Czech Statistical Office (CZSO)

Department of Society Development Statistics 

Na Padesátém 81, 100 82 Praha 10

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).

The time coverage of this quality report is 2010 to 2022 reference years. Total health care expenditure do not include HCR1 and HCR 2, but these categories are available and reported separately.

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. Ocupational 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 provide a complete overview of expenditure on health care goods and services consumed by the residents of Czechia.

Data according to SHA 2011 are available from 2010-2022 for Czechia. Preliminary data for 2023 are also available.

Not applicable.

Current expenditure data are presented according to following units:

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

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

This quality report covers the following reference years: 2010-2022.

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).

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.

All legal requirements are met. The publication of SHA data is done at high aggregated data-level. Detailed data are not published or distributed.

In the past, data t+2 at the national level were published in February. From 2021 onwards, the data t+2 are published later due to a change in the data source for health insurance companies. 

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

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.

Annual.

Press release for journalist is usually published on CZSO website when the publication "Výsledky zdravotnických účtů 2010-20xx" ("Results of Health Accounts 2010 - 20xx") is released. Výsledky zdravotnických účtů ČR - 2010–2021 | Produkty (gov.cz).

Data for t-2 are anually published by CZSO in the publication "Výsledky zdravotnických účtů 2010-20xx" ("Results of Health Accounts 2010 - 20xx"). Data are also published in other CZSO publications (for example Czech Statistical Yearbook) or articels in CZSO journal ("Statistika a My").

• Výsledky zdravotnických účtů ČR - 2010–2021 | Produkty (gov.cz);
• Výdaje na zdravotní péči v Česku - v roce 2022 | Produkty (gov.cz);
• Zdraví | Statistika a my (gov.cz);
• Statistická ročenka České republiky - 2023 | Produkty (gov.cz).

Data can be obtained on the Czech Statistical Office website or in the CZSO databases.
Data are published at health databases of OECD, EUROSTAT and WHO.

• Výstupní objekt VDB (czso.cz);
• Výstupní objekt VDB (czso.cz);
• Výdaje na zdravotní péči | Statistika (gov.cz).

Not applicable.

Data are used in OECD publications (e.g. Health At a Glance, Country Health Profile) and will be used in HSPA report published by Ministry of Health of the Czech Republic in 2025.

Information about HSPA are available here: Health System Performance Assessment Framework for the Czech Republic | OECD.

Short methodology is published in "Výsledky zdravotnických účtů 2010-2021" ("Results of Health Accounts 2010 - 2021").

Not available.

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.

Before publication, the data are checked for completeness, consistency and reliability. Any errors are corrected. Consultation with representatives of the data sources is possible if necessary.

The quality of the data may be affected mainly by the estimates. Estimates were used for health insurance companies and non-profit organisations for the years 2010-2016 due to a change in data source and to ensure better data comparability. Also revision of National Accounts data (used for HF2.2 NPISH and HF 3.1 OOP Payments) can significantly affects SHA 2011 data results. The preliminary data for HF2.2 NPISH and HF 3.1 OOP Payments are used in the JHAQ data collection. If the differences are significant, data are corrected and sent to ESTAT as soon as possible. If not, the revision is sent in the next JHAQ data collection.  

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

Main users of SHA data in Czech Republic are:

• Ministry for Labour and Social Affairs;
• Ministry for Health;
• Regional and local governments;
• Institute of Health Information and Statistics of the Czech Republic;
• The legislators;
• The research workers;
• The journalists including television;
• The university students.

Indicators that are often requested are total health care expenditure in general, public and private expenditure mainly OOP payments, expenditure on specific type of health care (for example  long-term care health and social, medicines) or expenditure of health insurance companies by sex, age or ICD-10 diagnoses which are published at national level. 

At the national level, Czech Statistical Office performs an online user satisfaction survey (in general, not just health care expenditure) to evaluate their level of satisfaction with the statistical information produced as well as the information available on its website at the level of content and usability.

The feedback directly from specific SHA health data users.

Almost all of mandatory variables of the three dimensions according to the Commission Regulation 359/2015 that are relevant/occurring in the Czech health system (exceptions are listed below).

HF categories

• HF.1.2.2 and HF.1.3 – categories do not exist;
• HF.3.1, HF.3.2 and HF.4 – missing (data not available).

HC categories

• HC.2.2, HC.2.4, HC.6.5 and HC.6.6 - missing (data not available);
• HC.3.4, HC.4, HC.6.2, HC.6.3 and HC.6.4 – partially missing (data is partially not available).

HP categories

• HP.4.9 and HP.7.9 - missing (data not available).

The sources to compile the data on health care expenditure are mainly administrative and register-based data, only a small percentage of the figures come from surveys or other means. Accordingly, for the health care expenditure data collection, accuracy deals with problems of coverage as the main possible source of errors.

Not applicable.

Not applicable.

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.

Czech Statistical Office complies with the Commission Regulation 2021/1901 transmission deadlines. Czech Statistical Office usually send SHA data annually to Eurostat by 30 April. There was a delay regarding transmission of data for 2021 due to change in data source for health insurance companies. The data were sent during June 2023.

Not applicable at national level.

Breaks in time series resulting from methodological changes:

• From 2010 - All items - Start of 2011 based accounts.    
• From 2017 - HF 1.2.1 - New data source from 2017.        
• From 2017 - HF 2.1 - New data source from 2017.           
• 1995, 2000, 2003 - 1995: Total health expenditure and financing schemes, 2000: All items, 2003: Total health expenditure, HF.1 and selected functions - Unfortunately, these databases have not been preserved.  

All financing schemes except HF.2.1 are comparable from 2010. Due to changes of data sources for HF.1.2 and HF.2.2, estimates were used for years 2010-2016.

Coherence occurs between National Accounts and SHA data for HF1, HF2.2 and HF3. Also between ESSPROS (data from The Ministry of Labour and Social Affairs) and SHA data for HCR.1.

At the national level data from health insurance companies (which is about 71 % of total health care expenditure) are compared to the annual health insurance plans. The JHAQ questionnaire is used to check for consistency of the data, atypical entries, etc. 

Summary of costs for production of statistical data and burden on respondents are minimal.

The transition to the new data source for HF1.2.1 has reduced the administrative burden on health insurance companies.

Data for NPISH and OOP expenditures are revised annually. Further revisions are made if any changes occur.

The 2017-2019 data for all HF except HF.2.1 and HF.2.3 were revised in 2022 and the 2010-2016 data were revised in 2023.

Data for households and non-profit institutions are revised annually. In the dataset send in March/April of year t+2 preliminary data for HF 3 and HF 2.2 are included, which are usually revised in year t+3 or earlier if necessary.

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 2023 JHAQ includes a number of features which allow national data correspondents to perform various quality checks before submitting the data. The embedded programmes allow the verification of:

1- Consistency of the data between tables,
This step checks if the marginal totals reported in each table of the JHAQ are consistent across all tables. For example, for each function (HC), the total across all financing schemes (HF) in the HCxHF table has to be equal to the total across all providers (HP) in the HCxHP table, i.e. the values in the column “All HF” in the HCxHF table have to be equal to the values in the column “All HP” in the HCxHP table. Any detected differences are flagged up in the corresponding row or column in the relevant tables and all inconsistencies are listed in the “Report” worksheet by variable code together with the amount by which the respective variable differs between the two compared tables. A positive value indicates that the first listed table has a higher value for the same variable, and vice versa.

2- Consistency of the data within tables,
Any detected inconsistencies are listed by variable code together with an indication of which total is not equal to the sum of its subcomponents as well as the numerical difference. A positive figure indicates that the total is greater than the reported sub-components, and vice versa.

• The presence of negative values,

Entries in the tables cannot be negative as they refer to the consumption of goods and services.
If an individual data table is checked for internal consistency, the negative values check is performed for the relevant table and then any negative values are highlighted red and crossed out.

• The presence of atypical entries,

The atypical entries check provides information whether the data tables contain values in cells which are – if at all – only reported by very few countries and are thus atypical for health accounting.
If an individual data table is checked for internal consistency, the atypical entries check is performed for the relevant table. In the data tables, any cell containing an atypical entry will be highlighted for national data providers.
Should any atypical entries be identified, compilers should scrutinize in detail the transactions that led to entries in those cells and assess whether the accounting rules of SHA have been correctly applied. If they come to the conclusion that the transactions are recorded in the correct categories of the ICHA classifications, then the corresponding atypical entries represent unique – and correctly accounted for – features of the country’s health system. In this case a short description of the nature of the transactions should be included in the accompanying Metadata file under “II.3. Atypical entries”.
If, on the other hand, compilers come to the conclusion that the transactions are not recorded correctly, then they need to make adjustments in the concerned tables. In case the transactions recorded in a cell do not belong to the boundaries of SHA (e.g. they refer to intermediate consumption) the value of the respective cell should be deleted (and all cells that are affected by this change adjusted accordingly). In case the transactions are misreported and another category of the ICHA classification is more appropriate, the value of the cell should be transferred to the correct cell of the table.

3- The growth rates against the previous year and the magnitude of revisions as compared to previously submitted data. Results are grouped into three different categories:

• Breaks in series (the current questionnaire shows no data for an item that is not null in the other file)
• Newly reported (the current questionnaire contains data for an item that is empty in the other file)
• Differences (all other types of differences)

Government schemes (HF 1.1)

The data are collected and controlled by the Ministry of Finance in the form of individual reports. These reports are collected by means of so called Integrated Treasury System (ITS).

The organizational and technological conditions for the transfer of data to the Ministry of Finance via the central system of accounting information of the State is stipulated in Decree No. 383/2009 Coll. on accounting records in the technical form of the selected accounting units and their transfer into the central system of accounting information of the State and on the requirements on technical and mixed forms of accounting records (so called Technical Decree).

For the SHA purposes, a separate chapter is the financing of nursing care provided in social services institutions. Since this type of care is not considered to be health care in our environment, it is not financed by public health insurance. The main financial burden is borne by the Ministry of Labour and Social Affairs (MPSV) and the founders of these facilities. For the SHA purposes, in accordance with the manual, only a part of expenditures in these facilities is considered to be healthcare expenditures and not social care expenditures.

 Social health insurance schemes (HF 1.2)

Data reported (from healthcare establishments) and acknowledged (from health insurance companies) are available according to the type of health establishment, type of provided health care, classification of diagnoses according to ICD-10, gender, five-year age groups and the amount of costs. The reference period is a calendar year.

From 2021, the National Registry of Reimbursed Health Services (NRRHS) administered by UZIS CR is the new data source. We have started to use this data source to reduce the administrative burden of health insurance companies. Health insurance companies transmit data to the NRRHS. Total payments to health care providers and individual health care services provided to specific patients are recorded in the NRRHS.

The calculation of the total expenditure on provided health care services is based on the valuation of the following components:

• Valuation of acute inpatient care using the hospitalisation cases according to the IR-DRG system;

• Valuation of direct costs in CZK;

• Valuation of indirect costs in points.

Acute inpatient care includes, for example costs of staying in a healthcare facility, nursing care, surgical procedures, directly consumed medical goods including pharmaceuticals (excluding pharmaceuticals provided in specialised centres), costs of laboratory services, rehabilitation, etc.

Direct costs for health care services include, for example, separately billed items for pharmaceuticals and other medical goods in outpatient care and selected pharmaceuticals provided in specialised centres and also in inpatient facilities, costs of prescribed pharmaceuticals or other goods, capitation payments and certain fixed-rate procedures (dental procedures).

Indirect costs for health care services include, for example, costs of health care services provided in the outpatient facilities, patient transportation, and some follow-up and long-term care. These procedures are assigned a virtual point value according to the data reported by the individual health insurance companies.

Voluntary health insurance schemes (HF.2.1)

1. Expenditure on insurance administration:

The estimate of the insurer’s net operating costs of insurance contract administration from the annual report of The Czech Insurance Association from the table Overview of the development of insurance, which includes Insurance of medical expenses abroad.

2. Expenditure on health care:

2010-2016: The structure by health care was obtained from data provided by The Insurance company of the General Health Insurance Company (Pojišťovna VZP). The type of care or provider cannot be specified in detail.

2017-2022: Total expenditure on medical expenses of residents abroad from the annual report of The Czech Insurance Association. The type of care or provider cannot be specified.

NPISHs financing schemes  (HF.2.2)

The two following health-related economic activities NACE 86 to 88 are an integral part of the questionnaire NI 1-01.

Enterprises financing schemes (HF.2.3)

Reporting units for the UNP 4-01 questionnaire of Labour Statistics Unit (total labour costs) comprise economic subjects of the business sphere registered in the Commercial Register.

Household out-of-pocket payment (HF.3)

The estimate of expenditures on final consumption of households in the area of health care is made by compiling a number of data sources. Expenditures on final consumption of households are monitored as a national concept. The data on expenditures on final consumption of households is initially recorded in the CZ-COICOP classification, which is in compliance with the international standard. For the purposes of national accounts, classes are broken down further than it is determined in the official publication of this classification.

Data at national level follow the SHA 2011 manual. CZSO publishes data three dimensionally - by financing schemes, functions and providers according to International classification for health accounts.

At the national level, health insurance data (HF.1.2.1) are also published in more detail (by sex, age, region or ICD-10).

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