System of Health Accounts (SHA 1.0)


Time series: Zdr_1.1_EN.xls
System of health accounts
Contact
Contact organisation

National Statistical Institute

Contact organisation unit

"Health and Justice Statistics" Department

Contact name

Evelin Yordanova

Contact person function

Head of department

Contact mail address

2, P. Volov Str.; 1038 Sofia, Bulgaria

Contact email address

[email protected]

Contact phone number

+359 2 9857 459

Contact fax number
Metadata update
Metadata last certified23 October 2018
Metadata last posted23 October 2018
Metadata last update23 October 2018
Statistical presentation
Data description

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:

  • to provide internationally comparable information in a system of standard matrices;
  • to define harmonized health sector boundaries and to apply harmonized definitions;
  • to distinguish the main functions of the health sector from the functions related to healthcare;
  • to analyze the healthcare system from an economic point of view in accordance with the methodological principles of the macroeconomic (national) accounts and in accordance with the International Classification of Health Accounts.

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 - 2016 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.

Classification system

The System of Health Accounts is built using the International Classification for Health Accounts by applying three specific classifications:

  • Classification of Health Care Functions (ICHA-HC);
  • Classification of Health Care Providers (ICHA-HP);
  • Classification of Health Care Financing Sources (ICHA-HF) (SHA, ver.1.0);
  • Classification of Health Care Financing Schemes (ICHA-HF) (SHA, ver. 2011).

Methodology and classifications have been developed by Eurostat, the Organisation for Economic Cooperation and Development and the World Health Organization.

Sector coverage

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:

  • defining the final use of health care goods and services according to the SHA classification of the functions;
  • determining the boundaries between health and social care and
  • classification of the healthcare expenditure by functions and providers.

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:

  • Expenses of the state budget;
  • Central government - ministries and institutions;
  • Local government - municipalities;
  • Social insurance funds - National Health Insurance Fund (NHIF) and the National Social Security Institute (NSSI).

According to the methododlogical requirements of the SHA, ver.1.0 the expenditure of the private sector include:

  • Individual consumption expenditures of households on regulated payments for medical, dental and dental technical services, supplies, and other therapeutic goods. Also included are the payments in the system of retail trade in pharmacies, optical and sanitary shops.
  • Claims paid by the voluntary health insurance companies;
  • Expenditures of non-profit institutions serving households - as these expenses can not be allocated in detail by functions and  by providers, they are allocated to non-classified activities.
  • Expenditure of enterprises and organizations for activities related to labour health care for employees.

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:

  • Curative care;
  • Rehabilitation;
  • Ancillary  services;
  • Medical goods for patients in outpatient care;
  • Prevention and public health;
  • Administrative costs for health administration and administration of health insurance.

2. Mode of provision

  • Inpatient care;
  • Outpatient care;
  • Day care;
  • Home based care.

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.

Statistical unit
Statistical population

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.

Reference area

Territory of the Republic of Bulgaria.

Time coverage

2010 - 2013 (data according to the SHA, ver.1.0);
2011 - 2016 (data according to the SHA, ver. 2011).

Base period

Not applicable.

Unit of measure

Million BGN.

Reference period

Year

Institutional mandate
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.
Commission Regulation (EU) 2015/359 implementing Regulation (EC) N 1338/2008 of the European Parliament and Council as regards statistics on healthcare expenditures and financing.

Data sharing

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.
Since 2014 data are provided to all three institutions in line with the Regulation (EU) 2015/359.

Confidentiality
Confidentiality - policy
  • Law on Statistics;
  • Regulation (EC) No 223/2009 on European statistics (recital 24 and Article 20(4)) of 11 March 2009 (OJ L 87, p. 164), stipulates the need to establish common principles and guidelines ensuring the confidentiality of data used for the production of European statistics and the access to those confidential data with due account for technical developments and the requirements of users in a democratic society.
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.

Release policy
Release calendar

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

User access

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

Annually

Accessibility and clarity
News release

Not available.

Publications

Not applicable.

On-line database

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

Micro-data access

Not available.

Other

Information service on request, according to the Rules for the dissemination of statistical products and services in NSI.

Documentation on methodology
  • System of Health Accounts - Organization for Economic Cooperation and Development, 2000 - ver. 1.0;
  • Eurostat methodological guidelines for the Joint OECD, EUROSTAT and WHO Health Accounts (SHA 2011) Data collection;
  • System of Health Accounts, OECD Publishing (SHA 2011) - OECD, Eurostat, WHO - ver. 2011.
Quality documentation

Not available.

Quality management
Quality assurance

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.

Quality assessment

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.

Relevance
User needs

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.

User satisfaction

Not applicable.

Completeness

Not applicable.

Accuracy and reliability
Overall accuracy

Not applicable.

Sampling error

Not applicable.

Non-sampling error

Not applicable.

Timeliness and punctuality
Timeliness

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

Punctuality

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

Not applicable.

Comparability - over time

2010 - 2013 - data according to the SHA, ver.1.0;

2011 - 2016 - data according to the SHA, ver. 2011. 

Coherence - cross domain

Not applicable.

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

Not applicable.

Data revision
Data revision - policy

Not applicable.

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.

Statistical processing
Source data
  • Ministry of Finance – Report on the State Budget Execution of the Republic of Bulgaria, Statement of the Cash Execution of the Budget and detailed information on the Function “Health” expenditures by paragraphs and sub-paragraphs of the Budgetary Classification;
  • National Health Insurance Fund - Report on NHIF budget execution; in addition detailed administrative information on the expenses of the NHIF according to the SHA methodology is provided;
  • Ministry of Health - Report on MH budget execution; in addition detailed administrative information on the expenses of the MH according to the SHA methodology is provided;
  • National Social Security Institute – „State Social Security“
  • Generally the National Accounts estimation on household’s individual consumption of health services is taken into account and a cross-validation between results obtained from NSI annual business statistical surveys and national accounts estimate is done. Disaggregation and reclassification of expenditure by providers and functions is done by combined using of data from statistical surveys in the field of business and health statistics;
  • National accounts - final consumption expenditure of non-profit institutions serving households for Health;
  • Business statistical surveys:
  1. Accountancy and statistical reports of Private health inshurance funds, by 'medical packages';
  2. “Annual report of non-trade enterprises” - accountancy and statistical reports of Health establishments applying double-entry accounting as well as those applying single-entry accounting (that do not prepare balance);
  3. Survey on domestic trade - Retale sales by group of goods.
Frequency of data collection

Annually

Data collection

Exhaustive for all units.

Data validation

Data is validated by a team of experts from the three organizations - Eurostat, WHO and OECD.

Data compilation

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:

  1. All enterprises in the country that submit “Annual report of non-trade enterprises” and are classified in 86, 87 and 32.50 according to the Classification of Economic Activities (NACE.BG-2008) are exhaustively covered.
  2. Units are reclassified in specially developed tables in accordance with the Classification of healthcare providers (ICHA-HP). For assessment of the coverage of the units as well as the correct classification of providers according to the methodological requirements of the SHA, information from the NSI exhaustive survey "Inpatient and outpatient health establishments and other health establishments" is used. For establishments outside the business statistical surveys coverage, information is based on expert estimation.
  3. Data are proceeded case by case in order to classify the revenue from population data in accordance to the Classification of Health Care Functions (ICHA-HC).
  4. Generally the National Accounts estimation on household’s individual consumption of health services is taken into account and a cross-validation between results obtained from NSI annual business statistical surveys and national accounts estimate is done.
  5. Concerning HC5 Medical goods estimation - Estimations are done based on retail sales by group of goods for the group "Pharmaceuticals, medical and orthopedic goods" according to the Classification COICOP and NACE code of the enterprises. NACE codes that are covered: 21, 26, 46, 47.1, 47.2, 47.73, 47.74, 47.78. The estimation is based on the methodological requirements of the SHA 2011 Manual.
  6. Household expenditures information broken down by providers and by function should be balanced.
Adjustment

Not applicable.

Comment
Download in SDMX 2.1 file format: System of health accounts
Metadata Structure Definition in SDMX 2.1: ESMS_MSD+BNSI+2.0+SDMX.2.1.xml
Download in SDMX 2.0 file format: System of health accounts
Metadata Structure Definition in SDMX 2.0: ESMS_MSD+BNSI+2.0+SDMX.2.0.xml
  • Friday, 10 May 2019 - 11:00

    The number of detached crèches and groups in kindergartens functioning in the country as of 31.12.2018 was 840 with 33 226 places in them.

    The number of children accommodated in crèches at the end of the year was 31 939. 16 449 of them were boys, and 15 490 - girls.

    The total number of places in crèches per 100 children aged up to 3 years as of 31.12.2018 was 17.3 and the coverage of children brought up in crèches - 16.6 per 100 children aged up to 3 years.

  • Friday, 15 June 2018 - 11:00

    The number of health establishments for hospital aid as of 31.12.2017 was 346 with 52 744 beds. 322 of them were hospitals with 50 519 beds.

    The number of out-patient health establishments was 2 043 with 1 263 beds and other health establishments were 144 with 2 179 beds in them.

    At the end of 2017 30 078 physicians were in practice under the basic labour contracts in health establishments. Dentists were 8 355, as 7 456 worked in practices that had signed contract with National Health Insurance Fund. Medical specialists on ‘Health cares’ who worked on a basic labour contract in health establishments were 46 702. 30 955 of them were nurses and 3 207 - midwives.

  • Friday, 27 April 2018 - 11:00

    The number of detached crèches and groups in kindergartens functioning in the country as of 31.12.2017 was 837 with 32 970 places in them.

    The number of children accommodated in crèches at the end of the year was 32 429. 16 738 of them were boys, and 15 691 - girls.

    The total number of places in crèches per 100 children aged up to 3 years as of 31.12.2017 was 16.9 and the coverage of children brought up in crèches - 16.6 per 100 children aged up to 3 years.

  • Friday, 16 June 2017 - 11:00

    The number of health establishments for hospital aid as of 31.12.2016 was 345 with 51 816 beds. 321 of them were hospitals with 49 589 beds.

    The number of out-patient health establishments was 2 029 with 1 163 beds and other health establishments were 140 with 2 193 beds in them.

    At the end of 2016 29 539 physicians were in practice under the basic labour contracts in health establishments. Dentists were 8 011, as 7 174 worked in practices that had signed contract with National Health Insurance Fund. Medical specialists on 'Health cares' who worked on a basic labour contract in health establishments were 46 930. 30 976 of them were nurses and 3 254 - midwives.

  • Friday, 12 May 2017 - 11:00

    The number of detached crèches and groups in kindergartens functioning in the country as of 31.12.2016 was 829 with 32 611 places in them. The number of places in the country has increased with 571, or with 1.8% compared to the previous year.

    The number of children accommodated in crèches at the end of the year was 32 476. 16 851 of them were boys, and 15 625 - girls.

    The total number of places in crèches per 100 children aged up to 3 years as of 31.12.2016 was 16.5 and the coverage of children brought up in crèches - 16.4 per 100 children aged up to 3 years.

  • Monday, 5 December 2016 - 11:00

    The survey is a part of the European Health Survey System in the framework of the European Statistical System. The EHIS aims at measuring on a harmonized basis and with a high degree of comparability among EU Member States, the health status, life style (health determinants) and health care services use of the EU citizens.

    NSI presents final results based on the conducted in 2014 EHIS.

  • Friday, 17 June 2016 - 11:00

    According to the preliminary data of the NSI the number of health establishments for hospital aid as of 31.12.2015 was 348 with 51 933 beds. 322 of them were hospitals with 49 028 beds.

    The number of out-patient health establishments was 1 915 with 1 044 beds and other health establishments were 136 with 2 394 beds in them.

    At the end of 2015 29 093 physicians were in practice under the basic labour contracts in health establishments. Dentists were 7 513 and medical specialists on 'Health cares' - 47 349.

  • Thursday, 12 May 2016 - 11:00

    The number of detached crèches and groups in kindergartens functioning in the country as of 31.12.2015 was 812 with 32 040 places in them. The number of places in the country has increased with 1 516, or with 5.0% compared to the previous year.

    The number of children accommodated in crèches at the end of the year was 32 124. 16 497 of them were boys, and - 15 627 girls.

  • Friday, 19 June 2015 - 11:00

    The number of health establishments for hospital aid as of 31.12.2014 was 349 with 51 505 beds. 323 of them were hospitals with 48 680 beds.

    The number of out-patient health establishments was 1 931 with 956 beds and other health establishments were 145 - 3 160 beds in them.

    At the end of 2014 28 842 physicians were in practice under the basic labour contracts in health establishments.

    For the first time the National Statistical Institute is publishing data on distribution of practicing physicians by sex and age.

    As of 31.12.2014 it was as follow: 
    12 827 (44.5%) were males and 16 015 (55.5%) - females.
    The largest was the share of physicians in the age group 45 - 54 years - 10 301 persons or 35.7%.
    The young physicians aged up to 35 years were 2 356 persons or 8.2%, while the elderly (aged 65 and over) - 3 557 or 12.3%. 
     
  • Tuesday, 12 May 2015 - 11:00

    The number of detached crèches and groups in kindergartens functioning in the country as of 31.12.2014 was 794 with 30 524 places in them. The number of places in the country has increased with 404, or with 1.3% compared to the previous year.

    The number of children accommodated in crèches at the end of the year was 31 489. 16 167 of them were boys, and - 15 322 girls.

    The coverage of children brought up in crèches at the end of 2014 was 15.8%.

Pages

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    The National Statistical Institute informs users of statistical information in the field of social statistics that the annual publication Health Services 2018 (in Bulgarian only) is already available.

    The publication Health Services is a joint edition of the National Statistical Institute and the National Centre for Public Health and Analyses at the Ministry of Health.

    The data sources are the statistical surveys carried out by the both institutions.

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  • Health Services 2017
    The National Statistical Institute informs users of statistical information in the field of social statistics that the annual publication Health Services 2017 (in Bulgarian only) is already available.

    The publication Health Services is a joint edition of the National Statistical Institute and the National Centre for Public Health and Analyses 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:

  • Bulgaria 2017
    The National Statistical Institute presents the bilingual (Bulgarian/English) brochure Bulgaria 2017 to users of statistical information. The brochure is addressed to a wide range of users (international institutions, business, students, experts etc.) and changes the traditional presentation of statistical information by offering an innovative structure with a parallel translation in English. The publication contains topical statistical information about the demographic, social and economic development of the country over the 2012 - 2016 period.
  • Statistical Yearbook 2016
    The National Statistical Institute (NSI) has the pleasure to present to the attention of national and foreign users of statistical information the 84th edition of the ‘Statistical Yearbook of the Republic of Bulgaria’ in printed and electronic format.

    It provides current statistical information about the demographic, economic and social development of the country for 2011 - 2015 in different territorial and classification aggregations and breakdowns.

  • Health Services 2016
    The National Statistical Institute informs users of statistical information in the field of social statistics that the annual publication Health Services 2016 (in Bulgarian only) is already available.
    The publication Health Services is a joint edition of the National Statistical Institute and the National Centre for Public Health and Analyses at the Ministry of Health.

    The data sources are the statistical surveys carried out by the both institutions.

  • Bulgaria 2016
    The National Statistical Institute presents the bilingual (Bulgarian/English) brochure Bulgaria 2016 to users of statistical information. The brochure is addressed to a wide range of users (international institutions, businessmen, students, experts etc.) and changes the traditional presentation of statistical information by offering an innovative structure with a parallel translation in English. The publication contains topical statistical information about the demographic, social and economic development of the country over the 2011 - 2015 period.
  • Statistical Yearbook 2015
    The National Statistical Institute (NSI) has the pleasure to present to the attention of national and foreign users of statistical information the 83rd edition of the ‘Statistical Yearbook of the Republic of Bulgaria’ in printed and electronic format.

    It provides current statistical information about the demographic, economic and social development of the country for 2010 - 2014 in different territorial and classification aggregations and breakdowns.

Pages