National Health Accounts

NHA Introduction - Counting Health Beans

• National Health Accounts (NHA): Systematic, comprehensive, and consistent monitoring of financial flows within a nation's health system. It maps the "economic footprint" of healthcare.
• Primary Goals:
  • Track all health expenditure: sources, providers, functions, and beneficiaries.
  • Inform evidence-based health policy, planning, and resource allocation.
  • Enhance transparency, accountability, and system efficiency.
• Guiding Framework: System of Health Accounts (SHA) 2011 - an international standard.
  • Provides common definitions, classifications (e.g., financing, providers, functions), and accounting rules for comparable data.
• NHA answers key questions:
  • Who pays for healthcare? (e.g., Government, households, insurance)
  • Who provides the services? (e.g., Hospitals, clinics, pharmacies)
  • What services are consumed? (e.g., Curative, preventive, long-term care)

⭐ NHA data is crucial for tracking progress towards Universal Health Coverage (UHC) by monitoring key indicators like Out-of-Pocket Expenditure (OOPE) as a percentage of total health expenditure. This is a major focus in India due to high OOPE levels (often >50%).

NHA Key Indicators - The Money Trail

• Total Health Expenditure (THE): Aggregate of all health spending (public & private) in a country.
  • THE as % of GDP: Reflects national health spending priority. India (NHA 2019-20): 3.2%.
• Current Health Expenditure (CHE): THE excluding capital formation (e.g., new infrastructure).
  • Government Health Expenditure (GHE): All public spending on health.
    • GHE as % of THE (2019-20): 41.4%.
    • GHE as % of GDP (2019-20): 1.33%.
    • Includes Central, State, Local govt. & social security funds.
  • Out-of-Pocket Expenditure (OOPE): Direct payments by households at point of service.
    • OOPE as % of THE (2019-20): 47.1% (significant ↓ trend).
  • Other: Private Health Insurance, NGOs, External/Donor funds.
• The Money Trail (NHA Framework):
  • Financing Sources (FS): Where money originates (e.g., Govt revenue, Household income).
  • Financing Agents (FA) / Schemes: Entities managing funds (e.g., MoHFW, Insurance schemes).
  • Healthcare Providers (HP): Entities delivering services (e.g., Hospitals, Pharmacies).
  • Healthcare Functions (HC): Purpose of expenditure (e.g., Curative, Preventive care).

⭐ Key Exam Fact: A significant ↓ in Out-of-Pocket Expenditure (OOPE) as a percentage of Total Health Expenditure (THE) is a major policy goal, indicating improved financial protection. India's OOPE fell from 62.6% (NHA 2014-15) to 47.1% (NHA 2019-20).

NHA India Profile - Rupee Health Report

• National Health Accounts (NHA) Estimates for India: Published periodically by National Health Systems Resource Centre (NHSRC) under Ministry of Health & Family Welfare (MoHFW).
• Key Indicators from NHA:
  • Total Health Expenditure (THE): % of GDP. Recent trend: ~3.2-3.6% of GDP.
  • Government Health Expenditure (GHE): % of THE. Recent trend: ↑, approx. 40-42%.
    • Centre:State share in GHE is approx. 40:60.
  • Out-of-Pocket Expenditure (OOPE): % of THE. Recent trend: ↓, but still high, approx. 47-49%.
    • Major cause of catastrophic health expenditure and impoverishment.
  • Private Health Expenditure: Includes OOPE, private insurance, NGO expenditure.
  • Social Security Schemes: Contribution to THE is relatively low, approx. 5-9%.
  • External/Donor Funding: % of THE, generally low, <1%.
• Per Capita Health Expenditure: Shows significant state-wise variations.
• Focus Areas:
  • Primary healthcare expenditure share.
  • Expenditure on preventive vs. curative care.

⭐ NHA 2019-20 Highlights: Government Health Expenditure (GHE) as a percentage of GDP increased from 1.13% in 2014-15 to 1.35% in 2019-20. Out-of-Pocket Expenditure (OOPE) as a percentage of Total Health Expenditure (THE) decreased from 62.6% to 47.1% during the same period.

• Rupee Health Report: Often refers to analysis of how healthcare is financed and where the money goes, using NHA data as a primary source. Highlights state-level performance and disparities.
• Policy Implications: NHA data crucial for health policy formulation, resource allocation, and monitoring progress towards Universal Health Coverage (UHC).

High‑Yield Points - ⚡ Biggest Takeaways

• National Health Accounts (NHA) track all health-related financial flows in a country.
• Key indicators: Total Health Expenditure (THE), Government Health Expenditure (GHE), Out-of-Pocket Expenditure (OOPE).
• NHA informs health policy, monitors spending, and allows international comparisons.
• India's NHA Cell is hosted by the National Health Systems Resource Centre (NHSRC).
• Follows the System of Health Accounts (SHA) 2011 global framework.
• Tracks desirable trends: ↑GHE/GDP, ↓OOPE/THE.