Intended for healthcare professionals


Make countries’ health spending easier to compare, says OECD

BMJ 2011; 343 doi: (Published 01 November 2011) Cite this as: BMJ 2011;343:d7088
  1. Sophie Arie
  1. 1London

The Organisation for Economic Co-operation and Development is urging all countries to meet a global standard in the way they account for their health service spending.

In October the OECD, in collaboration with Eurostat (the European Commission’s statistics directorate general) and the World Health Organization, published what it describes as a “monster of a manual” called A System of Health Accounts. It provides detailed guidelines to help countries develop better accounts that policy makers can use to quickly extract useful data.

“One of the weird things in health is that there are a lot of data around but sometimes the most useful data aren’t there,” said Mark Pearson, head of the OECD’s health division.

“If you ask countries how much they spend on salaries [in the health service] many will struggle. Usually that’s because accounting goes down through different bodies, and no one has central responsibility for providing the big picture.”

The OECD advises that as spending on healthcare rises worldwide—in large part because of new technology and drugs and ageing populations—it is worth investing in producing more specific and internationally consistent data on a range of areas from spending on specific diseases to cost versus quantity of services provided. The new manual proposes an international classification for health accounts covering three main dimensions of healthcare: healthcare function, healthcare service provider industries, and sources of financing.

Often, says Mr Pearson, the focus is on spending overall when a detailed breakdown of prices and quantities is needed. He cited the case of the Netherlands, where recent reforms led to a dramatic fall in prices but a rise in quantities of procedures. Since it carried out its reforms, aimed at introducing greater competition, the Netherlands has become the OECD’s second biggest spender on health services as a proportion of gross domestic product, after the United States.

“Bringing all your data together in a consistent way so you can actually understand what your health system looks like, compared with other countries, really does highlight some areas where you are different,” said Mr Pearson, arguing that this has in some cases led countries to make major policy changes.

The World Bank is also working on a global initiative to improve resource tracking to ensure better health outcomes, with the support of the Bill and Melinda Gates Foundation,.

However, many developing countries don’t have enough resources or technology to provide such comprehensive accounting. And some OECD countries, including the United Kingdom, Ireland, and Italy, do not yet break down their accounts in a way that they can be compared with those of other countries.

Draft legislation drawn up by Eurostat currently in circulation proposes obliging all member countries to provide this level of information.

The Department of Health for England was unable to comment on the proposal before the BMJ went to press.


Cite this as: BMJ 2011;343:d7088