2.11 Health spending and personnel
See Table 2.11 hereAbout the data
Definitions
Data sources
Most industrial countries have developed systems for tracking and comparing public and private health care expenditures over the past two decades.
By contrast, in developing countries data are rarely tabulated in national health accounts, which is necessary to ensure consistency and completeness. Compiling complete information on public health care spending has proved difficult in some developing countries. And estimates of private health spending are often lacking or incomplete. Data are provided here only for countries with actual data.
Data on physicians and nurses are mainly from the World Health Organization's (WHO) second evaluation of progress in implementing national health-for-all strategies. The data for developing countries here have been supplemented by country statistical yearbooks and World Bank sector studies.
Two factors affect the comparability of the WHO's physician ratios. First, in many developing countries a significant share of the population, particularly in rural areas, receives treatment from practitioners of indigenous medicine not included in the WHO definition of physician. Second, the extent to which homeopaths, osteopaths, and the like are included varies across countries.
Thus these are essentially indicators of availability, not of quality or use. They do not show how well trained physicians are or how well equipped hospitals or medical centers are-nor do they reveal the use of their services. Similarly, data on hospital beds and hospital usage may be misleading in poor countries, where hospital crowding can result in people sleeping on floors in wards and corridors.
The WHO reviews the international health statistics it compiles for validity and consistency, querying data that:
Vary by more than a reasonable amount from the value reported for the previous period. Are not consistent with data reported for other indicators. Are not consistent with data from other sources.
Inconsistent or grossly inaccurate data are not retained.
• Health expenditure includes outlays for the provision of health services (preventive and curative), population activities, nutrition activities, and emergency aid designated for health. It does not include water and sanitation.
• Public health expenditure comprises recurrent and capital government expenditures on health care (including government and social security expenditures for medical care) and donor assistance for health services.
• Private health expenditure covers direct out-of-pocket expenditures by households, direct payments by employers for health services, and expenditures by nongovernmental and charitable organizations.
• Physicians are defined as graduates of any faculty or school of medicine who are working in the country in any medical field (practice, teaching, research).
• Nurses are defined as persons who have completed a program of basic nursing education, are qualified and registered or authorized to provide service for the promotion of health, prevention of illness, care of the sick, and rehabilitation, and are working in the country. The data do not cover auxiliary and paraprofessional personnel.
• Hospital beds comprise those available in public and private, general and specialized hospitals and rehabilitation centers. Hospitals are establishments permanently staffed by at least one physician.
Country information on public health expenditures is from national sources, supplemented by World Bank sector studies, including:
Goldstein and others, Trends in Health Status, Services, and Finance, vol. 1. Chellaraj and others, Trends in Health Status, Services, and Finance, vol. 2. Klugman and Schieber, A Survey of Health Reform in Central Asia.
Data were also drawn from World Bank public expenditure reviews, the Pan American Health Organization, the International Monetary Fund's Government Finance Statistics, and other studies. Data for private expenditure are largely from household surveys, World Bank poverty assessments and sector studies, and other studies. Data on public and private health expenditures for industrial countries and Turkey are from the OECD. Data for physicians, nurses, and hospital beds come from government statistical yearbooks, the World Bank, the OECD, and the WHO.