International data on health service expenditure is compiled by a number of organisations including the Organisation for Economic Cooperation and Development (OECD), the World Health Organisation (WHO) and the EU’s statistical service (EUROSTAT). At a high level, data on national health expenditure can be compared and expressed as per capita expenditure, public versus private expenditure, as a percentage of GDP/GNP, or in terms of purchasing power parities (PPPs). At the lower level of specific service areas, it is much more difficult to arrive at valid comparisons between countries. The reason for this is that health systems differ widely in terms of structure, models of service delivery, and definitions of functions. For example, what constitutes an outpatient service in one country may not have a direct comparison in another country.
Recognising these difficulties, the international organisations, led by the OECD, have in recent years developed a new international standard for health accounting called the System of Health Accounts (SHA). The SHA is designed to provide detailed and standardised information on expenditure according to a three way cross-classification. The three axes are health service functions, health service providers, and health service funders. The resulting data will cover both public and private expenditure and will be a valuable source for health service evaluation, planning and international benchmarking.
Ireland is currently engaged in a major project to compile and submit national SHA data. The project is jointly led by the Department of Health and the Central Statistics Office and will submit SHA data for 2013 by March, 2016. An EU implementing regulation is in the process of being finalised which will make annual compilation of the SHA compulsory for all member states from 2016 onwards.