Health Accounts

Health Accounts Country Platform Approach

The country platform approach aims to institutionalize a harmonized country platform for annual and timely collection of health expenditure data, with a particular focus on the distribution of expenditure by disease. It will strengthen the capacity of the country health account team to report health expenditures using the global standard, the System of Health Accounts 2011, and to analyse and produce policy relevant reports.

The goal is to link expenditures to budgets and to health outputs annually in a sustainable fashion.

The main characteristics of a country platform for resource tracking are:

1. Maximal use of information technology

The Health Account Production Tool (HAPT) and Health Account Analysis Tool (HAAT) are the core of the country platform for production and analysis of health expenditure. Government expenditures data are downloaded from countries respective accounting systems, and automated surveys for donors, NGOs, insurance agents, and employers are imported into the HAPT and mapped to the different SHA2011 categories.

When expenditure items are mapped, the repeat mapping feature can be used every year thereafter, and will speed up the production process. Using the HAPT also builds institutional memory by facilitating consistent application of accounting rules and decisions, which will eliminate the pressure on one individual to make decisions. Production of tables, indicators and trend lines and links to budgets and other health data are facilitated by pre-defined reports in the HAAT.

2. Routine production:

Production of new tables showing distribution by beneficiary characteristics (disease, age, geography, etc.), is considered a routine part of the production of health accounts. Full distribution in this case alludes to the idea that there are standard methods for allocation to different categories. This prevents double counting of expenditure. Full distributions also provide a picture of the relative shares of the different diseases or subnational areas of the total health expenditures.

SHA 2011 methodology distributed health care expenditure by disease/condition for all those diseases that the country has data available for. As a result, it is no longer recommended that countries produce disease or condition level sub-accounts. This is to ensure that the sum of expenditures across all conditions equals the current estimate of health expenditure for the country.

3. Focus on the use of the data:

Potential audiences (policy makers, development partners, civil society, parliamentarians, media etc.), and their needs for health expenditure information have been identified. Production cycles are timed to produce reports in time for annual health sector reviews and the associated costing and budgeting cycles. The most recent data is made available through provisional health accounts T-1 year and final health accounts T-2 years. These are produced yearly with distributional tables by beneficiary characteristics (diseases).

4. Linking and country validation of internationally reported data:

Data reported to international database can be downloaded and compared to health expenditure data; e.g. OECD, DAC, CRS data on official development aid, databases on fund releases and drug purchases from GAVI and UNFPA . This can also ensure that the value of large non-financial contributions is included as health expenditure.

5. Public availability of results:

The HA tables and expenditure indicators for health and specific diseases are posted on country websites and on the WHO global health expenditure dataset as soon as the data is collected and approved by the country.

There are several advantages of institutionalizing this harmonized resource tracking platform at the country level:

  • The platform builds sustainable capacity in the MoH of production and analysis of health expenditure data.

  • It is more technically rigorous in that there is a standard way to allocate expenditures by diseases and type of interventions.

  • It ensures that there is an internally consistent estimate with current and capital health expenditure separated.

  • The use of a consistent platform that integrates data collection of health expenditures in existing routine health information systems ensures comparability of country data over time.

  • It minimizes multiple parallel data collection initiatives that are labour intensive and time consuming for national staff. It ensures reporting at more regular, consistent intervals, and reduces errors, allowing the process to focus more on the reporting of data and its use for national planning purposes.

  • Yearly production of health expenditure data makes the process a natural component of the health information system. The data will be relevant to inform policy choices, the development of national policies and strategic plans, including disease specific policies, which will be based on comprehensive evidence.

  • Using the Health Account Production Tool (HAPT) allows for robust and timely health expenditure data for the development and assessment of health sector strategic plans.