System of Health Accountsin Ireland

Future Health Summit

City West

26 May 2016

www.cso.ie 1

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

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

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

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

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

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

€b

illio

n

Public Current Health Expenditure - old approach

Public Current Health Expenditure - revised 2000-2012, new approach 2013

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

€m

illio

n

Total Health Care Expenditure Current Expenditure Capital Expenditure

Current health expenditure 2000-2013Ireland 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)

Current health expenditure 2000-2013Public/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

€m

illio

ns

Current Expenditure - Total Current Public Expenditure Current Private Expenditure

Detailed Preliminary 2013

results

www.cso.ie 11

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 CarePayments

HF.3 Household Out-of-Pocket

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

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

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 OtherSource: OECD and CSO

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

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 ServicesSource: OECD and CSO

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 andRehabilitative Care

Type of Care by Mode of Provision, 2013

Inpatient Day Outpatient Home-Based

€m

Cross-Classifying

www.cso.ie 19

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

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

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

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

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