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.
Health Statistics Unit - Division of Demography, Social Statistics and Tourism
1.3. Contact name
Confidential because of GDPR
1.4. Contact person function
Confidential because of GDPR
1.5. Contact mail address
Michael Karaolis Str.
1444 Nicosia CYPRUS
1.6. Contact email address
Confidential because of GDPR
1.7. Contact phone number
Confidential because of GDPR
1.8. Contact fax number
Confidential because of GDPR
2.1. Metadata last certified
27 May 2024
2.2. Metadata last posted
27 May 2024
2.3. Metadata last update
27 May 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
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.
3.8. Coverage - Time
Detailed data according to SHA2011 is available for the period 2010-2022 for Cyprus.
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).
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.
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).
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.
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).
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):
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.
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):
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.
10.2. Dissemination format - Publications
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.
10.3. Dissemination format - online database
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.
10.4. Dissemination format - microdata access
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.
10.5. Dissemination format - other
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.
10.6. Documentation on methodology
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:
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.
11.1. Quality assurance
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.
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.
12.1. Relevance - User Needs
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.
12.2. Relevance - User Satisfaction
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.
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.
13.1. Accuracy - overall
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.
13.2. Sampling error
Not applicable since no survey is being conducted specifically for the needs of compiling the SHA data.
13.3. Non-sampling error
ICHA-HF Code
Description
Please indicate any deviations from SHA definitions or missing data and explain
Explanations
HF.3
Household out-of-pocket payment
Deviation from SHA definition
The data for years prior to 2015 include health expenditure for non-residents.
HF.3.1
Out-of-pocket excluding cost-sharing
Deviation from SHA definition
The data for years prior to 2015 include health expenditure for non-residents.
HF.3.2
Cost-sharing with third-party payers
Deviation from SHA definition
The data for years prior to 2015 include health expenditure for non-residents.
HF.4
Rest of the world financing schemes (non-resident)
Missing (data not available)
From 2016 onwards, the data is not available, due to lack of data source. Up to 2015 the data was obtained from the ICCS. However, due to the fact that the foreign insurance companies are not obliged anymore to report such information to the ICCS, no data is available for this category from 2016 onwards.
HC.3
Long-term care (health)
Deviation from SHA definition
No full information exist in order to split the expenditure on long-term care in Health Services and in Social Services for cases providing both health and social care, hence all the amount has been included under HC.3.
HC.3.1
Inpatient long-term care (health)
Deviation from SHA definition
No full information exist in order to split the expenditure on long-term care in Health Services and in Social Services for cases providing both health and social care, hence all the amount has been included under HC.3.1.
HC.3.2
Day long-term care (health)
Deviation from SHA definition
No full information exist in order to split the expenditure on long-term care in Health Services and in Social Services for cases providing both health and social care, hence all the amount has been included under HC.3.2.
HC.3.3
Outpatient long-term care (health)
Deviation from SHA definition
No full information exist in order to split the expenditure on long-term care in Health Services and in Social Services for cases providing both health and social care, hence all the amount has been included under HC.3.3.
HC.3.4
Home-based long-term care (health)
Deviation from SHA definition
No full information exist in order to split the expenditure on long-term care in Health Services and in Social Services for cases providing both health and social care, hence all the amount has been included under HC.3.4.
HC.4.3
Patient transportation
Partially missing (data is partially not available)
The expenditure under HC4.3 is underreported due to the fact that in general, the expenditure on patient transportation is usually included under curative care. Only in cases where an ambulance from a private ambulance company is called in order to transfer a patient, the cost is reported under HC4.3. For cases where an ambulance of the public or private hospital is called in order to transfer a patient to or from the hospital, the respective cost is included in the total cost for treatment and cannot be distinguished from the total cost.
HC.6
Preventive care
Partially missing (data is partially not available)
The expenditure on preventive care is underestimated since some amounts related to preventive care are included in outpatient visits and ancillary services because they can not be distinguished (i.e. mammography for prevention, visit to dentist for prevention).
HC.6.6
Preparing for disaster and emergency response programmes
Missing (category reported elsewhere)
Expenditure under HC6.6 is included under HC6.3
Reporting items:
HC.RI.1
Total pharmaceutical expenditure (TPE)
Missing (data not available)
The private expenditure on pharmaceuticals for inpatients and daycases cannot be split from the total expenditure on inpatient and daycase care which is reported under items HC.1.1, HC1.2, HC.2.1, HC.2.2, HC.3.1 and HC.3.2.
HC.RI.2
Traditional, Complementary and Alternative Medicines (TCAM)
Missing (data not available)
As regards the public sector, such medicine is not applicable. As regards the private sector the expenditure on alternative medicines is included under the "ordinary" pharmaceuticals.
Health care related items:
HCR.1
Long-term care (Social)
Partially missing (data is partially not available)
For cases providing both health and social care but mainly health care, are included under HC.3. The figures reported under this item and refer to spending for governmental houses for the disabled people includes LTC health + social.
HCR.2
Health promotion with multisectoral approach
Partially missing (data is partially not available)
The figures reported under this item refer to the Public Sector. No data available for the Private Sector.
HP.2.1
Long-term nursing care facilities
Deviation from SHA definition
No information exist in order to split the expenditure on long-term care in Health Services and in Social Services, hence all the amount has been included under HP.2.1
HP.3.5
Providers of home health care services
Deviation from SHA definition
No information exist in order to split the expenditure on long-term care in Health Services and in Social Services, hence all the amount has been included under HP.3.5
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.
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.
14.2. Punctuality
There were no deviations from deadlines in the reference period.
15.1. Comparability - geographical
Not applicable.
15.2. Comparability - over time
The breaks in time series resulting from methodological changes are presented in the table below:
Year
Items affected by the break
Explanations
2021
HC.1 and HC.2 financed by HF.1
As regards HF.1, a break in series occurs between HC.1 and HC.2 due to the implementation of the General Health System for inpatient/day care. With the implementation of the GESY, chemotherapies, blood infusions, haemodialysis sessions etc. are considered as in-patient cases with zero length of stay, hence such cases are included in daycare patients (they were completely excluded from the data prior the GHS). The inclusion of these day cases from 2021 onwards, leads to a great increase of the expenditure allocated to day care compared to the inpatient care.
2020
HC.1.3.1+HC.1.3.3 financed by HF.1
As regards HF.1, a break in series occurs between HC.1.3.1 and HC.1.3.3 due to the implementation of the General Health System. All personal doctors (for adults and children) and gynecologists for whom no referral is required are included under HC.1.3.1., whereas doctors of other specialties are included under HC.1.3.3., since a referral is required in order to make a visit.
2010
all HC, all HP and all HF
In parallel with the switch from SHA1.0 to SHA 2011 in 2010, a completely new methodology has been introduced. Additionally, the National Accounts team of CYSTAT revised completely their figures. These two changes resulted in a break in time series from 2010 onwards.
2014-2015
HC4.3
Up to 2013, only the salaries of the personnel activated in patient trasportation in the public sector were reported under HC4.3. For reference years 2014 and 2015 in the government budget the salaries of the personnel activated in patient trasportation in the public sector were not presented in distinct categories, therefore the item HC4.3 was "empty". From 2016 the same applies as up to 2013.
2015
HC1+HC2 financed by HF1.1
Up to 2014, the expenditure on medical supplies was not presented as a distinct item in the Government budget; since the amount was included under other items it was distinguished to curative and rehabilitative care and to in-patient care, day care and outpatients care (HC.1+HC.2) according to an estimated percentage distribution. This percentage distribution is different from the distribution applied to the medical non durable goods for inpatient care, day care and for outpatients. However, from 2015 onwards, the medical supplies are presented as a separate point in the government budget; the summation of the expenditure on medical supplies and medical non-durables is broken down to into curative and rehabilitative care, inpatient care, day care and outpatients, according to the percentage distribution that was applied for medical non-durable goods from pharmaceutical services.
2015
HC1.3.1+HC1.3.3 financed by HF1.1
From 2015 onwards, the breakdown between general and specialised curative care has been revised, based on the number of visits to each specialty. This cannot be applied on previous year's data due to the fact that no such detailed information was available.
2015
All HC and all HP financed by HF2.2
From 2015 onwards, a new source regarding non profit institutions has been applied, providing more detailed breakdown.
2015
All HC and all HP financed by HF2.1
Up to the reference year 2014, the distribution obtained from the ESSPROS questionnaires as regards the Bank and Union funds had been applied for the private insurance companies, since no direct data from them was available. From 2015 new distribution for HC and HP categories is applied according to detailed information provided by insurance companies for HF2.1.
2015
All HC and all HP financed by HF3
The data for years prior to 2015 include health expenditure for non-residents. Additionally, from 2015 onwards, the distribution obtained from the latest Household Budget Survey (HBS2015) has been applied. Due to the fact that the revised distribution has not been applied on previous year's data, any comparison should be avoided.
2015
All HC and all HP financed by HF3.1
The data for years prior to 2015 include health expenditure for non-residents. Additionally, from 2015 onwards, the distribution obtained from the latest Household Budget Survey (2015) has been applied. Due to the fact that the revised distribution has not been applied on previous year's data, any comparison should be avoided. Moreover, according to the results of HBS2015, the distribution of health expenditure between categories HF.3.1 and HF.3.2 has been changed considerably .
2015
All HC and all HP financed by HF3.2
The data for years prior to 2015 include health expenditure for non-residents. Additionally, from 2015 onwards, the distribution obtained from the latest Household Budget Survey (2015) has been applied. Due to the fact that the revised distribution has not been applied on previous year's data, any comparison should be avoided. Moreover, according to the results of HBS2015, the distribution of health expenditure between categories HF.3.1 and HF.3.2 has been changed considerably
15.3. Coherence - cross domain
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.
15.4. Coherence - internal
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.
17.1. Data revision - policy
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.
17.2. Data revision - practice
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.
18.1. Source data
Several data sources are used (as of data notification in March 2024):
Surveys/census: 3
Public administrative records: 7
Financial reports: 3
Other: 0
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
Timeliness (Number of months after the end of the accounting period)
Frequency (e.g monthly, quarterly, annual, irregular)
Processing (e.g. brief description of any adjustments, correction or distribution applied to the original data sources)
Government Budget
The Government Budget is published by the Ministry of Finance and refers to the actual detailed expenditure by Ministry. The Government Budget is presented according to a national classification system. Each item of this classification system was given a unique ICHA code.
Public administrative records
HF1/HC1-HC7/HC9/HCR.1/HP1-HP7/HP9
2010-2022
12 months
Annual
The expenditure reported in the Government Budget under the Ministry of Health and selected items that are reported under the Ministry of Labor and are related to health, are assigned HC and HP codes according to SHA2011. In some cases the actual amounts as reported in the Government Budget are used, whereas in other, the amounts reported in the budget are used for making estimations for the needs of SHA.
Salaries of Public Employees
A datafile in electronic form presenting all the salaries of Public Employees including information on their location i.e. the Ministry they work at.
Public administrative records
HF1/HC1-HC7/HC9/HP1-HP7/HP9
2010-2022
12 months
Annual
Not only the salaries of the personnel reported under the budget of Ministry of Health should be included in SHA. The salaries of the personnel working for the Ministry of Health in positions such as administrative officers, hospital telephone operators etc., who are not reported under the Ministry of Health, are also included in SHA.
Pharmaceutical Services
Cystat obtains from the Pharmaceutical Services details on the amounts spent on medicines and vaccines for the Public sector. Also obtained are estimated figures on the breakdown of pharmaceuticals and other medical non durable goods to inpatient care, daycase and outpatient care.
Public administrative records
HF1.1/HC1/HC2/HC5/HP1/HP3
2010-2020
24 months
Annual
The Pharmaceutical Services provide to CYSTAT information on the amounts spent by the public sector for pharmaceuticals and vaccines, as well as with information in order to distinguish the expenditure to inpatients-daycases-outpatients.
Health Insurance Organisation
The source is the accounts of the Health Insurance Organisation (HIO) which is the responsible body for the implementation of the General Health Care System (GHS). Specifically, CYSTAT obtains the total expenditure of HIO by service and provider. The GHS has been partially introduced in June 2019 for outpatient care, drugs and ancillary services. In the 2nd semester of 2020 the GHS has also been introduced to in-patient care.
Public administrative records
HF1.2/HC1-HC5/HC7/HP1/HP3/HP4/HP5/HP7
2019-2022
12 months
Annual
The data obtained refer to the actual amounts spent from the HIO for the health care services included in the GHS and the providers that are under the GHS.
Health Insurance Organisation
Study conducted in 2010 for the implementation of the GHS.
Public administrative records
HF1.1/HC1/HC2/HC4/HP1/HP3-HP4
2010
Irregular
Estimations on the percentage distribution of health expenditure on inpatient care - day care and outpatient care, both in General Hospitals and Special Hospitals. As regards the special hospitals, further estimations on the percentage distribution of expenditure on laboratories and diagnostic imaging are performed. All the estimations were based on the Government Budget of year 2010, as well as on health indicators regarding health care utilisation.
Social Security Funds
The annual accounts of the Social Security Funds are used for obtaining information on the outpatient services and cash benefits provided for health.
Public administrative records
HF1.2/HC1.3/HC7.1/HP1.1/HP7.2
2003-2019
14 months
Annual
As regards the out-patient care, the actual amounts spent are applied. As regards the amounts spent on health administration the figures are estimated as a percentage of total administration expenditure. This data source will no longer be used, due to the implementation on primary care of the GHS in June 2019.
Household Budget Survey
The survey covered households residing in the Government controlled area and collected detailed information on the level of income and expenditure of the households. In particular it collected information on the expenditure pattern classified by kind of goods and services, on the distribution of income by source, as well as information useful in constructing socio-economic indicators on the standard of living of the population.
Surveys/censuses
HF3/HC1-HC5/HP1-HP5/HP9
2015
Irregular (the last round was in 2015-2016 with reference year 2015)
The National Accounts team of the Statistical Service of Cyprus, extrapolates the results of the Household Budget Survey (HBS) that was conducted in 2015 in order to estimate the health expenditure by type of service for recent years. In cases where the data obtained from the National Accounts are not detailed enough, the ratios calculated according to the HBS are applied.
Deputy Ministry of Social Welfare
Data obtained from the Social Welfare Services as regards the social care program for the elderly and people with disabilities, as well as the government structures for the disabled.
Public administrative records
HC3/HCR.1/HP8.9/HF1.1/HF2.2
2015-2022
18 months
Annual
The expenditure for programs provided for the elderly and people with disabilities from non-profit organizations is distinguished in the several services and providers. As regards the institutions providing both nursing and social care, this expenditure is included in the current health expenditure. All the other provisions are considered as social and are included in the HCR.1. The governemental structures for the disabled are considered as providing only social care.
Social Protection Statistics
The Social Protection Statistics are conducted in compliance with the European system, providing detailed data on the classification of Social Protection by functions, grouping of Social Protection schemes, types of receipts and expenditure, classification of institutional sectors from which receipts originate in Cyprus.
Surveys/censuses
HF2.1/HC1-HC5/HP1-HP5/HP9
2003-2021
The ESSPROS data are submitted to Eurostat according to an EU Regulation 18 months after the end of the accounting period. Hence the data are available for use for the compilation of SHA 18 months after the end of the accounting period.
Annual
The data obtained from the Social Protection Statistics 2021 had been processed (blown-up) in order to estimate the amounts for 2022, since the actual amounts were not available by the time the JQ2024 had been completed. The figures have been estimated according to previous years. Specifically, the decrease observed from 2020 to 2021 has been applied on the figures of 2021 in order to estimate the figures of 2022.
Survey amongst private insurances for ESSPROS purposes
The survey is conducted from 2016 onwards through questionnaires amongst private insurances, for ESSPROS purposes (scheme 9, sickness). The private insurance companies report the amounts spent from enterprises for their employees for health, by category of health care, i.e. in-patient care, out-patient care, examinations, etc.
Surveys/censuses
HC1-HC2/HC4/HC5/HP1/HP3-HP5/HP9
2015-2021
18 months
Annual
The questionnaire grants the breakdown in order to obtain the necessary information for distinguishing the expenditure of health insurances in the various health services and providers.The total health expenditure as obtained from the insurance companies control service is distributed according to this survey.
Insurance Association of Cyprus
Insurance Association of Cyprus (IAC) is the accredited and representative body for the Cypriot insurance industry
Financial reports
HF2.1
2016-2022
13 months
Annual
Gross claims incurred for Health Category.
Non profit institutions registered to Ministry of Health
Annual revenues and expenditures for all non profit institutions that are registered to Ministry of Health.
Financial reports
HF2.2
2015-2021
18 months
Annual
Actual expenditure for every non profit institution is registerd to Ministry of Health.
Insurance Companies Control Service
Τhe Insurance Companies Control Service is a governmental body responsible for the supervision of the operations of insurance undertakings and the implementation of the Insurance Services and other Related Issues Laws of 2002-2011 and the Insurance Services and other Related Issues Regulations of 2002-2009. An annual report is published presenting, amongst other issues, the claims incurred for health and accidents.
Financial reports
HF2.1/HF4
2010-2015
13 months
Annual up to 2015
From 2016 onwards, this report is not available (its production has been interrupted.
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 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).
18.5. Data compilation
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.
SHA variable(s)
Main method (see comment box for definitions)
Brief description of methodology
HF2.1+HF3+HF4
Balancing item/Residual method
The breakdown between HF2.1, HF3 and HF4 is based on: - The Total Private Health Expenditure as calculated from the Division of National Accounts (CYSTAT) - Up to 2015, the Insurance Companies Control Service as regards the health expenditure covered by private insurances (Domestic business and Foreign Business) - From 2016 onwards, the Insurance Association of Cyprus as regards the health expenditure covered by private insurances (Domestic business and Foreign Business) - The ESSPROS data for health expenditure of organisations having their own health funds (Scheme 5: Local Municipalities, Scheme 6: Occupational Social Insurance Institutions and from Scheme 9: Bank Fund, Unions Funds and enterprices with own health funds). - Subtracting Insurances and funds (ESSPROS) from the total private health expenditure, results in the household out of pocket expenditure (HF3).
HC1-HC2
Pro-rating/Utilisation key
Public sector: As regards the General Hospitals, according to calculations performed from the Health Insurance Organisation (HIO), it is estimated that 69,8% of total expenditure on HC1-2 corresponds to in-patients & day-cases and the remaining 30,2% to out-patients. In order to distinguish the expenditure between in-patient care and day-care, the percentage distribution of hospital days has been applied. Then what is estimated for in-patient care is disaggregated between curative and rehabilitative care according to an assumed proportion of 93% and 7% respectively, taking into consideration the actual number of visits to public hospitals for curative care and the actual number of visits to public hospitals for rehabilitation. Final estimation for general and specialised outpatient curative care is calculated according to the number of outpatient visits by speciality. From 2020 onwards the ratios allocated to inpatients-oupatients, hospitals and health centres have been revised due to the implementation of the General Health System. The revised ratios are based on the spending of HIO on hospitals contracted with GHS, disaggregated into the several health services provided. As regards the two Specialised Hospitals, calculations performed from the Health Insurance Organisation have been applied for each one, estimating the percentage distribution of the total expenditure on HC1-2 corresponding to in-patient care & day-care & out-patient care, as well as on laboratories and diagnostic imaging. Further breakdown to in-patient care and day-care has been performed according to the proportion of hospital days. Then what is assigned to in-patient care for a specific special hospital is disaggregated between curative and rehabilitative care according to an assumed proportion of 93% and 7% respectively, taking into consideration the actual number of visits in public hospitals for curative care and the actual number of visits in public hospitals for rehabilitation. Private sector: For the private insurances, it is assumed that 81% of the total expenditure on inpatient care corresponds to inpatients and the remaining 19% corresponds to day care (length of stay=0), according to the percentage distribution of expenditure on in-patient and day-care obtained from the Household budget Survey (HBS2015).Further breakdown between curative and rehabilitative care is made according to an assumed proportion of 90% and 10% respectively for the private sector, again based on the distribution obtained from HBS2015.
HC1.3.2 splitting to HP1.1 + HP3.4
Pro-rating/Utilisation key
Public sector: The calculations were made according to the number of visits under those providers offering such services.
HC3 + HP1 + HP2
Pro-rating/Utilisation key
Public sector: Estimations have been performed on the distribution of expenses to the specific health care services, i.e. the wages of nurses and doctors, operational expenses under mental health services. The calculations were made according to the number of patients and number of the personnel under those providers offering such services.
HC1+HC5.1
Balancing item/Residual method
Public sector: The expenditure on prescribed medicines and other medical non durables goods for outpatients has been estimated according to data provided from the Pharmaceautical Services.
HC6
Pro-rating/Utilisation key
The wages of health visitors have been distributed to the several items according to the number of visits to the specific services.
HP1.1 + HP1.3 + HP9
Pro-rating/Utilisation key
For the private insurances the estimates used were made according to the proportions of 84%, 12% and 4% assigned to HP1.1/HP1.3/HP9 respectively. These percentages have been calculated based on figures obtained from HBS2015 expenditure according to these categories.
18.6. Adjustment
Not applicable. No data is published at national level using different methodology than SHA2011.
None.
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 May 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).
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.
Health care expenditure data are annual data, corresponding to the calendar year.
This quality report covers the following reference years: 2018-2022.
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.
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.
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.
SHA variable(s)
Main method (see comment box for definitions)
Brief description of methodology
HF2.1+HF3+HF4
Balancing item/Residual method
The breakdown between HF2.1, HF3 and HF4 is based on: - The Total Private Health Expenditure as calculated from the Division of National Accounts (CYSTAT) - Up to 2015, the Insurance Companies Control Service as regards the health expenditure covered by private insurances (Domestic business and Foreign Business) - From 2016 onwards, the Insurance Association of Cyprus as regards the health expenditure covered by private insurances (Domestic business and Foreign Business) - The ESSPROS data for health expenditure of organisations having their own health funds (Scheme 5: Local Municipalities, Scheme 6: Occupational Social Insurance Institutions and from Scheme 9: Bank Fund, Unions Funds and enterprices with own health funds). - Subtracting Insurances and funds (ESSPROS) from the total private health expenditure, results in the household out of pocket expenditure (HF3).
HC1-HC2
Pro-rating/Utilisation key
Public sector: As regards the General Hospitals, according to calculations performed from the Health Insurance Organisation (HIO), it is estimated that 69,8% of total expenditure on HC1-2 corresponds to in-patients & day-cases and the remaining 30,2% to out-patients. In order to distinguish the expenditure between in-patient care and day-care, the percentage distribution of hospital days has been applied. Then what is estimated for in-patient care is disaggregated between curative and rehabilitative care according to an assumed proportion of 93% and 7% respectively, taking into consideration the actual number of visits to public hospitals for curative care and the actual number of visits to public hospitals for rehabilitation. Final estimation for general and specialised outpatient curative care is calculated according to the number of outpatient visits by speciality. From 2020 onwards the ratios allocated to inpatients-oupatients, hospitals and health centres have been revised due to the implementation of the General Health System. The revised ratios are based on the spending of HIO on hospitals contracted with GHS, disaggregated into the several health services provided. As regards the two Specialised Hospitals, calculations performed from the Health Insurance Organisation have been applied for each one, estimating the percentage distribution of the total expenditure on HC1-2 corresponding to in-patient care & day-care & out-patient care, as well as on laboratories and diagnostic imaging. Further breakdown to in-patient care and day-care has been performed according to the proportion of hospital days. Then what is assigned to in-patient care for a specific special hospital is disaggregated between curative and rehabilitative care according to an assumed proportion of 93% and 7% respectively, taking into consideration the actual number of visits in public hospitals for curative care and the actual number of visits in public hospitals for rehabilitation. Private sector: For the private insurances, it is assumed that 81% of the total expenditure on inpatient care corresponds to inpatients and the remaining 19% corresponds to day care (length of stay=0), according to the percentage distribution of expenditure on in-patient and day-care obtained from the Household budget Survey (HBS2015).Further breakdown between curative and rehabilitative care is made according to an assumed proportion of 90% and 10% respectively for the private sector, again based on the distribution obtained from HBS2015.
HC1.3.2 splitting to HP1.1 + HP3.4
Pro-rating/Utilisation key
Public sector: The calculations were made according to the number of visits under those providers offering such services.
HC3 + HP1 + HP2
Pro-rating/Utilisation key
Public sector: Estimations have been performed on the distribution of expenses to the specific health care services, i.e. the wages of nurses and doctors, operational expenses under mental health services. The calculations were made according to the number of patients and number of the personnel under those providers offering such services.
HC1+HC5.1
Balancing item/Residual method
Public sector: The expenditure on prescribed medicines and other medical non durables goods for outpatients has been estimated according to data provided from the Pharmaceautical Services.
HC6
Pro-rating/Utilisation key
The wages of health visitors have been distributed to the several items according to the number of visits to the specific services.
HP1.1 + HP1.3 + HP9
Pro-rating/Utilisation key
For the private insurances the estimates used were made according to the proportions of 84%, 12% and 4% assigned to HP1.1/HP1.3/HP9 respectively. These percentages have been calculated based on figures obtained from HBS2015 expenditure according to these categories.
Several data sources are used (as of data notification in March 2024):
Surveys/census: 3
Public administrative records: 7
Financial reports: 3
Other: 0
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
Timeliness (Number of months after the end of the accounting period)
Frequency (e.g monthly, quarterly, annual, irregular)
Processing (e.g. brief description of any adjustments, correction or distribution applied to the original data sources)
Government Budget
The Government Budget is published by the Ministry of Finance and refers to the actual detailed expenditure by Ministry. The Government Budget is presented according to a national classification system. Each item of this classification system was given a unique ICHA code.
Public administrative records
HF1/HC1-HC7/HC9/HCR.1/HP1-HP7/HP9
2010-2022
12 months
Annual
The expenditure reported in the Government Budget under the Ministry of Health and selected items that are reported under the Ministry of Labor and are related to health, are assigned HC and HP codes according to SHA2011. In some cases the actual amounts as reported in the Government Budget are used, whereas in other, the amounts reported in the budget are used for making estimations for the needs of SHA.
Salaries of Public Employees
A datafile in electronic form presenting all the salaries of Public Employees including information on their location i.e. the Ministry they work at.
Public administrative records
HF1/HC1-HC7/HC9/HP1-HP7/HP9
2010-2022
12 months
Annual
Not only the salaries of the personnel reported under the budget of Ministry of Health should be included in SHA. The salaries of the personnel working for the Ministry of Health in positions such as administrative officers, hospital telephone operators etc., who are not reported under the Ministry of Health, are also included in SHA.
Pharmaceutical Services
Cystat obtains from the Pharmaceutical Services details on the amounts spent on medicines and vaccines for the Public sector. Also obtained are estimated figures on the breakdown of pharmaceuticals and other medical non durable goods to inpatient care, daycase and outpatient care.
Public administrative records
HF1.1/HC1/HC2/HC5/HP1/HP3
2010-2020
24 months
Annual
The Pharmaceutical Services provide to CYSTAT information on the amounts spent by the public sector for pharmaceuticals and vaccines, as well as with information in order to distinguish the expenditure to inpatients-daycases-outpatients.
Health Insurance Organisation
The source is the accounts of the Health Insurance Organisation (HIO) which is the responsible body for the implementation of the General Health Care System (GHS). Specifically, CYSTAT obtains the total expenditure of HIO by service and provider. The GHS has been partially introduced in June 2019 for outpatient care, drugs and ancillary services. In the 2nd semester of 2020 the GHS has also been introduced to in-patient care.
Public administrative records
HF1.2/HC1-HC5/HC7/HP1/HP3/HP4/HP5/HP7
2019-2022
12 months
Annual
The data obtained refer to the actual amounts spent from the HIO for the health care services included in the GHS and the providers that are under the GHS.
Health Insurance Organisation
Study conducted in 2010 for the implementation of the GHS.
Public administrative records
HF1.1/HC1/HC2/HC4/HP1/HP3-HP4
2010
Irregular
Estimations on the percentage distribution of health expenditure on inpatient care - day care and outpatient care, both in General Hospitals and Special Hospitals. As regards the special hospitals, further estimations on the percentage distribution of expenditure on laboratories and diagnostic imaging are performed. All the estimations were based on the Government Budget of year 2010, as well as on health indicators regarding health care utilisation.
Social Security Funds
The annual accounts of the Social Security Funds are used for obtaining information on the outpatient services and cash benefits provided for health.
Public administrative records
HF1.2/HC1.3/HC7.1/HP1.1/HP7.2
2003-2019
14 months
Annual
As regards the out-patient care, the actual amounts spent are applied. As regards the amounts spent on health administration the figures are estimated as a percentage of total administration expenditure. This data source will no longer be used, due to the implementation on primary care of the GHS in June 2019.
Household Budget Survey
The survey covered households residing in the Government controlled area and collected detailed information on the level of income and expenditure of the households. In particular it collected information on the expenditure pattern classified by kind of goods and services, on the distribution of income by source, as well as information useful in constructing socio-economic indicators on the standard of living of the population.
Surveys/censuses
HF3/HC1-HC5/HP1-HP5/HP9
2015
Irregular (the last round was in 2015-2016 with reference year 2015)
The National Accounts team of the Statistical Service of Cyprus, extrapolates the results of the Household Budget Survey (HBS) that was conducted in 2015 in order to estimate the health expenditure by type of service for recent years. In cases where the data obtained from the National Accounts are not detailed enough, the ratios calculated according to the HBS are applied.
Deputy Ministry of Social Welfare
Data obtained from the Social Welfare Services as regards the social care program for the elderly and people with disabilities, as well as the government structures for the disabled.
Public administrative records
HC3/HCR.1/HP8.9/HF1.1/HF2.2
2015-2022
18 months
Annual
The expenditure for programs provided for the elderly and people with disabilities from non-profit organizations is distinguished in the several services and providers. As regards the institutions providing both nursing and social care, this expenditure is included in the current health expenditure. All the other provisions are considered as social and are included in the HCR.1. The governemental structures for the disabled are considered as providing only social care.
Social Protection Statistics
The Social Protection Statistics are conducted in compliance with the European system, providing detailed data on the classification of Social Protection by functions, grouping of Social Protection schemes, types of receipts and expenditure, classification of institutional sectors from which receipts originate in Cyprus.
Surveys/censuses
HF2.1/HC1-HC5/HP1-HP5/HP9
2003-2021
The ESSPROS data are submitted to Eurostat according to an EU Regulation 18 months after the end of the accounting period. Hence the data are available for use for the compilation of SHA 18 months after the end of the accounting period.
Annual
The data obtained from the Social Protection Statistics 2021 had been processed (blown-up) in order to estimate the amounts for 2022, since the actual amounts were not available by the time the JQ2024 had been completed. The figures have been estimated according to previous years. Specifically, the decrease observed from 2020 to 2021 has been applied on the figures of 2021 in order to estimate the figures of 2022.
Survey amongst private insurances for ESSPROS purposes
The survey is conducted from 2016 onwards through questionnaires amongst private insurances, for ESSPROS purposes (scheme 9, sickness). The private insurance companies report the amounts spent from enterprises for their employees for health, by category of health care, i.e. in-patient care, out-patient care, examinations, etc.
Surveys/censuses
HC1-HC2/HC4/HC5/HP1/HP3-HP5/HP9
2015-2021
18 months
Annual
The questionnaire grants the breakdown in order to obtain the necessary information for distinguishing the expenditure of health insurances in the various health services and providers.The total health expenditure as obtained from the insurance companies control service is distributed according to this survey.
Insurance Association of Cyprus
Insurance Association of Cyprus (IAC) is the accredited and representative body for the Cypriot insurance industry
Financial reports
HF2.1
2016-2022
13 months
Annual
Gross claims incurred for Health Category.
Non profit institutions registered to Ministry of Health
Annual revenues and expenditures for all non profit institutions that are registered to Ministry of Health.
Financial reports
HF2.2
2015-2021
18 months
Annual
Actual expenditure for every non profit institution is registerd to Ministry of Health.
Insurance Companies Control Service
Τhe Insurance Companies Control Service is a governmental body responsible for the supervision of the operations of insurance undertakings and the implementation of the Insurance Services and other Related Issues Laws of 2002-2011 and the Insurance Services and other Related Issues Regulations of 2002-2009. An annual report is published presenting, amongst other issues, the claims incurred for health and accidents.
Financial reports
HF2.1/HF4
2010-2015
13 months
Annual up to 2015
From 2016 onwards, this report is not available (its production has been interrupted.
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.
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.
Not applicable.
The breaks in time series resulting from methodological changes are presented in the table below:
Year
Items affected by the break
Explanations
2021
HC.1 and HC.2 financed by HF.1
As regards HF.1, a break in series occurs between HC.1 and HC.2 due to the implementation of the General Health System for inpatient/day care. With the implementation of the GESY, chemotherapies, blood infusions, haemodialysis sessions etc. are considered as in-patient cases with zero length of stay, hence such cases are included in daycare patients (they were completely excluded from the data prior the GHS). The inclusion of these day cases from 2021 onwards, leads to a great increase of the expenditure allocated to day care compared to the inpatient care.
2020
HC.1.3.1+HC.1.3.3 financed by HF.1
As regards HF.1, a break in series occurs between HC.1.3.1 and HC.1.3.3 due to the implementation of the General Health System. All personal doctors (for adults and children) and gynecologists for whom no referral is required are included under HC.1.3.1., whereas doctors of other specialties are included under HC.1.3.3., since a referral is required in order to make a visit.
2010
all HC, all HP and all HF
In parallel with the switch from SHA1.0 to SHA 2011 in 2010, a completely new methodology has been introduced. Additionally, the National Accounts team of CYSTAT revised completely their figures. These two changes resulted in a break in time series from 2010 onwards.
2014-2015
HC4.3
Up to 2013, only the salaries of the personnel activated in patient trasportation in the public sector were reported under HC4.3. For reference years 2014 and 2015 in the government budget the salaries of the personnel activated in patient trasportation in the public sector were not presented in distinct categories, therefore the item HC4.3 was "empty". From 2016 the same applies as up to 2013.
2015
HC1+HC2 financed by HF1.1
Up to 2014, the expenditure on medical supplies was not presented as a distinct item in the Government budget; since the amount was included under other items it was distinguished to curative and rehabilitative care and to in-patient care, day care and outpatients care (HC.1+HC.2) according to an estimated percentage distribution. This percentage distribution is different from the distribution applied to the medical non durable goods for inpatient care, day care and for outpatients. However, from 2015 onwards, the medical supplies are presented as a separate point in the government budget; the summation of the expenditure on medical supplies and medical non-durables is broken down to into curative and rehabilitative care, inpatient care, day care and outpatients, according to the percentage distribution that was applied for medical non-durable goods from pharmaceutical services.
2015
HC1.3.1+HC1.3.3 financed by HF1.1
From 2015 onwards, the breakdown between general and specialised curative care has been revised, based on the number of visits to each specialty. This cannot be applied on previous year's data due to the fact that no such detailed information was available.
2015
All HC and all HP financed by HF2.2
From 2015 onwards, a new source regarding non profit institutions has been applied, providing more detailed breakdown.
2015
All HC and all HP financed by HF2.1
Up to the reference year 2014, the distribution obtained from the ESSPROS questionnaires as regards the Bank and Union funds had been applied for the private insurance companies, since no direct data from them was available. From 2015 new distribution for HC and HP categories is applied according to detailed information provided by insurance companies for HF2.1.
2015
All HC and all HP financed by HF3
The data for years prior to 2015 include health expenditure for non-residents. Additionally, from 2015 onwards, the distribution obtained from the latest Household Budget Survey (HBS2015) has been applied. Due to the fact that the revised distribution has not been applied on previous year's data, any comparison should be avoided.
2015
All HC and all HP financed by HF3.1
The data for years prior to 2015 include health expenditure for non-residents. Additionally, from 2015 onwards, the distribution obtained from the latest Household Budget Survey (2015) has been applied. Due to the fact that the revised distribution has not been applied on previous year's data, any comparison should be avoided. Moreover, according to the results of HBS2015, the distribution of health expenditure between categories HF.3.1 and HF.3.2 has been changed considerably .
2015
All HC and all HP financed by HF3.2
The data for years prior to 2015 include health expenditure for non-residents. Additionally, from 2015 onwards, the distribution obtained from the latest Household Budget Survey (2015) has been applied. Due to the fact that the revised distribution has not been applied on previous year's data, any comparison should be avoided. Moreover, according to the results of HBS2015, the distribution of health expenditure between categories HF.3.1 and HF.3.2 has been changed considerably
