Office for National Statistics 

Efficiency Measurement Unit

Room 1.024, Office for National Statistics, Government Buildings, Cardiff Road, Newport, Wales, NP10 8XG

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.
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. social security, 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.

Data on a SHA 2011 consistent basis are available from 2013 to 2017 (calendar years) for the United Kingdom.

In addition to the core  functions required under European Commission Regulation 2015/359, the Office for National Statistics also report the following variables to the Eurostat, OECD and WHO: 

For further information on the UK health accounts see:

 https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/bulletins/ukhealthaccounts/previousReleases

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.

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.

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.

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.

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. This covers expenditure in the United Kingdom. 

SHA 2011 based health accounts from 2013 to 2017.

Not applicable.

Several data sources are used (as of data notification in April 2019):

-          Surveys/census: 3

-          Public administrative records: 31

-          Financial reports: 8

-          Other: 15

Surveys/censuses

Public administrative records

Financial reports

Other

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.

Financial years:

Financial reporting in the UK mostly operates around a financial year beginning in April. This means that calendar year estimates in the UK health accounts are mostly a combination of two financial years. This means that data needed to produce a calendar year are generally available later than for countries operating under a calendar year. 

Government expenditure (HF.1.1):

Data for the government control total mostly come from HM Treasury's Online System of Central Accounting and Reporting (OSCAR). Monthly data are provided to the Office for National Statistics (ONS) principally for the production of national accounts estimates of government expenditure. Additional data needed to supplement the OSCAR control total are collected by ONS from other government departments. 

The analysis of health expenditure by function and provider is done by health administrations in England, Wales, Scotland and Northern Ireland and submitted to the Office for National Statistics for compilation within the UK health accounts. 

Non-government expenditure:

Data needed for estimates of non-government expenditure (voluntary health insurance schemes, NPISH financing schemes, enterprise financing schemes and out-of-pocket payments) are collected from a variety of sources, with several data sources being publishing 'in-house' by ONS. These publications are available annually. ONS also arrange a bespoke annual private sector data collection from private sector healthcare experts primarily providing data for voluntary health insurance and out-of-pocket expenditure. 

The 2019 JHAQ includes a number of features which allow national data correspondents to perform various quality checks before submitting the data. The embedded programmes allow the verification of:

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.

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)

Before submission to the International Health Accounts Team, the UK health accounts data are published domestically by the Office for National Statistics (ONS). 

Quality assurance procedures are compliant with standards set out in the Code of Practice for Statistics: https://www.statisticsauthority.gov.uk/code-of-practice/

SHA data is compiled both by a bottom-up approach as well as by a top-down approach, depending on the data source. Compilation is done by financing schemes and by different health care functions/task areas. The results of the several calculations are then aggregated.

To gain the differentiation between the different SHA-dimensions (especially HC and HP) quotas and pro-rating and utilisation keys are applied on some spending items. For some spending items it is necessary to extra-/intrapolate data as there is no up-to-date data available or data is missing for certain years. For some other spending items, estimation methods have to be applied.

Several methods are normally used for estimations:

• Balancing item/Residual method: For example, if data are available from the financing side, which permit accurate estimation of the flows to a provider or function, then an acceptable estimation method is to subtract these expenditure flows from the total revenues, and derive the expenditure flows from the unmeasured financing scheme as a residual.
• Pro-rating/Utilisation key: Typically in the absence of direct spending data, a utilisation key linked to the proportion of resources used can be constructed in order to distribute e.g. aggregate provider spending across functions. For every key a fraction of total utilisation within the cost-unit is assigned: fractions in the key must add up to 100% of all care delivered by the cost-unit. Examples of utilisation keys are admissions, bed-days, contacts, staffing, etc.
• Interpolation/Extrapolation: In the absence of data for the period in question, missing values can be estimated using known data points.
• Or other.

Government expenditure (HF11)

Government expenditure on healthcare is calculated in two ways. Firstly, total government healthcare expenditure is calculated using data from HM Treasury’s Online System of Central Accounting and Reporting (OSCAR) as the core of the measure. Several adjustments, used in the national accounts measure of final consumption expenditure, are added to this. Expenditure relating to COFOG 7.5 (R&D health) and costs of eduction and training are removed. Finally, elements of expenditure that falls outside COFOG7 (e.g. elements of long-term care considered as social protection in the COFOG system) are added. This serves as a ‘control total’ for government healthcare spending.

The Department of Health and Social Care and equivalent bodies in the devolved administrations provide the data required to produce an analysis of UK government healthcare spending by function and provider. This HCxHP analysis is then reconciled to the control total. When the HCxHP analysis is greater than the control total, it is scaled down proportionally. When the HCxHP analysis is less than the control total, the residual is allocated to the category HC.0 x HP.0 – healthcare expenditure not elsewhere classified.

Where an item of expenditure cannot be identified at a granular enough level in one or more of the nations, values are imputed based on expenditure in other nations, in order to have the same level of detail for each country. For example, the breakdown of dental expenditure between curative and rehabilitative care, and preventive care is only available for Scotland, so the proportions are used for the other UK nations estimates.

Non-government expenditure (HF21, HF22, HF23 and HF3)

Voluntary health insurance expenditure is calculated by adding Insurance Premium Tax (IPT) and an imputed estimate of health insurers’ investment income to health insurance premiums for the range of different health insurance products available in the UK. Data informing the breakdown of spending by function and provider comes from analysis by private sector healthcare experts.

The measure of out-of-pocket expenditure is calculated largely using a bottom-up approach, whereby individual items of spending are aggregated to obtain total out-of-pocket expenditure. The first stage of the bottom-up approach is to determine a set of broad components by which to categorise health care expenditure: services provided in hospitals, ambulatory services, medical goods and long-term care. ONS then conducts research into the UK market for each of these sectors, identifying the different types of services and providers. The initial process included a number of private sector health care experts, to help ensure the coverage was comprehensive. The measurement of some areas are complex, such as for ambulatory services, where multiple providers and functions need to be identified and a wide range of detailed market reports on the various private health care markets are used to capture the full range of available services and providers.

For voluntary health insurance schemes and out-of-pocket expenditure, imputation is used to estimate the split of expenditure on curative and rehabilitative acute care between inpatient, day case and outpatient care, based on historical data. Due to a lack of available data, the split of dental expenditure by curative and rehabilitative care, and preventive care is estimated to be the same proportional split as for government expenditure. 

For NPISH, the proportions of expenditure for each function and provider category were estimated based on analysis of a subsample of charities from the NCVO dataset, conducted in 2013. Charity data were analysed to allocate sample charities by their primary function and provider type. The analysis from 2013 is uprated to obtain estimates for subsequent years, based on the growth in overall charity expenditure. 

Spending from enterprise financing schemes is estimated using national accounts estimates of intermediate consumption of healthcare services by non-health related industries. Data provided by private sector healthcare experts helps to inform the HC and HP split of spending, with the residual allocated to the category HC.0 x HP.0.

Data published domestically by the Office for National Statistics for years 2013 to 2017 are consistent with the international definitions of the System of Health Accounts 2011. No further adjustments are needed.

Authorities responsible for SHA data collection are working to ensure that the statistical practices used to compile national health accounts are in compliance with SHA methodological requirements and that good practices in the field are being followed, according to the methodology underlined in the SHA 2011 Manual and European Statistics Code of Practice respecting professional independence of the statistical authorities. Procedures are in place to plan and monitor the quality of the health care expenditure statistical production process.

The Office for National Statistics (ONS) define quality of a statistical product in relation to the European Statistical System dimensions of quality:

• relevance – is the degree to which a statistical product meets user needs in terms of content and coverage
• accuracy and reliability – is how close the estimated value in the output is to the true result
• timeliness and punctuality – describes the time between the date of publication and the date to which the data refers, and the time between the actual publication and the planned publication of a statistic
• accessibility and clarity – is the ease with which users can access data, and the quality and sufficiency of metadata, illustrations and accompanying advice
• coherence and comparability – is the degree to which data derived from different sources or methods, but that refers to the same topic, is similar, and the degree to which data can be compared over time and domain, for example, geographic level.

For further information on ONS policies around quality please see:

https://www.ons.gov.uk/methodology/methodologytopicsandstatisticalconcepts/qualityinofficialstatistics/qualitydefined

https://www.ons.gov.uk/file?uri=/methodology/methodologytopicsandstatisticalconcepts/qualityinofficialstatistics/qualitydefined/2015onsgmssf.pdf

To maximise the accuracy of the health accounts, considerable quality assurance was undertaken during the development of health accounts. The health accounts figure for total government healthcare expenditure is reconciled back to two other measures of healthcare expenditure produced using the OSCAR dataset – HM Treasury’s Public Expenditure Statistical Analysis (PESA) data series, and the national accounts-based measure of healthcare expenditure used in the former Office for National Statistics (ONS) publication "Expenditure on Healthcare in the UK". While now superseded by health accounts, data series used in the "Expenditure on Healthcare in the UK" publication are also used to validate the results of the non-government healthcare expenditure series.

One current weakness in the UK health accounts is the availablility of data to identify government expenditure on non-NHS providers by function and provider. While data from the Department of Health and Social Care, LaingBuisson and the Health and NHS Digital are available to apportion much of the NHS’s purchases of healthcare from non-NHS providers by function and provider, a proportion of this spending has not been possible to estimate and has been allocated to the “not elsewhere classified” category (HC.0xHP.0).

User needs

The main domestic users of SHA data in the UK are government health bodies to evaluate the level of health spending (in relation to GDP) in comparison to other OECD member states. International comparisons of long-term care spending are also used by central government to give international context to social care spending. Some SHA data are also used in ESSPROS figures. 

Outside of government, the UK health accounts are used by healthcare policy research organisations including the King's Fund and the Health Foundation, other research organisations, such as universities and private sector users. 

Unmet user needs

Unmet needs concern the lack of distinction for mental healthcare expenditure, expenditure by diseases and expenditure by age profiles.

The Office for National Statistics conducts a Steering Group made up of senior representatives from health departments, senior non-government health economists and international experts to ensure that development opportunities are discussed and agreed with users. 

Currently, no online satisfaction survey is conducted in relation to the national publication of health accounts data by the Office for National Statistics. 

With reference to the Commission Regulation (EU) 2015/359 of 4 March 2015 implementing Regulation (EC) No 1338/2008 of the European Parliament and of the Council as regards statistics on healthcare expenditure and financing, the UK provides all statistics required under the terms of the Regulation. 

The UK also provide several additional variables outside the scope of the Commission Regulation. For more information please see Section 2.1 Data description.

Variables required under the Commission Regulation: 100%

Government expenditure

Estimates of overall government expenditure (HF11) should be robust. Data are taken from administrative sources, primarily HM Treasury's Online System for Central Accounting and Reporting, which is also the primary data source used for Treasury and national accounts estimates of government expenditure. SHA estimates of expenditure are reconciled to these two sources. 

At the HC and HP level, data are compiled by the government health departments and reconciled to the overall "UK control total" based on Treasury and national accounts data. The HCxHP analysis conducted by departments is generally within the region of ±3% of the control total. When the HCxHP analysis is above the level of the control total, the proportions are scaled down, and when the HCxHP analysis is below the level of the control total, the difference is allocated to the category HC.0xHP.0. The main residual allocated to HC.0xHP.0 relates to non-NHS healthcare expenditure, including the provision of independent sector services that cannot be identified. 

Non-government expenditure (HF.2.1, HF.2.2, HF.2.3 and HF.3)

Imputation:

Supply-use tables are produced by the UK National Accounts department generally on a t-3 basis. This means that t-2 expenditure for HF.2.3 is uprated based on the growth in household final consumption expenditure for COICOP 06 and revised the following year.

Currently, expenditure under HF.2.2 is estimated based on the growth in overall charity expenditure between 2013 and the reference year. Currently the national accounts estimates of NPISH final consumption expenditure by industry are undergoing improvement, and this may offer a more specific source for the estimation of HF.2.2 in future. 

The breakdown of expenditure by function and provider for some elements of non-government schemes also require estimation or imputation. For further information on these see section 3.5. Data compilation.

Residual:

A small amount of out-of-pocket expenditure, relating to NHS private patient units, is estimated as a residual, after insurance and overseas payors have been accounted for. This represents less than 1% of HF.3.  

Living costs and food survey

For further information on sampling error see:

https://www.ons.gov.uk/file?uri=/peoplepopulationandcommunity/personalandhouseholdfinances/incomeandwealth/methodologies/livingcostsandfoodsurvey/livingcostsfoodtechnicalreport2015.pdf

Health Survey for England

For further information on sampling error see:

https://files.digital.nhs.uk/59/51128B/HSE17-data-quality-statement.pdf

National Council of Voluntary Organisations (NCVO)

For NPISH estimates of spending by function and providers, the Office for National Statistics took a subsample from the NCVO database of charities. To minimise sampling variability big charities were oversampled to ensure that totals were well estimated, but we also ensure that we have enough charities of all sizes in our sample so that we get good estimates of income and expenditure for the typical charity.

No information available.

See subsections 6.3.1 to 6.3.4.

Not applicable to surveys used.

Living costs and Food Survey (LCF)

Units surveyed are private households. For other components of HF.3, measured using non-survey sources, units measured include organisations providing healthcare and private households. 

Health Survey for England (HSE)

This survey was used to apportion home-based long-term care between HC.3.4 and HCR.1. The units of the survey are private households.

National Council for Voluntary Organisations (NCVO)

The NCVO covers charities. No other units are observed in the measurement of HF.2.2.

For the Living Costs and Food Survey (LCF) and Health Survey for England (HSE), there is no known measurement error.

The NCVO dataset contains detailed information on sources of income, but the ONS health accounts team were aware of some misrecording by the NCVO. The two issues to investigate were a misrecording of income from trading subsidiaries and a considerable proportion of government grants with attached SLAs being misrecorded as income from contracts. In the national accounts, an adjustment is applied to these two income sources to record the proportion of charity income which is NPISH.  However, it was thought that this adjustment is excessive in the case of healthcare charities, so for the health accounts this was recalculated based on research of healthcare charities’ published accounts.

The three main survey sources used - the Living Costs and Food Survey (LCF), NCVO dataset, and Health Survey for England (HSE) are all sample sources and therefore may be subject to non-response bias. However, all these surveys have weights calculated which are designed to correct for non-response bias. 

The overall non-response rate for the Living Costs and Food Survey (LCF) was 57% in the year 2017/18, the latest used. The non-response rate has been gradually rising for some time. To be counted in the overall response rate, the LCF requires satisfactory completion of the household consumption diary which is used in producing the data used in HF.3 in health accounts, hence the unit and item response rates are similar. More information on LCF response rates can be found here: https://www.ons.gov.uk/peoplepopulationandcommunity/personalandhouseholdfinances/expenditure/methodologies/livingcostsandfoodsurveytechnicalreportfinancialyearendingmarch2017

The Health Survey for England (HSE) had a non-response rate for adults of 45% in the year 2017, the latest used. More information on the HSE response rate can be found here: http://healthsurvey.hscic.gov.uk/media/78596/HSE17-Quick-Guide-rep.pdf

The NCVO dataset is produced from a sample of charity accounts data, and so does not have a non-response rate. 

To be counted in the overall response rate, the LCF requires satisfactory completion of the household consumption diary which is used in producing the data used in HF.3 in health accounts, hence the unit and item response rates are similar. The overall non-response rate for the LCF was 57% in 2017/18 (financial year), the latest year used.

The Health Survey for England (HSE) had a non-response rate for adults of 42% in the year 2013.

The NCVO dataset is produced from a sample of charity accounts data, and so does not have a non-response rate. 

We are not aware of any processing errors in the survey data used.

We are not aware of any imputation techniques being used in place of observations in the survey sources used in health accounts.

This section is not relevant for SHA.

Not applicable.

The Office for National Statistics report statistics from 2013 onwards on a SHA 2011 basis. 

HF.1.1: The control total for HF.1.1 will be revised each JHAQ based on changes reported in the national accounts and restated expenditure data from departmental annual accounts. The HC x HP analysis will only be revised to implement methods improvements.
HF.2.1: Total HF.2.1 will be revised in line with premiums data published by our data suppliers and revisions made to national accounts data for technical reserves investment income. The HC x HP analysis will be revised based on revisions to claims data.
HF.2.3: The control total for HF.2.3 will be revised in line with revisions to national accounts data. This will also impact upon expenditure reported under HC.0 x HP.0. The remaining HC x HP analysis will be revised according to the growth rate in non-government expenditure.
HF.3: HF.3 is produced using a bottom-up approach and will be revised each year in line with national accounts revisions and revisions to data provided by private sector suppliers. This will mean HF.3 expenditure will be revised each JHAQ.

Revisions tend to be no greater than ±1% of current healthcare expenditure.

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.

The Office for National Statistics (ONS) currently transmits T data to the International Health Acccounts team by 30th April T+2. Data are first published domestically by ONS around the end of April. 

The Office for National Statistics does not produce preliminary estimates of healthcare expenditure.

Final figures are produced in year T+2. These are subject to revisions if revisions to source data are made, for example supply-use balancing revisions to national accounts data.

The UK complies with the Commission Regulation deadline - delivery by the 30th April T+2.

Data are usually delivery to the International Health Accounts Team (IHAT) around the time of the Commission Regulation deadline: 30th April T+2.

Not applicable at national level.

Not applicable.

Breaks in time series resulting from methodological changes

SHA 2011 data for the United Kingdom are available from 2013 onwards.

A break in the series for HC.3.1, HC.3.4 and HCR.1 means that comparable time series for these subvariables are only available from 2015 onwards, but this does not affect HF aggregates.

Not applicable.

Atypical entries:

There should be no internal inconsistencies within UK data, as the expenditure estimates are compiled by allocating HC, HP and HF variables to each component of healthcare expenditure. Consequently there is no need to reconcile separate HPxHF and HCxHF analyses. The Office for National Statistics checks the final internal consistency of the three core tables of the Joint Health Accounts Questionnaires (HCxHP, HCxHF and HPxHF) submitted to the International Health Accounts Team through using the embedded macros within the questionnaires provided by OECD. 

National press are informed of the annual Office for National Statistics publication of health accounts by the Office press team.

An annual health accounts statistical bulletin is published on the Office for National Statistics website:

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/bulletins/ukhealthaccounts/previousReleases.

The bulletin provides commentary around the main messages of the release.

Additional ad hoc publications are sometimes produced to provide international context.

The Office for National Statistics does not currently have an online database. However, health accounts data are uploaded annually in MS Excel files and also as a csv download. 

These are available from:

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/datasets/healthaccountsreferencetables

Data on the number of unique visits to the health accounts publication on the Office for National Statistics are not currently collected.

Not applicable.

Health accounts for the United Kingdom are exclusively published by the Office for National Statistics. However, many media outlets often pick up the secondary release of data by OECD in their Health at a Glance publications published in November. 

Documentation on the methodology used to produce UK health accounts is available through the following links:

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/methodologies/introductiontohealthaccounts

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/methodologies/ukhealthaccountsmethodologicalguidance

Statistical bulletins produced by the Office for National Statistics are accompanied by Quality and Methodology Information reports (QMIs). These are quality reporting document that help our users understand the strengths and limitations of the data in our reports, so that they can make the best decisions available on how to use it.

QMI's are reevaluated periodically. The latest QMI report for health accounts is available at:

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/methodologies/ukhealthaccountsqmi

Information not available.

Information not available.

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

For information on how privacy and data confidentiality are approached in the UK see the following link:

https://gss.civilservice.gov.uk/policy-store/privacy-and-data-confidentiality-methods-a-national-statisticians-quality-review-nsqr/

Data in the UK health accounts are aggregated to a high enough level that no individual level person or firm can be identified. There is no need for cell suppression either at the HCxHP total level for for HCxHF or HPxHF for different financing schemes.

For further information see:

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/qmis/ukhealthaccountsqmi