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For any question on data and metadata, please contact: Eurostat user support |
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1.1. Contact organisation | Federal Statistical Office (Destatis) |
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1.2. Contact organisation unit | Health-Related Accounting System |
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1.5. Contact mail address | Graurheindorfer Str. 198 53117 Bonn |
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2.1. Data description | |||
Health care expenditure quantifies the economic resources dedicated to health functions, excluding capital investment. Healthcare expenditure concerns itself primarily with healthcare goods and services that are consumed by resident units, irrespective of where that consumption takes place (it may be in the rest of the world) or who is paying for it. As such, exports of healthcare goods and services (to non-resident units) are excluded, whereas imports of healthcare goods and services for final use are included. 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 2014 to 2016 reference years. In addition the national health care expenditure data provide information by financing agents on research and development in the health care sector, compensation of health-related implications (e.g. integration support for disabled people for occupational rehabilitation), income benefits (e.g. continued remuneration in case of illness) and capital investment. |
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2.2. Classification system | |||
Healthcare expenditure is recorded in relation to the international classification for health accounts (ICHA) defining:
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2.3. Coverage - sector | |||
1. Household individual consumption on health, including the collective consumption with two exceptions: |
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2.4. Statistical concepts and definitions | |||
SHA concept is the consumption of health care goods and services. Summary tables provide data on:
Cross-classification tables refer to:
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2.5. Statistical unit | |||
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". |
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2.6. 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). |
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2.7. Reference area | |||
The data aims at providing a complete overview of expenditure on health care goods and services consumption of services and goods by the resident population on the national territory of a country. |
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2.8. Coverage - Time | |||
1992 - 2017. |
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2.9. Base period | |||
Not applicable. |
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3.1. Source data | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Several data sources are used: - Surveys/census: 4 - Public administrative records: 11 - Financial reports: 6
Survey, Censuses
Public administrative records
Financial reports
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3.2. Frequency of data collection | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Annual. |
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3.3. Data collection | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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.
The Health Expenditure Accounts is a secondary statistical accounting system that summarizes the data sources available in the healthcare sector at the time of calculation - such as administrative data, sample surveys, annual reports and special evaluations - to calculate total expenditure on health care goods and services. The collection of the national data of health expenditure takes place primarily by the financing agents. The expenses of the different financing agents (for example, statutory health insurance) must be allocated to the types of functions and the providers rendering them. For this purpose, to some extent, appropriate quotas for the distribution of expenditure between the types of functions and the providers of functions are calculated. |
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3.4. Data validation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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:
2- Consistency of the data within tables,
Entries in the tables cannot be negative as they refer to the consumption of goods and services.
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.
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:
Some important basic statistics (e.g. long-term care statistics, social welfare statistics, statistics of cost structure in offices of physicians by Federal Statistical Office, national accounts) are subjected to the quality standards of the German official statistics. These basic statistics are subject to the quality control in the relevant specialised departments and are validated there. Other data are first validated internally through the data owner and checked again for completeness and plausibility by the Federal Statistical Office. |
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3.5. Data compilation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Several methods are normally used for estimations:
Due to a lack of data for household out-of-pocket payments a residual method is used. Starting point of the calculation is the volume of sales of the providers. Volumes of sales that cannot be allocated to health purposes, exports and expenditures of the other financing agents are subtracted. The residual amount is the health expenditure of the private households. Then these expenditures are allocated to functions and providers by means of distribution keys. |
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3.6. Adjustment | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
The boundary of healthcare goods and services at national level follows the recommended definitions of SHA 2011. The health expenditures are shown three-dimensionally – by financing schemes, functions and providers. The classifications of the three dimensions are harmonized with the International Classification for the Health Accounts. |
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4.1. Quality assurance | |||
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. General regulations are included in the Federal Statistics Law (BStatG) in Germany. These principles include for example neutrality, objectivity, scientific independence, application of appropriate methods and rules of statistical confidentiality and privacy. |
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4.2. Quality management - assessment | |||
Generally, sampling and non-sampling errors of the basic statistics integrated into the System of Health Accounts may also be contained in the results. Also, applying estimation methods and extrapolating time series may lead to inaccuracies. But it should be noted, that most of the basic statistics are complete surveys and estimations are only made where reliable data are missing. OOP expenditure data is mostly based on a residual method. Therefore under- or overestimations can exist. A quantification of the overall quality is not possible to identify. Altogether, we expect a good data quality. |
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5.1. Relevance - User Needs | |||
National users are especially the Federal Ministry of Health (BMG), the Federal Health Monitoring, research institutes, universities, trade associations, health care companies, the media and also the interested public. The data of health care expenditure is important for the political community for assessing health policies. Besides health expenditure data form the basis for expert opinions and forecasts. |
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5.2. Relevance - User Satisfaction | |||
There is an “expert committee“ every three years in the field of health. Main users will be informed about the current developments and can give their opinions from the user point of view. |
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5.3. Completeness | |||
For the compulsory variables of the HF categories the category HF4 “Rest of the world financing schemes (non-resident)” is missing because the data are not available.
For the compulsory variables of the HC categories the category HC.2.2 “Day rehabilitative care” and HC.2.4”Home-based rehabilitative care” is missing and reported either in HC.2.1 or HC.2.3. The category HC.3.3”Outpatient long-term care (health)” is missing and reported in HC.3.4 “Home-based long-term care (health).
For the compulsory variables of the HP categories all data are available. |
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5.3.1. Data completeness - rate | |||
Table HCxHF=78,6% Table HCxHP=78,6% Table HPxHF=100% |
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6.1. Accuracy - overall | |||
The quality of the Health Expenditure Accounts depends significantly on the quality of the basic statistics. In principle, in the selection of the basic statistics, full surveys have priority before sampling surveys and continuous surveys before single counting in order to avoid methodologically caused breaks in the time series. Lacks of clarity occur particularly where they are already present in the underlying statistics on which this calculation is based or where appropriate data sources for specific fields are missing (data gap). OOP expenditure is mostly based on a residual method. Therefore under- or overestimations can occur. However, a large part of the basic statistics are full surveys, therefore, the results of the Health Expenditure Accounts show only occasional random errors. |
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6.2. Sampling error | |||
In the survey "statistics of cost structure in offices of physicians" the relative standard error is below 15%. In the survey "statistics of cost structure in dental practises" the relative standard error is below 5 %. |
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6.2.1. Sampling error - indicators | |||
Not available. |
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6.3. Non-sampling error | |||
Not available. |
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6.3.1. Coverage error | |||
Health care goods and services by non-residents are excluded from domestic provider revenues. It is not possible to report the underground/informal/illegal health care goods and services in the data collection and should not be significant relevant in Germany. |
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6.3.1.1. Over-coverage - rate | |||
Not available. |
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6.3.1.2. Common units - proportion | |||
Not applicable. |
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6.3.2. Measurement error | |||
Should not be significant relevant. |
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6.3.3. Non response error | |||
Not available. |
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6.3.3.1. Unit non-response - rate | |||
Not available. |
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6.3.3.2. Item non-response - rate | |||
Not available. |
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6.3.4. Processing error | |||
Not available. |
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6.3.4.1. Imputation - rate | |||
Not available. |
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6.3.5. Model assumption error | |||
Not relevant. |
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6.4. Seasonal adjustment | |||
Not applicable. |
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6.5. Data revision - policy | |||
Revisions are generally applied to all years to assure data consistency across all years. Revisions are carried out every year and are usually due to revisions in our data sources. |
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6.6. Data revision - practice | |||
2014: Revisions were applied to the complete time series and affected all HF, all HC categories except HC.3.2 and HC.5.1.3 and all HP categories except HP.6. The revisions were due to the inclusion of new data sources and revisions in the existing data sources. 2015: Revisions were applied to the complete time series and affected in particular HF.2.2. The revisions were due to the inclusion of new data sources and revisions in the existing data sources. 2016: Revisions were applied to the complete time series. The revisions were due to the exclusion of expenditures for people living abroad but are insured in the German social insurance schemes. Furthermore, the financing scheme HF12 was broken down into HF121 and HF122 and there was a minor shifting between the financing schemes HF1 and HF2 due to an improved accounting of the implementation of the 2009 reform on mandatory health insurance. Moreover, HC.7xHF.1.1 based on COFOG is now reported. |
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6.6.1. Data revision - average size | |||
Not available. |
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7.1. Timeliness | |||
Member States are required to transmit their data to Eurostat in compliance with the Commission Regulation 359/2015 transmission deadlines.
Germany has sent data according to the transmission deadline. |
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7.1.1. Time lag - first result | |||
Germany does not publish first results. |
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7.1.2. Time lag - final result | |||
Final national results are published in a release after T+14 month. The release dates are reported to Eurostat after T+15 month. |
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7.2. Punctuality | |||
The deadlines were always met. |
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7.2.1. Punctuality - delivery and publication | |||
The deadlines were always met. |
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8.1. Comparability - geographical | ||||||||||||||||||
Not applicable at national level. |
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8.1.1. Asymmetry for mirror flow statistics - coefficient | ||||||||||||||||||
Not applicable. |
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8.2. Comparability - over time | ||||||||||||||||||
Breaks in time series resulting from methodological changes
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8.2.1. Length of comparable time series | ||||||||||||||||||
The number of reference periods is 25 (from 1992 - 2016). |
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8.3. Coherence - cross domain | ||||||||||||||||||
The data are not reconciled with other domains such as ESSPROS. |
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8.4. Coherence - sub annual and annual statistics | ||||||||||||||||||
Not applicable. |
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8.5. Coherence - National Accounts | ||||||||||||||||||
As the Health Expenditure Accounts measures the last consumption of health goods and services, there is also a limited reference to the concepts of the National Accounts. A connecting factor results from the classification of the providers in the health care sector into the economic sectors of the National Accounts. Among other things, there are differences in the concepts used. In the National Accounts applies the domestic concept (inclusion of exports), whereas the Health Expenditure Accounts uses the resident concept (exclusion of exports). |
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8.6. Coherence - internal | ||||||||||||||||||
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9.1. Dissemination format - News release | |||
There is a press release every year when the national data is published in February. |
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9.2. Dissemination format - Publications | |||
The results of the national data were published in "Fachserien" (subject-matter series) until 2015. |
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9.3. Dissemination format - online database | |||
National Data can be accessed on the website of the Federal Statistical Office. National Data and the SHA dataset are available on the website of the Information System of Federal Health monitoring. |
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9.3.1. Data tables - consultations | |||
Information is not available at the moment. |
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9.4. Dissemination format - microdata access | |||
Not applicable. |
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9.5. Dissemination format - other | |||
Other data dissemination is for example the publication "data of the health care sector" from the Federal Ministry of Health. |
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9.6. Documentation on methodology | |||
An article written by Moritz Mannschreck about the revision of the National System of Health Accounts in 2015 and only available in German language: “Die revidierte Gesundheitsausgabenrechnung", published in the magazine Wista Economy and Statistics. |
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9.7. Quality management - documentation | |||
The quality report for the National System of Health Accounts is only available in German language. |
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9.7.1. Metadata completeness - rate | |||
100% |
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9.7.2. Metadata - consultations | |||
Information not available. |
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For the production of the health care expenditure data approximately 2,5 FTE are needed. As the Health Expenditure Accounts is a complete accounting system that processes already existing results from primary, secondary and administrative data sources, there are no additional costs for respondents. Additional costs may arise in the context of data acquisition for the data holders of the basic statistics, who voluntarily provide their results to the Federal Statistical Office. Since the data are not always available in the required form, in some cases it may be necessary to compile special statistical evaluations. |
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11.1. Confidentiality - policy | |||
The Regulation (EC) No 223/2009 on European statistics (recitals 23-27, 31-32 and Articles 20-26) applies. |
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11.2. Confidentiality - data treatment | |||
Pursuant to §16 (1) BStatG, German official statistics are obligated to keep individual data. Excluded are data that cannot be assigned to the respondent or have been summarized (aggregated) to such an extent that they are not traceable. The Health Expenditure Accounts uses only aggregated data or data without direct personal reference. In addition, it is about a macroeconomic consideration. The results are not personally identifiable and in their presentation related only to the total population. Since only aggregated data or statistics without direct personal reference are used and since this is a macroeconomic consideration, no additional confidentiality procedures are applied. |
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