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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 of Statistics (NIS), ROMANIA |
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1.2. Contact organisation unit | Demography, Health, Culture and Justitice Statistics - Department of Studies, Demographic Projections and Population Census |
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1.5. Contact mail address |
National Institute of Statistics (INS)
16 Libertatii avenue, district 5
050706, Bucharest, Romania
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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). |
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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 | |||
Data is available, under the SHA 2011 methodology, for the period 2011-2016. |
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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 April 2019): - Surveys/census: 3 - Public administrative records: 7 - Financial reports: 4 - Other: 2
Surveys/censuses
Public administrative records
Financial reports
Other
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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. NIS Romania receive data from administrative and survey sources: - the National Health Insurance House (NHIH) send NIS data regarding amounts contracted by the sanitary units by ICHA codes. - data on budgetary execution of revenues and expenditures of public institutions with a health network are collected and publicly available on a Ministry of Finances(MoF) portal (at COFOG 3 level), the MoF sends to NIS the aggregated budgetary execution for the Local Administrations. These data, together with MoH and NHIH data, are used by NIS to consolidate the budget. - data on budgetary execution of revenues and expenditures of public network hospitals is collected and send to NIS by the Ministry of Health. The expenditures are available by source of revenues (state budget, local budget and social security, other own revenues revenues). - the MoH sends to NIS data regarding expenditures for the Annual National Health Programme by ICHA code by the end of year T-1. - data used for SHA indicators and estimations from the NIS survey "Activity of Sanitary units - SAN" is available for the previous year (T-1) for non-expenditure data and for T-2 for expenditure data. - Household Budget Survey is conducted by NIS and provides data for SHA regarding average monthly expenditure of a household for a list of health services and the total number of households. - data regarding private health expenditure is collected by the National Financial Authority based on a NIS questionnaire and sent to NIS by December T-1. |
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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:
In addition to the validation tools provided by Eurostat, NIS Romania performs other checks on data sources and growth rates, identifies policy changes to explain changes in data trends for specific type of providers, services or financing agents before compiling the SHA tables. |
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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:
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3.6. Adjustment | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
At national level, the ICHA is not used for classifying services and providers. NIS allocates ICHA codes for the national types of sanitary units. For hospitals, NIS introduced in the annual "Activity of Sanitary Units" codes for the types of hospitals of ICHA, these information for each hospital in Romania is used for all other data provided by the Ministry of Health and Ministry of Finance. Health expenditure data is diseminated in a publication based on SHA data tables but providing methodological information on how these data are linked with the national health system. |
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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. |
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4.2. Quality management - assessment | |||
NIS Romania compiles the data starting from healthcare unit or ministry level which are validated either by NIS (in the case of surveys) or by institutions providing administrative data. Using non-expenditure data or average costs can lead to over-estimation or under-estimation of some indicators where data are missing, but the base data used has a degree of reliability that we are expecting a good quality of the data resulted. NIS is making efforts to identify new high quality data sources and introduce SHA methodology in the national statistics in order to provide quality data. |
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5.1. Relevance - User Needs | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Main users of SHA data in Romania are the Ministry of Health and other central government institutions/ministries, researchers and journalists. The Eurostat database is often used by users to obtain SHA data. |
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5.2. Relevance - User Satisfaction | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Currently there is no specific user satisfaction accounting, but NIS is providing methodological suport and specifications to all users that are requesting the data. Also, communications are maintained with the central government institutions that are both providers and users of the SHA data. |
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5.3. Completeness | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Below are the information regarding the completeness of Romania SHA data.
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5.3.1. Data completeness - rate | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Table HCxHF = 67.0% Table HCxHP = 77.3% Table HPxHF = 62.5% |
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6.1. Accuracy - overall | |||
The accuracy of the base statistics used in compiling SHA data is of good quality as the data sources are mainly exhaustive and validated. Some over-estimations or under-estimations can occur when non-expenditure data is used. Data are underestimated for expenditure of the NPISH financing schemes that include expenditure of the main non-profit organisations for which public financial and non-financial reports were available giving the posibility of identiffying health care related data. Rest of the world financial schemes data sources were not identified and we cannot estimate if these expenditure can be included in other schemes. |
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6.2. Sampling error | |||
The administrative data used are exhaustive. |
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6.2.1. Sampling error - indicators | |||
Not applicable. |
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6.3. Non-sampling error | |||
Non-resident expenditure are excluded. SHA data does not cover informal payments. |
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6.3.1. Coverage error | |||
Double counting is eliminated in the base calculation of the public administration and social health insurance expenditure. Non-resident expenditure are not included in the private insurance scheme (HF.2.1) and in the household out-of-pocket payment schemes (HF.3) and is excluded from the social health insurance scheme (HF.1.2). Informal payments are not included in the SHA data. |
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6.3.1.1. Over-coverage - rate | |||
None. |
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6.3.1.2. Common units - proportion | |||
None. |
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6.3.2. Measurement error | |||
None. |
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6.3.3. Non response error | |||
Not applicable. |
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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 | |||
Not applicable. |
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6.3.4.1. Imputation - rate | |||
Not applicable. |
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6.3.5. Model assumption error | |||
No model is used. |
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6.4. Seasonal adjustment | |||
Not applicable. |
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6.5. Data revision - policy | |||
According to NIS revision policy, revisions for previously transmitted data are sent together with data for the reporting year. |
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6.6. Data revision - practice | |||
According to NIS revision policy, revisions for previously transmitted data are sent together with data for the reporting year. |
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6.6.1. Data revision - average size | |||
The last revision was transmitted in 2019 for the period 2011-2016. The revisions averaged -0.02% for 2014-2016 and represents the exclusions of expenditure for healthcare services of non-residents that were covered by the social health insurance fund. |
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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. |
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7.1.1. Time lag - first result | |||
Romania does not publish first results. |
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7.1.2. Time lag - final result | |||
Final results are published in December for the year T-2. |
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7.2. Punctuality | |||
The National Institute of Romania complies with the Commission Regulation 359/2015 transmission deadlines. |
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7.2.1. Punctuality - delivery and publication | |||
Delivery to Eurostat done by 30 April for T-2. |
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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 | ||||||||||||
With the few exceptions mentioned, data series are comparable for 2011 to 2017 reference years. |
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8.3. Coherence - cross domain | ||||||||||||
Although SHA and ESSPROS data intersect in respect to the data sources used (allowances for persons accompanying the severe visual impairment, general government and social health insurance scheme, expenditure in the elderly persons residential homes and residential units for persons with disabilities), the compilation of the two are different. The ESSPROS and SHA teams are colaborating and identified the intersections of the two datasets. |
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8.4. Coherence - sub annual and annual statistics | ||||||||||||
Not applicable. |
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8.5. Coherence - National Accounts | ||||||||||||
The SHA and National Accounts data are mostly comparable regarding COFOG total expenditure, differences appear in the COFOG structures as SHA is compiled (for HF.1.1 and HF.1.2) in a bottom-up approach. This leads to some differences in the distribution in COFOG categories. Other differences comes from the broader scope of the SHA leading to the inclusion of health related expenditure in social residential institutions, of occupational healthcare expenditure. |
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8.6. Coherence - internal | ||||||||||||
Internal consistency of the data is checked with the tools provided by Eurostat but NIS Romania also performs checks of the datasets used for every scheme (see point 3.4). |
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9.1. Dissemination format - News release | |||
The Healthcare Expenditure Accounts data are not included in a news release. |
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9.2. Dissemination format - Publications | |||
The Healthcare Expenditure Accounts are disseminated through an annual publication, "The System of Health Accounts in Romania", in December of year T for the year of reference T-2. The publication include T-2 data tables and analysis of data trends in the period of available SHA data. Also, a methodological analysis of SHA and national sources and data used for compilation is included. http://www.insse.ro/cms/ro/content/studiu-sistemul-conturilor-de-s%C4%83n%C4%83tate-%C3%AEn-rom%C3%A2nia (only available in Romanian) |
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9.3. Dissemination format - online database | |||
SHA data is not available in the NIS online database. Users are directed to the online publication or Eurostat database. |
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9.3.1. Data tables - consultations | |||
The number of consultations of the online publication is not currently available. |
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9.4. Dissemination format - microdata access | |||
Not applicable. |
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9.5. Dissemination format - other | |||
Indicators based on SHA data are published in the Annual Report on the Implementation of the National Health Strategy (http://www.ms.ro/wp-content/uploads/2016/10/Raport-Implementare-SNS-2015.pdf). |
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9.6. Documentation on methodology | |||
Methodological description of the compilation of SHA data is included in the annual publication "The System of Health Accounts in Romania". |
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9.7. Quality management - documentation | |||
Specifications on data sources, data management are available in the publication "The System of Health Accounts in Romania" (see point 9.2) and in the metadata available on Eurostat database. |
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9.7.1. Metadata completeness - rate | |||
The metadata on Eurostat database includes the specifications of data sources and estimations used in compiling the SHA tables. |
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9.7.2. Metadata - consultations | |||
NIS does not have information regarding consultations of the SHA metadata. |
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In the reference period the Health Expenditure Accounts were compiled, at NIS level, by 2 experts. |
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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 | |||
The Health Expenditure Accounts uses aggregated and public available data (healthcare units and survey data) and no personal information is used thus no confidentiality procedures are applied. |
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NPISH financing schemes are underestimated: expenditures included represent funds identified in the activities reports, available to the public, of the main fundations and non-profit associations which conducts health activities in Romania. Expenditures for laboratory services (HF.1.1 and HF.3.1) could include imaging services that cannot be identified. |
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