Population and social conditions Data in focus

Authors: Cornelis VAN MOSSEVELD, Dorota KAWIORSKA,

26/2008
Bart DE NORRE

Health expenditure, 2003-2005

This publication presents current health expenditure data based on the Joint Health Accounts
Questionnaire launched by EUROSTAT, OECD (Organisation for Economic Co-operation and
Development) and WHO (World Health Organisation), in 2005 and 2006.

1. Current health expenditure: totals per country

Current health expenditure Current health expenditure,
as percentage of GDP, 2003-2005 million of euro, 2003-2005
2003 2004 2005
Romania

Estonia Estonia 432 p 494 p 558 p

2005
Cyprus Cyprus 664 p 703 p 794 p
2004
Lithuania Lithuania : 1004 1185
2003

Poland Bulgaria 1353 1460 1664

Czech Republic Luxembourg 1906 2075 2276

Slovenia 2104 2173 2308

Bulgaria

Romania 2600 p 3031 p 4107 p

Luxembourg
Czech Republic 5784 6132 6889
Spain
Poland 11464 12096 14298
Japan
Portugal 12735 13687 14450
Slovenia
Denmark 16107 p 16799 p 18218 p
Denmark
Norway 18656 18792 :
Norw ay
Belgium 26731 p 28243 p 29151 p
Netherlands
Switzerland 32790 33455 34186

Portugal Netherlands 42683 44473 46792

Belgium Spain 59386 65833 72407

Germany France 169052 177514 185268

France Germany 224817 224822 230280

Sw itzerland
Japan 293976 291172 :
United States
United States 1433607 p 1397979 p 1495772 p

0.0 5.0 10.0 15.0

p = preliminary data : = unavailable
 Current health expenditure per capita in euro, 2003-2005

5000

4000 2003 2004 2005

3000

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2. Current health expenditure by financing agents

Current health care expenditure in euro per capita by selected financing agents, 2003 and 2005
All financing
General government (including
agents (HF.1- HF.2 Private sector
social security) (HF.1)
HF.3)
of which: Private
insurance of which: Private
of which: Social
enterprises household out-of-
Total HF.1 security funds Total HF.2
(including private pocket expenditure
(HF.1.2)
social insurance) (HF.2.3)
(HF.2.1 + HF.2.2)
2003 2005 2003 2005 2003 2005 2003 2005 2003 2005 2003 2005
Belgium 2576 2782 1803 1972 1564 1850 755 789 91 148 630 621
Bulgaria 173 215 106 128 52 72 67 87 0 1 66 84
Czech Republic 567 673 507 593 464 555 60 80 1 2 59 76
Denmark 2988 3362 2505 2805 0 0 483 557 24 53 434 502
Germany 2724 2792 2153 2160 1941 1951 571 632 246 264 302 345
Estonia 319 415 245 318 210 276 74 96 0 1 65 85
Spain 1414 1668 988 1185 76 78 425 483 95 111 320 360
France 2725 2949 2147 2336 2010 2187 578 613 350 380 205 210
Cyprus 919 1047 380 421 0 0 539 626 34 55 499 562
Lithuania : 347 : 232 : 207 : 115 : 1 : 114
Luxembourg 4219 4893 3803 4428 3164 3545 416 465 76 88 296 327
Netherlands 2631 2867 1718 1858 1617 1748 908 1004 479 557 210 220
Poland 300 375 208 257 188 230 93 117 2 2 83 104
Portugal 1220 1370 887 986 11 11 332 384 53 58 272 318
Romania 120 190 93 142 76 117 24 46 5 8 19 37
Slovenia 1054 1154 768 836 746 810 286 318 144 156 132 149
Norway : : 2740 : 686 : : : 676 : : :
Switzerland 4468 4597 2613 2744 1812 1955 1855 1853 401 406 1410 1404
Japan 2316 : 1874 : 1507 : 442 : 7 : 416 :
United States 4936 5055 2218 2302 : : 2718 2753 1838 1886 683 678

2 26/2008 — Data in focus

 Index (2005 compared to 2003) of current health expenditure by selected financing agents
All financing
General government (including
agents (HF.1- Private sector (HF.2 )
social security) (HF.1 )
HF.3)
of which: Private
insurance of which: Private
enterprises household out-of-
of which: Social (including private pocket
security funds social insurance) expenditure
Total HF.1 (HF.1.2) Total HF.2 (HF.2.1 + HF.2.2) (HF.2.3)

Belgium 109 110 119 106 164 100

Bulgaria 123 120 137 127 367 126
Czech Republic 119 117 120 133 125 129
Denmark 113 113 : 116 227 116
Germany 102 100 100 111 108 114
Estonia 129 129 131 129 : 130
Spain 122 124 107 117 121 116
France 110 110 110 107 110 103
Cyprus 120 116 110 122 169 118
Lithuania : : : : : :
Luxembourg 119 120 115 115 120 114
Netherlands 110 109 109 111 117 105
Poland 125 124 122 127 125 125
Portugal 113 112 105 117 111 118
Romania 158 152 152 191 182 193
Slovenia 110 109 109 111 109 113
Norway (2004/2003) : 125 99 : : :
Switzerland 104 106 109 101 103 101
Japan (2004/2003) 99 99 99 97 110 98
United States 104 106 : 103 105 101

3. Current health expenditure by health care functions

Health care function categories (1st digit level), percentage shares in current health expenditure, 2005

100
Not specified by kind
90 (HC.9 )

80 Health administration and

health insurance (HC.7 )
70
Prevention and public
60 health services (HC.6 )

50
Medical goods dispensed
to out-patients (HC.5 )
40

30 Ancillary services to health

care (HC.4 )
20
Services of long-term
10 nursing care (HC.3 )

0
Services of curative and
rehabilitative care
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Data in focus — 26/2008 3

4. Current health expenditure by health care providers
Health care provider categories (1st digit level|), percentage shares in current health expenditure, 2005
100
Rest of the world (HP.9)
90

Other industries (rest of the

80 economy) (HP.7)

70 General health administration

and insurance (HP.6)
60
Provision and administration
of public health programmes
50
(HP.5)
Retail sale and other
40
providers of medical goods
(HP.4 )
30 Providers of ambulatory
health care (HP.3)
20
Nursing and residential care
10 facilities (HP.2)

Hospitals (HP.1 )
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5. Breakdown of selected health care functions by financing agents

Sum of curative care and rehabilitative care services (HC.1& HC.2) financed by selected
financing agents: Government (HF.1), Social Security (HF.1.2, Private insurance (HF.2.1 & HF.2.2,
and Out-of-pocket (HF.2.3), 2005 (sorted by General government financing)

100

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Private household out-of-pocket expenditure (HF.2.3)

Private insurance enterprises (including private social insurance) (HF.2.1 + HF.2.2)
General government (excl. social security) (HF.1)
Social security funds (HF.1.2)

4 26/2008 — Data in focus

 Medical goods dispensed to out patients (HC.5) financed by selected financing agents:
Government (HF.1), Social Security (HF.1.2, Private insurance (HF.2.1 & HF.2.2,
and Out-of-pocket (HF.2.3), 2005 (sorted by General government financing)
100 0 0 1 0 3 0 0 0 0 2
4 4 5 6
8
0
90 23 21
22 20
29
33 33 23
80 38 39 30
0
43 45 41
53
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60 48 4
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Private insurance enterprises (including private social insurance) (HF.2.1 + HF.2.2)
Private household out-of-pocket expenditure (HF.2.3)
General government (excl. Social Securuty) (HF.1)
Sums may exceed 100% due to rounding
Social security funds (HF.1.2)

6. Breakdown of selected health care functions by providers

Sum of curative care and rehabilitative care services (HC.1& HC.2) provided by selected provider
categories: hospitals (HP.1) and providers of ambulatory health care (HP.3), 2005

100

90

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50

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Data in focus — 26/2008 5

Comments

The Joint Health Accounts Data Collection (a co-operation between EUROSTAT, OECD and WHO)
started in 2005 and two further waves were launched in 2006 and 2007. The data presented here are the
results of the first two waves (data for reference years 2003, 2004 and 2005).

Methodology

Health care expenditure statistics describe the process of providing and financing health care in countries
by referring to health care goods and services, its providers and financing agents.
Current expenditure on health measures the economic resources spent by a country on health care
services and goods, including administration and insurance. Total expenditure on health care represents
current expenditure on health enlarged by the expenditure on capital formation (investments) of health
care providers.
For the collection of the data on health care expenditure the System of Health Accounts (SHA) and its
related set of International Classification for the Health Accounts (ICHA) is used. The SHA shares the
goals of the System of National Account (SNA) to constitute an integrated system of comprehensive,
internally consistent, and internationally comparable accounts, which should as far as possible be
compatible with other aggregated economic and social statistical systems.
The SHA is organised around a tri-axial system for the recording of health expenditure, by means of an
International Classification for Health Accounts (ICHA), defining:
• health care financing agents: who is paying?
• health care by function: for which services and goods?
• health care service provider industries: who is paid, who provides the services?
Financing agent (ICHA-HF):
Mechanisms of health care financing are becoming increasingly complex in many countries with a wide
range of institutions involved. The financing of health care is one of the reporting dimensions. At least a
basic subdivision of public and private financing is reported in many cases. A detailed breakdown of
expenditure on health by financing agents is an essential component of a comprehensive SHA.
Function category (ICHA-HC):
The boundaries of a functionally defined health care system delimit the subject area of health accounts.
This approach is “functional” in the sense that it refers to the purposes of health care. Health care in a
country comprises the sum of activities performed either by institutions or individuals pursuing, through the
application of medical, paramedical and nursing knowledge and technology, the purposes of:
• promoting health and preventing disease;
• curing illness and reducing premature mortality;
• caring for persons affected by chronic illness who require nursing care;
• caring for persons with health-related impairment, disability, and handicaps who require nursing
care;
• assisting patients to die with dignity;
• providing and administering public health;
• providing and administering health programs, health insurance and other funding arrangements.
The core functions of health care refer to the purposes listed above. Health-related functions such as
education and training of health workforce, research and development in health and environmental health
should be distinguished from the core functions. They can be very closely linked to health care in terms of

6 26/2008 — Data in focus

operations, institutions and personnel, but should, as far as possible, be excluded when measuring
activities belonging to core health care functions.
Provider category (ICHA-HP):
The production and the provision of health care services along with their financing take place in a wide
range of institutional settings that vary across countries. The way of organising health care services
reflects the country-specific division of labour between providers of health care services which is
becoming increasingly complex in many countries. A classification of health care providers serves the
purpose of arranging country-specific institutions into common, internationally applicable categories and
providing tools for linking data on personnel and other resource inputs as well as output measurement

Further information

European Statistical Data Support:

Contact details for this support network can be found on our Internet site:
http://ec.europa.eu/eurostat/

Data: Eurostat Website/Population and social conditions

Population and social conditions

Health
Public health
Health care expenditure

The manuals related to the System of Health Accounts can be accessed via the CIRCA site:
Circa/Public Health Statistics

European Statistical Data Support:

Contact details for this support network can be found on our Internet site:
http://ec.europa.eu/eurostat/

Manuscript completed on: 24.06.2008

Data extracted on: 09.04.2008
ISSN 1977-0340
Catalogue number: KS-QA-08-026-EN-N
© European Communities, 2008