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 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
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
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
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
- Analysis of the benefit
incidence of health expenditure in Egypt (DDM No. 81. The Distribution of Health Care Resources in Egypt:
Implications for Equity An Analysis Using A National Health Accounts
Framework by Ravindra Rannan-Eliya)
- Estimation of the total
public and private financing for population and reproductive health
services in Egypt and Sri Lanka, (Financing Reproductive and Family Planning Services: A Comparative
Study of the Pattern and Cost-Efficiency of Financing Strategies in
Two Low-Income Developing Countries).
- Assessment of private out-of-pocket
expenditure in Poland, (DDM No. 65. Financing Health Services in Poland: New Evidence
on Private Expenditure).
- Development of health care
financing projection model building on the NHA framework in collaboration
with the Health Insurance Commission of Australia.
Initiatives Report No.25, Vol. 1, A Prototype Health Financing Projection
Tool Based on National Health Accounts: The EgyptPro Model. Alan Fairbank,
Peter Berman, Afsar Akal, Roy Harvey, and Katherine Burchfield, May
Initiatives Report No. 25 Vol. 3, Health Finance Reform Model for
Egypt Based on National Health Accounts. Afsar Akal and Katherine Burchfield,
May 2000. With Financial Support from USAID through the Partnership
for Health Reform.
of the impact of aging populations in developing countries on health
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