Health accounts have become an important instrument in nearly all OECD countries and beyond to systematically track health spending and financing and to provide evidence for informed policy making in health. Yet, how they have been implemented in practice and institutionalised differs to some extent across countries. A number of countries go beyond the standard applications set out in the international health accounting framework A System of Health Accounts 2011, with some also continuing to use classifications and categories that predate the development of SHA 2011.
Health accounts are a flexible toolkit catering for specific needs in addition to international reporting requirements which can explain why health accounts production is institutionalised in many different ways across countries. It is safe to say that there is no “one size fits all” approach. Many factors play a role in determining how health accounts should be best institutionalised in a country.
When it comes to the governance of health accounts production, there are several trade‑offs to consider when deciding which agency should be responsible for their production. A legal mandate for the production of health accounts (either explicitly or implicitly) exists in the majority of OECD countries surveyed, which is an important lever to ensure the continuity of the work, and it can also help facilitate data acquisition. Producing health accounts relies on combining data from many different data sources. Hence establishing and maintaining good relationships with the various data providers and other stakeholders is crucial. Several countries established different types of health accounts expert groups, which advise on health accounts production and dissemination of results. This appears to be a useful step to get additional buy-in from major stakeholders, potentially improve the quality of the accounts, and add legitimacy to their results.
The technical production process of health accounts differs to some degree across countries driven by adopted methodologies, differences in health data infrastructure and data availability and possibly also influenced by the culture in the agency where health accounts are institutionalised. That said, successful technical implementation requires the identification of the most appropriate data sources and their regular acquisition, clear and standardised procedures to process data and the calculation of health spending figures. Assuring data quality should be an integral part of this process. The systematic and comprehensive documentation of processes and calculation methods can be beneficial for an efficient transfer of knowledge and can speed up capacity building of new staff.
A successful dissemination of health accounts results can lead to increased policy use of this information. Best practices suggest developing different products for different users to increase impact. This includes media releases and accompanying data tables, complemented with in-depth analyses, also putting health spending data into a wider policy context, and can also cover other activity such as organising high-level dissemination events.
Widespread use of health accounts to inform health policy is a key objective of health accounts institutionalisation. Strategies to engage with staff in health ministries, parliamentarians, civil society representatives and the different stakeholders in the health sector can contribute to an increased policy use which in turn can trigger demand for more detailed health expenditure analysis, reinforcing a positive feedback loop.
In all of this, the capacity of health accounts to respond to changing (and growing) information needs is critical. The recent experience with the COVID‑19 pandemic has shown that new information needs for health spending data can emerge quickly and health accounts need to be flexible to accommodate them. With some adjustments and additional guidance, many OECD countries were indeed able to identify COVID‑19 spending separately as part of their annual health spending data submissions. Yet, there are also other priority areas, such as obtaining comparable spending data on primary healthcare, more granular information for preventive spending or on health system resilience. Hence, countries need to ensure that the process of health accounts institutionalisation goes hand in hand with the continuous methodological development to improve the policy relevance of health accounts data.
