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The International Classification for Health Accounts (ICHA)
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E-mail: sha@cso.ie Ciara O'Shea (+353) 1 498 4312
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information@cso.ie (+353) 21 453 5000 Visit StatCentral.ie, the portal to Ireland's official statistics On-line ISSN 2009-8812
CSO statistical release, 20 June 2017, 11am

System of Health Accounts

Ireland's System of Health Accounts, Annual Results 2015

Current Health Expenditure in Ireland, 2013 to 2015 
 201320142015
Current Health Expenditure (€ bn)18.819.119.9
Gross Domestic Product (GDP, € bn)180.2193.2255.8
Current Health Expenditure % GDP10.49.97.8

Current Health Expenditure Estimate for Ireland, €19.9 billion (2015)

System of Health Accounts 2015. Healthcare by Financing Scheme
go to full release

Ireland’s current health expenditure was €19.9 billion in 2015, representing 7.8% of GDP. In 2014 current health expenditure was €19.1bn or 9.9% of GDP. The decrease in the percentage share between 2014 and 2015 is due to the increase in the GDP level (see box below).

The majority of health expenditure (69%) was funded by government, with the balance funded by private sources including health insurance and out-of-pocket expenditure.

This release provides the first estimates of Irish health care expenditure for 2015 according to the System of Health Accounts standard. See Background Notes for further details on the System of Health Accounts.

The rounding of percentages to the nearest integer results in some subtotals not summing to 100%.

The GDP figures used in this publication are consistent with those published in the National Income and Expenditure 2015. There was a significant increase in the level of GDP in 2015. This level shift impacts the comparison over time of key aggregates using GDP as a denominator. Further details, along with planned actions to address user needs, can be found here:

Report of the Economic Statistics Review Group

Financing of Health Care Services in Ireland

In 2015 €13,896 million of health expenditure (69%) was financed by government (HF.1).

The remainder was mainly funded by household out-of-pocket payments (15%) and health insurance (13%). This is consistent with the financing profile in earlier years.

Table 1: Current Health Care Expenditure by Financing Scheme, 2013 to 2015
    201320142015
ICHA-HF Code €m%€m%€m%
HF.1Govt Financing Schemes and Compulsory Contributory Health Care Financing Schemes13,0967013,2656913,89669
HF.1.1Government Schemes13,0407013,2126913,83669
 HF.1.2 Compulsory Contributory Health Insurance Schemes560530600
HF.2Voluntary Health Care Payment Schemes2,858152,927152,94815
HF.2.1Voluntary Health Insurance Schemes2,376132,429132,43413
 HF.2.x Other Voluntary Care Payment Schemes482349835133
HF.3Household Out-of-Pocket Payments2,822152,956153,01115
HF.1-HF.3Total Current Health Care Expenditure18,77610019,14810019,855100

Health Care Providers in Ireland

Just over one-third of health expenditure took place in hospitals (HP.1) in 2015, 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 €2,726 million or 14% of all health care expenditure in 2015. The pattern of current health expenditure across providers remained stable over the period 2013-2015.

Table 2: Current Health Care Expenditure by Provider, 2013 to 2015
201320142015
ICHA-HP Code €m%€m%€m%
HP.1Hospitals6,596356,648356,98035
HP.2Long-Term Residential Facilities3,536193,640193,83919
HP.3Ambulatory Health Care Providers3,767203,842204,02920
HP.4Ancillary Health Care Providers249127812901
HP.5Retailers of Medical Goods2,753152,716142,72614
HP.6Providers of Preventative Care230122812281
HP.7Providers of Health Care Administration and Financing564367035653
HP.8Rest of the Economy1,04161,08761,1476
HP.9Rest of the World270280360
HP.0Providers N.E.C.120110140
HP.1 to HP.0Total Current Health Care Expenditure18,77610019,14810019,855100
Current Health Care Expenditure by Provider, 2015
Hospitals6.98030416464529
Long-Term Residential Facilities3.83887460993473
Ambulatory Health Care Providers4.02930534427011
Ancillary Health Care Providers0.290436352789671
Retailers of Medical Goods2.72639707162876
Other Providers1.9896230890518
Current Health Care Expenditure by Provider, 2015
Hospitals6.98030416464529
Long-Term Residential Facilities3.83887460993473
Ambulatory Health Care Providers4.02930534427011
Ancillary Health Care Providers0.0290436352789671
Retailers of Medical Goods2.72639707162876
Other Providers1.9896230890518

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  in 2015 related to curative and rehabilitative care (€10,777 million) and nearly half of this was for inpatient care (€4,802 million). The next largest category was long-term care which amounted to 23% of expenditure, again with inpatient services the largest component of this (€2,856 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 €570 million in 2015, which was 3% of total current health expenditure.

Table 3: Current Health Care Expenditure by Health Care Function, 2013 to 2015
    201320142015
ICHA-HC Code  €m%€m%€m%
HC.1+HC.2Curative and Rehabilitative Care10,1445410,2915410,77754
 HC.1.1+HC.2.1 Inpatient Curative & Rehabilitative Care4,416244,553244,80224
 HC.1.2+HC.2.2 Day Curative and Rehabilitative Care1,25471,28571,3297
 HC.1.3+HC.2.3 Outpatient Curative & Rehabilitative Care3,821203,774203,95620
 HC.1.4+HC.2.4 Home-Based Curative & Rehabilitative Care653367946903
HC.3Long-Term Care (Health)4,100224,263224,51323
 HC.3.1 Inpatient Long-Term Care (Health)2,593142,708142,85614
 HC.3.2 Day Long-Term Care (Health)166116911781
 HC.3.4 Home-Based Long-Term Care (Health)1,34071,38671,4797
HC.4Ancillary Services560354835683
 HC.4.1 Laboratory Services199119412001
 HC.4.2 Imaging Services500380400
 HC.4.3 Patient Transportation179118911981
   Ancillary Services N.E.C132112611301
HC.5Medical Goods (Non-Specified by Function)2,872152,838152,86914
 HC.5.1 Pharmaceuticals and Other Medical Non-Durables2655142,615142,64413
 HC.5.2 Therapeutic Appliances and Other Medical Goods217122302251
HC.6Preventive Care525352535413
 HC.6.1 Information, Education and Counceling Programmes670660730
 HC.6.2 Immunisation Programmes440430470
 HC.6.3 Early Disease Detection Programmes600600590
 HC.6.4 Healthy Condition Monitoring Programmes193119512041
 HC.6.5 Epidemiological Surveillance, Disease Control Programmes820760750
 HC.6.6 Preparing for Disaster and Emergency Response Programmes202020
   Preventative Care N.E.C770840810
HC.7Governance and Health System Administration and Financing569367445703
 HC.7.1 Govt Health Administration Agencies174118211791
 HC.7.2 Administration of Health Financing 395249233912
HC.9Health Care Services N.E.C7090170
HC.1 to HC.9Total Current Health Care Expenditure18,77610019,14810019,855100
Current Health Care Expenditure By Function, 2015
Curative and Rehabilitative Care10.7770328652365
Long-Term Care (Health)4.51282352196395
Ancillary Services0.568014550350617
Medical Goods (Non-Specified by Function)2.86915453425876
Other Health Care Functions1.12791516051055

Who is providing which services?

Table 4 presents a breakdown of health care expenditure by function (HC) and provider (HP) for 2015.

In 2015, 62% of expenditure of hospital based care was on inpatient services (€4,270 million).

Long-term facilities, which include nursing homes and residential facilities for people with a disability, predominantly provided long-term care inpatient services (€2,755 million).

Ambulatory care providers mainly delivered outpatient services. In 2015, €4,029 million was spent on health care in these settings with 71% of this spent on outpatient curative and rehabilitative care.

Expenditure on pharmaceuticals (€2,644 million) accounted for 13% 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 €1,197 million in 2015. Two-thirds of this expenditure (€779 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. Carer's Allowance and Domiciliary Care Allowance).

Table 4: Current Health Care Expenditure by Health Care Function and Health Care Provider, 2015€million
ICHA Code  HP.1 - Hospitals HP.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 Care6,5796373,497 83 2034 10,777
HC.1.1+HC.2.1 Inpatient Curative & Rehabilitative Care4,270505      27 4,802
HC.1.2+HC.2.2 Day Curative and Rehabilitative Care1,1960131     2 1,329
HC.1.3+HC.2.3 Outpatient Curative & Rehabilitative Care1,07832,844 8  185 3,956
 HC.1.4+HC.2.4 Home-Based Curative & Rehabilitative Care34129522  3 1  690
HC.3Long-Term Care (Health)1013,202430    779  4,513
HC.3.1 Inpatient Long-Term Care (Health)1012,755        2,856
HC.3.2 Day Long-Term Care (Health) 2176       178
 HC.3.4 Home-Based Long-Term Care (Health) 446254    779  1,479
HC.4Ancillary Services27203290    2 568
HC.4.1 Laboratory Services119  80      200
HC.4.2 Imaging Services40         40
HC.4.3 Patient Transportation20  178      198
   Ancillary Services N.E.C930332    2 130
HC.5Medical Goods (Non-Specified by Function)26 0 2,719  124  2,869
HC.5.1 Pharmaceuticals and Other Medical Non-Durables26 0 2,495  122  2,644
 HC.5.2 Therapeutic Appliances and Other Medical Goods    224  1  225
HC.6Preventative Care  98  219 223  541
 HC.6.1 Information, Education and Counceling Programmes  13  40 20  73
HC.6.2 Immunisation Programmes  15  32    47
HC.6.3 Early Disease Detection Programmes     59    59
HC.6.4 Healthy Condition Monitoring Programmes       204  204
HC.6.5 Epidemiological Surveillance, Disease Control Programmes     75    75
HC.6.6 Preparing for Disaster and Emergency Response Programmes     2    2
   Preventative Care N.E.C  70  11    81
HC.7Governance and Health System Administration and Financing     5565   570
HC.7.1 Govt Health Administration Agencies     5173   179
 HC.7.2 Administration of Health Financing       391   391
HC.9Health Care Services N.E.C2 0    001417
HC.1 to HC.9Total Current Health Care Expenditure6,9803,8394,0292902,7262285651,147361419,855

How are health care services being funded?

Table 5 presents a breakdown of health care expenditure by function (HC) and financing scheme (HF) for 2015.

Inpatient curative and rehabilitative care accounted for 24% (€3,268 million) of the total government spend on healthcare. Almost 40% of the total spend of household out-of-pocket payments was for outpatient curative and rehabilitative care (€1,133 million).

Of the €10,777 million spent on curative and rehabilitative care services in 2015, over two-thirds (€7,387 million) was funded by government and almost 18% (€1,900 million) was funded by voluntary health insurance payments.

A total of €4,513 million was spent on long-term care. Government financed almost 79% (€3,551 million) of long-term care services in 2015. Almost all of the remainder was paid for by household out-of-pocket payments (19% or €862 million).

Over a quarter (€724 million) of the expenditure on pharmaceuticals was funded by out-of-pocket payments with the remainder funded by government (€1,921 million).  Preventative 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 2015. 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, 2015€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 Care7,3877,371172,0701,9001701,31910,777
 HC.1.1+HC.2.1 Inpatient Curative & Rehabilitative Care3,2683,268 1,4331,372611014,802
 HC.1.2+HC.2.2 Day Curative and Rehabilitative Care847847 45943920231,329
 HC.1.3+HC.2.3 Outpatient Curative & Rehabilitative Care2,6642,6471715988711,1333,956
 HC.1.4+HC.2.4 Home-Based Curative & Rehabilitative Care608608 19 1963690
HC.3Long-Term Care (Health)3,5513,52130100 1008624,513
 HC.3.1 Inpatient Long-Term Care (Health)1,9371,937 76 768432,856
 HC.3.2 Day Long-Term Care (Health)169169 4 45178
 HC.3.4 Home-Based Long-Term Care (Health)1,4451,4153021 21131,479
HC.4Ancillary Services364364 131128274568
 HC.4.1 Laboratory Services142142 1 157200
 HC.4.2 Imaging Services3939   0140
 HC.4.3 Patient Transportation183183   015198
   Ancillary Services N.E.C   128128 2130
HC.5Medical Goods (Non-Specified by Function)1,9671,95413***9022,869
 HC.5.1 Pharmaceuticals and Other Medical Non-Durables1,9211,921 ***7242,644
 HC.5.2 Therapeutic Appliances and Other Medical Goods473413** 178225
HC.6Preventative Care324324 217 217 541
 HC.6.1 Information, Education and Counceling Programmes7373   0 73
 HC.6.2 Immunisation Programmes4747   0 47
 HC.6.3 Early Disease Detection Programmes5959 1 1 59
 HC.6.4 Healthy Condition Monitoring Programmes33 200 200 204
 HC.6.5 Epidemiological Surveillance, Disease Control Programmes7070 5 5 75
 HC.6.6 Preparing for Disaster and Emergency Response Programmes11   0 2
   Preventative Care N.E.C7171 11 11 81
HC.7Governance and Health System Administration and Financing156156 41439122 570
 HC.7.1 Govt Health Administration Agencies156156 22 22 179
 HC.7.2 Administration of Health Financing    391391  391
HC.9Health Care Services N.E.C147147 16152-14617
HC.1 to HC.9Total Current Health Care Expenditure13,89613,836602,9482,4345133,01119,855
* Confidential

How are health care providers being funded?

Table 6 presents a breakdown of health care expenditure by health care provider (HP) and financing source (HF) for 2015.

Almost 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 over three-quarters of voluntary health insurance payments (€1,873 million) were spent on hospital services.

After tax refunds of €146 million were taken into account, out-of-pocket expenditure amounted to €3,011 million in 2015. 38% of this (€1,149 million) was spent on ambulatory health care providers and 30% (€898 million) was on long-term care facilities. Over 20% of out-of-pocket payments (€625 million) was spent in pharmacies.

Table 6: Current Health Care Expenditure by Health Care Provider and Health Care Financing Scheme, 2015€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.1Hospitals4,8774,87701,9651,873921386,980
 HP.1.1 General Hospital4,0864,086 1,7201,640801175,923
 HP.1.x Specialised Hospitals (including Mental Health Hospitals)791791024523312211,057
HP.2Long-Term Residential Facilities2,8172,817 124221028983,839
HP.3Ambulatory Health Care Provider2,7222,7051715881771,1494,029
 HP.3.1 Medical Practices549549 4141 338927
 HP.3.2 Dental Practices85681717125501603
 HP.3.3 Other Health Care Practitioners6969 25241214308
 HP.3.4 Ambulatory Health Care Centres1,5631,563 67562361,667
 HP.3.5 Providers of Home Health Care Services456456 9 961525
HP.4Ancillary Health Care Provider189189 3232069290
 HP.4.1 Providers of Patient Transportation and Emergency Rescue164164 11014180
 HP.4.2 Medical and Diagnostic Laboratories2525 3030 55111
HP.5Retailer of Medical Goods1,9421,92913***7842,726
 HP.5.1 Pharmacies1,8971,897 ***6252,523
 HP.5.2 Retail Sellers of Durable Medical Goods and Appliances453213** 158204
HP.6Providers of Preventive Care203203 25 25 228
HP.7Providers of Health Care System Administration and Financing156156 40939117 565
 HP.7.1 Govt Health Administration Agencies156156 17 17 173
 HP.7.3 Private Health Insurance Administration Agencies   391391  391
HP.8Rest of the Economy82879830200 2001181,147
 HP.8.1 Households as Providers of Home Health Care1717     17
 HP.8.2 All Other Industries as Secondary Providers of Health Care81178130200 2001181,130
HP.9Rest of the World1616 20200 36
HP.0Provider N.E.C.146146 1414 -14614
HP.1 to HP.0Total Current Health Care Expenditure13,89613,836602,9482,4345133,01119,855
* 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 until 2015. The level shift in GDP in 2015 has seen a drop in this ratio. The OECD average for 2015 is not yet available.

Table 7: Revised Health Care Expenditure in Ireland, 2000 to 2015€million
  20002001200220032004200520062007200820092010201120122013b20142015
Total Health Care Expenditure (€m)6,9228,5329,89610,95012,20013,68114,43816,26317,89818,50918,19917,92418,20719,69020,04220,858
Capital Expenditure (€m)15227278227499186655398778076715837295269148941,003
Current Expenditure (€m)6,4007,8059,07510,20111,28213,01613,89915,38717,09117,83817,61617,19517,68218,77619,14819,855
Current Public Expenditure (€m)4,9616,1227,1688,0358,90310,26510,81712,19113,55713,74813,42013,06513,41013,09613,26513,896
 Current Private Expenditure (€m)1,4391,6831,9062,1662,3792,7503,0823,1953,5344,0904,1974,1304,2725,6805,8845,959
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%10.4%9.9%7.8%
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%11.6%9.7%
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%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
200614.43782627960770.53865299196149613.8991732876462
200716.26326117193530.8766000522577915.3866611196776
200817.89795754425440.80717222794635517.0907853163081
200918.50893884911490.67079035329657717.8381484958183
201018.19897463196740.58262934829113517.6163452836763
201117.92394703253010.7294140964241317.194532936106
201218.20749873673940.52577920080342817.681719535936
2013b19.68950860928270.91372799763494618.7757806116477
201420.04222969604480.89399180774740119.1482378882974
201520.85750128017521.0025606478548319.8549406323204
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
201218.20749873673940.52577920080342817.681719535936
2013b19.68950860928270.91372799763494618.7757806116477
201420.04222969604480.89399180774740119.1482378882974
201520.85750128017521.0025606478548319.8549406323204
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
2013b10.41889173773112.26357631621259.03947231926132
20149.913148627198911.6411153934018.97206857142857
20157.761445041268259.73825600204054

Reconciliation of HSE Gross Expenditure to Government (HF.1) Funded Current Health Expenditure, 2013 to 2015

Table 8 presents a reconciliation of HSE gross expenditure for 2015 (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, 2015€million
  2015
1HSE AFS - Expenditure - Pay and Pensions4,912
2HSE AFS - Expenditure - Non-Pay8,983
3=1+2Total HSE Annual Financial Statement Gross Expenditure13,895
   
4Exclude Non-Health Care Services-803
5Include Non-AFS Gross Expenditure (Mainly Related to Voluntary Agencies)643
6=4+5Total Adjustments to AFS Gross Expenditure-159
   
7=3+6Gross Expenditure of HSE included in SHA Expenditure13,735
   
8Non-Government Funding of HSE-1,089
9=7+8Total HSE HF.1 Funded Health Care Expenditure12,646
   
 Additional Government Health Care Expenditure: 
10 DSP Transfer payments732
11 Treatment Benefits from Social Insurance Fund60
12 Department of Health84
13 Tax Relief on Medical Expenses146
14 Expenditure of Other Government Departments and Agencies228
15=10+11+12+13+14Total Additional Government HF.1 Funded Expenditure1,250
   
16=9+15Government (HF.1) Funded Current Health Care Expenditure13,896

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 data in June 2016.  They are as follows:

HC.5.1 and HC.5.2:  Expenditure was incorrectly allocated to HC.5.1 Pharmaceuticals and Other Medical Non-Durables in previous publications.  This data has been correctly allocated to HC.5.2: Therapeutic Appliances and Other Medical Goods.  The correction to data for 2013 and 2014 has been made on the CSO’s data portal, Statbank:

http://www.cso.ie/px/pxeirestat/Database/eirestat/System%20of%20Health%20Accounts/System%20of%20Health%20Accounts_statbank.asp?SP=System%20of%20Health%20Accounts&Planguage=0

Revisions to GDP :The GDP figures used in the current publication are consistent with those published in the National Income and Expenditure 2015 and the latest Quarterly National Accounts publication. 

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

This section provides some detail on each classification.  Details of the current application of the standard in Ireland area 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 following methodological 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 and data sources used, see the following methodological 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 methodology: http://www.cso.ie/en/methods/nationalaccounts/

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