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About the data

2.16

Definitions

Health systems—the combined arrangements of

this reason, data for this indicator should not be

• Total health expenditure is the sum of public and

institutions and actions whose primary purpose

compared across editions.

private health expenditure. It covers the provision

is to promote, restore, or maintain health (World

External resources for health are disbursements

of health services (preventive and curative), family

Health Organization, World Health Report 2000)—

to recipient countries as reported by donors, lagged

planning and nutrition activities, and emergency aid

are increasingly being recognized as key to com-

one year to account for the delay between disburse-

for health but excludes provision of water and sani-

bating disease and improving the health status of

ment and expenditure. Disbursement data are not

tation. • Public health expenditure is recurrent and

populations. The World Bank’s Healthy Develop-

available before 2002, so commitments are used.

capital spending from central and local governments,

ment: Strategy for Health, Nutrition, and Population

Except where a reliable full national health account

external borrowing and grants (including donations

Results emphasizes the need to strengthen health

study has been done, most data are from the Organ-

from international agencies and nongovernmental

systems, which are weak in many countries, in order

isation for Economic Co-operation and Development

organizations), and social (or compulsory) health

to increase the effectiveness of programs aimed at

Development Assistance Committee’s Creditor

insurance funds. • Out-of-pocket health expendi-

reducing specific diseases and further reduce mor-

Reporting System database, which compiles data

ture is the percentage of total expenditure that is

bidity and mortality (World Bank 2007). To evaluate

from government expenditure accounts, government

direct household outlays, including gratuities and

health systems, the World Health Organization (WHO)

records on external assistance, routine surveys of

in-kind payments, for health practitioners and phar-

has recommended that key components—such as

external financing assistance, and special services.

maceutical suppliers, therapeutic appliances, and

financing, service delivery, workforce, governance,

Because of the variety of sources, care should be

other goods and services whose primary intent is

and information—be monitored using several key

taken in interpreting the data.

to restore or enhance health. • External resources

indicators (WHO 2008b). The data in the table are

In countries where the fiscal year spans two cal-

for health are funds or services in kind that are pro-

a subset of the first four indicators. Monitoring

endar years, expenditure data have been allocated

vided by entities not part of the country in ques-

health systems allows the effectiveness, efficiency,

to the later year (for example, 2008 data cover fis-

tion. The resources may come from international

and equity of different health system models to be

cal year 2007/08). Many low-income countries use

organizations, other countries through bilateral

compared. Health system data also help identify

Demographic and Health Surveys or Multiple Indica-

arrangements, or foreign nongovernmental orga-

weaknesses and strengths and areas that need

tor Cluster Surveys funded by donors to obtain health

nizations and are part of public and private health

investment, such as additional health facilities,

system data.

expenditure. • Health expenditure per capita is

better health information systems, or better trained human resources.

Data on health worker (physicians, nurses, and

total health expenditure divided by population in

midwives) density show the availability of medical

U.S. dollars and in international dollars converted

Health expenditure data are broken down into pub-

personnel. The WHO estimates that at least 2.5

using 2005 purchasing power parity (PPP) rates from

lic and private expenditures. In general, low-income

physicians, nurses, and midwives per 1,000 people

the World Bank’s International Comparison Project.

economies have a higher share of private health

are needed to provide adequate coverage with pri-

• Physicians include generalist and specialist medi-

expenditure than do middle- and high-income coun-

mary care interventions associated with achieving

cal practitioners. • Nurses and midwives include pro-

tries, and out-of-pocket expenditure (direct payments

the Millennium Development Goals (WHO, World

fessional nurses and midwives, auxiliary nurses and

by households to providers) makes up the largest

Health Report 2006). The WHO compiles data from

midwives, enrolled nurses and midwives, and other

proportion of private expenditure. High out-of-pocket

household and labor force surveys, censuses, and

personnel, such as dental nurses and primary care

expenditures may discourage people from access-

administrative records. Data comparability is limited

nurses. • Hospital beds are inpatient beds for both

ing preventive or curative care and can impoverish

by differences in definitions and training of medical

acute and chronic care available in public, private,

households that cannot afford needed care. Health

personnel varies. In addition, human resources tend

general, and specialized hospitals and rehabilita-

financing data are collected through national health

to be concentrated in urban areas, so that average

tion centers. • Outpatient visits per capita are the

accounts, which systematically, comprehensively,

densities do not provide a full picture of health per-

number of visits to health care facilities per capita,

and consistently monitoring health system resource

sonnel available to the entire population.

including repeat visits.

flows. To establish a national health account, coun-

Availability and use of health services, shown by

tries must define the boundaries of the health system

hospital beds per 1,000 people and outpatient visits

and classify health expenditure information along

per capita, reflect both demand- and supply-side fac-

several dimensions, including sources of financing,

tors. In the absence of a consistent definition these

Data sources

providers of health services, functional use of health

are crude indicators of the extent of physical, finan-

Data on health expenditures are from the WHO’s

expenditures, and beneficiaries of expenditures. The

cial, and other barriers to health care.

National Health Account database (latest updates

accounting system can then provide an accurate pic-

are available at www.who.int/nha/), supple-

ture of resource envelopes and financial flows and

mented by country data. Data on physicians, and

allow analysis of the equity and efficiency of financing

nurses and midwives, are from WHO’s Global Atlas

to inform policy.

of the Health Workforce. For the latest updates and

This year’s table presents out-of-pocket expendi-

metadata, see http://apps.who.int/globalatlas/.

ture as a percentage of total health expenditure; pre-

Data on hospital beds and outpatient visits are

vious editions presented out-of-pocket expenditure

from the WHO, supplemented by country data.

as a percentage of private health expenditure. For

2011 World Development Indicators

97

people

Health systems

World Development Indicators 2011 Part 1 of 2  

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