Czech Statistical Office

Department of Society Development Statistics 

Na Padesátém 81, 100 82 Praha 10

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 who is paying for it. The exports of healthcare goods and services (to non-resident units) are excluded.
Health care expenditure data provide information on expenditure in the functionally defined area of health distinct by provider category (e.g. hospitals, general practitioners), function category (e.g. services of curative care, rehabilitative care, clinical laboratory, patient transport, prescribed medicines) and financing scheme (e.g. health insurance companies, public budget - state/local,, private insurance company, household). For the collection of the data on health care expenditure the System of Health Accounts (SHA) and its related set of International Classification for the Health Accounts (ICHA) is used. SHA sets out an integrated system of comprehensive and internationally comparable accounts and provides a uniform framework of basic accounting rules and a set of standard tables for reporting health expenditure data. The System of Health Accounts - SHA 2011 is a statistical reference manual giving a comprehensive description of the financial flows in health care.

It provides a set of revised classifications of health care functions, providers of health care goods and services and financing schemes. The SHA is currently used as a basis for a joint data collection by OECD, Eurostat and WHO on health care expenditure. The manual sets out in more detail the boundaries, the definitions and the concepts of health accounting – responding to health care systems around the globe with very different organisational and financing arrangements.

Accounting period: Health expenditure and financing data pertain to the calendar year (1 January to 31 December).
The time coverage of this Quality report is 2014 to 2016 reference years. Total health care expenditure is shown without HCRI.3, HCR1 and HCR 2.

Health insurance companies constitute the largest source of funding. They cover 2/3 of all health expenditures in the long term. They draw money from public health insurance which is compulsory for all people who have permanent residence in the Czech Republic. The main principle of the public health insurance is solidarity and equality of access to health care. Public health insurance finances all health care guaranteed by Act No. 48/1997 Coll., on public health insurance (as amended). In principle, we can say that health insurance companies cover most of health care expenditure; other financial sources have a rather complementary role.

Direct household expenditure is the second source of financing health care (15% of all health expenditures in 2016). A great majority of households pay for medicine, extra services at the doctors, especially dentists, spa stays and often also various health certificates at general practitioners.

Public budgets constitute another source of financing health (almost 12% of all health expenditures in 2016). A public budget mainly finances public health insurance premiums for unproductive groups of the population. The role of public budgets also consists of funding specific activities that are not funded by public health insurance, such as expenditure for prevention programmes, operation of health authorities and operation of state health administration institutions.

In addition to these three basic pillars, there are also other (secondary) sources of financing, which are however, currently of negligible significance and account for about 3 % of all health expenditures. These sources are: travel medical insurance, companies (provided that they pay for a part of preventive health care), non-profit organizations (e.g. Red Cross, League Against Cancer, Mamma Help, etc.).

Providers of data in the CR for the purposes of SHA

Due to a large number of data providers, we have been facing a problem beyond our control. The problem lies in different times when data is released for the purposes of SHA.

 Timetable for releasing data for the purposes of SHA

Healthcare expenditure is recorded in relation to the international classification for health accounts (ICHA) defining:

• healthcare expenditure by financing schemes (ICHA-HF) — which classifies the types of financing arrangements through which people obtain health services; health care financing schemes include direct payments by households for services and goods and third-party financing arrangements;
• healthcare expenditure by function (ICHA-HC) — which details the split in healthcare expenditure following the purpose of healthcare activities — such as, curative care, rehabilitative care, long-term care, or preventive care;
• healthcare expenditure by provider (ICHA-HP) — which classifies units contributing to the provision of healthcare goods and services — such as hospitals, residential facilities, ambulatory health care services, ancillary services or retailers of medical goods.

In addition to the mandatory classification of the Commission Regulation 2015/359, Czech Statistical Office calculates and publishes voluntary items HCR 1.1 In-kind LTC social and HCR.1.2 LTC social cash-benefits at the national level.

1. Household individual consumption on health, including the collective consumption with two exceptions:
i. Occupational health care (intermediate consumption within establishments) minus an estimated share of occupational health in health providers’ and other medical industries net administration;
ii.“Remunerated” unpaid household production in the form of transfer payments (social benefits in cash) for home care of sick, disabled and elderly persons provided by family members.
SHA 2011 Manual recommends following the standard System of National Account (SNA) rules for drawing the production boundary of health care services, albeit with two notable exceptions:
- Occupational health care is included in the national totals of health care spending. In SNA, this item is recorded as ancillary services and part of intermediate production of enterprises and
- Part of the cash transfers to private households for care givers of home care for the sick and disabled are treated as the paid household production of health care.
2. Health care financing schemes: HF1 Government schemes and compulsory contributory health care financing schemes; HF2 -voluntary health care payment schemes;
HF3 - Household out-of-pocket payment; HF4 - rest of the world financing schemes.
3. NACE rev. 2, section Q, human health and social work activities.

Czech Statistical Office doesn´t use other NACE groups than Q, human health and social work activities.

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

Summary tables provide data on:

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

Cross-classification tables refer to:

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

Multidimensional classification provide users of this information with a more sophisticated and more detailed view of health expenditure, but it is also more demanding to gain and modify the required data. Especially useful is information on the representation and share of individual resources in health care financing.

Commission Regulation 2015/359 concerns the collection of data on "current expenditure on healthcare" which is defined as the "final consumption expenditure of resident units on health care goods and services".
There is a very close relationship between the concept of "final consumption expenditure" as defined in the System of Health Accounts (SHA) and in National Account and, as a consequence, also between the underlying economic transactions as recorded in the two accounting frameworks.
In National Accounts there are two types of statistical units: institutional units and local kind-of-activity units (KAU). A local KAU groups all the parts of an institutional unit in its capacity as producer which are located in a single site. A local KAU belongs to one and only one institutional unit.
SHA uses the same two types of units for data compilation.
Local KAUs operating as providers of healthcare goods and services to resident units are statistical units in SHA.
Also transactions by institutional units are recorded in SHA, in which framework institutional units are also referred to as "financing agents". More precisely, SHA financing agents are institutional units that manage one or more financing schemes. The transactions are executed by the financing agents, according to the rules of the financing schemes.
Financing agents serve as key statistical units in producing national health accounts. While financing schemes are the key units for analysing how the consumption of health care goods and services is financed, the data concerning the relevant transactions are collected either from the financing agents that operate the different financing schemes or from the providers.
The concept of "healthcare financing schemes" in SHA is an application and extension of the concept of "social protection schemes" defined by the European System of Social PROtection Statistics (ESSPROS):  "a distinct body of rules, supported by one or more institutional units, governing the provision of social protection benefits and their financing ...". The social protection scheme is the statistical unit in ESSPROS. It is an analytical unit that allows describing the complete structure of the social protection financing system:  expenditure and receipts.
According to SHA Manual 2011, "the key concepts for describing the structure of the health care financing system are based on measuring: (a) the expenditure of health care financing schemes, under which goods and services are purchased directly from health care providers, on the one hand, and (b) the types of revenues of health care financing schemes, on the other hand.  
Commission Regulation 2015/359 limits its scope to the collection of data on the expenditure of health care financing schemes.

Expenditures of social services providers.

ESSPROS - In terms of typology of social services governed by relevant legislation, the system includes all types (expenditures) of social services according to the institutional security in programmes no. 15 (the provider is the State), no. 16 (local government), and no. 17 (non-governmental institutions). According to the methodology of the system (the principle of reciprocity) ESSPROS does not include financial resources in the form of payments from clients (besides, the source is usually care allowances or pensions already reported elsewhere in ESSPROS) for services rendered. (This also eliminates the duplication of expenses with respect to the reporting of care allowances and pensions ESSPROS in its entirety).

SHA 2011 - According to the methodology of the SHA 2011 manual for the item HCR.1.1 In-kind long-term care, only the types of social services which provide long-term social care (long-term)  to a client with health problems (health problems) were included in the SHA framework. The types of social services which provide short-term or temporary care or provide care to target groups of users without health problems e.g. families with children, socially excluded groups of people – persons without shelter, persons released from prison or institutional facilities etc. (see the chapter 1.1 above) are not included in HCR.1 under SHA, unlike ESSPROS. Expenditures of providers of relevant selected types of social services are (unlike in ESSPROS) included in their entirety.

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).

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.

Detailed data according to SHA 2011 is available from 2010-2016 for Czech Republic. Main aggregates are also available for 2017 (see Joint Questionnaire 2017-T19-CZE).

Not applicable.

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

-          Surveys/census: 0

-          Public administrative records: 5

-          Financial reports: 2

-          Other: 0

Public administrative records

 Financial reports

Annual.

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.

Central government budget (Ministry of Health , Ministry of Labour and Social Affairs ), regional and municipal spending on health funded by internal transfers from general government revenues.

Main sources are employer, employee and self-employed contributions calculated as  % of wage or income. Government subsidizes premiums of economically inactive population.

Private health insurance in SHA 2011 data includes only travel insurance (0.14% of total health care expenditure for 2016).

Non-profit organizations and non-governmental organizations providing health services (e.g. Red cross) or organizing rehabilitation or lonf-term care where necessary. Funded by voluntary contributions from households and from government transfers/subsidies.

Employer organized preventative health services for employees, usually providing occupational health services and preventative care, funded by employer funding.

Household co-payments, user fees and out of pocket payments funded from household budgets.

The 2018 JHAQ includes a number of features which allow national data correspondents to perform various quality checks before submitting the data. The embedded programmes allow the verification of:

1- Consistency of the data between tables,
This step checks if the marginal totals reported in each table of the JHAQ are consistent across all tables. For example, for each function (HC), the total across all financing schemes (HF) in the HCxHF table has to be equal to the total across all providers (HP) in the HCxHP table, i.e. the values in the column “All HF” in the HCxHF table have to be equal to the values in the column “All HP” in the HCxHP table. Any detected differences are flagged up in the corresponding row or column in the relevant tables and all inconsistencies are listed in the “Report” worksheet by variable code together with the amount by which the respective variable differs between the two compared tables. A positive value indicates that the first listed table has a higher value for the same variable, and vice versa.

In addition to the validation features provided by the JHAQ, Czech Statistical office carries out next step to check and validate its SHA.  We check the time series for each data source. We prepare a detailed data analysis for national users every year.

2- Consistency of the data within tables,
Any detected inconsistencies are listed by variable code together with an indication of which total is not equal to the sum of its subcomponents as well as the numerical difference. A positive figure indicates that the total is greater than the reported sub-components, and vice versa.

• The presence of negative values,

Entries in the tables cannot be negative as they refer to the consumption of goods and services.
If an individual data table is checked for internal consistency, the negative values check is performed for the relevant table and then any negative values are highlighted red and crossed out.

• The presence of atypical entries,

The atypical entries check provides information whether the data tables contain values in cells which are – if at all – only reported by very few countries and are thus atypical for health accounting.
If an individual data table is checked for internal consistency, the atypical entries check is performed for the relevant table. In the data tables, any cell containing an atypical entry will be highlighted for national data providers.
Should any atypical entries be identified, compilers should scrutinize in detail the transactions that led to entries in those cells and assess whether the accounting rules of SHA have been correctly applied. If they come to the conclusion that the transactions are recorded in the correct categories of the ICHA classifications, then the corresponding atypical entries represent unique – and correctly accounted for – features of the country’s health system. In this case a short description of the nature of the transactions should be included in the accompanying Metadata file under “II.3. Atypical entries”.
If, on the other hand, compilers come to the conclusion that the transactions are not recorded correctly, then they need to make adjustments in the concerned tables. In case the transactions recorded in a cell do not belong to the boundaries of SHA (e.g. they refer to intermediate consumption) the value of the respective cell should be deleted (and all cells that are affected by this change adjusted accordingly). In case the transactions are misreported and another category of the ICHA classification is more appropriate, the value of the cell should be transferred to the correct cell of the table.

3- The growth rates against the previous year and the magnitude of revisions as compared to previously submitted data. Results are grouped into three different categories:

• Breaks in series (the current questionnaire shows no data for an item that is not null in the other file)
• Newly reported (the current questionnaire contains data for an item that is empty in the other file)
• Differences (all other types of differences)

Government schemes (HF 1.1)

The data are collected by the Ministry of Finance in the form of individual reports. In the case of OUS, these are quarterly reports using the FIN 2-04U questionnaire. In the case of TSGU, they are monthly reports using the FIN 2-12M questionnaire. These reports are collected by means of so called Integrated Treasury System (hereinafter referred to as ITS).

 The organizational and technological conditions for the transfer of data to the Ministry of Finance via the central system of accounting information of the State is stipulated in Decree No. 383/2009 Coll. on accounting records in the technical form of the selected accounting units and their transfer into the central system of accounting information of the State and on the requirements on technical and mixed forms of accounting records (so called Technical Decree).

 The ITS facilitates the retrieval of the OUS and TSGU data down to the level of each individual unit that is obligated to submit the data. The data in the ITS are checked – there are so called technical checks and after the end of each period the data are sealed and can no longer be edited. If a mistake is found, it cannot be corrected until the following period (in the course of one calendar year) to ensure the stability and reliability of the data. Besides the data on actual expenditures made in the given year, there are also data available on the budgeted amount of expenditures and adjustments in the expenditure budget.

 The deadlines for the data transfer into the ITS are as follows:

-          FIN 2-4U questionnaire is submitted no later than on 20th calendar day after the end of the quarter and not later than on 25th calendar day after the end of the calendar year.

-          FIN 2-12M questionnaire is submitted monthly no later than on 20th day of the following month. The questionnaire for the period between January and December must by submitted by 10th February of the following year.

 The ITS was launched in 2010, yet it includes data since the year 2009 (and OUS data since 2008).

For the SHA purposes, a separate chapter is the financing of nursing care provided in social services institutions. Since this type of care is not considered to be health care in our environment, it is not financed by public health insurance. The main financial burden is borne by the Ministry of Labour and Social Affairs (MPSV) and the founders of these facilities. For the SHA purposes, in accordance with the manual, only a part of expenditures in these facilities is considered to be healthcare expenditures and not social care expenditures.

 Social health insurance schemes (HF 1.2)

  Data reported (from healthcare establishments) and acknowledged (from health insurance companies) are available according to the type of health establishment, type of provided health care, classification of diagnoses according to ICD-10, gender, five-year age groups and the amount of costs. The reference period is a calendar year.

Healthcare establishments deliver administrative records to health insurance companies with records of provided care e.g. treatments, materials, medicines etc. Individual records are priced in points or CZK using code lists – so-called production data. Based on which reimbursements to healthcare establishments are calculated by reimbursement mechanisms. Through other tasks, code lists and calculation mechanisms, production data and reimbursements are used to generate data on expenditures on health care for SHA and regulatory fees for the analysis of health care in the Czech Republic.

 The provision of data for the purposes of SHA has not been supported by any regulations or an agreement between the CZSO and health insurance companies in the past. The Czech Statistical Office has repeatedly made a request to include information needs indispensable for the compilation of health accounts of the CR in the amended acts on public health insurance and health insurance companies. The Czech Statistical Office demanded the provision of data required for the purposes of SHA from all health insurance companies. In 2016, during the discussion of the governmental draft law in the Parliament, an amendment was passed expanding the original governmental proposal and the requirement of the CZSO was met.

With regard to the high number of health insurance companies, mutual communication with them and the representatives of the CZSO is time-consuming and technically demanding, as well as solving problems and planned changes. Processing data for the purposes of SHA is not, in most cases, carried out by a health insurance company but an external processing firm, which causes various complications for the CZSO. External processing firms require all changes or new information in a data file well in advance. The managements of units of statistical processing of individual health insurance companies are not in favour of the new requests of the CZSO due to increased financial costs as well as increased number of administrative steps.

Voluntary health insurance schemes (HF.2.1)

1.)   Expenditure on insurance administration: The estimate of the insurer’s net operating costs of insurance contract administration HC 7.2 + HP 7.3 + HF 2.1 (according to Manual SHA 2011).

The Czech Statistical Office obtains data necessary for data processing for SHA from the Annual Report of the Czech Insurance Association from the table Overview of the development of insurance, which includes Insurance of medical expenses abroad.

 2.)   Expenditure on health care: The structure is obtained from data provided by The Insurance company of the General Health Insurance Company (Pojišťovna VZP.), which is the amount of expenditure on claims paid HC1.1+HC1.3+HP 9+HF 2.1 (according to Manual SHA 2011). The type of care or provider cannot be specified in detail yet.

Reported (by health care establishments) and approved (by health insurance companies) health care is classified by the classification of diagnoses ICD -10, gender, five-year age groups and the amount of expenditure in CZK. The reference period is a calendar year.

NPISHs financing schemes  (HF.2.2)

The two following health-related economic activities NACE 86 to 89 and NACE 949 are an integral part of the questionnaire NI 1-01.

Enterprises financing schemes (HF.2.3)

Reporting units for the UNP 4-01questionnaire of  Labour Statistics Unit (total labour costs) comprise economic subjects of the business sphere registered in the Commercial Register.

Out-of-pocket exluding cost sharing (HF.3.1)

 The estimate of expenditures on final consumption of households in the area of health care is made by compiling a number of data sources. Expenditures on final consumption of households are monitored as a national concept. The data on expenditures on final consumption of households is initially recorded in the CZ-COICOP classification, which is in compliance with the international standard. For the purposes of national accounts, classes are broken down further than it is determined in the official publication of this classification.

Data sources

Household Budget Survey - HBS

The data from household accounts are an essential source of data for the estimate of expenditures on final consumption of households in the area of health care. And they are used for estimating expenditures on COICOP 6200 Outpatient health care and 6300 Inpatient health care.                

Data from Household budget Surveys´ statistics. It comprises data from households’ sample survey statistics. The household, i.e. a set of persons living together and on common budget, constitutes the reporting unit and also the sample unit. In general, the core of these households is constituted by a family, but it can also be an individual. Households included in household budget statistics are now sampled by the method of purposive quota sampling. The basic sampling characteristics include the social group of households, the number of dependent children and net money income per person. As for one-person households of pensioners, gender is another selection characteristic. For the selection of households into the basic reporting sample, the following social groups are measured: employees, farmers, self-employed persons and pensioners.

The data from household budget Surveys´ statistics for the calculation of final consumption of households are obtained from household accounts statistics in CZK per person in the COICOP classification. The National Accounts Unit multiplies the received data by a population mean according to individual consumption commodities by so-called 90% + 10% method, when 90% of a population mean is multiplied by the average consumption of population and 10% of a population mean is multiplied by the average consumption of the population in the 10th (highest) decile, when more weight is given to wealthier households for the upper so-called tenth decile.

Model calculation based on sales index

Model calculation based on sales index excl. VAT in retail, motor vehicles sales, accommodation and catering represents another data source. These indices are obtained from the Trade, Transport and Information Service Activities Statistics Unit. Based on the indices of individual commodities, annual growth rate in sales is calculated (e.g. the proportion of the 2012 annual index to the previous year 2011 of the given commodity). The calculated annual index of the given commodity is multiplied by expenditures on final consumption of households of the previous year (this country before balance adjustments) of the given commodity. The structure of COICOP individual items in the given commodity is broken down by expenditures on final consumption of households in the source data of the previous year. This estimation method of calculation is used for expenditures on final consumption of households in the area of health care COICOP 6100 Pharmaceuticals, medical devices.

A) Czech Statistical Office - Government Account Unit process budget data from Ministry of Finance HF 1.1, National Accounts data for OOP Payments HF 3.1, National Accounts data for Non-profit Institutions HF 2.2, Labout Statistics Unit data for Enterprise HF 2.3

B) External sources - Health insurance companies data for HF 1.2, Ministry of Labour and Social Affair - data for HF 1.1 (Long-term care health HC 3.1, HC 3.2, HC 3.4 and Long - term care social HCR.1.1  and HCR.1.2), Czech Insurance Asociation data for Voluntary private insurance HF 2.1.

The annual presentation and discussion of results and methods with Czech Statistical Office management before publishing data. Possible consultation with data sources representatives.

The Revision of National Accounts data (for HF 3.1 OOP Payments) significantly affects SHA 2011 data results. If the revision results differ from the originally submitted data as of March 31-st, then we send corrected Joint Questionnaire to EUROSTAT.

Although the quality of SHA data from the Czech Statistical Office is relatively high, there are several important points to be mentioned. These points have been changed in connection with the new methodology SHA 2011.

 Category HC1.1.1 General Inpatient care:

- for surgery

Resuscitation and intensive institutional inpatient care units, surgery -  type I

Resuscitation and intensive institutional inpatient care units, surgery -  type T

Standard institutional inpatient care units, surgery – type F

Standard institutional inpatient care units, surgery -  type H

Operating rooms of surgery units

- for internal medicine

Resuscitation and intensive institutional inpatient care units, internal medicine -  type I

Resuscitation and intensive institutional inpatient care units, internal medicine  -  type T

Standard institutional inpatient care units, internal medicine -  type F

Standard institutional inpatient care units, internal medicine -  type H

Long-term (chronic) internal inpatient care units -  type U

- for paediatrics

Resuscitation and intensive institutional inpatient care units, paediatrics -  type I

Resuscitation and intensive institutional inpatient care units, paediatrics  -  type T

Standard institutional inpatient care units, paediatrics -  type F

Standard institutional inpatient care units, paediatrics -  type H

Long-term (chronic) internal inpatient care units, paediatrics  -  type U

- for gynaecology and obstetrics

Resuscitation and intensive institutional inpatient care units, gynaecology – type I

Resuscitation and intensive institutional inpatient care units, gynaecology – type T

Standard institutional inpatient care units, gynaecology – type F

Standard institutional inpatient care units, gynaecology – type H

Operating rooms – gynaecology units

Intensive and intermediary institutional inpatient and obstetric care units

The remaining specialties of inpatient care to be recorded under the category HC 1.1.2 Specialised inpatient care.

Category HC1.2.1 General Day care:

Day care in the field of surgery

Day care in the field of gynaecology

Care in an intervention hall in the field of gynaecology

 Category HC1.2.2 Specialized Day care:

Day care in the field of orthopaedics

Day care in the field of ENT

Day care in the field of urology

Day care in the field of plastic surgery

Care in an intervention hall in the field of orthopaedics

Haemodialysis unit

The specialty Day care – day care centre to be moved to the category HC 3.2 Day long-term care.

HC 1.3 Outpatient curative care

Hematopoietic cell donor sites to move from HC 1.3.3 to HC 4.1

to move Nuclear medicine under category HC 4.2

 HC.3 Long-term care

The category HC 3.3 Outpatient long-term care is new and we are currently unable to determine a specialty for this category – in the Czech Republic, outpatient long-term care falls under the category of typical outpatient curative care under the SHA 2011 framework.

HC.RI.2 Traditional, complementary and alternative medicines. It cannot be currently completed, the data is not available.

Main users of SHA data in Czech Republic are:

Ministry for Labour and Social Affairs

Ministry for Health

Regional and local governments

Research institute for labour and social affairs

Instuitute of Health Information and Statistics of the Czech republic

The companies of health insurance

The Legislators

The Research workers

The journalists including television

The university students

Key indicators that are often requested are health expenditure in general, public and private expenditure mainly OOP payments, expenditure on long-term care health and social, expenditure on a wide range of functions of health care, expenditure on hospitals,  expenditure on medicines etc. Journalists often publish articles on the topic of expenditure on health care according to ICD 10 diagnosis, which we publish at national level. We observed unmet user needs especially in question on health expenditure on complementary and alternative medicine. Data is not available.

At the national level, Czech Statistical Office performs an online user satisfaction survey (in general, not just health care expenditure) to evaluate their level of satisfaction with the statistical information produced as well as the information available on its website at the level of content and usability.

The feedback directly from specific SHA health data users.

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

Table HC*HF - 88,9 %

Table HC*HP - 88,9 %

Table HP*HF - almost 100 %

 Overall accuracy of Czech SHA data can be considered to be quite good. Known under-coverages are explained in detail under 5.3.

Not applicable as we do not use any surveys directly for the compilation of SHA data.

Not applicable.

Not applicable as we do not use any surveys directly for the compilation of SHA data.

 Not applicable; the statistics are the result of an integration process.

Not applicable; the statistics are the result of an integration process.

Not applicable; the statistics are the result of an integration process.

 Not applicable.

Not applicable; the statistics are the result of an integration process.

Not applicable; the statistics are the result of an integration process.

Not applicable; the statistics are the result of an integration process.

Not applicable; the statistics are the result of an integration process.

Not applicable; the statistics are the result of an integration process.

Not applicable.

Not applicable.

Data are revised for longer or even for the whole time-series, if fundamental changes in methodology take place (e.g. the implementation of SHA 2011). The Revision of National Accounts data (for HF 3.1 OOP Payments) significantly affects SHA 2011 data results. If the revision results differ from the originally submitted data as of March 31st, then we send corrected Joint Questionnaire to EUROSTAT.

In the first half of 2017, the revision of the 2013-2015 data was carried out under the new SHA 2011 methodology. Joint Questionnaires with revised 2013-2015 data were sent to EUROSTAT in July 2018 via EDAMIS.

Revision of the data for 2015 was under way in the department of National Accounts, which was completed in July 2017. As there was a shift in mainly OTC medicines expenditure and Dental outpatient curative care, we sent revised data for 2015 again in September 2017. Next revision in 2018 (data for 2016) didn´t reveal any changes.

The 2015 revision resulted in a 1.3% increase in the total current expenditure according to SHA.

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 T should be transmitted to Eurostat by 30 April T+2.

Czech Statistical  Office transmits SHA data annually to Eurostat by March 31st latest in line with the deadline set-out by OECD for the JHAQ.

Czech Republic does not publish provisional figures for year t-1.

Czech Republic: Final results for t-2 are published through a press conference and publication in February (2019) at national level.
Previously it was at the end of May.

Czech Statistical Office complies with the Commission Regulation 359/2015 transmission deadlines. Czech Statistical  Office transmits SHA data annually to Eurostat by March 31st latest in compliance with  the deadline set-out by OECD for the JHAQ.

Not applicable.

Not applicable at national level.

Not applicable.

Breaks in time series resulting from methodological changes

Length of comparable time series 8 years (2010 - 2017) for SHA 2011 on national level.

Not applicable.

The Czech Statistical Office publishes several outputs in the area of ​​health care expenditures, especially the summary Health Accounts and General Government Expenditures (COFOG) in the concept of National Accounts. COFOG captures public budget expenditure. Health accounts also cover health expenditure from private sources, ie. households, non-profit institutions, private insurance or businesses. Different sources of funding are reflected in different data sources. While COFOG statistics are based only on administrative data sources provided by government, SHA statistic uses an extensive range of data sources including  private expenditure. However, there are also differences in the definition of aggregates of total expenditures, as COFOG statistics also cover expenditure that is indirectly related to the provision of health care, all public hospital expenditure, including taxes, interest, or all investments. COFOG statistics in the "health" class also counts most of the central health authorities' costs, including, for example, expenditure on the purchase of buildings, vehicles, software or collective consumption services.  Both statistical surveys differ in the completeness of the coverage of the sources of funding and the definition of the expenditure itself.

Not applicable.

National publication of SHA results of t-2 in Mid-February ("Results of Health Accounts 2010 - 2017") is accompanied by a press release for journalists   https://www.czso.cz/csu/czso/vysledky-zdravotnickych-uctu-cr-7luhzp32ax

The most important results are presented and explained at a press conference.

Several articles about SHA or published SHA data are published in the internal journal Statistika and My (monthly periodicity of the magazine) https://www.czso.cz/csu/czso/statistika_-_my

In addition, SHA data are published in Statistical Yearbook of the Czech Republic  https://www.czso.cz/csu/czso/statisticka-rocenka-ceske-republiky-2018

Data can be obtained at the Czech Statistical Office website  https://www.czso.cz/csu/czso/statistiky

Data are published at health databases of OECD, EUROSTAT and WHO.

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SHA data are used as a base line for evaluating the ongoing health care reform in Czech republic.  Other major publications using/containing SHA data are e.g.: OECD (2017): Health at a Glance 2017: OECD Indicators. OECD-Publishing, Paris.
A large number of articles with SHA data for the Czech Republic and international comparisons in newspapers and magazines.

Short methodological documentation is published in the national publication "Results of Health Accounts 2010 - 2017" (last in mid-February 2018) https://www.czso.cz/csu/czso/vysledky-zdravotnickych-uctu-cr-7luhzp32ax

See above for details.

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Summary of costs for production of statistical data and burden on respondents are minimal.

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

All legal requirements are met. The publication of SHA data is done at relatively high aggregated data-level, detailed data is not published or distributed.

No further comments.