is therefore important to have a clear understanding of what consumption with a health purpose is, and which are the relevant categories to be identified.

Health care providers encompass organisations and actors that deliver health care goods and services as their primary activity, as well as those for which health care provision is only one among a number of activities. They vary in their legal, accounting, organisational and operating structures. However, despite the huge differences that exist in the way health care provision is organised, there is a set of common approaches and technologies that all health care systems share and that helps to structure them. The classification of health care providers (ICHA-HP) therefore serves the purpose of classifying all organisations that contribute to the provision of health care goods and services, by arranging country-specific provider units into common, internationally applicable categories.

This chapter presents a summary of the conceptual accounting framework for health financing and of one of its main components, the new classification of health care financing schemes (ICHA-HF). This summary also serves as an introduction to Chapter 8, in which the classification of revenue of financing schemes (ICHA-FS) is presented. Furthermore, in SHA 2011 the accounting framework for health care financing also encompasses the concept of institutional units of health financing and the related classification of financing agents (ICHA-FA) as a tool for a more detailed national analysis (see Annex D). The three classifications together provide the tools to account comprehensively for health care financing and describe the flow of financial resources in the health system. This introduction therefore provides a brief definition of all the key concepts and highlights their relationships. The relevance of the particular classifications and cross-tabulations may vary for countries that differ in the organisational structure and level of resources of their health care systems, as well as in their level of economic development and their dependency on foreign resources.