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For any question on data and metadata, please contact: Eurostat user support |
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1.1. Contact organisation | Centraal Bureau voor de Statistiek (Statistics Netherlands) |
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1.2. Contact organisation unit | Team Health and Care |
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1.5. Contact mail address |
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2.1. Data description | |||
Health care expenditure quantifies the economic resources dedicated to health functions, excluding capital investment. Healthcare expenditure concerns itself primarily with healthcare goods and services that are consumed by resident units, irrespective of where that consumption takes place (it may be in the rest of the world) or who is paying for it. As such, exports of healthcare goods and services (to non-resident units) are excluded, whereas imports of healthcare goods and services for final use are included. 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. |
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2.2. Classification system | |||
Healthcare expenditure is recorded in relation to the international classification for health accounts (ICHA) defining:
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2.3. Coverage - sector | |||
1. Household individual consumption on health, including the collective consumption with two exceptions: 4. Parts of NACE rev.2: |
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2.4. Statistical concepts and definitions | |||
SHA concept is the consumption of health care goods and services. Summary tables provide data on:
Cross-classification tables refer to:
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2.5. Statistical unit | |||
Commission Regulation 2015/359 concerns the collection of data on "current expenditure on healthcare" which is defined as the "final consumption expenditure of resident units on health care goods and services". |
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2.6. Statistical population | |||
SHA focuses on the consumption of health care goods and services by the resident population irrespective of where this takes place. This implies the inclusion of imports (from non-resident providers) and the exclusion of exports (health care goods and services provided to non-residents). |
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2.7. Reference area | |||
The data aims at providing a complete overview of expenditure on health care goods and services consumption of services and goods by the resident population on the national territory of a country. |
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2.8. Coverage - Time | |||
1998-2017. |
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2.9. Base period | |||
Not applicable. |
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3.1. Source data | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Several data sources are used: - Surveys/census: 1 - Public administrative records: 1 - Financial reports: 2 - Other: 2
Surveys/censuses
Public administrative records
Financial reports
Other
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3.2. Frequency of data collection | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Annual. |
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3.3. Data collection | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Data are collected through the joint health accounts questionnaire (JHAQ) that countries submit to Eurostat during the annual data collection exercise. There is a voluntary deadline to send the JHAQ questionnaire for the calendar year T by the 31st of March T+2. The joint health accounts questionnaire (JHAQ) is coordinated in agreement with the World Health Organisation (WHO) and the Organization of Economic Co-operation and Development (OECD). These three international organisations are known collectively as the International Health Accounts Team (IHAT). Countries submit data to Eurostat on the basis of Commission Regulation (EU) 2015/359 of 4 March 2015 implementing Regulation (EC) No 1338/2008 of the European Parliament and of the Council as regards statistics on healthcare expenditure and financing. |
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3.4. Data validation | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
The 2018 JHAQ includes a number of features which allow national data correspondents to perform various quality checks before submitting the data. The embedded programmes allow the verification of:
2- Consistency of the data within tables,
Entries in the tables cannot be negative as they refer to the consumption of goods and services.
The atypical entries check provides information whether the data tables contain values in cells which are – if at all – only reported by very few countries and are thus atypical for health accounting.
3- The growth rates against the previous year and the magnitude of revisions as compared to previously submitted data. Results are grouped into three different categories:
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3.5. Data compilation | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Several methods are normally used for estimations:
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3.6. Adjustment | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Main sourcesStatistics Netherlands: surveys of health and social care providers; National Accounts; price and tariff data. See also Health care institutions, Health care practices, Production statistics. Structure of integration frameworkThe figures on health and social care and those on health care according to SHA use the system for integration of statistics: the health and social care accounts. The production of the figures according to the System of Health Accounts is integrated in the production process. Information is collected for groups of providers, called actors (e.g. physiotherapists, general hospitals, internal occupational health agencies); this is done for around 80 actors. For each actor (e.g. mental health care institutes) expenditure on specific types of care (e.g. psychiatric care) is allocated to financing schemes (e.g. private health insurance) and to the functions of the types of care (e.g. inpatient curative care). Each actor is mapped to a category of the Health Care Providers classification of the System of Health Accounts. Provisional figures for the previous year, published in May, are based on external sources and supplementary estimates. Revised provisional and final figures are based on internal sources of Statistics Netherlands and some external sources. |
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4.1. Quality assurance | |||
Authorities responsible for SHA data collection are working to ensure that the statistical practices used to compile national health accounts are in compliance with SHA methodological requirements and that good practices in the field are being followed, according to the methodology underlined in the SHA 2011 Manual and European Statistics Code of Practice respecting professional independence of the statistical authorities. Procedures are in place to plan and monitor the quality of the health care expenditure statistical production process. Checks are carried out for completeness, internal and external consistency and plausibility of the collected internal and external data. Where necessary, corrections are applied. |
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4.2. Quality management - assessment | |||
The sequential comparability of provisional data and final data shows that usually the difference is small for the aggregates (less than 1 %) and bigger for data that are disaggregated. The comparability with SNA aggregates shows that after correcting for differences in definitions and scope, the data are reasonably good reconcilable, see e.g. Health expenditure data for policy: Health accounts, national accounts or both? (https://doi.org/10.1016/j.healthpol.2018.06.004 ) |
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5.1. Relevance - User Needs | |||
Main users : - RIVM (Institute for Public Health and the Environment); usage for Cost-of-illness studies. RIVM receives detailed tables per year that are further processed with data on population and illnesses; including breakdown according to the budget of the Ministry of Health. - CPB (Netherlands Bureau for Economic Policy Analysis; usage for their medium-term forecasts. - Ministry of Health and Welfare; usage for main indicators; CBS produces linkages tables from Care accounts to the Health budget. - General public, including media like newspapers, magazines, independent journalists. |
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5.2. Relevance - User Satisfaction | |||
CBS has regularly meetings with the Ministry of health and welfare, and RIVM. With CPB we have a meeting once every two years, and several contacts during the year. Several tailor made answers to questions have been produced. |
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5.3. Completeness | |||
Data are complete as far as the Commission regulation is applicable. |
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5.3.1. Data completeness - rate | |||
100% |
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6.1. Accuracy - overall | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
As the SHA tables are the result of an integration process, as well as of estimation of details within the SHA framework, the character of the figures is inevitably not 100% accurate. The final figures derived from the Digimv source cover around 60 per cent of all expenditure, and are a solid source (missing less than 1% of annual reports). The integration process itself ensures a better accuracy, as we compare at least two sources whenever possible: Digimv and the sources on financing. Direct out of pocket expenditure is based on estimates, of which around 50% is a direct estimate and 50% a residual, with some minor expenditure figures based on an initial estimate and development. Some of the data on providers are also based on estimates like TCAM providers. |
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6.2. Sampling error | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Not applicable. |
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6.2.1. Sampling error - indicators | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Not applicable. |
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6.3. Non-sampling error | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
See also coherence and comparability in this case of integrative statistics. |
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6.3.1. Coverage error | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Coverage error in the case of this integrative statistics apply to the coverage of health care providers.
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6.3.1.1. Over-coverage - rate | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Not applicable; the statistics are the result of an integration process. |
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6.3.1.2. Common units - proportion | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Not applicable; the statistics are the result of an integration process. |
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6.3.2. Measurement error | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Not applicable. |
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6.3.3. Non response error | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Not applicable; the statistics are the result of an integration process. |
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6.3.3.1. Unit non-response - rate | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Not applicable; the statistics are the result of an integration process. |
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6.3.3.2. Item non-response - rate | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Not applicable; the statistics are the result of an integration process. |
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6.3.4. Processing error | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Not applicable; the statistics are the result of an integration process. |
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6.3.4.1. Imputation - rate | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Not applicable; the statistics are the result of an integration process. |
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6.3.5. Model assumption error | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Not applicable; the statistics are the result of an integration process. See statistical processing for remarks. |
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6.4. Seasonal adjustment | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Not applicable. |
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6.5. Data revision - policy | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
General publication strategy: In year t: Provisional figures for year t-1, revised provisional figures for year t-2 and definite figures for year t-3 are published in May of year t. Revised provisional figures for year t-1 and t-2 are published in November or December of year t. RevisionsThe system of health and social care accounts will be revised once every five to ten years. All actors are checked in terms of completeness, validity and reliability. New actors are created if necessary; actors can also be merged. |
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6.6. Data revision - practice | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
In 2016-2018 the team health and care has revised the whole system of Care Accounts, partly aligning with the revision of National Accounts that was going on in the same period. Several estimates of providers have been re-assessed (e.g. hospitals (downward), TCAM providers (downward), pharmaceuticals providers (downward), GP's (upward), Psychologists (upward), care for the handicapped (upward)). Overall, the revision has been downward in total. New data sources have been used for this, as well as for other providers and for structural information. For instance, the income statements of the large institutions have now a better breakdown according to type of (health) care service and from 2015 onwards, also a breakdown according to financing scheme. This has led to significant changes in the structure of financing and the structure of products, and for SHA, the structure of functions. |
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6.6.1. Data revision - average size | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
The adjustment due to the revision was for SHA -0.6%; due to the usual new data becoming available during the year, the normal adjustment would have been -0.4%. This has resulted in a total adjustment compared with the transmitted data in 2017 of -1.0% for the total current expenditure according to SHA. |
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7.1. Timeliness | |||
Member States are required to transmit their data to Eurostat in compliance with the Commission Regulation 359/2015 transmission deadlines. |
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7.1.1. Time lag - first result | |||
Provisional figures for year t-1 are published in May/June of year t. |
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7.1.2. Time lag - final result | |||
Definite figures for year t-3 are published in May/June of year t. |
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7.2. Punctuality | |||
Transmission of data was on time, on 31 March and April in year t for figures on year t-2. |
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7.2.1. Punctuality - delivery and publication | |||
Transmission to Eurostat : 30 April in year t for figures on year t-2. |
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8.1. Comparability - geographical | |||||||||
Not applicable at national level. |
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8.1.1. Asymmetry for mirror flow statistics - coefficient | |||||||||
Not applicable. |
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8.2. Comparability - over time | |||||||||
The figures of the Health Accounts are comparable sequentially, due to the fact that the used definitions and concepts are univocal and guide the process of integration. The sequential comparability applies both to levels and changes. However, if a choice has to be made between them, the level is preferable for data in current prices.
Breaks in time series resulting from methodological changes
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8.2.1. Length of comparable time series | |||||||||
1998-2017. |
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8.3. Coherence - cross domain | |||||||||
The SHA figures can be reconciled with figures from Business statistics (as they are an important source for the care accounts of which the SHA figures are a subset); with ESSPROS as far as ESSPROS covers the SHA figures or the figures of the care accounts. |
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8.4. Coherence - sub annual and annual statistics | |||||||||
Not applicable. |
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8.5. Coherence - National Accounts | |||||||||
The figures on health and social care expenditure for each actor are used by and discussed with National Accounts. SHA is a subset of health and social care expenditure. |
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8.6. Coherence - internal | |||||||||
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9.1. Dissemination format - News release | |||
In May/June of each year CBS publishes a news release on care expenditure of the previous year; it includes also the SHA indicator current expenditure as percentage of GDP. |
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9.2. Dissemination format - Publications | |||
On the revision of the care accounts, including SHA figures: https://www.cbs.nl/nl-nl/onze-diensten/methoden/onderzoeksomschrijvingen/aanvullende%20onderzoeksbeschrijvingen/revisie-zorgrekeningen-2015 (in Dutch). News release 2018: https://www.cbs.nl/nl-nl/nieuws/2018/22/zorguitgaven-stijgen-in-2017-met-2-1-procent (in Dutch) |
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9.3. Dissemination format - online database | |||
Data are published as open data and are accessible using the CBS Statline app. https://opendata.cbs.nl/statline/#/CBS/en/navigatieScherm/thema?themaNr=82765 With the three core tables: https://opendata.cbs.nl/statline/#/CBS/en/dataset/84043ENG/table?dl=C78F https://opendata.cbs.nl/statline/#/CBS/en/dataset/84078ENG/table?dl=C792 https://opendata.cbs.nl/statline/#/CBS/en/dataset/84035ENG/table?dl=C793 On the site in Dutch, more options are available: https://opendata.cbs.nl/statline/#/CBS/nl/navigatieScherm/thema?themaNr=82175 |
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9.3.1. Data tables - consultations | |||
In 2018, 5393 unique page views have been made pertaining to all tables in the Dutch language derived from the care accounts; of which 799 were for the tables with SHA figures. The tables covered both revised and non-revised figures (covering the 1998-2016 period). |
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9.4. Dissemination format - microdata access | |||
Not applicable. |
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9.5. Dissemination format - other | |||
None. |
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9.6. Documentation on methodology | |||
The metadata are enclosed in the tables. General descriptions of the method: https://www.cbs.nl/en-gb/our-services/methods/surveys/korte-onderzoeksbeschrijvingen/health-expenditure ; https://www.cbs.nl/nl-nl/onze-diensten/methoden/onderzoeksomschrijvingen/korte-onderzoeksbeschrijvingen/zorguitgaven on the revision: https://www.cbs.nl/nl-nl/onze-diensten/methoden/onderzoeksomschrijvingen/aanvullende%20onderzoeksbeschrijvingen/revisie-zorgrekeningen-2015 |
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9.7. Quality management - documentation | |||
Quality reports are based on self-assessment for the process. In the past 12 months no corrections have been made on published results (https://www.cbs.nl/nl-nl/cijfers/statline/correcties-en-revisies-in-statline ) |
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9.7.1. Metadata completeness - rate | |||
Not available. |
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9.7.2. Metadata - consultations | |||
Not available. |
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The statistics are secondary, the burden on data providers or respondents is the one from the sources. Additional: specific tables from Zorginstituut Nederland, that serve also National accounts and Government finance departments of CBS. |
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11.1. Confidentiality - policy | |||
The Regulation (EC) No 223/2009 on European statistics (recitals 23-27, 31-32 and Articles 20-26) applies. |
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11.2. Confidentiality - data treatment | |||
Disclosure of data on specific healthcare providers is suppressed by including them in a larger group of health care providers. |
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None.
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