The Future of Healthcare in America

Subject: Healthcare Financing
Pages: 25
Words: 9407
Reading time:
32 min
Study level: PhD


The future of healthcare in America looks bleak—but it does not have to be. Envoy Paul Ryan (R–WI) has proposed “A Roadmap for America’s Future”—the only complete plan in America that deals with the threatening pecuniary and economic crisis, driven by ever-increasing government spending on health care. Ryan’s Roadmap would lower the shortfall, let Medicare become justly sustainable, set up evenhandedness and aptitude in the federal levy dealing of health insurance, and recuperate contact to health care for middle and low-income family units. Congressman Ryan’s detractors have accused him of attempting to eradicate the Medicare system and allege that the Roadmap will raise the deficit. While they may have honed the severity of their expression, they have not offered a similar alternative. Heritage Foundation health strategy specialists explain how the Ryan Roadmap would actually operate, and how it would benefit Americans.

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The future of the stakeholders and physicians is geared towards partnership and offering affordable services to all. For example rather than pay hospitals, physicians, and pharmaceutical companies for entity treatments, CMS will instead disburse all concerned stakeholders for the bundle of services surrounding the entire occurrences of a patient’s care. This can be achieved if the stakeholders have communal associations under the Patient Protection and Affordable Care Act.

All in all, there is need for business coaching to all secondary stakeholders in order to help improve communication with the doctors and to understand the concerns of traditionally independent doctors with new skills thus leading to improved services.

However, the fundamental change from the reimbursement model in the United States healthcare system is changing, which requires an exchange of data among various entities involved in patient care to maximize the accomplishment outcome and treatment efficiencies. Not only data sharing but also medical payments will be shared resulting in the need for stakeholders in the most current transition to stakeholder’s partnership in new system.

The heterogeneous or diverse nature built in physicians will set task for communication among stakeholder partners disproportionally upon secondary stakeholder partners. To accept the behavior efficiencies demanded in a VBP system, secondary stakeholder partners will also be bound to assist in the physicians’ successful transition in to a homogeneous group of stakeholder partners. To achieve all this, evidence-based study on coaching of doctors is needed to assemble information and help transition into success.

Literature Review and Annotated Bibliography

To meet the growing health care needs of the population, doctors and stakeholders working with several insurance corporations came up with some feasible conclusions. They agreed that there is need to focus on practical and feasible solutions to health care financing. The stakeholders have devoted considerable attention to this topic, particularly over the last five to ten years, primarily on the issues of containing costs, mobilizing new resources, allocating existing resources more efficiently and increasing the role of the private insurance companies. Experience up to date has shown that, in general, almost every financing strategy works somewhere under some set of circumstances. On the other hand, specific financing schemes that are flourishing in one state are not necessarily successful in another. Since each state has different needs, standard set solutions cannot be imposed.

To help guide professionals towards suitable solutions, this annotated bibliography presents chosen reports and evaluations on health care financing issues drawing from several documents available in most health insurance companies. Such a large set makes a complete bibliography impractical. As a result, as stated by Berman “this compilation concentrates primarily on related case studies and reports that synthesize experience or lessons across various projects and country programs” ( Berman, 1997).

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Although many of the documents presented here may cover more than one face of health care financing, to provide some direction for the reader, the bibliography is divided in to the following sections:

  • Universal health care financing.
  • Privatization and the private sector.
  • Public sector and enhanced allocation and running of health insurance companies.
  • Major changes to the sector.
  • Insurance.
  • Future for the doctors.
  • Future of the health care stakeholders.

Universal health care financing

Due to the economic crisis, public health care expenditure and quality have declined in most states. This report presents findings on health care financing in ten years. The PAHO stated that “background information on the economy, health systems, and health policies is followed by research findings on three topics: health care costs, household demand for health care, and feasibility of alternatives to financing health care from general tax revenue” (Pan American Health Organization, 1994).

The report recommends that the legislature not only continues to highlight public health care, but widen its scope to include help to medical care programs under social security. These two sub-sectors account for two-thirds or more of the total health sector financing in the countries reviewed, and they have the main accountability for serving the low and middle income inhabitants.

Cost control efforts should aim at large hospitals operated by ministries of health and social security institutions and focus on restrictive personnel budgets and redirecting ambulatory care from hospitals to primary health care facilities.

Privatization and the private sector

Customer fulfillment through responsible advertising is central to successful privatization of health care services, according to the study prepared for AID’s near East Bureau. The study’s main segment explores several consumers relevant to classified privatization. These include the call to keep price strategies socially reasonable, continuance of the excellence of privatized health care, and transport services that meet consumers’ real and altering needs.

Public sector and enhanced allocation of health insurance companies

A major verdict is that policy improvement in this area, as much as it is an opinionated technical process, requires politically and culturally susceptible assistance. Moreover, there is no global technique for success. Health financing schemes that work in each state differ. For example what works in California may not work in Alabama. The review as well demonstrates that policy reform takes time in part because it involves extensive institutional change. It takes years to adopt a new scheme, for discussions must take place and thoroughly involving research undertaken.

Major changes to the sector

The stakeholders should be allowed to make suggestions to enhance services. A survey should be carried out to ask on the challenges and what is good. Due to the fact that the physicians and the clients boost the services, they also need to be incorporated in making decisions thus benefits are long term to the field. However, changes too must be discussed thoroughly for a substantial alteration to be effected after research.

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Undertaken in reaction to an increase of consciousness and need for an unconventional health care financing method in America, this volume reviews the presented level of prepaid health care in the region and examines the feasibility of nurturing the development of health maintenance organizations.

Several entity reports are included casing the principles underlying the health maintenance organizations, their advantages and disadvantages and the experience as a whole. The thorough analysis of pre-paid plans and projections for the development of the health maintenance organizations like delivery systems available and the legal and regulatory considerations for the development are also very vital as each state has its health laws. An administrative summary notes the miscellany of prepaid health plans in organizational structure, financing mechanisms and levels of coverage in the whole country where major numbers of prepaid health organization were found.

Future of the doctors

Considering the rise in diseases, there is the need to hire more doctors as well as the need to have more research undertaken. The reports included the number of years for thorough training on several diseases considering the mass of immigrants to the country, the amount involved for studying as more doctors are required to attend to patients; at least in a population of fifty there should be two and also the legal laws that should govern them which must be assessed so as to enable checks and balances in the services rendered.

However, a conclusive report showed that scores of research doctors are needed in order to achieve results for treating the many diseases that were erupting as well as financing to the hospitals which should be increased considerably for better results.

Future of the Stakeholders

Zshock stated that social financing “is a fashionable and very valuable solution to the demand of pooling risk to reduce the effects of disastrous losses” (Zshock, 1986). According to the World Bank, social insurance, however, often creates equity, coverage, and institutional problems in health care (World Bank, 1993). The study examines how the stake holder’s concept is perceived towards fair equity of financing.

Associations formed ensure the financing is also improved as more funds can be raised (World Bank, 1997). What suggestions are offered to get a sequential review of health insurance development in the United States to offer additional data on financing sources?

Policies were made up to ensure most of the new suggestions were affected duly as per the stakeholders request to improve on the health financing.

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Values and Approach

The same way all nations encounter hardships such as intricate situations as well as variety, so does the United States of America. Innovative medicines, technological developments, rising expectations and aging population’s fuel enlarged demand putting upward demands on system costs. Along with macro-economic, demographic and fiscal constraints, they limit the extent to which governments can simply allocate more public revenues for health. The blend of upward pressure on costs and limitations on the ability of governments to increase spending, forces countries to consider reforms to the way that their health systems are financed.

The approach is built on three pillars. They are a set of aims for health finance policy that are applicable to all parts of the country, grounded in the heart values espoused by WHO and derived from the structure given in the world health report (World Health Organization, 2003). These provide the direction in which reforms should try to push the systems. As such, the proposed policy objectives also serve as criteria against which the effects of reforms to health financing systems can be assessed.

The second pillar is a theoretical framework for analyzing the organization of national health financing systems. This is used to explain the functions and policies linked with all health financing systems, irrespective of the copy or label used to classify them. Use of such a descriptive framework is necessary for tailoring analysis to the deliberation of specific reforms in specific country contexts, because the way in which a health financing system is currently prepared provides the starting point from which any reform begins.

The third pillar consists of an appreciation and analysis of how key contextual factors, particularly fiscal constraints, bound the extent to which a country can maintain achievement of the policy objectives, and may limit the range of policy options that can be considered. This pillar thus allows a sensible analysis to be made of what is practicable to implement and what can be attained.

The move toward health financing policy recommended here embodies certain core principles and concepts outlined below.

As with all aspects of health policy, it is vital to make a clear division between the objectives of health financing policy like improving financial guard, improving access to care and instruments of health financing policy like formation of an insurance scheme and reform of provider methods. Related to this, the analysis of projected and implemented reforms should center on the effects upon the population and system as a whole. Schemes are not systems.

Given the first standard, it should be understood that all health financing systems other than pure cash expenses are systems of insurance, and should be assessed by how well they attain related objectives for the populations that is financial protection and equity of assess for example, to a certain extent than what is generally applied to existing system. It is essential that health correlated decision-makers should not let the label that is applied to their system limit deliberation of the available policy options.

There are no theoretical reasons as to why the source of funds should decide how they are pooled, how services are purchased, or the detail with which advantage entitlements are specified.

A clear focal point on the policy objectives should be joined with a deep understanding of the accessible organization of health financing functions and policies, and of the fiscal and other related factors that condition the possibility and expected effects of different policy options. Reforms should be leaning to the policy objectives and the descriptive frameworks used as a “checklist” to ensure that reform instruments are associated with the desired objectives.

Recent and expected future fiscal pressures involve the fact that all states must redouble efforts to advance the efficiency of their health financing systems. Efficiency is not synonymous with fiscal sustainability. Hence promoting efficiency does not imply a slight focus on cutting budgets. Instead, it suggests a larger approach to ensure that whatever is spent on health, yields the greatest return in terms of growth on policy objectives given the reality that spending must be in line with available resources.

Related to these conditions, incentives in the wide public finance surroundings should allow the benefits like savings from any efficiency gains made, to be retained by the health system and used to advance its performance.

Implementation, evaluation, learning and adaptation

Health financing reforms, like health reforms more generally, should be calculated using a strong conceptual and evidence base, while recognizing that not the whole lot can be considered. There will always be a degree of doubt in terms of both implementation and outcome. Hence, policy reform is as much art as science, and decision-makers should, where feasible, facilitate learning through accomplishment and costing of pilots. It is essential for every country to institutionalize reform evaluation mechanisms, thereby enabling an adjustable health policy procedure to build on information generated from its own reform experience. It is also significant and extremely helpful for states to learn from experiences of others because each state has its own situation and starting point for reform. However, it is equally vital to recognize that policies may not bluntly be transplanted from one state to another.

Although it’s not possible to reduce health financing policies or overall policies to a narrow, technocratic formula, the ‘three pillars’ provide a guide to decision-makers on how to approach health financing policies in their own context. Key steps include the following:

  • Using the health finance objectives as a guide to identifying an exact set of problems and priorities with regard to the performance of the health financing system.
  • Accommodating the fact that once it gets to creation of an effectual health financing strategy, a meticulous analysis ought to be prepared of the on hand structure of health funding using the expressive outline to offer a ‘checklist’ to guarantee deliberation of all sub functions and each and every resource allotment mechanisms, policies on people entitlements and compulsion and the stewardship provisions for the entire structure.

These measures should be plotted to take account of the flow of finances, the scope of vertical incorporation or disjointing of purposeful responsibilities and the market configuration contained by each sub function as a handy means of perceiving the offered health financing system- the “starting point” for any reorganizational plan.

The following significant functional locales where strategy mechanisms are uneven ought to be acknowledged:

  • Evaluating the fiscal framework in association with the funding ministry, by means of chronological data on communal proceeds and overheads, as well as forecasts of probable circumstances.
  • Categorizing and scrutinizing all other appropriate external aspects from the health scheme that may have repercussion for the accomplishment or penalties of meticulous restructuring alternatives.
  • Developing a set of reorganizational alternatives leaning to deal with the priority presentation tribulations or aims of the system. The expressive outline should be used as a channel to make certain of an all-inclusive approach from the contemporary preliminary point and to steer clear of the enticement of ‘magic bullet’ elucidations that accentuate just particular restructuring mechanisms. The aims and projected preference should be checked against the financial position to guarantee that these are sensible to the public perspective.
  • Facilitate educated civic discourse to the temperament of the system’s aims and tribulations, as well as the choice of improvement. Popular prospect that all will be offered for all and sundry ought to be administered by spreading the theory of sustainability substitution, and for this reason the call for some type of allotment. No resolution will please one and all, but the varieties and trade-offs must be made explicit.
  • Taking benefit all the way through the course of the authenticity that each nation in the globe is besieged with how to reorganize its health financing system.

These familiarities should be learnt from and meticulous lessons personalized to the national background.

In conclusion, it can be firmly stated that at hand is the need to accentuate that basically, there is no blueprint for how health funding systems should be prepared. As an alternative, the approach projected to affiliate states, is to use the policy objectives to familiarize the course for health financing reform, comprehend the on hand structure in terms of purpose and policies to set the preliminary position from which any modification must embark on and recognize the monetary and any other supplementary contextual aspects to ascertain reasonable confines on the scope to which the realization of strategy objectives can be nonstop and the assortment of policy reforms that can be well thought-out. Hence, while the advance is basically grounded in a widespread set of principles and target, it is also tolerant towards analysis and suggestions that are state-specific and pragmatic. More commonly, W.H.O. is devoted to any particular secretarial organization.

Validity and Reliability

The quality of health concerns is all the time more the theme of inquiry by an array of stakeholders, health care giving institutions, health experts and their agent bodies, health consumers and funders, policy architects and national governments, patients and clients of health services. The use of a multiplicity of quality measures has turned out to be extensive in the healthcare schemes in the nation. The identical tasks of measuring and humanizing the excellence of care typically termed as quality assurance have been dealt with by new provisions for specialized accountability, fresh approach to running and contrasting organizational presentation and up-to-the-minute governmental and official machinery.

There are unpleasant procedures in healthcare, which may be defined as cases in point which point out or may point out that a patient has been given low quality care and may present an imperative break for quality measurement and enhancement. There is far-reaching verification that unfavorable events are relatively widespread, that they have severe and long-lasting impacts on consumers thus amounting to colossal costs to healthcare institutions. Uniformly essential undesirable events, proffer an insight to the strong points and weaknesses of healthcare methods and a valuable prospect to bring about upgrading in the quality of care delivered.

Adverse proceedings have been used quite extensively, predominantly in America, as the foundation of a number of actions of the quality of healthcare. However, these actions have rarely been developed and weathered meticulously before they have entered practice and there have been disputes about their gains and drawbacks.

A string of experiential studies were embarked on, using statistics collected through the use of unpleasant incident measures of quality in an American acute infirmary designed at scrutinizing the validity and reliability of those procedures. The outcomes illustrated that the unfavorable incident measures being weathered had temperate to good face, substance and construct validity. Although their legitimacy was capable of enhancement, it was still apparent that they were evaluating meaningful and significant aspects of the quality of healthcare. However, the dependability of the measures being weathered was more assorted. While tentative studies of reliability pointed out that they had a temperate to good quality reliability, observational studies recommended that the reliability in real employ, might be subordinate to those established during tests.

This investigation wraps up with the fact that undesirable incident measures of quality are vital procedures of the quality of health care, which ought to be used in healthcare reassurance with two key requisites. The expansion of procedures must be very thorough and should give more thought to equal validity and reliability matters. Furthermore, the habitual use of such procedures should integrate some aspects of constant reliability testing, so as to guarantee that high-quality reliability is upheld.

Data type and collection

The veracity and tactic of the statistics and collection used, was survey on questionnaires. The evaluation was not to be used as a prognostic economic analysis of the brunt of the Affordable Care Act. It zooms in on the stance of employers and avails a perception of the issues that could sway decision making allied to employee and patient benefits.

As such, our survey conclusions are not on a par with the healthcare research and analysis carried out by others reminiscent of the Congressional Budget Office, RAND along with the Urban Institute IADB which was formed in 1998. Each one of those studies used economic reproductions, not opinion surveys, and was founded on the brunt of healthcare reform on persons, not employer stance.

While the McKinsey Quarterly critique touched on the survey and cited CBO approximation, any contrast would not be fitting. The lingo in the editorial column could direct all to suppose the research was a prophecy, except it is not.

As the survey results stated, 30% of respondents (9%“definitely” and 21% “probably”) who said their corporations offered employer subsidized health insurance, alleged they would “definitely” or “probably” abandon coverage in the days subsequent to 2014, the time that the Affordable Care Act would seize complete effect.

The third principal market and opinion research firm in the globe was to place the online study founded upon an opinion poll (questionnaire), developed by McKinsey, and acknowledged respondents from a team of just about 600,000 citizens, sustained by IPSOS, not from McKinsey regulars. The survey mechanism was provided straightforwardly by IPSOS by means of their individual online team.

Firms that had from under 20 employees to more than 10,000 employees were used to identify respondents who were employees. They all served as a traverse fragment of company magnitude subdivisions, industries as well as geographies. As is apparent industry standard operating procedure, the participant’s names and their companies were kept secret. All outcomes were weighted founded on the United States census statistics of firms by means of industry.

So as to go by as a respondent, the persons were required to reply to a number of screener queries to verify that they took part in preferring which remuneration their companies offer to employees either like key decision architects or having an enormous weight in the decision-making procedure. The IADB’s department of statistics stated that “All sample surveys and polls may be subject to sources of error, including, but not limited to coverage error, self-selection bias and measurement error” (IADB Department of statistics, 1998).

The opening lot of the survey focused on the stage of benefits presented by the company at the moment, and any fresh alteration to benefits or proposed amendments’ prior to the year 2014. Participants were subsequently asked their comprehension of nine key requirements of the Affordable Care Act such as the person and employer directives, subvention and definite subject.

After that, the assessment proceeded on to hit upon what respondents supposed they were to do in 2014 and after that, to make more accurate answers to the questions respondents received and in observance with customary survey practice, realistic information on the most important requirements of the Affordable Care Act (e.g., exchange founded funding levels by family circle earnings, assurance matter requirements, medical endorsements, ranking limitations, and employer consequence levels).

Respondents were next asked a set of questions which included as to whether they appreciated current coverage, whether they offered other models such as definite contribution or offer mechanisms to provide employees the preference of right of entry to the potential exchange market or stop providing coverage to the employees. Respondents were also asked about their larger apprehensions on stopping coverage as well as how they would pay compensation to employees if they did stop to grant coverage.

As noted, the survey merely exposed existing attitudes. Several alterations will thereby establish employers’ future exploits. Amongst them, the cost of medical inflation, new state health insurance interactions elements, worker attitudes to reimbursement and benefits, a company’s knack to magnetize and maintain endowment, procedures employed by competitors and the condition of the financial system at that point in time. Employer attitudes are highly likely to be manipulated by the stated factors and which are just but a minority.

To recap, the survey accounted in the McKinsey Quarterly was not a fiscal projection, but somewhat a computation of outlooks meant to comprehend the aspects implicated in employer resolution making concerning worker benefits.

Qualitative analysis

Health disparities, chiefly in the future of the stakeholders, have been recognized in a diversity of settings. A resultant qualitative analysis of focus group data wanted to explain stakeholders’ perceptions of health disparities. Via an interpretive descriptive loom, three main levels of dealings within the health-care setting were identified that enclosed barriers to receiving the best likely care. The subject of finances was the major barrier that concerned the insurance company, while racism, stance, setting, and waiting were the main obstacles concerned in the interaction in the health-care facility. The barriers at hand during the interaction with a private provider were racism, a language barrier, and being rushed. Additionally, five principles for patient-provider interaction were recognized, as well as three approaches that the participants used to tackle the barriers in the health-care setting. A broad structure was developed incorporating these major themes.

The connection of the insurance between the employer and employee can clearly describe to us how qualitatively we can achieve the analysis of the expenditure maintenances. With a quantitative balance model of the existing employer-based health insurance system that is dependable with a number of experimental regularities characterizing the accessible system and study quantitatively, the likelihood is that a penalty of the enacted legislation may be imposed. The detail that the system is employer-based implies that the effort, market and the employment association play a significant role in the sharing of medical expenses risk. In the course of mounting the model, we aspire to understand employers’ treatment of decisions and the mechanisms which maintain the observed degree of risk sharing in the accessible system.

Validity and Reliability

Conclusions that are strained from analyzing review data are only satisfactory to the degree to which they are resolute valid. Validity is used to decide the research measures, what it proposed to measure and to estimate the truthfulness of the results. Researchers frequently use their own meaning when it comes to what is well thought-out and valid. In quantitative research, testing for validity and reliability is a given.

However some qualitative researchers have gone so far as to propose that validity does not apply to their research even as they admit the need for some qualifying checks or measures in their work. This is incorrect. To ignore validity is to put the dependability of your work in question and to call into question others assurance in its results. Even when qualitative measures are used in study, they need to be looked at using measures of reliability and validity in order to sustain the honesty of the results. Validity and reliability make the difference between “good” and “bad” study reports. Quality research depends on a pledge to testing and increasing the validity as well as the reliability of your research outcome.

The threats to validity

  • The happenings in the history within the years the research was carried out with special attention given to the initial as well as the final years of the research.
  • In any case that change may take place, would the time taken to mature be worth the wait or whether it may initiate any errors in the form of effects? i.e. with or without treatment, most of the people partaking in the project can upgrade their performance.
  • In the cases of subsequent checks, would it be worthwhile re-doing the experiments considering that there would be consequences of getting a second opinion?
  • The instruments that may be used may give diverse outcomes totally unrelated to the first test since they may have been changed. Therefore the implement chosen should be very well scrutinized.
  • The statistical regression matters as regression to the mean. If the patients or physician are selected according to the extremes, better results might not be achieved as they may improve before maturation period.
  • Vigilant choosing of clusters as well as the favoritism that may well outcome in the process of choosing contrasting factions. Randomization (the random assignment) of faction association acts as a defense against this threat. However, in cases where the model magnitude is minimal, the randomization style can end up in indecisive outcomes
  • Experimental mortality: the loss of subjects. For example the loss of the stakeholders or insurance provider companies indicating that vague results may be achieved.
  • Selection-maturation interaction should be allowed for: the array of contrasting factions as well as maturation interacting which may show the way to perplexing outcomes, as well as flawed elucidation that the technique was the cause of the consequence.
  • Communication effects of selection biases and the experimental variable.
  • Hasty endings of investigational preparations: it is intricate to oversimplify non-experimental situations in cases where the end product was attributable to the investigational agreement of the study.
  • The numerous ways applied on the matching subjects may also tend to give the wrong impression about the whole study since various treatments are offered to the unchanged people; it is not easy to run for the effects of preceding treatments.

Threats to reliability

  • Dimension reliability has to do with the reliability of the measurement technique. There will always be haphazard measurement error. The threat here is systematic slip-ups.
  • While doing the re-testing, one can easily face the threat of detecting a change over time of maturation and history.
  • The equivalence of instruments should be observed keenly as the different forms of instrument administration need to be tested so as to assure equivalence.
  • Equivalence of data collectors for careful data intake and interpretation must be considered in order to achieve better results of the stake holder’s future.
  • Pilot testing is a great idea. You don’t want to have to figure out damage control in the middle of a major study. Thus the need for costly mistakes avoidance.

Having known the above threats at stake, while conducting the research, most concern was taken in place thus none affected our research enabling us to get the results that led to the full paper writing. A lot of keenness was adhered to leading to better results. However, the future of the insurance providers and the stakeholders needs to have a major refurbishment as we never dealt with the extremes which would just improve even before maturation of the history.

This paper presents summary results of the results of the future of the financing of health of America. Studies were conducted in most states using a common methodology. Substantial support among national groups fostered through a regional network, which planned meetings and coordinated procedural assistance to each other. The outcome shows that comprehensive national health accounts studies are practicable in lower income individuals and can significantly increase the exactness and detail of health expenditures relative to all previous studies. There are large differences across the country in the point of spending and in its composition. In many of the countries, private sector financing intermediaries consist of a large share of total health spending. Hospitals and public health services are generally supported by government funding while ambulatory treatment services are primarily supported by private sector funders.

The paper concludes with a discussion of policy applications and procedures of national health accounts and issues applying their methodology in lower income countries.


  • GDP Gross Domestic Product
  • IADB Inter-American Development Bank
  • ILO International Labor Organization
  • IMF International Monetary Fund
  • MOH Ministry of Health
  • NHA National Health Accounts
  • OECD Organization for Economic Cooperation and Development
  • PAHO Pan American Health Organization
  • PHR Partnerships for Health Reform
  • USAID United States Agency for International Development
  • W.H.O World Health Organization

An effective and highly efficient health financing policy calls for resolutions that address ways of how to increase donations such as funds, how to group them together, and how to make use of them impartially and professionally. Educated decision-making calls for steadfast information on the capacity of monetary capital utilized for health, their supply as well as the way they are applied. The World Bank in their handbook, were of the view that “National Health Accounts (NHA) makes available signs to check drifts in health expending for all quarters which are both communal as well as personal, diverse health care actions, health care givers, ailments, populace clusters and sections in a nation” (World Bank, 1993). It lends a hand in mounting national stratagems for effectual health financial support and in increasing supplementary resources for health. Information can be employed to craft fiscal forecasts of a state’s health structure necessities and measure up to their individual understanding either with the earlier periods or with those of other nations.

Superior information on the financial sponsorship of the health sector is a crucial base for shrewd guiding principle transformation in the quarter of health segment reorganization. The World Bank further stated that “scrutiny of health care funding ought to start in on sound estimations of countrywide health expenditure-total costs, the hand-outs to expenses from diverse sources and the assertions on expenditure by dissimilar uses of the financial resources” (World Bank, 1997). The associate nations of the OECD have effectively established such relative health spending accounts in terms of unvarying characterizations of the uses of finances as well as breakdown’s by communal and personal quarter sources. This has had outcomes in key research on health structure distinctions which could make clear variations in the intensity and composition of sponsorship. The United States of America has developed another thorough advance called National Health Accounts. This approach swells the OECD technique into a much more disaggregated ‘sources and uses’ matrix. The OECD says “In the developing countries, analysis of health expenditures has been much less systematic, despite several decades of calls by international researchers for more attention. Most developing countries have more pluralistic health financing structures than are found in most industrialized countries” (Organization for European Cooperation & Development, 1998).

The objective of this paper is the development of consistent and comparable national health accounts estimates in the whole country. There is an emphasis on capacity building in all states. NHA teams comprised specialists with different areas of expertise in health system and expenditure analysis, representing different public and private institutions. Typically, it included the Ministry of Health, Ministry of Finance, national statistical authorities and research or policy institutes. The network provided training and technical assistance through meetings, developed skills, shared experience in process, interim results and worked to standardize methods as well as classifications.

After every state produced its final report, they were preceded by national policy seminars in which results were presented to decision makers and their policy implications discussed.

This paper presents the comparison of the country/states results. Its focus is breadth of comparison rather than an in-depth look at specific health expenditure estimates or health care system issues. It covers the major elements of the NHA framework to convey the range of what can be analyzed. This paper describes a number of substantial differences across the nation in the level of health sector spending and composition. While this paper discusses explanations and implications of the estimates reported it seeks more to provoke questions and further inquiry rather than to provoke comprehensively reasoned explanations for similarities and differences.

Section two of the paper discusses recent experience with comparative analysis of health expenditure. This includes key aggregate system level results linking total health spending to health outcomes and levels of insurance coverage, the public-private mix of spending, resource allocation to specific types of health care services, and who finances specific types of expenditures, such as salaries, drugs, and capital investment.

The last section reviews the main results and their implication, limitations and proposed follow up steps for each state. The WHO states that:

We cannot over stress the importance of institutionalizing a nation’s health accounts. By “institutionalization” we mean having an established organizational “home’ and stable technical capacity to develop ongoing expenditure estimates. Experience around the globe has shown that a time series of national health expenditure estimates is infinitely superior to a one-time exercise. A time series provides an invaluable temporal context in which policy analysts can look at a given year’s figures, providing trend patterns in financing and consumption against which to assess progress towards meeting health system goals. Consistent and comparable estimates require consistent and stable methods as well as data, which in turn are greatly facilitated by a stable location for the health accounts team. Global experience has also shown that such a location is most effective when it is found within the central government (World Health Organization, 2003).

Literature Review

Comparative analysis of health expenditures

Comparing the levels, composition, and trends in national health spending is often a starting point for national debates on health sector policies and reform. Hurst highlighted many of the key issues in his comparison of health spending data (Hurst, 1992). He noted that the generally rising share of national income going to health care and the different rates in expenditure growth across the country had similar levels of types of health care services (Hurst, 1992). This leads to questions for national policy for future like what the appropriate level of spending should be in health care, what return in health improvement can a state expect from spending more or less or from altering the composition of its spending and what the health care system factors explain about growth in health spending and differences in that growth. Therefore health care system policies should be adjusted to achieve a desired or feasible rate of growth.

Comparison of America estimates with other recent efforts in the country

A careful set of estimates assembled for the World Bank’s world development report in 1993 and then recently revised by Govindaraj in 1998, and most recently preliminary results of a re-estimate by USAID in 2010 can be used for comparison with the current study to derive what to expect for the future.

The NHA methodology includes a common definition of what should be included as health care expenditure. Specific spending estimates were entered in to a “sources and uses” matrix framework that helps the analyst ensure consistency and avoid double counting. After reviewing the estimates, it helps identify problems thus getting solutions for the future.

Total health spending and outcomes

The total health expenditure emerges from a comprehensive NHA study linked to a variety of other important national-level variables such as national income (total per capita) and life expectancy. It is also instructive to explore how large health care system level factors such as the level of health insurance coverage in a state may be associated with health spending.

The Public-Private mix in health care financing

The NHA methodology provides two breakdowns of the public-private mix in health care financing. The first identifies public and private entities that provide funds to those who are the payers or purchasers of health care. The second breakdown relates to the public-private composition of expenditure by financing agents or intermediaries, the entities who receive funds from sources and use them to pay for health care services.

The approach differs from the usual presentation of the public-private mix in financing, which generally is drawn from analysis of financing intermediaries. Following the practice of health care expenditure information reported by the Organization for Economic Cooperation and Development, public finance typically includes departments of government and social health insurance institutions, while private finance includes private health insurance, NGO’s, direct payments for health care by private firms and out of pocket payments by households. Of course one would expect the breakdown by sources to differ significantly from that by financing intermediaries.

The NHA methodology makes this distinction by identifying firms and household’s contributions to different financing intermediaries, including mandatory and voluntary insurance contributions and other payments, such as user charges. Ultimately, all health care financing is derived from “private” sources, if one considers who pays the taxes. Therefore the NHA methodology does not disaggregate sources of government financing according to whom ultimately bears the burden.

Spending on major health care functions

Country analysts generally reported difficulty with this type of functional breakdown of expenditures, especially with data from the public sector. Government departments, especially the ministries of health, tend to report expenditures according to budget categories’. Often, a directorate of curative services funds both hospitals and clinics, with significant share of publicly provided ambulatory care given by hospitals. In contrast, preventive and promotion based public health services may be financed through budgets defined as such, although this may include the fixed costs of personnel and facilities supporting these services. Social health insurance organizations may also directly finance their own providers with only limited purchasing of services from private or government providers. This is an important area for future work on national health expenditures. The “financing intermediaries to function” matrices also can be used to analyze who finances different types of services.

Funding different types of health care providers

The primary analysis according to provider types, displays the flow of funds from different financing intermediaries to the different types of providers classified by ownership like government, social insurance, private for profit and not for profit providers and if possible by level of providers like hospitals, health centers and clinic, individual private practitioners and pharmacies. The government departments fund public owned providers while private payers purchase health care from private providers. Resource allocation across provider types provides another, significantly different picture of how health sector funds are being used thus giving room for improvement.

Expenditure shares to different types of health care inputs

The allocation of funds to different types of health care inputs can be used as a marker of factors related to efficiency and quality in health care production. Comparing similar funding or provision organizations, large differences in the shares of total spending to specific types of inputs, like drugs and supplies, can highlight problems in service delivery, although some of these comparisons are possible with available data.

In almost all of the states, the social health insurance organizations’ share the expenditure of drugs and supplies and is greater than that of ministries of health: ministries average about ten percent while social health insurance agencies average over twenty percent. Since personnel costs are probably higher in these agencies as well, this is probably a significant difference. It may also be reasonable to assume that the health insurance organizations are more likely to assure adequate drug supplies in their facilities and to be more responsive to consumer perceptions of quality. One should not draw strong normative conclusions from this simple comparison, since other factors such as mix of facilities, programs, and patients may account for such differences. But, combined with widespread anecdotal information that ministry facilities lack essential inputs, it does suggest a systematic problem in resource allocation.

Summary and implications of key findings

As with any detailed accounts, there are bound to be issues related to specific estimations that should be taken up to improve or refine figures. Nevertheless, a number of important findings emerged exposing the fact that the NHA method can be successful only if modest levels of technical support are applied for more than a year. The results can certainly be improved, for they provide human, institutional as well as technical basis for further work.

Potential for future investigation

The results raised awareness of the significant size of the health sector in the whole country’s economy, of regional socio-economic disparities in health spending, and of the major role played by private health care providers. This increase of awareness has encouraged expanded governments efforts to reach underserved regions and populations. Government efforts to increase funding for basic health care can be monitored along with success in re-orienting priorities toward cost-effective programs.

Methods, results and discussion

The NHA methods that were used had been developed and tested in a number of studies. Though this was the first time they were disseminated as part of the country network, where work was done by interagency national teams with only modest external support, external advisors observed and advised the counterparts to see a success in this methodology.

Not surprisingly, the results had both positive and negative elements. Some things worked well, while others didn’t. Based on this experience, it was exposed that the NHA methods can be improved. The national authorities can learn not only from the new information generated, but also from limitations of the results. Some of the key lessons were:

  • In general, comparable definitions of expenditure classifications are lacking. This is true when there are differences in categories across the nation and even true sometimes when terminology is used in different states. To strengthen comparability of findings, national authorities should work together to develop standardized definitions and to apply them in budgeting and expenditure for health care.
  • While all the states had usable household survey data to estimate private spending, the quality and scope of this data varied greatly. Sometimes there were multiple sources of data which gave highly conflicted results. Since household spending is a large source of total spending in all regions, further technical work on this aspect of national health expenditure estimation is needed. This include:
  • Better and more standardized instrument design for health items on national consumption surveys and for dedicated health care expenditure surveys.
  • Technical analysis of differences within states in estimates from different surveys.
  • Assessment methods of validating estimates like comparison with pharmaceutical market information and other sources.
  • Budget and expenditure information from ministries and social insurance organizations was difficult to allocate according to different types of health care services and functions. Most of these agencies do not do any kind of systematic program budgeting. The organizational structure of budgets like by directorates of curative or preventive care is a poor representation of functional breakdowns.
  • Financing intermediaries to line items. The matrix does not work well for non-budgetary organizations, covering most of the private sector. It is not meaningful to try to determine expenditures by input from volume and price data on final consumption. This should be dropped from further analysis.
  • The financing intermediaries to providers and to functions matrices were difficult to distinguish in practice for budgetary organizations, unless they kept their expenditure data in more disaggregated forms. For example if the ministry of health has a hospital directorate which administers expenditures for public hospitals, it will be difficult to separate out the inpatient and outpatient shares of hospital expenditure. Shifting focus toward a “providers to functions” breakdown as an alternative to the “financing intermediaries to functions” breakdown is under consideration.
  • Many of these issues are already being addressed for future outcome and policy making.

National Health Accounts (NHA) is made up of a systematic, unswerving as well as all-inclusive examination of the course or flow of resources of the health system in a country. These are special implements modeled particularly to put in the picture the health policy progression, which includes models of policies as well as putting in place of the policies, assessment as well as monitoring of the intercession in health care and finally the policies dialogues. These provides the verification that may assist groups like non-governmental stakeholders in the industry, administrators as well as the makers of the policies, to make more accurate and enhanced decisions as they endeavor in their attempts to perk up the achievements as well as spruce up performance of the health sector. In their handbook, the OECD commented that:

Most managers know very little about the technology they introduce into their firms, often preferring to leave such decisions to a small band of technological ‘experts’. As a result large amounts of time and money are often wasted on inappropriate and inefficient systems. The cost of retraining and reorganizing can also be prohibitive if the new technology does not deliver the desired results. In a business environment where technology is of increasing importance, the non-technical manager cannot afford to remain in the dark (Organization for European Cooperation Development, 1998).

In very many diverse instances, the use of more resources answers to the need for a much more effective as well as valuable use of available resources due to several factors. Robins said “health expectancies extend the concept of life expectancy to morbidity and disability by providing a means of dividing life expectancy into life spent in various states of good and bad health” (Robins, 2003). Robins further stated that “Being independent of the size of populations and of their age structure, health expectancies thus allow direct comparison of the different groups that constitute populations: sexes, socio-professional categories, regions” (Robins, 2003). They include brisk alterations in the prototypes of mortality as well as morbidity, dilemmas that arise which are related to public health such as the HIV/AIDS pandemic, change of demography and also progress in the field of technology. Zshock in his book queries:

With increasing life expectancy, measuring population health levels on the basis of mortality rates alone has become less and less relevant in many populations. At the same time, societies invest substantial resources in promoting healthy life, in addition to preventing premature death. But how effective have these efforts been? What is the appropriate metric to measure health life expectancy, or for that matter the contribution of different diseases and injuries to potential years of healthy life that are lost due to their occurrence? (Zshock, 1986)

A huge number of states rely on a complicated and changing amalgamation of institutions that are private as well as governmental for the provision of health care to their citizens and they may be either profit or non-profit oriented institutions. Speaking in his book, Berman held that “Health care and its financing will not be harmonized within the European Union. Therefore, the differences between the health systems of the member-states in a single European market are gaining in relevance. The process of economic integration also effects health” (Berman, 1997). Within these kinds of situations, information that is valuable regarding the nation about the supply and utilization of finances for the purpose of health care is required by the policy makers of the state, ideally equal across nations, so as to boost the performance of the vital sector of health care.

In regard to this, the (NHA) National Health Accounts assists widely in the provision of the necessary information. National Health Accounts give a clear picture of the utilization of resources in the health schemes in the present state of affairs. When used more often, National Health Accounts may be useful in marking out the tendencies of expenditure in health care which is a very important component in the evaluation as well as scrutiny of health care. The monetary projections of the needs of a state’s health schemes may also be acknowledged through the National Health Accounts strategy. One vital aspect of meticulous value in the course of setting up performance aims as well as standards within a country is the prospect of contrasting and comparing a states expenditure on its health scheme, with its peer states which is what the National Health Accounts proffer.

National Health Accounts are modeled to respond to defined inquiries that may touch on the health scheme of a state. The National Health Accounts make available a methodical collection as well as exhibit of the expenditure on health. The National Health Accounts may also be used to follow up on the amount of money being used up, the reasons for spending the finances as well as the people it is being spent on, wherever the finances are utilized, the ways in which the spending contrasts to other states that may be in circumstances that are related to the ones being faced as well as the ways in which it has diversified over a period of time. This is a very important aspect in the evaluation of the accomplishments as well as recognition of prospects for development of a successful health care system. A nation may be able to institutionalize the course of health accounts and bring into being a time sequence of consistent charts.

This will allow for a more comprehensive evaluation or assessment of the advancements going on in the direction of national objectives for the implemented health scheme. Seeing as the global community is looking for improved ways of edging out poverty as well as ensuring enhanced health for mid income to lower income nations, the National Health Accounts offers a foundation for following up on outside resources that are encompassed in projects that may include the “Poverty Reduction Strategy Plan” and may also assist in following up on the utilization of resources which may help attaining the “Millennium Development Goals” as well as several other worldwide aims and targets. The OECD, in their book said that:

Health care is one of the largest sectors in OECD countries, and accounts now for over 8% of GDP on average. Reliable international comparisons of health care expenditure levels are increasingly being sought by policy-makers and researchers, as several OECD countries re-examine the adequacy of total health spending, and the public and private shares of those expenditure. These accounts constitute a common framework for enhancing the comparability of data over time and across countries, and suggest basic links with non-monetary indicators. A conceptual basis is established made up of statistical reporting rules compatible with other economic and social statistics and proposes a newly developed International Classification for Health Accounts (ICHA) which covers three dimensions: health care by functions of care; providers of health care services; and sources of funding. The new System of Health Accounts provides basic concepts and definitions underlying the annual data collection of OECD Health Data. Once this new accounting standard has been implemented in a large number of OECD countries, it will allow for more consistent and reliable comparisons of health care expenditure across countries. (Organization for European Cooperation & Development, 1998)


Conclusions strained from analyzing review data are only satisfactory to the degree to which they are resolutely valid. Validity is used to decide on the research measures, what it proposes to measure and to estimate the truthfulness of the results. Researchers frequently use their own meaning when it comes to what is well thought-out as valid. In quantitative research, testing for validity and reliability is a given. However some qualitative researchers have gone as far as to propose that validity does not apply to their research even as they admit the need for some qualifying checks or measures in their work. This is incorrect. To ignore validity is to put the dependability of any work in question and to call into question others assurance in its results. Even when qualitative measures are used in study they need to be looked at using measures of reliability and validity in order to sustain the honesty of the results. Validity and reliability make the difference between “good” and “bad” study reports. Quality research depends on a pledge to testing and increasing the validity as well as the reliability of your research outcome.

Therefore, it can be stated that the whole nationwide network has taken large strides in developing consistent and comparable network health accounts in participating states. The capacity of national teams has been greatly increased. NHA estimates however, can always be improved to increase accuracy and refined to address specific national policy questions and agendas.


Berman, P. (1997). “What can the U.S. Learn from National Health Accounting Efforts Elsewhere?” Health Care Financing Review. 12 (1), 68-72.

Hurst, J. (1992). The Reform of Health Car: A comparative Analysis of Seven OECD Countries. Paris. Organization for Economic Cooperation and Development.

IADB Department of Statistics. (1998). Bridging the gender gap in developing regions. IADB Journal of statistics. Web.

Organization for European Cooperation and Development. (1998). OECD Health Data 98. Paris. Organization for European Cooperation and development.

Pan American Health Organization. (1994). Health Conditions in Americas. Washington, DC: Pan American Health Organization, World Health Organization.

Robins, J.M. (2003). Determining health expectancies. New Jersey. John Wiley & Sons.

World Bank. (1993). Investing in Health. World development Report. Washington, DC: The World Bank.

World Bank. (1997). World Development Report 1997. Washington, DC: The World Bank.

World Health Organization. (2003). Guide to producing national health accounts: With special applications for low-income and middle-income countries. Geneva. World Health Organization.

Zschock, (1986). Medical care under social insurance in Latin America.” Latin American Research Review 21(1), 99-122.