Health accounts

Se Allso Concepts and definitions in national accounts

Total expenditure on health measures the final consumption of health care goods and services (i.e. current health expenditures) in addition to capital investment in health care infrastructure. This includes spending by public and private sources (including households) on medical goods and services, public health, preventive health care programmes and administration. The two major components of total current health expenditure are expenditure on personal health care and expenditure on collective services. Personal health care services comprise curative care, rehabilitation, long-term health care, ancillary health care services, and medical goods dispensed to out-patients. Collective services comprise public health tasks such as health promotion and disease prevention services and health administration, which are delivered to society at large.

Health expenditure also includes expenditure on health care and social services. According to international guidelines only expenditure for health care and social services that are health related should be included in the health accounts. Long-term nursing care is typically a mix of medical care and social care. Thus only the former is included here.

The System of Health Accounts

The System of Health Accounts is organised around a tri-axial system of recording the health expenditure. The expenditure is grouped into the three following categories:

- health care by function (HC)

- health care service provider industries (HP)

- sources of funding (HF)

Functional classification of health care

The functional approach refers to the goals or purposes of health care. Different producers may provide the same kind of health care functions, i.e. hospitals or diagnostic laboratories could provide diagnostic imaging. The functional classifications are as follows:

For cross-classifications of the functional approach with the SNA 93 functional classifications, like COFOG (classification of the functions of government) and COICOP (classification of individual consumption by purpose), see: A System of Health Accounts .

Classification of health care providers

A classification of health care industries serves the purpose of arranging country specific institutions into common internationally applicable categories. The provider classification comprises both primary and secondary producers of health care services. The classification of health care provider industries is listed in the table below:

For cross-classifications of the health care providers with ISIC (International Standard Industrial Classification), see A System of Health Accounts .

Classification of health care financing

In Norway, health care goods and services are financed both by private and public sources. Central government, local government and the social security fund are the public sources, while the private sources mainly consist of household out-of-pocket payments. The classification of health care financing is listed in the table below:

Classification of Institutional sector

The health expenditures are also grouped by producing institutional sector. The institutional sector is a statistical standard used mainly in National Accounts. It splits the Norwegian economy into sectors on the basis of groups of homogeneous institutional units. In Norway, we have 6 main sectors: General government (central and local government), financial corporations, non-financial corporations, non-profit institutions serving households, households and rest of the world. The health expenditures are grouped into:

• Private corporations or imported from abroad
• Central government
• Local government
• Non-profit institutions serving households

Name: Health accounts
Topic: National accounts and business cycles

Division for National Accounts

National level.

The health accounts is compiled on an annual basis. The final figures are published around two years after the end of the reference year, and are based on detailed sources.

The preliminary figures are based on more aggregate sources, and are to some extent based on estimations. The accounts are normally published around three months after the end of the reference year.

The figures are reported annually to the OECD.

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The Norwegian health accounts are based on A System of Health Accounts (OECD, 2011). The accounts are designed to provide a model for uniform reporting for countries with different ways of organising their national health system, and to meet the needs of analysts of health care systems and policy makers.

The set of tables is based on common concepts, definitions, classifications and accounting rules in order to ensure comparability over time and across countries.

A complete set of tables based on A System of Health Accounts was first published in 2005, and included figures for the period 1997-2004. The health accounts will be compiled on a regular basis as an integrated part of the national accounts.

Major users of the health accounts include the Ministry of Health and Care Services and subordinate institutions, other ministries, research institutes, international organisations, the media etc.

No external users have access to the statistics and analyses before they are published and accessible simultaneously for all users on ssb.no at 08.00 am. Prior to this, a minimum of three months' advance notice is given in the Statistics Release Calendar. This is one of Statistics Norway’s key principles for ensuring that all users are treated equally.

The Norwegian health accounts are compiled within the framework of the national accounts, and thus consistent with the core national accounts data. It is also consistent with the central and local government fiscal accounts, hospital accounts etc.

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Total health expenditure measures the final consumption of health care goods and services (i.e. current health expenditure) in addition to capital investment in health care infrastructure.

The health accounts provide a comprehensive accounting framework for the entire field of health care activities. The system presents health expenditure by function of care, by source of funding and by provider industry. The objective of the health accounts is to constitute a system of comprehensive, internally consistent and internationally comparable accounts, which should also be compatible with other aggregate economic and social statistics as far as possible.

The health accounts are linked to the regular national accounts as a so-called satellite. This means that detailed data from a range of sources integrated in the national accounts serve as a tool for presenting the health expenditure.

The most important sources for compiling health expenditure are public accounts, statistics from public and private hospitals (specialist nursing homes, convalescence and rehabilitation institutions and hospitals) and the Household Budget Survey. Furthermore, all relevant data from the national accounts will be reorganised and utilised in the health accounts.

The health accounts are based on source statistics collected by other divisions in Statistics Norway. There is no separate data collection for the compilation of the health accounts. See item 3.2 for further details on data sources.

The health accounts are to some extent based on more detailed statistics than what is relevant for the national accounts.

The health accounts are based on information in the Norwegian national accounts, and revisions of the national accounts data will consequently influence the health accounts.

National accounts - revision strategy

The national accounts are compiled in different versions: annual accounts are normally compiled in three consecutive preliminary versions and a final one; and occasionally a main revision later on. Main revisions will be carried out every 5-7 years.

The degree of revisions will depend on the availability of new and more comprehensive data sources. For instance, the introduction of the new system developed for reporting data from local to central government (KOSTRA), resulted in improved municipality data and subsequent revisions of the local government figures in the national accounts.

The main part of the compilation of the health accounts consists of linking data from the national accounts to the health accounts according to the classifications defined in the OECD manual. In some cases the national accounts provide data at a more aggregate level than what is needed for the health accounts. In those cases extended data sources are used to identify the necessary details. For instance, data from the Norwegian Patient Register (NPR) is the basis for distinguishing between expenditures on in-patients and out-patients in hospitals.

The Norwegian health accounts provide data in current and constant prices. The calculations in constant prices are based on the national accounts methods. This means that the constant price estimates are calculated with prices from the previous year. The calculation is carried out at a detailed level, and then chained to the present reference year. The chaining is carried out separately for all items.

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According to the Statistics Act §2-6 information collected in accordance with any prescribed obligation to provide information, or which is given voluntarily, shall under no circumstances be published in such a way that it may be traced back to the supplier of any data or to any other identifiable individual to the detriment of the person concerned.

One of the main purposes of the health accounts is to provide a common framework for increased comparability of data over time and across countries. As the Norwegian health accounts are compiled according to A System of Health Accounts, the Norwegian data will be comparable with data from other countries using the same international guidelines.

Consistent Norwegian health expenditure data are available from 1997.

The Norwegian health accounts are compiled using several different statistical sources. The statistical sources consist of data from establishments, enterprises, and households. In addition, different administrative registers are used. The uncertainty in the national accounts estimates is related to the errors in source data and the compilation methods. Uncertainty connected to the different statistical sources is usually described as part of the documentation of the sources. Several of the statistical sources used in the compilation of the national accounts remain preliminary for longer periods, as they require extensive analysis and numerous revisions before the final figures are known.

Since the system of national accounts is an integrated system containing routines for consistency checks of data, one assumes that the national accounts contribute to reduce the uncertainty in source data. On the other hand, the national accounts require the compilation of figures in areas where source statistics are limited or even lacking. In such cases figures are compiled using statistical methods, and hence subject to uncertainty.

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