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National Health Accounts : an overview

WORLD HEALTH ORGANIZATION Regional Office for the Eastern Mediterranean DHS/HEC. National Health Accounts : an overview. Workshop on Health System Development Alexandria, 20-25 May, 2007. Understanding characteristics of health systems in countries from

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National Health Accounts : an overview

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  1. WORLD HEALTH ORGANIZATION Regional Office for the Eastern Mediterranean DHS/HEC National Health Accounts :an overview Workshop on Health System Development Alexandria, 20-25 May, 2007

  2. Understanding characteristics of health systems in countries from the WHO Eastern Mediterranean Region (EMR)

  3. 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

  4. 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,…)

  5. 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)

  6. NHA and Health Policy • Some examples (i): Philippines

  7. 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

  8. 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

  9. Sources Financing Agencies Providers MOF MOH MOH Facilities Social Health Insurance Private Facilities Firms Private Health Insurance LABs Households Households

  10. Financing Sources - FS $ Financing Agents - FA Health services $ Providers - P Beneficiaries (by age, sex, region, disease, income group)

  11. Financing Sources - FS $ Financing Agents - FA $ Functions

  12. Financing Sources - FS $ Financing Agents - FA $ Items

  13. Financing Sources - FS $ Financing Agents - FA $ Providers - P $ Functions or/and Items

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

  15. 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

  16. 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 / $)

  17. 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

  18. NHA development in EMRO-2005 Lebanon Tunisia Jordan , Palestine Syria Afghanistan Iraq Iran Pakistan Libya Morocco Egypt SAA Kuwait UAE Sudan Qatar Yemen Bahrain Never completed Oman 1 round Djibouti Somalia 2 or more rounds

  19. WHO Support for development and institutionalization of NHA

  20. 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.

  21. 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 country’s 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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