System of Health Accounts in Ireland CSO DATA

1. System of Health Accounts
in Ireland
Future Health Summit
City West
26 May 2016
www.cso.ie 1

2. Headline results
• New estimate of current health expenditure for
year 2013
• €18.4 billion in 2013
• 10.2% of GDP
• 12.4% of GNI
• 71% funded by government
• 15% funded by household out of pocket spending
• 14% by voluntary schemes – mainly health
insurance
www.cso.ie 2

3. What is the System of Health Accounts?
• Format for reporting health care expenditure
agreed between OECD, WHO, Eurostat
– Extension of core National Accounts
• Answers 3 main questions
– Where does the money to finance the health
system come from?
– Who does the money go to?
– What kind of (functionally defined) services are
performed and what type of goods are purchased
www.cso.ie 3

4. What’s new?
• First detailed profile of Irish current health
expenditure in accordance with System of
Health Accounts, 2011 (SHA)
• Previously only high level estimates
– Total
– Public / private
– Current / capital
• Now detailed breakdown of current spending
by 3 classifications
www.cso.ie 4

5. What is the System of Health Accounts?
• Based on the International Classification
for Health Accounts (ICHA) with
classifications for
–health care financing schemes (ICHA-HF);
–health care by service provider industries
(ICHA-HP);
–health care by function (ICHA-HC);
www.cso.ie 5

6. Boundary of health care
• Functional classification (ICHA-HC) is key to
defining the boundary of health care
• Excludes social care – difficult in practice
• Review of Irish data has led to inclusion of
wider range of services as health care than
previously reported
• Main changes – more long-term care for
older people and people with a disability
now included
www.cso.ie 6

7. Old versus new estimate
www.cso.ie 7
4.6
5.6
6.6
7.3
8.1
8.9
9.6
10.7
11.7
11.3
9.7
9.4
9.7
5.0
6.1
7.2
8.0
8.9
10.3
10.8
12.2
13.6
13.7
13.4
13.1
13.4
13.1
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
€billion
Public Current Health Expenditure - old approach
Public Current Health Expenditure - revised 2000-2012, new approach 2013

8. Health expenditure 2000-2013
www.cso.ie 8
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013b
€million
Total Health Care Expenditure Current Expenditure Capital Expenditure

9. Current health expenditure 2000-2013
Ireland and OECD
www.cso.ie 9
0%
2%
4%
6%
8%
10%
12%
14%
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013b
Current Expenditure % GDP, Ireland Current Expenditure % GNI, Ireland
Current Expenditure % GDP, OECD Average (adjusted)

10. Current health expenditure 2000-2013
Public/Private
www.cso.ie 10
-
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013b
€millions
Current Expenditure - Total Current Public Expenditure Current Private Expenditure

11. Detailed Preliminary 2013
results
www.cso.ie 11

12. Who pays for health care in
Ireland?
www.cso.ie 12
71%
14%
15%
Health Care Expenditure Distributed by
Financing Schemes, 2013
HF.1 Government
HF.2 Voluntary Health Care
Payments
HF.3 Household Out-of-
Pocket

13. www.cso.ie 13
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
USA
Greece
Australia
Ireland
Spain
Finland
Germany
Italy
France
New Zealand
UK
Denmark
Netherlands
Health Expenditure by Type of Financing, 2013
(Ireland and selected OECD countries)
Government Out of pocket Other voluntarySource: OECD and CSO

14. Who provides health care in Ireland?
www.cso.ie 14
9%
15%
1%
20%
20%
35%
0 1,000 2,000 3,000 4,000 5,000 6,000 7,000
Other Providers
Retailer of Medical Goods
Ancillary Health Care Provider
Ambulatory Health Care Provider
Long-Term Residential Facilities
Hospitals
Health Care Expenditure by Provider, 2013
€m

15. www.cso.ie 15
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Germany
Belgium
United States
Ireland
Netherlands
Switzerland
Finland
France
Sweden
Spain
Denmark
Health Expenditure by Provider (HP), 2013
(Ireland and selected OECD countries)
Hospitals Nursing and residential care Ambulatory providers Retailers Other
Source: OECD
and CSO

16. What kind of health care is funded
in Ireland?
www.cso.ie 16
4%
16%
3%
22%
55%
0 2,000 4,000 6,000 8,000 10,000 12,000
Other Health Care Functions
Medical Goods (Non-Specified by Function)
Ancillary Services
Long-Term Care (Health)
Curative and Rehabilitative Care
Health Care Expenditure By Health Care Function,
2013
€m

17. www.cso.ie 17
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Norway
Belgium
Netherlands
Germany
France
Ireland
Denmark
Switzerland
Spain
Greece
Austria
United States
Health Expenditure by Function (HC), 2013
(Ireland and selected OECD countries)
Curative & rehabilitative care Long-term care Medical goods Other Services
Source:
OECD and
CSO

18. www.cso.ie 18
62%
43% 12% 37%
34%
7%
0 2,000 4,000 6,000 8,000 10,000 12,000
Long-Term Care
(Health)
Curative and
Rehabilitative Care
Type of Care by Mode of Provision, 2013
Inpatient Day Outpatient Home-Based
€m

19. Cross-Classifying
www.cso.ie 19

20. 1.Who provides what kind of care?
www.cso.ie 20
22%
88%
17%
95%
66%
11%
83%
99.7%
4%
0 1,000 2,000 3,000 4,000 5,000 6,000 7,000
Other Providers
Medical Goods Retailers
Ambulatory Providers
Residential Facilities
Hospitals
Providers (HP) by Health Care Function (HC) , 2013
Curative and Rehabilitative Care Long-term care (health) Medical Goods Other Services
€m

21. 2.Who funds which type of care?
www.cso.ie 21
69%
80%
67% 21%
31%
16%
12%
0 2,000 4,000 6,000 8,000 10,000 12,000
Medical Goods
Long-term care (health)
Curative and Rehabilitative
Health Care Function (HC) by Financing (HF), 2013
Government Voluntary Payments Out-of-Pocket
€m

22. 3.Who funds which providers?
www.cso.ie 22
74%
72%
69%
75%
69%
26%
29%
28%
28%
21%
0 1,000 2,000 3,000 4,000 5,000 6,000 7,000
Other Providers
Medical Goods Retailers
Ambulatory Provider
Residential Facilities
Hospitals
Type of Provider (HP) by Financing
Government Voluntary Payment Out-of-Pocket
€m

23. Going forward
• Revised 2013 data and new 2014 data to be
submitted to Eurostat on 31st May and
thereafter annually.
• National publication in June/July.
• Data user seminar in Q3 2016.
• Detailed tables for 2011 and 2012 to be
produced in 2017.
www.cso.ie 23

24. www.cso.ie 24
For data and further information
CSO Publication
Ireland’s System of Health Accounts, Annual Results 2013 (Preliminary)
http://www.cso.ie/en/releasesandpublications/er/sha/systemofhealthaccounts2013/
International Data
OECD: - http://stats.oecd.org/ - see health expenditure and financing under Health theme
Eurostat: -http://ec.europa.eu/eurostat/web/health/health-care/data/database
Please refer to the following methodological papers on the CSO’s website
http://www.cso.ie/en/surveysandmethodology/nationalaccounts/
Mapping of Health Care Services in Ireland to the Functions Classification (ICHA – HC) within the System
of Health Accounts
Mapping of Health Care Services in Ireland to the Functions Classification (ICHA – HC) within the System
of Health Accounts
Mapping of Health Care Providers in Ireland to the Provider Classification (ICHA – HP) within the System
of Health Accounts
sha@cso.ie