International Health Systems Program  
Department of Global Health and Population
Harvard School of Public Health
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RESEARCH


National Health Accounts

1. IHSP's contribution towards the emerging international methodology
2. NHA Software (v. 1 and 2)
3. NHA Training
4. Development and Use of NHA Internationally

IHSP is a leader in the development and application of National Health Accounts internationally. Prof. Peter Berman, IHSP Director, and the IHSP staff and consultants have made widely recognized contributions to the development of NHA methods, dissemination of their application in more than 30 countries, and specific uses of NHA to address important health system and policy issues.

National Health Accounts is a methodology for analyzing total expenditure on health, including both public and private funding. It is increasingly recognized as an essential part of health systems analysis and assessment, much as good data on mortality or fertility is essential for assessing health and population conditions.

National health accounts provides a framework for collecting and organizing information on total health spending in a country or region during a year. It helps analysts understand where the money for health comes from, who are the payers and purchasers in the health system, and how the money is used, in terms of a well- defined set of "uses" definitions. National health accounts also provides the basis for more specific analysis of policy issues in health care financing, such as resource allocation to priority health problems and population groups, projecting the financing impact of proposed health financing reforms and other policy changes.

IHSP's contributions to NHA development worldwide include:

  • Early leadership in the adaptation of successful methods from the USA and OECD countries to the middle and lower income countries and further advancing methodology development towards a standard international approach.
  • NHA Software (versions 1 and 2)
  • "Creating and Using NHA in Health Financing Reform" - a two week training course for NHA practitioners from low and middle income countries, offered in 2000, 2001, 2002 in Stowe,Vermont, USA and likely to be offered again in 2004.
  • Technical assistance and research on NHA in Africa, Asia, and Latin America, and Eastern Europe and the Former Soviet Union and development of innovative policy applications using NHA data



 

1. The "Harvard Method" and the emerging international methodology

Prof. Berman advanced the application of conceptually consistent and multi-dimensional classification schemes for health expenditures in lower income countries as well as expanding the focus of NHA to include the resource mobilization aspects of health financing. This work was initially referred to by others as the "Harvard method" in NHA in the mid 1990s. (DDM No. 36. National Health Accounts in Developing Countries: Appropriate Methods and Recent Applications). The method includes explicit analysis of sources of financing, financing intermediaries, and logically consistent classifications of the uses of funds.

IHSP researchers has also helped analyze the link between NHA methods and the measurement of national income using the U.N.'s System of National Accounts (Health Accounting: A Comparison of the System of National Accounts and National Account Approaches).

Work by the OECD, specifically the development of the System of Health Accounts framework (OECD, 2000), further advanced many of these approaches and integrated them with international economic statistics standards developing a standard international classification scheme, the ICHA or International Classification for Health Accounting. Health accountants worldwide are increasingly moving towards a common international framework. This effort has been further supported by international organizations, including WHO, World Bank, USAID, OECD, and Sida, who have contributed to the development a new manual "A Producers Guide for National Health Accounts" which will be published by WHO and World Bank in Spring 2003. Peter Berman and Dan Waldo contributed substantially to this Guide (among others) and were its technical editors

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2. NHA Software (v. 1 and 2)

Prof. Berman has collaborated with David Cooper, an independent software developer, to produce the NHA software, now in its second version. The NHA software is a windows-based training and data management tool. "National Health Accounts v. 1" represents initial development of the "Harvard Method". It was developed with support from USAID through the Data for Decision Making Project. (National Health Accounts Framework and Software). "National Health Accounts v. 2" incorporates the new OECD ICHA classification scheme while still allowing flexibility for national adaptation and is compatible with more advanced versions of MS Windows such as Windows 95, 98, 2000, and NT. It was developed with support from USAID through the Partnerships for Health Reform Project. It is available from IHSP.

The NHA software has been used extensively in training programs in Latin America, Africa, and the Middle East, as well as by the World Bank Institute's Flagship Course on Health Sector Reform and Sustainable Financing and IHSP's NHA training (see below).

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3. NHA Training

IHSP's course on "Creating and Using National Health Accounts for Health Financing Reform" in Stowe, Vermont, USA has been offered 3 times, in 2000, 2001, and 2002. This two-week course provides training in theory, methods, and applications of NHA relevant to planners and practitioners in low and middle-income countries. The course will likely be offered again in 2004. Check the IHSP training page for updated information.

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4. Development and Use of NHA Internationally

IHSP has participated in the development of NHA data and analysis in more than thirty countries around the world. A major effort in NHA development has been supported by USAID via the Partnerships for Health Reform Project, in which IHSP was a sub-contractor to Abt Associates, Inc. Prof. Berman has been the Team Leader for the NHA Special Initiative under that project.

Through PHR, IHSP developed the regional NHA network approach. PHR funded three regional networks and IHSP led in the development and technical support for two of them: in Latin America (in collaboration with PAHO) and in Southern and Eastern Africa (in collaboration with the Swedish International Development Association (SIDA), the World Bank, and the Government of South Africa. IHSP also participated in the third network in the Middle East. Results from the Latin American Network have been published (Health Care Financing in Eight Latin American and Caribbean Nations)

Results from the other two networks may be available from the PHR+ project at http://www.phrplus.org/.

Prof. Berman and colleagues at IHSP has also been involved NHA work in a number of specific countries. This includes: Egypt 1991, (DDM No. 25. National Health Accounts of Egypt), 1995 NHA, (DDM No. 25.1. Egypt National Health Accounts 1994/95 estimates, Colombia, India, Bangladesh, Estonia, Russia, Poland, Hungary, Guatemala, Honduras, Zambia, Kenya, and Nicaragua), and (DDM No 65. Financing Health Services in Poland: New Evidence on Private Expenditures). Currently, IHSP is working with the governments of Turkey and Nicaragua on detailed NHA studies.

NHA data make valuable contributions to health systems analysis, but they also provide the means for more focused analysis of specific policy problems and issues. IHSP's research using NHA includes:

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