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Why was a revised system necessary?

• If countries do not follow common standards, comparing data across countries is like comparing apples and oranges. The OECD therefore produced A System of Health Accounts in 2000.  At around the same time, the WHO led work on a National Health Accounts Producer Guide, which while based on the SHA concepts, differed in a few definitions and directions.
• SHA 2011 is the result of a four-year collaborative effort between WHO, OECD and the European Commission to create a single global standard for producing health expenditure accounts. 
• It has been prepared after an extensive consultation process, with hearings held in all regions of the world. 
• Importantly, it brings together the original SHA manual with methodological work of the NHA Producer Guide into a single framework to be able to track resource flows through the health system from sources to uses. 

How will the System of Health Accounts 2011 be used?

• Essentially, SHA is a statistical reference manual, setting out in detail the boundaries, the definitions and the concepts and  responding to all health systems around the globe – from the simplest to the more complicated.
• It is not a set of guidelines for producing health accounts and critically, what it doesn’t do is prescribe the level of detail of data should be collected. None of the Organisations involved in preparing the manual will be asking countries to provide information referring directly to the manual.  Rather, the manual will used as a reference where necessary, as a source of definitions and to help statisticians facing particularly complex issues.
• Like any statistical manual it is useful to the extent that countries will refer to various aspects of it, and countries will undoubtedly apply parts that are most relevant to their own circumstances and adapted to their individual capacities.  

Is the new System of Health Accounts 2011 complicated?

• The new system is considerably clearer than the previous version. Many concepts have been clarified and many examples have been included.
• The system follows exactly the same approach as the previous version, in that it is built around the three dimensions of health functions; health providers and health financing. 
• It is much longer than the previous system of health accounts, because it seeks to cover the needs of health systems around the world with very different organisational and financing arrangements.  This will not have any effect in the vast majority of cases which are not complicated.

Does the new system imply a ‘one-size-fits-all’ approach to data collection? 

• No. Different countries (and different data collections) will want to focus on what matters for the purposes they have in mind.
• For instance, many analysts, and not exclusively in lower and middle income countries, may view the tracking of sources of financing as an inherent part of the development of their health accounts, while some higher income countries may place a higher importance on estimations of trade in health care or developing price and volume measures. The new SHA will help accountants in both cases, but does not require them to invest time and resources in doing something which is of, at best, marginal relevance.
• In summary, SHA is intended as a flexible toolkit for health accountants to refer to.

Are further guidelines needed?

• Yes. New guidelines for compiling consistent overall health expenditures including lighter and more rapid methodologies for capacity constrained countries are now necessary. The health care financing framework allows for a systematic assessment of how finances are mobilised, managed and used. Proposed tools would allow for improved resource tracking with both domestic financing and external aid and importantly mapping to already established statistical collections on aid flows (OECD CRS).
• Similarly further guidance for producing disease specific accounts within the overall health expenditure framework with resources dedicated to piloting in more low income, high aid countries is seen as a priority. This would allow the tracking, for example, of Maternal and Child Health (MCH) resources as well as other diseases such as HIV/AIDS, malaria and TB.

Guidelines for Accounting Long-Term Care Expenditure under SHA 2011

Implementing the Capital Account under SHA 2011

Guidelines to Measure Expenditure on Over-the-Counter (OTC) Drugs

Expenditure on Prevention Activities under SHA 2011: Supplementary Guidance

Related Documents

A System of Health Accounts