The framework for Health Accounts is set out in A System of Health Accounts, published by the OECD. It is available for viewing and printing online on the OECD website. It includes the following concept of health care, definition of expenditure on health care and classifications:
The concept of health care in A System of Health Accounts
Activities of health care in a country comprises the sum of activities performed either by institutions or individuals pursuing, through the application of medical, paramedical and nursing knowledge and technology, the goals of:
promoting health and preventing disease
curing illness and reducing premature mortality
caring for persons affected by chronic illness who require nursing care
caring for people with health-related impairment, disability, and handicaps who require nursing care
assisting patients to die with dignity
providing and administering public health
providing and administering health programmes, health insurance and other funding arrangements
Total health expenditure measures consumption of health goods and services within the year, as well as expenditure on capital items which typically last longer than a year, or the final use of resident units of health care goods and services plus gross fixed capital formation in health care provider industries.
Total health expenditure is the sum of all health functions in the function classification plus the health related function entitled gross capital formation.
Health classifications
The detailed categories in the three Health Accounts classifications are listed below. More detailed information is available in the OECD's manual entitled A System of Health Accounts.
Description from the international framework; A System of Health Accounts
HC.1 Services of curative care
Curative care comprises medical and paramedical services delivered during an episode of curative care. An episode of curative care is one in which the principal medical intent is to relieve symptoms of illness or injury, to reduce the severity of an illness or injury or to protect against exacerbation and/or complication of an illness and/or injury which could threaten life or normal function.
Includes: obstetric services; cure of illness or provision of definitive treatment of injury; the performance of surgery; diagnostic or therapeutic procedures.
Excludes: palliative care.
HC.2 Services of rehabilitative care
This item comprises medical and paramedical services delivered to patients during an episode of rehabilitative care. Rehabilitative care comprises services where the emphasis lies on improving the functional levels of the persons served and where the functional limitations are either due to a recent event of illness or injury or of a recurrent nature (regression or progression). Included are services delivered to persons where the onset of disease or impairment to be treated occurred further in the past or has not been subject to prior rehabilitation services.
Note: rehabilitative care is generally more intensive than traditional nursing facility care and less than acute (curative) care. It requires frequent (daily to weekly) recurrent patient assessment and review of the clinical course and treatment plan for a limited (several days to several months) time period, until a condition is stabilised or a predetermined treatment course is completed.
HC.3 Services of long-term nursing care
Long-term health care comprises ongoing health and nursing care given to those who need assistance on a continuing basis due to chronic impairments and a reduced degree of independence and activities of daily living. Inpatient long-term care is provided in institutions or community facilities. Long-term care is typically a mix of medical (including nursing care) and social services. Only the former is recorded in the SHA under health expenditure.
HC.4 Ancillary services to health care
This item comprises a variety of services, mainly performed by paramedical or medical technical personnel with or without the direct supervision of a medical doctor, such as laboratory, diagnosis imaging and patient transport.
HC.5 Medical goods dispensed to out-patients
This item comprises medical goods dispensed to outpatients and the services connected with dispensing, such as retail trade, fitting, maintaining, and renting of medical goods and appliances. Included are services of public pharmacies, opticians, sanitary shops, and other specialised or non-specialised retail traders including mail ordering and teleshopping.
HC.6 Prevention and public health services
Prevention and public health services comprise services designed to enhance the health status of the population as distinct from the curative services, which repair health dysfunction. Typical services are vaccination campaigns and programmes. Note: prevention and public health functions do not cover all fields of public health in the broadest sense of a cross-functional common concern for health matters and public actions. Some of these broadly defined public health functions, such as emergency plans and environmental protection, are not part of expenditure on health (but instead are classified as health related functions).
HC.7 Health administration and health insurance
Health administration and health insurance are activities of private insurers and central and local authorities, and social security. Included are the planning, management, regulation, and collection of funds and handling of claims of the delivery
Health-related functions
(Note: ONS has only compiled information on HC.R.1 Capital formation)
HC.R.1 Capital formation of health care provider institutions
HC.R.2 Education and training of health personnel
HC.R.3 Research and development in health
HC.R.4 Food, hygiene and drinking water control
HC.R.5 Environmental health
HC.R.6 Administration and provision of social services in kind to assist living with disease and impairment
HC.R.7 Administration and provision of health-related cash-benefits
Classification of health care financing
Source of financing
Description from the international framework; A System of Health Accounts
HF.1 General government
This item comprises all institutional units of central, state or local government, and social security funds on all levels of government. Included are non-market non-profit institutions that are controlled and mainly financed by government units.
HF.2 Private sector
This sector comprises all resident institutional units which do not belong to the government sector.
HF.3 Rest of the world
This item comprises institutional units that are resident abroad.
Classification of providers of health care
Provider
Description from the international framework; A System of Health Accounts
HP.1 Hospitals
This item comprises licensed establishments primarily engaged in providing medical, diagnostic, and treatment services that include physician, nursing, and other health services to inpatients and the specialised accomodation services required by inpatients. Hospitals may also provide out-patient services as a secondary activity. Hospitals provide inpatient health services, many of which can only be provided using the specialised facilities and equipment that form a significant and integral part of the production process. In some countries, health facilities need in addition a minimum size (such as number of beds) in or der to be registered as a hospital.
HP.2 Nursing and residential care facilities
This item comprises establishments primarily engaged in providing residential care combined with either nursing, supervisory or other types of care as required by the residents. In these establishments, a significant part of the production process and the care provided is a mix of health and social services with the health services being largely at the level of nursing services.
HP.3 Providers of ambulatory health care
This item comprises establishments primarily engaged in providing health care services directly to outpatients who do not require in-patient services. This includes establishments specialised in the treatment of day-cases and in the delivery of home care services. Consequently, these establishments do not usually provide in-patient services. Health practitioners in ambulatory health care primarily provide services to patients visiting the health professional’s office except for some paediatric and geriatric conditions.
HP.4 Retail sale and other providers of medical goods
This item comprises establishments whose primary activity is the retail sale of medical goods to the general public for personal or household consumption or utilisation. Establishments whose primary activity is the manufacture of medical goods for sale to the general public for personal or household use are also included as well as fitting and repair done in combination with sale.
HP.5 Provision and administration of public health programmes
This item comprises establishments primarily engaged in the sale of hearing aids to the general This item comprises both government and private administration and provision of public health programmes such as health promotion and protection programmes.
HP.6 General health administration and insurance
This item comprises establishments primarily engaged in the regulation of activities of agencies that provide health care, overall administration of health policy, and health insurance.
HP.7 Other industries (rest of the economy)
This item comprises industries not elsewhere classified which provide health care as secondary producers or other producers. Included are producers of occupational health care and home care provided by private households.
HP.9 Rest of the world
This item comprises all non-resident units providing health care for the final use by resident units.
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