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Health care expenditure (SHA 2011) (hlth_sha11)

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Compiling agency: Istat - Italian National Statistical Institute

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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).

This Quality Report covers data for reference years 2014 to 2022 .

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).

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: 2012 - 2022.

SHA data for Italy are the result of an integration process of data from several data sources, starting from National Accounts data. 

The coherence of SHA data with the National Accounts data according to the SEC2010 increase the accuracy of the estimations.

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).

To estimate the items of HF x HC, HC x HP and HP x HF tables several different methods are applied.

 

SHA variable(s) Main method Brief description of methodology
HF.1.1x HC.1-7xHP.1-6 Other The health care functions (HC) are, in general, based on the direct classification of health care levels (LA) for LHUs and on expenditures by COFOG for  not LHUs. For the year T+1 the final consumption expenditure COFOG division 7 (7.5 is excluded) of LHUs  is broken down according to the distribution by LA of the previous year. Each HC.1-7 function is mainly attributed to HP items according to the correspondence between the type of service/function to the producer based the organization of Italian Health System. In HP.1-6 are considered public and private providers. In particular, private (accredited) providers  are involved in supplying to households goods and services, purchased by General Government, as social transfers in kind. 
HF.1.1x(HC.1.1+HC.2.1)x HP.1 Other For LHUs, the expenditure for inpatient rehabilitative and curative care (HC.1.1+HC.2.1) provided in hospital (HP.1) is reported considering the related LA costs for inpatient health services (e.g. general acute care, rehabilitation services). For the period 2012-2018, a share of LA relative to emergency cases and urgent admission, followed by overnight stay, was estimated using the Information system for monitoring emergency care (EMUR), and the monthly form HSP24. Since 2019, the LA forms directly provides this information. The item also includes COFOG 7.3 for the other General Government units.
HF.1.1x(HC.1.1+HC.2.1)xHP.2 Other In the inpatient rehabilitative and curative care (HC.1.1+HC.2.1) delivered in residential facilities (HP.2) is accounted, for LHUs, a share of LA - rehabilitative care, supplied to patients with disability conditions, calculated using the information of  residential, and semi-residential care in the Italian Health System. Since 2019,  a share of LA cost for care services  supplied to people  with mental health problems is also included.
HF.1.1x( HC.1.2+HC.2.2)x HP.1  Other The value of day curative and rehabilitative care (HC.1.2+HC.2.2)  includes LA costs related to day hospital, day surgery and a share of day rehabilitative care provided to people with disabilities in hospital (HP.1).
HF.1.1x(HC.1.3+HC.2.3)x HP.1 Other For LHUs, in outpatient curative and rehabilitative care (HC.1.3+HC.2.3) a share of LA cost covering  the whole range of services usually performed in outpatient  services provided by hospital (HP.1), using the information on management and economic activities of  LHUs (Forms STS11 and STS21) was accounted for the period 2012-2018 . For the period 2012-2018, a share of LA relative to emergency cases and urgent admission, not followed by overnight stay, was estimated using the Information system for monitoring emergency care (EMUR), and the monthly form HSP24. Since 2019, the LA forms directly provides all the details of these data.
HF.1.1x(HC.1.3+HC.2.3)xHP.3  Other The outpatient curative and rehabilitative care (HC.1.3+HC.2.3) of LHUs includes a share of expenditure associated to LA covering the whole range of services usually performed in outpatient services (HP.3).
For the period 2012-2018, the proportion was calculated using information on management and economic activities of LHUs (Forms STS11 and STS21). Since 2019, the LA forms directly provides this information.
In the item are also included the shares of expenditure for services with curative and rehabilitative purpose, related to LA dispensed to outpatients with psychiatric problem, substance abuse and other dependencies and with disability conditions. For the period 2012-2018, the shares was estimated considering qualitative information about the functioning of Italian Health System and the data supplied by SISM and SIND. Since 2019, this information are improved with new data provided by the “Multipurpose survey on households: aspects of daily life”. This data source is specifically used to split the outpatient and home care LA costs related to disability.
For the other General Government units is reported the value of COFOG 7.2.1.
HF.1.1x(HC.1.4+HC.2.4)xHP.3 Other For LHUs in HC.1.4+HC.2.4 are included the LA-home based care, with curative and rehabilitative purpose, also when supplied to elderly or physically disabled people.
HF.1.1x(HC.1.4+HC.2.4)xHP.8 Other Since 2019, LA cost related to health care assistence in prison is included.
HF.1.1xHC.3.1xHP.1 Other The estimate of LTC (HC3.1) is based on LA costs for a range of medical and personal care services, provided in hospital (HP.1),  to reduce or manage the deterioration of health status in patients with a degree of long-term dependency.
HF.1.1xHC.3.1xHP.2 Other The item LTC (HC3.1) includes the costs of LA for residential care services (HP.2) supplied to people suffering from mental retardation, disability, terminally ill patients, mental health illnesses, HIV or substance abuse and other dependencies. Moreover, it is accounted a share of expenditures on pharmaceuticals, when included as component of a service package of LTC, estimated using the "Information system for monitoring direct and behalf distribution of medicines". Since 2019, HIV expenditure is not more included, because not specific data are available.
HF.1.1xHC.3.2xHP.3 Other In the LTC (HC.3.2)  are included the costs of LA for day care provided to people with HIV, substance abuse and other dependencies or mental illness problems or disability. Since 2019, HIV expenditure is not more included, because not specific data are available, moreover the LA cost for mental illness is shared between curative/rehabilitative care and LTC using SISM information.
HF.1.1xHC.3.3xHP.3 Other The value of LTC (HC.3.3) is related to the costs of LA - outpatient care, for people with disability problems, psychiatric diseases and substance abuse and other dependencies. From 2012 to 2018, a share of prosthetic care and integrated care associated to long term care was included, the proportion was estimated considering the information of  “ISTAT- Survey on households: health conditions and use of medical services”. Since 2019, this is classified in HC.3.4. 
HF.1.1xHC.3.4xHP.3 Other In the item LTC (HC.3.4), is reported the value of expenditure for LA -home based care, considering the health care services provided to terminally ill, elderly people, psychiatric patients and HIV patients.  Moreover, since 2019, it is reported a share expenditures on pharmaceuticals, when included as component of a service package of LTC, estimated using the "Information system for monitoring direct and behalf distribution of medicines". Since 2019, not specific data are available for HIV and elderly people expenditure, but in the LA forms there are informations about expenditure for dependent patients  that are reported in HC.3.4.
HF.1.1xHC.4 splitting HP.4/HP.1 Other For LHUs, in the ancillary services (HC.4) are considered costs for LA relative to diagnostic and imaging services (provided in outpatient setting). For the period 2012-2018, the amount was split between HP.4 and HP.1  taking into account the information on management and economic activities of  LHUs (Forms STS11 and STS21). Since 2019, detailed information for provider is supplied by LA forms. In HC.4 costs for LA - patient transportation supplied by the provider HP.4 are also included. For the other General Government units is reported the value of COFOG 7.2.4 (HP.4).
HF.1.1x HC.5.1xHP.5 Other For LHUs, the LA -pharmaceutical products and other medical non-durable goods are registered in HC.5.1 including also large part of expenditure for integrated care (provision of nutritional products to particular categories and provision of health facilities to patients with diabetes mellitus) provided by retailers of medical goods. Moreover, for the period 2012-2018, it was reported a share of LA expenditure on pharmaceuticals directly purchased by LHAs and distributed by retailers of medical goods on behalf LHUs, using data on the “Information system for monitoring direct and behalf distribution of medicines”. Since 2019, detailed information is supplied by LA forms. In the case of other General Government units is included the value of COFOG 7.1.
HF.1.1x HC.5.1 splitting HP.1/HP.3 Other For LHUs,in HC.5.1, a share of LA cost on pharmaceuticals directly purchased by LHAs and distributed, with internal facilities, by hospitals (HP.1) and ambulatory (HP.3) it was accounted, using data on the “Information system for monitoring direct and behalf distribution of medicines”, until 2018. Since 2019, detailed information is supplied by LA forms. 
HF.1.1x HC.5.2xHP.5 Other Regarding LHUs, in therapeutic appliances and other medical durable goods (HC.5.2) cost for LA - prosthetic care (provision of prostheses, orthopedic appliances, technical aids for the disabled) is in large part accounted, the residual part of cost was imputed to LTC (HC.3.3), until 2018, since 2019 it is classified in LTC (HC.3.4).
HF.1.1x HC.6 xHP.6 Other The data for preventive care (HC.6)  are estimated for LHUs adding all the expenditure of LA directly related to preventive care. For other General Government units, COFOG 7.4 data are accounted.
HF.1.1x HC.6 xHP.1 Other Since 2019, the data for preventive care (HC.6)  are estimated for LHUs acounting all the expenditure of LA directly related to preventive care provided in hospitals.
HF.1.1x HC.7xHP.7  Other The governance and health system and financing administration (HC.7) is estimated using COFOG 7.6 of General Government subsectors. 
HF.1.2.1xHC.1.3+HC.2.3xHP.3   Other In the amount of outpatient curative and rehabilitative care (HC.1.3+HC.2.3) is reported the expenditure for rehabilitative services provided in ambulatory centers related to Social Security Funds – COFOG 7.2.
HF.2.1xHC.7 Pro-rating/Utilisation key The expenditure on administration of private health insurance is calculated using the value of the output, defined as the sum of total premiums earned plus premiums supplements less adjusted claims incurred. For the absence of detailed information for different types of insurance, the amount of output is obtained applying to the value of output for non-life insurance the ratio between difference of premiums less claims of health insurance to difference of premiums less claims of total non-life insurance.
HF.2.1xHC.1-6 Pro-rating/Utilisation key Total expenditure financed by health insurance (except HC.7) is obtained as total non-life insurance claims (reimbursements) of private health insurance; classification by  HC  function and HP provider is obtained linking total claims to the distribution of household out-of-pocket expenditure by health care function/provider in selected  HCxHP items (HC.1.1+HC.2.1xHP.1; HC.1.2+HC.2.2xHP.1;HC.1.3+HC.2.3xHP.3; HC.4xHP.4; HC.5.2xHP.5).
HF.2.2xHC.1-6 Other Final consumption expenditure of NPISH by economic activity (at second level of Nace Rev.2) is used to estimate health good and services financed/provided by this type of units; division 86 "Human health activities" and part of division 87  "Residential care activities" are considered. In absence of detailed information on economic activity at fourth digit level, data on occupational structure by industry at four digit  level are used as key to distribute the amount available only at second level; in order to split expenditures relative to code 86.90 in different HC functions, characteristics of the units  that provide this type of services are investigated; health services in 87.10 and 87.20 are assigned to LTC services (HC.3.1).
HF.2.3xHC.6xHP.3 Other Output of occupational health services purchased by enterprises is estimated using the supply side method. Years 2012-2017 Business Sector Studies (BSS) collect revenues  of  units classified in the Medical  activities and, in particular, the information about revenues from occupational health is available. The percentage of revenues from occupational health is  applied to the enterprise's output,  calculated on the Frame - SBS data-base (The Integrated statistical system of administrative and survey data for SBS estimations). In order to estimate the output of enterprises not covered by the source (BSS) , the average percentage of occupational health revenues on the total revenues,  is applied to the output of the missing enterprises. Since the year 2018, there has been a change in the data source, the BSS has been replaced by Summary Reliability Indices (ISA), but without any change in the methology  applied. Concerning year T and T+1, as  the ISA source is not yet available , in order to update the occupational health output estimate an extrapolating method (price and volume) is used. The output of occupational health of the year T-1 is updated using the change of the price index of  medical services (in particular ECOICOP 062)  and the change of numbers of employees.
HP.1xHF.3  splitting (HC.1.1+HC.2.1)/(HC.1.2+HC.2.2)/(HC.1.3+HC.2.3) /HC.4 Other Household out-of-pocket expenditure on Hospitals (HP.1) providing inpatient and day curative and rehabilitative care (HC.1.1-HC.2.1 and HC.1.2-HC.2.2 ) is based on quantity per price  estimate using annual hospital discharge data (relating to private clinics and hospitalization paid by patients) and an average price derived from HBS data. Households out-of-pocket expenditure on Hospitals (HP.1) providing outpatient curative and rehabilitative care  (HC.1.3-HC.2.3) and ancillary services (HC.4) are based on household out-of-pocket expenditure for health services provided in intramural regime and co-payment (source: Ministry of Health- LHUs’ profit and loss accounts). The total value (irrespective of provider) of health services provided in intramural regime and co-payment are splitted in outpatient curative and rehabilitative care and ancillary services provided from hospitals (sources: STS11 "Dati anagrafici delle strutture sanitarie - STS21 "Assistenza specialistica territoriale").
HP.2xHF.3xHC.3.1 Balancing item/Residual method Household out-of-pocket expenditure on Residential LTC facilities (HP.2) providing inpatient LTC (HC.3.1)  is obtained as residual, deducting the total household expenditure on hospital (HP.1) providing inpatient curative and rehabilitative care (HC.1.1-HC.2.1) from the NA estimate  for the COICOP item "hospital services".
HP.3xHF.3  splitting (HC.1.3+HC.2.3)/(HC.1.4+HC.2.4)/HC.3.3 /HC.3.4 Pro-rating/Utilisation key Household out-of-pocket expenditure on ambulatory health care (HP.3) is based on NA estimate. The ratio resulting from HBS expenditure in ambulatory services is applied to the NA estimate for COICOP item " Outpatient services" (after deducting outpatient services in intramural regime). The obtained result is then split into HC functionts (HC.1.3-HC.2.3, HC.1.4-HC.2.4, HC.3.3,HC.3.4)  using the information provided by the survey on Health conditions and use of health services.
HP.4xHF.3xHC.4 Balancing item/Residual method Household out-of-pocket expenditure on ancillary services is obtained by deducting the expenditure on ambulatory health care (HP.3xHF.3) and the value of outpatient services provided by Hospitals in intramural regime from NA estimate on COICOP item " Outpatient services".
HP.5xHF.3 splitting HC.5.1/HC.5.2 Pro-rating/Utilisation key Household out-of-pocket expenditure on Pharmaceuticals and other medical nondurable goods ((HP.5xHC.5.1) and Therapeutic appliances and other medical goods (HP.5xHC.5.2) is obtained by applying  the HBS ratios (related to medicines and medical equipment)  to the NA estimate for  COICOP expenditure item "medical products, appliances and equipment".
HP.6xHF.3xHC.6 Other Household out-of-pocket expenditure on preventive care (HP.6xHC.6) includes only expenditure on vaccines, provided by AIFA (until 2018). Since 2019, data are estimated by applying the change rate in "medical products, appliances and equipment" item to previuos year vaccine expenditure.
HP.9xHF.3x(HC.1.3+HC.2.3) Other The expenditure of residents abroad for health treatments (HP.9xHC.1.3-HC.2.3) is provided by Bank of Italy until year T-1. Data for T  and T+1 are estimated by applying the change rate provided by Bank of Italy on "expenditure for travel  by other reasons ".

Several data sources are used to estimate SHA data, including administrative data, National Accounts data, and surveys. Below a list of sources used to compile SHA data.

 

Source name Brief description of source Type of data source Primary SHA variable(s) using this data source Time period covered by this data source Timeliness
(Number of months after the end of the accounting period)		 Frequency Processing
Ministry of Health -Assistance Level Costs (LA) forms  Data on expenditures of  Local Health Units  (LHUs) by health care level (Livelli Assistenza-LA). LHUs are: Local Health Agencies (LHAs), Hospital Agencies, Public Research Hospitals, University Hospitals. Data are related to the value of goods and services produced by LHUs themselves and the purchases by LHUs of goods and services produced by market producers.
The data, from 2001 to 2018, are based on the Assistance Level as defined in the DPCM of the 29th of November 2001. Since 2019, the structure of the “Assistance Level Costs” has been amended by the new DPCM of the 12th of January 2017. 		 Public administrative records HF.1.1, for all HC functions related to LHUs (except HC.7) and providers. 2001-T 12 months Annual Data are processed according to ESA 2010 principles and the consistency is assured with final consumption expenditure of General Government  by COFOG, division 7 "health". In line with SHA 2011 methodology the expenditure on R&D –COFOG 7.5 is excluded.
ISTAT- National Accounts, Final consumption expenditure of General Government Figures on final consumption expenditure of General Government  by sub-sector according to ESA2010 (European System of Account 2010, Eurostat) and by function according to COFOG, division 7 "health". Other HF.1.1 for  HC.7 related to LHUs                                HF.1.1 and HF.1.2  for all HC functions related to other  General Government units  (not LHUs) 1995-T+1 2 months Annual Final consumption expenditure relating to COFOG 7.5 (R&D health) is excluded according  to the SHA 2011 definitions.
ISTAT- Survey on households: health conditions and use of medical services The "Health conditions and use of health services" survey collects information on health status (chronic diseases, limitations, mental health, etc.), health determinants (smoking habits, overweight, physical activity, prevention, etc.), use of health services (medical consultations, inpatient and day care hospitalizations, diagnostic tests, etc.). The latest edition of the national survey was carried out between September 2012 and June 2013. Surveys/censuses HF1.1 to estimate a proportion of HC.3.3, HC.5.1, HC.5.2 related to LHUs
HF.3 (financing HC.1.3-HC.2.3, HC.1.4-HC.2.4,  HC.3.3, HC.3.4 provided by HP.3)		 1994, 1999-2000, 2004-2005, 2012-2013 6 months Periodical  
Ministry of Health -Survey forms on management and economic activities of  LHUs (Form STS11 -"Dati anagrafici delle strutture sanitarie" and form STS21 - "Assistenza specialistica territoriale - Attività clinica, di laboratorio, di diagnostica per immagini e di diagnostica strumentale"-HSP24 "Day hospital, nido, pronto soccorso, sale operatorie, ospedalizzazione domiciliare e nati immaturi")  Data on resources and activities of the LHUs and of other health care facilities (hospitals, outpatient   departments, residential care facilities, etc.). Public administrative records HF1.1 and HF.3 to estimate HC.1.3+HC.2.3 by HP.1 and HP.3 and HC.4 by HP.1 and HP.4 1991-T 12 months Annual An equivalent scale is used to adjust health care data, to take into account the difference in costs.
Ministry of Health - "Information system for monitoring direct and behalf distribution of medicines (Distribuzione diretta e distribuzione per conto-DD)" Data on pharmaceuticals (costs e quantities) directly purchased by LHAs and distribuited in non conventional channel. Public administrative records HF1.1, to estimate HC.3.4xHP.3, HC.3.1xHP.2, HC.5.1 splitting HP.1/HP.3/HP.5 2009-T 12 months Monthly  
Ministry of Health - Information system for monitoring emergency care (EMUR) Data for monitoring of the health-care emergency services provided by "118 units" and by hospitals. Public administrative records HF1.1 to estimate HC.1.1+HC.2.1 and HC.1.3+HC.2.3   2009-2018 12 months    
Ministry of Health-Mental health information system (SISM) The information system - established by the Decree of the Minister of Health of 15 October 2010 - provides at the national level information on health and social care interventions for the provision of assistance to adult persons (18 years and over) with psychiatric problems and to their families. The first report was published by the Ministry of Health on 2016 with data referred to 2015. Public administrative records HF1.1 to estimate HC.1.3+HC.2.3, HC.1.4+HC.2.4,  HC.3.3 and HC.3.4 provided by HP.3. Since 2019, it is used to estimate also  HC.1.2+HC.2.2 and HC.3.2 by provider HP.2 2015-T 12 months Annual The distribution of patients by age and diagnosis is used to establish the share of expenditure to allocate to curative/rehabilitative or to long term care.
Ministry of Health-National Information Dependency System (SIND)  The National Information Dependency System (SIND) was established by the Decree of the Minister of Health of 11 June 2010. The survey covers health and social care interventions provided by the National Health Service (SSN): for each patient under treatment information is referred to socio-demographic characteristics, pathological-infectious situation, the use of drugs, performance and pharmacological therapies delivered. Data are published annually in the Annual Report to the Parliament on the Status of Drug Addiction in Italy. Public administrative records HF1.1 to estimate HC.1.3+HC.2.3 and  HC.3.3 provided by HP.3 2012-T 12 months Annual The distribution of patients by type of drug used is used to establish the share of expenditure to allocate to curative/rehabilitative or to long term care.
Ministry of Health-Monitoring information system for home care (SIAD) SIAD collects information on health and social care interventions provided in a planned manner, at home, by operators of the National Health System. Public administrative records HF.1.1 Since 2019, SIAD data are used to split the LA costs between different HC: HC.1.4+HC.2.4 and  HC.3.4 provided by HP.3  2013-T 12 months Annual The distribution of patients by type of conditions, health care provided and its time span are used to establish the share of expenditure to allocate to curative/rehabilitative or to long term care and to identify the provider.
Ministry of Health-Monitoring Information system for residential and semi-residential care (FAR) The FAR system supplies information about  the services provided in residential and semi-residential settings for the elderly or dependent persons in a chronic condition. Public administrative records HF.1.1 Since 2019, FAR data are used to split the LA costs among different HC: HC.1.1+HC.2.1 and  HC.3.1 provided by HP.2 and HC.1.2+HC.2.2 and  HC.3.2 provided by HP.3 2013-T 12 months Annual The distribution of patients by type of conditions, health care provided and  its time span  are used to establish the share of expenditure to allocate to curative/rehabilitative or to long term care and to identify the provider.
IVASS-Financial Statements of Insurance Corporations It covers all domestic insurance corporations and the branches of  foreign non-EU insurance enterprises authorized to run their insurance and reinsurance business in Italy. IVASS (Italian Insurance Supervisory Authority) collects the financial statement data and additional supervisory information. Financial reports HF.2.1 1998-T+1 3 months and 12 months Quarterly and Annual  
ISTAT- National Accounts, Final consumption expenditure of non-profit Institutions serving households (NPISH) Figures on final consumption expenditure of NPISHs according to ESA2010 (European System of Account 2010, Eurostat) by economic activity. Other HF.2.2 1995-T+1 2 months    
ISTAT-Integrated statistical system of administrative and survey data for SBS estimations (Frame-SBS) Annual economic information for each unit present in the Business Register (ASIA-Enterprises) with less than 100 employees from a large set of sources. For units with 100 employees or more, SBS aggregates are derived from the “Survey on the financial statements of large enterprises” (SCI). Other HF.2.3 2011-T-1 18 months Annual  
Italian Revenue Agency -Business Sector Studies Annual records on professional activities , self-employed workers and enterprises under the threshold for turnover ; coverage is about 72% in terms of number of enterprises and 73% in terms of revenues. Other HF.2.3xHC.6 2008-2017 18 months Annual The economic activity from Statistical archive of active enterprises is applied to enterprises of the Business Sector Studies.
Italian Revenue Agency - Summary Reliability Indices (ISA) The ISA replace the BSS.  Annual records on professional activities , self-employed workers and enterprises under the threshold for turnover .  Other HF.2.3xHC.6 2018-T-1 18 months Annual The economic activity from Statistical archive of active enterprises is applied to enterprises of the Summary Reliability Indices.
Ministry of Health-Hospital discharges The Hospital discharge forms collect information on every discharge from public and private hospitals. Data on patient characteristics (age, gender, place of residence, marital status, etc.) and on hospitalization (diagnosis, procedures, length of stay, inpatient/day hospital, etc.) are collected. Public administrative records HF.3 (financing HC.1.1-HC.2.1, HC.1.2-HC.2.2,  provided by HP.1) 1995-T 18 months Annual  
Ministry of Health- LHUs’ profit and loss accounts Data source collecting standardized economic information about LHUs, with detailed breakdown in revenue and expenditure data. Financial reports HF.3 (financing HC.1.3-HC.2.3, HC.4  provided by HP.1 and HP.3) 2001-T+1 45 days and 6 months Quarterly and annual  
ISTAT- Household Budget Survey (HBS) The Household Budget Survey provides information on household expenditures for several goods and services (including health). Surveys/censuses HF.3 (financing: HC.1.1-HC.2.1, HC.1.2-HC.2.2,  provided by HP.1; HC.3.1 provided by Hp.2; all HC.5 provided by HP.5) 2000-T+1 2 months (provisional) and 6 months Annual  
ISTAT- National Account, Household consumption expenditure National Accounts estimate on household consumption expenditure by COICOP. Other HF.3 (financing all HC  provided by all HP except HP.6 and HP.9) 1995-T+1 2 months Annual Household final consumption expenditure in National Accounts refers to the domestic concept whereas SHA refers to the resident concept. Non-residents’ expenditures are subtracted and the residents' ones abroad are added. Moreover, health expenditure financed by voluntary insurance, included in household final consumption expenditure, is reclassified from HF.3 to HF.2.1.
ISTAT- Multipurpose survey on households: aspects of daily life The sample survey "Aspects of daily life" is part of an integrated system of social surveys - The Multipurpose Surveys on Households. It collects information on various individual and household aspect of daily life. Surveys/censuses HF1.1 Since 2019, this survey is used to estimate HC.1.3+HC.2.3, HC.3.3 and HC.3.4 provided by HP.3.  1993-T 9 months Annual The Global Activity Limitation Indicator and information on the use of health care services, home care assistance, chronic diseases, perceived health are used to establish the share of expenditure to allocate to curative/rehabilitative or to long term care.
Italian Medicines Agency (AIFA), The Medicines Utilisation Monitoring Centre (OsMed) Data on medicines use in Italy, described  in terms of expenditure, volume and type. Public administrative records HF.3 (financing HC.6 provided by HP.6) 2000-T 12 months Annual  
Bank of Italy - Survey on international tourism Survey on international tourism based on interviews and counting of resident and non-resident travelers at the Italian borders (road and rail crossings, international ports and airports), including information on expenditure by Italians abroad for health treatments. Surveys/censuses HF.3 (financing HC.1.3-HC.2.3 provided by HP.9) 1996-T+1 12 months Annual  

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.

The Italian National Institute of Statistics transmits data for the year T and T+1 with the same level of details by April T+2. At same time, Istat transmits also the updated data for the previous years, if necessary.

Not applicable.

Data according to SHA 2011 methodology are available from 2012 to 2023.

 In the year 2019, there is a break for the following aggregates:

all the items of HCxHF.1.1 (except  HC.7xHF.1.1 and ALL HCxHF.1.1);

all the items of HCxHF.1 (except HC.7xHF.1 and ALL HCxHF.1);

all the items of HCxAll HF (except HC.7xAll HF and All HCxAll HF);

all the items of HCxHP (except HC.1+HC.2xHP.9,  HC.1.3+HC.2.3xHP.9, HC.7x HP.7, HC.7xALLHP and ALL HCxHP.9);

all the items of HCxAll HP (except ALL HCx All HP);

all the items of HPxHF1.1 (except ALL HPxHF.1.1 and HP.7x HF.1.1);

all the items of HPxHF.1 (except ALL HPxHF.1 and and HP.7x HF.1);

all the items of HPxAll HF (except HP.9xAll HF, HP.7x ALLHF and All HPxAll HF).