System of Health Accounts (SHA 1.0)
National Statistical Institute
|Contact organisation unit|
"Health and Justice Statistics" Department
|Contact person function|
Head of department
|Contact mail address|
2, P. Volov Str.; 1038 Sofia, Bulgaria
|Contact email address|
|Contact phone number|
+359 2 9857 459
|Contact fax number|
|Metadata last certified||09 August 2019|
|Metadata last posted||09 August 2019|
|Metadata last update||09 August 2019|
System of Health Accounts is being developed as a statistical system with repetitive current calculations and production of statistical information in accordance with a harmonized methodology and standard classifications. System of Health Accounts is an internationally accepted statistical system for description, classification and analysis of health care expenditure and sources of funding. The application of this statistical system aims to assess all health care expenditure - both public and household, spending of non-profit organizations - foundations, associations, private health insurance funds of enterprises for activities in labour medicine.
The main objectives of the System of Health Account are:
SHA provides statistical information at national level on health expenditure by type of provider; by functions according to the aims of the medical activities (curative care, rehabilitation, clinical laboratory, sanitary transport, etc.) and according to the financial sources.
The definitions and classifications of the System of Health Accounts, Manual v.1.0. are followed for the period from 2010 to 2013, and for 2013 - 2017 data - the definitions and classifications of the System of Health Accaunts, ver. 2011. In addition, 2011 and 2012 data are elaborated according to the SHA, ver. 2011 requirements and following the requirements of "System of National Accounts, 2008" (SNA2008) and revisions done.
The System of Health Accounts is built using the International Classification for Health Accounts by applying three specific classifications:
Methodology and classifications have been developed by Eurostat, the Organisation for Economic Cooperation and Development and the World Health Organization.
Total for the country.
|Statistical concepts and definitions|
Health care boundaries
Determining the health care boundaries is supposed by the objectives of the SHA as a statistical system for representing the health expenditure of society as a whole and not just the healthcare system. The main criteria for defining the health care boundaries are as follow:
The development of the SHA methodologically starts with the definition of the goods and services whose final consumption forms the Healthcare sector. According to the SHA methodology the total health expenditures measure the final use of these goods and services plus capital investments in institutions providing health services - those where healthcare is a predominant activity. The difference with the system of national accounts is that the health accounts include institutional and analytical statistical units that have functions according to the SHA classification of functions, regardless of whether they are in the statistical practice units of the Health sector as economic activities. All primary and secondary healthcare providers has to be included, regardless of whether they are classified by national statistics as statistical units of the Health sector.
System of Health Accounts is being developed in three subsystems. Subsystems are designed so that the aggregated tables are obtained by a detailed allocation of expenditure by function, by providers and allocation of functions by providers in separate tables.
The total expenditure is the sum of current and capital expenditure.
Total health expenditure includes both expenditure made by the public and private sectors.
The expenditure of the public sector includes general government, including public social security funds:
According to the methododlogical requirements of the SHA, ver.1.0 the expenditure of the private sector include:
According to the methodological requirements of the SHA, ver. 2011 expenditures for Voluntary health care insurance and enterprises' and organisations' expenditures for labour medical activities are separated from private sector in a separate Voluntary Health Care Payment Schemes.
Classification of healthcare providers (ICHA-HP)
Classification of healthcare providers aims reclassification of national institutions in the health sector in internationally comparable and relevant categories of providers of health services. Classification of providers of health care services includes units in which the production of health services is a major activity and those in which the production of health care is a secondary activity. As providers of health services in SHA are also classified the households in the case of care for a sick family member and care of nursing type.
Classification of Health Care Functions (ICHA-HC) essentially contains two classification attributes:
1. Main purpose/type of medical care or activity:
2. Mode of provision
Through this classification the expenditures on personal and collective healthcare goods and services are analysed. Health care combines (includes) personal health services provided directly to the individual and collective health services which relate to the implementation of tasks of public health such as prevention, prophylactic, health administration and health insurance administration.
All institutional and analytical statistical units that have functions according to the SHA classification of functions, regardless of whether they are in the statistical practice units of the Health sector as economic activities are included.
Territory of the Republic of Bulgaria.
2010 - 2013 (data according to the SHA, ver.1.0);
|Unit of measure|
|Legal acts and other agreements|
Regulation (EC) No 1338/2008 of the European Parliament and of Council of 16 December 2008 on Community statistics on public health and health and safety at work.
In accordance with the basic principles and strategy for international cooperation in the field of health statistics, in December 2006 the Organization for Economic Cooperation and Development, the World Health Organisation and Eurostat launched a joint collection of information according the system of health accounts through a standardized questionnaire.
|Confidentiality - policy|
|Confidentiality - data treatment|
Individual data are not published in accordance with article 25 of the Law on Statistics. The publishing of individual data can be performed only in accordance with article 26 of the same law.
The date of the statistical information release is shown in the Release Calendar presenting the results of the statistical surveys carried out by the National Statistical Institute.
Statistical information by system of health accounts is published annually: 22 months after the expiration of the relevant reference period and after completion of the procedure on data validation by the international team of experts from Eurostat, OECD and WHO.
|Release calendar access|
The calendar is available on the NSI website: http://www.nsi.bg/en/node/480
Data on System for health accounts are published on the website of NSI, section Health in accordance with the Law on Statistics (Chapter 5) and the European Statistics Code of Practice, respecting professional independence and aiming objectivity and transparency, in which all users are treated fairly.
|Frequency of dissemination|
|Accessibility and clarity|
Detailed data on the system of health accounts are available to all users on the NSI website under the heading Health - System of Health Accounts: http://www.nsi.bg/en/node/5568
Online on Eurostat database: http://epp.eurostat.ec.europa.eu/portal/page/portal/health/public_health/data_public_health/database
Information service on request, according to the Rules for the dissemination of statistical products and services in NSI.
|Documentation on methodology|
The National Statistical Institute as an authoritie responsible for SHA data collection is working to ensure that the statistical practices used to compile national health accounts are in compliance with SHA methodological requirements and that good practices in the field are being followed, according to the methodology underlined in the SHA 2011 Manual.
The quality of the data is subject to the way, in which health care provision is organised in countrie, and which information is available to and collected by the respective institutions.
The National Statistical Institute is continuously working to maintain and improve the quality and the comparability of SHA data.
Health accounts are increasingly expected to provide inputs (along with other statistical information) into improved analytical tools to monitor and assess health system performance. One high priority is to develop reliable, timely data that is comparable both across countries and over time. This is indispensable for tracking trends in health spending and the factors driving it, which can in turn be used to compare it across countries and to project how it will grow in the future.
Health accounts are thus used in two main ways: internationally, where the emphasis is on a selection of internationally comparable expenditure data, and nationally, with more detailed analyses of health care spending and a greater emphasis on comparisons over time. Health accounts are crucial for both of these.
|Accuracy and reliability|
|Timeliness and punctuality|
The data are provided to Eurostat, WHO and OECD in accordance with the deadline set out in Commission Regulation 359/2015. Once the validation process has been successfully completed, the data is published - T + 22 months
Data are disseminated according to the Release Calendar presenting the results of the statistical surveys carried out by the National Statistical Institute.
|Coherence and comparability|
|Comparability - geographical|
|Comparability - over time|
2010 - 2013 - data according to the SHA, ver.1.0;
2011 - 2017 - data according to the SHA, ver. 2011.
|Coherence - cross domain|
|Coherence - internal|
The data are reconciled. Aggregate tables are obtained by a detailed allocation of expenses by function, by providers and about functions by providers in separate tables
|Cost and burden|
|Data revision - policy|
|Data revision - practice|
2011 and 2012 data are revised according to the System of Health Accaunts, ver. 2011 requirements. In addition, 2011 and 2012 data are elaborated following the requirements of "System of National Accounts, 2008" (SNA2008) and revisions done.
|Frequency of data collection|
Exhaustive for all units.
Data is validated by a team of experts from the three organizations - Eurostat, WHO and OECD.
Construction of the System of health accounts is done by usage of “bottom-up” approach, i.e. working with primary data by making a compilation, balance sheet according the three classifications.
Rules of arithmetic and logical sequence hitch between the three subsystems are applied.
Household expenditures estimation
Business statistical surveys (annual records on accountancy and statistical reports) conducted by NSI are the basic data source:
Statistical Yearbook 2008
The National Statistical Institute has the pleasure to submit to the attention of national and foreign users of statistical information the 76th edition of the Statistical Yearbook of the Republic of Bulgaria 2008. It provides topical statistical information on the demographic, economic and social development of the country for the 2002 - 2007 period in different territorial and classification aggregations and breakdowns.
Health Services 2008
The National Statistical Institute informs users of statistical information in the field of social statistics that the annual publication Health Services 2008 (in Bulgarian only) is already available.The publication Health Services is a joint edition of the National Statistical Institute and the National Centre of Health Information at the Ministry of Health.The data sources are the statistical surveys carried out by the both institutions.In the publication data are systematized as follows:
Statistical Reference Book of the Republic of Bulgaria 2008
The National Statistical Institute presents to users of statistical information one of its main publications - Statistical Reference Book of the Republic of Bulgaria 2008 in English. It is a concise form of the same issue in Bulgarian.The Statistical Reference Book presents topical information on the demographic processes as well as the economic, social and cultural development of the Republic of Bulgaria for the 2004 - 2007 period.