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For any question on data and metadata, please contact: Eurostat user support |
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1.1. Contact organisation | Statistics Sweden |
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1.2. Contact organisation unit | National Accounts Department |
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1.5. Contact mail address | Statistics Sweden National Accounts Department Public Finance and Microsimulations SE-70189 Örebro, Sweden |
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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 | |||
2001 - 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 2019): - Surveys/census: 3 - Public administrative records: 2 - Financial reports: 2 - Other/National Account data: 7
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. The Swedish SHA data are to almost 100 percent based on official National Accounts data. To be able to report the data at SHA codes, National Accounts data needs to be distributed by keys. For the largest part of the expenditure the county councils annual accounts can be used. Those annual accounts are collected by Statistics Sweden for the purpose of National Accounts. |
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3.4. Data validation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
The 2019 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 adition to the validation performed by using the tools provided by JHAQ, Statistics Sweden perform a number of validation steps at an earlier stage. Time series for each calculation step are analysed for trends, growth rates and anomalies. Consistency between dimensions is achieved as each single calculation is coded with all three corresponding dimensions. Results of years that are not re-transmitted 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. |
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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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Not applicable. |
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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. The overall guidelines for Statistics Sweden’s quality management are described in Statistics Sweden’s quality policy. The quality policy covers statistical output, process and organisational quality. Statistical quality Issues related to the quality of the statistics and how it can be improved have always been central to Statistics Sweden. Information on the quality of the statistics to the users of the statistics is reported for the quality components relevance, accuracy, timeliness and punctuality, availability and clarity as well as comparability and coherence. These quality components are described in the quality handbook. In cooperation with international experts, Statistics Sweden has developed a system to evaluate the quality of the statistics. The evaluations are applied to Statistics Sweden’s most important statistical outputs. Process quality Statistics Sweden produces statistics in a process-oriented manner and increasingly uses standardised operating procedures, methods and tools. These are described in an internal information and support system. In March 2014, Statistics Sweden became certified according to the Standards ISO 20252 for Market, opinion and social research. The certification confirms that Statistics Sweden meets the fundamental quality requirements in the production of statistics. Statistics Sweden is conducting regular internal quality audits to validate and provide a basis for improvements in its operations. Organisational quality The framework consists of Statistics Sweden’s management process, which takes its starting point in how external requirements and requests are handled until finalised by external reporting. Planning and follow-up of operations, finances, and human resources as well as risk management ensure that the agency meets the goals and solves the task that are ultimately governed by the Directive and Appropriations instructions. Principles and guidelines for statistics work Statistics Sweden meets the UN Fundamental Principles for Official Statistics, and its operations are conducted in line with the International Statistical Institute’s (ISI) Declaration on Professional Ethics and the Swedish Statistical Association’s code of ethics for statisticians and statistical operations. Statistics Sweden complies with the European Statistics Code of Practice, which is the cornerstone of the common quality framework of the European statistical system. The Code of Practice contains principles covering the institutional environment, statistical processes and statistical outputs. How the quality is organised Statistics Sweden’s managers are responsible for the quality work at each unit and department. The heads of each department are assisted by a quality coach, who works part-time to support managers and employees on quality issues. Statistics Sweden’s quality manager is in charge of evaluating the quality management system and coordinating the internal quality audits.
https://www.scb.se/en/About-us/main-activity/quality-work/
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4.2. Quality management - assessment | |||
The quality of the Swedish Health Accounts can be considered high. For a smaller part of the Swedish Health Accounts model assumptions are being used, for example occupational health care. |
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5.1. Relevance - User Needs | |||
Main national users of SHA data in Sweden are: -Swedish Association of Local Authorities and Regions (SALAR) wich is an organisation that represents and advocates for local government in Sweden. All of Sweden's municipalities, county councils and regions are members of SALAR. -The National Board of Health and Welfare wich is a government agency under the Ministry of Health and Social Affairs, with a very wide range of activities and many different duties within the fields of social services, health and medical services, patient safety and epidemiology. -The Ministry of Health and Social Affairs. |
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5.2. Relevance - User Satisfaction | |||
Statistics Sweden does not perform any user satisfaction surveys to determine user satisfaction.
Within the framework of the Swedish Health Accounts, there is an ongoing dialogue with the main users where knowledge and experience are being exchanged.
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5.3. Completeness | |||
Data are complete as far as the Commission regulation is applicable. |
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5.3.1. Data completeness - rate | |||
All of the for Sweden relevant data cells according to the regulation are complete. For some of the data cells outside the regulation data is missing. For example HF.3.1 Out-of-pocket excluding cost-sharing and HF.3.2 Cost-sharing with third-party payers are missing and instead reported under HF.3 Household out-of-pocket payment. |
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6.1. Accuracy - overall | |||
The Swedish Health Accounts are based almost exclusively on the National Accounts. In the National Account the largest proportion of the healthcare expenditure arise from the public sector which, in turn, are to a large extent examined through census. Therefore, the overall accuracy of the Swedish Health Accounts can be considered to be high. |
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6.2. Sampling error | |||
For the compilation of the Swedish Health Accounts, surveys are not directly used. Government consumption calculations are the main source of the Health Accounts. Since these are largely based on census, this source does not contribute to uncertainty. |
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6.2.1. Sampling error - indicators | |||
Not applicable. |
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6.3. Non-sampling error | |||
For the compilation of the Swedish Health Accounts, surveys are not directly used. |
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6.3.1. Coverage error | |||
The under- and over-covering that can occur is considered small and does not have any significant impact on reliability.
Underground/informal/illegal health services are included.
We are not able to exclude health care goods and services consumed by non-residents.
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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 | |||
The Swedish Health Accounts data are based almost exclusively on the National Accounts. A large part, government consumption, is made through the compilation of the National Accounts. The collection of National Account data takes place in different ways. Data regarding central government and social security funds is collected from the Financial Management Agency. The measurement errors are probably minimal in this collection even if there is no documentation that substantiates this. For data relating to the municipalities and county councils, the annual accounts are used as a source. The annual accounts have a high level of detail and are extensive and complex to fill in, which can entail some risk of measurement errors.
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6.3.3. Non response error | |||
All government agencies, municipalities and county councils submit data to the National Accounts and unit non-response is very rare. Item non-response may, however, occur, especially when individual respondents have not been able to specify the level of detail requested.
Overall, the non-response is considered to be very limited and does not significantly affect the reliability of the Swedish Health Accounts. |
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6.3.3.1. Unit non-response - rate | |||
All government agencies, municipalities and county councils submit data to the National Accounts and unit non-response is very rare.
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6.3.3.2. Item non-response - rate | |||
Item non-response may, however, occur, especially when individual respondents have not been able to specify the level of detail requested. |
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6.3.4. Processing error | |||
Data from government agencies is reviewed by the Swedish Financial Management Agency. Municipalities and county councils examine the data when they are compiling the data. Statistics Sweden then examines the material received at both micro and macro levels.
The collected material for the National Accounts is extensive and it is not possible to examine all the data equally carefully. |
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6.3.4.1. Imputation - rate | |||
Not applicable. |
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6.3.5. Model assumption error | |||
Model assumptions are only used for a small part of the Swedish Health Accounts. It is prevalent in the area of occupational health care, health care in the correctional services and for private health insurance. The uncertainty due to model assumptions has not yet been quantified. |
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6.4. Seasonal adjustment | |||
Not applicable. |
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6.5. Data revision - policy | |||
General publication strategy or the National Accounts: In year t (2019): Preliminary estimates for year t-1 (2018) are published in February of year t (2019). |
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6.6. Data revision - practice | |||
The data for 2017 are to be considered as preliminary and will be revised next year due to definitive National Account data for 2017 that will then be available. According to the same approach the estimates for 2016 are now revised and is considered to be final. The total health expenditure for the year 2016 was revised by 298 MSEK. It was largely due to revisions in HF.1 Government schemes, -777 MSEK and in HF.3 Household OOP, 395 MSEK. |
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6.6.1. Data revision - average size | |||
In 2019 JHAQ the total health expenditure for the year 2016 was revised by 298 MSEK. It was largely due to revisions in HF.1 Government schemes, -777 MSEK and in HF.3 Household OOP, 395 MSEK. |
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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 | |||
At an aggregated level the first result are published 3 months after the end of the reference year. At a more detailed level the results are published 15 months after the end of the reference year. |
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7.1.2. Time lag - final result | |||
Final results at detailed level are published 27 months after the end of the reference year. |
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7.2. Punctuality | |||
The data was delivered according to the voluntary deadline. |
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7.2.1. Punctuality - delivery and publication | |||
The data are delivered to Eurostat according to the voluntary deadline. At the same day as the transmission takes place national publications are published at www.scb.se/nr0109. |
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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 data in the Swedish Health Accounts according to SHA2011 are comparable at all levels from 2011 onwards. Time series are calculated back to 2001.
Data regarding Health care function (ICHA-HC) are comparable back to 2001 for all purposes except for HC.3, long-term care and health care services, and its sub-levels. HC.3, long-term care and health care services, and its sub-levels are comparable from 2011. The data on healthcare financing schemes (ICHA-HF) are comparable at all levels back to 2001.
Data on Health care providers (ICHA-HP) are comparable back to 2011.
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8.3. Coherence - cross domain | ||||||||||||
Both SHA and ESSPROS are compiled at Statistics Sweden, however SHA and ESSPROS are based on different underlying concepts as e.g. SHA is based on final consumption whereas ESSPROS is based on total expenditure. A full coherence between these different approaches are therefore not feasible. However, for some parts of SHA and ESSPROS where both are using the final consumption from the National Accounts coherence is achieved. |
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8.4. Coherence - sub annual and annual statistics | ||||||||||||
Not applicable. |
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8.5. Coherence - National Accounts | ||||||||||||
Since the Swedish Health Accounts are a refinement of the National Accounts, both of these calculations are consistent to a large amount.
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8.6. Coherence - internal | ||||||||||||
The data is consistent between the core-tables. |
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9.1. Dissemination format - News release | |||
The results are published annually at Statistics Sweden´s website, both as a "Statistical news" (text) and as tables in the statistical database.
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9.2. Dissemination format - Publications | |||
No publication is published. |
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9.3. Dissemination format - online database | |||
The data is available in the statistical database at Statistics Sweden website, https://www.scb.se/en/finding-statistics/statistics-by-subject-area/national-accounts/national-accounts/system-of-health-accounts-sha/ |
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9.3.1. Data tables - consultations | |||
Information not available. |
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9.4. Dissemination format - microdata access | |||
Not applicable. |
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9.5. Dissemination format - other | |||
Data from the Swedish Health Accounts are used in several national publication. Examples of national publications are "Ett tandvårdssystem för jämlik tandhälsa" https://www.regeringen.se/493a2e/contentassets/143410af196646079e141bff42d428db/ett-tandvardssystem-for-jamlik-tandhalsa-dir-2018_16.pdf , "Öppna jämförelser 2017 En god vård?" https://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/20804/2018-1-4.pdf |
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9.6. Documentation on methodology | |||
Documentation regarding the Swedish Health Accounts are published annualy at www.scb.se/nr0109 (in Swedish) according to the quality policy of Statistics Sweden. |
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9.7. Quality management - documentation | |||
The quality report for the Swedish Health Accounts are published annualy at www.scb.se/nr0109 (in Swedish) according to the quality policy of Statistics Sweden. |
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9.7.1. Metadata completeness - rate | |||
Information not available. |
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9.7.2. Metadata - consultations | |||
Information not available. |
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Since the Swedish Health Accounts Data are based almost entirely on official National Accounts data the response burden for compiling this data is close to non-existent. In terms of resources Statistics Sweden allocates approximately 560 hours per year to the production of the Swedish Health Accounts. |
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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.
For statistics included in Sweden's official statistics (SOS), special rules apply to quality and accessibility, see the Official Statistics Act (2001: 99), the Official Statistic Ordinance (2001: 100) on the official statistics and Statistics Sweden's regulations on quality in official statistics (SCB-FS 2016: 17).
As of 30 June 2009, confidentiality apply according to chapter 24 section 8 of The Public Access to Information and Secrecy Act (2009: 400). Prior to that, confidentiality was in accordance with chapter 9 section 4 of The Secrecy Act 1980: 100. The statistics only include aggregated data for which no special privacy rules apply. In the case of automated processing of personal data, the rules in the General Data Protection Regulation (2016/679) apply. No personal data is included in the statistics register.
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11.2. Confidentiality - data treatment | |||
The Swedish Health Accounts are based on aggregated data, mainly from the National Accounts, or data without direct personal reference. Since only aggregated data or statistics without direct personal reference are used no additional confidentiality procedures are applied. |
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The Swedish Health Accounts data are based almost exclusively on the National Accounts. |
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