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16. BASIC ACCOUNTING RULES AND GUIDELINES
Principles and analytical use
This chapter will cover some specific rules for accounting health expenditure and guidelines for selected issues. Such rules and guidelines are essential for ensuring consistency and comparability in health expenditure data collections. The power of the SHA as an analytical tool stems largely from its ability to link numerous, very varied economic phenomena by expressing them in a single accounting unit. The System does not attempt to determine the utility of the flows and stocks which come within its scope but measures the current exchange value of the entries in the accounts in money terms, i.e., the values at which goods and other assets, services, labour or the provision of capital are in fact exchanged or else could be exchanged for cash. The development of rules for health accounting will rely heavily on the accounting rules laid out in the SNA and will include issues such as cash vs. accrual accounting and the development of uidelines for subsidies, rules for estimation of consumption of fixed capital, valuation of exports and imports. Estimation of health expenditure faces some particular issues which are not well covered in the SNA. Examples are discriminating between long-term care health and social expenditures, estimating out-of-pocket household expenditures and accounting for illegal payments in health care.
Key issues
Guidelines for estimating total current expenditure. The following requirements for estimating internationally comparable total current expenditure will be discussed:
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The functional classification of health care (ICHA-HC) is applied in an internationally harmonised way (in particular, LTC)
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Expenditure by all the financing agents defined by the SHA is accounted for (in particular, HF.2.4; HF.2.5)
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All primary and secondary providers of health care are included (in particular, HP.7)
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Foreign trade of health services is estimated (in particular, HP.9)
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Common methods for valuation of health services are applied following the SHA framework
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Guidelines for estimating gross capital formation
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Guidelines for estimating long-term care
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Guidelines for estimating private expenditure
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Guidelines for estimating expenditure by disease, age and socioeconomic grouping
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