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CSO statistical release, 27 June 2016, 11am

System of Health Accounts

Ireland's System of Health Accounts, Annual Results 2014

Current Health Expenditure in Ireland, 2013 and 2014
 20132014
Current Health Expenditure (€ bn)18.819.1
Current Health Expenditure % GDP10.510.1
Current Health Expenditure % GNI12.311.7

Current Health Expenditure Estimate for Ireland, €19.1 billion (2014)

Ireland’s current health expenditure was €19.1 billion in 2014.  This represented 10.1% of gross domestic product (GDP) or 11.7% of gross national income (GNI).

This release provides the first estimates of Irish health care expenditure for 2014 and revised estimates for 2013, according to the System of Health Accounts standard.  See Background Notes for further details. Please note that the rounding of percentages to the nearest interger results in some subtotals not summing to 100%.

Financing of Health Care Services in Ireland

The majority of health expenditure in 2014 (€13,265 million or 69%) was financed by government (HF.1). 

The remainder was mainly funded by household out-of-pocket payments (15%) and health insurance (13%).

Table 1: Current Health Care Expenditure by Financing Scheme, 2013 and 2014
    20132014
ICHA-HF Code €m%€m%
HF.1Govt Financing Schemes and Compulsory Contributory Health Care Financing Schemes13,0967013,26569
 HF.1.1 Government Schemes13,0407013,21269
 HF.1.2 Compulsory Contributory Health Insurance Schemes560530
HF.2Voluntary Health Care Payment Schemes2,858152,92715
 HF.2.1 Voluntary Health Insurance Schemes2,376132,42913
 HF.2.x Other Voluntary Care Payment Schemes48234983
HF.3Household Out-of-Pocket Payments2,822152,95615
HF.1-HF.3Total Current Health Care Expenditure18,77610019,148100

Health Care Providers in Ireland

Just over one-third of health expenditure happened in hospitals (HP.1) in 2014, with a further 19% in long-term residential facilities (HP.2) such as nursing homes and residential disability services (see Table 2).  Ambulatory health care providers (HP.3), predominantly GPs and dentists, accounted for 20% of expenditure.  

Retailers of Medical Goods (mainly pharmacies) accounted for a further €2,716 million or 14% of all health care expenditure in 2014.

Table 2: Current Health Care Expenditure by Provider, 2013 and 2014  
  20132014
ICHA-HP Code €m%€m%
HP.1Hospitals6,596356,64835
HP.2Long-Term Residential Facilities3,536193,64019
HP.3Ambulatory Health Care Providers3,767203,84220
HP.4Ancillary Health Care Providers24912781
HP.5Retailers of Medical Goods2,753152,71614
HP.6Providers of Preventative Care23012281
HP.7Providers of Health Care Administration and Financing56436703
HP.8Rest of the Economy1,04161,0876
HP.9Rest of the World270280
HP.0Providers N.E.C.120110
HP.1 to HP.0Total Current Health Care Expenditure18,77610019,148100
Current Health Care Expenditure by Provider, 2014
Hospitals6.64777290241591
Long-Term Residential Facilities3.64008732119756
Ambulatory Health Care Providers3.84184978415254
Ancillary Health Care Providers0.278422067240694
Retailers of Medical Goods2.71636785702557
Other Providers2.0237379562651
Current Health Care Expenditure by Provider, 2014
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, i.e. the type of health services provided, 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 (€10,291 million) and nearly half of this was for inpatient care (€4,553 million).  The next largest category was long-term care which amounted to 22% of expenditure, again with inpatient services the largest component of this (€2,708 million). 

Pharmaceuticals and other medical non-durables (HC.5.1) made up the next largest category (14%).  Administration of the health care system (public and private) amounted to €674 million in 2014, 4% of current health expenditure.

The profile of health expenditure in Ireland by source of funding, by provider and by function was unchanged between 2013 and 2014.

Table 3: Current Health Care Expenditure by Health Care Function, 2013 and 2014  
    20132014
ICHA-HC Code  €m%€m%
HC.1+HC.2Curative and Rehabilitative Care10,1445410,29154
 HC.1.1+HC.2.1 Inpatient Curative & Rehabilitative Care4,416244,55324
 HC.1.2+HC.2.2 Day Curative and Rehabilitative Care1,25471,2857
 HC.1.3+HC.2.3 Outpatient Curative & Rehabilitative Care3,821203,77420
 HC.1.4+HC.2.4 Home-Based Curative & Rehabilitative Care65336794
HC.3Long-Term Care (Health)4,100224,26322
 HC.3.1 Inpatient Long-Term Care (Health)2,593142,70814
 HC.3.2 Day Long-Term Care (Health)16611691
 HC.3.4 Home-Based Long-Term Care (Health)1,34071,3867
HC.4Ancillary Services56035483
 HC.4.1 Laboratory Services19911941
 HC.4.2 Imaging Services500380
 HC.4.3 Patient Transportation17911891
   Ancillary Services N.E.C13211261
HC.5Medical Goods (Non-Specified by Function)2,872152,83815
 HC.5.1 Pharmaceuticals and Other Medical Non-Durables2,798152,76414
 HC.5.2 Therapeutic Appliances and Other Medical Goods740740
HC.6Preventive Care52535253
 HC.6.1 Information, Education and Counceling Programmes670660
 HC.6.2 Immunisation Programmes440430
 HC.6.3 Early Disease Detection Programmes600600
 HC.6.4 Healthy Condition Monitoring Programmes19311951
 HC.6.5 Epidemiological Surveillance, Disease Control Programmes820760
 HC.6.6 Preparing for Disaster and Emergency Response Programmes2020
   Preventative Care N.E.C770840
HC.7Governance and Health System Administration and Financing56936744
 HC.7.1 Govt Health Administration Agencies17411821
 HC.7.2 Administration of Health Financing 39524923
HC.9Health Care Services N.E.C7090  
HC.1 to HC.9Total Current Health Care Expenditure18,77610019,148100  
Current Health Care Expenditure By Function, 2014
Curative and Rehabilitative Care10.3
Long-Term Care (Health)4.3
Ancillary Services0.5
Medical Goods (Non-Specified by Function)2.8
Other Health Care Functions1.2

Who is providing which services?

Tables 4A and 4B present a breakdown of health care expenditure by function (HC) and provider (HP) for 2013 and 2014.  

Services provided by hospitals accounted for over one-third of health care expenditure in Ireland in 2014 (€6,648 million).  Nearly two-thirds of this was 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 (€2,610 million). 

Ambulatory health care providers (GPs, dentists and other services such as home care providers and health care centres) mainly delivered outpatient services.  In 2014,  €3,842 million was spent on health care in these settings with 70% of this spent on outpatient curative and rehabilitative care.  

Expenditure on pharmaceuticals (€2,636 million) accounted for almost 14% 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 €1,126 million in 2014.  Two-thirds of this expenditure (€730 million) was for the provision of long-term health care services in the home (HC.3.4) by persons in receipt of transfer payments (e.g. Carers’ Allowance and Domiciliary Care Allowance).

Table 4A: 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 ProvidersHP.4 - Ancillary Health Care ProvidersHP.5 - Retailers 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 Care6,2145873,282 73 1925810,144
 HC.1.1+HC.2.1 Inpatient Curative & Rehabilitative Care3,940454      2204,416
 HC.1.2+HC.2.2 Day Curative and Rehabilitative Care1,1301123     001,254
 HC.1.3+HC.2.3 Outpatient Curative & Rehabilitative Care1,11232,669 7  19283,821
 HC.1.4+HC.2.4 Home-Based Curative & Rehabilitative Care32128490  3   0653
HC.3Long-Term Care (Health)762,949392    682  4,100
 HC.3.1 Inpatient Long-Term Care (Health)762,517        2,593
 HC.3.2 Day Long-Term Care (Health) 2164       166
 HC.3.4 Home-Based Long-Term Care (Health) 430228    682  1,340
HC.4Ancillary Services303 4249    21560
 HC.4.1 Laboratory Services137  61      199
 HC.4.2 Imaging Services50         50
 HC.4.3 Patient Transportation19  160      179
   Ancillary Services N.E.C970427    21132
HC.5Medical Goods (Non-Specified by Function)  2 2,746  124  2,872
 HC.5.1 Pharmaceuticals and Other Medical Non-Durables  2 2,672  123  2,798
 HC.5.2 Therapeutic Appliances and Other Medical Goods    73  1  74
HC.6Preventative Care  86  223 216 0525
 HC.6.1 Information, Education and Counceling Programmes  11  33 23  67
 HC.6.2 Immunisation Programmes  8  36    44
 HC.6.3 Early Disease Detection Programmes     60    60
 HC.6.4 Healthy Condition Monitoring Programmes       193  193
 HC.6.5 Epidemiological Surveillance, Disease Control Programmes     82    82
 HC.6.6 Preparing for Disaster and Emergency Response Programmes     2    2
   Preventative Care N.E.C  67  10   077
HC.7Governance and Health System Administration and Financing     4564   569
 HC.7.1 Govt Health Administration Agencies     4170   174
 HC.7.2 Administration of Health Financing       395   395
HC.9Health Care Services N.E.C301    0037
HC.1 to HC.9Total Current Health Care Expenditure6,5963,5363,7672492,7532305641,041271218,776
Table 4B: Current Health Care Expenditure by Health Care Function and Health Care Provider, 2014 €million
ICHA Code  HP.1 - HospitalsHP.2 - Long-Term Residential FacilitiesHP.3 - Ambulatory Health Care ProvidersHP.4 - Ancillary Health Care ProvidersHP.5 - Retailers 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 Care6,2816043,345 7311925610,290
HC.1.1+HC.2.1 Inpatient Curative & Rehabilitative Care4,0574751   1 1804,553
HC.1.2+HC.2.2 Day Curative and Rehabilitative Care1,1571125     201,285
HC.1.3+HC.2.3 Outpatient Curative & Rehabilitative Care1,03432,701 7  19563,774
 HC.1.4+HC.2.4 Home-Based Curative & Rehabilitative Care33125517  3  00679
HC.3Long-Term Care (Health)973,036400    7300 4,263
HC.3.1 Inpatient Long-Term Care (Health)972,6100     0 2,708
HC.3.2 Day Long-Term Care (Health) 2168       169
 HC.3.4 Home-Based Long-Term Care (Health) 424232    730  1,386
HC.4Ancillary Services262 4278    31548
HC.4.1 Laboratory Services114 080    0 194
HC.4.2 Imaging Services38 0     0 38
HC.4.3 Patient Transportation19  170      189
   Ancillary Services N.E.C900428    21126
 Medical Goods (Non-Specified by Function)4 1 2,709  124  2,838
HC.5.1 Pharmaceuticals and Other Medical Non-Durables4 1 2,636  123  2,764
 HC.5.2 Therapeutic Appliances and Other Medical Goods    73  1  74
HC.6Preventative Care  91  220 214  525
HC.6.1 Information, Education and Counceling Programmes  11  36 20  66
HC.6.2 Immunisation Programmes  8  35    43
HC.6.3 Early Disease Detection Programmes     60    60
HC.6.4 Healthy Condition Monitoring Programmes       195  195
HC.6.5 Epidemiological Surveillance, Disease Control Programmes     76    76
HC.6.6 Preparing for Disaster and Emergency Response Programmes     2    2
   Preventative Care N.E.C  73  11   084
HC.7Governance and Health System Administration and Financing     5669   674
HC.7.1 Govt Health Administration Agencies     5177   182
 HC.7.2 Administration of Health Financing       492   492
HC.9Health Care Services N.E.C401    0049
HC.1 to HC.9Total Current Health Care Expenditure6,6483,6403,8422782,7162286701,087281119,148

How are health care services being funded?

Tables 5A and 5B present a breakdown of health care expenditure by function (HC) and financing scheme (HF) for 2013 and 2014.

Of the €10,291 million spent on curative and rehabilitative services in 2014, just over two-thirds (€7,017 million) was funded by government and 17% (€1,804 million) was funded from voluntary health insurance payments. 

Government financed just under 80% (€3,351 million) of long-term care services in 2014. Almost all of the remainder (21% or €912 million) was financed by out-of-pocket payments by households (€815 million).

Over 30% (€885 million) of pharmaceutical expenditure was funded by out-of-pocket payments with the remainder funded by government.  Preventive care (HC.6) such as immunisation and health promotion activities was funded by government (60%) and voluntary payments other than health insurance (40%).  Tax refunds for health expenditure amounted to €146 million in 2014.  As there is no information on what services were received, the expenditure is classified to health services not elsewhere classified.

Table 5A: Current Health Care Expenditure by Health Care Function and Health Care Financing Scheme, 2013€millions 
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 Care6,8926,873202,0111,8461651,24110,144
 HC.1.1+HC.2.1 Inpatient Curative & Rehabilitative Care2,9832,983 1,3351,27956984,416
 HC.1.2+HC.2.2 Day Curative and Rehabilitative Care767767 47445518141,254
 HC.1.3+HC.2.3 Outpatient Curative & Rehabilitative Care2,5862,56620173102711,0623,821
 HC.1.4+HC.2.4 Home-Based Curative & Rehabilitative Care556556 29101967653
HC.3Long-Term Care (Health)3,2573,2342391 917524,100
 HC.3.1 Inpatient Long-Term Care (Health)1,7981,798 68 687282,593
 HC.3.2 Day Long-Term Care (Health)162162 3 32166
 HC.3.4 Home-Based Long-Term Care (Health)1,2971,2742321 21221,340
HC.4Ancillary Services368368 130130 62560
 HC.4.1 Laboratory Services152152    46199
 HC.4.2 Imaging Services5050     50
 HC.4.3 Patient Transportation165165   014179
   Ancillary Services N.E.C   130130 2132
HC.5Medical Goods (Non-Specified by Function)1,9691,95514***9032,872
 HC.5.1 Pharmaceuticals and Other Medical Non-Durables1,9221,922 ***8762,798
 HC.5.2 Therapeutic Appliances and Other Medical Goods463314** 2874
HC.6Preventative Care318318 2072205 525
 HC.6.1 Information, Education and Counceling Programmes6767 1 1067
 HC.6.2 Immunisation Programmes4444     44
 HC.6.3 Early Disease Detection Programmes5959 1 1 60
 HC.6.4 Healthy Condition Monitoring Programmes33 189 189 193
 HC.6.5 Epidemiological Surveillance, Disease Control Programmes7676 5 5 82
 HC.6.6 Preparing for Disaster and Emergency Response Programmes22   0 2
   Preventative Care N.E.C6666 1129 77
HC.7Governance and Health System Administration and Financing156156 41339518 569
 HC.7.1 Govt Health Administration Agencies156156 18 18 174
 HC.7.2 Administration of Health Financing    395395  395
HC.9Health Care Services N.E.C137137 642-1367
HC.1 to HC.9Total Current Health Care Expenditure13,09613,040562,8582,3764822,82218,776
* Confidential
Table 5B: Current Health Care Expenditure by Health Care Function and Health Care Financing Scheme, 2014€million
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 Care7,0177,001161,9721,8041681,30210,291
 HC.1.1+HC.2.1 Inpatient Curative & Rehabilitative Care3,1323,132 1,3301,26663914,553
 HC.1.2+HC.2.2 Day Curative and Rehabilitative Care814814 44943020221,285
 HC.1.3+HC.2.3 Outpatient Curative & Rehabilitative Care2,4852,4691616397661,1273,774
 HC.1.4+HC.2.4 Home-Based Curative & Rehabilitative Care586586 30111962679
HC.3Long-Term Care (Health)3,3513,3272497 978154,263
 HC.3.1 Inpatient Long-Term Care (Health)1,8401,840 74 747932,708
 HC.3.2 Day Long-Term Care (Health)160160 3 36169
 HC.3.4 Home-Based Long-Term Care (Health)1,3511,3272420 20161,386
HC.4Ancillary Services349349 126124272548
 HC.4.1 Laboratory Services137137 1 156194
 HC.4.2 Imaging Services3737   0138
 HC.4.3 Patient Transportation175175 1 114189
   Ancillary Services N.E.C   124124 2126
HC.5Medical Goods (Non-Specified by Function)1,9251,91313***9132,838
 HC.5.1 Pharmaceuticals and Other Medical Non-Durables1,8801,880 ***8852,764
 HC.5.2 Therapeutic Appliances and Other Medical Goods463313** 2874
HC.6Preventative Care315315 2112208 525
 HC.6.1 Information, Education and Counceling Programmes6565 1 1 66
 HC.6.2 Immunisation Programmes4343   0 43
 HC.6.3 Early Disease Detection Programmes5959 1 1 60
 HC.6.4 Healthy Condition Monitoring Programmes33 191 191 195
 HC.6.5 Epidemiological Surveillance, Disease Control Programmes7272 5 5 76
 HC.6.6 Preparing for Disaster and Emergency Response Programmes11   0 2
   Preventative Care N.E.C7171 13210 84
HC.7Governance and Health System Administration and Financing161161 51349221 674
 HC.7.1 Govt Health Administration Agencies161161 21 21 182
 HC.7.2 Administration of Health Financing    492492  492
HC.9Health Care Services N.E.C147147 872-1469
HC.1 to HC.9Total Current Health Care Expenditure13,26513,212532,9272,4294982,95619,148
* Confidential
 

How are health care providers being funded?

Tables 6A and 6B present a breakdown of health care expenditure by health care provider (HP) and financing scheme (HF) for 2013 and 2014. 

Government was the majority funder of health care providers in Ireland in 2014 (69%).  Three-quarters of expenditure in long-term care facilities were government funded as was 70% of hospital expenditure.  Three-quarters of pharmaceutical expenditure was also funded by government.

Just under three-quarters of voluntary health insurance payments (€1,761 million) were spent on hospital services.   

After tax refunds of €146 million were taken into account, out of pocket expenditure amounted to €2,956 million in 2014.  Almost two-fifths of this (€1,145 million) was spent on ambulatory health care providers and over a quarter (€848 million) was on long-term care facilities.  Over 20% of out-of-pocket payments (€636 million) was spent in pharmacies.

Table 6A: Current Health Care Expenditure by Health Care Provider and Health Care Financing Scheme, 2013€million
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.1Hospitals4,5944,594 1,8761,801751266,596
 HP.1.1 General Hospitals3,8633,863 1,6531,590631045,620
 HP.1.2 Mental Health Hospitals191191 7876210279
 HP.1.3 Specialised Hospitals (other than Mental Health Hospitals)540540 1451351012697
HP.2Long-Term Residential Facilities2,6192,619 12123997963,536
HP.3Ambulatory Health Care Providers2,5112,49120183101821,0733,767
 HP.3.1 Medical Practices520520 5757 302878
 HP.3.2 Dental Practices9272201717 480588
 HP.3.3 Other Health Care Practitioners6464 13121195272
 HP.3.4 Ambulatory Health Care Centres1,4381,438 79772331,550
 HP.3.5 Providers of Home Health Care Services397397 1810863477
HP.4Ancillary Health Care Providers162162 2827 60249
 HP.4.1 Providers of Patient Transportation and Emergency Rescue146146 11014162
 HP.4.2 Medical and Diagnostic Laboratories1515 2626 4688
HP.5Retailers of Medical Goods1,9681,95514***7852,753
 HP.5.1 Pharmacies1,9231,923 ***6342,557
 HP.5.2 Retail Sellers of Durable Medical Goods and Appliances463214** 151196
HP.6Providers of Preventive Care207207 23 230230
HP.7Providers of Health Care System Administration and Financing156156 40839514 564
 HP.7.1 Govt Health Administration Agencies156156 14 14 170
 HP.7.3 Private Health Insurance Administration Agencies   395395  395
HP.8Rest of the Economy73271023189 1891191,041
 HP.8.1 Households as Providers of Home Health Care68265923    682
 HP.8.2 All Other Industries as Secondary Providers of Health Care5151 189 189119359
HP.9Rest of the World1010 1717  27
HP.0Providers N.E.C.136136 12121-13612
HP.1 to HP.0Total Current Health Care Expenditure13,09613,040562,8582,3764822,82218,776
* Confidential
Table 6B: Current Health Care Expenditure by Health Care Provider and Health Care Financing Scheme, 2014€million
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.1Hospitals4,6674,667 1,8531,761921286,648
 HP.1.1 General Hospitals3,8943,894 1,6441,563811105,649
 HP.1.2 Mental Health Hospitals203203 807736289
 HP.1.3 Specialised Hospitals (other than Mental Health Hospitals)570570 129121812710
HP.2Long-Term Residential Facilities2,6692,669 123211028483,640
HP.3Ambulatory Health Care Providers2,5252,50916172100721,1453,842
 HP.3.1 Medical Practices492492 5555 336883
 HP.3.2 Dental Practices8872161717 500605
 HP.3.3 Other Health Care Practitioners6666 11111211288
 HP.3.4 Ambulatory Health Care Centres1,4691,469 70762381,577
 HP.3.5 Providers of Home Health Care Services410410 2011960490
HP.4Ancillary Health Care Providers182182 2828 68278
 HP.4.1 Providers of Patient Transportation and Emergency Rescue156156 11014171
 HP.4.2 Medical and Diagnostic Laboratories2626 2727 54107
HP.5Retailers of Medical Goods1,9221,91013***7942,716
 HP.5.1 Pharmacies1,8771,877 ***6362,514
 HP.5.2 Retail Sellers of Durable Medical Goods and Appliances453213** 158202
HP.6Providers of Preventive Care203203 25 25 228
HP.7Providers of Health Care System Administration and Financing162162 50849216 670
 HP.7.1 Govt Health Administration Agencies162162 16 16 177
 HP.7.3 Private Health Insurance Administration Agencies   492492  492
HP.8Rest of the Economy77775324191 1911191,087
 HP.8.1 Households as Providers of Home Health Care73070624    730
 HP.8.2 All Other Industries as Secondary Providers of Health Care4848 191 191119357
HP.9Rest of the World1212 16160 28
HP.0Providers N.E.C.146146 1111 -14611
HP.1 to HP.0Total Current Health Care Expenditure13,26513,212532,9272,4294982,95619,148
* Confidential

Health expenditure over time

Health expenditure in Ireland expressed as a percentage of GDP exceeded the OECD average in 2008 and has remained consistently above the average ever since. 

Table 7: Revised Health Care Expenditure in Ireland, 2000 to 2014€million
  20002001200220032004200520062007200820092010201120122013b2014
Total Health Care Expenditure (€m)6,9228,5329,89610,95012,20013,68114,43816,26317,89818,50918,19917,92418,20719,69020,042
Capital Expenditure (€m)1522727822749918665539877807671583729526914894
Current Expenditure (€m)6,4007,8059,07510,20111,28213,01613,89915,38717,09117,83817,61617,19517,68218,77619,148
Current Public Expenditure (€m)4,9616,1227,1688,0358,90310,26510,81712,19113,55713,74813,42013,06513,41013,09613,265
 Current Private Expenditure (€m)1,4391,6831,9062,1662,3792,7503,0823,1953,5344,0904,1974,1304,2725,6805,884
Current Expenditure % GDP, Ireland5.9%6.4%6.7%7.0%7.2%7.7%7.5%7.8%9.1%10.5%10.6%9.9%10.1%10.5%10.1% 
Current Expenditure % GNI, Ireland6.8%7.5%8.0%8.1%8.4%8.8%8.5%9.0%10.5%12.5%12.5%12.0%12.2%12.3%11.7%
Current Expenditure % GDP, OECD Average (adjusted)27.2%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%N/A 
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
200614.43782627960770.53865299183476713.8991732876462
200716.26326117193530.87659973985395815.3866611196776
200817.89795754425440.80717163357750317.0907853163081
200918.50893884911490.67078973173069817.8381484958183
201018.19897463196740.58262866426842117.6163452836763
201117.92394703253010.7294134518520317.194532936106
201218.20749873673940.52577920080342817.681719535936
2013b19.68950860928270.91372799763494618.7757806116477
201420.04222969604480.89399180774740119.1482378882974
Current Expenditure % GDP, IrelandCurrent Expenditure % GNI, IrelandCurrent Expenditure % GDP, OECD Average (adjusted)
20005.906392851937046.776536109902997.2498656357818
20016.402782279455347.49744793642077.50368637450284
20026.675177463456127.962303022260297.74853027001789
20036.997848671550688.115271061584948.00322882478372
20047.223610728030418.369472150547338.03553801340461
20057.657209954345118.819572515989558.11261412952721
20067.516195004215918.529245569527428.04537645047115
20077.808347518790568.986223460170868.02529920577434
20089.1128012265235310.46844623074128.33150132963032
200910.528205118170312.52459083434678.99378406656827
201010.602228785832912.49412773582158.84852565383171
20119.8853242130079212.00140498503258.82638870696625
201210.112796783400112.21940231367648.91070490271844
2013b10.451927513233812.25853204821459.03947231926132
201410.128877568579811.68166687305

Reconciliation of HSE Gross Expenditure to Government (HF.1) Funded Current Health Expenditure, 2013 and 2014

Table 8 presents a reconciliation of HSE gross expenditure for 2013 and 2014 (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 and 2014€million
  20132014
1HSE AFS - Expenditure - Pay and Pensions4,8714,795
2HSE AFS - Expenditure - Non-Pay8,7718,425
3=1+2Total HSE Annual Financial Statement Gross Expenditure13,64213,220
    
4Exclude Non-Health Care Services-1,317-699
5Include Non-AFS Gross Expenditure (Mainly Related to Voluntary Agencies)538608
6=4+5Total Adjustments to AFS Gross Expenditure-780-90
    
7=3+6Gross Expenditure of HSE included in SHA Expenditure12,86313,130
    
8Non-Government Funding of HSE-920-1,040
9=7+8Total HSE HF.1 Funded Health Care Expenditure11,94312,090
    
 Additional Government Health Care Expenditure:  
10 DSP Transfer payments659670
11 Treatment Benefits from Social Insurance Fund5653
12 Department of Health8286
13 Tax Relief on Medical Expenses136146
14 Expenditure of Other Government Departments and Agencies220220
15=10+11+12+13+14Total Additional Government HF.1 Funded Expenditure1,1531,175
    
16=9+15Government (HF.1) Funded Current Health Care Expenditure13,09613,265

Background Notes

Introduction

This release is the 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 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 from reference year 2013.

 

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.

 

Data Revisions since Previous Publication

A number of revisions have been undertaken since the publication of preliminary 2013 data in December 2013.  They are as follows:

 

Estimate of administration of health financing (HC.7.2) by private health insurance administration agencies (HP.7.3): Upon review and clarification of the guidance on this item, this expenditure is now based on total premiums earned plus premium supplements less claims incurred.  In the preliminary data, the estimate was based solely on the administrative costs of the health insurance sector.

 

Revision of HSE data: The HSE have undertaken some revisions of their data based upon further review of the SHA standard and the services they provide.  These have resulted in some changes to the functional classification of their data.

 

Capital Expenditure: Capital expenditure included in Table 7 is sourced from CSO National Accounts data sources which has been recently updated.  The data now correctly includes an estimate of associated “transfer costs” which had been excluded in error in the preliminary publication.

 

Refund of Medical Expenses by Revenue: The latest estimate provided by Revenue have been included.

 

Changes in classification of some health care providers:  Upon review of the classification of health care providers, some health care providers were reclassified from residential care facilities (HP.2) to ambulatory health care centres (HP.3.4).  This mainly affected providers working with people with disabilities and people with addiction problems where a mixture of residential and day care services are provided.  The classification is based on the predominance of the services provided.

 

 

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/.

 

 

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. 

 

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 currently under review and coding may be revised in the future.

 

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 ongoing 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 ongoing.  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

 

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.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 atl 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 a 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 please and data sources used, see the following 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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