Health care expenditure (SHA 2011) (hlth_sha11)

National Reference Metadata in ESS Standard for Quality Reports Structure (ESQRS)

Compiling agency: Statistics Poland


Eurostat metadata
Reference metadata
1. Contact
2. Statistical presentation
3. Statistical processing
4. Quality management
5. Relevance
6. Accuracy and reliability
7. Timeliness and punctuality
8. Coherence and comparability
9. Accessibility and clarity
10. Cost and Burden
11. Confidentiality
12. Comment
Related Metadata
Annexes (including footnotes)
 



For any question on data and metadata, please contact: EUROPEAN STATISTICAL DATA SUPPORT

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1. Contact Top
1.1. Contact organisation

Statistics Poland

1.2. Contact organisation unit

Social Surveys Department – Health Statistics Division

1.5. Contact mail address

Niepodległości 208 Av. 00-925 Warsaw, Poland


2. Statistical presentation Top
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. 
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 2014 to 2016 reference years.

One of the important factors concerning SHA2011 data collection is the fact that Statistics Poland is using the cash method.

2.2. Classification system

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.
2.3. Coverage - sector

1. Household individual consumption on health, including collective consumption 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 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" (only healthcare section).

2.4. Statistical concepts and definitions

SHA concept is the consumption of health care goods and services.
Health care statistics describe the process of providing and financing health care in countries by referring to health care goods and services, its providers and financing. For the collection of the data on health care expenditure the System of Health Accounts (SHA) and its related set of International Classification for the Health Accounts (ICHA) is used. SHA is a tri-axial system in which the financing, provision and consumption dimensions are covered by the ICHA (International Classification for Health Accounts): Health Care Functions (HC), Health Care Providers (HP), Health Care Financing Schemes (HF).
Data are presented in 3 summary (one-dimensional) tables and 3 cross-classification tables (2-dimensional tables).

Summary tables provide data on:

  • Current expenditure by provider (ICHA-HP)
  • Current expenditure by function (ICHA-HC)
  • Current expenditure by financing scheme (ICHA-HF)

Cross-classification tables refer to:

  • HC x HP: Health care expenditure by function and provider: data on which type of health care goods and services are supplied by which health care provider;
  • HC x HF: Health care expenditure by function and by financing scheme: data on how are the different types of services and goods financed;
  • HP x HF: Health care expenditure by provider and by financing scheme: data on from which health care provider and under which particular financing scheme are the services and goods purchased.
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".
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.

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).

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.

2.8. Coverage - Time

Detailed data according to SHA 2011 is available from 2013-2016 for Poland. Main aggregates are also available for 2017.

2.9. Base period

Not applicable.


3. Statistical processing Top

 

 
3.1. Source data

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

-          Surveys/census: 3 (household budget survey, module survey “Health care in households”, non-profit institutions survey)

-          Public administrative records: 9

-          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, Labor Fund

Annual records on activity - 100%

HF.1.1
financing: HC.1 (except HC.1.3, HC.1.4), HC.3.2, HC.4.3, HC.5.1.1, HC.6.(except HC.6.6) HC.7.1
provided by: HP.1, (except HP.1.1), HP.2.1, HP.4.1, HP.7.1, HP.7.9, HP.8.2)

2013-2017 12 months Annual  

National Health Fund – Financial report of the National Health Fund

Annual records on activity - 100%

HF.1.1
financing: HC1, HC.2, HC.3 (except HC.3.3), HC.4, HC.5 (except HC.5.1.2), HC.6.1
provided by: HP.1, HP.2, HP.3, HP.4 (except HP.4.9), HP.5 (except HP.5.9), HP.6 and HP.9
HF1.2
financing: HC.1, HC.2, HC.3 (except HC.3.3), HC.4, HC.5 (except HC.5.1.2), HC.6.1, HC.6.4, HC.7.2
provided by: HP.1, HP.2., HP.3, HP4 (except HP.4.9), HP.5 (except HP.5.9), HP.6, HP.7.2, HP.8.2
HF.2.3.2
financing: HC.1, HC.2,HC.3 (except HC.3.3), HC.4 (except HC.4.3), HC.5.2, HC.6.1, HC6.4, HC.9
provided by: HP.1, HP.2, HP.3, HP.4 (except HP.4.9), HP.6.

2013-2017 12 months Annual  

Social Insurance Institution – Annual statistical report of Social Insurance Institution

Annual records on activity -100%

HF1.2
financing: HC.2.1, HC.3.4, HC.5.2, HC.9
provided by: HP.1.3, HP.3.4, HP.8.1

2013-2017 12 months Annual  
Agricultural Social Insurance Fund- Annual financial report of Agricultural Social Insurance Fund  Annual record for activity - 100%

HF1.1
financing: HC.2.1, HC.3.4
provided by: HP1.3, HP.8.1
HF1.2
financing: HC2.1, HC.3.4, HC.9
provided by: HP.1.3, HP.4.9, HP8.1
HF.3.1
financing: HC.2.1
provided by: HP.1.3

2013-2017 12 months Annual  

Ministry of National Defence -  Financial report on the realization of the state budget

Annual records on activity -100%

HF.1.1
financing: HC.1.1, HC.1.3.2, HC.4.1, HC.5.1.1, HC 6.4, HC.9
provided by: HP.1.1, HP.2.1, HP.3.1, HP.3.2, HP.4.2, HP.5.9, HP.8.2

2013-2017 12 months  Annual   

Ministry of Justice –  Financial report on the realization of the state budget (prisons’ budget)

Annual records on activity -100%

HF1.1
financing: HC.1.1,HC.1.3.1, HC.6.5, HC.7.1
provided by: all HP.1, HP.3.1, HP.7.9

2013-2017 12 months Annual  

Ministry of Social Policy –Annual report on Provision of Social Benefits in Cash and in Kind for the Period 1-12 2006 (MPiPS03)

Annual records on activity -100%

HF.1.1
financing: HC.3.4
provided by: HP.8.1, HP.8.2

2013-2017 12 months Annual  

Ministry of the Interior – Financial report on the realization of the state budget

Annual records on activity -100%

HF1.1
financing: HC.1.1, HC.1.3.1, HC.4.1, HC4.3, HC.6.1.,HC.6.5, HC.7.1
provided by: HP.1.1, HP.1.2, HP.2.1, HP.4.2, HP.6, HP.8.2

2013-2017 12 months Annual  

National Fund for Rehabilitation of Disabled – Financial report on state funds.

Annual records on activity -100%

HF.1.1
financing: HC.2.1, HC.5.2.
provided by: HP.1.3, HP.3.4

2013-2017 12 months Annual  

 

Financial reports

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

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

Annual records on activity - 100%

 

HF1.1
financing: HC.1.1, HC.1.3.1, HC.1.3.2, HC.3.1, HC.4.3, HC.6.1.,HC.6.4, HC.6.5, HC.7.1
provided by: HP.1, HP.2.1, HP.3.1, HP.3.2, HP.4.1, HP.7.1, HP.7.9, HP.8.2

2013-2017 12 months Annual  

Statistics Poland Surveys

Non-profit

institutions survey

  Other  

Non Profit in: HF.2.2:
/HP.1, HP.2.1, HP.3, HP.4, HP.5, HP.6
/HC.1.1, HC.1.3.1, HC.1.3.2, HC.1.3.3, HC.2.1, HC.2.3, HC.2.4, HC.3.1, HC.3.4, HC.4.2, HC.4.3, HC.5.1.1, HC.5.1.3, HC.5.2,
HC.6.1, HC.7.1, HC.9

 2013-2017  x  2 years  
 Household budget survey  Other  

Households budget in: HF3
/HP.1.1, HP.1.3, HP.2.1,HP.3.2, HP.3.3, HP.3.4, HP.4.2, HP.5.1, HP.5.2/ 
/HC.1.3.1, HC.1.3.2, HC.1.3.3, HC.1.3.9, HC.1.4, HC.2.1, HC.2.3, HC.2.4, HC.3.1, HC.4.1, HC.4.2, HC.5.1.1, HC.5.1.2, HC.5.1.3, HC.5.2, HC.9

 
  2013-2017    x   3 years    
survey module on health care in households   Other
Other estimations
Financial statements of insurance companies gathered annually by the Polish Financial Supervision Authority other

Private insurance in:
HF.2.1 / HP.1.1, HP.9 / HC.1.1, HC.1.3.1, HC.4.3,

  2013-2017   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
/ 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

  2013-2017   x Annual  
3.2. Frequency of data collection

Annual.

3.3. Data collection

Annual records on activity of ministries (Ministry of Health, Ministry of National Defence, Ministry of Justice, Ministry of Social Policy, Ministry of the Interior) and other institutions (National Health Fund, Social Insurance Institution, Agricultural Social Insurance Fund, National Fund for Rehabilitation of Disabled) are submitted annually in a standardized format to Statistics Poland. 

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 is obtained from Statistics Poland Macroeconomic Studies and Finance Department.

Expert estimations on the basis of the yearly conducted household budget survey and the module survey “Health care in households” carried out every 3 years.

Expert estimations on the basis of the non-profit institutions' survey (SOF).

Expert estimations on the basis of the number and price of the preventive medical examinations of working persons. (MZ-35A)

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:


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, Statistics Poland carries out several other steps to check and validate its SHA data. Time series for each data source/calculation step are analyzed 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 analyzed in detail. Consistency between dimensions is achieved as every 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.

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:

  • Balancing item/Residual method: For example, if data are available from the financing side, which permit accurate estimation of the flows to a provider or function, then an acceptable estimation method is to subtract these expenditure flows from the total revenues, and derive the expenditure flows from the unmeasured financing scheme as a residual.
  • Pro-rating/Utilisation key: Typically in the absence of direct spending data, a utilisation key linked to the proportion of resources used can be constructed in order to distribute e.g. aggregate provider spending across functions. For every key a fraction of total utilisation within the cost-unit is assigned: fractions in the key must add up to 100% of all care delivered by the cost-unit. Examples of utilisation keys are admissions, bed-days, contacts, staffing, etc.
  • Interpolation/Extrapolation: In the absence of data for the period in question, missing values can be estimated using known data points.
  • Or other.

SHA variable(s)

Main method

Brief description of methodology

Households budget in:
HF3/HP.1.3, HP.2.1,HP.3.2, HP.3.3, HP.3.4, HP.4.2, HP.5.1, HP.5.2/ HC.1.3.1, HC.1.3.2, HC.1.3.3, HC.1.3.9, HC.1.4, HC.2.1, HC.2.3, HC.2.4, HC.3.1, HC.4.1, HC.4.2, HC.5.1.1, HC.5.1.2, HC.5.1.3, HC.5.2

Other

Estimations on the basis of the yearly conducted household budget survey and the module survey “Health care in households” carried out every 3 years (the last one in 2017 with data for 2016). 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. 

Non Profit in:

Other Estimations on the basis of the non profit institutions survey carried out every 2 years (the last one in 2017 with data for 2016) 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.

Private insurance in:
HF.1.2 / HP.1.1, HP.3.4, HP.5.1, HP.5.2 / HC.1.1, HC.2.3, HC.5.1, HC.5.2;
HF.2.1 / HP.9 / HC. 1.1, HC.1.3, HC.4.3, HC.7.2

Other

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.2.1.2/ HP.1.1, HP.3.4, HP.4.1/HC.1.1, HC.1.3.1, HC.4.3
HF.2.3/ HP.3.1.3 / 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.

3.6. Adjustment

Statistics Poland publishes data at the national level according to international SHA 2011 methodology without changes.


4. Quality management Top
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.

Law on official statistics imposes the obligation to look after quality under the Code of Practice: Art. 25a. The President of Statistics Poland performs tasks specified in the Act, follows the principles of professional independence, impartiality, reliability and responsibility for the high quality of national and international statistics, under the European Statistics Code of Practice referred to in art. 11 of Regulation (EC) No 223/2009 of the European Parliament and of the Council of 11 March 2009 on European statistics and repealing Regulation (EC, Euratom) No 1101/2008 of the European Parliament and of the Council on the transmission of statistical data to the Statistical Office of the European Communities subject to the principle of confidentiality, Council Regulation (EC) No 322/97 on Community Statistics and Council Decision 89/382 / EEC, Euratom establishing a Committee for the Statistical Programs of the European Communities (OJ L 87/3131, 31.03.2009, page 164), "Regulation No. 223/2009".

SHA was introduced as a survey for the annual program of statistical surveys approved by Prime Minister's Office and imposes an obligation to provide data (within a given scope and structure) for the purposes of JHAQ.

4.2. 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.

The greatest difficulty is estimating by private health expenditure, including cost sharing.


5. Relevance Top
5.1. Relevance - User Needs

The main recipients of data from NRZ are financing agents, i.e. ministries, Social Insurance Institution, Agricultural Social Insurance Fund, etc. Data recipients are also media, institutions conducting scientific, educational and analytical activities and students. Some disadvantage for data users is a two-year delay in the publication of data, which makes data become potentially less attractive for users who want the latest data. Another problem could be a complex methodology (e.g. ICHA-HF) that requires a lot of time to understand its nuances.

5.2. Relevance - User Satisfaction
 Account's results included in Statistics Poland publications, always including a wide methodological and analytical commentary. Due to the complexity of the invoice and various purposes of using its results by users of data, Health Statistics Division are open to direct consultations, which happens several times a year.
5.3. Completeness

HF.4 is unavailable due to the lack of data sources.
HF.3 - no data on cost sharing.

5.3.1. Data completeness - rate

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


6. Accuracy and reliability Top
6.1. Accuracy - overall

The overall accuracy of Polish SHA data can be considered to be quite good. In many cases we avoid double counting, e.g. data provided by Ministry of Family, Work and Social Protection coincides with RB-28 report, non-profit expenditure coincides with NFZ expenditure, etc. Health Statistics Division compares the expenditure of ministries and other institutions with the reports on the use of the state budget.

6.2. Sampling error

Not applicable.

6.2.1. Sampling error - indicators

There is a sampling error in Household budget surveys used as a basis for the calculation of OOP expenditure. However, the HBS data undergoes further calculation for the NHA purpose. In the table below: selected indicators

 

               ABSOLUTE AND RELATIVE ERRORS OF ESTIMATES OF AVERAGE MONTHLY  EXPENDITURES ON HEALTH PER CAPITA
               IN HOUSEHOLDS

 

      SPECIFICATION
 x
̅ - average monthly expenditures per capita in zlotys
 s - absolute error in zlotys
 v - relative error in %

Grand total

 
 
 
 
 

Health              

x̅   

64,81

 

s   

0,68

 

v   

1,05

 

    medical products, appliances and equipment                                    

x̅   

40,82

 

s   

0,45

 

v   

1,11

 

    out-patient services                                                          

x̅   

21,98

 
 

s   

0,37

 
 

v   

1,67

 

    hospital and sanatorium services                                              

x̅   

2,01

 
 

s   

0,19

 
 

v   

9,36

 
6.3. Non-sampling error
Household budget surveys, or homeless people, for example, as part of the Population Census 2011. These people 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 in relation to private household members.
6.3.1. Coverage error
Household budget surveys, serving as the main source of data for estimation of OOP expenditure do not include people in collective accommodation establishments (about 1% according to Population Census 2011), neither homeless. These people have common health insurance, just like the rest of society, however, differences in the use of health care services cannot be ruled out.
6.3.1.1. Over-coverage - rate

All cases of double counting of expenditure are eliminated. An example can be non-profit expenditure and NFZ expenditure, which partly overlap. 

Other examples are local governments and subsidies on particular levels of local governments are also excluded. We take into account only the final financing agents.

6.3.1.2. Common units - proportion

Not applicable.

6.3.2. Measurement error

Health Statistics Division is not aware of any measurement errors.

6.3.3. Non response error

In HBS, 2017 response rate amounted to 37,7%.

6.3.3.1. Unit non-response - rate

In HBS, 2017 response rate amounted to 37,7%.

6.3.3.2. Item non-response - rate

Not applicable.

6.3.4. Processing error

No such errors.

6.3.4.1. Imputation - rate

No such errors.

6.3.5. Model assumption error

Not applicable.

6.4. Seasonal adjustment

Not applicable.

6.5. 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.

6.6. 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.  

6.6.1. Data revision - average size

Difficult to calculate.

 


7. Timeliness and punctuality Top
7.1. Timeliness
There were no deviations from deadlines in the reference period.
7.1.1. Time lag - first result

 Thirteen months.

7.1.2. Time lag - final result

Statistics Poland transmits SHA2011 data for t-2 and estimations t-1 annually via EDAMIS by end of April year t. The national publication takes place at the end of June for t-2.

7.2. Punctuality

There were no deviations from deadlines in the reference period.

7.2.1. Punctuality - delivery and publication

Not applicable.


8. Coherence and comparability Top
8.1. Comparability - geographical

Polish National Health Account is developed from the side of agents, which expenditure covers the whole area of Poland. There are no regional accounts because of the lack of regional data.
International comparisons are possible in all major classifications: ICHA-HC, ICHA-HP, ICHA-HF and are available in OECD, Eurostat and WHO databases:

https://stats.oecd.org/   (OECD)

http://apps.who.int/nha/database/Select/Indicators/en  (WHO)

https://ec.europa.eu/eurostat/data/database (Eurostat)

8.1.1. Asymmetry for mirror flow statistics - coefficient

Not applicable.

8.2. Comparability - over time

Data according to SHA 1 is available from 2004 to 2012 and is comparable in such timeframe. Data according to SHA2011 is available and comparable in the 2013-2017 timeframe.

Breaks in time series resulting from methodological changes (SHA1.0 to SHA2011 transition)

Year

Items affected by the break

Explanations

2013

HF.1.1

The increase of spending by Governmental Scheme was caused by additional components of “Governmental scheme” (National Health Fund and Agricultural Insurance Fund) and increased expenditure of Ministry of Health. 

2013

HF.2.1, HF.2.3

Since 2013 spending by Voluntary health insurance schemes (HF21) and Enterprises financing schemes (HF23) record high positive and negative change rates, respectively.  This is due to the re-classification of “medical subscriptions financed by employers.

2013

HC.2.3

The large increase in  2013 is caused by expenditure of National Insurance Institute. Previously these funds were reported under HC.R.7

2013

HC.3 

Decrease in HC.3 is caused by decrease of its main component "home-based long-term care" (HC.3.4). This fall of expenditure is due to different allocation of former components of HC.3 where expenditure increased. Example: benefits that were reported under HC.3.3 “Long-term nursing care: home care” can now be found in HC.3.1 “Outpatient long-term care (health)”  Also care allowance previously reported under HC.3.3 can now be found under HC.R.1.

2013

HC.6

The increase of spending on prevention in 2013 is caused by influence of additional components (in SHA 1.0 classified under HC.R.4, HC.R.5 and HC.5.). This case is due to methodology change and this categories shouldn’t be compared. 

2013

HP.3.5

Spending by Providers of home health care services has been cut to nearly zero.Most of these funds were classified under HP.8.1 “Households as providers of home health care”

2013

HP.8.2

Spending by All other industries as secondary providers of health care was drastically reduced. This reduction was a result of better disaggregation of funds by our agents.

8.2.1. Length of comparable time series

Definitive break in the series was caused by the implementation of SHA 2011 revision.

8.3. 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.

8.4. Coherence - sub annual and annual statistics

Not applicable.

8.5. Coherence - National Accounts
 NHA is calculated from the side of financing agents, no detailed analyses have been conducted so far concerning coherence with National Accounts.
8.6. 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 and HPxHF 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.


9. Accessibility and clarity Top
9.1. Dissemination format - News release
Statistics Poland publishes the President's announcement regarding the most important NHA aggregates:

https://stat.gov.pl/sygnalne/komunikaty-i-obwieszczenia/lista-komunikatow-i-obwieszczen/obwieszczenie-w-sprawie-narodowego-rachunku-zdrowia-za-2016-rok,283,5.html

https://stat.gov.pl/sygnalne/komunikaty-i-obwieszczenia/lista-komunikatow-i-obwieszczen/obwieszczenie-w-sprawie-narodowego-rachunku-zdrowia-za-2015-rok,283,4.html

https://stat.gov.pl/sygnalne/komunikaty-i-obwieszczenia/lista-komunikatow-i-obwieszczen/komunikat-w-sprawie-narodowego-rachunku-zdrowia-za-2014-r-,283,3.html

 
 
9.2. Dissemination format - Publications
Health and health care in 2017:

https://stat.gov.pl/obszary-tematyczne/zdrowie/zdrowie/zdrowie-i-ochrona-zdrowia-w-2017-r-,1,8.html

9.3. Dissemination format - online database

No online database at the national level.

9.3.1. Data tables - consultations

Restricted from publication.

9.4. Dissemination format - microdata access

Microdata is not disseminated.

9.5. Dissemination format - other

Not applicable.

9.6. Documentation on methodology

 The methodology is described, quite generally, in an information note: 

https://stat.gov.pl/obszary-tematyczne/zdrowie/zdrowie/narodowy-rachunek-zdrowia-za-2016-rok,4,9.html

More detail in the publication Health and health care in 2017:

https://stat.gov.pl/obszary-tematyczne/zdrowie/zdrowie/zdrowie-i-ochrona-zdrowia-w-2017-r-,1,8.html

9.7. Quality management - documentation

Not available.

9.7.1. Metadata completeness - rate

Not available.

9.7.2. Metadata - consultations

Not available.


10. Cost and Burden Top
 The cost incurred by Statistics Poland associated with the development of NHA is estimated annually, based on labor consumption, as part of work at the Program Of Public Statistic Surveys (PBSSP). It does not include costs incurred by our respondents - data providers.


11. Confidentiality Top
11.1. Confidentiality - policy

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

11.2. Confidentiality - data treatment
 Data on individual financing agents are not distributed.


12. Comment Top

No further comments.


Related metadata Top


Annexes Top