Statistik Austria

Directorate Macro-Economic Statistics / Department Sector Accounts and Public Finances

Guglgasse 13, A-1110 Wien

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).

The time coverage of this Quality report is 2004 to 2017 reference years.

Statistics Austria is compiling SHA data on behalf of and on the basis of a contract with the Federal Ministry for Labour, Social Affairs, Health and Consumer Protection. Data is published on Statistics Austria’s website. A detailed methodological documentation is also published at Statistics Austria’s website (German only), a English excerpt of this documentation is published here. In addition to the core functions of SHA, Statistics Austria also calculates figures for public and private expenditure on gross fixed capital formation (HK). Additionally, Statistics Austria also compiles SHA figures on public spending for State Health Funds financed hospitals (SHF hospitals, part of HP.1) for all nine Federal States of Austria and also provides an additional table where all three SHA-dimensions (HC, HP, HF) are represented in one table. For reference year 2014, health care expenditure according to SHA 2011 by Age and Gender was also compiled.

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

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

In addition to the mandatory classification of the Commission Regulation 2015/359, Statistik Austria calculates and partly publishes certain items of HC/HP/HF at a lower aggregation level. This is true especially for HC.1.3, HC.5.1, HC.5.2, HC.7, HP.1, HP.3, HP.4, HP.5, HP.7, HP.8, HF.1.2 and HF.3. Additionally, for the calculation on expenditure for State Health Funds financed hospitals (SHF hospitals) we also use an additional classification not included in the SHA-manual on HF.1.1.2, where we further differentiate between state/regional government schemes (HF.1.1.2.1) and local government schemes (HF.1.1.2.2). Gross capital formation is compiled by Statistik Austria as a whole but is not differentiated according to the classification of gross fixed capital formation in health systems by type of asset (chapter 11 of SHA manual).

1. Household individual consumption, consumption of NPISH and government consumption (both for individual and collective consumption) on health with two exceptions:
i. Occupational health care (intermediate consumption within establishments) minus an estimated share of occupational health in health providers’ and other medical industries net administration;
ii.“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,
- 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.

Additionally, Statistik Austria includes (parts of ) other NACE-groups (NACE rev.2) if they are within the scope of SHA:

• section C.21: Manufacture of basic pharmaceutical products and pharmaceutical preparations
• section C.26.60: Manufacture of irradiation, electromedical and electrotherapeutic equipment
• section C.30.92: Manufacture of medical and dental instruments and supplies
• section C.32.5: Manufacture of medical and dental instruments and supplies
• section H.49.32: Taxi Operation section
• section O: public administration and defence; compulsory social security
• section S.96.06: Physical well-being activities
• various other NACE as occupational health care is compiled by using intermediate consumption of enterprises.

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.

Commission Regulation 2015/359 concerns 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 2015/359 limits its scope to the collection of data on the expenditure of health care financing schemes.

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

The data aims at providing a complete overview of expenditure on health care goods and services consumption of services and goods by the resident population on the national territory of a country.

Detailed data according to SHA 2011 is available from 2004-2016 for Austria. Main aggregates are also available for 2017.

Not applicable.

Several data sources are used (as of data notification in March 2018):

-          Surveys/census: 4

-          Public administrative records: 9

-          Financial reports: 3

-          Other: 9

Surveys/censuses

Public administrative records

Financial reports

Other

Annual.

Data are collected through the joint health accounts questionnaire (JHAQ) that countries submit 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). Countries submit data to Eurostat on the basis of 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.

Annual accounts of central, provincial and local governments as well as financial reports of public corporations and government funds (especially State Health Funds) are submitted annually to Statistik Austria (mainly for the purpose of National Accounts and GFS/EDP compilations).

Data for core units of government is submitted standardised and electronically in detail, data for some public corporations and government funds is transmitted via a web-based tool.

Data for social insurance funds is transmitted in a non-standardised form and is processed and coded (also SHA-coded) by Statistik Austria.

Results from National Accounts as well as from several social statistics are obtained from our colleagues in Statistik Austria.

Reports of the regional governments on social activity are published on their websites and taken from there.

Additional data/reports/information from some ministries, the Main association of Austrian social insurances, regional/local government, the Austrian Insurance Association and the Austrian economic chambers are submitted by them after request.

The 2018 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)

In addition to the validation features provided by the JHAQ, Statistik Austria carries out several other steps to check and validate its SHA data. Time series for each data source / calculation step are analysed for trends, growth rates and anomalies. Growth of aggregate data is decomposed in its single elements to detect possible miscalculations. New entries and revisions are double-checked and analysed in detail. Consistency between dimensions is achieved as each single calculation is coded with all three corresponding dimensions. Results of years that are not re-transmitted/re-published are also calculated even if there is no change and these results are compared with calculations in previous years to secure consistency of the calculation methods over time.

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.
• Or other

Not applicable.

Authorities responsible for SHA data collection are working 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.

Quality criteria for Statistik Austria are also set out in the “Bundesstatistikgesetz 2000” (§14 and §24), and in the quality guidelines of Statistik Austria. Additional measures undertaken to guarantee high quality of SHA data compilation are Internal Audits carried out by Statistik Austria, annual presentation and discussion of results and methods with main user of SHA data and regular feedback dialogues with quality management of Statistik Austria, colleagues from Statistik Austria, SHA data users and experts on methodological and quality aspects.

The quality of SHA figures from Statistik Austria can be considered to be quite high. Areas where data is not fully in line with SHA guidelines or are partially missing are outlined under 5.3 and 6.3.1.

Main users of SHA data in Austria are Federal Ministries (especially Ministry for Labour, Social Affairs, Health and Consumer Protection), regional and local governments and the social insurance funds as well as the Court of Audit for policy making and policy evaluation purposes. SHA data is e.g. the basis for the monitoring of the effects of the most recent health reform in Austria (especially for public expenditure).

Social partners also use the data for informing their opinion on policy issues. Research institutions like WIFO, IHS, Gesundheit Österreich etc. use SHA data for research projects and studies. Media, education institutions like universities, other research institutions, students and the general public also are requesting SHA data on an ad-hoc basis depending on the question they are dealing with.

Key indicators that are often requested are health expenditure in general, public and private expenditure, expenditure on long-term care, expenditure on a wide range of functions of health care, expenditure on hospitals etc.

We observed unmet user needs (due to insufficient data on these topics) especially in questions on health expenditure on specific diseases, total pharmaceuticals expenditure (HC.RI.1) and regional break-downs of health expenditure. The latter is done only for State Health Funds financed hospitals but not for other parts of the health care sector.

User satisfaction is discussed annually when presenting and discussing main results and methods of SHA with main users in a designated meeting. Also, there are regular feedback dialogues with quality management of Statistik Austria, colleagues from Statisitk Austria, SHA data users and experts on methodological and quality aspects. Feedback from main users is incorporated in the compilation of SHA figures if feasible and possible.

Overall, SHA data for Austria can be considered almost complete. One slight deviation from SHA-definition occurs in HF.3, were Household out-of-pocket payment is in large parts calculated according to the domestic concept (including exports, excluding imports health goods and services) and not for all residents, irrespective of the location of transaction. As a consequence, data for HP.9 (Rest of the world) is partially missing as it is not yet possible to identify all Out-of-Pocket Payments of Household for several medical services abroad. Other items were data is partially missing are HP.7.1 (Government health administration agencies) where it is not possible to identify all health-related administration costs of ministries apart from the former Ministry of Health (now included in the Federal Ministry for Labour, Social Affairs, Health and Consumer Protection) and of regional government administration, for OOP-expenditure for HC.4.3 (transportation in conventional vehicles (e.g. taxi)), for medicines purchased via internet and illegally purchased medicines in HC.5.1 and for occupational health care expenditure for the entire public administration as well as for hospitals, medical practices and residential long-term care facilities in. However, these topics all can be considered relatively minor in terms of the volume of expenditure.

Within the categories of the three SHA-dimensions, there are also some minor topics where a clear distinction between SHA categories is not always possible:

• Utilisation of income tax deductibles are not assigned to government schemes and conditional cash transfers of government to households for (dominantly) medical goods (HC.5) are reported as OOP.
• Expenditure on HC.1.4 is to a large extent reported in HC.1.3.
• Expenditure on HC.3.3 is to a large extent reported in HC.1.3.
• Data for HC.2.2 & HC.2.4 is not available and/or reported in other HC.2-sub-categories.
• Data for HP.4.9 (Other providers of ancillary services) is mostly reported under HP.3 and HP.5. We may not rule out that part of this expenditure is also missing.

Almost 100% of mandatory variables of the three dimensions according to Commission Regulation 359/2015 that are relevant/occurring in the Austrian health system (for exceptions see 5.3).

Overall accuracy of Austrian SHA data can be considered to be quite good. Known under-coverages are explained in detail under 5.3 and 6.3.1.

Not applicable as we do not use any surveys directly for the compilation of SHA data. However, some of our data sources (e.g. from National Accounts) are based on results of surveys (e.g. consumer survey).

Not applicable.

Not applicable as we do not use any surveys directly for the compilation of SHA data. However, some of our data sources (e.g. from National Accounts) are based on results of surveys (e.g. consumer survey).

We are not aware of any double-counting of expenditure items in our SHA figures at the moment. However, if double-counting of expenditure is detected, it is removed and consolidated. A known under-coverage exists in OOP payments for HP.9 (rest of world, see 5.3) although we were able to include expenditure for dental services in Hungary in our last data submission, which is the major case were medical services are consumed by Austrian residents abroad. Other known under-coverages are laid out in detail under 5.3, although the effect of these under-coverages can all be considered to be relatively minor in terms of the volume of health expenditure.

Underground/informal/illegal health services and goods are in large part included. Only for illegally purchased medicines and the “shadow” economy for nursing care data is (partly) missing.

Not applicable.

Not applicable.

We are not aware of any measurement errors.

Not applicable.

Not applicable.

Not applicable.

We are not aware of any processing errors.

Not applicable.

Not applicable.

Not applicable.

Data are routinely revised annually for the latest 2-3 years, as all data are expected to be final at that time.

Data are often revised for longer or even for the whole time-series, if fundamental changes in methodology take place (e.g. ESA 2010 implementation, implementation of SHA 2011).

Data for the most recent year are preliminary.

In general, with each data submission t-2 was newly compiled and the two previous data years were revised. Additionally, in 2016 a major revision was undertaken to implement SHA 2011 for data years 2011-2014. In 2018, another major revision was carried out to compile data according to SHA 2011 also for data years 2004-2010 and to also revise data for 2011-2015 due to some new insights gained by compiling the whole time-series 2004-2016.

The magnitude of revision amounted to 0.5% -1.5% of current health care in the last years depending on the kind of revision.

Member States are required to transmit their data to Eurostat in compliance with the Commission Regulation 359/2015 transmission deadlines.
Data and reference metadata for the reference year T should be transmitted to Eurostat by 30 April T+2.

Statistik Austria transmits SHA data for t-2 annually to EUROSTAT by March 31st latest in line with the deadline set out by OECD for the JHAQ. National publication takes place in Mid-February for t-2. A flash estimate of (highly aggregated) SHA-data for t-1 is published nationally and transmitted to OECD/EUROSTAT/WHO end of June since 2018.

Around 6 months (national publication of flash estimate of main aggregates).

Around 13 months (national publication of preliminary results of detailed SHA data, can be revised – see 6.5 and 6.6).

There were no deviations from deadlines in the reference period.

Not applicable.

Not applicable at national level.

Not applicable.

Data according to SHA 2011 is available from 2004-2016 (and main aggregates for 2017) for Austria and comparable over this time frame with one minor exemption, a minor break between 2007 and 2008 (see below).

Breaks in time series resulting from methodological changes

14 years (2004-2017) for SHA 2011 data (2017 only main aggregates published so far, minor break 2007-2008 – see 8.2).

SHA and ESSPROS are based on different underlying concepts as e.g. SHA is based on final consumption whereas ESSPROS is based on total expenditure. Also, e.g. in the domain of LTC SHA core variables are only focusing on health-related LTC whereas ESSPROS takes into account also the social aspects of LTC. A full coherence between these different approaches is therefore not feasible. In addition, compilation methods for SHA and ESSPROS are different in Statistik Austria and therefore data cannot be mapped from one approach to the other.

Not applicable.

Generally speaking, the approach for compiling SHA data is at large in line with the approach of National accounts and a great amount of SHA data is directly taken (and sometimes modified/pro-rated to fit within the SHA-boundaries) from National Accounts or Government Finance Statistics (e.g. household consumption according to COICOP, government expenditure according to COFOG, supply-use tables, gross-fixed capital formation,…). However, for some spending items (e.g. public spending in hospitals) direct data from financial reports is used and the compilation of these figures is not always fully in line with the concept of final consumption. The starting point of compiling public spending in hospitals is data from the State health funds (serving as intermediates that distribute government transfers to state-owned hospitals and other transfers to hospitals owned by NPISH) and not data from hospitals themselves on their cost structure. This is mainly done as an assignment to the different financing schemes contributing to the State Health Funds would not be possible if using data from the hospitals. Also, for health providers owned by the social insurance, the transfers (D.73) of the social insurance funds to these providers are accounted instead of compiling the final consumption of these providers as these providers are now classified inside the government sector in National Accounts. Nevertheless, these approaches lead to around the same overall figures than an approach by final consumption (we have compared both approaches for internal validation purposes in the past).

 Two major differences of SHA in comparison to National accounts should also be mentioned (see also SHA 2011 manual):

1.  occupational health is treated as intermediate consumption of enterprises in National accounts (and therefore accounted for in the NACE sector of the enterprise and not necessarily within health care) whereas they are included in the final consumption within the SHA framework and therefore classified as health expenditure.
2. Second, SHA treats payments of central government to households in the form of nursing allowances as a proxy for household production and includes this kind of transfers as health expenditure whereas National accounts do not recognise any form of unpaid household production at all.

Underground/informal/illegal health care goods and services are included in SHA figures but there are some exceptions covered under 6.3.1.

The treatment of imports/exports under SHA is outlined under 5.3 and 6.3.1.

Internal coherence of SHA tables is achieved. For consistency checks and validation methods see 3.4.

National publication of SHA results of t-2 in Mid-February is accompanied by a press release (last in German and English from February 2018) by Statistics Austria.

Results on health care expenditure on aggregates as well as in the three SHA-dimensions and figures for public spending for State Health Funds financed hospitals are published in Mid-February for t-2 on Statistik Austria's website together with explanatory texts and alongside a press release. Public expenditure for State Health Funds financed hospitals are also published end of September for t-1. The figures of the flash estimation for t-1 are published at the end of June.

In addition, SHA data are published in Statistik Austria's yearly publication "Statistisches Jahrbuch Österreichs" (last edition: Statistik Austria (2017): Statistisches Jahrbuch Österreichs 2018) which can be ordered on Statistik Austria's website.

Another publication of Statistics Austria including SHA data is the yearly publication "Jahrbuch der Gesundheitsstatistik" (last edition: Statistik Austria (2018): Jahrbuch der Gesundheitsstatistik 2016) which also can be ordered on Statistik Austria's website.

In addition, several articles on SHA or containing SHA data were published in Statistik Austria’s monthly publication “Statistische Nachrichten”.  The most recent articles were:

• Klimont, J. / Baldaszti, E. / Kalmar, M (2017): Stationäre Gesundheitsversorgung in Österreich. In: Statistik Austria (2017): Statistische Nachrichten 7/2017
• Kalmar, M / Kavlik, W (2015): System of Health Accounts – Gesundheitsausgaben in Österreich 1990-2013. In: Statistik Austria (2015): Statistische Nachrichten 8/2015

On the national level, we currently do not use an on-line database for the dissemination of SHA data but we provide EXCEL files with main aggregates as well as the three cross-classification tables, one table were all three dimensions are represented and one table were public spending for State Health Funds financed hospitals per Federal State is presented on Statistics Austria’s website. Data can also be obtained at the health-databases of OECD, EUROSTAT and WHO.

Not applicable.

SHA data are used as a base line for evaluating the ongoing health care reform in Austria. Other major publications using/containing SHA data are e.g.:

OECD (2017): Health at a Glance 2017: OECD Indicators. OECD-Publishing, Paris.

Bachner, Florian et al. (2018): Austria: Health system review. Health Systems in Transition. 2018; 20(3): 1 – 256

Countless other publications, surveys, web-based texts etc.

A detailed methodological documentation (Statistik Austria 2016: Standard-Dokumentation Metainformationen (Definitionen, Erläuterungen, Methoden, Qualität) zu Gesundheitsausgaben nach System of Health Accounts für Österreich) is published in German at Statistik Austria’s website, an English excerpt of this documentation can also be found there.

Not available.

Not available.

Not available.

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

On national level, the “Datenschutzgesetz 1999” and the “Bundesstatistikgesetz 2000” (§17 - §19), applies. At Statistik Austria, there are guidelines in place with regards to the policy on confidentiality.

All legal requirements are met and Statistik Austria’s guidelines are followed. The publication of SHA data is done at relatively high aggregated data-level, detailed data is not published or distributed. For most data sources, already aggregated data already (partly) published elsewhere is used. If data from financial reports or other information of single units is taken into account, it is secured that a sufficient number of units are aggregated together to be able to publish the relevant HF/HC/HP combination.

No further comments