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.
Social Statistics Department, Social Statistics Data Compilation and Analysis Section
1.3. Contact name
Confidential because of GDPR
1.4. Contact person function
Confidential because of GDPR
1.5. Contact mail address
1, Lāčplēša Street
Riga, LV-1301
Latvia
1.6. Contact email address
Confidential because of GDPR
1.7. Contact phone number
Confidential because of GDPR
1.8. Contact fax number
Confidential because of GDPR
2.1. Metadata last certified
24 May 2024
2.2. Metadata last posted
24 May 2024
2.3. Metadata last update
24 May 2024
3.1. Data description
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 Latvia.
3.8. Coverage - Time
SHA 2011 based accounts from 2013.
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: 2013-2022.
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
No press releases at national level have been published.
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.
Ministry of Finance (Long-term care – HC.3 and HCR.1; HF.3);
Diseases Prevention and Control Centre (for national indicator database);
Data users – researchers working on public health and social care; dental care indicators;
Data users: National Accounts Section (for data comparisons).
Data users also use Eurostat database online and request to explain differences between total public expenditure by Government Finance Section of the CSB (according to the ESA 2010) and data collection according to the SHA approach.
12.2. Relevance - User Satisfaction
Not available.
12.3. Completeness
HCxHF
Category does not exist
HF.1.2/1.3 - Government schemes and compulsory contributory health care financing schemes
Missing (data not available)
HF.2.3 - there are cases when enterprises directly finance health services (for instance, occupational health care, preventive exams, check-ups) but it is not possible to separate these expenditures. Enterprises accounting reports also do not allow to distinguish these costs as they are included in the total labour costs. These expenses are included in HC.131 or HC.133 services provided by general practitioners or medical specialists.
Missing (category reported elsewhere):
Disaster and emergency response programmes (HC.6.6) are included into HC.4.3.
Deviation from SHA definition:
HC.3 and HCR.1A - splitting between ADL, IADL and "outside of LTC-health".
HPxHF
Deviation from SHA definition:
Residential long-term care facilities (HP.2). The division between subcategories HP.2 is incomplete.
Missing (data not available):
There are some electronic shopping and mail-order enterprises in Latvia. However, there is no key to calculating what part to take for medical goods.
13.1. Accuracy - overall
The sources to compile the data on health care expenditure are mainly administrative and register-based data, only a small percentage of the figures come from surveys or other means. Accordingly, for the health care expenditure data collection, accuracy deals with problems of coverage as the main possible source of errors.
13.2. Sampling error
Not applicable.
13.3. Non-sampling error
In 2019 the Diseases Prevention and Control Centre carried out survey asking health care providers to fill in questionnaire about services provided for non-residents. From 2020 national SHA data do not included non-resident expenditure.
Latvia is not able to report informal health care goods and services in the data collection.
Private expenditure will be improved, deducting from HF.3, the eligible expenses reimbursed by the state, that is, types of expenditures - planned operations and dentistry expenses, or other expenditure on health - are deducted from taxable incomes when the annual tax declaration is submitted. Accordingly, to the Law On Personal Income Tax, in a year a person receives back 23 % of expenses for medical services.
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
LV provides data accordingly to Commission Regulation (EU) 2021/1901 by 30 April T+2.
15.1. Comparability - geographical
Not applicable.
15.2. Comparability - over time
Data according to the SHA 2011 methodology is comparable over the time with no break in time from 2013.
15.3. Coherence - cross domain
Comparison of SHA and ESSPROS data collection approaches was carried out in 2015 in the frame work of Grant project "Health Accounts (SHA 2011)". SHA and ESSPROS data are compared annually to the extent possible, mainly between ESSPROS sickness/ health care scheme and SHA. In collecting information, we use the same data sources - the National Health Services data (health data) and statistics from the Ministry of Welfare (social LTC statistics, home care, etc.).
1.5 months for the National Health Service (NHS) for data collection and processing. NHS worked out a specification of IT solutions for adaptation of ICHA-HC and ICHA-HP for data menagement systems in order to do automatic data processing in accordance with SHA 2011 methodology.
17.1. Data revision - policy
The revision of SHA tables occurs when the methodology is being changed.
17.2. Data revision - practice
The revision of the prepared and published data is mainly carried out after unplanned data revisions, that is, when errors are discovered in the calculations of individual data sets, in case of changes in data sources, or upon receiving additional or clarified information from the participating institutions (NHS, Ministry of Welfare, etc.) or other administrative data sources used in the data collection process.
18.1. Source data
Surveys/censuses
Source name
Brief description of source (e.g. coverage, reference year, etc)
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)
Latvian State Agency Of Medicine
Summary on operation of pharmacies, medicine wholesales enterprises and medicines production enterprises. Coverage is approximately 96% from all registered pharmacies.
HF.3, HC.5 and HP.5.1
2004-2023
3 months
Annual
Ministry of Welfare
Report "Survey of the long-care social care and social rehabilitation services, Report "Survey of social services and social assistance in rural municipalities/cities"
HF.2.1, all HC. (except HC.3; HC.5.1.2, HC.5.1.3, HC.5.2, HC.6, HC.7)
2015-2023
Annual
Data provided by CSB National Accounts Section experts
Centre for Disease Prevention and Control
Statistical reports
For calculations of share of the medical personnel for HP.8.2 (schools, prison health care service, military units, etc.), This agency also prepares a list of HP (facilities, doctor's practices, etc.) that may engage in health care by providing services.
Expenditures of non-residents in Latvia for healthcare services (from 2021).
2004-2023
9 months
Non-monetary indicators are used for calculations (number of physicians, nurses, visits, consultations, ambulatory services, etc.).
The list of providers is used as a basis for data collection from service provider side, as well as for data matching at the enterprise level with CSB and NHS data.
Public administrative records
Source name
Brief description of source (e.g. coverage, reference year, etc)
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)
The Management Information System database of the National Health Service
MIS contains information on persons, medical persons and medical information. Data are received from the Population Register, the Information system of the State Agency of Medicines, from the Registry of Medical Institutions and the Register of Medical Persons and Medical Support Persons.
HF.1.1 (financing all HC (except HC.4.3, HC.5.1.2; HC.7.1) provided by all HP (except HP.4.1; HP.5.2; HP.5.9; HP.7.2; HP.7.3) or health providers that have contractual relations with NHS
2004-2023
3 months
Annual
This is the main data source for public financing (HF.11).
Financial reports
Source name
Brief description of source (e.g. coverage, reference year, etc)
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)
Report on the performance of the central government budget and local government budgets, the Ministry of Finance. Information on budgets from different ministries is used including the Ministry of Health, the Ministry of Education and Science, the Ministry of Welfare, the Ministry of Interior, the Ministry of Defence, the Ministry of Justice.
Annual report
Data source is used for single entry in order to fill-in data on HC and HP.
2004-2023
6-7 months
Annual
Single records are applied to characterized budgetary institutions or programmes.
Integrated Statistical Data Management System (ISDMS), the Central Statistical Bureau of Latvia
Annual reports: - on expenditure of budgetary institutions and information from statistical surveys on the activity of central and local government-controlled enterprises; - statistical survey on merchants`(commercial companies) activities including detailed information on the financial assets and liabilities;
- Statistical Business register - Statistical Business register includes also all natural persons (sole proprietors) without threshold by size, legal form or activity class who are registered in the State Revenue Taxpayer's Register. Legal form of sole proprietorship is enterprise owned exclusively by one natural person.
HF.1, HF.2, HF.3, all HC and all HP (except HP.5.1) where it is relevant
2004-2023
10 months
Annual
The State Revenue Service
Review of Income Declarations of Physical Persons
HF.3, HC.1.3; HC.1.4, HC.2.3, HC.2.4/HP.3
2018-2023
Annual
Data are used for calculation eligible expenses.
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 to perform various quality checks before submitting the data.
1- Consistency of the data between tables.
May be some minor inconsistencies due to rounding.
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,
There are no negative entries in the data tables.
The presence of atypical entries
There are no atypical entries in the data tables.
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
Several methods are normally used for estimations:
Balancing item/Residual method: For example, if data are available from the financing side, which permit accurate estimation of the flows to a provider or function, then an acceptable estimation method is to subtract these expenditure flows from the total revenues, and derive the expenditure flows from the unmeasured financing scheme as a residual.
Pro-rating/Utilisation key: Typically in the absence of direct spending data, a utilisation key linked to the proportion of resources used can be constructed in order to distribute e.g. aggregate provider spending across functions. For every key a fraction of total utilisation within the cost-unit is assigned: fractions in the key must add up to 100% of all care delivered by the cost-unit. Examples of utilisation keys are admissions, bed-days, contacts, staffing, etc.
Interpolation/Extrapolation: In the absence of data for the period in question, missing values can be estimated using known data points.
Or other
SHA variable(s)
Main method
Brief description of methodology
HF.3.1 and HF.3.2/HP.1x HP.1; HP.3-4
Balancing item/Residual method
Splitting HF.3 into HC.1.1/HC.1.2/HC.1.3 in hospitals is done using the share and estimates from the National Health Service data
HF.3.1 and HF.3.2/HP.3/HC
Balancing item/Residual method
Out-of-pocket spending is calculated by subtracting all HF.11 from total receipts of enterprises and using the main activity of the enterprises. In cases where the company has indicated a specific activity, such as surgery or day hospital, or it has scored two activities, distribution by function HC it is made.
HF.1 and HF.3/HC.31/HP.2; HP.82; HP.89
Balancing item/Residual method
Total budgetary information on LTC facilities (HP21; HP.22 and HP.29) providing inpatient LTC (HC31) is based on statistics from the Ministry of Welfare. The separation of the long- term care (health) and LTC (social) is performed after that by using different approaches: 1. For HP.21 the main problem is that there is no clear definition for such provider in the national health system; all expenditure are using as "health component"; 2. HP.22 provided services are included as fully referring to health, 3. HP.82 provided services are included partly into HC.31. Since 2020 it is possible to use the distribution of the level of personal care.
HF.1xHC.32 and HC.34
Balancing item/Residual method
Concerning LTC we tried to allocate the services HC.32 and HC.34 services for people with disabilities (mental and functional) from total LTC services and we considered that all such services as HC3; for instance, we included day care services for dependent people. Data available only from financing and provider side. The other services are included in HCR.1.
HF2.1xHCxHP
Utilisation key
Information on HF.21 is received from the National Accounts Department in the form of a summary. The further division between HC and HP is carried out using the opinion of an insurance expert.
HF.3xHP.51XHC.51
Utilisation key
Data from the Latvian State Agency Of Medicine is received on operation of pharmaciesis received as summary. The further splitting among HC categories is carried out using the expert opinion and previous distribution by products when detailed information was available.
18.6. Adjustment
Not applicable.
No further comments.
Health care expenditure quantifies the economic resources dedicated to health functions, excluding capital investment. Healthcare expenditure concerns itself primarily with healthcare goods and services that are consumed by resident units, irrespective of where that consumption takes place (it may be in the rest of the world) or who is paying for it. As such, exports of healthcare goods and services (to non-resident units) are excluded, whereas imports of healthcare goods and services for final use are included. Health care expenditure data provide information on expenditure in the functionally defined area of health distinct by provider category (e.g. hospitals, general practitioners), function category (e.g. services of curative care, rehabilitative care, clinical laboratory, patient transport, prescribed medicines) and financing scheme (e.g. social security, private insurance company, household). For the collection of the data on health care expenditure the System of Health Accounts (SHA) and its related set of International Classification for the Health Accounts (ICHA) is used. SHA sets out an integrated system of comprehensive and internationally comparable accounts and provides a uniform framework of basic accounting rules and a set of standard tables for reporting health expenditure data. The System of Health Accounts - SHA 2011 is a statistical reference manual giving a comprehensive description of the financial flows in health care.
It provides a set of revised classifications of health care functions, providers of health care goods and services and financing schemes. The SHA is currently used as a basis for a joint data collection by OECD, Eurostat and WHO on health care expenditure. The manual sets out in more detail the boundaries, the definitions and the concepts of health accounting – responding to health care systems around the globe with very different organisational and financing arrangements.
Accounting period: Health expenditure and financing data pertain to the calendar year (1 January to 31 December).
24 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 Latvia.
Health care expenditure data are annual data, corresponding to the calendar year.
This quality report covers the following reference years: 2013-2022.
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).
Several methods are normally used for estimations:
Balancing item/Residual method: For example, if data are available from the financing side, which permit accurate estimation of the flows to a provider or function, then an acceptable estimation method is to subtract these expenditure flows from the total revenues, and derive the expenditure flows from the unmeasured financing scheme as a residual.
Pro-rating/Utilisation key: Typically in the absence of direct spending data, a utilisation key linked to the proportion of resources used can be constructed in order to distribute e.g. aggregate provider spending across functions. For every key a fraction of total utilisation within the cost-unit is assigned: fractions in the key must add up to 100% of all care delivered by the cost-unit. Examples of utilisation keys are admissions, bed-days, contacts, staffing, etc.
Interpolation/Extrapolation: In the absence of data for the period in question, missing values can be estimated using known data points.
Or other
SHA variable(s)
Main method
Brief description of methodology
HF.3.1 and HF.3.2/HP.1x HP.1; HP.3-4
Balancing item/Residual method
Splitting HF.3 into HC.1.1/HC.1.2/HC.1.3 in hospitals is done using the share and estimates from the National Health Service data
HF.3.1 and HF.3.2/HP.3/HC
Balancing item/Residual method
Out-of-pocket spending is calculated by subtracting all HF.11 from total receipts of enterprises and using the main activity of the enterprises. In cases where the company has indicated a specific activity, such as surgery or day hospital, or it has scored two activities, distribution by function HC it is made.
HF.1 and HF.3/HC.31/HP.2; HP.82; HP.89
Balancing item/Residual method
Total budgetary information on LTC facilities (HP21; HP.22 and HP.29) providing inpatient LTC (HC31) is based on statistics from the Ministry of Welfare. The separation of the long- term care (health) and LTC (social) is performed after that by using different approaches: 1. For HP.21 the main problem is that there is no clear definition for such provider in the national health system; all expenditure are using as "health component"; 2. HP.22 provided services are included as fully referring to health, 3. HP.82 provided services are included partly into HC.31. Since 2020 it is possible to use the distribution of the level of personal care.
HF.1xHC.32 and HC.34
Balancing item/Residual method
Concerning LTC we tried to allocate the services HC.32 and HC.34 services for people with disabilities (mental and functional) from total LTC services and we considered that all such services as HC3; for instance, we included day care services for dependent people. Data available only from financing and provider side. The other services are included in HCR.1.
HF2.1xHCxHP
Utilisation key
Information on HF.21 is received from the National Accounts Department in the form of a summary. The further division between HC and HP is carried out using the opinion of an insurance expert.
HF.3xHP.51XHC.51
Utilisation key
Data from the Latvian State Agency Of Medicine is received on operation of pharmaciesis received as summary. The further splitting among HC categories is carried out using the expert opinion and previous distribution by products when detailed information was available.
Surveys/censuses
Source name
Brief description of source (e.g. coverage, reference year, etc)
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)
Latvian State Agency Of Medicine
Summary on operation of pharmacies, medicine wholesales enterprises and medicines production enterprises. Coverage is approximately 96% from all registered pharmacies.
HF.3, HC.5 and HP.5.1
2004-2023
3 months
Annual
Ministry of Welfare
Report "Survey of the long-care social care and social rehabilitation services, Report "Survey of social services and social assistance in rural municipalities/cities"
HF.2.1, all HC. (except HC.3; HC.5.1.2, HC.5.1.3, HC.5.2, HC.6, HC.7)
2015-2023
Annual
Data provided by CSB National Accounts Section experts
Centre for Disease Prevention and Control
Statistical reports
For calculations of share of the medical personnel for HP.8.2 (schools, prison health care service, military units, etc.), This agency also prepares a list of HP (facilities, doctor's practices, etc.) that may engage in health care by providing services.
Expenditures of non-residents in Latvia for healthcare services (from 2021).
2004-2023
9 months
Non-monetary indicators are used for calculations (number of physicians, nurses, visits, consultations, ambulatory services, etc.).
The list of providers is used as a basis for data collection from service provider side, as well as for data matching at the enterprise level with CSB and NHS data.
Public administrative records
Source name
Brief description of source (e.g. coverage, reference year, etc)
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)
The Management Information System database of the National Health Service
MIS contains information on persons, medical persons and medical information. Data are received from the Population Register, the Information system of the State Agency of Medicines, from the Registry of Medical Institutions and the Register of Medical Persons and Medical Support Persons.
HF.1.1 (financing all HC (except HC.4.3, HC.5.1.2; HC.7.1) provided by all HP (except HP.4.1; HP.5.2; HP.5.9; HP.7.2; HP.7.3) or health providers that have contractual relations with NHS
2004-2023
3 months
Annual
This is the main data source for public financing (HF.11).
Financial reports
Source name
Brief description of source (e.g. coverage, reference year, etc)
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)
Report on the performance of the central government budget and local government budgets, the Ministry of Finance. Information on budgets from different ministries is used including the Ministry of Health, the Ministry of Education and Science, the Ministry of Welfare, the Ministry of Interior, the Ministry of Defence, the Ministry of Justice.
Annual report
Data source is used for single entry in order to fill-in data on HC and HP.
2004-2023
6-7 months
Annual
Single records are applied to characterized budgetary institutions or programmes.
Integrated Statistical Data Management System (ISDMS), the Central Statistical Bureau of Latvia
Annual reports: - on expenditure of budgetary institutions and information from statistical surveys on the activity of central and local government-controlled enterprises; - statistical survey on merchants`(commercial companies) activities including detailed information on the financial assets and liabilities;
- Statistical Business register - Statistical Business register includes also all natural persons (sole proprietors) without threshold by size, legal form or activity class who are registered in the State Revenue Taxpayer's Register. Legal form of sole proprietorship is enterprise owned exclusively by one natural person.
HF.1, HF.2, HF.3, all HC and all HP (except HP.5.1) where it is relevant
2004-2023
10 months
Annual
The State Revenue Service
Review of Income Declarations of Physical Persons
HF.3, HC.1.3; HC.1.4, HC.2.3, HC.2.4/HP.3
2018-2023
Annual
Data are used for calculation eligible expenses.
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.
Data according to the SHA 2011 methodology is comparable over the time with no break in time from 2013.
