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 Luxembourg
3.8. Coverage - Time
Health care revenues and health care expenditure from 2011
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: 2018-2022.
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.
Annual
10.1. Dissemination format - News release
SHA data are not disseminated on national level.
10.2. Dissemination format - Publications
SHA data are not disseminated on national level.
10.3. Dissemination format - online database
SHA data are not disseminated on national level.
10.4. Dissemination format - microdata access
SHA data are not disseminated on national level.
10.5. Dissemination format - other
SHA data are not disseminated on national level.
10.6. Documentation on methodology
SHA data and documentation are not disseminated on national level.
10.7. Quality management - documentation
SHA data are not disseminated on national level.
11.1. Quality assurance
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
Goverment accounts are classified based on budgetary article label. This may lead to overestimation or underestimation of some items. Subsidies or programs on local level are excluded.
Out-of-pocket payments for glasses are only partly included and thus do not perfectly reflect private consumption patterns. It is not always evident to include/exclude consumption of residents abroad and consumption of non-residents in Luxembourg, as Luxembourg is faced with a lot of cross-border activity.
12.1. Relevance - User Needs
The main users of health care expenditure data are policy makers, research institutes, media, and students.barely used at national level.
SHA data are barely used at national level.
12.2. Relevance - User Satisfaction
Not applicable.
12.3. Completeness
ICHA- Code
Description
Please indicate any deviations from SHA definitions or missing data and explain
Explanations
HF.2.3
Enterprise financing schemes
Missing (category reported elsewhere)
(Big) Employers are allowed to organize and finance the legally foreseen occupational health schemes (Santé au travail) by themselves, and are in such case not obliged to join a social security-type mutual occupational health scheme. Currently 4 such cases exist. As the amount is difficult to split, the total amount of occupational health expenditure is reported under HF.1.2.1
HC.1.3.9
All other outpatient curative care
Missing (category reported elsewhere)
reported under other HC1 categories.
HC.2.2
Day rehabilitative care
Missing (category reported elsewhere)
reported under other HC1/HC2 categories.
HC.2.4
Home-based rehabilitative care
Missing (category reported elsewhere)
reported under other HC1/HC2 categories.
HC.3.3
Outpatient long-term care (health)
Missing (category reported elsewhere)
reported under other HC1/HC3 categories.
HC.6.4
Healthy condition monitoring programmes
Partially missing (data is partially not available)
Data on services financed and organised at local level is not available
HC.6.6
Preparing for disaster and emergency response programmes
Missing (category reported elsewhere)
reported under other HC6/HC7 categories.
HC.RI.2
Traditional, Complementary and Alternative Medicines (TCAM)
Missing (data not available)
HCR.2
Health promotion with multisectoral approach
Missing (data not available)
HP.2.2
Mental health and substance abuse facilities
Missing (category reported elsewhere)
reported under other HP2/HP1 categories.
HP.2.9
Other residential long-term care facilities
Missing (category reported elsewhere)
reported under other HP2/HP1 categories.
HP.4.9
Other providers of ancillary services
Missing (category reported elsewhere)
reported under other HP4 categories.
HP.5.9
All other miscellaneous sellers and other suppliers of pharmaceuticals and medical goods
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
not applicable
13.3. Non-sampling error
not applicable
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
SHA exercise
Delivery deadline
Delivery date
time lag
JHAQ21
30 April 21
30 April 21
0 days
JHAQ22
30 April 22
13 May 22
13 days
JHAQ23 (including t-1)
30 April 23
02 May 23
2 days
JHAQ24 (including t-1)
30 April 24
30 April 24
0 days
15.1. Comparability - geographical
Not applicable at national level.
15.2. Comparability - over time
Breaks in series
Year
SHA exercice
Selected items
Breaks
2019
JHAQ2020
Selected items
Selected updates (see below)
2013
JHAQ2019
All items
Revision for the years 2013-2017. Major revision of internal methodology
2011
All items
Switch from SHA 1.0 to SHA 2011
2000
All items
Start of SHA-based reporting
JHAQ22 revision - break in series for 2019
Year (SHA exercice)
Selected items
Updates
2019 (JHAQ 2022)
HC.RI.1 TPE
The memorandum item : total pharmaceutical expenditure is prepared for the first time for the JHAQ2022, retroactively since 2019. All other items (i.e the core CHE) of JHAQ2021 for 2019 remain unchanged
2019 (JHAQ 2022)
HC1 and HC2
Reallocation of rehabilitative care items formerly classified under curative care (HC1). No impact on the total CHE amount.
2019 (JHAQ 2022)
HF3
Revision of the estimation of Healthcare OOP payments (excluding OTC drugs and LTC), allowing a split between HF3.1 and HF3.2.(formerly the whole amount was allocated to HF3.2). Furthermore a double counting in JHAQ20 methodology has been redressed as of 2019. Modest impact on the total CHE amount.
2019 (JHAQ 2022)
HC3 + HCR
A more precise allocation of LTC insurance benefits to either LTC health or LTC social is possible as of 2019 based on the improved data quality after the LTC insurance reform in 2018, Minor impact on the total CHE amount (due to new split HC3/HCR)
2019 (JHAQ 2022)
HC6 * HF1
Improving completeness of data on "school doctor programs" . Very minor impact on the total CHE amount (+/- 4mioEUR)
15.3. Coherence - cross domain
National accounts are compiled using different methods, and cannot be mapped.
ESSPROS is compiled usig different methods and cannot be mapped.
15.4. Coherence - internal
Internal chacks included in the questionnaires (internal consitency of tables, atypical entries,..)
Cost estimation is not possible
17.1. Data revision - policy
Unless major data or methodolgical issues detected, revision of previous years data is not foreseen.
17.2. Data revision - practice
SHA exercise
Data revision
JHAQ24
Minor revision of Y2021 figures Compared to the 2023_JHAQ_version, recent new more detailed data allowed a more precise classification of Covid-related expenditure (HF.1.1.0), both whitin the "standard" CHE- and the HC.COV-categories. An amount of approx 104mEUR is concerned by this revision. The total amount of CHE is not impacted.
JHAQ23
As a result of the validation process, an updated version for the year 2020 has been uploaded on 26 June 2023 The update consists in including an item omitted in last years JHAQ :-> HC513xHF11XHP52 of +/- 16mNCU
JHAQ22
n/a
JHAQ21
n/a
18.1. Source data
I.1. Administrative and statistical data sources
Source name
Brief description of source (e.g. coverage, reference year, etc)
Type of data source
Primary SHA variable(s) using this data source
Time period covered by this data source
Timeliness (Number of months after the end of the accounting period)
Frequency (e.g monthly, quarterly, annual, irregular)
Processing (e.g. brief description of any adjustments, correction or distribution applied to the original data sources)
Example: Statistics of National Health Insurance
Annual records on activity and spending financed by NHI; coverage 100% of all activity of NHI
Public administrative records
HF.1.2 (financing all HC (except HC.3 and HC.1.3.2) provided by all HP (except HP.2 and HP.3.2))
2003-2013
11 months
Annual
Contains 80 SHA-relevant spending items; 60 can be attributed to a single HC and single HP; other 20 items are distributed to more than one HC and/or HP using distribution keys
1.1 Financial statements + additional data on benefits delivered by accounting departments of the social security funds
Benefits in kind per category (ex: medical consultation, dentist consultation, ...).available as per date of payment/reimbursement (accounting date) and per date of benefit, including provisions. (For AAA, only date of payment is available).
financial statements + supplementary tables
HF.1.2.1, HC: All; HP: All
2012-2018
6-8 months
Annual
Elimination of benefits out of scope of SHA (cash benefits, rents,..). Consumption by non-residents is eliminated using prorata per category deducted from social security data files (+/- 2% of benefits in LUX).
1.1 Financial statements + additional data on benefits delivered by accounting departments of the social security funds
Percentage rate, per category, of patient's out-of-pocket participation (statutory participation+ supplementary participation "personal convenience"). Rates observed/estimated by social security funds and included in financial statements
Financial reports
HF.3.2, HC: All; HP: All
2012-2018
6-8 months
Annual
Calculation of "gross" out-of-pocket participation using given percentage rates. Validity check using social security data files (1.2)
1.2 Social security data files
Database of social security contains information on healthcare benefits at individual level. Only "reimbursed" benefits included (no provisions).
public administrative records
HF.1.2.1, HC: All; HP: All
2012-2018
at least 12 months. To be considered as "provisional data " for at least 24 months
continuous
Pro-rata calculation in case the detail of the financial statements information (1.1) is insufficient for the requested 2.or 3-digit HC and HP classification.
1.3 Financial statements of social security funds
Financial statements of social security funds used for non-benefit details (ex: administrative costs) and FS classification
Balance sheet, Income statement
HF1.2.1; HP7, HC7, FS:1;3&6
2012-2018
6-8 months
Annual
Elimination of "non Sha related" administrative costs (sickness benefit (cash benefits), rents (AAA),…) (prorata if necessary). Proratisation of revenu categories for FS-classification
2.1 General account of State / State budget
"Financial statement" of general administration expenditure, detailed by budget item
Law
HF.1.1; HF.2.2
2012-2018
+/- 7 months (draft law); +/- 12 months (law)
Annual
Data mainly used for HC7 categories (Governance and Administration of healthcare system); preventive care programms, occupational healthcare for public servants and HC benefits in kind (partially/fully) taken in charge by State (social assistance, prisons, ...). Data also used to estimate preventive care programms by NPISH providers that are mainly financed by state subsidies. Data also used to doublecheck transfers to social security and other schemes.
2.2 Financial statements + Administrative data on National solidarity funds (FNS)
Detailed data on benefit "accueil gérontologique". For people with insufficient ressources, FNS (partially) takes in charge "room and board" in nursing homes (residential LTC facilities) and CIPAs (assisted living facilities).
financial statements + public administrative records
HF1.1 / HC3 and HCR.1
2012-2018
6-8 months
Annual
Data also used to estimate room and board expenditure in LTC facilities.
2.3 Financial statements / Activity reports of several non-profit organisiations
financial statements
HF.2.2
2012-2018
3. Statistical office - turnover of pharmacies (estimation)
For national account compilation (final consumption of households), the national statistical office (Statec), uses (among others) data from tax administration to estimate turnover/sales of pharmacies (detailed by VAT rate)
Other
HC.5.1.2 OTC medecines
2012-2016
at least 12 months
irregular
The part of pharmacy-turnover subject to the reduced VAT rate of 3% (applicable to pharmaceuticals) is used as a proxy (see II.5). The total amount of prescribed pharmaceuticals (part paid/reimbursesd by social security (or other mandatory) schemes + statutory participation of patients) is deducted from this turnover in order to estimate the OTC medicine expenditure.
4.1 Financial statements and data on benefits from CMCM (Caisse médico-complémentaire mutualiste)
Financial statements and detailed data (individual level) of services and goods reimbursed by CMCM
financial statements + supplementary tables
HF.2.1, HC: All; HP: All
2012-2018
6-12 months
Annual
Reimbursements from CMCM and private supplementary insurance schemes are deducted from the "gross" out of pocket participation (see 1.1) in order to estimate "net" cost sharing with third party payers
4.2 Other supplementary schemes - Insurance companies - Activity report of Commissariat aux assurance (CAA = Administration supervising the insurance sector)
CAA gives the overal amount of healthcare benefits in kind reimbursed by insurance companies on supplementary healthcare insurance contracts by residents.
Public administrative records
HF.2.1, HC: All; HP: All
2012-2018
6-8 months
Annual
Reimbursements from CMCM and private supplementary insurance schemes are deducted from the "gross" out of pocket participation (see 1.1) in order to estimate "net" cost sharing with third party payers
4.3 Other supplementary schemes - Insurance companies - Questionnaire
IGSS questionnaire to major insurance companies asking for more details on above-mentioned reimbursements
Surveys/censuses
HF.2.1, HC: All; HP: All
2014-2017/2018
6-12 months
Irregular
Data used to classify the "CAA amount (4.2.)". Detailed (2- and 3.digit) classification based on prorata of social security funds (1.2).
5. Healthcare schemes for international bodies - Data on benefits received from RCAM (scheme for EU-officials)
Aggregated data of Healthcare services reimbursed by RCAM in Luxembourg (by categorie of service)
Aggregated data
HF4 ; HC: All; HP: All
2012-2018
6-12 months
Annual
Detailed (2- and 3.digit) classification based on prorata of social security funds (4.2).
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 variable(s)
Main method
Brief description of methodology
HF.4
Pro-rating/Utilisation key
Pro-rating of RCAM data using health care data of the national health insurance as key
HF.2.1
Pro-rating/Utilisation key
Pro-rating of CMCM and Insurance company data using health care data of the national health insurance as key
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).
30 April 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 Luxembourg
Health care expenditure data are annual data, corresponding to the calendar year.
This quality report covers the following reference years: 2018-2022.
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 variable(s)
Main method
Brief description of methodology
HF.4
Pro-rating/Utilisation key
Pro-rating of RCAM data using health care data of the national health insurance as key
HF.2.1
Pro-rating/Utilisation key
Pro-rating of CMCM and Insurance company data using health care data of the national health insurance as key
Brief description of source (e.g. coverage, reference year, etc)
Type of data source
Primary SHA variable(s) using this data source
Time period covered by this data source
Timeliness (Number of months after the end of the accounting period)
Frequency (e.g monthly, quarterly, annual, irregular)
Processing (e.g. brief description of any adjustments, correction or distribution applied to the original data sources)
Example: Statistics of National Health Insurance
Annual records on activity and spending financed by NHI; coverage 100% of all activity of NHI
Public administrative records
HF.1.2 (financing all HC (except HC.3 and HC.1.3.2) provided by all HP (except HP.2 and HP.3.2))
2003-2013
11 months
Annual
Contains 80 SHA-relevant spending items; 60 can be attributed to a single HC and single HP; other 20 items are distributed to more than one HC and/or HP using distribution keys
1.1 Financial statements + additional data on benefits delivered by accounting departments of the social security funds
Benefits in kind per category (ex: medical consultation, dentist consultation, ...).available as per date of payment/reimbursement (accounting date) and per date of benefit, including provisions. (For AAA, only date of payment is available).
financial statements + supplementary tables
HF.1.2.1, HC: All; HP: All
2012-2018
6-8 months
Annual
Elimination of benefits out of scope of SHA (cash benefits, rents,..). Consumption by non-residents is eliminated using prorata per category deducted from social security data files (+/- 2% of benefits in LUX).
1.1 Financial statements + additional data on benefits delivered by accounting departments of the social security funds
Percentage rate, per category, of patient's out-of-pocket participation (statutory participation+ supplementary participation "personal convenience"). Rates observed/estimated by social security funds and included in financial statements
Financial reports
HF.3.2, HC: All; HP: All
2012-2018
6-8 months
Annual
Calculation of "gross" out-of-pocket participation using given percentage rates. Validity check using social security data files (1.2)
1.2 Social security data files
Database of social security contains information on healthcare benefits at individual level. Only "reimbursed" benefits included (no provisions).
public administrative records
HF.1.2.1, HC: All; HP: All
2012-2018
at least 12 months. To be considered as "provisional data " for at least 24 months
continuous
Pro-rata calculation in case the detail of the financial statements information (1.1) is insufficient for the requested 2.or 3-digit HC and HP classification.
1.3 Financial statements of social security funds
Financial statements of social security funds used for non-benefit details (ex: administrative costs) and FS classification
Balance sheet, Income statement
HF1.2.1; HP7, HC7, FS:1;3&6
2012-2018
6-8 months
Annual
Elimination of "non Sha related" administrative costs (sickness benefit (cash benefits), rents (AAA),…) (prorata if necessary). Proratisation of revenu categories for FS-classification
2.1 General account of State / State budget
"Financial statement" of general administration expenditure, detailed by budget item
Law
HF.1.1; HF.2.2
2012-2018
+/- 7 months (draft law); +/- 12 months (law)
Annual
Data mainly used for HC7 categories (Governance and Administration of healthcare system); preventive care programms, occupational healthcare for public servants and HC benefits in kind (partially/fully) taken in charge by State (social assistance, prisons, ...). Data also used to estimate preventive care programms by NPISH providers that are mainly financed by state subsidies. Data also used to doublecheck transfers to social security and other schemes.
2.2 Financial statements + Administrative data on National solidarity funds (FNS)
Detailed data on benefit "accueil gérontologique". For people with insufficient ressources, FNS (partially) takes in charge "room and board" in nursing homes (residential LTC facilities) and CIPAs (assisted living facilities).
financial statements + public administrative records
HF1.1 / HC3 and HCR.1
2012-2018
6-8 months
Annual
Data also used to estimate room and board expenditure in LTC facilities.
2.3 Financial statements / Activity reports of several non-profit organisiations
financial statements
HF.2.2
2012-2018
3. Statistical office - turnover of pharmacies (estimation)
For national account compilation (final consumption of households), the national statistical office (Statec), uses (among others) data from tax administration to estimate turnover/sales of pharmacies (detailed by VAT rate)
Other
HC.5.1.2 OTC medecines
2012-2016
at least 12 months
irregular
The part of pharmacy-turnover subject to the reduced VAT rate of 3% (applicable to pharmaceuticals) is used as a proxy (see II.5). The total amount of prescribed pharmaceuticals (part paid/reimbursesd by social security (or other mandatory) schemes + statutory participation of patients) is deducted from this turnover in order to estimate the OTC medicine expenditure.
4.1 Financial statements and data on benefits from CMCM (Caisse médico-complémentaire mutualiste)
Financial statements and detailed data (individual level) of services and goods reimbursed by CMCM
financial statements + supplementary tables
HF.2.1, HC: All; HP: All
2012-2018
6-12 months
Annual
Reimbursements from CMCM and private supplementary insurance schemes are deducted from the "gross" out of pocket participation (see 1.1) in order to estimate "net" cost sharing with third party payers
4.2 Other supplementary schemes - Insurance companies - Activity report of Commissariat aux assurance (CAA = Administration supervising the insurance sector)
CAA gives the overal amount of healthcare benefits in kind reimbursed by insurance companies on supplementary healthcare insurance contracts by residents.
Public administrative records
HF.2.1, HC: All; HP: All
2012-2018
6-8 months
Annual
Reimbursements from CMCM and private supplementary insurance schemes are deducted from the "gross" out of pocket participation (see 1.1) in order to estimate "net" cost sharing with third party payers
4.3 Other supplementary schemes - Insurance companies - Questionnaire
IGSS questionnaire to major insurance companies asking for more details on above-mentioned reimbursements
Surveys/censuses
HF.2.1, HC: All; HP: All
2014-2017/2018
6-12 months
Irregular
Data used to classify the "CAA amount (4.2.)". Detailed (2- and 3.digit) classification based on prorata of social security funds (1.2).
5. Healthcare schemes for international bodies - Data on benefits received from RCAM (scheme for EU-officials)
Aggregated data of Healthcare services reimbursed by RCAM in Luxembourg (by categorie of service)
Aggregated data
HF4 ; HC: All; HP: All
2012-2018
6-12 months
Annual
Detailed (2- and 3.digit) classification based on prorata of social security funds (4.2).
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 at national level.
Breaks in series
Year
SHA exercice
Selected items
Breaks
2019
JHAQ2020
Selected items
Selected updates (see below)
2013
JHAQ2019
All items
Revision for the years 2013-2017. Major revision of internal methodology
2011
All items
Switch from SHA 1.0 to SHA 2011
2000
All items
Start of SHA-based reporting
JHAQ22 revision - break in series for 2019
Year (SHA exercice)
Selected items
Updates
2019 (JHAQ 2022)
HC.RI.1 TPE
The memorandum item : total pharmaceutical expenditure is prepared for the first time for the JHAQ2022, retroactively since 2019. All other items (i.e the core CHE) of JHAQ2021 for 2019 remain unchanged
2019 (JHAQ 2022)
HC1 and HC2
Reallocation of rehabilitative care items formerly classified under curative care (HC1). No impact on the total CHE amount.
2019 (JHAQ 2022)
HF3
Revision of the estimation of Healthcare OOP payments (excluding OTC drugs and LTC), allowing a split between HF3.1 and HF3.2.(formerly the whole amount was allocated to HF3.2). Furthermore a double counting in JHAQ20 methodology has been redressed as of 2019. Modest impact on the total CHE amount.
2019 (JHAQ 2022)
HC3 + HCR
A more precise allocation of LTC insurance benefits to either LTC health or LTC social is possible as of 2019 based on the improved data quality after the LTC insurance reform in 2018, Minor impact on the total CHE amount (due to new split HC3/HCR)
2019 (JHAQ 2022)
HC6 * HF1
Improving completeness of data on "school doctor programs" . Very minor impact on the total CHE amount (+/- 4mioEUR)
