National health accounts: tracking health investments towards better health for all

Investing in health is an investment in the overall economy. When people can enjoy good health without facing financial hardship due to health-care costs, the benefits spill over to the broader economy. A healthier population means a more productive society.

The COVID-19 pandemic revealed significant gaps in health-care systems in many countries, forcing governments to re-evaluate their health-care spending. The crisis was particularly acute in places that faced challenges in infrastructure and lacked the capacities to track and manage their health-care spending effectively.

Health accounts provide crucial information for policy-makers

Countries can track whether they are making good investments in health-care systems through national health accounts. National health accounts offer a comprehensive picture of a country's health-care spending by tracking all financial resources that go into health-care - including from taxes, insurance and people's out-of-pocket spending. They break down how this money is spent, whether it is on primary care, medicines, hospital stays or other health-related expenses.

In combination with other data, health accounts provide crucial information for policy-makers to evaluate how and where money is being spent, allowing them to make more informed decisions about budgets and policies. Through national health accounts, governments and health organizations can monitor whether resources are being used for services and initiatives that allow people to access the care they need, while protecting them from financial hardship. National health accounts are constructed in comparable ways, allowing governments to compare their health spending patterns with that of other countries.

Health accounts and households: the real-world impact

Beyond their significance for governments, health accounts also play a crucial role in the lives of ordinary citizens. "If you care about your household budget, you should care about health accounts," said Dr Rabindra Abeyasinghe, WHO Representative to Malaysia, Brunei Darussalam and Singapore. Households often bear the brunt of inefficient health-care spending through high out-of-pocket expenses, pushing vulnerable families into poverty or significantly impacting their financial ability to live healthy and productive lives. Health accounts are a powerful tool for policy-makers to make health system and policy decisions that have real-world impact on the economic security of households.

Remaining gaps: sustainability and quality

Since 2000, the World Health Organization (WHO) has worked with more than 190 countries to produce national health accounts. The Organization also publishes annual national health accounts information on the Global Health Expenditure Database and through Global Health Expenditure Reports, supporting cross-country analyses of health expenditure trends. Similarly, the Organisation for Economic Co-operation and Development (OECD) works with its 38 member countries, five key partners and eight accession candidate countries to collect and publish annual comparative data to describe financial flows through health systems (OECD Data Explorer).

Although almost all WHO Member States are represented on these platforms, gaps remain in the production of health accounts. Recent reporting indicated that almost half of the 97 countries surveyed rely largely on donor and other external support to produce national health accounts, due to domestic financing and capacity challenges. This reliance on external help can undermine the sustainability and policy use of the health accounts. Further, challenges remain around the comprehensiveness, accuracy and quality of existing health accounts. For example, around 30% of countries worldwide do not have reliable data on financial flows for services such as curative care, preventative and promotive care, and rehabilitation. This percentage rises to 40% in the WHO South-East Asia Region and 63% in the WHO Western Pacific Region. These gaps limit a country's ability to accurately understand health-care spending, making it difficult to assess whether investments are reaching critical areas.

Moving forward: the future of health accounts

WHO is working with partners and governments to address these challenges. At the 19th  Meeting of Asia Pacific Health Accounts Experts organized by WHO and the OECD in Kuala Lumpur, Malaysia, on 28-29 August 2024, WHO Regional Director for South-East Asia, Dr Saima Wazed, emphasized the importance of institutionalizing health accounts. She highlighted the need for countries to enhance technical capacities to regularly produce and track health accounts and strengthen their use in policy-making. She also urged Member States to improve pharmaceutical expenditure tracking to inform health financing policies aimed at reducing out-of-pocket medicine costs. These steps, she noted, are essential for achieving better financial protection.

Mr Luca Lorenzoni from the OECD emphasized that investments that promote good health without causing financial hardship result in broader economic gains through improvements in human and physical capital, which drive higher productivity and per capita GDP.

The meeting concluded with a call to action for countries to continuously strengthen their health accounts production and policy use. Adopting existing frameworks and tools − such as the System of Health Accounts 2011 and the Health Accounts Production Tool − can support easy and comparable health accounts production, providing the ability to delve into health expenditure tracking for pharmaceuticals, disease, and rehabilitation. By building robust, transparent systems for tracking health-care spending, countries can ensure high-quality monitoring to ensure that their investments in health are well spent and improve the lives of their populations.

Comprehensive and accurate health accounts support policies that ensure all resources spent on health care translate to better services and health outcomes for all without causing financial hardship.