A System of Health Accounts

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Introduction | Joint OECD-Eurostat-WHO Data Collection | SHA Development Work

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Introduction

OECD member countries are at varying stages in the process of implementing the System of Health Accounts. Country specific documents as well as the latest standard SHA Tables are available on SHA-Based Health Accounts in OECD Countries.

In 2006, OECD countries spent, on average, around 9% of their GDP on health care – growing from around 7% in 1990 and 5% in 1970. However, there are considerable variations between countries and there is ongoing concern regarding the adequacy of resource levels for health care and the way that those resources are used. As such, there has been a growing need from health policy analysts to address such questions as:

What are the main drivers accounting for health expenditure growth?
What factors explain the observed differences between countries?
What are the main structural differences in health spending between countries?
How are changes in the structure of health spending and performance of health systems related?

These issues, together with the need to monitor the impact of rapid technological change, the influence of the private sector and the provision of care to an ageing population, among other changes to the health care system, have been challenging the traditional system of health expenditure statistics over recent decades.
Consequently, a growing number of policy-makers and researchers are seeking more detailed and comparative information on health care expenditures. To respond to these needs, the OECD manual, A System of Health Accounts (SHA) provides a standard framework for producing a set of comprehensive, consistent and internationally comparable accounts to meet the needs of public and private-sector health analysts and policy-makers.

The SHA manual establishes a conceptual basis of statistical reporting rules that are compatible with other economic and social statistics. It proposes an International Classification for Health Accounts (ICHA) - currently in its 1.0 version - which covers three dimensions of health care:

Standard SHA tables cross classify expenditures under the three basics classifications providing new and deeper analysis of how health services and goods are financed and provided.

The SHA manual in English or French is available from our Online Bookshop

Related documents

Information about 10th Meeting Of Health Accounts Experts And Correspondents For Health Expenditure Data, 8-9 Oct, 2008
Information about 9th Meeting Of Health Accounts Experts And Correspondents For Health Expenditure Data, 8-9 Oct, 2007
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Joint OECD-Eurostat-WHO Health Accounts (SHA) Data Collection

Background

Since the publication of A System of Health Accounts in 2000 and the subsequent Producers Guide (WHO, World Bank and USAID, 2003), a number of OECD and non-OECD countries have undergone SHA implementation and produced SHA Tables. In 2004, OECD, Eurostat and WHO agreed on the need for a common strategy for the joint collection of health statistics. Building on this general approach, the three organisations developed a framework for a joint data collection in the area of health expenditure data in order to:

Reduce the burden of data collection for the national authorities
Increase the use of international standards and definitions for health expenditure data
Further encourage harmonisation across national health accounting practices in order to improve availability and comparability of health expenditure data

The resulting Joint Questionnaire is based on the original (detailed) set of classifications of the SHA manual with some additional minor amendments to the classifications, drawing on feedback and experience from implementation since the publication of the manual. In addition, two further dimensions were included in the questionnaire, seeking data on sources of funding and information on human resource costs. A number of additional memorandum items, deemed important from a health policy perspective were also added.

Results

The third Joint Health Accounts (SHA) Data Collection, conducted in 2008, validated health expenditure data for 21 OECD countries and 2 candidate countries. The main comparative tables and charts are:

In addition, the main SHA tables for the available years from 2003 to 2006 for the individual participant countries are available via SHA-Based Health Accounts in OECD Countries.

Related documents:
No. 16 - SHA-Based National Health Accounts in Thirteen OECD Countries: A Comparative Analysis (Aug. 2004) Eva Orosz and David Morgan

SHA Development Work

Main components of SHA developmental work in 2007-2008

Refinement of ICHA, including Guidelines for LTC
Estimating Expenditure by Disease, Age and Gender under the System of Health Accounts (SHA) Framework
Refinement of the SHA framework for health financing
Improving the comparability and availability of private health expenditure
Development of reliable health-specific Purchasing Power Parities (PPPs)
Incorporating Input, Output and Productivity Measurement into the SHA Framework
Strengthening the connection between the SHA and the SNA

All the methodological projects will contribute to the revision of the SHA Manual.

Revision of the SHA Manual

The SHA manual (OECD, 2000) is used in a large and growing number of OECD and non-OECD countries as the standard accounting framework for statistics on health expenditure and financing. The use of the manual over time however has highlighted a number of flaws, inconsistencies and omissions. Thus a revision of the manual, including the International Classifications of Health Accounts Classifications (ICHA) is deemed necessary to enhance its analytical power and usefulness of the statistical guidelines. Please refer to the SHA revision webpage for further information.

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