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Introduction 
     Institutional units of financing sources (FSRI) 
     Financing sources (FS) 
     Financing schemes (HF) 
     Financing agents (FA) 
     Health care providers (HP) 
     Factors of health care provision (FP) 
     Health care functions (HC) 
     Beneficiary characteristics 
     Gross fixed capital formation (HK) 
General Methodology 
     National government (Department of Health)/ Domestic revenue based 
     National government (Other agencies) 
     Foreign-assisted projects (FAPs) 
     Local government 
     Social security agencies/PhilHealth 
     Social security agencies/SSS, GSIS (Employees Compensation Insurance Fund) 
     Social security agencies/GSIS-government based voluntary insurance 
     Insurance corporations/Life and non-life insurance corporations 
     Insurance corporations/Health maintenance organizations (HMOs) 
     Households 
     Corporation (other than providers of health care)/Government corporations 
     Corporations (other than providers of health care)/Private corporations (employee health care) 
     Gross Fixed Capital Formation 
References

Introduction [back to top]

The System of Health Accounts (SHA) 2011 provides a standard for classifying health expenditures according to three (3) axes: consumption, provision, and financing. It gives guidance and methodological support for the compilation of health accounts, which seeks to describe the health care system from an expenditure perspective both for international and national purposes. The SHA 2011 is the international standard for health accounting (OECD, Eurostat, and WHO 2011) which presents a multi-dimensional approach to analyze the structure of health in a country.

The SHA-based Philippine National Health Accounts (PNHA-SHA) not only provides the Total Health Expenditures (THE) of the country, but it also differentiates between two (2) aggregates of health, namely Current Health Expenditures (CHE) and Health Capital Formation (HK). PNHA-SHA consists of a total of 46 tables; 35 tables on CHE, three (3) on HK and eight (8) on derived indicators. These tables contain 12 health expenditure classifications defined as follows:

Institutional units of financing sources (FSRI): Institutional units that provide revenues to health financing schemes (a “Reporting Item” or RI under the Financing Sources or FS dimension). [back to top]

Financing sources (FS): The revenues of the health financing schemes received or collected through specific contribution mechanisms. [back to top]

 Financing schemes (HF): Components of a country’s health financial system that channel revenues received and use those funds to pay for, or purchase health care goods, services, and activities. [back to top]

Financing agents (FA): Institutional units that manage health financing schemes. [back to top]

Health care providers (HP): Entities that receive money in exchange for, or in anticipation of producing the activities inside the health accounts boundary. [back to top]

Factors of health care provision (FP): The types of inputs used in producing the goods and services or activities covered by the health accounts boundary. [back to top]

Health care functions (HC): The types of goods and services provided and activities performed within the health accounts boundary. [back to top]

Beneficiary characteristics: The attributes of those who receive health care goods and services or benefit from health activities. There are four (4) classifications of characteristics in the PNHA-SHA. These include disease group (DIS), income quintile group (INC), age/sex group (AGE), and region of residence (REG). [back to top]

Gross fixed capital formation (HK): The type of assets that health providers have acquired during the accounting period and that are used repeatedly or continuously for more than one year in the production of health services; memorandum items (HKR) reported under the capital formation account include health research and training. [back to top]

General Methodology [back to top]

1. The Philippine National Health Accounts based on the System of Health Accounts 2011 (PNHA-SHA) measures expenditures for the final consumption of health goods and services. It covers expenditures on activities with the primary purpose of improving, maintaining, and preventing the deterioration of health and mitigating the consequences of ill-health of individuals in the Philippines for a given year through the application of qualified health knowledge. The health accounts boundary is determined based on the following criteria: (a) primary purpose, (b) use of qualified health knowledge, (c) expenditure for resident persons (spatial boundary), (d) expenditure incurred in a specified year (time boundary), and (e) transacted (produced and paid for). 
    

2. Current health expenditures (CHE) and health capital formation (HK) are estimated as two separate aggregates of the PNHA-SHA. 
    

3. Health expenditures are classified into 12 schemes. The expenditure classifications under each of the three major dimensions of SHA 2011 are listed as follows:

Financing Dimension

- Financing sources (FS): the revenues of the health financing schemes received or collected through specific contribution mechanisms; 
- Institutional units of financing sources (FS.RI): institutional units that provide revenues to health financing schemes (a “Reporting Item” or RI under the FS dimension); 
- Financing schemes (HF): components of a country’s health financial system that channel revenues received and use those funds to pay for, or purchase, the activities inside the Health Accounts (HA) boundary; 
- Financing agents (FA): institutional units that manage health financing schemes.

Provision Dimension

- Healthcare providers (HP): entities that receive money in exchange for or in anticipation of the provision of the activities inside the health accounts boundary; 
- Factors of healthcare provision (FP): the types of inputs used in producing the goods and services or activities conducted inside the HA boundary; 
- Capital formation (HK): the types of assets that health providers have acquired during the accounting period and that are used repeatedly or continuously for more than one year in the production of health services.

Consumption Dimension

- Healthcare functions (HC): the types of goods and services provided and activities performed within the health accounts boundary; 
- Beneficiary characteristics: the attributes of those who receive health care goods and services or benefit from health activities performed within the HA boundary – e.g., age/sex (AGE), income quintile group (INC), disease group (DIS), and region of residence (REG).

4. There are particular health expenditure items that could not be classified into the given schemes above due to lack of detail in the existing data. The breakdowns of these expenditure items are estimated using percentage distributions referred to as distribution keys. Distribution keys were prepared using data from research studies, statistical reports, administrative reports, censuses, household survey tabulations, and/or other data sources. 
    

5. Health expenditures classified under the schemes mentioned above are reported and summarized in a series of two-dimensional tables.

Health Expenditure in the PNHA-SHA is compiled by component. Components generally correspond to financing agents (FA) or subcategories of FAs. The components have been primarily defined to correspond to expenditure core data sets. These are the same core data sources used in the previous version of the PNHA. The succeeding notes describe the coverage, data sources, estimation methods, and distribution keys data sources by component of the health expenditures of the PNHA-SHA.

I. National  government  (Department  of Health) / Domestic revenue based [back to top]

Coverage:

- These are the expenditures of national government agencies for health-related activities funded by appropriations, with health activities identified based on agency mandate or activity descriptions.

Source Agency and Publication/ Data Inputs:

- Commission on Audit (COA): Annual Financial Report of the National Government, Annual Financial Report of the Government Owned and/or Controlled Corporations, Financial Statements of the four Specialty Hospitals (i.e., Philippine Heart Center (PHC), Philippine Children’s Medical Center (PCMC), Lung Center of the Philippines (LCP) and National Kidney and Transplant Institute (NKTI))

- Department of Budget and Management (DBM): National Expenditure Program (NEP), Budget of Expenditure and Sources of Financing (BESF)

Estimation Methodology:

- Activities under the DOH in the NEP are scaled up using the ratio between the agency-level obligations incurred stated in the COA-AFR and agency-level programmed expenditures stated in the NEP.

- In the estimation of the national government spending on the four specialty hospitals, the amount of subsidy reported in their individual Statement of Income and Expenditures is used.

- In the estimation of the health capital formation of national government, actual health expenditures on capital outlays reported in the BESF are employed.

Distribution Keys:

- Distribution of the general population by income quintile from the 2015 and 2018 Family Income and Expenditure Survey (FIES)

- Distribution of total billing by disease from PHIC database for users of government hospitals

- Distribution of total billing by age/sex from PHIC database for users of government hospitals

- Distribution of general population by age/sex from Census of Population and Housing (CPH)

II. National  government  (Other  Agencies) [back to top]

Coverage:

- These are the expenditures (loans or grants proceeds) of all FAPs of the DOH and other national government agencies whose mandates are entirely health-related (e.g., Food and Nutrition Research Institute (FNRI), Philippine Council for Health Research and Development (PCHRD), etc.); and expenditures of FAPs of other government agencies identified as health-related based on stated purpose.

Source Agency and Publication/ Data Inputs:

- COA: Annual Financial Report of the National Government

- DBM: NEP, BESF

Estimation Methodology:

- All health-related activities from identified government agencies in the NEP is scaled up using the ratio between the agency-level obligations incurred stated in the COA-AFR and agency-level programmed expenditures stated in the NEP.

- In the estimation of the national government spending on the four specialty hospitals, the amount of subsidy reported in their individual Statement of Income and Expenditures is used.

- In the estimation of the health capital formation of national government, actual health expenditures on capital outlays reported in the BESF are employed.

Distribution Keys:

- Distribution of the general population by income quintile from the APIS

- Distribution of total billing by disease from PHIC database for users of government hospitals

- Distribution of total billing by age/sex from PHIC database for users of government hospitals

- Distribution of general population by age/sex from Census of Population and Housing

III. Foreign-assisted projects (FAPs) [back to top]

Coverage:

- Expenditures (loans or grants proceeds) of all Foreign Assisted Projects of the DOH and other national government which are entirely health-related.

Source Agency and Publication/ Data Inputs:

- DOH-BIHC: Profile and Status of FAPs

- NEDA: List of Active ODA Loans and Grants

- DBM: BESF

Estimation Methodology:

- Current health expenditures of government on FAPS are estimated using actual expenditures data of projects reported in the DOH Report. Expenditures of health projects reported in the NEDA Report not found in the DOH Report are also included.

- Data provided by NEDA for loans already includes actual loan disbursements/drawdowns for the year (in USD). These are then converted to Philippine Peso (PhP).

IV. Local government [back to top]

Coverage:

- These are the expenditures of provincial, city, and municipal hospitals, as well as expenditures of local governments for health, nutrition, family planning services, health governance, and general administration.

Source Agency and Publication/ Data Inputs:

- COA: Annual Financial Report for Local Government, Financial Statements of LGUs

- DOF: Bureau of Local Government Finance (BLGF), Statement of Receipts and Expenditures by LGU

Estimation Methodology:

- Health expenditures of provinces, cities, and municipalities are estimated by applying the health proportions to the total expenditures of each level of LGUs reported in the COA Annual Report.

- The health proportions are computed using BLGF data. The health expenditures (Health, Nutrition, and Population Control) are divided by the total expenditures for each level of LGU.

- The expenditures for hospitals, health services (health centers), and general administration for health are estimated using distributions detailed data from the BLGF. The detailed information is scaled up to match the estimated health expenditure of LGUs.

Distribution Keys:

- Distribution of the general population by income quintile from the 2015 and 2018 Family Income and Expenditure Survey (FIES)

- Distribution of total billing by disease for users of government hospitals from PHIC database

- Distribution of visits by disease using Field Health Service Information System (FHSIS) data

- Distribution of total billing by age/sex for users of government hospitals from PHIC database

- Distribution of population age/sex from Census of Population and Housing (CPH)

V. Social security agencies/PhilHealth [back to top]

Coverage:

- These are the benefit payments of PhilHealth and all its other expenditures.

Source Agency and Publication/ Data Inputs:

- PhilHealth: Annual Report/Financial Statements, Claims Database Tabulations

- DBM: BESF

- COA: AFR

Estimation Methodology:

- Detailed tabulations of claims payments from the Claims Database for each type of PhilHealth programs (i.e., Formal Economy, Informal Economy, Sponsored, Indigents, Senior Citizens, and Lifetime) are adjusted according to the benefit claims expense totals by program reported in the Philhealth Annual Report/Financial Statements.  Philhealth operating costs (i.e., Personnel Services and other operating expenses), which are disaggregated using distribution keys, are also included in the estimation.

Distribution Keys:

- Distributions of PhilHealth contributions according to the contribution schemes of the government, private, and lifetime programs (employee vs. employer)

- Distributions of PhilHealth contributions according to the contribution schemes of the government, private and lifetime programs (employee vs. employer by institutional type) – one distribution key per program

- Distribution of PhilHealth claims paid by region from PHIC database

- Distribution of primary and intermediate inputs from the 2018 Supply and Use Tables (SUT)

VI. Social security agencies / SSS, GSIS (Employees’ Compensation Insurance Fund) [back to top]

Coverage:

- These are the benefit claims payments from the ECIF of SSS and GSIS that are for medical and rehabilitation services purposes.

Source Agency and Publication/ Data Inputs:

- Government Service Insurance System (GSIS): Statement of Claims and Benefits Paid – Employees Compensation Insurance Fund, Optional Life Insurance Business/ Hospitalization Insurance Plan, and Pre-Need Business/ Family Hospitalization Plus Plan (submission upon the request of PSA)

- Social Security System (SSS): Computation of EC Health Expenditures (submission upon the request of PSA)

Estimation Methodology:

- EC benefit claims payments data, specifically the claims for medical and rehabilitation services, from reports provided by GSIS and SSS are used as reported without adjustments.

Distribution Keys:

- Distribution of the workers by income quintile from the FIES (2015 and 2018)

- Distribution of ill persons or injured at work by age/sex group from APIS or other survey

VII. Social security agencies/GSIS-government based voluntary insurance [back to top]

Coverage:

- These are the benefit claims payments from the GSIS optional health insurance plans. Existing optional plans include the Optional Life Insurance Fund/Hospitalization Insurance Plan (HIP) and the Pre-Need Insurance Fund/Family Hospitalization Plus Plan (FHPP).

Source Agency and Publication/ Data Inputs:

- GSIS: Statement of Claims and Benefits Paid – Employees Compensation Insurance Fund, Optional Life Insurance Business/ Hospitalization Insurance Plan, and Pre-Need Business/ Family Hospitalization Plus Plan (submission upon the request of PSA)

Estimation Methodology:

- Data on benefit claims payments of the GSIS-HIP and GSIS-FHPP taken from the submission of the GSIS are used as reported without adjustments.

VIII. Insurance corporations/Life  and non-life insurance corporations [back to top]

Coverage:

- These are the health benefits payments by both life and non-life insurance companies and the administrative costs attributed with health insurance activities.

Source Agency and Publication/ Data Inputs:

- Insurance Commission (IC): Annual Report, financial data on insurance operations and health benefit payments

Estimation Methodology:

- Expenditures of private insurance companies for health and accident benefit payments are sourced directly from the IC annual report.

- General administration and operating costs of health and accident insurance activities are estimated by multiplying the proportion of health and accident premiums to the total general and other operating expenditures of the same company.

Distribution Keys:

- Distribution of persons covered by private health insurance by quintile from the FIES (2015 and 2018)

- Distribution of benefit claims of the Private Sector Program by disease from PHIC database

- Distribution of benefit claims for the Private Sector Program by age/sex from PHIC database

IX. Insurance corporations/Health  maintenance organizations  (HMOs) [back to top]

Coverage:

- Total expenditures of HMOs are provided (a) through the Insurance Commission (IC), (b) through the Association of Health Maintenance Organizations of the Philippines, Inc. (AHMOPI), or the Securities and Exchange Commission (SEC).

Source Agency and Publication/ Data Inputs:

- Insurance Commission (IC): Annual Report on HMOs, health benefits payments and administration costs

- Association of Health Maintenance Organizations of the Philippines, Inc. (AHMOPI): Financial statements (FS) of member HMOs

- Securities and Exchange Commission (SEC): Financial statements (FS) of HMOs

Estimation Methodology:

- Expenditures of HMOs for health benefit payments and for general administration are taken directly from the IC annual report. If the said report is not available, the health expenditures will be taken from the individual financial statements of HMOs.

Distribution Keys:

- Distribution of persons covered by private health insurance by income quintile from FIES (2015 and 2018)

- Distribution of benefit claims of the Private Sector Program by disease from PHIC database

- Distribution of benefit claims for the Private Sector Program by age/sex from PHIC database

- Distribution of primary and intermediate inputs from the 2018 Supply and Use Tables (SUT)

X. Households [back to top]

Coverage:

- These are the out-of-pocket expenditures of households for goods and services within the health accounts boundary. In the Family Income and Expenditures Survey (FIES), these include the following: medicines, food supplements, other medical products, therapeutic appliances, outpatient medical care, dental care, diagnostic services, and private and public hospital care.

Source Agency and Publication/ Data Inputs:

- Philippine Statistics Authority (PSA): Family Income and Expenditure Survey (FIES), data on the proportion of medical care expenditure to total household expenditure

- PSA: Data on household final consumption expenditure (HFCE) from the National Accounts of the Philippines (NAP)

Estimation Methodology:

- The private household out-of-pocket health expenditures are estimated by applying the proportion of health expenditures derived from the FIES to the HFCE level from the NAP. HFCE levels were adjusted from the proportion of health expenditure to total expenditures.

- For non-FIES years, household expenditures are estimated by extrapolating the FIES-year estimate with the trend of the HFCE Health less benefits from PHIC, Insurance, and HMOs.

Distribution Keys:

- Distribution of primary and intermediate inputs from the 2018 Supply and Use Tables (SUT)

- Distribution of total billing of users of government and private hospitals by age/sex from PHIC database

- Distribution of private clinic users by age/sex from APIS or other survey

- Distribution of total billing of users of government and private hospitals by disease from PHIC database

- Distribution of Out-Patient Department (OPD) visits by disease using data from the Hospital Operations and Management Information System or HOMIS (sample hospitals only), or using data from other sources

- Combined distribution of government hospital, private hospital. and private clinic expenditures by disease (with the distribution for each health facility weighted by out-of-pocket spending on the facility)

XI. Corporation (other than providers of health care)/Government corporations [back to top]

Coverage:

- These are the expenditures for health care by the Philippine Charity Sweepstakes Office (PCSO) and the Philippine Amusement and Gaming Corporation (PAGCOR). PCSO health expenditures include those of the Individual Medical Assistance Program (IMAP) and the Charity Clinic Department. PAGCOR health expenditures include subsidies for health (individual medical assistance and assistance to hospitals, NGOs and foundations), hospitalization (paid directly to hospitals), medical missions, wheelchairs, medical/laboratory equipment, and medicines.

Source Agency and Publication/ Data Inputs:

- COA: Philippine Charity Sweepstakes Office (PCSO) Annual Audit Report

- PCSO: Report of Health Expenditures (issued upon request)

- Philippine Amusement and Gaming Corporation (PAGCOR): Report of Health Expenditures (issued upon request)

Estimation Methodology:

- Data from the reports and submissions of the PCSO and PAGCOR are used as reported without adjustments.

XII. Corporations (other than providers of health care)/Private corporations (employee health care) [back to top]

Coverage:

- These are the expenditures by private establishments for employee health care through, among others, (a) in-house provision of health care (personnel and other facility costs), (b) in-house provision of drugs and medicines, (c) cost of retained health care providers, and (d) fitness/health programs.

Source Agency and Publication/ Data Inputs:

- PSA: 2018 Supply and Use Tables

- Average expenditures per establishment by employment size and industry group from Racelis (2014) study on private establishments health spending for employees

Estimation Methodology:

- For the benchmark estimate, health expenditures of private corporations are estimated by multiplying the average health expenditure per establishment with the number of firms by employment size and by industry group for the current year. Total expenditure is estimated as the sum of all expenditures of private establishments across all industries.

- For non-benchmark years, the estimates from the benchmark year is extrapolated with the trend of health inputs by industry, derived by multiplying Gross Value Added with the technical Coefficient of Human Health Intermediate inputs in the 2018 SUT.

Distribution Keys:

- Distribution of ill persons or injured at work by income quintile from APIS or other survey

- Distribution of ill persons or injured at work by age/sex group from APIS or other survey

XIII. Gross Fixed Capital Formation [back to top]

Coverage:

- Total value of the fixed assets that health providers have acquired during the accounting period and that are used repeatedly or continuously for more than one year in the production of health services.

Source Agency and Publication/ Data Inputs:

- DBM: National Expenditure Program (NEP), Budget of Expenditure and Sources of Financing (BESF)

- PSA: Census of Philippine Business and Industry (CPBI), Annual Survey of Philippine Business and Industry (ASPBI), National Accounts of the Philippines (NAP)

- DOF: Bureau of Local Government Finance (BLGF), Statement of Receipts and Expenditures by LGU

- DBM: National Expenditure Program (NEP), Budget of Expenditure and Sources of Financing (BESF)

Estimation Methodology:

- For the national government estimate, detailed data of capital outlay from NEP is utilized as the basic data for estimation. Health expenditures for capital outlay in the NEP is scaled up using the ratio between the agency level actual expenditures on capital outlays reported in the BESF and agency level programmed expenditures on capital outlays stated in the NEP.

- For the local government estimate, actual data on capital outlay as reported by BLGF was utilized. The structure of national government was used to break the total capital outlay of LGU by asset type.

- For the private sector estimate, data on CPBI and ASPBI was used to extract the share of health to total construction and durable equipment in NAP.

References [back to top]

Racelis, R. H. (2014). “Study to Support Improvement of the Philippine National Health Accounts (PNHA): Update on Expenditures for Employer-Provided Health Care and Private Schools Health Services”, Makati City: Philippine Institute for Development Studies, Discussion Paper Series No. 2014-44, April 2014.

World Health Organization. (2011). “A System of Health Accounts 2011” Edition: 2011 Edition (Vol. 2011). OECD Publishing.