![09-03-2022
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National health accounts (NHA)
It is a systematic approach to mapping the flow of health sector funds through the national
health system over a defined time period
• gives a snapshot of the flow of funds in the health system
• NHA are an important tool to focus attention of policy-makers on financing issues, and to
communicate to them the major issues facing health financing at the national/state level
Provides consistent and comprehensive data that contributes to evidence based policy making
Can track changes in policy priorities and understand if the introduction of reforms and new
programs resulted in changes in health resources allocation and expenditure
Defining current health care expenditures (Boundaries)
The functional classification of health care (ICHA-HC) delineates the boundaries of health care
activities from an international perspective
the boundary contains all activities with the primary purpose of improving, maintaining and
preventing the deterioration of the health status of persons and mitigating the consequences of ill-
health through the application of qualified health knowledge [medical, paramedical and nursing
knowledge, including technology, and traditional, complementary and alternative medicine (TCAM)]](https://image.slidesharecdn.com/nationalhealthaccountsandestimatesofhealthexpenditureforindia-220309054730/85/National-health-accounts-and-estimates-of-health-expenditure-for-india-3-320.jpg)
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National health accounts and estimates of health expenditure for india
- 1. 09-03-2022 1 System of Health Accounting and India’s National Health Expenditure Estimates Dr T R Dilip International Institute for Population Sciences Course E3.1: HEALTH ECONOMICS AND HEALTH FINANCING 9th March 2022 Where and how do you get such health expenditure estimates?
- 2. 09-03-2022 2 Contents Purposes of Health Accounts International Classification for Health Accounts (ICHA) for health care, providers and financing schemes Defining current health care expenditures Limitations of SHA/NHA Illustration using National Health Accounts-India 2017-18 Purposes of Health Accounts Can we monitor financial resource flow in health care systems? How to we arrive at total/ current health expenditure in a health care system? Are these expenditure data comparable over time across health care systems? Health expenditure when estimated at national level using System of health accounts (SHA) methods generates the National Health Accounts (NHA)
- 3. 09-03-2022 3 National health accounts (NHA) It is a systematic approach to mapping the flow of health sector funds through the national health system over a defined time period • gives a snapshot of the flow of funds in the health system • NHA are an important tool to focus attention of policy-makers on financing issues, and to communicate to them the major issues facing health financing at the national/state level Provides consistent and comprehensive data that contributes to evidence based policy making Can track changes in policy priorities and understand if the introduction of reforms and new programs resulted in changes in health resources allocation and expenditure Defining current health care expenditures (Boundaries) The functional classification of health care (ICHA-HC) delineates the boundaries of health care activities from an international perspective the boundary contains all activities with the primary purpose of improving, maintaining and preventing the deterioration of the health status of persons and mitigating the consequences of ill- health through the application of qualified health knowledge [medical, paramedical and nursing knowledge, including technology, and traditional, complementary and alternative medicine (TCAM)]
- 4. 09-03-2022 4 Functional boundaries of health care expenditures in SHA Includes health care activities whose “primary purpose” is ● Health promotion and prevention; ● Diagnosis, treatment, cure and rehabilitation of illness; ● Caring for persons affected by chronic illness; ● Caring for persons with health-related impairment and disability; ● Palliative care; ● Providing community health programmes; ● Governance and administration of the health system Core and extended boundaries The advantages of this tri-axial approach include an optimal use of the data sources to ensure that neither double-counting nor omissions occur.
- 5. 09-03-2022 5 Core accounting framework Organised around a tri-axial system for the classifying/recording of health care expenditure functions of health care (ICHA-HC) health care provision (ICHA-HP) financing schemes (ICHA-HF) 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? Functional classification of health care (ICHA-HC)
- 6. 09-03-2022 6 Functional classification of health care (ICHA-HC) detailed Classification of Health Care Providers (ICHA-HP)
- 7. 09-03-2022 7 Classification of Health Care Financing Schemes (ICHA-HF) Definition of health care financing schemes (SHA 2011) Health care financing schemes are structural components of health care financing systems: they are the types of financing arrangements through which people obtain health services. Health care financing schemes include direct payments by households for services and goods and third- party financing arrangements. Classification of Health Care Financing Schemes (ICHA-HF)
- 8. 09-03-2022 8 Other classifications / Miscellaneous Revenue of health financing schemes Factors of health care provision Beneficiary characteristics ● Age and gender; ● Type of disease or condition; ● Socioeconomic status; ● Geographical region Health care functions The basic dividing lines for structuring the health care functions are individual versus collective health care goods and services, the purposes of care (e.g. curative, rehabilitative, long-term care), and the modes of provision (e.g. inpatient, outpatient). SHA 2011 distinguishes the health care functions (HC) and certain health care related functions (HCR)
- 9. 09-03-2022 9 Benefits of NHA The provision of timely data can have an impact on resource allocations Enable policymakers to make timely decisions Evidence base for the negotiation between Ministries of Health and Ministry of Finance It can highlight the need to focus on regulatory issues It can track the impact of financing changes on health sector reforms Facilitate cross country comparisons Monitoring health financing targets at national/sub-national (Health policy) and global level (eg SDGs) Provide the country or state with a better bargaining position with donors. Citizens have the right to access information about wealth redistribution The huge amounts of resources in the health system should be monitored and accounted for Satisfaction of health needs require a large amount of resources, allocation of resources require decisions linked to social values Health services require resources to be generated and decisions on allocation affect the distribution of their benefits NHA is a tool for Transparency and Governance
- 10. 09-03-2022 10 Limitations of NHA Provides snap shot picture of source and use of funds and not trend Focus only on financial dimension of health system, must be combined with non financial data to answer policy questions Accrual method of accounting and actual expenditure estimates Information on quality /efficiency of expenditure beyond NHA purview National Health Accounts in India
- 11. 09-03-2022 11 NHA Initiative so far in India National Health Policy 2002 targeted setting up NHA by 2005 NHA Cell set up at MOHFW in 2003 First estimates released in 2005 for the year 2001-02 Second set of estimates released in 2009 for the year 2004-05 National Health Accounts Technical Secretariat (NHATS) with the guidance from NHA Steering Committee and the NHA Expert Group for India NHATS prepared NHA estimates for 2013-14, 2014-15, 2015-16, 2016-17 & 2017-18 https://nhsrcindia.org/national-health-accounts-records India is slow starter in NHA and yet to take it to the state level
- 12. 09-03-2022 12
- 13. 09-03-2022 13 NHA Estimates India 2017-18
- 14. 09-03-2022 14 -NHA Estimates India 2017-18 -NHA Estimates India 2017-18
- 15. 09-03-2022 15 -NHA Estimates India 2017-18
- 16. 09-03-2022 16 Capital Formation NHA Estimates India 2017-18: Is there any capital formation in private sector?????? NHA Table: Illustration on free from double counting (Estimates India 2017-18)
- 17. 09-03-2022 17 NHA Table: Illustration II on NHA Table/Matrix for India 2017-18) NHA India Estimates: Limitations Household Out of pocket expenses (OOPE) is the dominant component in total health expenditure OOPE estimates based on national surveys where data quality is important Health expenditure will be biased if quality of survey estimates are not considered
- 18. 09-03-2022 18 NHA India Estimates: Future needs Estimates only available at national level (Health is a State Govt subject) NHA capacity building across stakeholders in health system requires a strengthening Debates at policy level limited to a few of the so called “key” NHA indicators NHA not fully institutionalized (turn around of staff involved in preparation of estimates) Resources: National Health Systems Resource Centre (2021). National Health Accounts Estimates for India (2017-18). New Delhi: Ministry of Health and Family Welfare, Government of India https://nhsrcindia.org/sites/default/files/2021- 11/National%20Health%20Accounts-%202017-18.pdf OECD, Eurostat and World Health Organization (2017), A System of Health Accounts 2011: Revised edition, OECD Publishing, Paris. http://dx.doi.org/10.1787/9789264270985-en Dilip, T.R. and Nandraj, S., 2017. The More Things Change, the More They Remain the Same: National Health Accounts Estimates. Economic and Political Weekly, 52, pp.20-23. https://www.epw.in/journal/2017/23/commentary/national-health-accounts-estimates.html