Ruben M. Suarez Berenguela Suarezru@paho Regional Advisor Health Economics and Financing

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 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


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


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


SNA Based:



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



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



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


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


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


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%


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 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


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)


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 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


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


Español Acronyms Glossary

Home About This Website What Are Health Accounts?

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

Welcome to the

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

Top of Form

Select a Country

Library Links Q&A LAC HA Newsletter Professionals Network Contact Us

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


Insitutional Units and

Sector -SNA (5) + Rest of

the World

Classification of Expenditures by

Functions or Purposes CEF/CEP: COFOG, COICOP,

COPNI, COOP



SNA Based:

Heaalth Accounts Approaches Concepts Classifications Boundaries

Data Sources/Estimation

Methods


Insitutional Units and Sector -SNA (5) + Rest of the

World

Classification of Expenditures by

Functions or Purposes

CEF/CEP: COFOG, COICOP, COPNI,

COOP


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


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


Household Sector

Satellite Accounts:

Gender and Health



World


CPC; Functional

by Purposes;

ICATUS

Activities, or Products


Populations' Health

Satellite Accounts (Health

Outcomes)



World


CPC; Functional

by Purposes; ICATUS, Human

Development HD*

? Economic and Financial Indicators

SNA Based:

Ruben M. Suarez Berenguela Suarezru@paho Regional Advisor Health Economics and Financing

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