How Can National Health Accounts Be Transformed into a Data-Driven Strategic Management Tool

Since the 1970s, OECD countries have struggled to control health care expenditure, which has grown much faster than GDP. One of the responses was the development of National Health Accounts (NHA). Today, NHA provide an accounting, classification, and monitoring framework for health expenditure. Developed by the OECD and recommended by WHO, they are mandatory in all European Union countries and are used by many WHO member states under the international SHA 2011 standard. However, the introduction of NHA has not curbed health care spending in OECD countries, which continues to outpace GDP growth. The authors argue that a key limitation of NHA is the lack of end-to-end integration with financial and managerial accounting systems, which reduces the accuracy, timeliness, and practical value of NHA data and makes them poorly suited for management purposes. As a result, NHA are currently used primarily for retrospective monitoring and sector-level analysis, macroeconomic research, and cross-country comparisons. The authors propose transforming NHA from a method of statistical observation into a data-driven management tool by combining the SHA 2011 standard with end-to-end financial management of the health sector based on line‑item budgeting—an approach that ensured the high efficiency of the Soviet health system.

1. Political economy and innovations of the Nikolai Semashko system as a basis for financing universal health coverage in middle- and low-income countries: А monograph (2024). Moscow, Academy of Labor and Social Relations. (In Russ.)

2. Popov G.A. Economics and healthcare planning. Moscow, Publishing House of Moscow University, 1976. (In Russ.)

3. Starodubov V.I., Flek V.O., Dmitrieva E.D. (2007). Comprehensive assessment of healthcare financing in the Russian Federation according to the version of the system of accounts for the period from 2000 to 2006. Part 1. Healthcare Manager, 10: 4-11. (In Russ.)

4. A system of health accounts 2011: Revised edition (2017). Paris, OECD Publishing. DOI: 10.1787/9789264270985-en.

5. A system of health accounts. Version 1.0 (2000). Paris, OECD Publishing. https://library.cystat.gov.cy/NEW/ICHA_OECD_EN.pdf.

6. Berman P. (1997). National health accounts in developing countries: Appropriate methods and recent applications. Journal of Health Economics, 6: 11-30.

7. Best practice in institutionalising health accounts: Learning from Experiences in 13 OECD Countries (2025). Paris, OECD Publishing. DOI: 10.1787/cf997130-en.

8. Colombo F., Morgan D. (2006). Evolution of health expenditure in OECD countries. Revue française des affaires sociales, 6: 19-42.

9. Framework for assessing maturity of health accounts institutionalization (2023). Geneva, World Health Organization.

10. Global spending on health: A world in transition (2019). Geneva, World Health Organization.

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

12. Langenbrunner J. C., Cashin C., O’Dougherty S. (eds.) (2009). Designing and implementing health care provider payment systems: How-to manuals. Washington, DC, World Bank. DOI: 10.1596/978-0-8213-7815-1.

13. Maeda A., Harrit M., Mabuchi S., Siadat B., Nagpal S. (2012). Creating evidence for better health financing decisions: A strategic guide for the institutionalization of national health accounts. Washington, DC, World Bank.

14. Mon H., Pholpark A., Lim L. T., Tsilaajav T., Cruz V., Hanvoravongchai P. (2025). Financing and purchasing mechanisms of primary health care in Southeast Asia region: Findings from a scoping review. SSM - Health Systems, 5: 100132. DOI: 10.1016/j.ssmhs.2025.100132.

15. Pholpark A., Mon H.M., Lim L.T., Tsilaajav T., de Oliveira Cruz V., Hanvoravongchai P. (2025). Challenging inadequate and fragmented primary health care financing: Findings from Bangladesh, Indonesia, Maldives, and Nepal. The Lancet Regional Health - Southeast Asia, 38: 100613. DOI: 10.1016/j.lansea.2025.100613.

16. Rathe M., Hernández P., Mosseveld C.V., Pescetto C., de Maele N.V. (2018). Health accounts from past to present for political arithmetic. Revista Panamericana De Salud Publica - Pan American Journal Of Public Health, 42: e89. DOI: 10.26633/RPSP.2018.89.

17. Turcanu G., Domente S., Buga M., Richardson E. (2012). Republic of Moldova: Health system review. Health Systems in Transition, 14(7): 1-151.