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National health accounts (NHA) are a synthesis of the fi nancing and spending fl ows recorded in the operation of a health system, with the potential to monitor all transactions from funding sources to the distribution of benefi ts across geographical, demographic, socioeconomic and epidemiological dimensions. NHA are related to the macroeconomic and macrosocial accounts whose methodology they borrow. Annex Table 5 provides the best estimates that were available to WHO up to July 2003 for each of its 192 Member States. Although more and more countries collect health expenditure data, only a limited number have produced full national health accounts. Nationally and internationally available information that has been identifi ed and obtained has been compiled for each country. Standard accounting estimation and extrapolation techniques have been applied to provide adequate time series. A policy-relevant breakdown of the data (for example, public/private expenditure) is also provided. Each year draft templates are sent to ministers of health for their comments and their assistance in obtaining additional information as appropriate. The constructive responses from ministries have provided valuable information for the NHA estimates reported here. An important methodological contribution to producing national health accounts is now available in the Guide to producing national health accounts with special applications for low-income and middle-income countries (31). This guide is based on the Organisation for Economic Co-operation and Development (OECD) System of health accounts (32). Both reports are built on the principles of the United Nations System of national accounts (commonly referred to as SNA93) (33). The principal international references used to produce the tables are the International Monetary Fund (IMF) Government fi nance statistics yearbook, 2002 (34), International fi nancial statistics yearbook, 2003 (35) and International fi nancial statistics (September 2003) (36); the Asian Development Bank Key indicators 2002 (37); OECD Health Data 2003 (38) and International development statistics (39); and the United Nations National accounts statistics: main aggregates and detailed tables, 2000 (40). The organizations charged with producing these reports facilitated the supply of advance copies for WHO and gave additional related information, and their contributions are acknowledged here with gratitude.
Applied Health Economics and Health Policy (Springer Nature)
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National sources include: national health accounts reports, public expenditure reports, statistical yearbooks and other periodicals, budgetary documents, national accounts reports, statistical data on offi cial web sites, nongovernmental organization reports, academic studies, and reports and data provided by central statistical offi ces, ministries of health, ministries of fi nance and economic development, planning offi ces, and professional and trade associations. Annex Table 5 provides both updated and revised fi gures for 1997–2001. Figures have been updated when new information that changes the original estimates has become available. This category includes benchmarking revisions, whereby an occasional wholesale revision is made by a country owing to a change in methodology, when a more extensive NHA effort is undertaken, or when shifting the denominator from SNA68 to SNA93. Colombia is a case in point. Total expenditure on health has been defi ned as the sum of general government expenditure on health (GGHE or public expenditure on health), and private expenditure on health (PvtHE). All estimates are calculated in millions of national currency units (million NCU). The estimates are presented as ratios to gross domestic product (GDP), to total health expenditure (THE), to total general government expenditure (GGE), or to private expenditure on health (PvtHE). GDP is the value of all goods and services provided in a country by residents and non-residents without regard to their allocation among domestic and foreign claims. This (with small adjustments) corresponds to the total sum of expenditure (consumption and investment) of the private and government agents of the economy during the reference year. The United Nations National accounts statistics: main aggregates and detailed tables, 2000 (40), Table 1.1, was the main source of GDP estimates. For the 30 Member countries of the OECD, the macroeconomic accounts have been imported from the National accounts of OECD countries: detailed tables 1990/2001, 2003 edition, Volume II (41), Table 1. Collaborative arrangements between WHO and the United Nations Statistics Division and the Economic Commission for Europe of the United Nations have permitted the receipt of advance information on 2001. For Iraq, Lebanon and the United Arab Emirates, United Nations Economic and Social Commission for Western Asia data were used. When United Nations data were unavailable, GDP data reported by the IMF (International fi nancial statistics, September 2003) as well as unpublished data from the IMF Research Department have been used. They included Cape Verde, Comoros, Djibouti, Eritrea, the Gambia, Ghana, Guinea, Mauritania, and Sao Tome and Principe. In the few cases where none of the preceding institutions reported updated GDP information, WHO has used data from other institutions or national series. National series were used for Andorra, Federated States of Micronesia, Nicaragua, Niue, Palau, Samoa, Solomon Islands and Tonga. Figures for Kiribati were obtained from the Asian Development Bank. The estimates for the Democratic People’s Republic of Korea and Timor-Leste originate from policy reports, as no standard statistical sources had any information on these countries. Likewise, the estimates for Afghanistan, Liberia and Somalia orginate from the web site of the United Nations Statistical Department (UNSTAT). Estimates for Equatorial Guinea originate from the Banque des Etats de l’Afrique Centrale (BEAC). The data for China exclude estimates for Hong Kong Special Administrative Region and Macao Special Administrative Region. The health expenditure data for Jordan exclude the contributions from United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), which provided basic health services support to
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Denys Wilkinson 1982
1 562 136 (000) % total (000) % total (000) % total (000) (000) (000) (000) (000) (000) (000) (000) (000) (000) (000) (000) (000) (000) Respiratory diseases 3 702 6.5 1 912 6.4 1 790 6.6 124 133 199 176 23 Respiratory diseases 153 721 220 72 112 27 128 59 1 550 Chronic obstructive pulmonary disease 2 748 4.8 1 413 4.7 1 335 4.9 52 65 141 90 10 Chronic obstructive pulmonary disease 100 556 140 45 76 15 80 21 1 354 Asthma 240 0.4 122 0.4 118 0.4 12 14 6 10 2 Asthma 20 77 12 9 22 2 14 5 37 Digestive diseases 1 968 3.5 1 094 3.7 874 3.2 75 82 99 154 31 Digestive diseases 87 415 182 76 131 22 130 45 435 Peptic ulcer disease 264 0.5 155 0.5 109 0.4 7 8 6 11 3 Peptic ulcer disease 15 84 17 9 13 2 10 4 75 Cirrhosis of the liver 786 1.4 503 1.7 283 1.0 26 28 31 61 13 Cirrhosis of the liver 34 170 65 39 67 8 59 14 171 Appendicitis 21 0.0 12 0.0 10 0.0 1 1 1 2 1 Appendicitis 1 7 1 0 1 0 1 0 5 Diseases of the genitourinary system 848 1.5 442 1.5 406 1.5 51 55 66 55 15 Diseases of the genitourinary system 57 149 62 25 25 21 62 28 175 Nephritis/nephrosis 677 1.2 345 1.2 332 1.2 47 52 47 43 12 Nephritis/nephrosis 45 124 42 20 14 9 56 24 141 Benign prostatic hypertrophy 32 0.1 32 0.1 … … 1 1 1 2 0 Benign prostatic hypertrophy 2 11 1 1 3 1 2 0 6 Skin diseases 69 0.1 26 0.1 43 0.2 10 9 5 6 2 Skin diseases 5 10 9 0 3 1 4 1 3 Musculoskeletal diseases 106 0.2 38 0.1 69 0.3 4 3 17 10 2 Musculoskeletal diseases 7 10 20 2 4 1 2 6 20 Rheumatoid arthritis 25 0.0 7 0.0 18 0.1 1 0 3 2 1 Rheumatoid arthritis 1 3 4 1 1 0 0 2 5 Osteoarthritis 5 0.0 2 0.0 3 0.0 0 0 1 1 0 Osteoarthritis 0 0 1 0 0 0 0 0 0 Congenital abnormalities 493 0.9 255 0.9 238 0.9 21 35 13 40 5 Congenital abnormalities 20 129 11 13 14 19 64 4 104 Oral diseases 2 0.0 1 0.0 1 0.0 0 0 0 0 0 Oral diseases 0 0 0 0 0 0 0 0 0 Dental caries 0 0.0 0 0.0 0 0.0 0 0 0 0 0 Dental caries 0 0 0 0 0 0 0 0 0 Periodontal disease 0 0.0 0 0.0 0 0.0 0 0 0 0 0 Periodontal disease 0 0 0 0 0 0 0 0 0
World Health Organization
W waiting lists 35 water source, improved access to 108–109 western Africa, HIV prevalence 3 western Europe, incidence of sexually transmitted infections 4 WHO AIDS Medicines and Diagnostics Service xiv, 24, 26 collaborative assessment of child mortality levels 94 Evidence and Information for Policy cluster 93 guidance on ethical aspects 36, 37 guidelines 17, 23, 26, 27 Member States 156 Multi-Country Survey Study (MCSS) 96 responsibility for reporting on Millennium Development Goals