A System of Health Accounts

A System of Health Accounts

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Auteur(s):
OCDE, OMS, Eurostat
Date de publication :
10 oct 2011
Pages :
522
ISBN :
9789264116016 (PDF) ; 9789264116009 (imprimé)
DOI :
10.1787/9789264116016-en

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A System of Health Accounts 2011 provides a systematic description of the financial flows related to the consumption of health care goods and services. As demands for information increase and more countries implement and institutionalise health accounts according to the system, the data produced are expected to be more comparable, more detailed and more policy relevant.

This new edition builds on the original OECD Manual, published in 2000, and the Guide to Producing National Health Accounts to create a single global framework for producing health expenditure accounts that can help track resource flows from sources to uses. The Manual is the result of a four-year collaborative effort between the OECD, WHO and the European Commission, and sets out in more detail the boundaries, the definitions and the concepts – responding to health care systems around the globe – from the simplest to the more complicated. 

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    Foreword
    Health care systems in all countries continue to evolve in response to changing demographics and disease patterns, rapid technological advances and more and more complex financing and delivery mechanisms, to name but a few factors. In striving towards some of the common health care system goals of equity, efficiency and effectiveness of care, one of the key questions for policy makers is "How much do we spend on health and is it measured in a comparable way?"
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    Acronyms
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  • Ouvrir / Fermer Cacher / Voir les résumés Foundations of the System of Health Accounts

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      Introduction
      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.
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      Purposes and Principles of Health Accounts
      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.
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      Accounting Concepts and SHA Aggregates
      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.
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      Global Boundaries of Health Care
      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.
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      Classification of Health Care Functions (ICHA-HC)
      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.
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      Classification of Health Care Providers (ICHA-HP)
      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.
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      Classification of Health Care Financing Schemes (ICHA-HF)
      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.
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  • Ouvrir / Fermer Cacher / Voir les résumés Further Classifications, Applications and Methodology Concerning Health Accounts

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      Classification of Revenues of Health Care Financing Schemes (ICHA-FS)
      This chapter presents the concept of the revenues of health financing schemes (FS) and their classification. The accounting framework for health financing presented in Chapter 7 provides the conceptual basis for this chapter.v
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      Classification of Factors of Health Care Provision (ICHA-FP)
      Knowing how much health providers spend on the inputs needed to produce health care goods and services (factors of provision)1 can have many policy uses. This information is typically tracked at national aggregate levels to meet the need to ensure an efficient, appropriate allocation of resources in the production of health care services. Specific policy needs may require information regarding total payments for human resources, expenditure on pharmaceuticals, and other significant inputs. Furthermore, the financial planning of health programmes and services often relies on information about the volume and mixture of factor spending.
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      Health Spending by Beneficiary Characteristics
      This chapter provides an illustrative example of how SHA data can be used in conjunction with other data sources to further develop health accounts, in this case the allocation of current health expenditure for specific analyses according to classifications of beneficiary characteristics, such as disease, age, sex, region and economic status.
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      Capital Formation in Health Systems
      Knowing how much a health system is investing in infrastructure, machinery and equipment is very relevant for policy making and analysis. Although health systems remain a highly labour-intensive sector, capital has been increasingly important as a factor of production of health services over recent decades. Consider, for example, the growing importance of diagnostic and therapeutic equipment or the expansion of information, computer and telecommunications technology in health care over the last few years. The availability of statistics on capital are essential to the analysis of the health system’s production capacity (that is, whether capacity is appropriate, deficient or excessive), which is needed in turn to inform policy implementation (for example, if excess capacity exists, the marginal cost of expanding coverage will be lower than if the health care system is already straining to fill current demand). Information on capital could also assist with the estimation of productivity, capital intensity and rates of return.
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      Trade in Health Care
      As defined in Chapter 4 "Global boundaries of health care", the System of Health Accounts focuses on final consumption of health care goods and services by the resident population, irrespective of where this takes place. As a further qualification, this should also be irrespective of who is financing the goods or services consumed. Therefore, current health expenditure should include all final consumption by residents, both in the economic territory and abroad. This means the explicit inclusion of imports (health care goods and services provided by non-resident units, HP.9) and the exclusion of exports (those goods and services provided to non-residents by resident providers, HP.1-8) in order to correctly determine total health spending.
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      Price and Volume Measures
      Getting more value for money is a common interest of policy makers and consumers. While progress has been made since the release of the first edition of the SHA Manual, there remains concern among policy makers and statisticians that the difficult task of price and volume measurement in health care needs more attention. This chapter provides a methodological discussion and several illustrative examples of the developmental work related to health care prices and volumes.
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      Basic Accounting and Compilation Guidance
      The System of Health Accounts provides a toolkit for describing and summarising health consumption expenditure that enables an analysis of the consumption, provision and financing dimensions of health care goods and services, both over time and between countries. This chapter describes some of the basic accounting guidelines for SHA and provides some initial assistance on compilation processes, including practical guidance on good accounting practice in relation to selected measurement issues.
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      Presentation of Results, Tables and Basic Indicators
      Health expenditure is the object of measurement in health accounts. A country’s health accounts (HA) provide the measurements for a given time period and present these in a set of tables in which various aspects of the nation’s health expenditure are arrayed. The tables themselves are simply a means to display the financial flows related to a country’s consumption of health care goods and services. The data contained are intended for use by analysts and national policy makers to assist in assessing and evaluating a country’s health system. Reporting the data and estimates in a comparative way allows for evaluations between countries and is thus useful for international comparisons.
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      References
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    • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/a-system-of-health-accounts/annex-a-relationship-of-the-icha-to-other-classifications_9789264116016-19-en
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    Annex A: Relationship of the ICHA to Other Classifications
    Annex A aims to support the mapping of categories of the three core classifications of SHA 2011 with international economic classifications used within the frameworks of the System of National Accounts (SNA) and the European System of Social Protection Statistics (ESSPROS). Each of the three core classifications of SHA 2011 – ICHA-HC, ICHA-HP and ICHA-HF – focuses on specific characteristics of actors (organisations) and transactions that differ from those of the other classifications. This annex briefly discusses some of the conceptual issues involved and then presents correspondence tables with the classification categories of the SNA and ESSPROS. Despite similar terms and some overlap with the main categories, there is no one-to-one relationship between the classifications of SHA and those of the two other statistical systems. Both users and compilers should also be aware that the international classifications undergo regular revisions and can be differently applied by countries. The same holds for the actors (organisations) used as statistical units in SHA and the economic entities (institutional units) used in SNA. The cross-tables of this annex, therefore, can only serve as a tentative guide to map the different classifications. Furthermore, the classifications discussed are not the only available classifications in the statistical systems of the countries.
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    Annex B: The Relationship between SHA and SNA
    This annex illustrates the relationship between the System of Health Accounts (SHA) and the System of National Accounts (SNA). Readers who are to some extent familiar with either health accounts or national accounts, but not both, will find a description of how health expenditure and financing data reported in the SHA cross-classified tables relate to the main macroeconomic variables in the SNA. In other words, the point is to develop a common language between the two disciplines, which should be of value both theoretically and practically.
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    Annex C: Health and Health Associate Professionals and ISCO-08
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    Annex D: Financing of Health Systems – Supplementary Tools
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    Annex E: Classifying Health Care Products
    The health system provides health care goods and services to the population in the form of health care products. Health products are repeatedly referred to throughout the SHA 2011 Manual and, as such, a standardised concept of what a health product is should be established as a basis for any analysis of the production and consumption processes. This annex discusses the development of a classification of health care products based on their composition and characteristics. The categories presented are not intended as a definitive classification at this stage. The annex also includes an initial overview of the potential uses of such a classification and a brief reference to products as mentioned in the main chapters.
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    Annex F: Medical Classifications
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    Annex G: International Standards and Classifications of Trade and Tourism
    Trade statistics play an important information role in analysing the strengths and weaknesses of economies and in assessing the impacts of different policies and identifying opportunities offered by partners’ markets. The World Trade Organisation, recognising the increasing role of the service sector, concluded the General Agreement of Trade in Services (GATS) in 1995, bringing services more into the spotlight of considerations about international trade. In addition to the general obligations that apply across all service sectors of all WTO Members, countries can choose which service sector and mode they wish to open up to trade. GATS has been an important driving force for the development of statistics on the international supply of services,1 and has influenced the establishment of a classification of four different modes of trade in services. The supply of health care services can take place in all four of these GATS modes, although not all are relevant to the measurement of trade under the System of Health Accounts.
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