Istat - Italian National Statistical Institute

Department for Statistical Production

Directorate for National Accounts (DCCN)

Division “Supply of goods and services and institutional sectors accounts”

Istat - Italian National Institute of Statistics 

Via Agostino Depretis 74B - 00184 Roma, Italy

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 .

Healthcare expenditure is recorded in relation to the international classification for health accounts (ICHA) defining:

• healthcare expenditure by financing schemes (ICHA-HF) — which classifies the types of financing arrangements through which people obtain health services; health care financing schemes include direct payments by households for services and goods and third-party financing arrangements;
• healthcare expenditure by function (ICHA-HC) — which details the split in healthcare expenditure following the purpose of healthcare activities — such as, curative care, rehabilitative care, long-term care, or preventive care;
• healthcare expenditure by provider (ICHA-HP) — which classifies units contributing to the provision of healthcare goods and services — such as hospitals, residential facilities, ambulatory health care services, ancillary services or retailers of medical goods.

1. Household individual consumption on health, including the collective consumption with two exceptions:

1. Occupational health care (intermediate consumption within establishments) minus an estimated share of occupational health in health providers’ and other medical industries net administration;
2. “Remunerated” unpaid household production in the form of transfer payments (social benefits in cash) for home care of sick, disabled and elderly persons provided by family members.

SHA 2011 Manual recommends following the standard System of National Account (SNA) rules for drawing the production boundary of health care services, albeit with two notable exceptions:

• Occupational health care is included in the national totals of health care spending. In SNA, this item is recorded as ancillary services and part of intermediate production of enterprises and
• Part of the cash transfers to private households for care givers of home care for the sick and disabled are treated as the paid household production of health care.

2. Health care financing schemes:

• HF1 Government schemes and compulsory contributory health care financing schemes;
• HF2 -voluntary health care payment schemes;
• HF3 - Household out-of-pocket payment;
• HF4 - rest of the world financing schemes.

3. NACE rev. 2, section Q, human health and social work activities.

SHA concept is the consumption of health care goods and services.

Health care statistics describe the process of providing and financing health care in countries by referring to health care goods and services, its providers and financing. For the collection of the data on health care expenditure the System of Health Accounts (SHA) and its related set of International Classification for the Health Accounts (ICHA) is used. SHA is a tri-axial system in which the financing, provision and consumption dimensions are covered by the ICHA (International Classification for Health Accounts): Health Care Functions (HC), Health Care Providers (HP), Health Care Financing Schemes (HF).

Data are presented in 3 summary (one-dimensional) tables and 3 cross-classification tables (2-dimensional tables).

Summary tables provide data on:

• Current expenditure by provider (ICHA-HP)
• Current expenditure by function (ICHA-HC)
• Current expenditure by financing scheme (ICHA-HF)

Cross-classification tables refer to:

• HC x HP: Health care expenditure by function and provider: data on which type of health care goods and services are supplied by which health care provider;
• HC x HF: Health care expenditure by function and by financing scheme: data on how are the different types of services and goods financed;
• HP x HF: Health care expenditure by provider and by financing scheme: data on from which health care provider and under which particular financing scheme are the services and goods purchased.

The classifications and definitions presented in the SHA 2011 manual are to be followed. Additional guidelines and material useful for compilers are also available at this address.

Commission Regulation (EU) 2021/1901, and Commission Regulation (EU) 2015/359 previously in force,  concern the collection of data on "current expenditure on healthcare" which is defined as the "final consumption expenditure of resident units on health care goods and services".

There is a very close relationship between the concept of "final consumption expenditure" as defined in the System of Health Accounts (SHA) and in National Account and, as a consequence, also between the underlying economic transactions as recorded in the two accounting frameworks.

In National Accounts there are two types of statistical units: institutional units and local kind-of-activity units (KAU). A local KAU groups all the parts of an institutional unit in its capacity as producer which are located in a single site. A local KAU belongs to one and only one institutional unit.

SHA uses the same two types of units for data compilation.

Local KAUs operating as providers of healthcare goods and services to resident units are statistical units in SHA.

Also transactions by institutional units are recorded in SHA, in which framework institutional units are also referred to as "financing agents". More precisely, SHA financing agents are institutional units that manage one or more financing schemes. The transactions are executed by the financing agents, according to the rules of the financing schemes.

Financing agents serve as key statistical units in producing national health accounts. While financing schemes are the key units for analysing how the consumption of health care goods and services is financed, the data concerning the relevant transactions are collected either from the financing agents that operate the different financing schemes or from the providers.

The concept of "healthcare financing schemes" in SHA is an application and extension of the concept of "social protection schemes" defined by the European System of Social PROtection Statistics (ESSPROS):  "a distinct body of rules, supported by one or more institutional units, governing the provision of social protection benefits and their financing ...". The social protection scheme is the statistical unit in ESSPROS. It is an analytical unit that allows describing the complete structure of the social protection financing system:  expenditure and receipts.

According to SHA Manual 2011, "the key concepts for describing the structure of the health care financing system are based on measuring: (a) the expenditure of health care financing schemes, under which goods and services are purchased directly from health care providers, on the one hand, and (b) the types of revenues of health care financing schemes, on the other hand.  

Commission Regulation (EU) 2021/1901  and (prior Commission Regulation (EU) 2015/359) limits its scope to the collection of data on the expenditure of health care financing schemes.

SHA focuses on the consumption of health care goods and services by the resident population irrespective of where this takes place. This implies the inclusion of imports (from non-resident providers) and the exclusion of exports (health care goods and services provided to non-residents).

The data 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.

SHA data are available from 2012 onward (up to year T, according to Regulation (EC) 2015/359 and Regulation (EC) 2021/1901 and the definitions and classifications of System of Health Accounts 2011 Manual).

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: 2012 - 2022.

Countries submit data to Eurostat on the basis of Commission Regulations (EU): 

• 2015/359 of 4 March 2015 implementing Regulation (EC) No 1338/2008 of the European Parliament and of the Council as regards statistics on healthcare expenditure and financing, until the reference year 2020.
• 2021/1901 of 29 October 2021 implementing Regulation (EC) No 1338/2008 of the European Parliament and of the Council as regards statistics on health care expenditure and financing, for which the first reference year will be in 2021.

The implementing Regulations specify the areas and the level of aggregation to be submitted by EU Member States and EEA countries (see Annex II of the Regulation).

Data collection takes place in agreement with the World Health Organization (WHO) and the Organization of Economic Co-operation and Development (OECD).

The Regulation (EC) No 223/2009 on European statistics (recitals 23-27, 31-32 and Articles 20-26) applies.

Several national legal acts guarantee the confidentiality of data requested for statistical purposes. In Italy, according to art. 9, paragraph 1 of the Legislative Decree n. 322 of 1989, statistical data cannot be disseminated but in aggregated form, in order to make it impossible to make any reference to identifiable individuals. They can only be used for statistical purposes.

Official statistics must also safeguard the rights, basic freedoms, and dignity of respondents, in particular with regard to the right to confidentiality and personal identity. Istat assures the protection of personal data according to the General Data Protection Regulation (Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC) and the Italian Data Protection Code (Legislative Decree no. 196/2003) and Code of conduct and professional practice applying to the processing of personal data for statistical and scientific research purposes within the framework of the national statistical system.

In order to make statistical secrecy and protection of personal data effective, Istat is currently taking appropriate organisational, logistical, methodological and statistical measures in accordance with internationally established standards. Moreover, Legislative Decree n. 322 of 1989, art. 6 and 6 bis provides that the exchange of personal data within the National Statistical System (Sistan) is possible if it is necessary to fulfil requirements provided by the National Statistical Programme or to allow the pursuit of institutional purposes.

Finally, in implementation of art. 5-ter of the legislative decree 14 March 2013, no. 33, the new “Guidelines for the access for scientific purposes to the elementary data of the National Statistical System” establish the conditions under which the bodies and offices of the National Statistical System can allow researchers to access their own elementary data for scientific purposes.

Only aggregated data or statistics without personal information are used in the System Health Accounts estimation process and no further confidentiality procedures are applied.

For the health expenditure data , there is not a schedule of statistical release dates. They are published by Istat about 30 days after the transmission to Eurostat (due by the 30 April). 

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

The dissemination on Istat's website is included in the weekly update calendar of releases and events “Calendario delle diffusioni e degli eventi” (Istat calendario-diffusioni-ed-eventi).

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.

Time series are available on IstatData and I.stat (data warehouse), and users can choose information according to their needs, building customised tables or downloading pre-packaged datasets. Metadata, classifications and definitions always accompany data. All Istat information is available free of charge and data are reusable providing the source.

Annual.

Only with the first dissemination at national level of SHA data Istat published a press release:

Statistiche Report - Il sistema dei conti della sanità per l’Italia - Anni 2012-2016.

Istat archivio.

A shorter version in English is available at the following link

Istat archivio.

There are no specific publications. Health care expenditure data are included  in Rapporto Osservasalute (2017-2023). Stato di salute e qualità dell’assistenza nelle regioni italiane, Osservatorio nazionale sulla salute nelle regioni italiane. “La sanità italiana nel confronto europeo” Rapporto osservasalute.

The data are disseminated online,  both in Italian and English,  on IstaData and I.stat (in National Accounts domain),  the warehouse of statistics produced by Istat. IT1,DATAWAREHOUSE,1.0/UP_ACC_HEALTH.

Not applicable.

The total current health care expenditure and long term care expenditure for General Government under SHA methodology are published every year in “Le tendenze di medio-lungo periodo del sistema pensionistico e socio-sanitario” by Ragioneria Generale dello Stato, the Ministry of Economy and Finance.

RGS Spesa_pensionistica.

The link for the  English version is the following:

RGS pension_expenditure.

The health care expenditure data are estimated according to European System of Accounts ESA 2010 - Blue Book (2013) and the Manual "A System of Health Accounts 2011: Revised Edition 2017" (OECD, Eurostat, WHO).

The methodology used to estimate SHA data is reported, in Italian, in the section “Nota Metodologica” of press release Statistics-Report - The System of Health accounts in Italy. Years 2012-2016. Edition: 2017, Reference period for data: Years 2012-2016; ISTAT archivio.

The methodology is, also, described, in Italian and in English, in I.Stat and IstatData, alongside the data, at the following links:

• Dati.istat ShowMetadata.
• Esploradati.ISTAT  IT1,DATAWAREHOUSE,1.0/UP_ACC_HEALTH.

The Istat Information System on Quality (SIQual) (Siqual Istat) contains information on the execution, on Istat statistical production processes, and on activities developed to guarantee quality of the produced statistical information.

For details on SHA data.

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.

Since the 90s Istat adopted a systematic approach to ensure quality in both statistical information and service to the community. For this purpose, the Italian National Institute of Statistics has defined a quality policy providing itself with appropriate tools as well as management changes to carry it out.

Istat quality policy is aimed at the improvement of statistical outputs and processes through the development of appropriate methodologies and tools as well as an appropriate scientific and technical support, provided to the personnel directly involved in the production and dissemination of statistical information.

Istat quality policy is coherent with the European framework developed by Eurostat, taking up its main principles and definitions stated in the European Statistics Code of Practice and useful to ensure and strengthen the accountability and governance of the European Statistical System and of the National Statistical Systems.

For details: Istat quality-commitment.

In line with European reference standards, Istat makes available detailed data quality reports for all statistical processes. Each report includes quantitative indicators of the quality of the statistical process and data produced: non-response rate, timeliness indicator, length of time series, etc. The SHA reports is availlable to the link: Istat archivio.

The long experience of Italy in carrying out expenditure estimations for National Accounts according to European rules established in Regulations has been fundamental to reduce quality problems. The main strengths of SHA are:

• The use of administrative data of good quality providing very detailed information.
• The adoption of estimation methodologies developed in a national working group with the participation of several different institutions, among them the Ministry of Health, the Ministry of Economy and Finance.

Out of Pocket data are compiled starting from National Account data already subjected to quality check.

SHA data provide key information for economic policy monitoring and decision making, for forecasting, for administrative purposes, for informing the public, and as input for economic research.

Ministry of Finance, Ministry of Health and other economic institutions, scientific and academic communities, researchers in the economic field are usually the entities who most use health accounts data. International Organizations (OECD, WHO) and EU Institutions use SHA data too.

Istat is constantly interested in understanding who the users of the statistics it produces are, what the information needs are, whether they match production and if the statistics produced satisfy users. To this aim, together with the analysis of user requests received through the Web Contact Center service, tools for direct consultation were developed, such as the annual online survey of customer satisfaction and indirect tools such as analysis of accesses and of users' browsing paths on the web site.

Data are available with the detail required by the Commission Regulation (EU) 2021/1901 and 2015/359 implementing Regulation (EC) No 1338/2008 of the European Parliament and of the Council as regards statistics on healthcare expenditure and financing.

Among the compulsory variables of the HF categories, the category HF4 “Rest of the world financing schemes (non-resident)” is missing because the data are not available.

HF.2.1 “Voluntary health insurance schemes” data are related to voluntary non-life insurance (sickness claims) and don’t report components on supplementary/complementary health insurance. This last category, existing in Italian health system, is not reported because there are not enough detailed information, to give an exhaustive representation of it in National Accounts and in SHA data.

For the category HF.2.3 “Enterprise financing schemes”, the data are partially missing since the estimates reported are related only to occupational health outsourced (contracted out to offices of medical specialists), that in National Accounts are included in intermediated consumption. The occupational health care can be also provided in-house but, currently, there are not identified sources to estimate it are not identified. Enterprises can also finance or provide directly health care services as a part of the overall benefits for employees; also in this case, the lack of detailed information in data sources, does not allow an estimate of this kind of services.

The HC and HP compulsory categories are complete.

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.

Not applicable.

Not applicable.

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

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.

Italy, usually delivers tables before or in line with the legal deadline, with exception of 2022, when the transmission was delayed of 4 days.

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).

In general, the SHA data are coherent with National Accounts. The consistency is assured between total expenditure HF.1 “Government schemes and compulsory contributory health care financing schemes” reported in SHA data and total final consumption expenditure by COFOG, division 7 "health", excluded COFOG 7.5 “R&D”.

Out of Pocket expenditure are coherent with household expenditure on health estimated in National Accounts, classified by COICOP. However, conceptual differences exist between COICOP and SHA but sources allow transposing COICOP definitions into SHA framework. In National Accounts, health expenditure financed by insurance is included in household final consumption expenditure, whereas according to SHA it is reclassified from HF.3 to HF.2.1. Moreover, National Accounts refers to the domestic concept whereas SHA refers to the resident concept. This implies that the total amount of expenditure in health goods and services on SHA does not match with National Accounts.

The boundaries, the methodologies, and the purposes of the health care expenditure of SHA and ESSPROS statistics are different; for example, SHA is based on the final consumption, while ESPROSS on the total current expenditure. Istat transmits ESSPROS data on General Government health expenditure accordingly to the definition of the Part 1 chapter 2.2 point 16 and of chapter 2.3.4 point 23 of the ESSPROS Manual 2022, with the consequence that only the public expenditure is considered compliant with the definition provided. Istat compiles the SHA data using different methodologies than ESSPROS.

The item General government total current health expenditure is reconciled across various domains (National Accounts - COFOG, ESSPROS, SHA). These reconciliation tables are for internal analysis and for institutional users.

The internal coherence of SHA data is checked with statistical procedures and assured before the transmission to Eurostat.

For the production of SHA statistics in Istat is involved an average of 0,5 FTE.

There are not available information on costs.

The revision policy is the same applied for the General Government accounts in accordance with European rules concerning EDP statistics (Excessive Deficit Procedure Council Regulation No 479/2009). With the transmission, in the year T+2, of reference year T there could be revisions extend back to year T-2 data.

Revisions are classified as routine or extraordinary.  The data are revised once a year (routine revisions) and are coherent with General Government data (EDP Notification April T+2) and National Accounts data released in March T+2.

Revisions are defined extraordinary when they are triggered by methodological changes in the treatment of basic data, extraordinary changes in the classification and/or definition of variables. The major revisions – usually introduced every five years – affect the whole time series of data, (defined as benchmark estimate).

The data transmitted with JHAQ (2020) in April 2020,  was revised for the period from 2012 to 2018, consistent with the major revision of National Accounts (benchmark 2019) held in September 2019, based on the new European System of Accounts (ESA 2010), exploiting new advances in methods and sources.

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.

Annual.

Data are collected through the joint health accounts questionnaire (JHAQ) that is submitted to Eurostat during the annual data collection exercise. There is a voluntary deadline to send the JHAQ questionnaire for the calendar year T by the 31st of March T+2. The joint health accounts questionnaire (JHAQ) is coordinated in agreement with the World Health Organisation (WHO) and the Organization of Economic Co-operation and Development (OECD). These three international organisations are known collectively as the International Health Accounts Team (IHAT). Data are submitted to Eurostat based on Commission Regulation (EU) 2015/359 of 4 March 2015 implementing Regulation (EC) No 1338/2008 of the European Parliament and of the Council as regards statistics on healthcare expenditure and financing, until reference year 2020. As of reference year 2021 onwards Commission Regulation (EU) 2021/1901 of 29 October 2021 implementing Regulation (EC) No 1338/2008, is in force. 

Most of data used for the compilation of SHA are already collected annually by the Istat Directorate of National Accounts, for the purpose of National Accounts and GFS/EDP compilation. Others come from external bodies and Institutions and the data flows is regulated by negotiating Acts (framework agreements and conventions) established with Istat. There are other information and data flows internal to Istat (with other Directorates) and Service Level Agreements (SLA) regulate relations between the statistical production structures and directions that provide services (data capturing, methodological assistance, IT services, dissemination and communication).

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)

The Italian National Institute of Statistics carries out several in depth controls of the SHA data, before the transmission of JHAQ. Data are compared with information from other independent sources. The consistency between the data, of the year and of previous editions is checked and evaluated. The available time series are analyzed and double-checked, looking for trends and anomalies; finally the adequacy of the estimates is assessed and compared to the definitions of System Health Aaccounts 2011 Manual.

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

No adjustment are performed.

There are no additional comments.