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 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 resident population on the national territory of a country.
3.8. Coverage - Time
2000-2022
3.9. Base period
Not applicable.
Current expenditure data are presented according to following units:
expenditure amount in millions of euro
expenditure amount in millions of national currency
expenditure amount in millions of PPS
percentage of GDP
amount in euro per capita
amount in national currency per capita
amount in PPS per capita
percentage of current health expenditure (CHE)
Health care expenditure data are annual data, corresponding to the calendar year.
This quality report covers the following reference years: 2000-2022.
6.1. Institutional Mandate - legal acts and other agreements
Countries submit data to Eurostat on the basis of Commission Regulations (EU):
2015/359 of 4 March 2015 implementing Regulation (EC) No 1338/2008 of the European Parliament and of the Council as regards statistics on healthcare expenditure and financing, until the reference year 2020.
2021/1901 of 29 October 2021 implementing Regulation (EC) No 1338/2008 of the European Parliament and of the Council as regards statistics on health care expenditure and financing, for which the first reference year will be in 2021.
The implementing Regulations specify the areas and the level of aggregation to be submitted by EU Member States and EEA countries (see Annex II of the Regulation).
6.2. Institutional Mandate - data sharing
Data collection takes place in agreement with the World Health Organization (WHO) and the Organization of Economic Co-operation and Development (OECD).
In line with the Community legal framework and the European Statistics Code of Practice Eurostat disseminates European statistics on Eurostat's website (see item 10 - 'Accessibility and clarity') respecting professional independence and in an objective, professional and transparent manner in which all users are treated equitably. The detailed arrangements are governed by the Eurostat protocol on impartial access to Eurostat data for users.
Authorities responsible for SHA data collection work to ensure that the statistical practices used to compile national health accounts are in compliance with SHA methodological requirements and that good practices in the field are being followed, according to the methodology underlined in the SHA 2011 Manual and European Statistics Code of Practice respecting professional independence of the statistical authorities. Procedures are in place to plan and monitor the quality of the health care expenditure statistical production process.
11.2. Quality management - assessment
No information available.
12.1. Relevance - User Needs
The main users of health care expenditure data are policy makers, research institutes, media, and students.
12.2. Relevance - User Satisfaction
No information available.
12.3. Completeness
ICHA-HF Code
Description
Please indicate any deviations from SHA definitions or missing data and explain
Explanations
III.1. Current state of ICHA-HF implementation
HF.1
Government schemes and compulsory contributory health care financing schemes
HF.1.1
Government schemes
HF.1.2/1.3
Compulsory contributory health insurance schemes/CMSA
Category does not exist
HF.1.2.1
Social health insurance schemes
Category does not exist
HF.1.2.2
Compulsory private insurance schemes
Category does not exist
HF.1.3
Compulsory Medical Savings Accounts (CMSA)
Category does not exist
HF.2
Voluntary health care payment schemes
HF.2.1
Voluntary health insurance schemes
Missing (data not available)
HF.2.2
NPISH financing schemes
HF.2.3
Enterprise financing schemes
Category does not exist
HF.3
Household out-of-pocket payment
HF.3.1
Out-of-pocket excluding cost-sharing
Missing (data not available)
HF.3.2
Cost-sharing with third-party payers
Missing (data not available)
HF.4
Rest of the world financing schemes (non-resident)
Category does not exist
III.2. Current state of ICHA-HC implementation
HC.1
Curative care
HC.1.1
Inpatient curative care
HC.1.2
Day curative care
HC.1.3
Outpatient curative care
HC.1.3.1
General outpatient curative care
HC.1.3.2
Dental outpatient curative care
HC.1.3.3
Specialised outpatient curative care
HC.1.3.9
All other outpatient curative care
HC.1.4
Home-based curative care
HC.2
Rehabilitative care
HC.2.1
Inpatient rehabilitative care
HC.2.2
Day rehabilitative care
HC.2.3
Outpatient rehabilitative care
HC.2.4
Home-based rehabilitative care
Missing (category reported elsewhere)
HC.3
Long-term care (health)
Partially missing (data is partially not available)
HC3 x HF3
HC.3.1
Inpatient long-term care (health)
HC.3.2
Day long-term care (health)
HC.3.3
Outpatient long-term care (health)
Partially missing (data is partially not available)
until 2019 missing and reported under HC.1.3. For some providers, still missing and reported under HC.1.3.
HC.3.4
Home-based long-term care (health)
HC.4
Ancillary services (non-specified by function)
HC.4.1
Laboratory services
HC.4.2
Imaging services
HC.4.3
Patient transportation
HC.5
Medical goods (non-specified by function)
HC.5.1
Pharmaceuticals and other medical non durable goods
HC.5.1.1
Prescribed medicines
HC.5.1.2
Over-the-counter medicines
HC.5.1.3
Other medical non-durable goods
HC.5.2
Therapeutic appliances and other medical durable goods
HC.6
Preventive care
HC.6.1
Information, education and counseling programmes
HC.6.2
Immunisation programmes
Partially missing (data is partially not available)
partially missing due to lack of breakdown of data for HF 3
HC.6.3
Early disease detection programmes
HC.6.4
Healthy condition monitoring programmes
HC.6.5
Epidemiological surveillance and risk and disease control
HC.6.6
Preparing for disaster and emergency response programmes
HC.7
Governance and health system and financing administration
HC.7.1
Governance and health system administration
HC.7.2
Administration of health financing
Reporting items:
HC.RI.1
Total pharmaceutical expenditure (TPE)
Partially missing (data is partially not available)
HC.RI.2
Traditional, Complementary and Alternative Medicines (TCAM)
Missing (data not available)
Health care related items:
HCR.1
Long-term care (Social)
Partially missing (data is partially not available)
HCR.2
Health promotion with multisectoral approach
Missing (data not available)
III.3. Current state of ICHA-HP implementation
HP.1
Hospitals
HP.1.1
General hospitals
HP.1.2
Mental health hospitals
Category does not exist
HP.1.3
Specialised hospitals (other than mental health hospitals)
Category does not exist
HP.2
Residential long-term care facilities
HP.2.1
Long-term nursing care facilities
HP.2.2
Mental health and substance abuse facilities
Missing (category reported elsewhere)
HP 2.1. - if reported under health care
HP.2.9
Other residential long-term care facilities
Missing (category reported elsewhere)
HP 2.1. - if reported under health care
HP.3
Providers of ambulatory health care
HP.3.1
Medical practices
HP.3.2
Dental practices
HP.3.3
Other health care practitioners
HP.3.4
Ambulatory health care centres
HP.3.5
Providers of home health care services
HP.4
Providers of ancillary services
HP.4.1
Providers of patient transportation and emergency rescue
HP.4.2
Medical and diagnostic laboratories
HP.4.9
Other providers of ancillary services
HP.5
Retailers and other providers of medical goods
HP.5.1
Pharmacies
HP.5.2
Retail sellers and other suppliers of durable medical goods and medical appliances
HP.5.9
All other miscellaneous sellers and other suppliers of pharmaceuticals and medical goods
HP.6
Providers of preventive care
HP.7
Providers of health care system administration and financing
HP.7.1
Government health administration agencies
HP.7.2
Social health insurance agencies
HP.7.3
Private health insurance administration agencies
Missing (data not available)
HP.7.9
Other administration agencies
HP.8
Rest of the economy
HP.8.1
Households as providers of home health care
Missing (data not available)
HP.8.2
All other industries as secondary providers of health care
HP.9
Rest of the world
13.1. Accuracy - overall
The sources to compile the data on health care expenditure are mainly administrative and register-based data, only a small percentage of the figures come from surveys or other means. Accordingly, for the health care expenditure data collection, accuracy deals with problems of coverage as the main possible source of errors.
13.2. Sampling error
Surveys are only used to divide expenditure into SHA functions, not to estimate total health expenditure.
13.3. Non-sampling error
no information
14.1. Timeliness
Member States were required to transmit their data to Eurostat in compliance with the Commission Regulation (EU) 2015/359 transmission deadlines, until reference year 2020. As of reference year 2021, data are transmitted pursuant to Commission Regulation (EU) 2021/1901. Data and reference metadata for the reference year T should be transmitted to Eurostat by 30 April T+2.
14.2. Punctuality
Data submitted on april 30th 2024.
15.1. Comparability - geographical
Not applicable.
15.2. Comparability - over time
Breaks in time series resulting from methodological changes
Year
Items affected by the break
Explanations
2000
All items
Break in series due to the switch to SHA 2011 based reporting
Other comparability issues:
We need to investigate better the LTC expenditure, especially in regards to ADL, IADL and assisted living.
15.3. Coherence - cross domain
Calculations are cross-checked with other sources at national level.
15.4. Coherence - internal
Coherence is verified within the validation process
Mainly secondary use of administrative data but also surveys sent out to health care service providers. No estimation on cost or burden available.
17.1. Data revision - policy
National Accounts and Public finance statistics revised up to 3 years (September publication), which thus can affect health care expenditure and SHA. In december 2020 we had a benchmark revision, and the public finance statistics were revised back to 1998.
17.2. Data revision - practice
2011-2021, revisions in line with local revisions (corrected cofog classification) in national accounts and government finance statistics. 2021; where provider hospital or health care center, figures have been revised as there were still preliminary figures for some units in last transmission.
18.1. Source data
Several data sources are used (as of data notification in March 2019):
Surveys/census: 1
Public administrative records: 3
Financial reports: 0
Other: 6
Surveys/censuses
Source name
Brief description of 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
Processing
The base of the consumer price index, Statistics Iceland
Household expenditure surveys are carried out on a yearly basis and the results are used for annual rebasing (in March).
HF 2.2 and HF 3.1 (HC 1-HC 5). HP 1- HP 5.
2000-2023
Annual
Information from the Consumer Price Index survey (based on household surveys) used to divide the total OOP and NPISH spending (as according to private consumption, national accounts) between the various functions (HC).
Public administrative records
Source name
Brief description of 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
Processing
Central Government
Annual reports
HF 1.1 (Various functions (HC), e.g. Partial HC 6.1-HC 6.6 and HC 7.1-HC 7.2)
2000-2022
7 months
Annual
Statistics of National Health Insurance
Annual records on spending
HF 1.1
2000-2022
7 months
Annual
The Financial Management Authority (FJS)
Quarterly preliminary data on central government spending
HF 1.1
2023
3 months
quartlerly
Other
Source name
Brief description of 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
Processing
National health statistics
Gathered annually by Statistics Iceland
HF 1.1
2000-2023
9 months (preliminary 3.5 months)
Annual
The National University Hospital of Iceland, Akureyri Hospital and The Health Care Institution of North Iceland*
Questionaires sent to and filled out by the hospitals in order to determine how their expenditure is divided between health care functions (HC); coverage 86% of national hospital spending
HF 1.1 (HC.1.1-HC1.4, HC.2.1-HC.2.4, partial HC.3.1-HC.3.2). HP 1.
2013-2022
Irregular
National data estimates based on information from the largest hospitals. The Health Care Institution of North Iceland included from reference year 2017, they operate eighteen health clinics, four hospitals and three nursing homes
Reykjavik Health Care Clinics and The Health Care Institution of North Iceland*
Questionaires sent to and filled out by the clinics in order to determine how their expenditure is divided between health care functions (HC); coverage 57% of national health care clinic spending (2013 first reference year).
HF 1.1 (HC. 1.3.1, HC.1.4, HC.3.4, partial HC 6.1-HC.6.5). HP 3.4.
2013-2022
Irregular
National data estimates based on information from questionaires
Directorate of Health
Questionaire - in order to determine how much of their expenses are due to prenventive care (HC6)
HF 1.1 (partial HC 6.1-6.6, partial HC 7.1). HP 6.
2013-2022
Irregular
Private consumption, National accounts, Statistics Iceland
Gathered and computed by the National Accounts team
HF 2.2 and HF 3.1 (total HC). HP 1- HP 5.
2000-2023
9 months (preliminary 3.5 months)
Information from the Consumer Price Index survey (based on household surveys) used to divide the total OOP and NPISH spending (as according to private consumption, national accounts) between the various functions (HC).
Ministry of health
Overview of covid-related expenditure
2020-2022
irregular
18.2. Frequency of data collection
Annual.
18.3. Data collection
Data are collected through the joint health accounts questionnaire (JHAQ) that is submitted to Eurostat during the annual data collection exercise. There is a voluntary deadline to send the JHAQ questionnaire for the calendar year T by the 31st of March T+2. The joint health accounts questionnaire (JHAQ) is coordinated in agreement with the World Health Organisation (WHO) and the Organization of Economic Co-operation and Development (OECD). These three international organisations are known collectively as the International Health Accounts Team (IHAT). Data are submitted to Eurostat based on Commission Regulation (EU) 2015/359 of 4 March 2015 implementing Regulation (EC) No 1338/2008 of the European Parliament and of the Council as regards statistics on healthcare expenditure and financing, until reference year 2020. As of reference year 2021 onwards Commission Regulation (EU) 2021/1901 of 29 October 2021 implementing Regulation (EC) No 1338/2008, is in force.
18.4. Data validation
The 2023 JHAQ includes a number of features which allow national data correspondents to perform various quality checks before submitting the data. The embedded programmes allow the verification of:
1- Consistency of the data between tables, This step checks if the marginal totals reported in each table of the JHAQ are consistent across all tables. For example, for each function (HC), the total across all financing schemes (HF) in the HCxHF table has to be equal to the total across all providers (HP) in the HCxHP table, i.e. the values in the column “All HF” in the HCxHF table have to be equal to the values in the column “All HP” in the HCxHP table. Any detected differences are flagged up in the corresponding row or column in the relevant tables and all inconsistencies are listed in the “Report” worksheet by variable code together with the amount by which the respective variable differs between the two compared tables. A positive value indicates that the first listed table has a higher value for the same variable, and vice versa.
2- Consistency of the data within tables, Any detected inconsistencies are listed by variable code together with an indication of which total is not equal to the sum of its subcomponents as well as the numerical difference. A positive figure indicates that the total is greater than the reported sub-components, and vice versa.
The presence of negative values,
Entries in the tables cannot be negative as they refer to the consumption of goods and services. If an individual data table is checked for internal consistency, the negative values check is performed for the relevant table and then any negative values are highlighted red and crossed out.
The presence of atypical entries,
The atypical entries check provides information whether the data tables contain values in cells which are – if at all – only reported by very few countries and are thus atypical for health accounting. If an individual data table is checked for internal consistency, the atypical entries check is performed for the relevant table. In the data tables, any cell containing an atypical entry will be highlighted for national data providers. Should any atypical entries be identified, compilers should scrutinize in detail the transactions that led to entries in those cells and assess whether the accounting rules of SHA have been correctly applied. If they come to the conclusion that the transactions are recorded in the correct categories of the ICHA classifications, then the corresponding atypical entries represent unique – and correctly accounted for – features of the country’s health system. In this case a short description of the nature of the transactions should be included in the accompanying Metadata file under “II.3. Atypical entries”. If, on the other hand, compilers come to the conclusion that the transactions are not recorded correctly, then they need to make adjustments in the concerned tables. In case the transactions recorded in a cell do not belong to the boundaries of SHA (e.g. they refer to intermediate consumption) the value of the respective cell should be deleted (and all cells that are affected by this change adjusted accordingly). In case the transactions are misreported and another category of the ICHA classification is more appropriate, the value of the cell should be transferred to the correct cell of the table.
3- The growth rates against the previous year and the magnitude of revisions as compared to previously submitted data. Results are grouped into three different categories:
Breaks in series (the current questionnaire shows no data for an item that is not null in the other file)
Newly reported (the current questionnaire contains data for an item that is empty in the other file)
Differences (all other types of differences)
18.5. Data compilation
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 can be 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 must 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 can be estimated using known data points.
Or other.
SHA variable(s)
Main method
Brief description of methodology
HP 1.1 / HF 1.1 / HC 1-3
Pro-rating/Utilisation key
Questionnaires sent out to the largest hospitals and their replies used to split spending due to general hospital services, as according to the cofog health classification, between functions (HC) as per SHA 2011 classification.
HP 3.4.5 and HP 3.5 / HF 1.1 / HC 1-3 and HC 6
Pro-rating/Utilisation key
Questionnaires sent out to health care clinics and their replies in addition to public administration records used to split spending due to general medical services, as according to the cofog health classification, between functions (HC) as per SHA 2011 classification.
HP 6 / HF 1.1 / HC 6-7
Other
Questionnaire sent to the Directorate of Health in order to split their spending between functions (HC) as per SHA 2011 classification.
HP 2.1 / HF 1.1 / HC 3.1-3.2
Balancing item/Residual method
Nursing and canvalescent home services as according to cofog health classification split between HC 3.1 and HC 3.2 via expert estimation.
HP 1-5 / HF 2.2 and 3.1 / HC 1-5
Pro-rating/Utilisation key
Total household health cost / OOP spending and NPISH from National Accounts, Private consumption. Information on % spending from household surveys (CPI) used to split the total cost between functions (HC) and providers (HP) as per SHA 2011 classification.
18.6. Adjustment
Not relevant.
no comments
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).
16 June 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 resident population on the national territory of a country.
Health care expenditure data are annual data, corresponding to the calendar year.
This quality report covers the following reference years: 2000-2022.
The sources to compile the data on health care expenditure are mainly administrative and register-based data, only a small percentage of the figures come from surveys or other means. Accordingly, for the health care expenditure data collection, accuracy deals with problems of coverage as the main possible source of errors.
Current expenditure data are presented according to following units:
expenditure amount in millions of euro
expenditure amount in millions of national currency
expenditure amount in millions of PPS
percentage of GDP
amount in euro per capita
amount in national currency per capita
amount in PPS per capita
percentage of current health expenditure (CHE)
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 can be 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 must 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 can be estimated using known data points.
Or other.
SHA variable(s)
Main method
Brief description of methodology
HP 1.1 / HF 1.1 / HC 1-3
Pro-rating/Utilisation key
Questionnaires sent out to the largest hospitals and their replies used to split spending due to general hospital services, as according to the cofog health classification, between functions (HC) as per SHA 2011 classification.
HP 3.4.5 and HP 3.5 / HF 1.1 / HC 1-3 and HC 6
Pro-rating/Utilisation key
Questionnaires sent out to health care clinics and their replies in addition to public administration records used to split spending due to general medical services, as according to the cofog health classification, between functions (HC) as per SHA 2011 classification.
HP 6 / HF 1.1 / HC 6-7
Other
Questionnaire sent to the Directorate of Health in order to split their spending between functions (HC) as per SHA 2011 classification.
HP 2.1 / HF 1.1 / HC 3.1-3.2
Balancing item/Residual method
Nursing and canvalescent home services as according to cofog health classification split between HC 3.1 and HC 3.2 via expert estimation.
HP 1-5 / HF 2.2 and 3.1 / HC 1-5
Pro-rating/Utilisation key
Total household health cost / OOP spending and NPISH from National Accounts, Private consumption. Information on % spending from household surveys (CPI) used to split the total cost between functions (HC) and providers (HP) as per SHA 2011 classification.
Several data sources are used (as of data notification in March 2019):
Surveys/census: 1
Public administrative records: 3
Financial reports: 0
Other: 6
Surveys/censuses
Source name
Brief description of 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
Processing
The base of the consumer price index, Statistics Iceland
Household expenditure surveys are carried out on a yearly basis and the results are used for annual rebasing (in March).
HF 2.2 and HF 3.1 (HC 1-HC 5). HP 1- HP 5.
2000-2023
Annual
Information from the Consumer Price Index survey (based on household surveys) used to divide the total OOP and NPISH spending (as according to private consumption, national accounts) between the various functions (HC).
Public administrative records
Source name
Brief description of 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
Processing
Central Government
Annual reports
HF 1.1 (Various functions (HC), e.g. Partial HC 6.1-HC 6.6 and HC 7.1-HC 7.2)
2000-2022
7 months
Annual
Statistics of National Health Insurance
Annual records on spending
HF 1.1
2000-2022
7 months
Annual
The Financial Management Authority (FJS)
Quarterly preliminary data on central government spending
HF 1.1
2023
3 months
quartlerly
Other
Source name
Brief description of 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
Processing
National health statistics
Gathered annually by Statistics Iceland
HF 1.1
2000-2023
9 months (preliminary 3.5 months)
Annual
The National University Hospital of Iceland, Akureyri Hospital and The Health Care Institution of North Iceland*
Questionaires sent to and filled out by the hospitals in order to determine how their expenditure is divided between health care functions (HC); coverage 86% of national hospital spending
HF 1.1 (HC.1.1-HC1.4, HC.2.1-HC.2.4, partial HC.3.1-HC.3.2). HP 1.
2013-2022
Irregular
National data estimates based on information from the largest hospitals. The Health Care Institution of North Iceland included from reference year 2017, they operate eighteen health clinics, four hospitals and three nursing homes
Reykjavik Health Care Clinics and The Health Care Institution of North Iceland*
Questionaires sent to and filled out by the clinics in order to determine how their expenditure is divided between health care functions (HC); coverage 57% of national health care clinic spending (2013 first reference year).
HF 1.1 (HC. 1.3.1, HC.1.4, HC.3.4, partial HC 6.1-HC.6.5). HP 3.4.
2013-2022
Irregular
National data estimates based on information from questionaires
Directorate of Health
Questionaire - in order to determine how much of their expenses are due to prenventive care (HC6)
HF 1.1 (partial HC 6.1-6.6, partial HC 7.1). HP 6.
2013-2022
Irregular
Private consumption, National accounts, Statistics Iceland
Gathered and computed by the National Accounts team
HF 2.2 and HF 3.1 (total HC). HP 1- HP 5.
2000-2023
9 months (preliminary 3.5 months)
Information from the Consumer Price Index survey (based on household surveys) used to divide the total OOP and NPISH spending (as according to private consumption, national accounts) between the various functions (HC).
Ministry of health
Overview of covid-related expenditure
2020-2022
irregular
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.
Breaks in time series resulting from methodological changes
Year
Items affected by the break
Explanations
2000
All items
Break in series due to the switch to SHA 2011 based reporting
Other comparability issues:
We need to investigate better the LTC expenditure, especially in regards to ADL, IADL and assisted living.
