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I. Introduction 
II. Data and Data Sources 
      II.1 National government (Department of Health)/ Domestic revenue-based 
      II.2 National government (other agencies) 
      II.3 Foreign-assisted projects (FAPs) 
      II.4 Local government 
      II.5 Social security agencies/PhilHealth 
      II.6 Social security agencies/SSS, GSIS (Employees’ Compensation Insurance Fund) 
      II.7 Insurance corporations/Life and non-life insurance corporations 
      II.8 Corporations (Other than insurance corporations)/Health maintenance organizations (HMOs) 
      II.9 Households 
      II.10 Corporations (other than providers of health care)/ Government corporations 
      II.11 Corporations (other than providers of health care)/ Private establishments (employee health care) 
III. Methodology 
      III.1 National government (Department of Health)/ Domestic revenue-based 
      III.2 National government (other agencies) 
      III.3 Foreign-assisted projects (FAPs) 
      III.4 Local government 
      III.5 Social security agencies/PhilHealth 
      III.6 Social security agencies/SSS, GSIS (Employees’ Compensation Insurance Fund) 
      III.7 Insurance corporations/Life and non-life insurance corporations 
      III.8 Corporations (Other than insurance corporations)/Health maintenance organizations (HMOs) 
      III.9 Households 
      III.10 Corporations (other than providers of health care)/ Government corporations 
      III.11 Corporations (other than providers of health care)/ Private establishments (employee health care) 
IV. Concepts and Definition of Terms 
     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) 
V. Dissemination of Results and Revision 
VI. Citation 
VII. Contact Information

I. Introduction [back to top]

The Philippine National Health Accounts (PNHA) provides information on health care spending in the country. It provides data in determining whether the aggregate health care spending from all sources is adequate to meet basic requirements and identifies probable areas as inefficiencies in allocating health care resources.

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.

II. Data and Data Sources [back to top]

Health expenditure in the PNHA 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 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.

II.1 National government (Department of Health)/ Domestic revenue-based [back to top]

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 Expenditures and Sources of Financing (BESF)

Distribution Keys:

- Distribution of the general population by income quintile from the 2015, 2018, and 2021 Family Income and Expenditure Survey (FIES) 
- Distribution of total billing by disease from Philippine Health Insurance Corporation (PhilHealth) database for users of government hospitals 
- Distribution of total billing by age/sex from PhilHealth database for users of government hospitals 
- Distribution of general population by age/sex from Census of Population and Housing (CPH)

II.2 National government (other agencies) [back to top]

Source Agency and Publication/ Data Inputs:

- COA: Annual Financial Report of the National Government 
- DBM: NEP, BESF

Distribution Keys:

- Distribution of the general population by income quintile from APIS 
- Distribution of total billing by disease from PhilHealth database for users of government hospitals 
- Distribution of total billing by age/sex from PhilHealth database for users of government hospitals 
- Distribution of general population by age/sex from Census of Population and Housing

II.3 Foreign-assisted projects (FAPs) [back to top]

Source Agency and Publication/ Data Inputs:

- DOH-BIHC: Profile and Status of FAPs 
- NEDA: List of Active Official Development Assistance (ODA) Loans and Grants 
- DBM: BESF

II.4 Local government [back to top]

Source Agency and Publication/ Data Inputs:

- COA: Annual Financial Report for Local Government, Financial Statements of LGUs 
- DOF: Bureau of Local Government Finance (BLGF), Annual Statement of Receipts and Expenditures and Health, Nutrition and Population Control by LGU Type

Distribution Keys:

- Distribution of the general population by income quintile from the 2015, 2018, and 2021 Family Income and Expenditure Survey (FIES) 
- Distribution of total billing by disease for users of government hospitals from PhilHealth 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 PhilHealth database 
- Distribution of population age/sex from Census of Population and Housing (CPH)

II.5 Social security agencies/PhilHealth [back to top]

Source Agency and Publication/ Data Inputs:

- PhilHealth: Annual Report/Audited Financial Statements, Stats and Charts Report, Claims Database Tabulations 
- DBM: BESF 
- COA: AFR

Distribution Keys:

- Distributions of PhilHealth contributions according to the contribution schemes of the government, private and individually-paying members – one distribution key per program 
- Distribution of PhilHealth claims paid by region from PhilHealth database 
- Distribution of the general population by income quintile from FIES.

II.6 Social security agencies/SSS, GSIS (Employees’ Compensation Insurance Fund) [back to top]

Source Agency and Publication/ Data Inputs:

- Employees’ Compensation Commission (ECC): Benefit claims of Social Security System (SSS) and Government Service Insurance System (GSIS) that are for medical and rehabilitation services purposes (submission upon request of PSA) 
- Government Service Insurance System (GSIS): Statement of Claims and Benefits Paid – Employees Compensation Insurance Fund (submission upon request of PSA)

Distribution Keys:

- Distribution of employee and employer share of SSS and GSIS

II.7 Insurance corporations/Life and non-life insurance corporations [back to top]

Source Agency and Publication/ Data Inputs:

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

Distribution Keys:

- Distribution of persons covered by private health insurance by quintile from the FIES (2015, 2018 and 2021) 
- Distribution of benefit claims for the Private Sector Program by disease from PhilHealth database 
- Distribution of benefit claims for the Private Sector Program by age/sex from PhilHealth database 
- Distribution of benefit claims for the Private Sector Program by region from PhilHealth database 
- Distribution of primary and intermediate inputs from the 2018 Supply and Use Tables (SUT)

II.8 Corporations (Other than insurance corporations)/Health maintenance organizations (HMOs) [back to top]

Source Agency and Publication/ Data Inputs:

- Insurance Commission (IC): Annual Report on HMOs, health benefits payments and administration costs 
- Securities and Exchange Commission (SEC): financial statements (FS) of HMOs

Distribution Keys:

- Distribution of persons covered by private health insurance by income quintile from FIES (2015, 2018, and 2021) 
- Distribution of benefit claims of the Private Sector Program by disease from PhilHealth database< 
- Distribution of benefit claims for the Private Sector Program by age/sex from PhilHealth database

- Distribution of benefit claims for the Private Sector Program by region from PhilHealth database

II.9 Households [back to top]

Source Agency and Publication/ Data Inputs:

- Philippine Statistics Authority (PSA): 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)

Distribution Keys:

- Distribution of primary and intermediate inputs from the 2018 SUT 
- Distribution of total billing of users of government and private hospitals by age/sex from PhilHealth database 
- Distribution of total billing of users of government and private hospitals by disease from PhilHealth database 
- Distribution of total billing of users of ambulatory health care facilities and private hospitals by age/sex from PhilHealth database 
- Distribution of total billing of users of ambulatory health care facilities by disease from PhilHealth database

II.10 Corporations (other than providers of health care)/ Government corporations [back to top]

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)

II.11 Corporations (other than providers of health care)/ Private establishments (employee health care) [back to top]

Source Agency and Publication/ Data Inputs:

- PSA: 2018 SUT and data on private human health from NAP

Distribution Keys:

- Distribution of persons covered by private health insurance by income quintile from FIES (2015, 2018 and 2021) 
- Distribution of benefit claims for the Private Sector Program by age/sex from PhilHealth database

III. Methodology [back to top]

1. The Philippine National Health Accounts based on the System of Health Accounts 2011 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); 
- Institutional units of financing sources (FS.RI); 
- Financing schemes (HF); and 
- Financing agents (FA).

Provision Dimension 
- Providers (HP); 
- Factors of provision (FP); and 
- Capital formation (HK).

Consumption Dimension 
- Functions (HC); and 
- Beneficiary characteristics.

4. There are 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 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.

III.1 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.

Estimation methodology:

- Activities under the DOH in 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 NEP. 
- In the estimation of the national government spending on the four specialty hospitals, the expenses for Personnel Services and Maintenance and Other Operating Expenses reported in their individual Statement of Income and Expenditures is used. 
- In the estimation of the health capital formation of national government, actual health expenditure on capital outlays reported in the BESF is used.

III.2 National  government  (Other  agencies) [back to top]

Coverage:

- These are expenditures of 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 other government agencies identified as health-related based on stated purpose.

Estimation methodology:

- All health-related activities from identified government agencies 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 health capital formation of other national government agencies, actual health expenditures on capital outlays reported in the BESF are employed.

III.3 Foreign-assisted projects (FAPs) [back to top]

Coverage:

- Expenditures (loans or grants proceeds) of all Foreign Assisted Projects from foreign institutions which are intended primarily for health purposes.

Estimation methodology:

- Current health expenditures from foreign institutions are estimated using actual expenditures/disbursement data of projects for a specific year as reported in the DOH Report. Expenditures of health projects reported in the NEDA ODA Report not found in the DOH Report are also included. 
- The amount is then converted to Philippine Peso (PhP) using the exchange rate from BSP. 
- FAPs reported in the DBM BESF are used to validate and supplement the data from DOH and NEDA as necessary.

III.4 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.

Estimation methodology:

- Health expenditures of provinces, cities, and municipalities are estimated by applying the health shares to the total expenditures of each level of LGUs reported in the COA Annual Report. 
- The health shares 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 detailed data from BLGF.

III.5 Social security agencies/PhilHealth [back to top]

Coverage:

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

Estimation methodology:

- Data on claims payment for each type of PhilHealth Program based on Claims Database Tabulations are adjusted according on the totals by program as reported in the PhilHealth Audited Financial Statements/Annual Reports.

III.6 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.

Estimation Methodology:

- EC benefit claims payments data for medical and rehabilitation services from reports provided by GSIS and SSS are used as reported.

III.7 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.

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.

III.8 Corporations (Other than insurance corporations)/ Health maintenance organizations (HMOs) [back to top]

Coverage:

- Total expenditures of HMOs submitted (a) to the Insurance Commission (IC), and (b) the Securities and Exchange Commission (SEC).

Estimation Methodology:

- Expenditures of HMOs for health benefit payments and for general administration are taken directly from the IC annual report. These are being supplemented by individual financial statements of HMOs.

III.9 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.

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 are adjusted using the share of health expenditures 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 PhilHealth, Insurance, and HMOs.

III.10 Corporations (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 expenditure includes 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.

Estimation Methodology:

- Data from the reports and submissions of the PCSO and PAGCOR are used as reported.

III.11. Corporations (Other than providers of health care)/ Private corporations (Employee health care) [back to top]

Coverage:

- These are expenditures of 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.

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 (GVA) with the technical Coefficient of Human Health Intermediate inputs in the 2018 SUT.

IV. Concepts and Definition of Terms [back to top]

The Philippine National Health Accounts 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 44 tables: 36 tables on CHE, three (3) on HK and five (5) on derived indicators.

Institutional units of financing sources (FSRI) [back to top]

Institutional units that provide revenues to health financing schemes (a “Reporting Item” or RI under the Financing Sources or FS dimension).

Financing sources (FS):  [back to top]

The revenues of the health financing schemes received or collected through specific contribution mechanisms.

Financing schemes (HF) [back to top]

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.

Financing agents (FA) [back to top]

Institutional units that manage health financing schemes.

Health care providers (HP) [back to top]

Entities that receive money in exchange for, or in anticipation of producing the activities inside the health accounts boundary.

Factors of health care provision (FP) [back to top]

The types of inputs used in producing the goods and services or activities covered by the health accounts boundary.

Health care functions (HC) [back to top]

The types of goods and services provided and activities performed within the health accounts boundary.

Beneficiary characteristics [back to top]

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).

Gross fixed capital formation (HK) [back to top]

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.

V. Dissemination of Results and Revision [back to top]

The schedule of release of PNHA is ten (10) months after the reference period. A press release, publication, statistical tables, and infographic are posted on the PSA website.

VI. Citation [back to top]

Philippine Statistics Authority. (2022). Technical Notes on Philippine National Health Accounts. https://psa.gov.ph/statistics/pnha/technical-notes

VII. Contact Information [back to top]

Mr. Gerald Junne L. Clariño 
Chief Statistical Specialist 
Satellite Accounts Division 
(02) 8376-2019 
g.clarino@psa.gov.ph

For data request, you may contact: 
Knowledge Management and Communications Division 
(02) 8462-6600 loc. 820 and 823
info@psa.gov.ph | kmcd.staff@psa.gov.ph