The health of nations

Abstract

In the twenty-first century, the need for countries to reliably measure and compare how much they spend on health is somewhat obvious. By accounting for health expenditure, governments can identify how money flows through their health systems: who funds health care and who provides it, how much money is being spent, and on what. In this way, governments can adjust their priorities, evaluate the impact of interventions, improve health services, and address various structural problems. The complexity of health systems and methodological problems surrounding national health accounting, however, have undermined attempts to compare health expenditures globally over the last century. This chapter traces the history of international health accounting: organised attempts to measure and compare health spending across national boundaries, including the rules and conventions that ensure the coherence of this information. Although a comprehensive system of health accounts (SHA) has been established only recently, it has had various precursors over the twentieth century. This chapter traces its antecedents through the work of various international organisations, including the League of Nations Health Organisation (LNHO), the United Nations, the International Labour Organisation (ILO), the Organisation for Economic Co-operation and Development (OECD), and the World Bank. In presenting a genealogy of international health accounting, this chapter describes the evolving role the issue of health care financing has played in international health. It also highlights the development of accounting technologies, such as standardised tables and accounting manuals, which have facilitated international measurement and comparison.