This chapter presents the concept of the revenues of health financing schemes (FS) and their classification. The accounting framework for health financing presented in Chapter 7 provides the conceptual basis for this chapter.v

Knowing how much health providers spend on the inputs needed to produce health care goods and services (factors of provision)1 can have many policy uses. This information is typically tracked at national aggregate levels to meet the need to ensure an efficient, appropriate allocation of resources in the production of health care services. Specific policy needs may require information regarding total payments for human resources, expenditure on pharmaceuticals, and other significant inputs. Furthermore, the financial planning of health programmes and services often relies on information about the volume and mixture of factor spending.

This chapter provides an illustrative example of how SHA data can be used in conjunction with other data sources to further develop health accounts, in this case the allocation of current health expenditure for specific analyses according to classifications of beneficiary characteristics, such as disease, age, sex, region and economic status.

Knowing how much a health system is investing in infrastructure, machinery and equipment is very relevant for policy making and analysis. Although health systems remain a highly labour-intensive sector, capital has been increasingly important as a factor of production of health services over recent decades. Consider, for example, the growing importance of diagnostic and therapeutic equipment or the expansion of information, computer and telecommunications technology in health care over the last few years. The availability of statistics on capital are essential to the analysis of the health system’s production capacity (that is, whether capacity is appropriate, deficient or excessive), which is needed in turn to inform policy implementation (for example, if excess capacity exists, the marginal cost of expanding coverage will be lower than if the health care system is already straining to fill current demand). Information on capital could also assist with the estimation of productivity, capital intensity and rates of return.

As defined in Chapter 4 “Global boundaries of health care”, the System of Health Accounts focuses on final consumption of health care goods and services by the resident population, irrespective of where this takes place. As a further qualification, this should also be irrespective of who is financing the goods or services consumed. Therefore, current health expenditure should include all final consumption by residents, both in the economic territory and abroad. This means the explicit inclusion of imports (health care goods and services provided by non-resident units, HP.9) and the exclusion of exports (those goods and services provided to non-residents by resident providers, HP.1-8) in order to correctly determine total health spending.

Getting more value for money is a common interest of policy makers and consumers. While progress has been made since the release of the first edition of the SHA Manual, there remains concern among policy makers and statisticians that the difficult task of price and volume measurement in health care needs more attention. This chapter provides a methodological discussion and several illustrative examples of the developmental work related to health care prices and volumes.

The System of Health Accounts provides a toolkit for describing and summarising health consumption expenditure that enables an analysis of the consumption, provision and financing dimensions of health care goods and services, both over time and between countries. This chapter describes some of the basic accounting guidelines for SHA and provides some initial assistance on compilation processes, including practical guidance on good accounting practice in relation to selected measurement issues.

Health expenditure is the object of measurement in health accounts. A country’s health accounts (HA) provide the measurements for a given time period and present these in a set of tables in which various aspects of the nation’s health expenditure are arrayed. The tables themselves are simply a means to display the financial flows related to a country’s consumption of health care goods and services. The data contained are intended for use by analysts and national policy makers to assist in assessing and evaluating a country’s health system. Reporting the data and estimates in a comparative way allows for evaluations between countries and is thus useful for international comparisons.