Health care expenditure (hlth_sha)

Reference Metadata in Euro SDMX Metadata Structure (ESMS)

Compiling agency: Eurostat, the statistical office of the European Union

Eurostat metadata
Reference metadata
1. Contact
2. Metadata update
3. Statistical presentation
4.Unit of measure
5. Reference Period
6. Institutional Mandate
7. Confidentiality
8. Release policy
9. Frequency of dissemination
10. Dissemination format
11. Accessibility of documentation
12. Quality management
13. Relevance
14. Accuracy
15. Timeliness and punctuality
16. Comparability
17. Coherence
18. Cost and Burden
19. Data revision
20. Statistical processing
21. Comment
Related Metadata
Annexes (including footnotes)

For any question on data and metadata, please contact: EUROPEAN STATISTICAL DATA SUPPORT


1. Contact Top
1.1. Contact organisation Eurostat, the statistical office of the European Union
1.2. Contact organisation unit F5: Education, health and social protection
1.5. Contact mail address 2920 Luxembourg LUXEMBOURG

2. Metadata update Top
2.1. Metadata last certified 15/02/2013
2.2. Metadata last posted 15/02/2013
2.3. Metadata last update 26/02/2013

3. Statistical presentation Top
3.1. Data description

Health care expenditure data provide information on expenditure in the functionally defined area of health distinct by provider category (e.g. hospitals, general practitioners), function category (e.g. services of curative care, rehabilitative care, clinical laboratory, patient transport, prescribed medicines) and financing agent (e.g. social security, private insurance company, household).

The definitions and classifications of the System of Health Accounts (SHA) (see the annex at the bottom of the page) are followed, e.g. International Classification for Health Accounts - Providers of health care (ICHA-HP).

Health care data on expenditure are largely based on surveys and administrative (register) data sources in the countries. Therefore, they reflect the country-specific way of organising health care and may not always be completely comparable.

The database is based on a co-operation between EUROSTAT, the OECD (Organisation for Economic Co-Operation and Development) and the WHO (World Health Organisation), executing a Joint Questionnaire on Health expenditure since 2005.

The area covered consists of EU-27 (excluding EL, IE, IT, MT, and UK), Norway, Iceland, Switzerland, Japan, USA, Australia and Korea.

3.2. Classification system

For all data on expenditure two sources for classifications are available:

  • the System of Health Accounts (Manual v.1.0) as presented by the OECD in 2000 and
  • the Guide to producing national health accounts with special application for low and middle income countries produced by WHO/Worldbank/USAID in 2003

These two manuals are complemented by the Guidelines produced for EUROSTAT by the Office for National Statistics (UK) in 2003.

3.3. Coverage - sector

Public Health

3.4. Statistical concepts and definitions

Health care statistics describe the process of providing and financing health care in countries by referring to health care goods and services, its providers and financing.

Current expenditure on health measures the economic resources spent by a country on health care services and goods, including administration and insurance. Total expenditure on health care represents current expenditure on health enlarged by the expenditure on capital formation of health care providers.

For the collection of the data on health care expenditure the System of Health Accounts (SHA) and its related set of International Classification for the Health Accounts (ICHA) is used. The SHA shares the goals of the System of National Account (SNA) to constitute an integrated system of comprehensive, internally consistent, and internationally comparable accounts, which should as far as possible be compatible with other aggregated economic and social statistical systems.

The SHA is organised around a tri-axial system for the recording of health expenditure, by means of the International Classification for Health Accounts (ICHA), defining:

  • health care by function (ICHA-HC)
  • health care service provider industries (ICHA-HP) and
  • health care financing agents (ICHA-HF).

Under the ICHA expenditure data are described according to the following classifications:

Provider category (ICHA-HP):

The production and the provision of health care services along with their financing take place in a wide range of institutional settings that vary across countries. The way of organising health care services reflects the country-specific division of labour between providers of health care services which is becoming increasingly complex in many countries. A classification of health care providers serves the purpose of arranging country-specific institutions into common, internationally applicable categories and providing tools for linking data on personnel and other resource inputs as well as output measurement.

Function category (ICHA-HC):

The boundaries of a functionally defined health care system delimit the subject area of health accounts. This approach is "functional" in the sense that it refers to the purposes of health care. Health care in a country comprises the sum of activities performed either by institutions or individuals pursuing, through the application of medical, paramedical and nursing knowledge and technology, the purposes of:

  • promoting health and preventing disease;
  • curing illness and reducing premature mortality;
  • caring for persons affected by chronic illness who require nursing care;
  • caring for persons with health-related impairment, disability, and handicaps who require nursing care;
  • assisting patients to die with dignity;
  • providing and administering public health;
  • providing and administering health programmes, health insurance and other funding arrangements.

The core functions of health care refer to the purposes listed above. Health-related functions (like education and training of health workforce, research and development in health, environmental health) should be distinguished from the core of health care functions. They can be very closely linked to health care in terms of operations, institutions and personnel, but should, as far as possible, be excluded when measuring activities belonging to core health care functions.

Financing agent (ICHA-HF):

Mechanisms of health care financing are becoming increasingly complex in many countries with a wide range of institutions involved. The financing of health care is one of the reporting dimensions. At least a basic subdivision of public and private financing is reported in many cases. A detailed breakdown of expenditure on health by financing agents is an essential component of a comprehensive SHA.

Data are presented in 4 summary (one-dimensional) tables and 3 cross-classification tables (2-dimensional tables).

Summary tables provide data on:

  • Current expenditure by provider (ICHA-HP)
  • Current expenditure by function (ICHA-HC) plus health related functions
  • Current expenditure by financing agents (ICHA-HF)
  • Current expenditure on long- term care (HC.3 plus HC.R.6)

Cross-classification tables refer to:

  • HC x HP: Health care expenditure by function and provider: data on which type of health care goods and services are supplied by which health care provider;
  • HC x HF: Health care expenditure by function and by financing agent: data on who pays for which type of services and goods;
  • HP x HF: Health care expenditure by provider and by financing agent: data on who pays which health care provider.
3.5. Statistical unit

The economy of a country is the outcome of the activity of a very large number of units which carry out numerous transactions of various kinds for purposes of production, finance, insurance, redistribution and consumption. The units and groupings of units used in the accounts must be defined with reference to the kind of economic analysis for which they are intended. To analyse the process of production, it is essential to select units which bring out relationships of a technico-economic nature; to analyse flows affecting financial transactions it is essential to select units which make it possible to study relationships among economic agents.

Statistical and administrative sources refer usually to institutional units active in providing health (care) services to the population. In the description of the financing of health care the units mainly refer to those involved in the process of paying for the services delivered for consumption. Expenditure refers to the payments related to final consumption of all goods and services by the domestic population. (In the majority of countries health care services provided to foreigners cannot be separated and are included in the domestic consumption).

In the health care expenditure data collection three approaches are possible. Data collection can be built starting either from the financing, or from the provider side or from the functional side. Depending on the information source available various elements can be used as statistical unit. It may be an observation unit on which information is received and statistics are compiled or an analytical unit which statisticians create by splitting or combining observation units with the help of estimations or imputations in order to supply more detailed and/or homogenous data than would otherwise be possible

3.6. Statistical population

The data aim at providing a complete overview of expenditure on health care goods and services consumed by the domestic population and produced by providers of health care, from whichever source this consumption is financed.

3.7. Reference area

EU-27 (excluding Greece, Ireland, Italy, Malta and the United Kingdom), Norway, Iceland, Switzerland, Japan, USA, Australia and Korea.

3.8. Coverage - Time

For almost all countries the data are available from 2003 onwards. However the availability varies across countries and classifications.

3.9. Base period

Not applicable.

4. Unit of measure Top

Current expenditure data are presented according to following units:

  • expenditure amount in millions of euro
  • expenditure amount in millions of national currency
  • expenditure amount in millions of PPS
  • percentage of GDP
  • amount in euro per capita
  • amount in national currency per capita 
  • amount in PPS per capita
  • percentage of current health expenditure (CHE)

5. Reference Period Top

Calendar year; in case calendar years are not available fiscal years can be used.

6. Institutional Mandate Top
6.1. Institutional Mandate - legal acts and other agreements

Countries submit data to Eurostat on the basis of a gentlemen's agreement established in the framework of the Eurostat Working Group on "Public Health Statistics".

Data collection takes place in agreement with the World Health Organisation (WHO) and the Organization of Economic Co-operation and Development (OECD). Common definitions and data specifications are used in the data collection.

6.2. Institutional Mandate - data sharing

Data collection takes place in agreement with the World Health Organisation (WHO) and the Organization of Economic Co-operation and Development (OECD).

7. Confidentiality Top
7.1. Confidentiality - policy

Regulation (EC) No 223/2009 on European statistics (recital 24 and Article 20(4)) of 11 March 2009 (OJ L 87, p. 164), stipulates the need to establish common principles and guidelines ensuring the confidentiality of data used for the production of European statistics and the access to those confidential data with due account for technical developments and the requirements of users in a democratic society.

7.2. Confidentiality - data treatment

Not applicable

8. Release policy Top
8.1. Release calendar

Not applicable

8.2. Release calendar access

Not applicable

8.3. Release policy - user access

In line with the Community legal framework and the European Statistics Code of Practice Eurostat disseminates European statistics on Eurostat's website (see item 10 - 'Dissemination format') respecting professional independence and in an objective, professional and transparent manner in which all users are treated equitably. The detailed arrangements are governed by the Eurostat protocol on impartial access to Eurostat data for users.

9. Frequency of dissemination Top


10. Dissemination format Top
10.1. Dissemination format - News release

Not applicable

10.2. Dissemination format - Publications

10.3. Dissemination format - online database

Please consult free data on-line or refer to point 10.5.

10.4. Dissemination format - microdata access

Not applicable

10.5. Dissemination format - other

11. Accessibility of documentation Top
11.1. Documentation on methodology

Some countries are unable to cover all providers of care (the inclusion of private providers seems particularly difficult) or unable to cover all financing agents or all functions at the detailed level requested.

11.2. Quality management - documentation

Please see files in Annex

12. Quality management Top
12.1. Quality assurance

Not applicable

12.2. Quality management - assessment

The quality of the data is subject to the way, in which health care provision is organised in countries, and which information is available to and collected by the respective institutions.

13. Relevance Top
13.1. Relevance - User Needs

Not available

13.2. Relevance - User Satisfaction

Not available.

13.3. Completeness

Not available.

14. Accuracy Top
14.1. Accuracy - overall

Data for 2003-2010 are extracted from the 2012 SHA Joint (Eurostat-OECD-WHO) Questionnaire and, at the time of dissemination, are not fully validated. Therefore, they should be considered as preliminary estimates and may be subject to refinement. More detailed information on the validation status of the data submitted by countries is provided in the Methodological Information of each country in the Annex.

14.2. Sampling error

Not applicable.

14.3. Non-sampling error

Not applicable.

15. Timeliness and punctuality Top
15.1. Timeliness

EUROSTAT, OECD and WHO ask for submission of the data for year N at N+15 months. A number of countries still face difficulties with this timetable.

15.2. Punctuality

Not available.

16. Comparability Top
16.1. Comparability - geographical

Comparability across countries is improving being strongly influenced by the classification digit levels (higher at the 1st digit level, lower at following digits)

16.2. Comparability - over time

Comparability over time is still very difficult to determine as for various countries the time series are very short.

More detailed information on per-country comparability issues is provided in the Methodological Information of each country in the Annex.

17. Coherence Top
17.1. Coherence - cross domain


17.2. Coherence - internal

The data are consistent.

18. Cost and Burden Top

Not available.

19. Data revision Top
19.1. Data revision - policy


19.2. Data revision - practice

In case a country sends new data for previous years the data set for this country is updated.

20. Statistical processing Top
20.1. Source data

The data are collected, stored and disseminated via different tables (expenditure by provider, by financing agent and by function). The data are based on:

  • different statistical sources, ranging from specific surveys performed for the health care branch, household budget surveys and administrative sources (registers);
  • the basic data collected for the purpose of the National Accounts and
  • the data information systems available in the Ministries of Health, other Ministries and other types of agencies involved in the health care branch.

These different sources may lead to differences in the coverage of time series, data validity, reliability and comparability. Furthermore, it may not always be possible to have the health care system being consistently defined across data sources.

For expenditure calculated as share of GDP, the national GDP in euro as available in the EUROSTAT database is used. Expenditure per capita is calculated using the corresponding national (average) population data. Expenditure data expressed in PPS is calculated using the the corresponding national data as collected by the National Accounts department in EUROSTAT.

Please note that some of the data sources used nationally may not have been initially intended to be used for statistical purposes, and that the initial purpose of a data source may differ across countries. Both facts may influence the comparability of results.

20.2. Frequency of data collection


20.3. Data collection

Aggregated data collected via a Joint Questionnaire.

20.4. Data validation

Consistency checks are carried out in co-operation with OECD and WHO health accountants. Principally the consistency of all the subtotals at all levels of aggregation are checked against the relevant totals. All identical items are checked for consistency across the various tables. Plausibility of values is checked (as far as possible) against documentation provided in the metadata and if possible against other countries. Also the development in time is checked for consistency (e.g. against the metadata provided by the country).

20.5. Data compilation

All transactions are to be calculated on accrual principles, meaning that the expenditure data relate to all transactions or activities carried out during the calendar year for which data are reported, irrespective of the date of payment for these services.

As there are no data available for all MS, no EU aggregates are calculated for the moment.

20.6. Adjustment

No adjustement is needed

21. Comment Top

See the methodological information of each country in the annex.

Related metadata Top

Annexes Top