National health accounts data from 1996 to 2010: a systematic review

Abstract

ObjectiveTo collect, compile and evaluate publicly available national health accounts (NHA) reports produced worldwide between 1996 and 2010.MethodsWe downloaded country-generated NHA reports from the World Health Organization global health expenditure database and the Organisation for Economic Co-operation and Development (OECD) StatExtract website. We also obtained reports from Abt Associates, through contacts in individual countries and through an online search. We compiled data in the four main types used in these reports: (i) financing source; (ii) financing agent; (iii) health function; and (iv) health provider. We combined and adjusted data to conform with OECD’s first edition of A system of health accounts manual, (2000).FindingsWe identified 872 NHA reports from 117 countries containing a total of 2936 matrices for the four data types. Most countries did not provide complete health expenditure data: only 252 of the 872 reports contained data in all four types. Thirty-eight countries reported an average not-specified-by-kind value greater than 20% for all data types and years. Some countries reported substantial year-on-year changes in both the level and composition of health expenditure that were probably produced by data-generation processes. All study data are publicly available at http://vizhub.healthdata.org/nha/.ConclusionData from NHA reports on health expenditure are often incomplete and, in some cases, of questionable quality. Better data would help finance ministries allocate resources to health systems, assist health ministries in allocating capital within the health sector and enable researchers to make accurate comparisons between health systems.

Evolution and patterns of global health financing 1995–2014: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries

“…An additional data limitation is that NHA reports are sparse and contain gaps 61 . These issues prevent analysis at a more granular level.…”

How to ensure quality of health accounts

“…The challenge of quality in health accounts is thus linked to policies. The quality of HA has been a recurrent concern both of producers and users [2,3,4]. However, to date, there is still no a systematic measure of quality of HA.…”

“…It implies also the compliance of the associated standard accounting procedures and estimation techniques. Non-compliance to the standard leads to comparability problems as demonstrated in a recent systematic review [4].…”

“…In 2015 OECD [3] has summarized the problems of estimation of OOPS among their Member States as: a) lack of a standard approach to measure it, b) incomplete coverage, c) wrong coding, d) incomplete metadata. Another recent analysis of health accounts [4] refers also that reports are not accessible, they include partial data, the classes of "other", or "not elsewhere classified" are large, and that year to year data include unexplained major changes.…”

Global health financing and the need for a data revolution

“…While recent investments will likely increase the depth, reliability and frequency of these reports, historically, the framework has not been systematically or comparably applied (Bui et al, 2015). Health accounting is challenging and wrought with important assumptions that are not necessarily transferred from one health accounting team to the next.…”