Reference metadata describe statistical concepts and methodologies used for the collection and generation of data. They provide information on data quality and, since they are strongly content-oriented, assist users in interpreting the data. Reference metadata, unlike structural metadata, can be decoupled from the data.
DG Analysis and Monitoring - dept. Financing and budget
1.3. Contact name
Confidential because of GDPR
1.4. Contact person function
Confidential because of GDPR
1.5. Contact mail address
Finance Tower
Kruidtuinlaan 50 bus 135
1000 Brussels
Belgium
1.6. Contact email address
Confidential because of GDPR
1.7. Contact phone number
Confidential because of GDPR
1.8. Contact fax number
2.1. Metadata last certified
30 June 2023
2.2. Metadata last posted
27 March 2024
2.3. Metadata last update
27 March 2024
3.1. Data description
Health care expenditure quantifies the economic resources dedicated to health functions, excluding capital investment. Healthcare expenditure concerns itself primarily with healthcare goods and services that are consumed by resident units, irrespective of where that consumption takes place (it may be in the rest of the world) or who is paying for it. As such, exports of healthcare goods and services (to non-resident units) are excluded, whereas imports of healthcare goods and services for final use are included. 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 scheme (e.g. social security, private insurance company, household). 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. SHA sets out an integrated system of comprehensive and internationally comparable accounts and provides a uniform framework of basic accounting rules and a set of standard tables for reporting health expenditure data. The System of Health Accounts - SHA 2011 is a statistical reference manual giving a comprehensive description of the financial flows in health care.
It provides a set of revised classifications of health care functions, providers of health care goods and services and financing schemes. The SHA is currently used as a basis for a joint data collection by OECD, Eurostat and WHO on health care expenditure. The manual sets out in more detail the boundaries, the definitions and the concepts of health accounting – responding to health care systems around the globe with very different organisational and financing arrangements.
Accounting period: Health expenditure and financing data pertain to the calendar year (1 January to 31 December).
healthcare expenditure by financing schemes (ICHA-HF) — which classifies the types of financing arrangements through which people obtain health services; health care financing schemes include direct payments by households for services and goods and third-party financing arrangements;
healthcare expenditure by function (ICHA-HC) — which details the split in healthcare expenditure following the purpose of healthcare activities — such as, curative care, rehabilitative care, long-term care, or preventive care;
healthcare expenditure by provider (ICHA-HP) — which classifies units contributing to the provision of healthcare goods and services — such as hospitals, residential facilities, ambulatory health care services, ancillary services or retailers of medical goods.
3.3. Coverage - sector
1. Household individual consumption on health, including the collective consumption with two exceptions:
Occupational health care (intermediate consumption within establishments) minus an estimated share of occupational health in health providers’ and other medical industries net administration;
“Remunerated” unpaid household production in the form of transfer payments (social benefits in cash) for home care of sick, disabled and elderly persons provided by family members.
SHA 2011 Manual recommends following the standard System of National Account (SNA) rules for drawing the production boundary of health care services, albeit with two notable exceptions:
Occupational health care is included in the national totals of health care spending. In SNA, this item is recorded as ancillary services and part of intermediate production of enterprises and
Part of the cash transfers to private households for care givers of home care for the sick and disabled are treated as the paid household production of health care.
2. Health care financing schemes:
HF1 Government schemes and compulsory contributory health care financing schemes;
HF2 -voluntary health care payment schemes;
HF3 - Household out-of-pocket payment;
HF4 - rest of the world financing schemes.
3. NACE rev. 2, section Q, human health and social work activities.
3.4. Statistical concepts and definitions
SHA concept is the consumption of health care goods and services.
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. 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. SHA is a tri-axial system in which the financing, provision and consumption dimensions are covered by the ICHA (International Classification for Health Accounts): Health Care Functions (HC), Health Care Providers (HP), Health Care Financing Schemes (HF).
Data are presented in 3 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)
Current expenditure by financing scheme (ICHA-HF)
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 scheme: data on how are the different types of services and goods financed;
HP x HF: Health care expenditure by provider and by financing scheme: data on from which health care provider and under which particular financing scheme are the services and goods purchased.
The classifications and definitions presented in the SHA 2011 manual are to be followed. Additional guidelines and material useful for compilers are also available at this address.
3.5. Statistical unit
Commission Regulation (EU) 2021/1901, and Commission Regulation (EU) 2015/359 previously in force, concern the collection of data on "current expenditure on healthcare" which is defined as the "final consumption expenditure of resident units on health care goods and services".
There is a very close relationship between the concept of "final consumption expenditure" as defined in the System of Health Accounts (SHA) and in National Account and, as a consequence, also between the underlying economic transactions as recorded in the two accounting frameworks.
In National Accounts there are two types of statistical units: institutional units and local kind-of-activity units (KAU). A local KAU groups all the parts of an institutional unit in its capacity as producer which are located in a single site. A local KAU belongs to one and only one institutional unit.
SHA uses the same two types of units for data compilation.
Local KAUs operating as providers of healthcare goods and services to resident units are statistical units in SHA.
Also transactions by institutional units are recorded in SHA, in which framework institutional units are also referred to as "financing agents". More precisely, SHA financing agents are institutional units that manage one or more financing schemes. The transactions are executed by the financing agents, according to the rules of the financing schemes.
Financing agents serve as key statistical units in producing national health accounts. While financing schemes are the key units for analysing how the consumption of health care goods and services is financed, the data concerning the relevant transactions are collected either from the financing agents that operate the different financing schemes or from the providers.
The concept of "healthcare financing schemes" in SHA is an application and extension of the concept of "social protection schemes" defined by the European System of Social PROtection Statistics (ESSPROS): "a distinct body of rules, supported by one or more institutional units, governing the provision of social protection benefits and their financing ...". The social protection scheme is the statistical unit in ESSPROS. It is an analytical unit that allows describing the complete structure of the social protection financing system: expenditure and receipts.
According to SHA Manual 2011, "the key concepts for describing the structure of the health care financing system are based on measuring: (a) the expenditure of health care financing schemes, under which goods and services are purchased directly from health care providers, on the one hand, and (b) the types of revenues of health care financing schemes, on the other hand.
Commission Regulation (EU) 2021/1901 and (prior Commission Regulation (EU) 2015/359) limits its scope to the collection of data on the expenditure of health care financing schemes.
3.6. Statistical population
SHA focuses on the consumption of health care goods and services by the resident population irrespective of where this takes place. This implies the inclusion of imports (from non-resident providers) and the exclusion of exports (health care goods and services provided to non-residents).
3.7. Reference area
Belgium.
3.8. Coverage - Time
2003 - 2021.
3.9. Base period
Not applicable.
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).
Health care expenditure data are annual data, corresponding to the calendar year.
This quality report covers the following reference years: 2003 to 2022.
6.1. Institutional Mandate - legal acts and other agreements
Countries submit data to Eurostat on the basis of Commission Regulations (EU):
2015/359 of 4 March 2015 implementing Regulation (EC) No 1338/2008 of the European Parliament and of the Council as regards statistics on healthcare expenditure and financing, until the reference year 2020
2021/1901 of 29 October 2021 implementing Regulation (EC) No 1338/2008 of the European Parliament and of the Council as regards statistics on health care expenditure and financing, for which the first reference year will be in 2021.
The implementing Regulations specify the areas and the level of aggregation to be submitted by EU Member States and EEA countries (see Annex II of the Regulation).
6.2. Institutional Mandate - data sharing
Data collection takes place in agreement with the World Health Organization (WHO) and the Organization of Economic Co-operation and Development (OECD).
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 - 'Accessibility and clarity') 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.
Authorities responsible for SHA data collection work to ensure that the statistical practices used to compile national health accounts are in compliance with SHA methodological requirements and that good practices in the field are being followed, according to the methodology underlined in the SHA 2011 Manual and European Statistics Code of Practice respecting professional independence of the statistical authorities. Procedures are in place to plan and monitor the quality of the health care expenditure statistical production process.
11.2. Quality management - assessment
Data used are drawn from official sources:
Annual accounts of administrations and entities involved - submitted to certification;
National accounts.
12.1. Relevance - User Needs
The main users of health care expenditure data are policy makers, research institutes, media, and students.
12.2. Relevance - User Satisfaction
Eurostat performs regularly satisfaction surveys to determine user satisfaction.
12.3. Completeness
Complete.
13.1. Accuracy - overall
The sources to compile the data on health care expenditure are mainly administrative and register-based data, only a small percentage of the figures come from surveys or other means. Accordingly, for the health care expenditure data collection, accuracy deals with problems of coverage as the main possible source of errors.
13.2. Sampling error
Not applicable.
13.3. Non-sampling error
Not applicable.
14.1. Timeliness
Member States were required to transmit their data to Eurostat in compliance with the Commission Regulation (EU) 2015/359 transmission deadlines, until reference year 2020. As of reference year 2021, data are transmitted pursuant to Commission Regulation (EU) 2021/1901. Data and reference metadata for the reference year T should be transmitted to Eurostat by 30 April T+2.
14.2. Punctuality
Data are available in the deadlines foreseen.
15.1. Comparability - geographical
Not applicable.
15.2. Comparability - over time
Data are consistent over the full period available. Methodological corrections are applied to the full data series.
15.3. Coherence - cross domain
Data are coherent with national accounts, taken into account the methodological and scope differences between both.
Data sources used are the same.
15.4. Coherence - internal
Data are internally conherent and consistent.
1 FTE.
0.2 Mio EUR.
17.1. Data revision - policy
Data are revised when methodological corrections need to be applied. This might be a consequence of new or more complete sources, etc..
Data are revised, when necessary when new data are available, at the occasion of the annual submission of the new data year.
17.2. Data revision - practice
Revisions are applied, as far as necessary at the annual transmission.
18.1. Source data
I.1. Administrative and statistical data sources
Source name
Brief description of source (e.g. coverage, reference year, etc)
Type of data source
Primary SHA variable(s) using this data source
Time period covered by this data source
Accounts social security insitutions
Annual accounts of social security insitutions
INAMI/RIZIV Health insurance
Financial reports
HF121
2003-2021
Fedris
Financial reports
HF121
2003-2021
ONEM/RVA
Financial reports
HF121
2003-2021
HZIV/CAAMI
Financial reports
HF121
2003-2021
Budgets governments
budgets federal government
Other
HF11
2003-2007
cofog accounts federal government expenditure
COFOG classification for federal government
Financial reports
HF11
2008-2021
Budgets governments
budgets regional government French speaking community
Other
HF11
2003-2015
cofog accounts regionall government expenditure
COFOG classification for French speaking community
Financial reports
HF11
2016-2021
Budgets governments
budgets regional government Walloon region
Other
HF11
2003-2013
cofog accounts regional government expenditure
COFOG classification for Walloon region
Financial reports
HF11
2014-2021
Budgets governments
budgets regional government Flemish community
Other
HF11
2003-2017
cofog accounts regional government expenditure
COFOG classification for Flemish community
Financial reports
HF11
2016-2021
Budgets governments
budgets regional government German speaking community
Other
HF11
2003-2014
cofog accounts regional government expenditure
Government German speaking community
Financial reports
HF11
2015-2021
Budgets governments
Government Brussels region
Other
HF11
2003-2017
cofog accounts regional government expenditure
Government Brussels region
Financial reports
HF11
2018-2021
Budgets governments
FlemishCommission for the Brussels Region (VGC)
Other
HF11
2003-2017
cofog accounts regional government expenditure
FlemishCommission for the Brussels Region (VGC)
Financial reports
HF11
2018-2021
Budgets governments
French Commissions for the Brussels Region (COCOF)
Other
HF11
2003-2018
cofog accounts regional government expenditure
French Commissions for the Brussels Region (COCOF)
Financial reports
HF11
2021
Budgets governments
Common Commissions for the Brussels Region (COCOM)
Other
HF11
2003-2017
cofog accounts regional government expenditure
Common Commissions for the Brussels Region (COCOM)
Financial reports
HF11
2018-2021
Accounts social protection agency
IRISCARE
Financial reports
HF11
2019 onwards
Agency pour une vie de qualité (AVIQ)
Financial reports
HF11
2003-2021
Vlaams Fonds/Vlaamse sociale bescherming
Financial reports
HF11
2003-2021
Dienstelle fur ein selbstbestimmtes Leben
Financial reports
HF11
2003-2021
PHARE
Financial reports
HF11
2003-2021
Kind & Gezin
Financial reports
HF11
2003-2021
Office de l'Enfance et de la Naissance
Financial reports
HF11
2003-2021
household final consumption by national accounts
estimates of final household consumption by households
Other
HF31
2003-2021
accounts red cross
financial accounts
Financial reports
HF22
2003-2021
accounts railways
financial accounts
Financial reports
HF23
2003-2021
Assuralia- federation of insurance companies
aggregated statistics on benefits and administrative costs of private health insurance
Surveys/censuses
HF21
2003-2021
Controledienst der ziekenfondsen/Service de contrôle des mutuelles
financial statistics
Public administrative records
HF21
2003-2021
Pharma.be - federation of pharmaceutical sector
pharmaceutical consumption
Surveys/censuses
HC51
2003-2021
18.2. Frequency of data collection
Annual.
18.3. Data collection
Data are collected through the joint health accounts questionnaire (JHAQ) that is submitted to Eurostat during the annual data collection exercise. There is a voluntary deadline to send the JHAQ questionnaire for the calendar year T by the 31st of March T+2. The joint health accounts questionnaire (JHAQ) is coordinated in agreement with the World Health Organisation (WHO) and the Organization of Economic Co-operation and Development (OECD). These three international organisations are known collectively as the International Health Accounts Team (IHAT). Data are submitted to Eurostat based on Commission Regulation (EU) 2015/359 of 4 March 2015 implementing Regulation (EC) No 1338/2008 of the European Parliament and of the Council as regards statistics on healthcare expenditure and financing, until reference year 2020. As of reference year 2021 onwards Commission Regulation (EU) 2021/1901 of 29 October 2021 implementing Regulation (EC) No 1338/2008, is in force.
18.4. Data validation
The 2023 JHAQ includes a number of features which allow national data correspondents to perform various quality checks before submitting the data. The embedded programmes allow the verification of:
1- Consistency of the data between tables, This step checks if the marginal totals reported in each table of the JHAQ are consistent across all tables. For example, for each function (HC), the total across all financing schemes (HF) in the HCxHF table has to be equal to the total across all providers (HP) in the HCxHP table, i.e. the values in the column “All HF” in the HCxHF table have to be equal to the values in the column “All HP” in the HCxHP table. Any detected differences are flagged up in the corresponding row or column in the relevant tables and all inconsistencies are listed in the “Report” worksheet by variable code together with the amount by which the respective variable differs between the two compared tables. A positive value indicates that the first listed table has a higher value for the same variable, and vice versa.
2- Consistency of the data within tables, Any detected inconsistencies are listed by variable code together with an indication of which total is not equal to the sum of its subcomponents as well as the numerical difference. A positive figure indicates that the total is greater than the reported sub-components, and vice versa.
The presence of negative values,
Entries in the tables cannot be negative as they refer to the consumption of goods and services. If an individual data table is checked for internal consistency, the negative values check is performed for the relevant table and then any negative values are highlighted red and crossed out.
The presence of atypical entries,
The atypical entries check provides information whether the data tables contain values in cells which are – if at all – only reported by very few countries and are thus atypical for health accounting. If an individual data table is checked for internal consistency, the atypical entries check is performed for the relevant table. In the data tables, any cell containing an atypical entry will be highlighted for national data providers. Should any atypical entries be identified, compilers should scrutinize in detail the transactions that led to entries in those cells and assess whether the accounting rules of SHA have been correctly applied. If they come to the conclusion that the transactions are recorded in the correct categories of the ICHA classifications, then the corresponding atypical entries represent unique – and correctly accounted for – features of the country’s health system. In this case a short description of the nature of the transactions should be included in the accompanying Metadata file under “II.3. Atypical entries”. If, on the other hand, compilers come to the conclusion that the transactions are not recorded correctly, then they need to make adjustments in the concerned tables. In case the transactions recorded in a cell do not belong to the boundaries of SHA (e.g. they refer to intermediate consumption) the value of the respective cell should be deleted (and all cells that are affected by this change adjusted accordingly). In case the transactions are misreported and another category of the ICHA classification is more appropriate, the value of the cell should be transferred to the correct cell of the table.
3- The growth rates against the previous year and the magnitude of revisions as compared to previously submitted data. Results are grouped into three different categories:
Breaks in series (the current questionnaire shows no data for an item that is not null in the other file)
Newly reported (the current questionnaire contains data for an item that is empty in the other file)
Differences (all other types of differences)
18.5. Data compilation
I.2. Estimation methods
SHA variable(s)
Main method (see comment box for definitions)
Brief description of methodology
HF11, HF121
direct attribution
In general: All expenditure items that are directly attributable to a HC or HP category, are directly classified under the applicable HC/HP code. For HF11, this is done for all relevant budget items available in the accounts or budgets of the different governments. The same applies for specific benefits by the social security institutions (eg prevention campaigns 'sponsored' on the budget of NIHII, etc... Only for items where this is not possible, alternative methods are used on observed expenditure.
HC & HP xHF121
Pro-rating/Utilisation key
HF121 covers different schemes of social security: the general health care insurance scheme, administered by the NIHII, but also reimbursement of medical care in the framework of the occupational hazards (accidents and occupational illness) insurance, the scheme for seafarers and adherents to the so called overseas social security scheme. The information used for these institutions is drawn from their accounts. (administrative records and accounts)
HC & HP xHF121
Pro-rating/Utilisation key
NIHII: data are available on reimbursements by medical act (cfr fee for service reimbursement system), including the administrative distinction 'ambulatory care' and 'hospital care'. Every item is assigned to individual HC or HP classification codes.
HC & HP xHF121
Pro-rating/Utilisation key
Seafarers and adherents 'overseas workers insurance': expenditure is split, using a key calculated as a proportional split, identical to the proportionally obtained split of NIHDII expenditure
HC & HP xHF121
Pro-rating/Utilisation key
Occupational hazards: expenditure is split following a key calculated on a selection of NIHII reimbursement items that can occur in treatment of occupational hazards.
HC & HP xHF121
Pro-rating/Utilisation key
Expenditure is split based on a key calculated on the basis of the proportional split of the patients copayments, corresponding to the so called 'nomenclature' (list of reimbursable acts of the social security health insurance) The expenditure concerns only the complementary insurance of railway personnel (introduced by collective labour agreement), that legally can only reimburse the copayments (or non reimbursable acts) of the health insurance. For this reason, the key is calculated on the basis of the copayments list. The starting point of the calculation is accounting information of the institution concerned.
HC & HP x HF21
Pro-rating/Utilisation key
Complementary insurances in Belgium can, by law, only insure the copayments foreseen for reimbursable acts and non reimbursable acts by the health insurance (NIHII scheme). In most cases, these insurances in Belgium insure the copayments in the framework of an hospital admission or treatment. Therefore a key is used to split the expenditure, based on the copayments of the 'hospital care' reimbursements by NIHII. HF21 covers both insurances sold by private insurance companies, as the insurances offered by the sickness funds. The starting point is administrative information on the aggregate expenditure of these institutions (or their professional association)
HC & HP x HF3
Other
OOP expenditure is split between HC and HP following a mixed method, using direct assignment and keys. Starting point is the estimate made for the final household consumption in the friamework of National Accounts (hospital services/pharmaceuticals/medical, dental and nursing care (ambulatory). These estimates are corrected for non health expenditure, using data from the hospitals' accounts (exhaustive aggregation by the Ministry of health) to exclude 'other revenues' (parking fees, shop revenues, interest on investments or financial reserves,..) and sector data to exclude non medical sales in pharmacies. The household final consumption estimate is also corrected for care allowances received by households (are in national accounts included in the revenue side of households, and need thus be excluded for expenditure at charge of households and reallocated to government or social security expenditure (HF11 and HF121)). The 'remaining' OOP at charge of housholds is then attributed to a HC or HP group (HC1, HP1, etc..) and the split further using a calculation key, based on the corresponding proportional composition of the copayments in the framework (nomenclature) of the legal health insurance (NIHII). With regards to acquisition of hearing aids and optical devices (glasses, lenses), the amount obtained for the split of household consumption, is corrected (completed) with an estimate for consumption of these items (are in National Accounts included in retail consumption) based on a key calculated as a multiplicator of the health insurance reimbursement on these specific items, defined on an hypothesis around observed professional associations' data. LTC is split for OOP between HC3 and HCR1, based on a key with in the nominator the number of patients in nursing homes evaluated autonomy categories B, C, Cd and D divided by the total number of residents at 31/12.
Health care expenditure quantifies the economic resources dedicated to health functions, excluding capital investment. Healthcare expenditure concerns itself primarily with healthcare goods and services that are consumed by resident units, irrespective of where that consumption takes place (it may be in the rest of the world) or who is paying for it. As such, exports of healthcare goods and services (to non-resident units) are excluded, whereas imports of healthcare goods and services for final use are included. 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 scheme (e.g. social security, private insurance company, household). 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. SHA sets out an integrated system of comprehensive and internationally comparable accounts and provides a uniform framework of basic accounting rules and a set of standard tables for reporting health expenditure data. The System of Health Accounts - SHA 2011 is a statistical reference manual giving a comprehensive description of the financial flows in health care.
It provides a set of revised classifications of health care functions, providers of health care goods and services and financing schemes. The SHA is currently used as a basis for a joint data collection by OECD, Eurostat and WHO on health care expenditure. The manual sets out in more detail the boundaries, the definitions and the concepts of health accounting – responding to health care systems around the globe with very different organisational and financing arrangements.
Accounting period: Health expenditure and financing data pertain to the calendar year (1 January to 31 December).
27 March 2024
SHA concept is the consumption of health care goods and services.
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. 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. SHA is a tri-axial system in which the financing, provision and consumption dimensions are covered by the ICHA (International Classification for Health Accounts): Health Care Functions (HC), Health Care Providers (HP), Health Care Financing Schemes (HF).
Data are presented in 3 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)
Current expenditure by financing scheme (ICHA-HF)
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 scheme: data on how are the different types of services and goods financed;
HP x HF: Health care expenditure by provider and by financing scheme: data on from which health care provider and under which particular financing scheme are the services and goods purchased.
The classifications and definitions presented in the SHA 2011 manual are to be followed. Additional guidelines and material useful for compilers are also available at this address.
Commission Regulation (EU) 2021/1901, and Commission Regulation (EU) 2015/359 previously in force, concern the collection of data on "current expenditure on healthcare" which is defined as the "final consumption expenditure of resident units on health care goods and services".
There is a very close relationship between the concept of "final consumption expenditure" as defined in the System of Health Accounts (SHA) and in National Account and, as a consequence, also between the underlying economic transactions as recorded in the two accounting frameworks.
In National Accounts there are two types of statistical units: institutional units and local kind-of-activity units (KAU). A local KAU groups all the parts of an institutional unit in its capacity as producer which are located in a single site. A local KAU belongs to one and only one institutional unit.
SHA uses the same two types of units for data compilation.
Local KAUs operating as providers of healthcare goods and services to resident units are statistical units in SHA.
Also transactions by institutional units are recorded in SHA, in which framework institutional units are also referred to as "financing agents". More precisely, SHA financing agents are institutional units that manage one or more financing schemes. The transactions are executed by the financing agents, according to the rules of the financing schemes.
Financing agents serve as key statistical units in producing national health accounts. While financing schemes are the key units for analysing how the consumption of health care goods and services is financed, the data concerning the relevant transactions are collected either from the financing agents that operate the different financing schemes or from the providers.
The concept of "healthcare financing schemes" in SHA is an application and extension of the concept of "social protection schemes" defined by the European System of Social PROtection Statistics (ESSPROS): "a distinct body of rules, supported by one or more institutional units, governing the provision of social protection benefits and their financing ...". The social protection scheme is the statistical unit in ESSPROS. It is an analytical unit that allows describing the complete structure of the social protection financing system: expenditure and receipts.
According to SHA Manual 2011, "the key concepts for describing the structure of the health care financing system are based on measuring: (a) the expenditure of health care financing schemes, under which goods and services are purchased directly from health care providers, on the one hand, and (b) the types of revenues of health care financing schemes, on the other hand.
Commission Regulation (EU) 2021/1901 and (prior Commission Regulation (EU) 2015/359) limits its scope to the collection of data on the expenditure of health care financing schemes.
SHA focuses on the consumption of health care goods and services by the resident population irrespective of where this takes place. This implies the inclusion of imports (from non-resident providers) and the exclusion of exports (health care goods and services provided to non-residents).
Belgium.
Health care expenditure data are annual data, corresponding to the calendar year.
This quality report covers the following reference years: 2003 to 2022.
The sources to compile the data on health care expenditure are mainly administrative and register-based data, only a small percentage of the figures come from surveys or other means. Accordingly, for the health care expenditure data collection, accuracy deals with problems of coverage as the main possible source of errors.
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).
I.2. Estimation methods
SHA variable(s)
Main method (see comment box for definitions)
Brief description of methodology
HF11, HF121
direct attribution
In general: All expenditure items that are directly attributable to a HC or HP category, are directly classified under the applicable HC/HP code. For HF11, this is done for all relevant budget items available in the accounts or budgets of the different governments. The same applies for specific benefits by the social security institutions (eg prevention campaigns 'sponsored' on the budget of NIHII, etc... Only for items where this is not possible, alternative methods are used on observed expenditure.
HC & HP xHF121
Pro-rating/Utilisation key
HF121 covers different schemes of social security: the general health care insurance scheme, administered by the NIHII, but also reimbursement of medical care in the framework of the occupational hazards (accidents and occupational illness) insurance, the scheme for seafarers and adherents to the so called overseas social security scheme. The information used for these institutions is drawn from their accounts. (administrative records and accounts)
HC & HP xHF121
Pro-rating/Utilisation key
NIHII: data are available on reimbursements by medical act (cfr fee for service reimbursement system), including the administrative distinction 'ambulatory care' and 'hospital care'. Every item is assigned to individual HC or HP classification codes.
HC & HP xHF121
Pro-rating/Utilisation key
Seafarers and adherents 'overseas workers insurance': expenditure is split, using a key calculated as a proportional split, identical to the proportionally obtained split of NIHDII expenditure
HC & HP xHF121
Pro-rating/Utilisation key
Occupational hazards: expenditure is split following a key calculated on a selection of NIHII reimbursement items that can occur in treatment of occupational hazards.
HC & HP xHF121
Pro-rating/Utilisation key
Expenditure is split based on a key calculated on the basis of the proportional split of the patients copayments, corresponding to the so called 'nomenclature' (list of reimbursable acts of the social security health insurance) The expenditure concerns only the complementary insurance of railway personnel (introduced by collective labour agreement), that legally can only reimburse the copayments (or non reimbursable acts) of the health insurance. For this reason, the key is calculated on the basis of the copayments list. The starting point of the calculation is accounting information of the institution concerned.
HC & HP x HF21
Pro-rating/Utilisation key
Complementary insurances in Belgium can, by law, only insure the copayments foreseen for reimbursable acts and non reimbursable acts by the health insurance (NIHII scheme). In most cases, these insurances in Belgium insure the copayments in the framework of an hospital admission or treatment. Therefore a key is used to split the expenditure, based on the copayments of the 'hospital care' reimbursements by NIHII. HF21 covers both insurances sold by private insurance companies, as the insurances offered by the sickness funds. The starting point is administrative information on the aggregate expenditure of these institutions (or their professional association)
HC & HP x HF3
Other
OOP expenditure is split between HC and HP following a mixed method, using direct assignment and keys. Starting point is the estimate made for the final household consumption in the friamework of National Accounts (hospital services/pharmaceuticals/medical, dental and nursing care (ambulatory). These estimates are corrected for non health expenditure, using data from the hospitals' accounts (exhaustive aggregation by the Ministry of health) to exclude 'other revenues' (parking fees, shop revenues, interest on investments or financial reserves,..) and sector data to exclude non medical sales in pharmacies. The household final consumption estimate is also corrected for care allowances received by households (are in national accounts included in the revenue side of households, and need thus be excluded for expenditure at charge of households and reallocated to government or social security expenditure (HF11 and HF121)). The 'remaining' OOP at charge of housholds is then attributed to a HC or HP group (HC1, HP1, etc..) and the split further using a calculation key, based on the corresponding proportional composition of the copayments in the framework (nomenclature) of the legal health insurance (NIHII). With regards to acquisition of hearing aids and optical devices (glasses, lenses), the amount obtained for the split of household consumption, is corrected (completed) with an estimate for consumption of these items (are in National Accounts included in retail consumption) based on a key calculated as a multiplicator of the health insurance reimbursement on these specific items, defined on an hypothesis around observed professional associations' data. LTC is split for OOP between HC3 and HCR1, based on a key with in the nominator the number of patients in nursing homes evaluated autonomy categories B, C, Cd and D divided by the total number of residents at 31/12.
I.1. Administrative and statistical data sources
Source name
Brief description of source (e.g. coverage, reference year, etc)
Type of data source
Primary SHA variable(s) using this data source
Time period covered by this data source
Accounts social security insitutions
Annual accounts of social security insitutions
INAMI/RIZIV Health insurance
Financial reports
HF121
2003-2021
Fedris
Financial reports
HF121
2003-2021
ONEM/RVA
Financial reports
HF121
2003-2021
HZIV/CAAMI
Financial reports
HF121
2003-2021
Budgets governments
budgets federal government
Other
HF11
2003-2007
cofog accounts federal government expenditure
COFOG classification for federal government
Financial reports
HF11
2008-2021
Budgets governments
budgets regional government French speaking community
Other
HF11
2003-2015
cofog accounts regionall government expenditure
COFOG classification for French speaking community
Financial reports
HF11
2016-2021
Budgets governments
budgets regional government Walloon region
Other
HF11
2003-2013
cofog accounts regional government expenditure
COFOG classification for Walloon region
Financial reports
HF11
2014-2021
Budgets governments
budgets regional government Flemish community
Other
HF11
2003-2017
cofog accounts regional government expenditure
COFOG classification for Flemish community
Financial reports
HF11
2016-2021
Budgets governments
budgets regional government German speaking community
Other
HF11
2003-2014
cofog accounts regional government expenditure
Government German speaking community
Financial reports
HF11
2015-2021
Budgets governments
Government Brussels region
Other
HF11
2003-2017
cofog accounts regional government expenditure
Government Brussels region
Financial reports
HF11
2018-2021
Budgets governments
FlemishCommission for the Brussels Region (VGC)
Other
HF11
2003-2017
cofog accounts regional government expenditure
FlemishCommission for the Brussels Region (VGC)
Financial reports
HF11
2018-2021
Budgets governments
French Commissions for the Brussels Region (COCOF)
Other
HF11
2003-2018
cofog accounts regional government expenditure
French Commissions for the Brussels Region (COCOF)
Financial reports
HF11
2021
Budgets governments
Common Commissions for the Brussels Region (COCOM)
Other
HF11
2003-2017
cofog accounts regional government expenditure
Common Commissions for the Brussels Region (COCOM)
Financial reports
HF11
2018-2021
Accounts social protection agency
IRISCARE
Financial reports
HF11
2019 onwards
Agency pour une vie de qualité (AVIQ)
Financial reports
HF11
2003-2021
Vlaams Fonds/Vlaamse sociale bescherming
Financial reports
HF11
2003-2021
Dienstelle fur ein selbstbestimmtes Leben
Financial reports
HF11
2003-2021
PHARE
Financial reports
HF11
2003-2021
Kind & Gezin
Financial reports
HF11
2003-2021
Office de l'Enfance et de la Naissance
Financial reports
HF11
2003-2021
household final consumption by national accounts
estimates of final household consumption by households
Other
HF31
2003-2021
accounts red cross
financial accounts
Financial reports
HF22
2003-2021
accounts railways
financial accounts
Financial reports
HF23
2003-2021
Assuralia- federation of insurance companies
aggregated statistics on benefits and administrative costs of private health insurance
Surveys/censuses
HF21
2003-2021
Controledienst der ziekenfondsen/Service de contrôle des mutuelles
financial statistics
Public administrative records
HF21
2003-2021
Pharma.be - federation of pharmaceutical sector
pharmaceutical consumption
Surveys/censuses
HC51
2003-2021
Annual
Member States were required to transmit their data to Eurostat in compliance with the Commission Regulation (EU) 2015/359 transmission deadlines, until reference year 2020. As of reference year 2021, data are transmitted pursuant to Commission Regulation (EU) 2021/1901. Data and reference metadata for the reference year T should be transmitted to Eurostat by 30 April T+2.
Not applicable.
Data are consistent over the full period available. Methodological corrections are applied to the full data series.
