Health expenditure

What does the survey comprise?

Purpose

Description of final expenditure on health care (financial flows associated with the consumption of health care) according to the System of Health Accounts. Another purpose is to show the link with the Dutch figure on health and social care expenditure. Health care expenditure is broken down by types of health care providers, financing schemes, and health care functions (goods and services grouped according to their purpose). Several sources have been integrated for this purpose.

Description of domain

This survey covers expenditure on and financing (in current prices) of health care used by residents of the Netherlands in one year. It covers all activities in the area of health care, irrespective of whether they are performed within or outside the health care sector. The figures are based on the definition of the System of Health Accounts as used by Eurostat, the OECD and the WHO.

According to the System of Health Accounts, health care covers all activities with the primary purpose of improving, maintaining and preventing the deterioration of the health status of persons and mitigating the consequences of ill-health through the application of qualified health knowledge (medical, paramedical and nursing knowledge, including technology, and traditional, complementary and alternative medicine (TCAM)). Four criteria are essential in this respect:

1. The primary intent of the activity is to improve, maintain or prevent the deterioration of the health status of individuals, population groups or the population as a whole, as well as to mitigate the consequences of ill health;
2. This is achieved through qualified medical or health care knowledge and skills, under supervision of those with such knowledge, through governance and health system administration and its financing;
3. Consumption is the final use of health care goods and services by residents;
4. There is a transaction of health care services or goods.

The figures are taken from the Dutch figures on health and social care expenditure, which cover a broader range of activities (including e.g. child day care, welfare, and social services). These figures include exports, which in this table are included in the financing item Rest of the world; exports.

The survey also makes it possible to show how the total figure in accordance with the System of Health Accounts is calculated from the total figure and social care:

Total figure on health and social care
-/- exports
-/- health-related activities, other goods and services (welfare, child day care, social services) for residents
= Total current expenditure on health.

Expenditure is covered on the basis of three questions:

1. Where does the money come from (financing, according to the classification of financing schemes, HF)?
2. Where does the money go (providers, according to the classification of health care providers, HP)?
3. What kind of services and what types of goods are consumed (functionally defined products, according to the classification of health care functions, HC)?

Date/year survey started

2005.

Frequency

Annual.

Publication strategy

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.

How is the survey conducted?

Main sources

Statistics Netherlands: surveys of health and social care providers; National Accounts; price and tariff data.
External sources: financing data (National Health Care Institute, the former health insurance fund); budget data (Ministry of Health, Welfare and Sports); tariff information (Dutch Health Authority), Vektis (health care data of the health insurers), annual reports.

See also Health care institutions, Health care practices, Production statistics.

Structure of integration framework

The 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.

The figures on health and social care expenditure for each actor are used by and discussed with National Accounts.

Quality of the results

Sequential comparability

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.

Revisions

The 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.

Quality strategy

Checks are carried out for completeness, internal and external consistency and plausibility of the collected internal and external data. Where necessary, corrections are applied.