Institutionalising Health Accounts in Brazil

1. Introduction

Abstract

With ageing societies and rising incomes, health spending is projected to increase over the coming decades. This makes a systematic tracking of the financial resources mobilised to address the increased demand for healthcare vital to better inform policy making. The OECD Secretariat is supporting the Ministry of Health of Brazil in the implementation and institutionalisation of health accounts – a powerful tool to facilitate the tracking and monitoring of health spending. This chapter provides background information on this collaboration and introduces the remainder of this publication.

With ageing populations and the associated increase in chronic conditions, technological developments in treatment and service delivery, and expanding demands for care as incomes rise, the resources allocated to health have been growing steadily over the past decades in high, medium and low-income countries, and can be generally expected to further increase in the decades to come. Currently, across the OECD, spending on health typically represents more than 9% of the Gross Domestic Product (GDP) or around 15% of a country’s government budget (OECD, 2024[1]). Based on pre‑pandemic trends, health expenditure in OECD countries is expected to surpass 11% of GDP by 2040, on average (OECD, 2024[2]). Yet, for informed health policy decision-making it is essential to make health spending transparent and better understand how such significant financial resources are mobilised, for what purposes they are used, whether they are spent efficiently and equitably, and whether they sufficiently meet the demands of the population. For this reason, spending on health should be systematically tracked over time, ideally using a global framework applying established concepts and international standards to also facilitate comparisons across countries.

Several countries have been monitoring health expenditures through their national systems, with records in some cases extending back 50 years and more. Building on these national efforts, over the past 25 years, the Organisation for Economic Co‑operation and Development (OECD), the World Health Organization (WHO), and other international organisations have worked to develop harmonised frameworks to define and categorise health expenditure. This collaboration has aimed to both facilitate international comparisons as well as standardise national efforts to track health spending. In 2011, these collaborative efforts culminated in the release of A System of Health Accounts 2011 (SHA 2011), which became the universal health accounting standard (OECD/WHO/Eurostat, 2011[3]). The adoption of SHA 2011 has significantly enhanced the ability of OECD countries and many other nations globally to systematically monitor and analyse health spending, thereby supporting informed policy making and international health comparisons.

Given that Brazil dedicates a sizeable proportion of its resources to health, the country has recognised the critical importance to systematically track health spending. This understanding led to the implementation of health satellite accounts (HSA), which focus primarily on the production side of the health sector (IBGE, 2022[4]). HSAs measure the sector’s contribution to the overall economy in terms of value added and employment, providing a comprehensive view of the economic impact of health-related activities. In addition to HSAs, Brazil has also made several previous attempts to institutionalise sector-specific National Health Accounts (NHA). These efforts aimed to provide more focused and detailed insights into health expenditure and financing within Brazil. Over the past decade, two significant reports were published under these initiatives, culminating in the production of two sets of preliminary results (Ministério da Saúde, Fiocruz, 2018[5]; Brasil. Ministério da Saúde, 2022[6]).

Despite these efforts and the underlying objective to create a coordinated process via an interministerial Ordinance, the subsequent revocation led to a deprioritisation of the work. As a result, the outcomes of these studies were not widely disseminated, limiting their effective impact. The lack of a long-term sustained approach meant that the valuable data generated was not effectively integrated into the decision-making processes of health authorities.

Moreover, the production process, including the methodologies applied, was not sufficiently documented. This lack of thorough documentation hindered the ability to maintain and replicate the production of health accounts on a regular basis. Without standardised procedures and clear guidelines, the continuity and sustainability of health account production were compromised. Consequently, the potential benefits of having a robust and institutionalised health accounting system were not fully realised, highlighting the need for a more structured and co‑ordinated approach to health expenditure tracking in Brazil.

Hence, to unlock the full potential of health accounts to inform health policy decision-making, the Brazilian Ministry of Health decided to re‑engage in this work with the intention of fully institutionalising the annual production of health spending estimates at a more granular level and in alignment with international standards. This renewed commitment aims not only to produce accurate and comprehensive results but also to deliver detailed documentation or a “handbook” on the data sources and methodologies employed. Such documentation is also expected to enhance the transparency and legitimacy of the results, thereby fostering greater trust among stakeholders. Additionally, having standardised procedures and clear guidelines will help ensure the continuity and sustainability of health account production, even in the face of changes in personnel. By adopting this more structured and co‑ordinated approach, the ministry hopes to reap the full benefits of a robust and institutionalised health accounting system, ultimately leading to more informed and effective health policy decisions.

The OECD Secretariat has been supporting the Ministry of Health in their efforts for an improved institutionalisation of the National Health Accounts in Brazil. As part of this co‑operation, the OECD Secretariat has reviewed the current and proposed methodology to estimate health spending (as described in the Brazilian handbook) and has provided a set of recommendations to best align it with current OECD standards going forward. It also evaluates the organisation and governance structure of the production process and suggest ways to strengthen the publication and dissemination strategy to engender greater policy impact of health accounts results. This assessment and recommendations form the content of this report. In a separate but related report, the OECD Secretariat reviews and summarises the best practices in institutionalisation of health accounts based on the experience in more than a dozen OECD countries (OECD, 2025[7]).

This rest of this document is structured as follows: Chapter 2 provides an introduction into the key concepts of health accounts and summarises the existing work to date in this domain in Brazil. In Chapter 3, some key features of the Brazilian health system and its health data environment are presented to fully appreciate the technical discussion on how health spending should be estimated. Chapter 4 discusses the proposed data sources and planned methodology to calculate health spending estimates as described in the “handbook” by the Brazilian Ministry of Health.1 Chapter 5 analyses the most recent health spending data on Brazil (based on the new methodology) and puts it into an international context. Chapter 6 highlights the potential for additional applications for health accounts analysis in Brazil that could be explored in the future, for example a regional breakdown of health spending. Finally, Chapter 7 develops some recommendations on how Brazil should institutionalise this work and discusses some dissemination strategies to increase the impact of health accounts to inform policy making, based on best practices in other OECD countries.

References

[6] Brasil. Ministério da Saúde (2022), Contas de saúde na perspectiva da contabilidade internacional : conta SHA para o Brasil, 2015 a 2019, Ipea, https://doi.org/10.38116/978-65-5635-028-8.

[4] IBGE (ed.) (2022), Conta-satélite de saúde : Brasil : 2010-2019, https://biblioteca.ibge.gov.br/visualizacao/livros/liv101928_informativo.pdf.

[5] Ministério da Saúde, Fiocruz (2018), Contas do SUS na perspectiva da contabilidade internacional: Brasil, 2010-2014, Ministério da Saúde; Fiocruz, https://bvsms.saude.gov.br/bvs/publicacoes/contas_SUS_perspectiva_contabilidade_internacional_2010_2014.pdf.

[7] OECD (2025), Best Practice in Institutionalising Health Accounts: Learning from Experiences in 13 OECD Countries, OECD Publishing, Paris, https://doi.org/10.1787/cf997130-en.

[2] OECD (2024), Fiscal Sustainability of Health Systems: How to Finance More Resilient Health Systems When Money Is Tight?, OECD Publishing, Paris, https://doi.org/10.1787/880f3195-en.

[1] OECD (2024), Latest health spending trends: Navigating beyond the recent crises, OECD Publishing, Paris, https://www.oecd.org/en/publications/latest-health-spending-trends_df0bb1ba-en.html.

[3] OECD/WHO/Eurostat (2011), A System of Health Accounts: 2011 Edition, OECD Publishing, Paris, https://doi.org/10.1787/9789264116016-en.

Note

← 1.  The assessment has been made based on the version of the handbook available at the end of January 2025. Any modifications that may have occurred after this time are not reflected in the OECD assessment.