Reference metadata describe statistical concepts and methodologies used for the collection and generation of data. They provide information on data quality and, since they are strongly content-oriented, assist users in interpreting the data. Reference metadata, unlike structural metadata, can be decoupled from the data.
Eurostat, the statistical office of the European Union
1.2. Contact organisation unit
F5: Education, health and social protection
1.3. Contact name
Confidential because of GDPR
1.4. Contact person function
Confidential because of GDPR
1.5. Contact mail address
2920 Luxembourg LUXEMBOURG
1.6. Contact email address
Confidential because of GDPR
1.7. Contact phone number
Confidential because of GDPR
1.8. Contact fax number
Confidential because of GDPR
2.1. Metadata last certified
5 November 2025
2.2. Metadata last posted
5 November 2025
2.3. Metadata last update
5 November 2025
3.1. Data description
Health care expenditure quantifies the economic resources dedicated to health functions, excluding capital investment. Health care expenditure covers health care 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 health care goods and services (to non-resident units) are excluded, whereas imports of health care goods and services for final use are included.
Health care expenditure data provide information on expenditure broken down by function category (e.g. services of curative care, rehabilitative care, clinical laboratory, patient transport, prescribed medicines), provider category (e.g. hospitals, general practitioners) and financing scheme (e.g. social security, private insurance company, household). These categories form the 3 core classifications of the System of Health Accounts.
The complementary classification for the revenues broken down by health care financing schemes is also disseminated by Eurostat.
health care expenditure by provider (ICHA-HP) — which classifies units contributing to the provision of health care goods and services — such as hospitals, residential facilities, ambulatory health care services, ancillary services or retailers of medical goods;
health care expenditure by function (ICHA-HC) — which details the split in health care expenditure following the purpose of health care activities — such as curative care, rehabilitative care, long-term care, or preventive care;
health care 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;
revenues of health care financing schemes (ICHA-FS) — which details the sources from which the financing arrangements get their revenues.
3.3. Coverage - sector
Public Health
3.4. Statistical concepts and definitions
Health care expenditure statistics describe the process of providing and financing health care in countries by referring to final consumption of 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. The SHA shares the goals of the System of National Accounts (SNA) to constitute an integrated system of comprehensive, internally consistent, and internationally comparable accounts, which should as far as possible be compatible with other economic and social statistical systems. Commission Regulation (EU) 2021/1901 provides a list of mandatory items, a more detailed list of voluntary breakdowns can be found in the SHA Manual.
The SHA is organised around a tri-axial system - which represents the consumption of health care goods and services - for the recording of health expenditure, by means of the International Classification for Health Accounts (ICHA), defining:
health care by function (ICHA-HC);
health care service provider industries (ICHA-HP); and
health care financing scheme (ICHA-HF).
To extend the core accounting framework of SHA, complementary classifications can be linked to one of the three above-mentioned axes. Eurostat disseminates the additional classification related to the revenues of health care financing schemes (ICHA-FS). These data are provided by countries on a voluntary basis.
Health care functions
Health care functions mean the type of need that health care goods and services aim to satisfy or the kind of health objective pursued. The following main items are defined as:
'inpatient curative and rehabilitative care': 'inpatient care' means the treatment and/or care provided in a health care facility to patients formally admitted and requiring an overnight stay; 'curative care' means the health care services during which the principal intent is to relieve symptoms or to reduce the severity of an illness or injury, or to protect against its exacerbation or complication that could threaten life or normal function; 'rehabilitative care' means the services to stabilise, improve or restore impaired body functions and structures, compensate for the absence or loss of body functions and structures, improve activities and participation and prevent impairments, medical complications and risks;
'day curative and rehabilitative care': 'day care' means the planned medical and paramedical services delivered in a health care facility to patients who have been formally admitted for diagnosis, treatment or other types of health care and are discharged on the same day; 'curative care' means the health care services during which the principal intent is to relieve symptoms or to reduce the severity of an illness or injury, or to protect against its exacerbation or complication that could threaten life or normal function; 'rehabilitative care' means the services to stabilise, improve or restore impaired body functions and structures, compensate for the absence or loss of body functions or structures, improve activities and participation and prevent impairments, medical complications and risks;
'outpatient curative and rehabilitative care': 'outpatient care' means the medical and ancillary services delivered in a health care facility to a patient who is not formally admitted and does not stay overnight; 'curative care' means the healthcare services during which the principal intent is to relieve symptoms or to reduce the severity of an illness or injury, or to protect against its exacerbation or complication that could threaten life or normal function; 'rehabilitative care' means the services to stabilise, improve or restore impaired body functions and structures, compensate for the absence or loss of body functions and structures, improve activities and participation and prevent impairments, medical complications and risks;
'home-based curative and rehabilitative care': 'home-based care' means the medical, ancillary and nursing services that are consumed by patients at their home and involve the providers' physical presence; 'curative care' means the healthcare services during which the principal intent is to relieve symptoms or to reduce the severity of an illness or injury, or to protect against its exacerbation or complication that could threaten life or normal function; 'rehabilitative care' means the services to stabilise, improve or restore impaired body functions and structures, compensate for the absence or loss of body functions and structures, improve activities and participation and prevent impairments, medical complications and risks;
'inpatient long-term care (health)': 'inpatient care' means the treatment and/or care provided in a health care facility to patients formally admitted and requiring an overnight stay; 'long-term care (health)' means a range of medical or nursing care and personal care services providing help with activities of daily living that are consumed with the primary goal of alleviating pain and suffering and reducing or managing the deterioration in health status in patients with a degree of long-term dependency;
'day long-term care (health)': 'day care' means the planned medical and paramedical services delivered in a health care facility to patients who have been formally admitted for diagnosis, treatment or other types of health care and are discharged on the same day; 'long-term care (health)' means a range of medical or nursing care and personal care services providing help with activities of daily living that are consumed with the primary goal of alleviating pain and suffering and reducing or managing the deterioration in health status in patients with a degree of long-term dependency;
'outpatient long-term care (health)': 'outpatient care' means the medical and ancillary services delivered in a health care facility to a patient who is not formally admitted and does not stay overnight; 'long-term care (health)' means a range of medical or nursing care and personal care services providing help with activities of daily living that are consumed with the primary goal of alleviating pain and suffering and reducing or managing the deterioration in health status in patients with a degree of long-term dependency;
'home-based long-term care (health)': 'home-based care' means the medical, ancillary and nursing services that are consumed by patients at their home and involve the providers' physical presence; 'long-term care (health)' means a range of medical or nursing care and personal care services providing help with activities of daily living that are consumed with the primary goal of alleviating pain and suffering and reducing or managing the deterioration in health status in patients with a degree of long-term dependency;
'ancillary services (non-specified by function)': means the health care or long-term care related services non-specified by function and non-specified by mode of provision, which the patient consumes directly, in particular during an independent contact with the health system and that are not an integral part of a care service package, such as laboratory or imaging services or patient transportation and emergency rescue;
'pharmaceuticals and other medical non-durable goods (non-specified by function)': means pharmaceutical products and non-durable medical goods intended for use in the diagnosis, cure, mitigation or treatment of disease, including prescribed medicines and over-the-counter drugs, where the function and mode of provision are not specified;
'therapeutic appliances and other medical goods (non-specified by function)': means medical durable goods including orthotic devices that support or correct deformities and/or abnormalities of the human body, orthopaedic appliances, prostheses or artificial extensions that replace a missing body part, and other prosthetic devices including implants which replace or supplement the functionality of a missing biological structure and medico-technical devices, where the function and the mode of provision are not specified;
'preventive care': means any measure that aims to avoid or reduce the number or the severity of injuries and diseases, their sequelae and complications;
'governance, and health system and financing administration': means services that focus on the health system rather than direct health care, direct and support health system functioning, and are considered to be collective, as they are not allocated to specific individuals but benefit all health system users;
'other health care services not elsewhere classified (n.e.c.)': includes any other health care services not classified in HC.1 to HC.7.
Finally, 'current expenditure on health care' means the final consumption expenditure of resident units on health care goods and services, including the health care goods and services provided directly to individual persons as well as collective health care services.
Health care financing schemes
‘Health care financing schemes’ mean types of financing arrangements through which people obtain health services, including both direct payments by households for services and goods and third-party financing arrangements. The following main items are defined as:
'government schemes': means health care financing schemes whose characteristics are determined by law or by the government and where a separate budget is set for the programme and a government unit that has an overall responsibility for it;
'social health insurance schemes': means a financing arrangement to ensure access to health care for specific population groups through mandatory participation determined by law or by the government, and eligibility based on the payment of health insurance contributions by or on behalf of the individuals concerned;
'compulsory private insurance schemes': means a financing arrangement to ensure access to health care for specific population groups through mandatory participation determined by law or by the government and eligibility based upon the purchase of a health insurance policy;
'voluntary health insurance schemes': means schemes based upon the purchase of a health insurance policy, which is not made compulsory by government and where insurance premiums may be directly or indirectly subsidised by the government;
'non-profit institutions financing schemes': means non-compulsory financing arrangements and programmes with non-contributory benefit entitlement that are based on donations from the general public, the government or corporations;
'enterprise financing schemes': means primarily arrangements where enterprises directly provide or finance health services for their employees without the involvement of an insurance-type scheme;
'household out-of-pocket payment': means a direct payment for health care goods and services from the household primary income or savings, where the payment is made by the user at the time of the purchase of goods or the use of the services;
'rest of the world financing schemes': means financial arrangements involving or managed by institutional units that are resident abroad, but who collect, pool resources and purchase health care goods and services on behalf of residents, without transiting their funds through a resident scheme.
Health care providers
'Health care providers' mean the organisations and actors that deliver health care goods and services as their primary activity, as well as those for which health care provision is only one among a number of activities. The following main items are defined as:
'hospitals': means the licensed establishments that are primarily engaged in providing medical, diagnostic and treatment services that include physician, nursing and other health services to inpatients and the specialised accommodation services required by inpatients and which may also provide day care, outpatient and home health care services;
'residential long-term care facilities': means establishments that are primarily engaged in providing residential long-term care that combines nursing, supervisory or other types of care as required by the residents, where a significant part of the production process and the care provided is a mix of health and social services with the health services being largely at the level of nursing care in combination with personal care services;
'providers of ambulatory health care': means establishments that are primarily engaged in providing health care services directly to outpatients who do not require inpatient services, including both offices of general medical practitioners and medical specialists and establishments specialising in the treatment of day-cases and in the delivery of home care services;
'providers of ancillary services': means establishments that provide specific ancillary type of services directly to outpatients under the supervision of health professionals and not covered within the episode of treatment by hospitals, nursing care facilities, ambulatory care providers or other providers;
'retailers and other providers of medical goods': means establishments whose primary activity is the retail sale of medical goods to the general public for individual or household consumption or utilisation, including fitting and repair done in combination with sale;
'providers of preventive care': means organisations that primarily provide collective preventive programmes and campaigns/public health programmes for specific groups of individuals or the population-at-large, such as health promotion and protection agencies or public health institutes, as well as specialised establishments providing primary preventive care as their principal activity;
'providers of health care system administration and financing': means establishments that are primarily engaged in the regulation of the activities of agencies that provide health care and in the overall administration of the health care sector, including the administration of health financing;
'rest of the economy': means other resident healthcare providers not elsewhere classified, including households as providers of personal home health services to family members, in cases where they correspond to social transfer payments granted for this purpose, as well as all other industries that offer health care as a secondary activity;
'rest of the world providers': means all non-resident units providing health care goods and services, as well as those involved in health-related activities.
Revenues of financing schemes
Revenues are defined as an increase in the funds of a health care financing scheme through specific contribution mechanisms. The categories of the classification are the particular types of transactions through which the financing schemes obtain their revenues. The objective of this classification is to group types of revenues of health financing schemes into mutually exclusive classes. If appropriate, the revenue category has sub-categories that are defined according to who (or which institutional sector) provides the given revenue.
The following main items are defined as:
'transfers from government domestic revenues': funds allocated from government domestic revenues for health purposes;
'transfers distributed by government from foreign origin': transfers originating abroad that are distributed through the general government;
'social insurance contributions': receipts either from employers on behalf of their employees or from employees, the self-employed or non-employed persons on their own behalf that secure entitlement to social health insurance benefits;
'compulsory prepayment': compulsory private insurance premiums paid from the individuals/households, the employers or institutional units to the benefit of compulsory health insurance schemes;
'voluntary prepayment': voluntary private insurance premiums received from the insuree or other institutional units on behalf of the insuree to secure entitlement to benefits of the voluntary health insurance schemes;
'other domestic revenues n.e.c': domestic revenues of financing schemes not included in the above-mentioned categories;
'direct foreign transfers': revenues from foreign entities directly received by the health financing schemes.
Data are disseminated in 4 summary tables (one-dimensional) and 4 cross-classification tables (2-dimensional).
Summary tables provide data on:
Current expenditure by provider (ICHA-HP);
Current expenditure by function (ICHA-HC);
Current expenditure by financing scheme (ICHA-HF);
Revenues of health care financing schemes (ICHA-FS).
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 the different types of services and goods are financed;
HP x HF: Health care expenditure by provider and by financing scheme: data on which health care provider and under which particular financing scheme the services and goods are purchased from;
HF x FS: Revenues of health care financing schemes by health care financing scheme: data on the sources of revenues for each financing scheme.
3.5. Statistical unit
The economy of a country is the outcome of the activity of a very large number of units which carry out numerous transactions of various kinds for purposes of production, finance, insurance, redistribution and consumption. The units and groupings of units used in the accounts must be defined with reference to the kind of economic analysis for which they are intended. To analyse the process of production, it is essential to select units which bring out relationships of a technical-economic nature; to analyse flows affecting financial transactions it is essential to select units which make it possible to study relationships among economic agents.
Statistical and administrative sources refer usually to institutional units active in providing health (care) services to the population. In the description of the financing of health care, the units mainly refer to those involved in the process of paying for the services delivered for consumption. Expenditure refers to the payments related to final consumption of all goods and services by the domestic population (in the majority of countries, health care services provided to foreigners cannot be separated and are included in the domestic consumption).
In the health care expenditure data collection, three approaches are possible. Data collection can be built starting either from the financing side, from the provider side or from the functional side. Depending on the information source available, various elements can be used as statistical unit. It may be an observation unit on which information is received and statistics are compiled, or an analytical unit which statisticians create by splitting or combining observation units with the help of estimations or imputations, in order to supply more detailed and/or homogenous data than would otherwise be possible.
3.6. Statistical population
The data aim at providing a complete overview of expenditure on health care goods and services consumed by the domestic population and produced by providers of health care, from whichever source this consumption is financed.
3.7. Reference area
European Union Member States, EFTA countries (Norway, Liechtenstein, Iceland, Switzerland), Bosnia and Herzegovina, Georgia, Moldova, Montenegro and the Republic of Serbia provide data for Health Care Expenditure. Data for the United Kingdom is disseminated until reference year 2019.
3.8. Coverage - Time
According to the Regulation, the first mandatory transmission was for the reference year 2014. Historical data, subject to gentleman's agreement, was also reported by many countries. However, the availability varies across countries and classifications.
3.9. Base period
Not applicable
Current expenditure data are presented according to the following units:
expenditure amount in millions of euro;
expenditure amount in millions of national currency;
expenditure amount in millions of PPS;
percentage of GDP;
amount in euro per capita;
amount in national currency per capita;
amount in PPS per capita;
percentage of current health expenditure (CHE).
EU aggregates are available from reference year 2014 and for subsequent years when all EU Member States data is disseminated.
Calendar year
6.1. Institutional Mandate - legal acts and other agreements
Countries submit data to Eurostat on the basis of Commission Regulations (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 health care expenditure and financing until the reference year 2020;
2021/1901 of 29 October 2021 implementing Regulation (EC) No 1338/2008 of the European Parliament and of the Council as regards statistics on health care expenditure and financing for which the first reference year will be in 2021.
The implementing Regulations specify the areas and the level of aggregation to be submitted by EU Member States and EEA countries (see Annex II of the Regulation).
6.2. Institutional Mandate - data sharing
Data collection takes place in agreement with the World Health Organisation (WHO) and the Organization of Economic Co-operation and Development (OECD).
7.1. Confidentiality - policy
Regulation (EC) No 223/2009 on European statistics (recital 24 and Article 20(4)) of 11 March 2009 (OJ L 87, p. 164), stipulates the need to establish common principles and guidelines, ensuring the confidentiality of data used for the production of European statistics and the access to those confidential data with due account for technical developments and the requirements of users in a democratic society.
7.2. Confidentiality - data treatment
Not applicable.
8.1. Release calendar
The voluntary release date for SHA data is 15 November t+2. The dissemination of data in Eurobase is complemented by the release of related News Items and Statistics Explained articles.
8.2. Release calendar access
Not applicable.
8.3. Release policy - user access
In line with the Community legal framework and the European Statistics Code of Practice, and respecting professional independence, Eurostat disseminates European statistics on Eurostat's website (see item 10 - 'Accessibility and clarity') in an objective, professional and transparent manner in which all users are treated equitably. The detailed arrangements are governed by the Eurostat protocol on impartial access to Eurostat data for users.
Annual.
Data is disseminated country by country once the data has been fully validated by Eurostat.
the national quality reports (see top of the page);
the methodological information per country available in Annex (updated every year).
10.7. Quality management - documentation
National quality reports have been disseminated in accordance with article 8 of the Regulation (EC) No 1338/2008 of the European Parliament and of the Council of 16 December 2008 on Community statistics on public health and health and safety at work.
Accordingly, national quality reports have been published at the latest on 27 March 2025.
11.1. Quality assurance
Eurostat and the National authorities responsible for the SHA data collection are working to ensure that the statistical practices used to compile national health accounts are in compliance with the SHA methodological requirements, as well as that good practices in the field are being followed, according to the methodology underlined in the SHA 2011 Manual.
11.2. Quality management - assessment
The quality of the data is influenced by the statistical production process implemented at country level, by the organisation and articulation of each national health care system and by the data sources available at national level.
Member States and Eurostat are continuously working to maintain and improve the quality and the comparability of SHA data. In line with Article 8 of the Regulation (EC) No 1338/2008 of the European Parliament and of the Council of 16 December 2008 on Community statistics on public health and health and safety at work, Member States have transmitted to Eurostat a report on the quality of their data (individual reports are available at the top of the page).A consolidated quality report on healthcare expenditure and financing statistics — 2020 edition has also been published.
12.1. Relevance - User Needs
Health accounts are increasingly expected to provide inputs (along with other statistical information) into improved analytical tools to monitor and assess health system performance. One high priority is to develop reliable, timely data that is comparable both across countries and over time. This is indispensable for tracking trends in health spending and the factors driving it, which can in turn be used to compare it across countries and to project how it will grow in the future.
Health accounts are thus used in two main ways: internationally, where the emphasis is on a selection of internationally comparable expenditure data, and nationally, with more detailed analyses of health care spending and a greater emphasis on comparisons over time. Health accounts are crucial for both of these.
The data is used in multiple publications and policy approaches. A key publication is ‘Health at a glance: Europe 2024’ from OECD, which discusses major challenges facing European health systems, like the labour shortage, as well as an ageing population. Discussions on these issues are impossible without health accounts data. Other key publications using health accounts data are for example the health annex to the European Semester, the European Care Strategy and the Ageing report.
12.2. Relevance - User Satisfaction
Not available.
12.3. Completeness
All the information as required by the Regulations (see point 6.1) has been disseminated by Eurostat.
13.1. Accuracy - overall
Accuracy of SHA data is linked to and depends on the accuracy of the data received from the countries. Data sources are mainly administrative and register-based data, only a small percentage of the figures come from surveys or other sources. Accordingly, for SHA data collection, accuracy deals with problems of coverage as the main possible source of errors. For the detailed information on sources used by countries see the countries' Methodological information in the Annex.
13.2. Sampling error
Not applicable.
13.3. Non-sampling error
Not applicable.
14.1. Timeliness
Member States are required to transmit their data to Eurostat in compliance with the Commission Regulation 359/2015 transmission deadlines.
Data and reference metadata for the reference year N shall be transmitted to Eurostat by 30 April N+2. Preliminary data for the year N+1 is transmitted by some Member States on a voluntary basis.
14.2. Punctuality
Nearly all countries participating to SHA data collections are currently able to meet the legal deadlines for transmissions of data and metadata (see paragraph 14.1, as reference).
15.1. Comparability - geographical
The comparability is insured by the application of common definitions (System of Health Accounts SHA2011).
By using a common framework, i.e. the System of Health Accounts SHA2011, data can be comparable over time.
For countries that provide only short time series, it is difficult to determine the comparability over time.
More detailed information on country-specific comparability issues is provided in the Methodological Information of each country in the Annex.
15.3. Coherence - cross domain
None.
15.4. Coherence - internal
The data are consistent. Internal consistency checks include investigating the consistency of the data between tables, the consistency of the data within tables (including the checking of the presence of negative values and/or atypical entries), the growth rate against the previous year and the magnitude of revisions as compared to previously submitted data.
Not available.
17.1. Data revision - policy
The general Eurostat revision policy applies to this domain.
National data are revised according to national schedules (see methodological information per country in the Annex and in the national quality reports).
In general, methodological improvements apply to the total time span for most countries, while punctual data corrections could occur (new data sources, updated statistical information based on surveys or administrative sources, errors discovered in the data compilation). When a new source for information is identified and used, the data for previous years are revised, if possible. The revisions of the National Accounts data could also trigger possible revisions.
Revisions are applied to Eurostat's online database as soon as they become available to Eurostat.
17.2. Data revision - practice
All reported errors (once validated) result in corrections of the disseminated data.
Reported errors that are deemed to be significant are corrected in the disseminated data as soon as the correct data have been validated. Corrections for other errors are carried out in connection with the regular scheduled data dissemination.
Data are only published once they are deemed to be sufficiently complete for all data providers.
New data are only used to update disseminated data if provided according to the provision schedule set by Eurostat, or in the case of reported errors.
In case a country sends new data for previous years, the data set for this country is updated.
18.1. Source data
Data are collected through the joint health accounts questionnaire (JHAQ) that countries submit to Eurostat during the annual data collection exercise. To compile the JHAQ, countries use data from their national health accounts registries, which comprise, but are not limited to, data that are based on different statistical sources:
specific surveys performed for health care activities;
household budget survey;
administrative sources (registers);
data collected for the purpose of national accounts;
data information systems available in health (and other) ministries / departments as well as other agencies involved in health care.
The different sources may lead to differences in the coverage of the time series, data validity, reliability and comparability. Furthermore, it may not always be possible to have the health care system being consistently defined across data sources.
For expenditure calculated as share of GDP, the national GDP in euro as available in the EUROSTAT database is used. Expenditure per capita is calculated using the corresponding national (average) population data. Expenditure data expressed in PPS is calculated using the corresponding national data as collected by the National Accounts department in EUROSTAT.
Please note that some of the data sources used nationally may not have been initially intended to be used for statistical purposes, and that the initial purpose of a data source may differ across countries. Both facts may influence the comparability of results.
18.2. Frequency of data collection
Annual.
18.3. Data collection
Data are collected through the joint health accounts questionnaire (JHAQ) that countries submit to Eurostat during the annual data collection exercise.
18.4. Data validation
Consistency checks are carried out in co-operation with OECD and WHO. Principally, the consistency of all the subtotals at all levels of aggregation are checked against the relevant totals. All identical items are checked for consistency across the various tables. Plausibility of values is checked (as far as possible) against the documentation provided in the metadata and, if possible, against other countries. Also, the development over time is checked for consistency (e.g. against the metadata provided by the country).
18.5. Data compilation
All transactions are to be calculated on accrual principles, meaning that the expenditure data relate to all transactions or activities carried out during the calendar year for which data are reported, irrespective of the date of payment for these services.
Health care expenditure quantifies the economic resources dedicated to health functions, excluding capital investment. Health care expenditure covers health care 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 health care goods and services (to non-resident units) are excluded, whereas imports of health care goods and services for final use are included.
Health care expenditure data provide information on expenditure broken down by function category (e.g. services of curative care, rehabilitative care, clinical laboratory, patient transport, prescribed medicines), provider category (e.g. hospitals, general practitioners) and financing scheme (e.g. social security, private insurance company, household). These categories form the 3 core classifications of the System of Health Accounts.
The complementary classification for the revenues broken down by health care financing schemes is also disseminated by Eurostat.
5 November 2025
Health care expenditure statistics describe the process of providing and financing health care in countries by referring to final consumption of 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. The SHA shares the goals of the System of National Accounts (SNA) to constitute an integrated system of comprehensive, internally consistent, and internationally comparable accounts, which should as far as possible be compatible with other economic and social statistical systems. Commission Regulation (EU) 2021/1901 provides a list of mandatory items, a more detailed list of voluntary breakdowns can be found in the SHA Manual.
The SHA is organised around a tri-axial system - which represents the consumption of health care goods and services - for the recording of health expenditure, by means of the International Classification for Health Accounts (ICHA), defining:
health care by function (ICHA-HC);
health care service provider industries (ICHA-HP); and
health care financing scheme (ICHA-HF).
To extend the core accounting framework of SHA, complementary classifications can be linked to one of the three above-mentioned axes. Eurostat disseminates the additional classification related to the revenues of health care financing schemes (ICHA-FS). These data are provided by countries on a voluntary basis.
Health care functions
Health care functions mean the type of need that health care goods and services aim to satisfy or the kind of health objective pursued. The following main items are defined as:
'inpatient curative and rehabilitative care': 'inpatient care' means the treatment and/or care provided in a health care facility to patients formally admitted and requiring an overnight stay; 'curative care' means the health care services during which the principal intent is to relieve symptoms or to reduce the severity of an illness or injury, or to protect against its exacerbation or complication that could threaten life or normal function; 'rehabilitative care' means the services to stabilise, improve or restore impaired body functions and structures, compensate for the absence or loss of body functions and structures, improve activities and participation and prevent impairments, medical complications and risks;
'day curative and rehabilitative care': 'day care' means the planned medical and paramedical services delivered in a health care facility to patients who have been formally admitted for diagnosis, treatment or other types of health care and are discharged on the same day; 'curative care' means the health care services during which the principal intent is to relieve symptoms or to reduce the severity of an illness or injury, or to protect against its exacerbation or complication that could threaten life or normal function; 'rehabilitative care' means the services to stabilise, improve or restore impaired body functions and structures, compensate for the absence or loss of body functions or structures, improve activities and participation and prevent impairments, medical complications and risks;
'outpatient curative and rehabilitative care': 'outpatient care' means the medical and ancillary services delivered in a health care facility to a patient who is not formally admitted and does not stay overnight; 'curative care' means the healthcare services during which the principal intent is to relieve symptoms or to reduce the severity of an illness or injury, or to protect against its exacerbation or complication that could threaten life or normal function; 'rehabilitative care' means the services to stabilise, improve or restore impaired body functions and structures, compensate for the absence or loss of body functions and structures, improve activities and participation and prevent impairments, medical complications and risks;
'home-based curative and rehabilitative care': 'home-based care' means the medical, ancillary and nursing services that are consumed by patients at their home and involve the providers' physical presence; 'curative care' means the healthcare services during which the principal intent is to relieve symptoms or to reduce the severity of an illness or injury, or to protect against its exacerbation or complication that could threaten life or normal function; 'rehabilitative care' means the services to stabilise, improve or restore impaired body functions and structures, compensate for the absence or loss of body functions and structures, improve activities and participation and prevent impairments, medical complications and risks;
'inpatient long-term care (health)': 'inpatient care' means the treatment and/or care provided in a health care facility to patients formally admitted and requiring an overnight stay; 'long-term care (health)' means a range of medical or nursing care and personal care services providing help with activities of daily living that are consumed with the primary goal of alleviating pain and suffering and reducing or managing the deterioration in health status in patients with a degree of long-term dependency;
'day long-term care (health)': 'day care' means the planned medical and paramedical services delivered in a health care facility to patients who have been formally admitted for diagnosis, treatment or other types of health care and are discharged on the same day; 'long-term care (health)' means a range of medical or nursing care and personal care services providing help with activities of daily living that are consumed with the primary goal of alleviating pain and suffering and reducing or managing the deterioration in health status in patients with a degree of long-term dependency;
'outpatient long-term care (health)': 'outpatient care' means the medical and ancillary services delivered in a health care facility to a patient who is not formally admitted and does not stay overnight; 'long-term care (health)' means a range of medical or nursing care and personal care services providing help with activities of daily living that are consumed with the primary goal of alleviating pain and suffering and reducing or managing the deterioration in health status in patients with a degree of long-term dependency;
'home-based long-term care (health)': 'home-based care' means the medical, ancillary and nursing services that are consumed by patients at their home and involve the providers' physical presence; 'long-term care (health)' means a range of medical or nursing care and personal care services providing help with activities of daily living that are consumed with the primary goal of alleviating pain and suffering and reducing or managing the deterioration in health status in patients with a degree of long-term dependency;
'ancillary services (non-specified by function)': means the health care or long-term care related services non-specified by function and non-specified by mode of provision, which the patient consumes directly, in particular during an independent contact with the health system and that are not an integral part of a care service package, such as laboratory or imaging services or patient transportation and emergency rescue;
'pharmaceuticals and other medical non-durable goods (non-specified by function)': means pharmaceutical products and non-durable medical goods intended for use in the diagnosis, cure, mitigation or treatment of disease, including prescribed medicines and over-the-counter drugs, where the function and mode of provision are not specified;
'therapeutic appliances and other medical goods (non-specified by function)': means medical durable goods including orthotic devices that support or correct deformities and/or abnormalities of the human body, orthopaedic appliances, prostheses or artificial extensions that replace a missing body part, and other prosthetic devices including implants which replace or supplement the functionality of a missing biological structure and medico-technical devices, where the function and the mode of provision are not specified;
'preventive care': means any measure that aims to avoid or reduce the number or the severity of injuries and diseases, their sequelae and complications;
'governance, and health system and financing administration': means services that focus on the health system rather than direct health care, direct and support health system functioning, and are considered to be collective, as they are not allocated to specific individuals but benefit all health system users;
'other health care services not elsewhere classified (n.e.c.)': includes any other health care services not classified in HC.1 to HC.7.
Finally, 'current expenditure on health care' means the final consumption expenditure of resident units on health care goods and services, including the health care goods and services provided directly to individual persons as well as collective health care services.
Health care financing schemes
‘Health care financing schemes’ mean types of financing arrangements through which people obtain health services, including both direct payments by households for services and goods and third-party financing arrangements. The following main items are defined as:
'government schemes': means health care financing schemes whose characteristics are determined by law or by the government and where a separate budget is set for the programme and a government unit that has an overall responsibility for it;
'social health insurance schemes': means a financing arrangement to ensure access to health care for specific population groups through mandatory participation determined by law or by the government, and eligibility based on the payment of health insurance contributions by or on behalf of the individuals concerned;
'compulsory private insurance schemes': means a financing arrangement to ensure access to health care for specific population groups through mandatory participation determined by law or by the government and eligibility based upon the purchase of a health insurance policy;
'voluntary health insurance schemes': means schemes based upon the purchase of a health insurance policy, which is not made compulsory by government and where insurance premiums may be directly or indirectly subsidised by the government;
'non-profit institutions financing schemes': means non-compulsory financing arrangements and programmes with non-contributory benefit entitlement that are based on donations from the general public, the government or corporations;
'enterprise financing schemes': means primarily arrangements where enterprises directly provide or finance health services for their employees without the involvement of an insurance-type scheme;
'household out-of-pocket payment': means a direct payment for health care goods and services from the household primary income or savings, where the payment is made by the user at the time of the purchase of goods or the use of the services;
'rest of the world financing schemes': means financial arrangements involving or managed by institutional units that are resident abroad, but who collect, pool resources and purchase health care goods and services on behalf of residents, without transiting their funds through a resident scheme.
Health care providers
'Health care providers' mean the organisations and actors that deliver health care goods and services as their primary activity, as well as those for which health care provision is only one among a number of activities. The following main items are defined as:
'hospitals': means the licensed establishments that are primarily engaged in providing medical, diagnostic and treatment services that include physician, nursing and other health services to inpatients and the specialised accommodation services required by inpatients and which may also provide day care, outpatient and home health care services;
'residential long-term care facilities': means establishments that are primarily engaged in providing residential long-term care that combines nursing, supervisory or other types of care as required by the residents, where a significant part of the production process and the care provided is a mix of health and social services with the health services being largely at the level of nursing care in combination with personal care services;
'providers of ambulatory health care': means establishments that are primarily engaged in providing health care services directly to outpatients who do not require inpatient services, including both offices of general medical practitioners and medical specialists and establishments specialising in the treatment of day-cases and in the delivery of home care services;
'providers of ancillary services': means establishments that provide specific ancillary type of services directly to outpatients under the supervision of health professionals and not covered within the episode of treatment by hospitals, nursing care facilities, ambulatory care providers or other providers;
'retailers and other providers of medical goods': means establishments whose primary activity is the retail sale of medical goods to the general public for individual or household consumption or utilisation, including fitting and repair done in combination with sale;
'providers of preventive care': means organisations that primarily provide collective preventive programmes and campaigns/public health programmes for specific groups of individuals or the population-at-large, such as health promotion and protection agencies or public health institutes, as well as specialised establishments providing primary preventive care as their principal activity;
'providers of health care system administration and financing': means establishments that are primarily engaged in the regulation of the activities of agencies that provide health care and in the overall administration of the health care sector, including the administration of health financing;
'rest of the economy': means other resident healthcare providers not elsewhere classified, including households as providers of personal home health services to family members, in cases where they correspond to social transfer payments granted for this purpose, as well as all other industries that offer health care as a secondary activity;
'rest of the world providers': means all non-resident units providing health care goods and services, as well as those involved in health-related activities.
Revenues of financing schemes
Revenues are defined as an increase in the funds of a health care financing scheme through specific contribution mechanisms. The categories of the classification are the particular types of transactions through which the financing schemes obtain their revenues. The objective of this classification is to group types of revenues of health financing schemes into mutually exclusive classes. If appropriate, the revenue category has sub-categories that are defined according to who (or which institutional sector) provides the given revenue.
The following main items are defined as:
'transfers from government domestic revenues': funds allocated from government domestic revenues for health purposes;
'transfers distributed by government from foreign origin': transfers originating abroad that are distributed through the general government;
'social insurance contributions': receipts either from employers on behalf of their employees or from employees, the self-employed or non-employed persons on their own behalf that secure entitlement to social health insurance benefits;
'compulsory prepayment': compulsory private insurance premiums paid from the individuals/households, the employers or institutional units to the benefit of compulsory health insurance schemes;
'voluntary prepayment': voluntary private insurance premiums received from the insuree or other institutional units on behalf of the insuree to secure entitlement to benefits of the voluntary health insurance schemes;
'other domestic revenues n.e.c': domestic revenues of financing schemes not included in the above-mentioned categories;
'direct foreign transfers': revenues from foreign entities directly received by the health financing schemes.
Data are disseminated in 4 summary tables (one-dimensional) and 4 cross-classification tables (2-dimensional).
Summary tables provide data on:
Current expenditure by provider (ICHA-HP);
Current expenditure by function (ICHA-HC);
Current expenditure by financing scheme (ICHA-HF);
Revenues of health care financing schemes (ICHA-FS).
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 the different types of services and goods are financed;
HP x HF: Health care expenditure by provider and by financing scheme: data on which health care provider and under which particular financing scheme the services and goods are purchased from;
HF x FS: Revenues of health care financing schemes by health care financing scheme: data on the sources of revenues for each financing scheme.
The economy of a country is the outcome of the activity of a very large number of units which carry out numerous transactions of various kinds for purposes of production, finance, insurance, redistribution and consumption. The units and groupings of units used in the accounts must be defined with reference to the kind of economic analysis for which they are intended. To analyse the process of production, it is essential to select units which bring out relationships of a technical-economic nature; to analyse flows affecting financial transactions it is essential to select units which make it possible to study relationships among economic agents.
Statistical and administrative sources refer usually to institutional units active in providing health (care) services to the population. In the description of the financing of health care, the units mainly refer to those involved in the process of paying for the services delivered for consumption. Expenditure refers to the payments related to final consumption of all goods and services by the domestic population (in the majority of countries, health care services provided to foreigners cannot be separated and are included in the domestic consumption).
In the health care expenditure data collection, three approaches are possible. Data collection can be built starting either from the financing side, from the provider side or from the functional side. Depending on the information source available, various elements can be used as statistical unit. It may be an observation unit on which information is received and statistics are compiled, or an analytical unit which statisticians create by splitting or combining observation units with the help of estimations or imputations, in order to supply more detailed and/or homogenous data than would otherwise be possible.
The data aim at providing a complete overview of expenditure on health care goods and services consumed by the domestic population and produced by providers of health care, from whichever source this consumption is financed.
European Union Member States, EFTA countries (Norway, Liechtenstein, Iceland, Switzerland), Bosnia and Herzegovina, Georgia, Moldova, Montenegro and the Republic of Serbia provide data for Health Care Expenditure. Data for the United Kingdom is disseminated until reference year 2019.
Calendar year
Accuracy of SHA data is linked to and depends on the accuracy of the data received from the countries. Data sources are mainly administrative and register-based data, only a small percentage of the figures come from surveys or other sources. Accordingly, for SHA data collection, accuracy deals with problems of coverage as the main possible source of errors. For the detailed information on sources used by countries see the countries' Methodological information in the Annex.
Current expenditure data are presented according to the following units:
expenditure amount in millions of euro;
expenditure amount in millions of national currency;
expenditure amount in millions of PPS;
percentage of GDP;
amount in euro per capita;
amount in national currency per capita;
amount in PPS per capita;
percentage of current health expenditure (CHE).
EU aggregates are available from reference year 2014 and for subsequent years when all EU Member States data is disseminated.
All transactions are to be calculated on accrual principles, meaning that the expenditure data relate to all transactions or activities carried out during the calendar year for which data are reported, irrespective of the date of payment for these services.
Data are collected through the joint health accounts questionnaire (JHAQ) that countries submit to Eurostat during the annual data collection exercise. To compile the JHAQ, countries use data from their national health accounts registries, which comprise, but are not limited to, data that are based on different statistical sources:
specific surveys performed for health care activities;
household budget survey;
administrative sources (registers);
data collected for the purpose of national accounts;
data information systems available in health (and other) ministries / departments as well as other agencies involved in health care.
The different sources may lead to differences in the coverage of the time series, data validity, reliability and comparability. Furthermore, it may not always be possible to have the health care system being consistently defined across data sources.
For expenditure calculated as share of GDP, the national GDP in euro as available in the EUROSTAT database is used. Expenditure per capita is calculated using the corresponding national (average) population data. Expenditure data expressed in PPS is calculated using the corresponding national data as collected by the National Accounts department in EUROSTAT.
Please note that some of the data sources used nationally may not have been initially intended to be used for statistical purposes, and that the initial purpose of a data source may differ across countries. Both facts may influence the comparability of results.
Annual.
Data is disseminated country by country once the data has been fully validated by Eurostat.
Member States are required to transmit their data to Eurostat in compliance with the Commission Regulation 359/2015 transmission deadlines.
Data and reference metadata for the reference year N shall be transmitted to Eurostat by 30 April N+2. Preliminary data for the year N+1 is transmitted by some Member States on a voluntary basis.
The comparability is insured by the application of common definitions (System of Health Accounts SHA2011).
