A System of Health Accounts

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

Bookmark this page: http://www.oecd.org/health/sha.

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 2005, 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:

• Health care functions (ICHA-HC);
• Health care service provider industries (ICHA-HP);
• Sources of financing health care (ICHA-HF)

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 9th Meeting Of Health Accounts Experts And Correspondents For Health Expenditure Data, 8-9 Oct, 2007
• For more information, please contact us
  

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 second Joint Health Accounts (SHA) Data Collection, conducted in 2007, validated health expenditure data for 17 OECD countries.  The main comparative tables and charts are:

• Total Health Expenditure as % of GDP, 2003-05  [Excel]
• Total Health Expenditure in USD PPP, 2003-05 [Excel]
• Total Health Expenditure by Healthcare Function, ICHA-HC, 2005 [Excel]
• Current Health Expenditure by Healthcare Provider, ICHA-HP, 2005 [Excel]
• Current Health Expenditure by Healthcare Financing, ICHA-HF, 2005 [Excel]

In addition, the main SHA tables for the available years from 2003 to 2005 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

Background

The basic methodological framework presented in the SHA Manual has become widely accepted: the SHA manual is currently 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. At the same time, experience has shown that, in order to enhance the analytical power of the SHA and the usefulness of the statistical guidelines, both the SHA Manual and the International Classification for Health Accounts (ICHA) require some refinement and further extension. The key challenges for an improved SHA framework are to:

• improve the comparability of health expenditure;
• reflect changes taking place in health care systems;
• better contribute to the evaluation of health systems performance;
• better present the importance of health sector within the national economy.

The SHA Manual emphasised that Version 1.0 should be considered as work in progress, and envisaged a revision process in the light of experience from pilot implementations. OECD, Eurostat and WHO have been engaged in several projects aimed at the further development of health accounting methodology during the past few years. Methodological development has also been achieved in several OECD member countries.  These efforts by the international organisations and countries provide important input for the revision of the SHA Manual.