Health Expenditure and Financing

Quality description

The quality description of the Statistics of Health Expenditure and Financing assesses the reliability and suitability of the statistics for different purposes in accordance with the quality description recommendation of the Official Statistics of Finland (OSF).

Relevance of statistical data

In 2016, Finnish Institute for Health and Welfare (THL) began reporting its statistics for health expenditure and financing based on the concepts and classifications of the SHA 2011 (System of Health Accounts) model used by OECD, Eurostat and WHO . Reporting on health expenditure, financing and service providers has been binding to EU member countries since 1 January 2016 . The SHA 2011 system meets national and international reporting needs in that a set of reporting tables have been produced on the basis of the data content of the SHA while also taking into account national special features. More accurate data are reported nationally on, for example, expenditure on elderly care and medicines. 

The purpose of the statistics is to support decision-making and guidance in social and health policy especially at the national level. The statistics are targeted at decision-makers, planning officials, researchers and students in the field of social and health care and all others who need basic information on trends in health expenditure and financing and related statistics nationally and internationally.

Description of methods used in statistical research

The statistics are based on SHA 2011, which is a statistical framework concerning health care functions, service providers, funders, sources of financing, resources and investments. The system allows national health systems to be examined from a perspective consistent with the national accounts. The system for examining health expenditure is based on the International Classification for Health Accounts (ICHA). National health expenditure statistics are based on the reporting of data related to health expenditure and financing.

The data for the statistics are gathered annually by making use of various statistics and registers, research reports and financial statements. Due to the limitations and shortcomings of statistical datasets, the statistics are partly based on estimates. For example, municipal and joint municipal authority statistics on outpatient and inpatient primary health care expenditure have been further specified using, among others, data from the National Institute for Health and Welfare’s Care Register for Health Care (including AvoHilmo).

The focus of SHA 2011 is current health care expenditure, which means that investment costs have been deducted from total health expenditure. In health expenditure statistics using the SHA concepts, the calculations of outputs and consumption expenditure are based on the definitions used in national accounts.  Market products, which are services produced by the private sector, are valued according to what has been paid for the services (basic price). Non-market products, which are social and health services produced by municipalities and joint municipal authorities, are valued according to production costs. As a result, client fees have been subtracted from the output of municipalities and joint municipal authorities. Thus, public sector client fees are not included in current health care expenditure.

Although health care client fees paid by households are subtracted from the output of the local government sector, they are nevertheless included in the calculations of the financial shares of different sectors. In these cases, client fees paid by households have been subtracted from municipalities' financial share when expenditure is considered from a financial perspective.

The following indexes are used in fixing expenditure at the prices in the most recent statistical year:

  • Travel: Consumer price index for public transport (Liikenteen kuluttajahintaindeksi, Statistics Finland) 
  • Prescription medication: wholesale price index for prescription medicines (Reseptilääkkeiden tukkuhintaindeksi, Statistics Finland)
  • Over-the-counter medication: wholesale price index for over-the-counter medicines (Käsikauppalääkkeiden tukkuhintaindeksi, Statistics Finland)
  • Other medical non-durables: consumer price index for pharmaceutical products (Farmaseuttisten tuotteiden kuluttajahintaindeksi, Statistics Finland)
  • Other: Price index of public expenditure, municipal health services (Statistics Finland)

Correctness and accuracy of data

The data are correct in so far as they have been reported correctly and accurately. The data are checked at different stages of the production process of the statistics. At the recording and reporting stage, the data are compared with data from previous years using various checking procedures. In unclear cases, those who have produced the data are contacted in order to avoid errors and find causes for changes.

Timeliness and promptness of published data

The statistics on health expenditure and financing are produced by THL once a year after the data needed for the accounting process are available. The final statistical data are published annually 14 months after the end of each statistical year. Drawing on these data, the Ministry of Social Affairs and Health produces annual preliminary data and predictions on health expenditure and financing. International reporting follows the timetables of the international statistical organisations (OECD, Eurostat, WHO, NOMESCO).

Accessibility and transparency/clarity of data

Key data on health expenditure and financing are compiled into a statistical report published on the THL website. In addition, key data are reported nationally in two other THL publications: the Statistical Yearbook on Social Welfare and Health Care, and Facts about Social Welfare and Health Care in Finland. Internationally, the SHA-based data are reported in the OECD Health Data database and in the databases and publications of Eurostat, WHO and NOMESCO.

Comparability of statistical data

National statistical data based on the SHA 2011 system is not fully comparable with data produced before the statistical year 2000. The most significant content difference in comparison to earlier statistics is broader inclusion of expenditure on long-term care for the elderly and persons with disabilities in the statistics since 2000. In terms of methodology, the greatest difference in comparison to earlier statistics is the use of current health care expenditure (investment costs are subtracted from total expenditure on health) instead of total expenditure. International statistics organisations (Eurostat, OECD and WHO) also began using current health care expenditure to, for example, examine the relationship between health expenditure and GDP. Data that is comparable with the SHA 2011 system has been retroactively produced back to 2000.

A reorganisation of Statistics Finland’s statistics on Local government finances and the related data content changes made in activity categories starting in the statistical year 2015 affect the comparability of the data on social and health services provided by municipalities and joint municipal authorities and on administration to data from previous years. For example, the new data collection method allocates social and health care administration costs directly to the social and health care activity categories. Furthermore, home nursing expenditures have not been included in the outpatient primary health care activity category of Local government finances data collection since the statistical year 2015. On the other hand, new and more detailed activity categories in Local government finances data collection provide further information concerning the cost breakdowns. For example, cost data about 24-hour institutional care and housing services for the elderly and persons with disabilities has been collected in separate activity categories since the statistical year 2015. 

Clarity and consistency

Data on health expenditure and financing are gathered for the whole country. The statistics and reporting that draw on the data thus cover health expenditure and financing at the national level. In addition, the statistical report that is prepared on the basis of the statistics on health expenditure and financing contains a SHA-based comparison of health expenditure and financing in different OECD countries.

Special issues concerning the 2019 statistics

While compiling the 2019 statistical report, retroactive corrections were also made to 2018 data as a result of the corrections in the data for the national economy income and formation accounts for the local government health services sector. In addition, the 2018 expenditure for occupational health care was corrected to fit the final data.

Due to changes made in 2019 to the data collection processes for the Care Register for Health Care, the day surgery expenditures for somatic special health care are not fully comparable with data from previous years. This is due to changes made to Hilmo data collection processes. This change applies to the implementation of the Hilmo Contact Method and Urgency classification, which replaces the Hilmo Service Sector classification previously in use.  The data of the Care Register for Health Care is utilised in municipal statistics when subdividing the expenses of the special health care activity category into more detailed special health care activities. Due to this change, more procedures and thus more expenses were allocated to day surgery, as it became more difficult to distinguish between outpatient visits and day surgery procedures. The information is more comparable at the level of total expenditure on both special health care day surgery and outpatient care.

In all other respects, the 2019 statistical report is in line with those of previous years.