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CSO statistical release, 03 December 2015, 11am

System of Health Accounts

Ireland's System of Health Accounts, Annual Results 2013 (Preliminary)

Current Health Expenditure in Ireland, 2013
Current Health Expenditure (€ bn)18.4
Current Health Expenditure % GDP10.2
Current Health Expenditure % GNI12.4

New Current Health Expenditure Estimate for Ireland, €18.4 billion (2013)

System of Health Accounts 2013. Healthcare by Financing Scheme.

Ireland’s current health expenditure was €18.4 billion in 2013.  This represented 10.2% of gross domestic product (GDP) or 12.4% of gross national income (GNI).  Government funded over 70% of this expenditure with household out-of-pocket payments and health insurance funding the majority of the remaining expenditure.

This release provides the first detailed profile of current health spending (i.e. excluding capital expenditure) for Ireland according to the System of Health Accounts (SHA) methodology.  The new presentation provides detail on what kind of health care goods and services are provided, by whom they are provided and how they are funded.

The data for 2013 under this new approach to estimating health care expenditure are preliminary and will be subject to revision.

The introduction of this new methodology has resulted in a break in series from 2013.   Data for 2000 to 2012 presented in Table 7 have been revised to take account of the new boundary for health care services but remain based on previously used data sources and estimation methodologies (see Background Notes and commentary on Table 7).

Financing of Health Care Services in Ireland

The majority of health expenditure in 2013 (€13,082 million or 71%) was financed by government (HF.1).  Most of this related to expenditure of the Health Service Executive but also included other government expenditure such as Department of Social Protection transfer payments to households and Treatment Benefit payments (HF.1.2) from the Social Insurance Fund (Table 1 and Table 8).

The remaining expenditure was financed in almost equal parts by household out-of-pocket payments (HF.3) at €2,667 million and voluntary health care payments (HF.2), the majority of which related to voluntary health insurance (€2,177 million).  Other voluntary payments came from income such as car-parking, restaurant receipts and fund-raising.

Table 1: Current Health Care Expenditure by Financing Scheme, 2013
 
ICHA-HF Code €m%
HF.1Govt Financing Schemes and Compulsory Contributory Health Care Financing Schemes13,08271
 HF.1.1 Government Schemes13,02671
 HF.1.2 Compulsory Contributory Health Insurance Schemes560
HF.2Voluntary Health Care Payment Schemes2,63714
 HF.2.1 Voluntary Health Insurance Schemes2,17712
 HF.2.x Other Voluntary Payment Schemes4603
HF.3Household Out-of-Pocket Payments2,66715
HF.1-HF.3Total Current Health Care Expenditure18,387100

Health Care Providers in Ireland

Just over one-third of health expenditure happened in hospitals (HP.1), with a further 20% in long-term residential facilities (HP.2) such as nursing homes and residential disability services (see Table 2).  Ambulatory health care providers (HP.3), which were predominantly made up of GPs and dentists, also accounted for 20% of expenditure.  

Retailers of Medical Goods (predominantly pharmacies) accounted for a further €2,758 million or 15% of all health care expenditure.

Table 2: Current Health Care Expenditure by Provider, 2013
 
ICHA-HP Code €m%
HP.1Hospitals6,48235
HP.2Long-Term Residential Facilities3,60120
HP.3Ambulatory Health Care Provider3,63420
HP.4Ancillary Health Care Provider2331
HP.5Retailer of Medical Goods2,75815
HP.6Providers of Preventive Care2321
HP.7Providers of Health Care Administration and Financing3862
HP.8Rest of the Economy1,0236
HP.9Rest of the World260
HP.0Providers N.E.C.100
HP.1 to HP.0Total Current Health Care Expenditure18,387100
Current Health Care Expenditure by Provider, 2013
Hospitals6.49038004832299
Long-Term Residential Facilities3.59359991658288
Ambulatory Health Care Provider3.63427176249534
Ancillary Health Care Provider0.233457874781588
Retailer of Medical Goods2.75983958544838
Other Providers1.67524481752315

Health Care Services in Ireland

The functional classification under the SHA is the key classification for defining the boundary of health care (see Table 3). 

The majority of health expenditure related to curative and rehabilitative care (€10,204 million) and nearly half of this was for inpatient care (€4,354 million).  The next largest category was long-term care which amounted to 22% of expenditure again with inpatient services the largest component of this (€2,567 million).  Pharmaceuticals and other medical non-durables (HC.5.1) made up the next largest category (15%).  Administration of the health care system (public and private) amounted to €390 million in 2013 (2% of current health expenditure).

Table 3: Current Health Care Expenditure by Health Care Function, 2013
 
ICHA-HC Code  €m%
HC.1+HC.2Curative and Rehabilitative Care10,20455
 HC.1.1+HC.2.1 Inpatient Curative & Rehabilitative Care4,35424
 HC.1.2+HC.2.2 Day Curative and Rehabilitative Care1,2737
 HC.1.3+HC.2.3 Outpatient Curative & Rehabilitative Care3,82321
 HC.1.4+HC.2.4 Home-Based Curative & Rehabilitative Care7554
HC.3Long-Term Care (Health)4,13522
 HC.3.1 Inpatient Long-Term Care (Health)2,56714
 HC.3.2 Day Long-Term Care (Health)1751
 HC.3.4 Home-Based Long-Term Care (Health)1,3948
HC.4Ancillary Services5133
HC.5Medical Goods (Non-Specified by Function)2,87616
 HC.5.1 Pharmaceuticals and Other Medical Non-Durables2,76615
 HC.5.2 Therapeutic Appliances and Other Medical Goods1101
HC.6Preventive Care2611
HC.7Governance and Health System Administration and Financing3902
HC.9Health Care Services N.E.C70
HC.1 to HC.9Total Current Health Care Expenditure18,387100
Current Health Care Expenditure By Function, 2013
Curative and Rehabilitative Care10.2041615145776
Long-Term Care (Health)4.13539770094111
Ancillary Services0.513395194385293
Medical Goods (Non-Specified by Function)2.87902809034153
Other Health Care Functions0.654811504908821

Who is providing which services?

The cross-classifying of the data allows for further analysis of health care expenditure.  

Table 4 presents a breakdown of health care expenditure by function (HC) and provider (HP).  This illustrates which providers are providing which services. 

Services provided by hospitals accounted for over one-third of health care expenditure in Ireland (€6,482 million) with nearly two-thirds of this expenditure (€3,854 million) on inpatient services.  Long-term residential facilities and ambulatory health care providers each accounted for one-fifth of expenditure.  Long-term facilities, which include nursing homes and residential facilities for people with a disability, predominantly provided long-term care inpatient services (€2,493 million).  Ambulatory health care providers mainly deliver outpatient services.  These comprise GPs, dentists and other services such as home care providers and health care centres (€2,488 million).  

Expenditure on pharmaceuticals (€2,766 million) accounted for over 15% of health care expenditure with the vast majority being provided by pharmacies (which are included in retail sellers of medical goods, HP.5). 

Other Sectors (HP.8, HP.9 and HP.0) also provided health care services amounting to €1,059 million in 2013.  Two-thirds of this expenditure (€682 million) was for the provision of long-term health care services in the home by persons in receipt of transfer payments (e.g. Carers’ Allowance and Domiciliary Care Allowance).

Table 4: Current Health Care Expenditure by Health Care Function and Health Care Provider, 2013
              €million
ICHA Code  HP.1 - HospitalsHP.2 - Long-Term Residential FacilitiesHP.3 - Ambulatory Health Care ProviderHP.4 - Ancillary Health Care ProviderHP.5 - Retailer of Medical GoodsHP.6 - Providers of Preventative CareHP.7 - Providers of Health Care Administration and Financing HP.8 - Rest of the EconomyHP.9 - Rest of the World HP.0 - Providers N.E.C.HP.1 to HP.0 - Total
HC.1+HC.2Curative and Rehabilitative Care6,1306253,211 73 19823710,204
HC.1.1+HC.2.1 Inpatient Curative & Rehabilitative Care3,854479      2104,354
HC.1.2+HC.2.2 Day Curative and Rehabilitative Care1,1451125    1001,273
HC.1.3+HC.2.3 Outpatient Curative & Rehabilitative Care1,101222,488 7  197273,823
 HC.1.4+HC.2.4 Home-Based Curative & Rehabilitative Care30123598  3  00755
HC.3Long-Term Care (Health)742,977403    682  4,135
HC.3.1 Inpatient Long-Term Care (Health)742,493        2,567
HC.3.2 Day Long-Term Care (Health) 2173       175
 HC.3.4 Home-Based Long-Term Care (Health) 482230    682  1,394
HC.4Ancillary Services276 0233    21513
HC.5Medical Goods (Non-Specified by Function)  2 2,750  124  2,876
HC.5.1 Pharmaceuticals and Other Medical Non-Durables  2 2,677  88  2,766
 HC.5.2 Therapeutic Appliances and Other Medical Goods    73  37  110
HC.6Preventative Care0 17  225 19 0261
HC.7Governance and Health System Administration and Financing     4386   390
HC.9Health Care Services N.E.C3 101  0027
HC.1 to HC.9Total Current Health Care Expenditure6,4823,6013,6342332,7582323861,023261018,387

How are health care services being funded?

Table 5 presents a breakdown of health care expenditure by function (HC) and financing scheme (HF).  This illustrates which services are funded from which financing schemes.

Of the €10,204 million spent on curative and rehabilitative services, just over two-thirds (€6,877 million) was funded by government and nearly one-fifth (€1,837 million) was funded from voluntary health insurance payments. 

Government financed almost 80% (€3,300 million) of long-term care services. Of the remainder, 16% was financed by out-of-pocket expenditure and just under 4% by other voluntary health care payments.  The latter includes own resource income of the providers and donations received.

Nearly 30% (€882 million) of pharmaceutical expenditure was funded by out-of-pocket payments with the remainder predominantly funded by government.  Preventive care such as immunisation and health promotion activities was predominantly funded by government (93%).  Tax refunds for health expenditure amounted to €134m in 2013.  As there is no information on what services were received, the expenditure is classified to health services not elsewhere classified.

Table 5: Current Health Care Expenditure by Health Care Function and Health Care Financing Scheme, 2013
           €million
           2013
ICHA Code  HF.1 - Govt and CompulsoryHF.1.1 - Government Financing SchemesHF.1.2 - Compulsory Contributory SchemesHF.2 - Voluntary Health Care Payment SchemesHF.2.1 - Voluntary Health Insurance Schemes HF.2.x - Other Voluntary Health Care Payment SchemesHF.3 - Household Out-of-Pocket PaymentsHF.1 to HF.3 - Total
HC.1+HC.2Curative and Rehabilitative Care6,8776,858202,1051,8372681,22210,204
 HC.1.1+HC.2.1 Inpatient Curative & Rehabilitative Care2,9642,964 1,2801,249311104,354
 HC.1.2+HC.2.2 Day Curative and Rehabilitative Care756756 50348518141,273
 HC.1.3+HC.2.3 Outpatient Curative & Rehabilitative Care2,4962,47720306932131,0213,823
 HC.1.4+HC.2.4 Home-Based Curative & Rehabilitative Care661661 1611677755
HC.3Long-Term Care (Health)3,3003,27723157 1576784,135
 HC.3.1 Inpatient Long-Term Care (Health)1,7871,787 116 1166642,567
 HC.3.2 Day Long-Term Care (Health)170170 3 32175
 HC.3.4 Home-Based Long-Term Care (Health)1,3431,3202338 38131,394
HC.4Ancillary Services369369 128128016513
HC.5Medical Goods (Non-Specified by Function)1,9911,97714***8852,876
 HC.5.1 Pharmaceuticals and Other Medical Non-Durables1,9441,944 ***8222,766
 HC.5.2 Therapeutic Appliances and Other Medical Goods463314** 63110
HC.6Preventive Care243243 18216 261
HC.7Governance and Health System Administration and Financing167167 22320716 390
HC.9Health Care Services N.E.C135135 643-1347
HC.1 to HC.9Total Current Health Care Expenditure13,08213,026562,6372,1774602,66718,387
* Confidential

How are health care providers being funded?

Table 6 presents a breakdown of health care expenditure by health care provider (HP) and financing scheme (HF).  This illustrates which providers are funded from which financing schemes.

Government was the majority funder of health care providers in Ireland (71%).  Three-quarters of expenditure in long-term care facilities were government funded as was nearly 70% of hospital expenditure.  Three-quarters of pharmaceutical expenditure was also funded by government. Nearly 82% of voluntary health insurance payments (€1,781 million) were spent on hospital services.   Almost two-fifths of out-of-pocket payments (€1,026 million) were spent on ambulatory health care providers.  Over a quarter of out-of-pocket expenditure (€750 million) was on long-term care facilities and approximately another quarter (€634 million) was spent in pharmacies.

Table 6: Current Health Care Expenditure by Health Care Provider and Health Care Financing Scheme, 2013
        €million
           2013
ICHA Code  HF.1 - Govt and CompulsoryHF.1.1 - Government Financing SchemesHF.1.2 - Compulsory Contributory SchemesHF.2 - Voluntary Health Care Payment SchemesHF.2.1 - Voluntary Health Insurance Schemes HF.2.x - Other Voluntary Health Care Payment SchemesHF.3 - Household Out-of-Pocket PaymentsHF.1 to HF.3 - Total
HP.1Hospitals4,5014,501 1,8561,781751266,482
 HP.1.1 General Hospital3,8043,804 1,6341,571631045,542
 HP.1.2 Mental Health Hospitals194194 7978210284
 HP.1.3 Specialised Hospitals (other than Mental Health Hospitals)503503 1431331012657
HP.2Long-Term Residential Facilities2,6852,685 167241437503,601
HP.3Ambulatory Health Care Provider2,4992,4792010980291,0263,634
 HP.3.1 Medical Practices548548 51510308907
 HP.3.2 Dental Practices92722055 487583
 HP.3.3 Other Health Care Practitioners6868 13121131212
 HP.3.4 Ambulatory Health Care Centres1,3881,388 22319361,446
 HP.3.5 Providers of Home Health Care Services404404 1910964487
HP.4Ancillary Health Care Provider161161 5958014233
 HP.4.1 Providers of Patient Transportation and Emergency Rescue142142 5403150
 HP.4.2 Medical and Diagnostic Laboratories1818 545401183
HP.5Retailer of Medical Goods1,9911,97714***7672,757
 HP.5.1 Pharmacies1,9451,945 ***6342,579
 HP.5.2 Retail Sellers of Durable Medical Goods and Appliances463214** 133178
HP.6Providers of Preventive Care209209 23 23 232
HP.7Providers of Health Care System Administration and Financing167167 21820712 386
 HP.7.1 Govt Health Administration Agencies166166 10 10 176
 HP.7.3 Private Health Insurance Administration Agencies   207207  207
 HP.7.9 Other Administration Agencies11 1 1 3
HP.8Rest of the Economy7267042317801781191,023
 HP.8.1 Households as Providers of Home Health Care68265923    682
 HP.8.2 All Other Industries as Secondary Providers of Health Care4545 1780178119341
HP.9Rest of the World99 1717  26
HP.0Provider N.E.C.134134 11101-13411
HP.1 to HP.0Total Current Health Care Expenditure13,08213,026562,6372,1774602,66718,387
* Confidential

Revised health care expenditure, 2000 to 2013

Prior to the implementation of detailed  SHA reporting, Ireland reported data on health care expenditure at a high level only.  These estimates were revised in light of the outputs of the SHA project and resulted in a revised times series of health care expenditure from 2000 to 2012.    The revisions predominantly affected public expenditure on health and related to the expansion of the health care boundary to include a greater proportion of long-term care services, in particular services for older people and disability services.  Although the data from 2000 to 2012 now take account of the revised health care boundary, the data sources and methods used for revision were not the same as those used for compiling the 2013 estimate and thus result in a break in series.

Table 7 and related graphs present the revised time series.  Over this period, health care expenditure increased as a proportion of GDP.  In 2000, it was estimated to represent just under 6% of GDP, rising to just over 10% in 2013.  This compares to an OECD average of 7.3% in 2000 and 9% in 2013.   Irish health care expenditure as a percentage of GNI rose from just under 7% in 2000 to 12.4% in 2013.

Table 7: Revised Health Care Expenditure in Ireland, 2000 to 2013
               €million
  20002001200220032004200520062007200820092010201120122013b
Total Health Care Expenditure (€m)6,9228,5329,89610,95012,20013,68114,43816,26317,89818,50918,19917,92418,50019,229
Capital Expenditure (€m)1522727822749918665539877807671583729818843
Current Expenditure (€m)6,4007,8059,07510,20111,28213,01613,89915,38717,09117,83817,61617,19517,68218,387
Current Public Expenditure (€m)4,9616,1227,1688,0358,90310,26510,81712,19113,55713,74813,42013,06513,41013,082
 Current Private Expenditure (€m)1,4391,6831,9062,1662,3792,7503,0823,1953,5344,0904,1974,1304,2725,304
Current Expenditure % GDP, Ireland5.9%6.4%6.7%7.0%7.3%7.7%7.6%7.8%9.1%10.5%10.6%9.9%10.1%10.2%
Current Expenditure % GNI, Ireland6.8%7.6%8.1%8.3%8.5%9.0%8.7%9.1%10.6%12.8%12.7%12.4%12.4%12.4%
Current Expenditure % GDP, OECD Average (adjusted)27.3%7.5%7.7%8.0%8.0%8.1%8.0%8.0%8.3%9.0%8.8%8.8%8.9%9.0%
b Break in series
1 Sourced from CSO National Accounts data
2 OECD Average recalculated with revised Irish data and latest GDP estimates
Total Health Care ExpenditureCapital ExpenditureCurrent Expenditure
20006.921752326866130.5215850325071546.40016729435898
20018.531808868774490.7272654648779897.8045434038965
20029.89629792846740.8216611739973529.07463675447005
200310.95025280189780.74878900851122710.2014637933866
200412.19980448997610.91825819936731111.2815462906088
200513.68085598918150.66528365298477613.0155723361967
200614.43782627960770.53865299196149613.8991732876462
200716.26326117193530.8766000522577915.3866611196776
200817.89795754425440.80717222794635517.0907853163081
200918.50893884911490.67079035329657717.8381484958183
201018.19897463196740.58262934829113517.6163452836763
201117.92394703253010.7294140964241317.194532936106
201218.49990225245130.81818271651533617.681719535936
2013b19.22932691993620.84253291478185418.3867940051543
Current Expenditure % GDP, IrelandCurrent Expenditure % GNI, IrelandCurrent Expenditure % GDP, OECD Average (adjusted)
20005.93711426826536.828645712723877.25076920685028
20016.439459918666147.594279120108177.50476512859727
20026.713047827194568.118630368103767.74964410424549
20037.043274379419438.264107568736358.00456487501515
20047.256405853748448.499892353569178.03650257592573
20057.694561735975278.969870057317898.11371271133986
20067.563797377350748.656987276591948.04677652026923
20077.820469949446599.06704029606368.02565574785245
20089.1458072050179310.58846940163838.33247209370369
200910.528224510319612.76471070381958.9937846369256
201010.602199025898812.70348221151768.84852477853953
20119.8853252291042512.36193107051998.82638873685143
201210.112778446388812.39786795050088.91070436339458
2013b10.246326182752312.36431048899729.03304727768378

Reconciliation of HSE Gross Expenditure to Government (HF.1) Funded Current Health Expenditure, 2013

Table 8 presents a reconciliation of HSE gross expenditure for 2013 (as reported in their Annual Financial Statement) to the HF.1 Government Financing Schemes total reported under the SHA methodology.  The purpose of the table is to illustrate the components of Government funded health care expenditure under the SHA methodology and to relate these to national expenditure data.

Table 8: Reconciliation of HSE Gross Expenditure to Government (HF.1) Funded Current Health Expenditure, 2013
  €m
1HSE AFS 2013 - Expenditure - Pay and Pensions4,871
2HSE AFS 2013 - Expenditure - Non-Pay8,771
3=1+2Total HSE Annual Financial Statement 2013 Gross Expenditure13,642
   
4Exclude Non-Health Care Services-1,414
5Include Non-AFS Gross Expenditure (Mainly Related to Voluntary Agencies)567
6=4+5Total Adjustments to AFS 2013 Gross Expenditure-847
   
7=3+6Gross Expenditure of HSE included in SHA Expenditure12,795
   
8Non-Government Funding of HSE-838
9=7+8Total HSE HF.1 Funded Health Care Expenditure11,957
   
 Additional Government Health Care Expenditure: 
10 DSP Transfer payments715
11Treatment Benefits from Social Insurance Fund56
12 Department of Health82
13 Tax Relief on Medical Expenses134
14 Expenditure of Other Government Departments and Agencies139
15=10+11+12+13+14Total Additional Government HF.1 Funded Expenditure1,126
   
16=9+15Government (HF.1) Funded Current Health Care Expenditure13,082

Background Notes

Introduction

This release is the first official publication by CSO of health care expenditure estimates for Ireland according to the international standard of the System of Health Accounts, 2011.  The release provides for the first time a detailed profile of Irish current health expenditure according to the classifications of the functions of health care (ICHA-HC), health care provision (ICHA-HP), and financing schemes (ICHA-HF).  This level of detail is available only for reference year 2013. Data will be available at this level of detail annually in the future. 

Estimates for earlier years which were reported only as high level aggregates have been revised as a result of the work undertaken to produce this more detailed profile of health expenditure – see section Revision of Previous Estimates (2000 to 2012)

International comparisons for this data can be found in the Eurostat data explorer http://ec.europa.eu/eurostat/data/database under the theme:

Population and Social Conditions\Health\Health Care\Health Care Expenditure and in the OECD statistical database at http://stats.oecd.org/index.aspx?DataSetCode=SHA.

 

Overview of the System of Health Accounts

What is the System of Health Accounts?
The System of Health Accounts (SHA) was devised by the Organisation for Economic Co-operation and Development (OECD) and has been adopted for joint reporting of health care expenditure by the OECD, Eurostat and the World Health Organisation.  It is an extension of the core National Accounts and consists of a family of interrelated tables for reporting expenditure on health and its financing. 

The SHA contains common concepts, definitions, classifications and accounting rules to enable comparability over time and across countries.  It provides a basis for uniform reporting by countries with a wide range of different models of organising their national health systems.  The SHA also draws a commonly defined boundary around what is health care and distinguishes it from related social care services.  This is particularly important for international comparisons given the diversity in health and social care services provision and their funding across Europe and the rest of the world.

The provision of health care and its funding is a complex, multi-dimensional process.  The set of core tables in the SHA addresses three basic questions:

  1.  Where does the money to finance the health system come from? (financing schemes);
  2.  Who does the money go to? (provider of health care services and goods);
  3.  What kind of (functionally defined) services are performed and what type of goods are purchased?

Consequently, the SHA is organised around a tri-axial system for the recording of health expenditure, by means of the International Classification for Health Accounts (ICHA), defining;

  • health care financing schemes (ICHA-HF);
  • health care by service provider industries (ICHA-HP);
  • health care by function (ICHA-HC);

Summary details of the categories in each classification are given in the section International Classification of Health Accounts and linked documents.  A detailed description of the classifications and their application is set out in the manual on the System of Health Accounts which is available at http://www.who.int/nha/sha_revision/en/.

 

Revision of Previous Estimates (2000 to 2012)
A key feature of the SHA methodology is defining the boundary of health care services and distinguishing it from health-related services and social care services.  In the course of the SHA implementation project, the boundary of health care services in Ireland was revised to include services which previously had been defined as social care services and thus excluded from estimates of health care expenditure.

Prior to the introduction of the SHA, Ireland reported data on health care expenditure to international organisations at a high level only.  These estimates have now been revised in light of the outputs of the SHA project and a revised times series of health care expenditure for 2000 to 2012 is available.    The revisions predominantly affect public expenditure on health and relate to the expansion of the health care boundary to include a greater proportion of long-term care services, in particular services for older people and people with a disability. The data sources and methodology prior to 2013 are different to the current method under the SHA and result in a break in series in 2013.

 

National application of the SHA standard
A detailed review of data sources to allow coding to the SHA classifications has been undertaken over the past two years, and much progress has been made.  However this work is ongoing and revisions, especially to the more detailed profile of the data are to be expected.  In particular some revisions to the functional categorisation of HSE expenditure are now expected due to an on-going review of data coding.

 

Specific known data issues at this point include:
All HSE hospital expenditure funded by HSE Mental Health Services has been allocated to HP.1.2 Mental Health Hospitals.  This is not in accordance with the SHA standard which requires that where the services are provided by a General Hospital (HP.1.1), the expenditure should be recorded under this provider as specialist care.  This will be reviewed in future iterations of the data.

Expenditure included under the SHA reporting standard should relate to Final Consumption Expenditure (FCE) only.  The expenditure included in this publication includes some items that should not be included in FCE e.g. interest payments.  This deviation is not material.

Coverage
Non-Profit Providers
: There is on-going work to improve the coverage of data on expenditure on health care.  In particular, further development work on Non-Profit providers of health care and their non-government funding is on-going.  The funding of health care services from Non-Profit Institutions Serving Households Financing Schemes (HF.2.2) is under represented in the current data and will be revised in future data reporting.

Residents and Non-Residents:  Health expenditure should relate only to residents of the Republic of Ireland.  Most data sources do not capture information on residence and thus expenditure on non-residents may be included in the data (export of health care services).  Expenditure by residents in other countries is also difficult to capture, particularly out-of-pocket expenditure.  Some expenditure funded by the HSE and private health insurers has been captured.  There is likely to be an underestimate of import of health care services in the Irish SHA data. 

Health Care/Social Care Boundary: The project to implement the SHA reporting standard in Ireland reviewed the boundary of health care and social care with the HSE Service Providers.  This resulted in a number of services and the associated expenditure, previously categorised as social care, being reclassified to health care.  Given that health care and social care are often delivered in the same package of services, it has been hard to separate the two types of services and thus the predominant activity (generally health care) has been used to classify the activity and associated expenditure.  This has resulted in the amount of health care being somewhat over-stated in some areas.

 

International Classification of Health Accounts

This section provides some detail on each classification.  Details of the current application of the standard in Ireland are available at http://www.cso.ie/en/surveysandmethodology/nationalaccounts/.  The SHA manual provides a full description of the classifications and their categories.  The manual is available at http://www.who.int/health-accounts/methodology/sha2011.pdf.

 

ICHA – HF:  Health Care Financing Schemes
Health care financing schemes are structural components of health care financing systems.  They are the main types of financing arrangements through which people obtain health services.  These include:

  • government schemes
  • social health insurance
  • compulsory private insurance
  • compulsory medical saving accounts
  • voluntary health insurance
  • other financing arrangements in which participation is voluntary
  • out-of pocket expenditure by households.

For information on mapping of Irish health care financing system to the ICHA-HF classification and data sources used, please see the methodological note Mapping of the Structure of Health Care Financing in Ireland to the Health Care Financing Schemes Classification (ICHA – HF) within the System of Health Accounts at http://www.cso.ie/en/surveysandmethodology/nationalaccounts/

 

ICHA – HP: Classification of Health Care Providers
The classification of health care providers (ICHA-HP) classifies all organisations that contribute to the provision of health care goods and services, by arranging country-specific provider units into common, internationally applicable categories. The “principal activity” undertaken is the basic criterion for classifying health care providers.  These include:

  • Hospitals
  • Residential long-term care facilities (e.g. for older people or for people with a disability)
  • Ambulatory health care providers (e.g. GPs, dentists)
  • Ancillary service providers (e.g. transport, emergency rescue, laboratory services)
  • Retailers and other providers of medical goods (e.g. pharmacies)
  • Providers of preventive care (e.g. organisation of public health programmes)
  • Providers of health care administration and financing
  • Other providers (e.g. households, other industries, rest of world)

For information on mapping of Irish health care providers to the ICHA-HP classification please see the methodological note Mapping of Health Care Providers in Ireland to the Provider Classification (ICHA – HP) within the System of Health Accounts at http://www.cso.ie/en/surveysandmethodology/nationalaccounts/.

 

ICHA – HC: Classification of Health Care Functions Explained
The functional classification under the SHA is the key classification for defining the boundary of health care. It groups health care services by purpose.  The first five categories relate to goods and services consumed by individuals.  These categories comprise

  • Curative and rehabilitative care – where the principal intent is to:
    • relieve symptoms of illness or injury, to reduce the severity of an illness or injury, or to protect against exacerbation and/or complication of an illness and/or injury that could threaten life or normal functioning: and/or
    • to empower persons with health conditions who are experiencing or are likely to experience disability so that they can achieve and maintain optimal functioning, a decent quality of life and inclusion in the community and society.
  • Long-term care (health) – which consists of a range of medical and personal care services with the primary goal of alleviating pain and suffering and reducing or managing the deterioration in health status in patients with a degree of long-term dependency.  The SHA distinguishes between long-term care with a “health” purpose and long-term care with a “social” purpose.  As these elements of long-term care are often delivered in a single package of care, it is very difficult to separate them – as has been noted above in the case of Ireland.
  • Ancillary services such as laboratory services, imaging services, patient transport and emergency rescue.  Data is reported explicitly in this category only when the services are received independently of an overall episode of health care – the majority of these services are recorded as part of curative and rehabilitative or long-term care and are not separately identified.
  • Medical goods dispensed to outpatients – by a health care establishment or by a retailer of medical goods.  Like ancillary services, those goods consumed as part of other functions are not identified separately.

Two other categories relate to the collective consumption of health care, namely:

  • Prevention and public health services – such as information, education and counselling programmes, immunisation programmes, screening programmes and disease surveillance.
  • Health administration and governance – includes the formulation and administration of government policy; the setting of standards; the regulation, licensing or supervision of producers.  These activities are mainly carried out by governments but may also be provided by private bodies such as health insurers and advocacy/representative groups.

For information on mapping of Irish health care services to the ICHA-HC classification and data sources used, please see the methodological note Mapping of Health Care Services in Ireland to the Functions Classification (ICHA – HC) within the System of Health Accounts at http://www.cso.ie/en/surveysandmethodology/nationalaccounts/.

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