Health care has become one of the largest industries in OECD countries and one of the most dynamic in
terms of job creation and innovation. There have been impressive achievements in improved health
status of populations and in universal coverage for most OECD countries. There remains, however, a
recurrent concern regarding the adequacy of resources and the way they are currently used, and how best
to increase the equity, efficiency and effectiveness of health care. The challenges of rapid technological
change, growing patient expectations and ageing populations reinforced the appeal for further reforms.
Consequently, there is a rising demand for a core set of financial data provided by National
Health Accounts as well as by international comparisons of health care spending. This manual of
A System of Health Accounts (SHA) provides a set of comprehensive, consistent and flexible accounts.
It establishes a conceptual basis of statistical reporting rules 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 proposed accounts are designed to meet the needs of analysts of health care systems and
policy-makers. They provide a common framework for enhancing the comparability of data over
time and across countries. They are intended for use in international comparisons that include a
broad range of countries with different ways of organising health care and its financing.
This manual builds on more than fifteen years of work of the OECD Secretariat on international
comparisons of health care data in support of economic analysis of health policy. A number of experts
in OECD countries and from other international organisations have assisted in producing this manual
by commenting on various draft versions. Their contributions are gratefully acknowledged. The manual
was prepared by Manfred Huber, an administrator in the Directorate for Education, Employment,
Labour and Social Affairs and is published on the responsibility of the Secretary-General of the OECD.
National statistical agencies and other users of the manual may contact the SHA Hotline at
[email protected] for questions and queries. Additional information on the SHA and further
practical guidelines are available at http://www.oecd.org/els/health/sha.htm. All users of this manual
are invited to take an active part in its further development.