Notes

• Topic: Health: Health systems
• Definition: Total health expenditure is the sum of public and private health expenditures as a ratio of total population. It covers the provision of health services (preventive and curative), family planning activities, nutrition activities, and emergency aid designated for health but does not include provision of water and sanitation. Data are in international dollars converted using 2011 purchasing power parity (PPP) rates.
• Source: World Health Organization Global Health Expenditure database (see http://apps.who.int/nha/database for the most recent updates).
• Statistical concept and methodology: Health expenditure data are broken down into public and private expenditures. In general, low-income economies have a higher share of private health expenditure than do middle- and high-income countries, and out-of-pocket expenditure (direct payments by households to providers) makes up the largest proportion of private expenditures. High out-of-pocket expenditures may discourage people from accessing preventive or curative care and can impoverish households that cannot afford necessary care. Health financing data are collected through national health accounts, which systematically, comprehensively, and consistently monitor health system resource flows. To establish a national health account, countries must define the boundaries of the health system and classify health expenditure information along several dimensions, including sources of financing, providers of health services, functional use of health expenditures, and beneficiaries of expenditures. The accounting system can then provide an accurate picture of resource envelopes and financial flows and allow analysis of the equity and efficiency of financing to inform policy.
• Development relevance: Health systems - the combined arrangements of institutions and actions whose primary purpose is to promote, restore, or maintain health (World Health Organization, World Health Report 2000) - are increasingly being recognized as key to combating disease and improving the health status of populations. The World Bank's Healthy Development: Strategy for Health, Nutrition, and Population Results emphasizes the need to strengthen health systems, which are weak in many countries, in order to increase the effectiveness of programs aimed at reducing specific diseases and further reduce morbidity and mortality. To evaluate health systems, the World Health Organization (WHO) has recommended that key components - such as financing, service delivery, workforce, governance, and information - be monitored using several key indicators. The data are a subset of the key indicators. Monitoring health systems allows the effectiveness, efficiency, and equity of different health system models to be compared. Health system data also help identify weaknesses and strengths and areas that need investment, such as additional health facilities, better health information systems, or better trained human resources.
• Notes from original source: PPP series derived from the International Comparison Program (ICP) and estimated by the World Bank have been used. For countries where these are not available, PPPs are estimated by WHO. All the health expenditure indicators refer to expenditures by financing agent except external resources which is a financing source. When the number is smaller than 0.05%, the percentage may appear as zero. In countries where the fiscal year begins in July, expenditure data have been allocated to the later calendar year (for example, 2010 data will cover the fiscal year 2009–10), unless otherwise stated for the country.
• Limitations and exceptions: Country data may differ in terms of definitions, data collection methods, population coverage and estimation methods used. In countries where the fiscal year spans two calendar years, expenditure data have been allocated to the later year (for example, 2010 data cover fiscal year 2009/10).