ruben m. suarez berenguela suarezru@paho regional advisor health economics and financing
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II National Meeting of Producers and Users of Social, Economic and Territorial Information Rio de Janeiro, August 21- 25, 2006 V National Conference on Statistics IV National Conference on Geography and Cartography. - PowerPoint PPT PresentationTRANSCRIPT
II National Meeting of Producers and Users of Social, Economic and Territorial Information
Rio de Janeiro, August 21- 25, 2006
V National Conference on StatisticsIV National Conference on Geography and Cartography
Health Satellite Accounts: Diagnostic of the Health Accounts Methodologies in Latin America and the
CaribbeanAugust 23, 2006
Ruben M. Suarez [email protected]
Regional AdvisorHealth Economics and Financing
Health Satellite Accounts: Diagnostic of the Health Accounts Methodologies in Latin America and the Caribbean
Health Accounts Methodologies:
• Non-SNA:– National Health Accounts - NHA– System of Health Accounts – National Health Accounts
• SNA - Based:– National Health Expenditure Accounts -NHEA– Health in the System of National Accounts– Health Satellite Accounts:
• Health Sector/System Satellite Accounts• Household Sector Satellite Accounts: Gender & Health• Populations’ Health Satellite Accounts
Health Satellite Accounts: Diagnostic of the Health Accounts Methodologies in Latin America and the Caribbean
Health Accounts Methodologies: • Non-SNA:
– National Health Accounts - NHA– System of Health Accounts –
National Health Accounts
• SNA - Based:– National Health Expenditure
Accounts -NHEA– Health in the System of National
Accounts -SNA– Health Satellite Accounts:
• Health Sector/System Satellite Accounts
• Household Sector Satellite Accounts: Gender & Health
• Populations’ Health Satellite Accounts
• Methodologies:
– Concepts– Classifications– Boundaries– Data Sources/Estimation
Procedures
• Results:
– National Health Expenditures - Gross
– Final Consumption Expenditure
National Health Expenditure Accounts -NHEA (Expenditure and
Flows of Funds -NHA *)
Health Accounts: Approaches
National Health Expenditure Accounts -NHEA (Expenditure
and Sources of Financing/Revenues)
Health in the System of National Accounts -SNA
Satellite Accounts - Health
Health Satellite Accounts: Diagnostic of the Health Accounts Methodologies in Latin America and the Caribbean
System of Health Accounts
OECD's SHA
Health Expenditure
and Financing
Flows (NHA*)
NHA Harvard PHR Plus USAID
National Health Expenditure Accounts -
NHEA (Expenditure and Flows of
Funds -NHA *)
NHA* Producers Guide;
USAID/World Bank/WHO
Health Satellite Accounts: Diagnostic of the Health Accounts Methodologies in Latin America and the Caribbean
Non SNA:
Health Accounts Approaches National Health
Expenditure Accounts –
(NHEA)
National Health Expenditure and Sources
of Financing/R
evenues
PAHO NHEA (NHExp Data Base) UN/SNA: Functional Classifications
Health Satellite Accounts: Diagnostic of the Health Accounts Methodologies in Latin America and the Caribbean
SNA Based:
Health Satellite Accounts: Diagnostic of the Health Accounts Methodologies in Latin America and the Caribbean
System of Health Accounts
Harvard PHR Plus USAID USAID/ WHO/ WB Locally Produced
OECD's SHA/ NHA* NHA*NHA* Producers
Guide
NHEA/ NHA* and Sector
Studies Public Sector: COFOGPrivate Sector:
COICOP CPIArgentina X X X X
Belize X XBolivia X X X X X XBrazil X X XCanada X X XColombia X X X XCosta Rica X X XChile X X X X XDominican Republic X X X X X XEcuador X X X XEl Salvador X X X XGrenada X Guatemala X X X XGuyana X X Haiti X XHonduras X X X
PAHO NHEA (NHExp**) - UN's Functional Classifications
SNA Based
National Health Expenditure Accounts - NHEA
Non SNA
Availability of Estimates of National Health Expenditures by Type of Approach in the Americas
Health Accounts in the Americas
Health Satellite Accounts: Diagnostic of the Health Accounts Methodologies in Latin America and the Caribbean
System of Health Accounts
Harvard PHR Plus USAID USAID/ WHO/ WB Locally Produced
OECD's SHA/ NHA* NHA*NHA* Producers
Guide
NHEA/ NHA* and Sector
Studies Public Sector: COFOGPrivate Sector:
COICOP CPIMexico X > x x > X X XNicaragua X X X X X XPanama X XPeru X X XSuriname X X Trinidad & Tobago X XUruguay X X XUnited States X X X XVenezuela X X
PAHO NHEA (NHExp**) - UN's Functional Classifications
x At least one completed country study or estimates for 2003 or before.
SNA Based
National Health Expenditure Accounts - NHEA
Non SNA
X : Ongoing or up- dated estimates to 2003- 05
Availability of Estimates of National Health Expenditures by Type of Approach in the Americas
Health Accounts in the Americas
Health Satellite Accounts: Diagnostic of the Health Accounts Methodologies in Latin America and the Caribbean
National Health Care Expenditures: The public-private mix aroung regions of the World
0
2
4
6
8
10
12
14
Africa -Sub-
Sahara
Asia delSur
Low andMiddleincome
Asia delEste y delPacífico
MedioOriente yAfrica del
Norte
LatinAmerica
andCaribbean
WorldTotal
Europa delEste yAsia
Central
Americas EuropeanUnion
Canada Other HighIncome
Countries
HighIncome
Countries
UnitedStates
NH
E %
of
GD
P
Public Private Total
Health Satellite Accounts: Diagnostic of the Health Accounts Methodologies in Latin America and the Caribbean
LATINOAMÉRICA Y EL CARIBE, 1998-2000: Gasto Nacional en Salud como Porcentaje del Producto Interno Bruto
0.00
2.00
4.00
6.00
8.00
10.00
12.00
0 1000 2000 3000 4000 5000 6000 7000 8000 9000Ingreso per cápita en Dólares de EEUU de 1999
Gasto
Nacio
nal e
n S
alu
d c
om
o P
orc
enta
je d
el P
IB
HAI
NIC
HON GUY
BOL
CUB
GUT
DOR
ELS
ECUJAM
PAR
COL
PER
STV
BEL
PAN
VEN
COR
BRA
CHI
TRT
MEX
URU
ANG
BAR
NEA
ARG
Health Satellite Accounts: Diagnostic of the Health Accounts Methodologies in Latin America and the Caribbean
Chart 2: Range of NHE as % of GDP by Income Groups; Average, Minimun and Maximun Values
44.4 4.5
3.9
6.2 6.2
7.2
6.5
9.2 9.3
10.3
13
0
2
4
6
8
10
12
14
1 2 3 4
Group of Countries, by Income per capita
NH
% o
f G
DP
Health Satellite Accounts: Diagnostic of the Health Accounts Methodologies in Latin America and the Caribbean
Latinoamérica y el Caribe, 1998-2000
COMPOSICIÓN DEL GASTO NACIONAL EN SALUD
Gasto P rivado
Indirecto(Seguros/P re-
pagas)
18%
Gasto P rivado Hogares
directo
37%
Gobierno Central
23%
Gobiernos Locales
8%
Seguridad Soc ial
14%
Latinoamérica y el Caribe, 1998-2000
COMPOSICIÓN DEL GASTO NACIONAL EN SALUD
Gasto P rivado
Indirecto(Seguros/P re-
pagas)
18%
Gasto P rivado Hogares
directo
37%
Gobierno Central
23%
Gobiernos Locales
8%
Seguridad Soc ial
14%
Health Satellite Accounts: Diagnostic of the Health Accounts Methodologies in Latin America and the Caribbean
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
NH
E a
s %
of
GD
P
1980 1985 1990 1995 1998-2000 2004-05
National Health Expenditure in Latin America and the Caribbean: 1980-2004/05
Central Gov. Local Gov. Public Insurance Household's Final Cons. Private Ins./Prepaid Medic.
Health Satellite Accounts: Diagnostic of the Health Accounts Methodologies in Latin America and the Caribbean
Health Accounts Methodologies: • Non-SNA:
– National Health Accounts - NHA– System of Health Accounts –
National Health Accounts
• SNA - Based:– National Health Expenditure
Accounts -NHEA– Health in the System of National
Accounts -SNA– Health Satellite Accounts:
• Health Sector/System Satellite Accounts
• Household Sector Satellite Accounts: Gender & Health
• Populations’ Health Satellite Accounts
• Methodologies:
• Convergence to work within the SNA framework
• Correspondance or Satellite Accounts
• Results: ?• We know how much is being
spent (NHExp);• We do not know how much
is being produced and how much is being used as Final Consumption Expenditures
National Health Expenditure Accounts -NHEA (Expenditure
and Sources of Financing/Revenues)
National Health Expenditure and
Sources of Financing
PAHO NHEA (NHExp**) -UN's Functional Classifications
Health Accounts
Approaches
Health in the System of National Accounts -
SNA
Health and
Health Sector
Economic and
Financial Indicators
Supply and Uses Tables SUT -Health
Health Satellite Accounts: Diagnostic of the Health Accounts Methodologies in Latin America and the Caribbean
SNA Based:
Tabelas de Usos de bens e serviços - Demanda e Valor Adicionado
A = B 1 + B2
C
Health in the System of National Accounts -SNA
Health Services Sector/ System
Satellite Accounts
Health Accounts
Approaches
Health Satellite Accounts HAS
Health and
Health Sector Economic and
Financial Indicators
Household Sector Satellite Accounts: Gender and Health
Populations' Health Satellite Accounts (Health Outcomes)
Health Satellite Accounts: Diagnostic of the Health Accounts Methodologies in Latin America and the Caribbean
SNA Based:
Household Sector Satellite Accounts: Gender & Health
Actions: Making visible women’s contributions to health and development:
• Household sector accounts – complement to HSA & SNA
• The burden of under-funded public health care systems
• “cost shifting”/ invisible costs of cost containment/adjustment policies
• The impact of demographic and epidemiologic changes
• Women’s contribution to human development potential & poverty reduction
Health Satellite Accounts: Diagnostic of the Health Accounts Methodologies in Latin America and the Caribbean
Health Satellite Accounts: Diagnostic of the Health Accounts Methodologies in Latin America and the Caribbean
Health Satellite Accounts: Diagnostic of the Health Accounts Methodologies in Latin America and the Caribbean
Health Sector in SNA
Countries SUT Health
Health Care Services Sector/
Systems
Household Sector: Gender and Health
Populations' Health Satellite Accounts (Health Outcomes)
Argentina X X
Belize Bolivia X Brazil X X Canada X (X)Colombia XCosta Rica X (X)Chile X X (X)Dominican Republic (X)Ecuador X XEl SalvadorGrenadaGuatemalaGuyanaHaitiHondurasMexico X X XNicaraguaPanama (X)Peru X XSurinameTrinidad & TobagoUruguayUnited States X (X)Venezuela X
Health Accounts in the Americas
SNA Based
(X): Being propossed
Health Satellite Accounts
x At least one completed country study or estimates for 2003 or before.
X : Ongoing or up- dated estimates to 2003- 05
Health Satellite Accounts: Diagnostic of the Health Accounts Methodologies in Latin America and the Caribbean
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Key Topics Estimation Methods Data Creating Health Accounts Obtaining Funding Identifying Country Team Choosing the Methodology Identifying Data Sources Disseminating Results Sustaining Health Accounts Events and Research Events Research Findings Using Health Accounts For Policy-Making To Assess Equity To Assess Efficiency To Understand Patterns of Spending
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Latin America and the Caribbean
Health Accounts
Website
This Website aims to inform and educate about health accounts, and to link all stakeholders to relevant
empirical data.
Descriptions of methodologies and of estimation results are intended to guide technical staff and health
sector policy-makers in using health accounts for policy
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Health Satellite Accounts: Diagnostic of the Health Accounts Methodologies in Latin America and the Caribbean
Heaalth Accounts Approaches Concepts Classifications
Boundaries
Data Sources/Estimation
Methods
System of Health Accounts OECD's
SHA
Agents: Providers, Sources of
Funding, Resident Units
Functional: (Activities, Products, Purposes)
HICHAFinancial/
Administrative Data
NHA Harvard PHR Plus USAID
Agents, Providers, Financial
Intermediaries Ad-hocFinancial/
Administrative Data
NHA* Producers Guide; USAID/World
Bank/WHO
Agents, Actors, Provider Agents, Financing Agents
Functional: (Activities, Products, Purposes)
HICHA
Financial/Administrative Data
PAHO NHEA (NHExp**) -UN's Functional Classifications
Insitutional Units and
Sector -SNA (5) + Rest of
the World
Classification of Expenditures by
Functions or Purposes CEF/CEP: COFOG, COICOP,
COPNI, COOP
Financial/Administrative Data
Health Satellite Accounts: Diagnostic of the Health Accounts Methodologies in Latin America and the Caribbean
SNA Based:
Heaalth Accounts Approaches Concepts Classifications Boundaries
Data Sources/Estimation
Methods
PAHO NHEA (NHExp**) -UN's Functional Classifications
Insitutional Units and Sector -SNA (5) + Rest of the
World
Classification of Expenditures by
Functions or Purposes
CEF/CEP: COFOG, COICOP, COPNI,
COOP
Financial/Administrative Data
Supply and Uses Tables SUT -Health
Insitutional Units and Sector -SNA (5) + Rest of the
World
Activities -ISIC; Products, CPC; Expenditure by
Functions or Purposes CEF/CEP)
Economic and Financial Indicators
Health Satellite Accounts: Diagnostic of the Health Accounts Methodologies in Latin America and the Caribbean
SNA Based:
Heaalth Accounts Approaches Concepts Classifications Boundaries
Data Sources/Estimati
on Methods
Health Services Sector/ System Satellite Accounts
Insitutional Units and Sector -
SNA (5) + Rest of the
World
Activities -ISIC; Products,
CPC; Expenditure
by Functions
or Purposes CEF/CEP)
Institutions, Activities,
or Products & Services
Economic and Financial Indicators
Household Sector
Satellite Accounts:
Gender and Health
Insitutional Units and Sector -
SNA (5) + Rest of the
World
Activities -ISIC; Products,
CPC; Functional
by Purposes;
ICATUS
Activities, or Products
Economic and Financial Indicators
Populations' Health
Satellite Accounts (Health
Outcomes)
Insitutional Units and Sector -
SNA (5) + Rest of the
World
Activities -ISIC; Products,
CPC; Functional
by Purposes; ICATUS, Human
Development HD*
? Economic and Financial Indicators
SNA Based: