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For any question on data and metadata, please contact: Eurostat user support |
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1.1. Contact organisation | National Institute for Health Development |
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1.2. Contact organisation unit | Health statistics department |
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1.5. Contact mail address | Hiiu 42, 11619 Tallinn, Estonia |
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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. 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). National Institute for Health Development (NIHD) is compiling SHA data in accordance with its statutes and at the request of the Ministry of Social Affairs. Data is published on webpage www.tai.ee, in Health Statistics and Health Research Database http://pxweb.tai.ee/PXWeb2015/index.html . |
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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). Expenses of non-residents are excluded as much as possible. |
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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 | |||
2003-2017 |
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2.9. Base period | |||
Not applicable. |
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3.1. Source data | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Several data sources are used (as of data notification in March 2018): - Surveys/census: 4 - Public administrative records: 7 - Financial reports: 3 - Other: 0
Surveys/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. Data for Estonia is collected by National Institute for Health Development in in SHA-standardised form for ministries, standardised form from healthcare providers, non-standardised form from other institutions and is processed and SHA-coded by National Institute for Health Development. Data request is sent official letter signed by the Director of Institute to data providers annually. Double counting is eliminated from the calculations during the processing The data are verified and if necessary, specified together with the data providers and all made expenses are classified according to the function (purpose) for which the money was spent. During the work, it will be specified as much as possible through which service provider money was spent for the corresponding purpose, and where final consumption took place. Since the objective is to classify expenditure according to final consumption (and exclude intermediate consumption), then the contributor is often not the one, which carries out the corresponding activity or where the money is actually spent – therefore, the data obtained through organisers will be further classified according to the corresponding service providers and activities. In practice, classification means marking each amount spent according to all applicable classifications (financing source, health function, service provider, and financing scheme). Expenditure where the primary proposes of the activity is not health or related to health and health care indirectly will be excluded. Therefore, the labour and social field expenditure of the Ministry of Social Affairs is not included. Neither does health expenditure include compensations for the temporary incapacity to work paid by the EHIF. |
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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:
Results are compared with initial data and calculations of previous years in Estonia. General available information is cross-checked between data sources: National Accounts data from Statistics Estonia, pharmaceutical market data from State Agency of Medicines, household expenses from Statistics Estonia Household Budget Survey, annual reports of the Commercial (Business) Register of health service providers. |
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3.5. 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:
For households out-of-pocket payments is used the volume of sales of the providers and retail sales (glasses), also data from Health Insurance Fund and Ministry of Social Affairs about household co-payments for medicines and aids. Volumes of sales of services are allocated to functions by means of distribution keys. Data for over-the-counter medicines expenses comes from the State Agency of Medicines. |
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3.6. Adjustment | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Some adjustments have been done in data if some expenses were classified differently in a single year when compared to neighboring years in historical data. This has been related to recalculations of time-series according to the SHA 2011. Voluntary part in EHIF health insurance system has been distributed by HF proportionally. |
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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. National Institute for Health Development operates as a central institution in charge of health statistics in Estonia. The Department of Health Statistics does data collection, analyses and publishing of health expenditure statistics in accordance with internationally approved SHA methodology. The statistical information is produced by following the principles of objectivity, reliability, relevance, confidentiality and transparency. Legal acts: https://www.tai.ee/en/r-and-d/health-statistics/legal-acts Dissemination principles: http://pxweb.tai.ee/esf/pxweb2008/dialog/Info/HealthStatisticsDisseminationPrinciples.pdf |
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4.2. Quality management - assessment | |||
Overall quality is good. Bases on administrative data, which is complemented by special requests for function and provider details. Primary data are cross-checked with publicly available general economic data. |
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5.1. Relevance - User Needs | |||
Main users of SHA data in Estonia are Ministry of Social Affairs, professional health associations, health professionals, media, researchers, students. Key indicators that are often requested are health expenditure in general, public and private expenditure with services distribution, the share of health expenditure in GDP. |
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5.2. Relevance - User Satisfaction | |||
Based on 2016 health statistics users satisfactory survey (NIHD) were satisfied with health expenditure data publishing deadline 88% of respondents, with reliability 90% and with level of detail 78%. |
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5.3. Completeness | |||
Data are complete as far as the Commission regulation is applicable. Household out-of-pocket payment HF3 is without distribution between HF31 Out-of-pocket excluding cost-sharing and HF32 Cost-sharing with third-party payers. From services over-the-counter medicines HC512 are without any cost sharing. Rest of the services include some cost sharing (HF321), but from household expenditure paid services without cost-sharing and services with cost-sharing are not distinguished.
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5.3.1. Data completeness - rate | |||
Review of LTC health and social expenditure data is in progress, based on 2017 pilot data collection current LTC health expenditure is underestimated. Rate will be specified next year. Ministry of Social Affairs started mapping of social welfare services in 2019 according to the 2018 OECD guidelines about Accounting and mapping of long-term expenditure under SHA 2011. |
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6.1. Accuracy - overall | |||
The quality depends on the quality of administrative and reported data. Out-of-pocket expenditure distribution between services is estimated. No sampling surveys are used, except health spendings of private companies (EKOMAR module E, Statistics Estonia). |
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6.2. Sampling error | |||
Sample surveys are not used, only for health spendings of private companies. |
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6.2.1. Sampling error - indicators | |||
No sample surveys, except health spendings of private companies. |
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6.3. Non-sampling error | |||
Not relevant. |
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6.3.1. Coverage error | |||
Health care goods and services used by non-residents are excluded, except in case of out-pocket expenses paid directly to service provider. For health spendings of private companies is used module E in EKOMAR survey 2008, 2013, provided by Statistics Estonia. |
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6.3.1.1. Over-coverage - rate | |||
Not applicable |
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6.3.1.2. Common units - proportion | |||
Not applicable |
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6.3.2. Measurement error | |||
Not applicable |
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6.3.3. Non response error | |||
Certain minor non response has been compensated with previous year data (eye-glasses stores sales). |
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6.3.3.1. Unit non-response - rate | |||
Not applicable |
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6.3.3.2. Item non-response - rate | |||
Not applicable |
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6.3.4. Processing error | |||
Errors due to misinterpretation in coding are possible if description of expenses is not complete. |
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6.3.4.1. Imputation - rate | |||
Not applicable. |
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6.3.5. Model assumption error | |||
Not applicable. |
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6.4. Seasonal adjustment | |||
Not applicable. |
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6.5. Data revision - policy | |||
Generally, revisions are made only if new relevant information emerge or mistakes have been discovered. New health expenditure data are published T+10 months annually. Main reason for revison of previously delivered data during the 2015-2018 data delivery was the implementation of SHA2011 and introduction of the new methodology for estimation household expediture.
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6.6. Data revision - practice | |||
Main reason for the revisions during the 2015-2019 data delivery has been the implementation of SHA2011 and the introduction of a new methodology for estimation household expenditure. Revision of the time series during the last years does not correspond to the general revision policy. It has been an exceptional period, involving a lot of extra-work, including reconsiderations and reclassifications of previous data according to the new principles, also knowledge with exploration of new available information. For example, in 2018 with new 2016 data also revised data series were submitted for years 2008-2015. There were two causes for revision. Correction inlcuded change in FS table where revenues for Russian military pensioners were removed from FS2 to FS71. In main tables including HF distribution according to the discussions results with WHO and OECD voluntary health insurance expenditure in Estonian Health Insurance Fund (payments of private persons to EHIF for purchasing EHIF health insurance) has been removed from HF121 to voluntary health insurance schemes HF21. Time-series are harmonised step by step.
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6.6.1. Data revision - average size | |||
Household spending increased by 7% on average over the 11 years concerned within the change in methodology and taking into use of administrative sources instead of household budget survey data from 2013. Biggest impact in addition to the elimination of annual unspecified fluctuations was the elimination of under-coverage of OOP spending for years 2010-2012 (average increase 22,7%). The total number has been affected by an average of 1.2%. |
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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. National data are published in Estonian Health Statistics and Health Research Database annually by 31 October T+1. |
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7.1.1. Time lag - first result | |||
Estonia does not publish first results. For international comparison we calculate preliminary data by HF in the beginning of April T+1. |
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7.1.2. Time lag - final result | |||
Results are generally final after 12 months from first results. |
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7.2. Punctuality | |||
There were no deviations from deadlines in the reference period. |
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7.2.1. Punctuality - delivery and publication | |||
As planned. |
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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
Generally comparable time series for 15 years. Same OOP spending (HF.3) calculation methodology is implemented in the SHA 2011 recalculated time-series for 2003-2017. During this time-period some changes have influence for comparability listed here.
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8.2.1. Length of comparable time series | |||||||||||||||||||||
Data according to SHA 2011 is available for years from 2003 to 2017. |
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8.3. Coherence - cross domain | |||||||||||||||||||||
Calculations are cross-checked with other sources at national level. |
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8.4. Coherence - sub annual and annual statistics | |||||||||||||||||||||
Not applicable. |
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8.5. Coherence - National Accounts | |||||||||||||||||||||
Results are compared with the National Accounts. |
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8.6. Coherence - internal | |||||||||||||||||||||
Atypical entries:
Coherence is verified within the validation process (see point 3.4). |
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9.1. Dissemination format - News release | |||
At the national level annual news release is published with national data at the end of October T+1 on the National Institute of Health Development webpage (www.tai.ee). |
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9.2. Dissemination format - Publications | |||
Estonian Health Care Expenditure in 2015 (last in English) https://www.tai.ee/en/health-data/research-reports/download/412 2016 and 2017 analysis in Estonian only https://www.tai.ee/et/terviseandmed/uuringud/download/435 https://www.tai.ee/et/terviseandmed/uuringud/download/475 Health in the Baltic countries 2016 https://www.tai.ee/en/health-data/research-reports/download/447 |
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9.3. Dissemination format - online database | |||
The online national Health statistics and health research database is available on the National Institute of Health Development webpage: http://pxweb.tai.ee/PXWeb2015/index_en.html Data online publication includes metadata. |
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9.3.1. Data tables - consultations | |||
Not available. |
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9.4. Dissemination format - microdata access | |||
Not applicable. |
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9.5. Dissemination format - other | |||
Used by Ministry of Social Affairs. |
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9.6. Documentation on methodology | |||
The metadata are enclosed to the tables and explained in published analysis. Methodology change in detail is described in the analysis: Health expenditure in Estonia 2013. Change in Methodology https://www.tai.ee/en/health-data/research-reports/download/339 Health expenditure 2014. Change in OOP expenditure calculation methodology https://www.tai.ee/en/health-data/research-reports/download/366 Classifications are published under Health statistics metadata section (in Estonian) https://www.tai.ee/et/tegevused/tervisestatistika/metaandmed/klassifikaatorid Links are added to SHA 2011 revised version in Estonian and in English webpage.
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9.7. Quality management - documentation | |||
Quality report published for 2012. |
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9.7.1. Metadata completeness - rate | |||
Metadata is provided in publications and in public database. |
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9.7.2. Metadata - consultations | |||
Not available. |
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Mainly secondary use of administrative data. |
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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 | |||
Statistical confidentiality is applied, aggregated data is published. |
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Data delivery 2018 JHAQ include files for years 2008-2016, and preliminary aggregates for 2017. 2008-2015 corrections in 2 main tables including HF and FS table have been made. Details of these corrections are provided at page V. Revisions. NB As previously provided HKxHP tables for 2012-2015 are not updated, only 2016 data file include new HKxHP filled in table in current data delivery and for previous years HK tables are left empty. For the HCR.1 Long-term care (social) first estimates have been calculated in 2018. As the 3.04 data transmission (2008-2017) was perfomed without filling in HCR.1 in the tables, data is added in separate file. for your information. If during the validation process any updates for data-files are needed, HCR.1 will be added to the JQ files. These first estimates will be specified later this year within 2017 HE data collection process, when Ministry of Social Affairs will review LTC data according to the new Guidelines for Accounting Long-Term Care Expenditure under SHA 2011. Results will be provided within next year data delivery. |
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