Health Accounts

Health Accounts methodology

System of Health Accounts (SHA) 2011 tracks all health spending in a given country over a defined period of time regardless of the entity or institution that financed and managed that spending. It generates consistent and comprehensive data on health spending in a country, which in turn can contribute to evidence-based policy-making.

SHA 2011 can be used as a monitoring and evaluation tool to track changes in policy priorities and if the introduction of reforms and new programs resulted in changes in health resources allocation and expenditure.

The core accounting framework is organised around a tri-axial system for the recording of health care expenditure, namely classifications of the functions of health care (ICHA-HC), health care provision (ICHA-HP), and financing schemes (ICHA-HF), as presented in the below figure.

These three core classifications address the three basic questions:

  • What kinds of health care goods and services are consumed?
  • Which health care providers deliver these goods and services?
  • Which financing scheme pays for these goods and services?

The ultimate goal of data compilation of the core accounts is to answer these three questions with respect to each transaction that incurs health care expenditures – in other words, to use the three axes of the International Classifications for Health Accounts (ICHA), namely, function, provider and financing, to describe each financial flow in the health care sector.


The SHA 2011 methodology yields information that can be used to address such questions by collecting and analysing data on health spending from donors, nongovernmental organizations (NGOs), private companies, insurance providers, government entities and households, which each contribute to health spending. Data from all of these different sources are cross-checked to avoid double counting and to produce an accurate estimate of current and capital spending in a country over a fixed time period, typically a fiscal year.

A number of additional components deemed important from a health policy perspective have been developed. Links to SHA 2011 development work and its main components is found below and with OECD health policies and data.

Manual: A System of Health Accounts 2011 (SHA 2011)