National Health Accounts development: lessons from Thailand

National Health Accounts (NHA) are an important tool to demonstrate how a c ountry's health resources are spent, on what services, and who pays for the m. NHA are used by policy-makers for monitoring health expenditure patterns ; policy instruments to re-orientate the pattern can then be further introd uced. The National Economic and Social Development Board (NESDB) of Thailan d produces aggregate health expenditure data but its estimation methods hav e several limitations. This has led to the research and development of an N HA prototype in 1994, through an agreed definition of health expenditure an d methodology, in consultation with peer and other stakeholders. This is an initiative by local researchers without external support, with an emphasis on putting the system into place. It involves two steps: firstly, the flow of funds from ultimate sources of finance to financing agencies; and secon dly, the use of funds by financing agencies. Five ultimate sources and 12 f inancing agencies (seven public and five private) were identified. Use of c onsumption expenditures was listed under four main categories and 32 sub-ca tegories. Using 1994 figures, we estimated a total health expenditure of 128 305.11 m illion Baht; 84.07% consumption and 15.93% capital formation. Of total cons umption expenditure, 36.14% was spent on purchasing care from public provid ers, with 32.35% on private providers, 5.93% on administration and 9.65% on all other public health programmes. Public sources of finance were respons ible for 48.79% and private 51.21% of the total 1994 health expenditure. To tal health expenditure accounted for 3.56% of GDP (consumption expenditure at 3.00% of GDP and capital formation at 0.57% of GDP). The NESDB consumpti on expenditure estimate in 1994 was 180 516 million Baht or 5.01% of GDP, o f which private sources were dominant (82.17%) and public sources played a minor role (17.83%). The discrepancy of consumption expenditure between the two estimates is 2.01% of GDP There is also a large difference in the publ ic and private proportion of consumption expenses, at 46:54 in NHA and 18:8 2 in NESDB. Future NHA sustainable development is proposed. Firstly, we need more accur ate aggregate and disaggregated data, especially from households, who take the lion's share of total expenditure, based on amended questionnaires in t he National Statistical Office Household Socio-Economic Survey. Secondly, p artnership building with NESDB and other financing agencies is needed in th e further development of the financial information system to suit the bienn ial NHA report. Thirdly, expenditures need breaking down into ambulatory an d inpatient care for monitoring and the proper introduction of policy instr uments. We also suggest that in a pluralistic health care system, the break down of spending on public and private providers is important. Finally, a s ustainable NHA development and utilization of NHA for planning and policy d evelopment is the prime objective. International comparisons through collab orative efforts in standardizing definition and methodology will be a usefu l by-product when developing countries are able to sustain their NHA report s.