Statistical Service of Cyprus

Health Statistics Unit - Division of Demography, Social Statistics and Tourism

Michael Karaolis Str. 

1444 Nicosia CYPRUS

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 is recorded in relation to the international classification for health accounts (ICHA) defining:

• 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.

1. Household individual consumption on health, including the collective consumption with two exceptions:

1. Occupational health care (intermediate consumption within establishments) minus an estimated share of occupational health in health providers’ and other medical industries net administration;
2. “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.

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).

The data aims at providing a complete overview of expenditure on health care goods and services consumption of services and goods by the population residing in the Government controlled areas of the Republic of Cyprus.

Detailed data according to SHA2011 is available for the period 2010-2022 for Cyprus.

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).

As regards the national data disseminated on the website of the Statistical Service of Cyprus, only the national currency, i.e. euro is applied.

Health care expenditure data are annual data, corresponding to the calendar year.

This quality report covers the following reference years: 2018-2022.

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).

Moreover, according to the Regulation the data should be transmitted to Eurostat by 30 April N+2 for reference year N. According to a Gentlemen’s agreement, the data is tranmitted to Eurostat by the end March N+2.

National Legislation 

Article 3 of the national Official Statistics Law, No. 25(I) of 2021 defines the functions of the Statistical Service of Cyprus regarding the production and dissemination of official statistics. Moreover, Article 13, explicitly stipulates the mandate for data collection and introduces a mandatory response to statistical enquiries by stipulating the obligation of respondents to reply to surveys and provide the data required. This relates not only to national but also to European statistics which, by virtue of Article 8 of the said Law, are incorporated in the annual and multiannual programmes of work without any further procedure.

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

The Regulation (EC) No 223/2009 on European statistics (recitals 23-27, 31-32 and Articles 20-26) applies.

Official statistics are released in accordance to all confidentiality provisions of the following:

• National Official Statistics Law No. 25(I) of 2021 (especially Article 16 on statistical confidentiality).
• Regulation (EC) No 223/2009 of the European Parliament and of the Council of 11 March 2009 on European statistics and its later amendments (especially Chapter 5 on statistical confidentiality).
• European Statistics Code of Practice (especially Principle 5 on statistical confidentiality).
• CYSTAT's Code of Practice for the Collection, Publication and Storage of Statistical Data.

Links to all of the above documents should be attached (or the actual documents):

• Statistics Law No. 25(I) of 2021.

• Regulation (EC) No 223/2009 on European statistics (consolidated text).

• European Statistics Code of Practice.

• Code of Practice for the Collection, Publication and Storage of Statistical Data.

The treatment of confidential data is regulated by CYSTAT's Code of Practice for the Collection, Publication and Storage of Statistical Data.

• Code of Practice for the Collection, Publication and Storage of Statistical Data.

In general, there is an annual release calendar for all the data disseminated by CYSTAT, which is announced during the 4th quarter of the year, includes provisional dates of publication for the following year, which are finalized the week before publication. Aggregated tables on health expenditure are disseminated from CYSTAT under the domain of health statistics. By the date of submission of the current report, the release date of health statistics was not included in the release calendar. However, 1 week before publication, the health statistics will be added in the calendar. 

Please refer to the Release calendar - Eurostat (europa.eu) and publicly available on the Eurostat’s website.

National Level:

Link to CYSTAT’s release calendar.

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.

National Level:

According to the Dissemination and Pricing Policy of the Statistical Service of Cyprus (section 2.3) CYSTAT΄s main channel for dissemination of statistics is the website, which offers the same conditions to everyone and is updated at the same time every working day (12:00 noon). Privileged pre-released access (of no more than 1 day in advance) has been granted to a few selected users for specific statistics. These are specified in the Dissemination Policy (section 2.3).

In addition to the annual release calendar, users are informed of the various statistical releases through the “Alert” service provided by CYSTAT.

Link to the Dissemination and Pricing Policy should be attached (or the actual document):

• Dissemination Policy of the Statistical Service of Cyprus.

Annual.

No specific news release for the dissemination of SHA data is announced. Aggregated SHA data as well as cross tables are published through the annual report “Health and Hospital Statistics”, for which an announcement and a news release is uploaded in CYSTAT’s website informing the users of the new publication.

From 2024, SHA data will also be included in the CYSTAT's database for reference years 2010-2022.

The annual report mentioned in the previous point is usually published in June year t with reference year t-2, including amongst others aggregated SHA data, as well as cross tables. The publication can be downloaded for free from CYSTAT’s website (Part G regards to SHA results for year t-2). 

In 2024, SHA data has also been included in the CYSTAT's database for reference years 2010-2022. 

In 2024, SHA data has also been included in the CYSTAT's database for reference years 2010-2022. The specific topic can be viewed at the CYSTAT website.

Statistical micro-data from CYSTAT’s surveys are accessible for research purposes only and under strict provisions as described below:

Under the provisions of the Statistics Law, CYSTAT may release microdata for the sole use of scientific research. Applicants have to submit the request form "APPLICATION FOR DATA FOR RESEARCH PURPOSES" giving thorough information on the project for which micro-data are needed.

The application is evaluated by CYSTAT’s Confidentiality Committee and if the application is approved, a charge is fixed according to the volume and time consumed for preparation of the data. Micro-data may then be released after an anonymisation process which ensures no direct identification of the statistical units but, at the same time, ensures usability of the data. The link for the application is attached below.

Link to the application for access to microdata on CYSTAT's website.

Applicants for tailor-made data must submit the following CYSTAT website.

Depending on the request, a charge is fixed according to the volume and time consumed for the preparation of the tailor-made data. Applicants are informed about the total charges and the output is produced as soon as the applicants accept the specified costs.

The methodology applied for the compilation of health indicators, as well as the data sources used, are presented in the pdf document published in CYSTAT's website. It can be found at the following link:

2020: HEALTH_HOSPITAL_STATS-2020-EN.

2021: HEALTH_HOSPITAL_STATS-2021-EN.

Metadata report in Eurostat's database.

The quality of statistics in CYSTAT is managed in the framework of the European Statistics Code of Practice which sets the standards for developing, producing and disseminating European Statistics as well as the ESS Quality Assurance Framework (QAF). CYSTAT endorses the Quality Declaration of the European Statistical System. In addition, CYSTAT is guided by the requirements provided for in Article 11 of the Statistics Law No. 25(I) of 2021 as well as Article 12 of Regulation (EC) No 223/2009 on European statistics, which sets out the quality criteria to be applied in the development, production and dissemination of European statistics.

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.

The quality of statistics in CYSTAT is managed in the framework of the European Statistics Code of Practice which sets the standards for developing, producing and disseminating European Statistics as well as the ESS Quality Assurance Framework (QAF). CYSTAT endorses the Quality Declaration of the European Statistical System. In addition, CYSTAT is guided by the requirements provided for in Article 11 of the Statistics Law No. 25(I) of 2021 as well as Article 12 of Regulation (EC) No 223/2009 on European statistics, which sets out the quality criteria to be applied in the development, production and dissemination of European statistics.

The codification of the diagnosis during discharge is performed from specially trained coders. For any discrepancies found in the data during the processing and analysis phase, CYSTAT goes back to the owners of the data and asks for clarifications. 

Peer Reviews

Peer reviews form part of the European Statistical System (ESS) strategy to monitor the implementation of the European Statistics Code of Practice. Their objective is to review the compliance/alignment of the ESS with the Code and to help the statistical authorities making up the ESS to further improve and develop the national statistical systems.

The first round of peer reviews took place during the period 2006 - 2008, the second round during the period 2013 - 2015 and the third round during the period 2021 - 2023.

In Cyprus, the first round took place in December 2006, the second round in March 2015 and the third round in March 2023. With the completion of the third peer review a list of improvement actions was compiled, on the basis of the conclusions of the evaluation included in the compliance report. A timetable for the implementation of these actions was also set, while their implementation is monitored by Eurostat on an annual basis.

The compliance reports as well as the improvement actions for each country can be accessed at Eurostat's website. The files regarding Cyprus are also available below (relevant files).

The third peer review for the National Statistical System of Cyprus took place in March, 2023.

• European Statistics Code of Practice.

• ESS Quality Assurance Framework (QAF).

• Quality Declaration of the European Statistical System.

• Statistics Law No. 25(I) of 2021.

• Regulation (EC) No 223/2009 on European statistics (consolidated text).

Links to the peer reviews:

PEER_REVIEW_CY_2006-EN.

Evaluation_Code_of_Practice_2015-EN.

Code_of_Practice_Improvement_Actions_2015-EN.

Evaluation_Code_of_Practice-2023-EN.

The main weakness is the lack of information for specific topics. These issues are outlined under points 12.3 and 13.3 of this report.

The main users of health care expenditure data are policy makers, research institutes, media, and students.

At national level: 

• Users of data consist of Ministries (of Health and Finance), researchers, academics, health care professionals, students, companies conducting studies for the health care system in Cyprus

• The Ministry of Health needs the data for the policy making, researchers and academics needs the data for supporting their studies, students use health statistics for supporting their thesis statements, private companies assinged the conducting of studies regarding the health sector need data in order to support the outcomens of their work.

Key indicators that are often included in the requests are: the current health expenditure in total, as well as the current health expenditure of the public sector as a percentage of the GDP and the respective figure for the private sector.

CYSTAT always remains on the disposal of the SHA users for any suggestions for improvement. Any feedback from main users is considered accordingly and if it is feasible it is incorporated in the compilation of SHA.

Since 2008 (with the exception of 2010, 2013 and 2020) CYSTAT carries out an annual online “Users Satisfaction Survey”. The results of the surveys are available on CYSTAT’s website at the link attached below.

Overall, there is a high level of satisfaction of the users of statistical data published by CYSTAT.

• Results of CYSTAT’s User Satisfaction Surveys.

Data is complete as far as the Commission regulation is applicable.

The only scheme for which data is not available from reference years 2016 onwards is "HF.4 Rest of the world financing schemes", due to lack of data source. However that fact does not lead to underestimation of the total health expenditure, since this expenditure is included in other HF items of the private sector.

Mainly administrative sources and registered-based data are used to compile the data on health care expenditure. Moreover, some estimations are performed based on the results of surveys or other statistical activities, i.e. the ESSPROS, the Household Budget Survey, the National Accounts, etc. Accordingly, for the health care expenditure data collection, accuracy deals with problems of coverage as the main possible source of errors. Since the SHA tables are the result of integrating different data sources into a given methodology, as well as the application of several estimations in order to result in the detailed SHA categories, the outcome is inevitably not 100% accurate; however the methodologies applied are improving, so is the coverage. 

Not applicable since no survey is being conducted specifically for the needs of compiling the SHA data.

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.

However, the member states are encouraged to transmit the data for reference year T, earlier, by the end of March T+2.

Cyprus submits the data by the end of March T+2.

There were no deviations from deadlines in the reference period.

Not applicable.

The breaks in time series resulting from methodological changes are presented in the table below:

Coherence is not applicable, since data from other sources, such as the National Account Data and ESSPROS data are applied to SHA2011 methodology in order to compile SHA.

Consistency checks are embedded in the cross tables in advance, so CYSTAT performs these checks before submitting the data to Eurostat. No other internal consistency check are performed.

The data sources used for the compilation of SHA data are administrative data, as well as information obtained from other surveys that are not conducted for the needs of SHA, but their results also serve SHA purposes (additional questions are included in the HBS questionnaire, as well as ESSPROS questionnaire for the needs of SHA). Therefore, the burden on the providers and the respondents does not significanlty reflects SHA.

As regards the Private Sector, since the data for the reference year are always preliminary, they are revised during the next year's submission. Additionally, the National Accounts are usually being reviewed 3 years back.

Revision Practices Applied in JHAQ2024

As regards HF.1.1, for years 2020-2021, the provisional figures on depreciation of capital formation have been revised and applied to the several HC and HP items. Additionally the capital formation for year 2020 has been revised. Also actual data for year 2021 from Social Welfare has been applied to HC.R1, since the figures submitted last year were estimations. 

After the full implementation of the GHS in 2021, in HF.1.1 and HF.1.2, a new distribution of inpatient/daycare and general/specialised hospitals is available from HIO which applied to 2021 and 2022 data. Specifically, until 2020 the distribution of inpatient/daycare under HF1.1 was very different since chemotherapies, blood infusion, haemodialysis sessions, etc. were not included in inpatients, since they were considered as outpatient cases. The data for previous years is not available in order to revise data from 2020 backwards. After the implementation of the GHS, such treatments are considered as day-care in all hospitals contracted with GHS. That fact, leads to considerable changes in the allocation of the expenditure between in-patient and day care.

Moreover, for years 2020-2021 revised figures as regards HF.1.2 for administrative data (HC.7.2/HP.7.2) have been obtained from the HIO and have been applied.

Revised figures for years 2020-2021 have been obtained from the National Accounts division (in CYSTAT) as regards the individual consumption expenditure of households (HF.3.1 and HF.3.2), according to the regular revising practices of that division.

For year 2021, data referring to HF2.1 (Local Government Schemes, Enterprises having their own funds, as well as Bank and Union funds), as well as data referring to HF2.2 (Non Profit Institutions), have been revised according to the actual data obtained from ESSPROS. 

As regards the submitted data for 2021-2022, it should be noted that the data referring to the Private Sector, as well as the depreciation for the Public Sector are preliminary.

Additional revisions may apply after Eurostat's feedback during the validation procedure for the JQ2024.

Several data sources are used (as of data notification in March 2024):

• Surveys/census: 3
• Public administrative records: 7
• Financial reports: 3
• Other: 0

Annual.

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.

The 2024 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).

SHA data is compiled both by a bottom-up approach as well as by a top-down approach, depending on the data source. Compilation is done by financing schemes and by different health care functions/task areas. The results of the several calculations are then aggregated.

To gain the differentiation between the different SHA-dimensions (especially HC and HP) quotas and pro-rating and utilisation keys are applied on some spending items. For some spending items it is necessary to extra-/intrapolate data as there is no up-to-date data available or data is missing for certain years. For some other spending items, estimation methods have to be applied.

Several methods are normally used for estimations:

• Balancing item/Residual method: For example, if data are available from the financing side, which permit accurate estimation of the flows to a provider or function, then an acceptable estimation method is to subtract these expenditure flows from the total revenues, and derive the expenditure flows from the unmeasured financing scheme as a residual.
• Pro-rating/Utilisation key: Typically in the absence of direct spending data, a utilisation key linked to the proportion of resources used is constructed in order to distribute e.g. aggregate provider spending across functions. For every key, a fraction of total utilisation within the cost-unit is assigned: fractions in the key add up to 100% of all care delivered by the cost-unit. Examples of utilisation keys are admissions, bed-days, contacts, staffing, etc.
• Interpolation/Extrapolation: In the absence of data for the period in question, missing values are estimated using known data points.
• Or other.

Not applicable. No data is published at national level using different methodology than SHA2011.

None.