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 Surveys and Labour Market Department – Health Statistics Division
1.3. Contact name
Confidential because of GDPR
1.4. Contact person function
Confidential because of GDPR
1.5. Contact mail address
Niepodległości 208 Av. 00-925 Warsaw, Poland
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
31 May 2024
2.2. Metadata last posted
31 May 2024
2.3. Metadata last update
31 May 2024
3.1. Data description
Health care expenditure quantifies the economic resources dedicated to health functions, excluding capital investment. Health care expenditure concerns itself primarily with health care 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 health care goods and services (to non-resident units) are excluded, whereas imports of health care 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), financing scheme (e.g. social security, private insurance company, household) and revenues of health care financing schemes (eg. transfers from government domestic revenue, transfers distributed by government from foreign origin, social insurance contributions, compulsory prepayment, voluntary prepayment).
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, financing schemes and revenues of health care 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: calendar year (1 January to 31 December).
3.2. Classification system
Health care expenditure is recorded according to the International Classification for Health Accounts (ICHA) defining:
health care 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;
health care expenditure by function (ICHA-HC) — which details the split in healthcare expenditure following the purpose of health care activities — such as curative care, rehabilitative care, long-term care, or preventive care;
health care expenditure by provider (ICHA-HP) — which classifies units contributing to the provision of health care goods and services — such as hospitals, residential facilities, ambulatory healthcare services, ancillary services, or retailers of medical goods.
revenues of health care financing schemes (ICHA-FS) - which details the sources from which the financing arrangements get their revenues.
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 the intermediate production of enterprises and
Part of the cash transfers to private households for caregivers 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, their providers, and financing. For the collection of 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) and Revenues of health care financing schemes (FS).
Data are presented in 3 summary (one-dimensional) tables and 4 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);
Current revenues of health care financing schemes (ICHA-FS) - additional classification.
Health care functions
Healthcare functions relate to the type of need that current expenditure on healthcare aims to satisfy or the kind of objective pursued. The following main items are defined as:
curative care, which means the healthcare services during which the principal intent is to relieve symptoms or to reduce the severity of an illness or injury, or to protect against its exacerbation or complication that could threaten life or normal function;
rehabilitative care, which means the services to stabilise, improve or restore impaired body functions and structures, compensate for the absence or loss of body functions and structures, improve activities and participation and prevent impairments, medical complications and risks;
inpatient care, which means the treatment and/or care provided in a healthcare facility to patients formally admitted and requiring an overnight stay;
outpatient care, which means the medical and ancillary services delivered in a healthcare facility to a patient who is not formally admitted and does not stay overnight;
day care, which means the planned medical and paramedical services delivered in a healthcare facility to patients who have been formally admitted for diagnosis, treatment or other types of healthcare and are discharged on the same day;
long-term care (health), which means a range of medical and personal care services that are consumed with the primary goal of alleviating pain and suffering and reducing or managing the deterioration in health status in patients with a degree of long-term dependency. Main results and findings from a questionnaire submitted to countries on sources and methodology for long-term care spending can be found as an annex;
home-based care, which means the medical, ancillary and nursing services that are consumed by patients at their home and involve the providers' physical presence;
ancillary services (non-specified by function), which means the healthcare or long-term care related services non-specified by function and non-specified by mode of provision, which the patient consumes directly, in particular during an independent contact with the health system and that are not integral part of a care service package, such as laboratory or imaging services or patient transportation and emergency rescue;
pharmaceuticals and other medical non-durable goods (non-specified by function), which means pharmaceutical products and non-durable medical goods intended for use in the diagnosis, cure, mitigation or treatment of disease, including prescribed medicines and over-the-counter drugs, where the function and mode of provision are not specified;
therapeutic appliances and other medical goods (non-specified by function), which means medical durable goods including orthotic devices that support or correct deformities and/or abnormalities of the human body, orthopaedic appliances, prostheses or artificial extensions that replace a missing body part, and other prosthetic devices including implants which replace or supplement the functionality of a missing biological structure and medico-technical devices, where the function and the mode of provision are not specified;
preventive care, which means any measure that aims to avoid or reduce the number or the severity of injuries and diseases, their sequelae and complications; Preventive care includes interventions for both individual and collective consumption;
governance, and health system and financing administration, which means services that focus on the health system rather than direct healthcare, direct and support health system functioning, and are considered to be collective, as they are not allocated to specific individuals but benefit all health system users.
Finally, current expenditure on health care means the final consumption expenditure of resident units on healthcare goods and services, including the healthcare goods and services provided directly to individual persons as well as collective healthcare services.
Health care financing schemes
‘Health care financing schemes’ means types of financing arrangements through which people obtain health services, including both direct payments by households for services and goods and third-party financing arrangements. The following main items are defined as:
government schemes, which means healthcare financing schemes whose characteristics are determined by law or by the government and where a separate budget is set for the programme and a government unit that has an overall responsibility for it;
compulsory contributory health insurance scheme, which means a financing arrangement to ensure access to healthcare for specific population groups through mandatory participation determined by law or by the government and eligibility based on the payment of health insurance contributions by or on behalf of the individuals concerned;
social health insurance schemes, which means a financing arrangement to ensure access to healthcare for specific population groups through mandatory participation determined by law or by the government, and eligibility based on the payment of health insurance contributions by or on behalf of the individuals concerned;
compulsory private insurance schemes, which means a financing arrangement to ensure access to healthcare for specific population groups through mandatory participation determined by law or by the government and eligibility based upon the purchase of a health insurance policy;
voluntary health insurance schemes, which means schemes based upon the purchase of a health insurance policy, which is not made compulsory by government and where insurance premiums may be directly or indirectly subsidised by the government;
non-profit institutions financing schemes, which means non-compulsory financing arrangements and programmes with non-contributory benefit entitlement that are based on donations from the general public, the government or corporations;
enterprise financing schemes, which means primarily arrangements where enterprises directly provide or finance health services for their employees without the involvement of an insurance-type scheme;
household out-of-pocket payment, which means a direct payment for healthcare goods and services from the household primary income or savings, where the payment is made by the user at the time of the purchase of goods or the use of the services. A report summarising some of the main findings from a supplementary questionnaire on sources and methodology for OOP payments and current practices of OOP reporting in SHA can be found as an annex;
rest of the world financing schemes, which means financial arrangements involving or managed by institutional units that are resident abroad, but who collect, pool resources and purchase healthcare goods and services on behalf of residents, without transiting their funds through a resident scheme.
Health care providers
Healthcare providers means the organisations and actors that deliver healthcare goods and services as their primary activity, as well as those for which healthcare provision is only one among a number of activities. The following main items are defined as:
hospitals, which means the licensed establishments that are primarily engaged in providing medical, diagnostic and treatment services that include physician, nursing and other health services to inpatients and the specialised accommodation services required by inpatients and which may also provide day care, outpatient and home healthcare services;
residential long-term care facilities, which means establishments that are primarily engaged in providing residential long-term care that combines nursing, supervisory or other types of care as required by the residents, where a significant part of the production process and the care provided is a mix of health and social services with the health services being largely at the level of nursing care in combination with personal care services;
providers of ambulatory healthcare, which means establishments that are primarily engaged in providing healthcare services directly to outpatients who do not require inpatient services, including both offices of general medical practitioners and medical specialists and establishments specialising in the treatment of day-cases and in the delivery of home care services;
providers of ancillary services, which means establishments that provide specific ancillary type of services directly to outpatients under the supervision of health professionals and not covered within the episode of treatment by hospitals, nursing care facilities, ambulatory care providers or other providers;
retailers and other providers of medical goods, which means establishments whose primary activity is the retail sale of medical goods to the general public for individual or household consumption or utilisation, including fitting and repair done in combination with sale;
providers of preventive care, which means organisations that primarily provide collective preventive programmes and campaigns/public health programmes for specific groups of individuals or the population-at-large, such as health promotion and protection agencies or public health institutes as well as specialised establishments providing primary preventive care as their principal activity;
providers of healthcare system administration and financing means establishments that are primarily engaged in the regulation of the activities of agencies that provide healthcare and in the overall administration of the healthcare sector, including the administration of health financing;
rest of the economy means other resident healthcare providers not elsewhere classified, including households as providers of personal home health services to family members, in cases where they correspond to social transfer payments granted for this purpose as well as all other industries that offer healthcare as a secondary activity;
rest of the world providers means all non-resident units providing healthcare goods and services as well as those involved in health-related activities.
Revenues of financing schemes
Revenues of financing schemes provide information on the funding of health expenditures: how the revenues financing the different schemes are raised and from what sources they are financed. The identification of revenues can also identify the private from the public part funding. A Revenue is classified according to the types of transactions through which the financing arrangements derive their income. The following main items are defined as:
transfers from government domestic revenues: funds allocated from government domestic revenues for health purposes;
transfers distributed by government from foreign origin: transfers originating abroad that are distributed through the general government;
social insurance contributions: receipts either from employers on behalf of their employees or from employees, the self-employed or non-employed persons on their own behalf that secure entitlement to social health insurance benefits;
compulsory prepayment: compulsory private insurance premiums paid from the individuals/households, the employers or institutional units to the benefit of compulsory health insurance schemes;
voluntary prepayment: voluntary private insurance premiums received from the insuree or other institutional units on behalf of the insuree to secure entitlement to benefits of the voluntary health insurance schemes;
other domestic revenues n.e.c: domestic revenues of financing schemes not included in the above-mentioned categories;
direct foreign transfers: revenues from foreign entities directly received by the health financing schemes.
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.
HF x FS: Revenues of health care financing schemes by health care financing scheme: data on the sources of revenues for each financing scheme.
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 health care" 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 analyzing 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.
Revenues of health care financing schemes provide information on the funding of health expenditures: how the revenues financing the different schemes are raised and from what sources they are financed.
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.
3.8. Coverage - Time
Detailed data according to SHA 2011 is available from 2018 to 2022 for Poland. Main preliminary aggregates are also available for 2023.
3.9. Base period
Not applicable.
Current expenditure data are presented according to following units:
expenditure amount in millions of national currency;
percentage of GDP;
amount in national currency 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).
Data on individual financing agents are not distributed.
8.1. Release calendar
Statistics Poland disseminates National Health Account results according to the following calendar:
End of July - Statistics Poland publishes the information consisting comparison between SHA2011 methodology and the Ministry of Health methodology calculating expenditure on health. Ministry of Health methodology refers only to public funds and is not limited to current expenditure and does not include local government expenditure.
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
Statistics Poland publishes the President's announcement regarding the most important NHA aggregates:
Statistics Poland publishes the information consisting comparison between SHA2011 methodology and the Ministry of Health methodology calculating expenditure on health. Ministry of Health methodology refers only to public funds and is not limited to current expenditure and does not include local government expenditure.
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
The best-developed classification is HF.1 public / compulsory expenditure schemes because Health Statistics Division uses detailed reports of financing agents based on reports on implementing material and financial plans, reports on implementing the state budget (RB-28), reports on implementing the budget of local government units (RB-28s). Health Statistics Division works closely with the largest financing agent (National Health Fund) to maximize the precision of classifying individual expenditure. Frequent fluctuations in public / compulsory expenditure schemes result from frequently introduced laws concerning this area.
The greatest difficulty is estimating by private health expenditure, including cost sharing.
12.1. Relevance - User Needs
The main users of health care expenditure data are policy makers, the Ministry of health, research institutes, media, and students.
12.2. Relevance - User Satisfaction
Account's results included in Statistics Poland publications, always include a wide methodological and analytical commentary. Due to the complexity of the account and various purposes of application, Health Statistics Division is open to direct consultations, which occur several times a year.
12.3. Completeness
HF.4 is unavailable due to the lack of data sources. HF.3 - no data on cost sharing.
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 Household budget surveys (HBS), only private households are taken into account (and do not include people in institutions or homeless). For SHA2011 purposes results are generalized on the whole population of Poland. People not included in HBS are covered by general health insurance, just like the rest of society, however, some differences in the use of health care services cannot be excluded from private household members.
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
In 2022 (with data for 2020) due to problems in calculating the tables, the data transmission has been postponed from 30 April 2022 to 31 May 2022. It was the only lag between the actual delivery of the data and the target date when it should have been delivered (end of April T-2).
15.1. Comparability - geographical
Not applicable.
15.2. Comparability - over time
Due to constant and very frequent legislative changes in regulations (Last regulation which taken place on July 1, 2019. The Ministry of Health resigned from the codes of health care functions associated with the statistical unit code. (Regulation of the Minister of Health of June 26, 2019 on the scope of necessary information processed by health care providers, of registering this information and its transfer to entities obliged to financing public funds, Journal of Laws, item 1207, as amended).
This resulted in breaks in the data series for 2019 and onwards for all Health Care Services and all Providers.
15.3. Coherence - cross domain
SHA and ESSPROS cannot be mapped from one to another, however, some SHA data referring to LTC is used for ESSPROS calculation.
15.4. Coherence - internal
SHA2011 working tables in addition to the ICHA-HC, ICHA-HP, and ICHA-HF also include financing agents (ICHA-FA operating often in various financing schemes). Financing agent data is added up for each classification (the sums must, of course, be equal) and the individual values and totals are compared with previous years. The HCxHF, HCxHP, HPxHF and HFxFS tables are summed up taking into account classifications at the level of one digit but also at the level of two digits. These sums must also be equal between the individual tables.
Currently, approximately 2.1 people (full-time equivalent) work on the compilation of SHA data in Poland.
In public expenditure, the compilation of SHA data is based on data developed on our request and comes from the implementation of the state budgets of the given entities (Ministry of Health, National Health Fund, The Social Insurance Institution, Agricultural Social Insurance Fund, Ministry of Interior, Ministry of Defence, etc. These data must be converted and adjusted to the classifications applicable in SHA 2011.
In the case of private expenditure, data from Statistics Poland’s surveys (Non-profit institutions survey, Household budget survey, Survey module on health care in households, Occupational medicine - Experts estimations on the basis of the number and price of the preventive medical examinations of working persons) are used.
17.1. Data revision - policy
Generally, when calculating national health account for each subsequent year, the categories of expenditure are compared with previous periods and checked for their accuracy and coherence due to current knowledge. In justified cases and, as far as possible, data for previous years are revised in order to achieve comparability of data over time.
17.2. Data revision - practice
Generally, when calculating national health accounts for each subsequent year, the categories of expenditure are compared with previous periods and checked for their accuracy and coherence due to current knowledge. In justified cases and, as far as possible, data for previous years are revised in order to achieve comparability of data over time.
18.1. Source data
Several data sources are used (as of data notification in March 2024):
Surveys/census: 3 (household budget survey, module survey “Health care in households”, non-profit institutions survey)
Public administrative records: 10
Financial reports: 1
Other: 0
Public administrative records
Source name
Brief description of source
Primary SHA variable(s) using this data source
Time period covered by this data source
Timeliness
(Number of months after the end of the accounting period)
Frequency
Processing
Ministry of Health – Realization of the state budget, Labour Fund
(Number of months after the end of the accounting period)
Frequency
Processing
Rb-28 Annual report on realization of state budget expenditure plan, Rb-28s Annual report on realization of territorial self-government budgetary units’ expenditure plan
Financial statements of insurance companies gathered annually by the Polish Financial Supervision Authority
other
Private insurance in: HF.2.1
HC.1.1, HC.1.3.1, HC.4.3, HC.7.2
provided by:
HP.1.1, HP.7.3, HP.9
2018-2022
x
Annual
Occupational medicine - Experts estimations on the basis of the number and price of the preventive medical examinations of working persons.
other
Corporations in: HF.2.1:HC.1.1, HC.1.3.1, HC.4.3
provided by: HP.1.1, HP.3.4, HP.4.1
Corporations in: HF.2.3
HC.6.4
Provided by:
HP.3.1
2018-2022
x
Annual
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 2024 JHAQ includes a number of features which allow national data correspondents to perform various quality checks before submitting the data. The embedded programmes allow the verification of:
1- Consistency of the data between tables, This step checks if the marginal totals reported in each table of the JHAQ are consistent across all tables. For example, for each function (HC), the total across all financing schemes (HF) in the HCxHF table has to be equal to the total across all providers (HP) in the HCxHP table, i.e. the values in the column “All HF” in the HCxHF table have to be equal to the values in the column “All HP” in the HCxHP table. Any detected differences are flagged up in the corresponding row or column in the relevant tables and all inconsistencies are listed in the “Report” worksheet by variable code together with the amount by which the respective variable differs between the two compared tables. A positive value indicates that the first listed table has a higher value for the same variable, and vice versa.
2- Consistency of the data within tables, Any detected inconsistencies are listed by variable code together with an indication of which total is not equal to the sum of its subcomponents as well as the numerical difference. A positive figure indicates that the total is greater than the reported sub-components, and vice versa.
The presence of negative values,
Entries in the tables cannot be negative as they refer to the consumption of goods and services. If an individual data table is checked for internal consistency, the negative values check is performed for the relevant table and then any negative values are highlighted red and crossed out.
The presence of atypical entries,
The atypical entries check provides information whether the data tables contain values in cells which are – if at all – only reported by very few countries and are thus atypical for health accounting. If an individual data table is checked for internal consistency, the atypical entries check is performed for the relevant table. In the data tables, any cell containing an atypical entry will be highlighted for national data providers. Should any atypical entries be identified, compilers should scrutinize in detail the transactions that led to entries in those cells and assess whether the accounting rules of SHA have been correctly applied. If they come to the conclusion that the transactions are recorded in the correct categories of the ICHA classifications, then the corresponding atypical entries represent unique – and correctly accounted for – features of the country’s health system. In this case a short description of the nature of the transactions should be included in the accompanying Metadata file under “II.3. Atypical entries”. If, on the other hand, compilers come to the conclusion that the transactions are not recorded correctly, then they need to make adjustments in the concerned tables. In case the transactions recorded in a cell do not belong to the boundaries of SHA (e.g. they refer to intermediate consumption) the value of the respective cell should be deleted (and all cells that are affected by this change adjusted accordingly). In case the transactions are misreported and another category of the ICHA classification is more appropriate, the value of the cell should be transferred to the correct cell of the table.
3- The growth rates against the previous year and the magnitude of revisions as compared to previously submitted data. Results are grouped into three different categories:
Breaks in series (the current questionnaire shows no data for an item that is not null in the other file);
Newly reported (the current questionnaire contains data for an item that is empty in the other file);
Differences (all other types of differences).
18.5. Data compilation
SHA data is compiled both by a bottom-up approach as well as by a top-down approach, depending on the data source. Compilation is done by financing schemes and by different health care functions/task areas. The results of the several calculations are then aggregated.
To gain the differentiation between the different SHA-dimensions (especially HC and HP) quotas and pro-rating and utilisation keys are applied on some spending items. For some spending items it is necessary to extra-/intrapolate data as there is no up-to-date data available or data is missing for certain years. For some other spending items, estimation methods have to be applied.
Several methods are normally used for estimations:
Balancing item/Residual method: For example, if data are available from the financing side, which permit accurate estimation of the flows to a provider or function, then an acceptable estimation method is to subtract these expenditure flows from the total revenues, and derive the expenditure flows from the unmeasured financing scheme as a residual.
Pro-rating/Utilisation key: Typically in the absence of direct spending data, a utilisation key linked to the proportion of resources used can be constructed in order to distribute e.g. aggregate provider spending across functions. For every key a fraction of total utilisation within the cost-unit is assigned: fractions in the key must add up to 100% of all care delivered by the cost-unit. Examples of utilisation keys are admissions, bed-days, contacts, staffing, etc.
Interpolation/Extrapolation: In the absence of data for the period in question, missing values can be estimated using known data points.
Estimations on the basis of the yearly conducted household budget survey and the module survey “Health care in households” carried out every 3-5 years (the last one in 2021 with data for 2020). For classification of expenditures in the household budget survey four-level classification of individual consumption by purposes (COICOP) has been used. While constructing the conversion keys from the classification of expenditures used in the households’ budget survey to the classification used in the health account (ICHA) we also used indicators on the expenditures’ structure from the module survey which refer to more detailed groups and which better correspond with ICHA than groupings used in the households’ budget surveys. There is no cost sharing of health care services in Poland, except for medicines, where specified items of medicines, for special population groups are co-financed by social security funds. This information can be collected directly from the National Health Fund register, where data on the total value, on value paid by households and by the National Health Fund separately, are provided.
Estimations on the basis of the non profit institutions survey carried out every 2 years (the last one in 2023 with data for 2022) with the use of additional information from the National Health Fund. There was methodological change - it turned out possible to eliminate some double counting of expenditure which have already been included into expenditures of National Health Fund.
Experts estimations on the basis of available financial statements of insurance companies gathered annually by the Polish Financial Supervision Authority. Health expenditure were estimated taking into account the data on gross paid claims of life and non-life insurance for insurance classes regarding sickness and person damage. It includes also expenditures on subscribtion packages for which corporations are financing agents.
Corporations in:
HF.2.1
/ HP.1.1, HP.3.4, HP.4.1
/HC.1.1, HC.1.3.1, HC.4.3
HF.2.3
/HP.3.1/HC.6.4
Other
Occupational medicine - Experts estimations on the basis of the number and price of the preventive medical examinations of working persons.
It excludes quasi-insurance which, according to the methodology is included in voluntary insurance scheme.
18.6. Adjustment
Statistics Poland publishes data at the national level according to international SHA 2011 methodology without changes.
No further comments.
Health care expenditure quantifies the economic resources dedicated to health functions, excluding capital investment. Health care expenditure concerns itself primarily with health care 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 health care goods and services (to non-resident units) are excluded, whereas imports of health care 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), financing scheme (e.g. social security, private insurance company, household) and revenues of health care financing schemes (eg. transfers from government domestic revenue, transfers distributed by government from foreign origin, social insurance contributions, compulsory prepayment, voluntary prepayment).
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, financing schemes and revenues of health care 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: calendar year (1 January to 31 December).
31 May 2024
SHA concept is the consumption of health care goods and services.
Health care statistics describe the process of providing and financing health care in countries by referring to health care goods and services, their providers, and financing. For the collection of 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) and Revenues of health care financing schemes (FS).
Data are presented in 3 summary (one-dimensional) tables and 4 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);
Current revenues of health care financing schemes (ICHA-FS) - additional classification.
Health care functions
Healthcare functions relate to the type of need that current expenditure on healthcare aims to satisfy or the kind of objective pursued. The following main items are defined as:
curative care, which means the healthcare services during which the principal intent is to relieve symptoms or to reduce the severity of an illness or injury, or to protect against its exacerbation or complication that could threaten life or normal function;
rehabilitative care, which means the services to stabilise, improve or restore impaired body functions and structures, compensate for the absence or loss of body functions and structures, improve activities and participation and prevent impairments, medical complications and risks;
inpatient care, which means the treatment and/or care provided in a healthcare facility to patients formally admitted and requiring an overnight stay;
outpatient care, which means the medical and ancillary services delivered in a healthcare facility to a patient who is not formally admitted and does not stay overnight;
day care, which means the planned medical and paramedical services delivered in a healthcare facility to patients who have been formally admitted for diagnosis, treatment or other types of healthcare and are discharged on the same day;
long-term care (health), which means a range of medical and personal care services that are consumed with the primary goal of alleviating pain and suffering and reducing or managing the deterioration in health status in patients with a degree of long-term dependency. Main results and findings from a questionnaire submitted to countries on sources and methodology for long-term care spending can be found as an annex;
home-based care, which means the medical, ancillary and nursing services that are consumed by patients at their home and involve the providers' physical presence;
ancillary services (non-specified by function), which means the healthcare or long-term care related services non-specified by function and non-specified by mode of provision, which the patient consumes directly, in particular during an independent contact with the health system and that are not integral part of a care service package, such as laboratory or imaging services or patient transportation and emergency rescue;
pharmaceuticals and other medical non-durable goods (non-specified by function), which means pharmaceutical products and non-durable medical goods intended for use in the diagnosis, cure, mitigation or treatment of disease, including prescribed medicines and over-the-counter drugs, where the function and mode of provision are not specified;
therapeutic appliances and other medical goods (non-specified by function), which means medical durable goods including orthotic devices that support or correct deformities and/or abnormalities of the human body, orthopaedic appliances, prostheses or artificial extensions that replace a missing body part, and other prosthetic devices including implants which replace or supplement the functionality of a missing biological structure and medico-technical devices, where the function and the mode of provision are not specified;
preventive care, which means any measure that aims to avoid or reduce the number or the severity of injuries and diseases, their sequelae and complications; Preventive care includes interventions for both individual and collective consumption;
governance, and health system and financing administration, which means services that focus on the health system rather than direct healthcare, direct and support health system functioning, and are considered to be collective, as they are not allocated to specific individuals but benefit all health system users.
Finally, current expenditure on health care means the final consumption expenditure of resident units on healthcare goods and services, including the healthcare goods and services provided directly to individual persons as well as collective healthcare services.
Health care financing schemes
‘Health care financing schemes’ means types of financing arrangements through which people obtain health services, including both direct payments by households for services and goods and third-party financing arrangements. The following main items are defined as:
government schemes, which means healthcare financing schemes whose characteristics are determined by law or by the government and where a separate budget is set for the programme and a government unit that has an overall responsibility for it;
compulsory contributory health insurance scheme, which means a financing arrangement to ensure access to healthcare for specific population groups through mandatory participation determined by law or by the government and eligibility based on the payment of health insurance contributions by or on behalf of the individuals concerned;
social health insurance schemes, which means a financing arrangement to ensure access to healthcare for specific population groups through mandatory participation determined by law or by the government, and eligibility based on the payment of health insurance contributions by or on behalf of the individuals concerned;
compulsory private insurance schemes, which means a financing arrangement to ensure access to healthcare for specific population groups through mandatory participation determined by law or by the government and eligibility based upon the purchase of a health insurance policy;
voluntary health insurance schemes, which means schemes based upon the purchase of a health insurance policy, which is not made compulsory by government and where insurance premiums may be directly or indirectly subsidised by the government;
non-profit institutions financing schemes, which means non-compulsory financing arrangements and programmes with non-contributory benefit entitlement that are based on donations from the general public, the government or corporations;
enterprise financing schemes, which means primarily arrangements where enterprises directly provide or finance health services for their employees without the involvement of an insurance-type scheme;
household out-of-pocket payment, which means a direct payment for healthcare goods and services from the household primary income or savings, where the payment is made by the user at the time of the purchase of goods or the use of the services. A report summarising some of the main findings from a supplementary questionnaire on sources and methodology for OOP payments and current practices of OOP reporting in SHA can be found as an annex;
rest of the world financing schemes, which means financial arrangements involving or managed by institutional units that are resident abroad, but who collect, pool resources and purchase healthcare goods and services on behalf of residents, without transiting their funds through a resident scheme.
Health care providers
Healthcare providers means the organisations and actors that deliver healthcare goods and services as their primary activity, as well as those for which healthcare provision is only one among a number of activities. The following main items are defined as:
hospitals, which means the licensed establishments that are primarily engaged in providing medical, diagnostic and treatment services that include physician, nursing and other health services to inpatients and the specialised accommodation services required by inpatients and which may also provide day care, outpatient and home healthcare services;
residential long-term care facilities, which means establishments that are primarily engaged in providing residential long-term care that combines nursing, supervisory or other types of care as required by the residents, where a significant part of the production process and the care provided is a mix of health and social services with the health services being largely at the level of nursing care in combination with personal care services;
providers of ambulatory healthcare, which means establishments that are primarily engaged in providing healthcare services directly to outpatients who do not require inpatient services, including both offices of general medical practitioners and medical specialists and establishments specialising in the treatment of day-cases and in the delivery of home care services;
providers of ancillary services, which means establishments that provide specific ancillary type of services directly to outpatients under the supervision of health professionals and not covered within the episode of treatment by hospitals, nursing care facilities, ambulatory care providers or other providers;
retailers and other providers of medical goods, which means establishments whose primary activity is the retail sale of medical goods to the general public for individual or household consumption or utilisation, including fitting and repair done in combination with sale;
providers of preventive care, which means organisations that primarily provide collective preventive programmes and campaigns/public health programmes for specific groups of individuals or the population-at-large, such as health promotion and protection agencies or public health institutes as well as specialised establishments providing primary preventive care as their principal activity;
providers of healthcare system administration and financing means establishments that are primarily engaged in the regulation of the activities of agencies that provide healthcare and in the overall administration of the healthcare sector, including the administration of health financing;
rest of the economy means other resident healthcare providers not elsewhere classified, including households as providers of personal home health services to family members, in cases where they correspond to social transfer payments granted for this purpose as well as all other industries that offer healthcare as a secondary activity;
rest of the world providers means all non-resident units providing healthcare goods and services as well as those involved in health-related activities.
Revenues of financing schemes
Revenues of financing schemes provide information on the funding of health expenditures: how the revenues financing the different schemes are raised and from what sources they are financed. The identification of revenues can also identify the private from the public part funding. A Revenue is classified according to the types of transactions through which the financing arrangements derive their income. The following main items are defined as:
transfers from government domestic revenues: funds allocated from government domestic revenues for health purposes;
transfers distributed by government from foreign origin: transfers originating abroad that are distributed through the general government;
social insurance contributions: receipts either from employers on behalf of their employees or from employees, the self-employed or non-employed persons on their own behalf that secure entitlement to social health insurance benefits;
compulsory prepayment: compulsory private insurance premiums paid from the individuals/households, the employers or institutional units to the benefit of compulsory health insurance schemes;
voluntary prepayment: voluntary private insurance premiums received from the insuree or other institutional units on behalf of the insuree to secure entitlement to benefits of the voluntary health insurance schemes;
other domestic revenues n.e.c: domestic revenues of financing schemes not included in the above-mentioned categories;
direct foreign transfers: revenues from foreign entities directly received by the health financing schemes.
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.
HF x FS: Revenues of health care financing schemes by health care financing scheme: data on the sources of revenues for each financing scheme.
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 health care" 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 analyzing 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.
Revenues of health care financing schemes provide information on the funding of health expenditures: how the revenues financing the different schemes are raised and from what sources they are financed.
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.
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 national currency;
percentage of GDP;
amount in national currency per capita;
percentage of current health expenditure (CHE).
SHA data is compiled both by a bottom-up approach as well as by a top-down approach, depending on the data source. Compilation is done by financing schemes and by different health care functions/task areas. The results of the several calculations are then aggregated.
To gain the differentiation between the different SHA-dimensions (especially HC and HP) quotas and pro-rating and utilisation keys are applied on some spending items. For some spending items it is necessary to extra-/intrapolate data as there is no up-to-date data available or data is missing for certain years. For some other spending items, estimation methods have to be applied.
Several methods are normally used for estimations:
Balancing item/Residual method: For example, if data are available from the financing side, which permit accurate estimation of the flows to a provider or function, then an acceptable estimation method is to subtract these expenditure flows from the total revenues, and derive the expenditure flows from the unmeasured financing scheme as a residual.
Pro-rating/Utilisation key: Typically in the absence of direct spending data, a utilisation key linked to the proportion of resources used can be constructed in order to distribute e.g. aggregate provider spending across functions. For every key a fraction of total utilisation within the cost-unit is assigned: fractions in the key must add up to 100% of all care delivered by the cost-unit. Examples of utilisation keys are admissions, bed-days, contacts, staffing, etc.
Interpolation/Extrapolation: In the absence of data for the period in question, missing values can be estimated using known data points.
Estimations on the basis of the yearly conducted household budget survey and the module survey “Health care in households” carried out every 3-5 years (the last one in 2021 with data for 2020). For classification of expenditures in the household budget survey four-level classification of individual consumption by purposes (COICOP) has been used. While constructing the conversion keys from the classification of expenditures used in the households’ budget survey to the classification used in the health account (ICHA) we also used indicators on the expenditures’ structure from the module survey which refer to more detailed groups and which better correspond with ICHA than groupings used in the households’ budget surveys. There is no cost sharing of health care services in Poland, except for medicines, where specified items of medicines, for special population groups are co-financed by social security funds. This information can be collected directly from the National Health Fund register, where data on the total value, on value paid by households and by the National Health Fund separately, are provided.
Estimations on the basis of the non profit institutions survey carried out every 2 years (the last one in 2023 with data for 2022) with the use of additional information from the National Health Fund. There was methodological change - it turned out possible to eliminate some double counting of expenditure which have already been included into expenditures of National Health Fund.
Experts estimations on the basis of available financial statements of insurance companies gathered annually by the Polish Financial Supervision Authority. Health expenditure were estimated taking into account the data on gross paid claims of life and non-life insurance for insurance classes regarding sickness and person damage. It includes also expenditures on subscribtion packages for which corporations are financing agents.
Corporations in:
HF.2.1
/ HP.1.1, HP.3.4, HP.4.1
/HC.1.1, HC.1.3.1, HC.4.3
HF.2.3
/HP.3.1/HC.6.4
Other
Occupational medicine - Experts estimations on the basis of the number and price of the preventive medical examinations of working persons.
It excludes quasi-insurance which, according to the methodology is included in voluntary insurance scheme.
Several data sources are used (as of data notification in March 2024):
Surveys/census: 3 (household budget survey, module survey “Health care in households”, non-profit institutions survey)
Public administrative records: 10
Financial reports: 1
Other: 0
Public administrative records
Source name
Brief description of source
Primary SHA variable(s) using this data source
Time period covered by this data source
Timeliness
(Number of months after the end of the accounting period)
Frequency
Processing
Ministry of Health – Realization of the state budget, Labour Fund
(Number of months after the end of the accounting period)
Frequency
Processing
Rb-28 Annual report on realization of state budget expenditure plan, Rb-28s Annual report on realization of territorial self-government budgetary units’ expenditure plan
Financial statements of insurance companies gathered annually by the Polish Financial Supervision Authority
other
Private insurance in: HF.2.1
HC.1.1, HC.1.3.1, HC.4.3, HC.7.2
provided by:
HP.1.1, HP.7.3, HP.9
2018-2022
x
Annual
Occupational medicine - Experts estimations on the basis of the number and price of the preventive medical examinations of working persons.
other
Corporations in: HF.2.1:HC.1.1, HC.1.3.1, HC.4.3
provided by: HP.1.1, HP.3.4, HP.4.1
Corporations in: HF.2.3
HC.6.4
Provided by:
HP.3.1
2018-2022
x
Annual
Annual.
Member States were required to transmit their data to Eurostat in compliance with the Commission Regulation (EU) 2015/359 transmission deadlines, until reference year 2020. As of reference year 2021, data are transmitted pursuant to Commission Regulation (EU) 2021/1901. Data and reference metadata for the reference year T should be transmitted to Eurostat by 30 April T+2.
Not applicable.
Due to constant and very frequent legislative changes in regulations (Last regulation which taken place on July 1, 2019. The Ministry of Health resigned from the codes of health care functions associated with the statistical unit code. (Regulation of the Minister of Health of June 26, 2019 on the scope of necessary information processed by health care providers, of registering this information and its transfer to entities obliged to financing public funds, Journal of Laws, item 1207, as amended).
This resulted in breaks in the data series for 2019 and onwards for all Health Care Services and all Providers.
