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Croatia

Health care expenditure (SHA 2011) (hlth_sha11)

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National Reference Metadata in Euro SDMX Metadata Structure (ESMS)

Compiling agency: Croatian Institute of Public Health

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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).

31 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).

Croatia

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

This quality report covers the following reference years: 2013 - 2021.

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

Current expenditure data are presented according to following units:

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

I.2. Estimation methods

SHA variable(s) Main method
(see comment box for definitions)		 Brief description of methodology
HF.1.1 (counties)/HC.7.1 Pro-rating/Utilisation key Several counties estimated these costs according to percentage of personnel and their working hours on health topics (county offices for health are usually combined with social policy and/or education)
HF.1.1/HC.3.1/HP.2 Pro-rating/Utilisation key Only three regional authorities were able to provide nursing care expenditures for in-patient long-term care in nursing homes (which are actually combination of nursing homes and residential homes because they, besides nursing care departments, also have pure residential parts) separately from total expenditures for such homes. Majority of regional authorities were only able to provide total expenditures for nursing homes (including both nursing care and residential departments), so we estimated nursing care expenditures from total expenditures for them by using average percentage of share of nursing care in total expenditures for these homes which we calculated for those counties which had it available (25%).
HF.3 Interpolation/Extrapolation Estimations of household expenditures in 2015 and 2016 were prepared using Household Budget Survey data from 2014 and 2017 and they were linearly positioned between data for 2014 and data for 2017 (Household Budget Survey was not executed in 2015 nor in 2016, therefore there are no direct data for 2015 and 2016 available from this survey). The same was done to estimate the data for 2018 by using Household Budget Survey data from 2017 and 2019.  Estimation for 2020 was done so that all data for all HC and HP categories which were obtained from Household Budget Survey data 2019, were decreased for % of final consumption expenditure of households decrease presenting  in Croatia in 2020 (-4.95 %).  Estimation for 2021 was done so that all data for all HC and HP categories for 2020 were increased for % of final consumption expenditure of households increase presenting  in Croatia in 2021 (12,64 %). Estimation for 2022 was done so that all data for all HC and HP categories for 2020 were increased for % of final consumption expenditure of households increase presenting  in Croatia in 2022 (18,67 %).
HF.3 Pro-rating/Utilisation key Due to lack of harmonisation between SHA and data on health care expenditures from Household Budget Survey, the following estimations were done on the data from Household Budget Survey:  data on laboratory and imaging services (aggregated data in Household Budget Survey) were devided into HC.4.1 and HC.4.2 in ratio 50%:50%; data on hospitalisations were devided into HC.1.1 and HC.3.1 and into HP.1.1 and HP.1.3 according to shares of these categories in HF.1.2; for 2014 data on long-term care from Household Budget Survey were included in SHA for the first time - as it contains aggregated long-term care data which include both health and social long-term care, the same ratio as described for HF.1.1/HC.3.1/HP.2 was used to estimate the share of health component (25%)
HF.2.3 Pro-rating/Utilisation key Costs of enterprises financing schemes were calculated by multiplying number of preventive medical examination in occupational health paid by enterprises in specific year with cost of such examinations according to the pricelist of Croatian Chamber of Medical Doctors
HC.1.1 and HC.1.2/HF.3 Pro-rating/Utilisation key Total expenditure for sum of HC.1.1 and HC.1.2 in HF.3 which contained both HC.1.1 and HC.1.2, was divided into HC.1.1 and HC.1.2 using ratio between HC.1.1 and HC.1.2 in the sum of HF.1 and HF.2 as a distribution key.
HC.2.1 and HC.2.2/HF.3 Pro-rating/Utilisation key Total expenditure for sum of HC.2.1 and HC.2.2 in HF.3 which contained both HC.2.1 and HC.2.2, was divided into HC.2.1 and HC.2.2 using ratio between HC.2.1 and HC.2.2 in the sum of HF.1 and HF.2 as a distribution key.
HF.3 / HC.5.1.1 Balancing item/Residual method Out-of-pocket expenditures for HC.5.1.1 were calculated by subtracting expenditure on OTC (HC.5.1.2) from total expenditure on medicines which was not paid for by obligatory health insurance . The obtained difference was increased for estimated taxes and after that expenditure on prescribed medicines paid by HF.2 was subtracted from the result in order to calculate out-of-pocket (HF.3) expenditures on HC.5.1.1. Expenditure for OTC pharmaceuticals was increased for 35% and expenditure for Rx pharmaceuticals was increased for 25% as a retail margin estimated from “Decision on mode of determination of retail prices of pharmacueticals and other goods which are not paid for by Croatian Health Insurance Fund” which specifies allowed retail margins which are different depending on the price categories. The highest percentage of retail margin was applied for OTC pharmaceuticals (35 %) because most of them are in the lowest price category which has the highest retail margin of 35 %. Retail margin for Rx pharmaceuticals was estimated at 25% because there is a significant share of these pharmaceuticals which are in more expensive categories.
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
Statistics of Croatian Health Insurance Fund (CHIF) Annual record on activity and spending financed by CHIF; coverage 100% of compulsory health insurance (CHIF is the only compulsory insurer in Croatia); covers also part of voluntary health insurance Public administrative records complete HF.1.2.1 + part of HF 2.1.2 (financing all HC provided by all HP) 2013-2022
Statistics of Ministry of Health Annual record on activity and spending financed by Ministry of Health Public administrative records HF.1.1 (financing HC.6 provided by HP.6 and HP.7 and HK.1.1 in HP.1 and HP.3). 2013-2022
Statistics of Ministry of Health Record on subsidies paid directly to hospitals in order to cover their losses Public administrative records HF.1.1.1. financing  HP.1  2017-2022
Statistics of Ministry of Defense Annual record on activity and spending financed by Ministry of Defense Public administrative records HF.1.1 (financing HC.1.3.1 provided in HP.1 and by HP.8.2 - ambulatory health care providers employed inside army, HC.4.1 in HP.4.2, HC.5.1.1 in HP.5.1, HC.5.1.3 in HP.5.9, HC.5.2.9 in HP.5.9 and HC.6.2 and HC.6.3 in HP.6) 2013-2022
Statistics of Ministry of Justice Annual record on activity and spending financed by Ministry of Justice Public administrative records HF.1.1 (financing all HC (except HC.3) provided by all HP) 2013-2022
Statistics of counties and City of Zagreb (21 regional units) Annual records on activity and spending financed by counties and City of Zagreb Public administrative records HF.1.1 (data for regional government expenditures) 2013-2022
Statistics of Ministry of Finance Ministry of Finance Report with Aggregated Data on Achieving Budget 2011-2022 Financial reports HF.1.1 (data for local government expenditures and part of additional data for regional government expenditures) 2013-2022
Statistics of private health insurance companies (6 companies in 2013-2016, 8 companies in 2017, 7 companies in 2018, 8 companies in 2019-2022) Annual records on activity and spending financed by private health insurance companies Public administrative records HF.2.1.2 (financing all HC provided by all HP) 2013-2022
Croatian Bureau of Statistics Household Budget Survey Surveys/censuses HF.3 (only data for HC.1.1, HC.1.3.1, HC.1.3.2, HC.1.3.9, HC.2.1, HC.3.1, HC.4.1, HC.4.2, HC.5.2) 2013-2022
Non-governmental organisations and foundations (8 for 2014, 9 for 2015, 8 for 2016, 11 for 2017, 11 for 2018, 19 for 2019, 14 for 2020, 15 for 2021, 11 for 2022) Annual record on activity and spending Public administrative records HF.2.2 2014-2022
Statistics of Croatian Institute of Public Health and Pricelist of Croatian Chamber of Medical Doctors Report on number of preventive medical examinations in occupational health and pricelist of health services in occupational health Other HF.2.3, HC.6.4 2014-2022
Statistics of Croatian Health Insurance Fund (CHIF) Annual record on losses of hospitals owned by the state Public administrative records HF.1.2.1, all HC provided by HP.1.1 2014-2022
 Ministry of Croatian Veterans Annual Financial Report Financial reports HF.1.1.1, HC.1.3.3 in HP.1.1, HC.2.1 in HP.1.3, HC.6.4 in HP.3.4 and HP1.1, HC.5.2.3 in HP.5.2 2013-2022
Ministry for Demography, Family, Youth and Social Policy Annual records on activity and spending financed by Ministry for Demography, Family, Youth and Social Policy Public administrative records HF.1.1.1, HC.3.1 in HP.2.2 and HP.2.9, HK.1.1.1 and HK.1.1.2 in HP.2.2. and HP.2.9 2013-2022
Agency for Medicinal Products and Medical Devices of Croatia Annual report on drug utilisation Financial reports HF.3, HC.5.1.1 and HC.5.1.2 2013-2022

Annual

Member States were required to transmit their data to Eurostat in compliance with the Commission Regulation (EU) 2015/359 transmission deadlines, until reference year 2020. As of reference year 2021, data are transmitted pursuant to Commission Regulation (EU) 2021/1901.
Data and reference metadata for the reference year T should be transmitted to Eurostat by 30 April T+2.

Not applicable.

II.4. Breaks in time series

Year Items affected by the break Explanations
2014 HP.2 and HP.3.5 in HF.3 Data on expenditures for long-term care in residential long-term care facilities and by providers of home health care services estimated from Household Budget Survey were included for the first time in HF.3
2014 HF.2.2 and HF.2.3 HF.2.2 and HF.2.3 included for the first time