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System of Health Accounts

Ireland's System of Health Accounts, Annual Results 2017

Current Health Expenditure in Ireland, 2012 to 2017 
Current Health Expenditure (€ bn)18.718.518.919.320.221.1
Current Health Expenditure % GDP10.7%10.3%9.7%7.3%7.4%7.2%
Current Health Expenditure % GNI*14.8%13.5%12.7%11.9%11.5%11.7%

Current Health Expenditure for Ireland, €21.1 billion (2017)

Figure 1
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Ireland’s current health expenditure was €21.1 billion in 2017, which represents 7.2% of GDP or 11.7% of GNI*. Overall there was a 5% increase in health expenditure in Ireland between 2016 and 2017. Health expenditure has increased by 13% since 2012.

The majority of health expenditure (73%) was funded by government, with the balance funded by private sources including health insurance (14%) and household out-of-pocket expenditure (12%).

This release provides the first estimate of Irish current health care expenditure for 2017 and revised data for years 2012 – 2016.  Capital health expenditure is shown in Table 7 of this release. Within this release detailed cross tabulations are provided for 2017, cross tabulations for all years 2011-2017 can be found in Statbank. Please note that the rounding of numbers to the nearest integer results in some subtotals not summing to 100%. See Background Notes for further details on the System of Health Accounts.  

The GDP figures used in this publication are consistent with those published in the National Income and Expenditure 2017. Current health expenditure is shown as a percentage of GDP and GNI*. See Background Notes for definitions. 

Financing of Health Care Services in Ireland

The majority of health expenditure in 2017 (€15,487 million) was financed by government (HF.1). The remainder was mainly funded by household out-of-pocket payments (12%) and health insurance (14%).

Table 1 shows the breakdown of financing schemes from 2012 to 2017. There was a 15% increase in health spending by government (HF.1) between 2012 and 2017. Health expenditure by private health insurance (HF.2.1) increased by 21% in the same period. Household out-of-pocket expenditure has remained fairly stable over this period.

Table 1: Current Health Care Expenditure by Financing Scheme, 2012 to 2017 €million
ICHA-HF Code       
HF.1Govt Financing Schemes and Compulsory Contributory Health Care Financing Schemes13,48813,17313,38713,86814,62115,487
 HF.1.1 Government Schemes13,43613,11313,32313,80714,55715,410
 HF.1.2 Compulsory Contributory Health Insurance Schemes536064606478
HF.2Voluntary Health Care Payment Schemes2,6272,6902,8182,8362,9743,048
 HF.2.1 Voluntary Health Insurance Schemes2,2162,2852,4062,4532,6002,678
 HF.2.x Other Voluntary Care Payment Schemes411405413383373370
HF.3Household Out-of-Pocket Payments2,5992,6422,6452,5502,5772,595
HF.1-HF.3Total Current Health Care Expenditure18,71518,50618,85019,25420,17121,130

Health Care Providers in Ireland

Just over one-third of health expenditure was in hospitals (HP.1) in 2017, with a further 18% 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 (HP.5, mainly pharmacies) accounted for a further €2,983 million (14%) of all health care expenditure in 2017.

Expenditure in hospitals (HP.1) increased by 20% between 2012 and 2017.

Spending by providers of preventive care (HP.6) increased by 10% between 2016 and 2017.

Table 2: Current Health Care Expenditure by Provider, 2012 to 2017 €million
ICHA-HP Code       
HP.2Long-Term Residential Facilities3,6243,4493,4933,5343,6463,724
HP.3Ambulatory Health Care Providers3,7673,7603,7743,9184,0984,207
HP.4Ancillary Health Care Providers283284263271280277
HP.5Retailers of Medical Goods2,8912,7382,7052,7372,8512,983
HP.6Providers of Preventative Care238230228228233256
HP.7Providers of Health Care Administration and Financing423488625557544618
HP.8Rest of the Economy9179851,0709941,0451,151
HP.9Rest of the World262628364151
HP.0Providers N.E.C.131234410
HP.1 to HP.0Total Current Health Care Expenditure18,71518,50618,85019,25420,17121,130
Current Health Care Expenditure by Provider, 2017
Ambulatory Health Care Provider19.9099817289944
Long-Term Residential Facilities17.62478775687
Retailer of Medical Goods14.1163170698798
Ancillary Health Care Provider1.31079485246618
Other Providers9.86943426715609
Current Health Care Expenditure by Provider, 2017
Ambulatory Health Care Provider19.8991594485444
Long-Term Residential Facilities17.6684625460581
Retailer of Medical Goods14.1086439969292
Ancillary Health Care Provider1.31008235610637
Other Providers9.86406963212145


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 (€11,808 million)  related to curative and rehabilitative care (HC.1+HC.2) with almost half of this for inpatient care (€5,336 million). The next largest category was long-term care (HC.3) which amounted to 21% of expenditure, again with inpatient services(HC.3.1) being the largest component (€2,560 million).

Pharmaceuticals and other medical non-durables (HC.5.1) made up the next largest category (13%). Administration(HC.7) of the health care system (public and private) amounted to €625 million in 2017, which was 3% of total current health expenditure.

There was a 22% increase in expenditure on home-based long-term care (HC.3.4) over the period 2012-2017. Spending on curative and rehabilitative care (HC.1+HC.2) increased by 17% between 2012 and 2017.

There was a 2% increase in spending on long-term care (HC.3) between 2016 and 2017. Within this category there was a 10% increase in expenditure on home-base long-term care (HC.3.4) and a 3% decrease in expenditure on inpatient long term care (HC.3.1).

Table 3: Current Health Care Expenditure by Health Care Function, 2012 to 2017 €million
ICHA-HC Code        
HC.1+HC.2Curative and Rehabilitative Care10,03110,03810,15610,58611,18311,808
 HC.1.1+HC.2.1 Inpatient Curative & Rehabilitative Care4,5004,4094,5914,8055,0805,336
 HC.1.2+HC.2.2 Day Curative and Rehabilitative Care1,3001,2521,2671,3231,4041,577
 HC.1.3+HC.2.3 Outpatient Curative & Rehabilitative Care3,6133,7323,6183,7484,0444,193
 HC.1.4+HC.2.4 Home-Based Curative & Rehabilitative Care618644681709655701
HC.3Long-Term Care (Health)4,2314,0704,2434,2094,3854,469
 HC.3.1 Inpatient Long-Term Care (Health)2,6622,4832,5642,5652,6312,560
 HC.3.2 Day Long-Term Care (Health)170167170178189194
 HC.3.4 Home-Based Long-Term Care (Health)1,3991,4211,5101,4651,5651,714
HC.4Ancillary Services514569529549578593
 HC.4.1 Laboratory Services172199177174187198
 HC.4.2 Imaging Services365038404240
 HC.4.3 Patient Transportation179179190195196213
 HC.4.9 Ancillary Services N.E.C127141125140153141
HC.5Medical Goods (Non-Specified by Function)2,9722,8042,7722,8242,9423,074
 HC.5.1 Pharmaceuticals and Other Medical Non-Durables275525692,5312,5842,6982,812
 HC.5.2 Therapeutic Appliances and Other Medical Goods217235242239244261
HC.6Preventive Care533525514517525555
 HC.6.1 Information, Education and Counceling Programmes726766737480
 HC.6.2 Immunisation Programmes504443474252
 HC.6.3 Early Disease Detection Programmes636060596065
 HC.6.4 Healthy Condition Monitoring Programmes200193183178185187
 HC.6.5 Epidemiological Surveillance, Disease Control Programmes808276757982
 HC.6.6 Preparing for Disaster and Emergency Response Programmes222200
 HC.6.9 Preventative Care N.E.C677784838688
HC.7Governance and Health System Administration and Financing428492630563551625
 HC.7.1 Govt Health Administration Agencies148174182179185201
 HC.7.2 Administration of Health Financing 280318447384367424
HC.9Health Care Services N.E.C675678
HC.1 to HC.9Total Current Health Care Expenditure18,71518,50618,85019,25420,17121,130
Current Health Care Expenditure By Function, 2017
Curative and Rehabilitative Care55.8798993943433
Long-Term Care (Health)21.1475078689308
Medical Goods (Non-Specified by Function)14.5465148041461
Ancillary Services2.80495535968522
Other Health Care Functions 5.62112257289459
Current Health Care Expenditure By Function, 2017
Curative and Rehabilitative Care55.7714225688844
Long-Term Care (Health)21.136245654753
Medical Goods (Non-Specified by Function)14.5387679828052
Ancillary Services2.8034615662692
Other Health Care Functions 5.75010222728808

Who is providing which services?

Table 4 presents a breakdown of health care expenditure by function (HC) and provider (HP) for 2017.

Curative and rehabilitative care services (HC.1 + HC.2) provided by hospitals (HP.1) accounted for over one-third of health care expenditure in Ireland in 2017 (€7,419 million), of which 63% was on inpatient services (€4,641 million).

Long-term residential facilities (HP.2 accounted for approximately 17% of the total current health care expenditure. Long-term facilities, which include nursing homes and residential facilities for people with a disability, predominantly provided long-term care inpatient services (HC.3.1) (€2,468 million).

Ambulatory health care providers (HP.3) accounted for 20% of health care expenditure in Ireland in 2017.  These providers, which include GPs, dentists and other services such as home care providers and health care centres, mainly delivered outpatient services. In 2017, €4,207 million was spent on health care in these settings with 67% of this spent on outpatient curative and rehabilitative care  (HC1.3+HC.2.3).

Expenditure on pharmaceuticals (HC.5.1) (€2,812 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 €1,212 million in 2017. Two-thirds of this expenditure (€929 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 4: Current Health Care Expenditure by Health Care Function and Health Care Provider, 2017€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 Care7,4197813,522182 2050511,808
 HC.1.1+HC.2.1 Inpatient Curative & Rehabilitative Care4,641637100    4355,336
 HC.1.2+HC.2.2 Day Curative and Rehabilitative Care1,42301501    3 1,577
 HC.1.3+HC.2.3 Outpatient Curative & Rehabilitative Care1,31442,84408  19404,193
 HC.1.4+HC.2.4 Home-Based Curative & Rehabilitative Care41140518  2 10 701
HC.3Long-Term Care (Health)922,943505    9290 4,469
 HC.3.1 Inpatient Long-Term Care (Health)922,468      0 2,560
 HC.3.2 Day Long-Term Care (Health) 1194       194
 HC.3.4 Home-Based Long-Term Care (Health) 474311    929  1,714
HC.4Ancillary Services31105276    1 593
 HC.4.1 Laboratory Services139  59    0 198
 HC.4.2 Imaging Services40       0 40
 HC.4.3 Patient Transportation28  185    0 213
 HC.4.9 Ancillary Services N.E.C1050531    0 141
HC.5Medical Goods (Non-Specified by Function)30   2,975  69  3,074
 HC.5.1 Pharmaceuticals and Other Medical Non-Durables30   2,714  68  2,812
 HC.5.2 Therapeutic Appliances and Other Medical Goods    261  1  261
HC.6Preventative Care0 1750 247 1330 555
 HC.6.1 Information, Education and Counceling Programmes  14  46 21  80
 HC.6.2 Immunisation Programmes  8  44    52
 HC.6.3 Early Disease Detection Programmes     65    65
 HC.6.4 Healthy Condition Monitoring Programmes  75    113  187
 HC.6.5 Epidemiological Surveillance, Disease Control Programmes  0  82    82
 HC.6.6 Preparing for Disaster and Emergency Response Programmes           
 HC.6.9 Preventative Care N.E.C0 780 9  0 88
HC.7Governance and Health System Administration and Financing00 0 7618  0625
 HC.7.1 Govt Health Administration Agencies     7194   201
 HC.7.2 Administration of Health Financing 00 0  423  0424
HC.9Health Care Services N.E.C3 0    0058
HC.1 to HC.9Total Current Health Care Expenditure7,8543,7244,2072772,9832566181,151511021,130

How are health care services being funded?

Table 5 presents a breakdown of health care expenditure by function (HC) and financing scheme (HF) for 2017.

Inpatient curative and rehabilitative care (HC.1.1 + HC.2.1) accounted for 24% (€3,720 million) of the total government (HF.1) spend on healthcare. Over 36% of the total spend of household out-of-pocket payments (HF.3) was for outpatient curative and rehabilitative care (€952 million).

Of the €11,808 million spent on curative and rehabilitative care services in 2017, Government (HF.1) funded over 71% (€8,365 million) and 18% (€2,105 million) was funded by voluntary health insurance payments (HF.2.1).

A total of €4,469 million was spent on long-term care services (HC.3). Government (HF.1) financed 86% (€3,844 million) of long term care services in 2017. Almost all of the remainder was paid for by household out-of-pocket payments (13% or €583 million).

Almost a quarter (€688 million) of the expenditure on pharmaceuticals (HC.5.1) was funded by household out-of-pocket payments with the remainder funded by government (€2,124 million). 

Preventive care (HC.6), such as immunisation and health promotion activities, was funded by government (63%) and voluntary payments other than health insurance (HF.2.x) (22%). The remainder was funded by household out-of-pocket payments which would relate mainly to preventative dental care.

Tax refunds for health expenditure amounted to €164 million in 2017. 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, 2017€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 Care8,3658,344212,2802,1051751,16211,808
 HC.1.1+HC.2.1 Inpatient Curative & Rehabilitative Care3,7203,720 1,5011,439621155,336
 HC.1.2+HC.2.2 Day Curative and Rehabilitative Care989989 56454321241,577
 HC.1.3+HC.2.3 Outpatient Curative & Rehabilitative Care3,0473,02621194122729524,193
 HC.1.4+HC.2.4 Home-Based Curative & Rehabilitative Care609609 2212171701
HC.3Long-Term Care (Health)3,8443,8073742 425834,469
 HC.3.1 Inpatient Long-Term Care (Health)1,9671,967 30 305642,560
 HC.3.2 Day Long-Term Care (Health)188188 2 25194
 HC.3.4 Home-Based Long-Term Care (Health)1,6891,6533710 10141,714
HC.4Ancillary Services406406 143139344593
 HC.4.1 Laboratory Services163163 2 234198
 HC.4.2 Imaging Services3939 0 0140
 HC.4.3 Patient Transportation204204 2 27213
 HC.4.9 Ancillary Services N.E.C   139139 2141
HC.5Medical Goods (Non-Specified by Function)2,1782,15820***8963,074
 HC.5.1 Pharmaceuticals and Other Medical Non-Durables2,1242,124    6882,812
 HC.5.2 Therapeutic Appliances and Other Medical Goods533320***208261
HC.6Preventative Care351351 129512475555
 HC.6.1 Information, Education and Counceling Programmes8080 1 1 80
 HC.6.2 Immunisation Programmes5252 0 0 52
 HC.6.3 Early Disease Detection Programmes6464 1 1 65
 HC.6.4 Healthy Condition Monitoring Programmes44 109 10975187
 HC.6.5 Epidemiological Surveillance, Disease Control Programmes7878 404 82
 HC.6.6 Preparing for Disaster and Emergency Response Programmes        
 HC.6.9 Preventative Care N.E.C7474 1459 88
HC.7Governance and Health System Administration and Financing178178 44742423 625
 HC.7.1 Govt Health Administration Agencies178178 23 23 201
 HC.7.2 Administration of Health Financing    424424  424
HC.9Health Care Services N.E.C165165 752-1648
HC.1 to HC.9Total Current Health Care Expenditure15,48715,410783,0482,6783702,59521,130
* Confidential

How are the health care providers being funded?

Table 6 presents a breakdown of health care expenditure by health care provider (HP) and financing source (HF) for 2017.

Government (HF.1) was the majority funder of health care providers in Ireland in 2017 (73%). Over 80% of expenditure in long-term care facilities (HP.2) were government funded. Government also funded 71% of hospital (HP.1) expenditure. The majority (79%) of pharmaceutical expenditure was also funded by government.

Over three-quarters (76%) of voluntary health insurance payments (€2,043 million) were spent on hospital services.

After tax refunds of €164 million were taken into account, houshold out-of-pocket expenditure amounted to €2,595 million in 2017. Over 40% of this (€1,043 million) was spent on ambulatory health care providers (HC.3) and 25% (€640 million) was on long-term care facilities (HP.2). Over 25% of household out-of-pocket payments (€649 million) was spent in pharmacies.

Table 6: Current Health Care Expenditure by Health Care Provider and Health Care Financing Scheme, 2017€million
ICHA Code  HF.1 - Government 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.1Hospitals5,5765,576 2,1362,043931417,854
 HP.1.1 General Hospitals4,6644,664 1,8881,804841246,676
 HP.1.x Specialised Hospitals (including Mental Health Hospitals)912912 2482399181,178
HP.2Long-Term Residential Facilities3,0163,016 6821466403,724
HP.3Ambulatory Health Care Providers2,9522,93121212133801,0434,207
 HP.3.1 Medical Practices596596 7070 294960
 HP.3.2 Dental Practices85642118154356460
 HP.3.3 Other Health Care Practitioners7878 30301276384
 HP.3.4 Ambulatory Health Care Centres1,6621,662 70862471,779
 HP.3.5 Providers of Home Health Care Services531531 24101369624
HP.4Ancillary Health Care Providers204204 3432139277
 HP.4.1 Providers of Patient Transportation and Emergency Rescue177177 3117186
 HP.4.2 Medical and Diagnostic Laboratories2727 3131 3290
HP.4.9Other providers of ancillary services11  1
HP.5Retailers of Medical Goods2,1512,13120***8322,983
 HP.5.1 Pharmacies2,0982,098    6492,747
 HP.5.2 Retail Sellers of Durable Medical Goods and Appliances533320***183236
HP.6Providers of Preventive Care232232 24 24 256
HP.7Providers of Health Care System Administration and Financing177177 44042317 618
 HP.7.1 Govt Health Administration Agencies177177 17 17 194
 HP.7.3 Private Health Insurance Administration Agencies   423423  423
HP.8Rest of the Economy979942371090109641,151
 HP.8.1 Households as Providers of Home Health Care92989237    929
 HP.8.2 All Other Industries as Secondary Providers of Health Care5050 109010964223
HP.9Rest of the World3535 15150 51
HP.0Providers N.E.C.164164 1010 -16410
HP.1 to HP.0Total Current Health Care Expenditure15,48715,410783,0482,6783702,59521,130
* 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 large increase in GDP in 2015 led to a drop in this ratio. GNI* excludes globalisation effects that are disproportionally impacting the measurement of the size of the Irish economy, and hence may be a more appropriate indicator to use. 

Table 7: Revised Health Care Expenditure in Ireland, 2000 to 2017 €million
Total Health Care Expenditure (€m)6,9228,5329,89610,95012,20013,68114,43816,26317,89818,50918,19919,02419,23919,41919,74920,32021,35222,181
Capital Expenditure (€m)15227278227499186655398778076715837315249148981,0661,1801,051
Current Expenditure (€m)6,4007,8059,07510,20111,28213,01613,89915,38717,09117,83817,61618,29318,71518,50618,85019,25420,17121,130
 Current Public Expenditure (€m)4,9616,1227,1688,0358,90310,26510,81712,19113,55713,74813,42013,23313,48813,17313,38713,86814,62115,487
 Current Private Expenditure (€m)1,4391,6831,9062,1662,3792,7503,0823,1953,5344,0904,1975,0595,2265,3325,4645,3865,5515,643
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%10.7%10.7%10.3%9.7%7.3%7.4%7.2%
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%14.5%14.8%13.5%12.7%11.9%11.5%11.7%
Current Expenditure % GDP, OECD Average (adjusted)27.2%7.5%7.7%8.0%8.0%8.0%7.9%7.9%8.2%8.8%8.7%8.7%8.8%8.8%8.8%8.8%8.9%8.8%
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
Total Health Care Expenditure Capital Expenditure Current Expenditure 2000 6.92175232686613 0.521585032507154 6.40016729435898 2001 8.53180886877449 0.727265464877989 7.8045434038965 2002 9.8962979284674 0.821661173997352 9.07463675447005 2003 10.9502528018978 0.748789008511227 10.2014637933866 2004 12.1998044899761 0.918258199367311 11.2815462906088 2005 13.6808559891815 0.665283652984776 13.0155723361967 2006 14.4378262794809 0.538652991834767 13.8991732876462 2007 16.2632608595315 0.876599739853958 15.3866611196776 2008 17.8979569498856 0.807171633577503 17.0907853163081 2009 18.508938227549 0.670789731730698 17.8381484958183 2010 18.1989739479447 0.582628664268421 17.6163452836763 2011b 19.1464010725859 0.7314510582849 18.414950014301 2012 19.4361454089611 0.5242820322751 18.911863376686 2013 19.4852866317829 0.9138903881389 18.571396243644 2014 19.7422027822814 0.898514323361 18.8436884589204 2015 20.5754177152331 1.0640011605661 19.511416554667 2016 21.5016713148477 1.1694920509742 20.3321792638735
Current Expenditure % GDP, IrelandCurrent Expenditure % GNI*, IrelandCurrent Expenditure % GDP, OECD Average (adjusted)
Current Expenditure % GDP, IrelandCurrent Expenditure % GNI*, IrelandCurrent Expenditure % GDP, OECD Average (adjusted)


Reconciliation of HSE Gross Expenditure to Government (HF.1) Funded Current Health Expenditure, 2017

Table 8 presents a reconciliation of HSE gross expenditure for 2017 (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, 2017€million
1HSE AFS - Expenditure - Pay and Pensions5,357
2HSE AFS - Expenditure - Non-Pay9,872
3=1+2Total HSE Annual Financial Statement Gross Expenditure15,229
4Exclude Non-Health Care Services-932
5Include Non-AFS Gross Expenditure (Mainly Related to Voluntary Agencies)776
6=4+5Total Adjustments to AFS Gross Expenditure-156
7=3+6Gross Expenditure of HSE included in SHA Expenditure15,073
8Non-Government Funding of HSE-1,010
9=7+8Total HSE HF.1 Funded Health Care Expenditure14,063
 Additional Government Health Care Expenditure: 
10 DSP Transfer payments881
11 Treatment Benefits from Social Insurance Fund78
12 Department of Health104
13 Tax Relief on Medical Expenses164
14 Expenditure of Other Government Departments and Agencies197
15=10+11+12+13+14Total Additional Government HF.1 Funded Expenditure1,424
16=9+15Government (HF.1) Funded Current Health Care Expenditure15,487

Background Notes


This release is the official publication by CSO of health care expenditure 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 from 2011.

International comparisons for this data can be found in Eurostat data explorer here under the theme:

Population and Social Conditions\Health\Health Care\Health Care Expenditure and OECD statistical database here.

 Data revisions since previous publication

The following are a number of revisions undertaken since the publication of data in June 2017:

HP.3: A review of the processing of the household out-of-pocket payments on medical and dental practices has resulted in a revision for the years 2013-2016. Revised series is available on the CSO’s data portal statbank.

HP.8: A revision in the methodology of expenditure on other industries as secondary providers of healthcare has resulted in a revision for the years 2013-2016. Revised series is available on the CSO’s data portal statbank. 

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

Gross Domestic Product (GDP) 

The GDP figures used in the current publication are consistent with those published in the National Income and Expenditure 2017 and the latest Quarterly National Accounts publication. See here

Modified Gross National Income (GNI*)

Modified Gross National Income (GNI*) is equal to Gross National Income at current market prices less the factor income of redomiciled companies, less depreciation on research and development related intellectual property imports and less depreciation on aircraft related to aircraft leasing.

 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 below, 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 here

 National application of the SHA standard

Much progress has been made in the coding of data sources to the SHA classifications.  However this work is ongoing and revisions, especially to the more detailed profile of the data are to be expected. 

 Specific known data issues

All HSE hospital expenditure funded by HSE Mental Health Services has been allocated to HP.1.2 Mental Health Hospitals. 

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.


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 (purchasing of healthcare abroad) 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 expenditure been 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 are available here:

 The SHA manual available here, provides a full description of the classifications and their categories.  

 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, see the methodology here.

 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 and data sources used, see the methodology here.

 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 difficult to separate them.
    • 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 methodology here.




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