National Health Accounts : an overview

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National Health Accounts an overview
WORLD HEALTH ORGANIZATION Regional Office for
the Eastern Mediterranean DHS/HEC

• Workshop on Health System Development
• Alexandria,
• 20-25 May, 2007

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Understanding characteristics of health systems
in countries from the WHO Eastern Mediterranean
Region (EMR)
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What are National Health Accounts?

• NHA are a standard set of tables showing and
  describing the financial flows of health system.
• The tables provide key indicators to policymakers
  as well as researchers to diagnose the financial
  health of the health system
• NHA is a tool for policy formulation, monitoring,
  and evaluation

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What Questions CanNHA answer?

• Who pays and how much do they pay for
• health?
• (Resource mobilization)
• Who are important actors in health system
• for financing, for health care delivery, and
  
• how significant are they?
• (Resource management risk pooling and
• providers payment mechanisms,)

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What Questions CanNHA answer? (cont.)

• How are health funds distributed across
• different services, interventions, and
  activities that health system produces?
• (What is produced, who provides what
  services,)
• Who benefits from health expenditure?
• (income, gender , diseases, and regions)

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NHA and Health Policy

• Some examples (i) Philippines

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NHA and Health Policy

• Some examples (ii) South Africa

In South Africa, NHA significantly contributed to
the development of policies to improve equity by
providing information on the extent to which each
income level and province absorbed country health
care resources
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NHA and Health Policy

• Some examples (iii) Morocco
• Advocacy to promote and develop social protection
  in health
• Health insurance schemes were voluntary and
  covered 17 of the population
• After the reform mandatory health insurance for
  formal sector covering the third of the
  population
• new scheme for Independents
• on-going new scheme for poor

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Sources
Financing Agencies
Providers
MOF
MOH Facilities
MOH
Social Health Insurance
Private Facilities
Firms
Private Health Insurance
LABs
Households
Households
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Financing Sources - FS

Financing Agents - FA
Health services

Providers - P
Beneficiaries (by age, sex, region, disease,
income group)
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Financing Sources - FS

Financing Agents - FA

Functions
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Financing Sources - FS

Financing Agents - FA

Items
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Financing Sources - FS

Financing Agents - FA

Providers - P

Functions or/and Items
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NHA format

• National Health Accounts are presented in two-way
  Tables (matrix format)
• Tables are interconnected

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The Essence of NHA
There are many possible combinations in NHA such
as 1 . Financing Sources X Financing Agents
2 . Financing Agents X Providers 3 . Financing
Agents X Functions 4 . Providers X
Functions 5 . Financing Agents X Items 6 .
Providers X Items Each table states 1 - How
much is spent by each actor 2 - Where exactly
their funds are transferred to
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Indicators that are derived from NHA Tables

• Total health expenditure (THE)
• Total expenditure for inpatient care
• Total expenditure for medicines,
• Total expenditure on GPs, dentists
• Per-capita total health expenditure
• Per-capita expenditure on medicine
• Per-capita expenditure on PHC
• (current / constant prices) , (local currency / )

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Indicators that are derived from NHA Tables cont

• Share of THE from GDP
• Share of out-of-pocket expenditure from THE
• Share of public health expenditure from THE
• Share of MOH from THE
• Share of medicine from THE
• Share of medicine from out-of-pocket expenditure
• Share of expenditure of health professionals
  (GPs, specialists, dentists) from THE

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NHA development in EMRO-2005
Lebanon
Tunisia
Syria
Jordan , Palestine
Afghanistan
Iran
Iraq
Pakistan
Libya
Morocco
Egypt
SAA
Kuwait
UAE
Sudan
Qatar
Yemen
Bahrain
Never completed
Oman
1 round
Djibouti
Somalia
2 or more rounds
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WHO Support for development and
institutionalization of NHA
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WHO plays the role of a platform for NHA efforts
across the world

• "Guide to producing national health accounts,
  with special emphasis for low and middle income
  countries (WHO, WB, USAID)
• A short guide to producing national health
  accounts English, French and Arabic (EMRO)
• National Health Accounts Web Site
• To promote the development, institutionalization
  and use of national health accounts in an
  efficient and cost minimizing way.

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WHO Global NHA website

• The objectives of the site are to
• Disseminate documentation of national health
  accounts
• How to produce NHA
• How it can be used in policy formulation.
• Answer technical questions from countries
• A FAQ page was put together using questions most
  frequently heard in workshops and in countries
• A group of experts are at countrys disposal to
  answer questions of a technical nature.
• Provide and exchange experience, knowledge and
  expertise
• Documents and links related to NHA are posted.
• http//www.who.int/nha/en

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