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For Official Use English text only For Official Use Organisation de Coopération et de Développement Économiques Organisation for Economic Co-operation and Development English text only DIRECTORATE FOR EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS HEALTH COMMITTEE Cancels & replaces the same document of 19 October 2010 Health Accounts Experts EVALUATION OF THE 2010 JOINT OECD, EUROSTAT AND WHO HEALTH ACCOUNTS (SHA) DATA COLLECTION 12TH MEETING OF HEALTH ACCOUNTS EXPERTS AND CORRESPONDENTS FOR HEALTH EXPENDITURE DATA OECD Conference Centre, 2 rue André Pascal, 16th arrondissement, Paris, France To be held on 3-4 November, starting at 9:30 on the first day and ending at 18:00 on 4 November Contacts: Roberto Astolfi, Email: roberto.astolfi@oecd.org; Tel.: +33 (0) 1 45 24 15 96; David Morgan, Email: david.morgan@oecd.org; Tel: +33 (0) 1 45 24 76 09 Document complet disponible sur OLIS dans son format d'origine Complete document available on OLIS in its original format

NOTE BY THE SECRETARIAT 1. In response to the growing demands for internationally comparable information on health spending, the OECD, in co-operation with the Eurostat Task Force CARE members and experts in the field of health accounting, developed the manual A System of Health Accounts (SHA), releasing the initial 1.0 version in 2000. By 2005, nearly all EU member states and OECD countries had at least started a pilot implementation of the SHA framework. Furthermore, OECD, Eurostat and WHO had been increasingly co-operating in health accounting activities. These antecedents provided a solid basis to launch the first joint Health Accounts data collection in December 2005. The International Health Accounts Team (IHAT), consisting of experts working in the area of health accounting at the three organisations, was established in order to manage this joint data collection. 2. This report provides an initial evaluation of the 2010 Joint Health Accounts data collection. The contents of this report have been agreed by the International Health Accounts Team. 3. Besides this report, an additional agenda paper of the 12th Meeting of Health Accounts Experts [DELSA/HEA/HA(2010)8] presents proposals for the 2011 Joint OECD, Eurostat and WHO Health Accounts Questionnaire. 4. The Secretariat invites participating experts to: COMMENT on the preliminary evaluation presented in this paper; INFORM participants about their results from, together with any difficulties encountered during the work related to the 2010 joint data collection. 2

TABLE OF CONTENTS NOTE BY THE SECRETARIAT... 2 EVALUATION OF THE 2010 JOINT OECD, EUROSTAT AND WHO HEALTH ACCOUNTS (SHA) DATA COLLECTION... 4 Background to the joint collection... 4 The validation process for the 2010 collection... 5 Availability and comparability of data... 6 Dissemination of the results from the 2010 collection... 10 Main conclusions from the 2010 collection... 10 ANNEX 1. AVAILABILITY OF DATA FROM THE 2010 JOINT OECD, EUROSTAT AND WHO HEALTH ACCOUNTS DATA COLLECTION... 12 ANNEX 2. EXAMPLE OF AN INITIAL VALIDATION SHEET AS PART OF THE 2010 VALIDATION PROCEDURE... 17 Tables Table 1. System of Health Accounts (SHA) Joint OECD, Eurostat, and WHO Data Collection... 9 Table 2. Completeness and coverage of responses: 2010 vs. 2009 JHAQ... 10 Table A1.1 2010JHAQ: Variables of ICHA-HF reported by country... 13 Table A1.2 2010JHAQ: Variables of ICHA-HP reported by country... 14 Table A1.3 2010JHAQ: Variables of ICHA-HC reported by country... 15 Table A1.4 2010JHAQ: Variables of ICHA-FS reported by country... 16 Figures Figure 1. Number of countries submitting the SHA questionnaire from 2005 to 2010... 7 3

EVALUATION OF THE 2010 JOINT OECD, EUROSTAT AND WHO HEALTH ACCOUNTS (SHA) DATA COLLECTION Background to the joint collection 5. Since the publication of the OECD manual A System of Health Accounts in 2000, the basic methodological framework has become widely accepted and has been adopted in a large and growing number of OECD and non-oecd countries as the standard accounting framework for statistics on health expenditure and financing. 6. The SHA Manual also served as a basis for the Guide to producing national health accounts with special applications for lower and middle-income countries ( Producer Guide ) published by the WHO, World Bank and USAID in 2003. Many WHO Member States have implemented national health accounts according to the Producer Guide, and many others are initiating the process. 7. OECD, Eurostat and WHO have a responsibility, based on their respective mandates to regularly collect and publish health expenditure data of their member countries and further develop the underlying methodologies. With the purposes of reducing the burden of data collection for the national authorities, increasing the use of international standards and thereby harmonising national health accounting practices, the three organisations established a framework for a joint health accounts data collection to cover OECD and EU member and candidate and accession countries in 2005. 8. The International Health Accounts Team (IHAT) consisting of experts responsible for health accounts work at OECD, EUROSTAT and WHO, was established and drew up the Practical working arrangements for cooperation between OECD, EUROSTAT and WHO and the tables and methodological documentation for the first Joint SHA Questionnaire. These documents were finalised following discussions at the OECD Health Accounts Experts Meeting (29-30 September 2005), and the Eurostat Technical Meeting Care (21-22 September 2005). 9. Due to the importance attached to this joint exercise, letters were sent in November 2005 to the heads of the relevant national organisations about the main purposes of co-operation between the three international organisations in health accounting. This included a joint WHO-OECD letter to Ministers of Health, and a joint EUROSTAT-OECD letter to the Heads of the national statistical offices. Furthermore, the relevant national organisations were asked to nominate a single person as a focal point for the Joint Health Accounts data collection. 10. The first joint questionnaire was sent to the countries concerned in December 2005, to which a total of 22 countries responded (18 OECD 1 member countries and 4 non-oecd EU member states). The 1 Three countries recently joined the OECD: Chile became a member of the Organisation on 7 May 2010, Slovenia became a member on 21 July 2010 and Israel became a member on 7 September 2010. On 10 May 2010, the OECD invited Estonia to become member of the OECD. The country membership will become official once necessary formalities, including parliamentary approval, have been completed. At the time of preparation of this report Estonia is still included in the non-oecd-eu countries. Slovenia, which had been previously included in the non-oecd-eu countries, is now integrated in the OECD group. Data 4

success of the first collection and feedback from data providers led to an enhanced 2007 questionnaire being sent out in December 2006 and was duly completed by 26 countries (20 OECD and 6 non-oecd EU member states). The two successive editions saw the participation of 30 countries (24 OECD member countries and 6 non OECD-EU). The 2010 questionnaire has continued to build on this success with submitted questionnaires being received from 31 countries by the middle of October 2010, comprising 25 OECD countries and 6 non-oecd EU Member States. Adding one other country that had reported the Joint Questionnaire in the past and is expected to also return the 2010 questionnaire by the end of the year makes a total of 32 countries which have submitted the questionnaire at least once. The validation process for the 2010 collection 11. For the first time the ultimate aim to finalise the data validation process within two months after the data submission has been achieved. On average the validation lasted 59 calendar days this year. The significant improvements recorded this year are mainly due to the commitment of resources from both the international organisations and the national reporting authorities. Additional contribution came from the accumulated experience from the previous joint data collections and from the constant technical improvements and refinement introduced in the programmes embedded in the questionnaire to assist both the data compilers and the international organisations in their validation efforts. 12. To reduce initial data errors in the submitted files, consistency checks have been systematically enabled in the data files. By ensuring, or at least improving, both the internal consistency of the tables, the automatic research of negative values, and, most importantly, the consistency between the dimensions, and making these checks clear to the user, an important step in the validation process was improved. The reduction of data errors and/or the clear labelling up of any remaining consistency issues has allowed more emphasis on the analysis of the data. 13. For the first data collection in 2006, IHAT had agreed to co-operate on the validation process and drew up a procedure to check, verify and finally validate the data. The main tool developed consisted of an automatic initial validation sheet that checked the completeness and consistency of the data submission and calculated the shares of the total expenditure on health for the main components of each dimension. In addition, ad hoc checks on the nominal growth rates and comparison with existing data, i.e. in OECD Health Data, were made to ensure time-series coherence. 14. The validation process for the 2010 collection built on an already enhanced and automated validation sheet introduced during the 2007 validation exercise. Annex 2 contains an example of this expanded initial validation sheet for the 2010 collection. Automatic loading and checking of the latest country submission provides details of the completed tables and, at each classification level, the share of current health expenditure with the ranking, automatic detection of structural break through a comparison with validated data from previous years data. Additionally, a more systematic approach during this year s collection has provided a deeper analysis of the nominal change and contribution to growth compared to the preceding period, and if relevant, previous JHAQ and OECD Health Data submissions. It should be stressed that the full analysis of the data must be done in conjunction with the methodological information provided. referring to previous JHAQ data collection have been revised and now include Slovenia within the OECD member countries also in the period prior to 2010. Please note that the statistical data for Israel are supplied by and under the responsibility of the relevant Israeli authorities. The use of such data by the OECD is without prejudice to the status of the Golan Heights, East Jerusalem and Israeli settlements in the West Bank under the terms of international law. 5

15. Based on this validation exercise, an initial set of questions or issues needing clarification is drawn up and, once agreed by IHAT, is sent to the focal point. An iterative process of revision and revalidation between the reporting country and IHAT will then finish in acceptance of the data and a final confirmation message being sent. Availability and comparability of data The 2010 JOINT Health Accounts Questionnaire 16. The Joint Questionnaire consists of a data and a methodological information questionnaire; as well as Explanatory Notes providing a description on the structure of the classifications and tables and additional definitions used in the Joint Questionnaire. 17. The 2010 data questionnaire consisted of five two-dimensional tables for each year of the time period 2003 to 2008. Three of these tables were extended versions from the basic tables 2-5 of the SHA manual, but using the detailed version of the ICHA classifications and supplemented with a number of Memorandum items not included in the original manual: Functions of Health Care by Health Care Financing agents/schemes (HCxHF) Functions of Health Care by Health Care Provider (HCxHP) Health Care Provider by Health Care Financing agents/schemes (HPxHF) 18. In addition, the questionnaire included two tables not included in the SHA Manual, but taking as their basis the additional dimensions for Financing Sources (FS) and Resource Costs (RC) outlined in the Producer Guide: Health Care Financing agents/schemes by Financing Source (HFxFS) Human Resources x Health Care Provider (RCxHP) 19. In the HPxHF and HCxHP tables a distinction on expenditure by sector (government private) was included in order to provide information on the role of the private sector in health care provision. 20. At the 2006 Expert Meeting, in an effort to improve the timeliness of OECD Health Data, it was agreed to add a new table to the JHAQ 2007 collecting preliminary estimates for the major aggregates of public, private, and total health expenditures for 2006. This procedure was followed for the JHAQ 2010 with a request to provide preliminary estimates for 2009. Availability of data Reported Questionnaires 21. By mid October 2010, 25 OECD countries and 6 non-oecd EU Member States had returned the Joint Questionnaire. Of these, 21 countries were able to supply the questionnaire within the first month after the deadline. This compares with 20 countries returning the questionnaire within the first month for the 2009 collection. One additional country who had submitted the Joint Questionnaire in previous years is expected to submit data by the end of the year. 6

22. With regard to non-oecd European Union Member States, six countries (Bulgaria, Cyprus 23, Estonia, Latvia, Lithuania, and Romania) reported data for the SHA questionnaire. 23. A comparison with previous SHA data collections (Figure 1) shows that the number of countries returning the questionnaire kept increasing also in 2010. The number of countries submitting data in 2010 is expected to register a net increase of two countries over the previous year s collection. Four countries, which hadn t submitted JHAQ last year, returned the 2010 JHAQ: two countries for the first time (Italy and Israel) plus other two (Luxembourg and Turkey) which had temporarily interrupted the compilation of SHA. Two OECD countries, which had regularly reported the joint questionnaire over the last years, were not in the position to submit the 2010 JHAQ as major revision to their National Accounts were undertaken this year (Norway and Portugal). This means that the 2011 data collection could potentially see the participation of 34 countries. Figure 1 Number of countries submitting the SHA questionnaire from 2005 to 2010 Availability of SHA tables 24. The 2010 JHAQ requested SHA tables over the period 2003 to 2008. However, countries have different practices regarding the revision and therefore resubmission of previous years tables is a common practice. The tally of SHA tables for each year therefore reflects new submissions and revisions from this year s collection together with unrevised tables from previous collections. Revised tables submitted for 2003 totalled 15. Together with previous submissions, SHA tables for 2003 are now available for 27 countries (24 OECD countries). Similarly, combining new and revised submissions received this year with previously reported tables, means that 2004, 2005 and 2006 SHA tables are available for up to 34 countries 2 3 Footnote by Turkey: The information in this document with reference to Cyprus relates to the southern part of the Island. There is no single authority representing both Turkish and Greek Cypriot people on the Island. Turkey recognizes the Turkish Republic of Northern Cyprus (TRNC). Until a lasting and equitable solution is found within the context of United Nations, Turkey shall preserve its position concerning the Cyprus issue. Footnote by all the European Union Member States of the OECD and the European Commission: The Republic of Cyprus is recognized by all members of the United Nations with the exception of Turkey. The information in this document relates to the area under the effective control of the Government of the Republic of Cyprus. 7

(28 OECD countries). SHA tables for the year 2008 were requested for the first time this year and have been returned by 23 countries (of which 20 are OECD countries). The number of countries for which a complete set of SHA tables from 2003 to 2008 is now available is 23 (of which 19 are OECD countries) (Table 1). 25. Less than half the countries are able to submit either of the two additional tables included in the Joint Questionnaire. With respect to the HFxFS table, there has been a gradual increase in submissions with up to 14 countries now regularly reporting this table. Two additional countries had estimated it on a one-off trial basis for the year 2006. 26. The request for preliminary estimates for year t-1 which was introduced into the 2007 questionnaire for the first time has recorded a considerable increase this year. Via the Joint Questionnaire, eight countries (Canada, Iceland, Italy, Korea, Luxembourg, Slovenia and Switzerland) provided preliminary estimates for 2009. This would normally be supplemented by Norway which reports data for t- 1 through the OECD Health Data questionnaire. In the 2009 exercise, six countries had reported the preliminary estimates. 27. 28 out of 34 countries have provided the Methodological Information as part of their submission. It should be emphasised that the Methodological Information is an integral part of the SHA data collection. In particular, because most countries have some deviations from the ICHA standard definitions, it is of vital importance to make these methodological deviations transparent. Completeness of responses Availability of data by the three basic dimensions of International Classification for Health Accounts 28. The availability of health expenditure data by the three basic dimensions varies widely depending on the country and on the reference year. Table 2 shows the availability of health expenditure data by function, provider and financing agent for the most recent year submitted in the 2010 JHAQ data collection. Detailed information at the variable level is provided in Tables A1.1 to A1.4 in Annex 1. Regarding the ICHA-HF financing agent/scheme breakdown, 30 countries are able to report current expenditure at the 1 st digit level, that is, the main public/private breakdown (Table 2) while only one country (reporting SHA for the first time in 2010) is able to provide information on the public side only. At the 2 nd digit category level - the breakdown into general government, social security and the main components of private financing - there was a coverage rate of almost 80%, meaning that on average 27 countries out of the 30 can provide data for these variables. This is notably down on last year s figure and is mainly attributable to the level of reporting of those countries not considered in 2009. Concentrating on the particular variables, 30 countries report information on the general government/social security split as well as households spending while for private insurance it is unclear whether the gaps reflect the nonexistence or negligible size of private insurance in the particular countries (in which case a zero should be entered) rather than any lack of estimation. The other categories of NPISH (HF.2.4) and Corporations (HF.2.5) were reported by 84% and 77% of countries respectively. The important 3 rd digit level categories related to cost-sharing have been reported by almost 58% of the countries, slightly up on the 2009 data collection. 8

HCxHF HCxHP HPxHF HFxFS RCxHP HCxHF HCxHP HPxHF HFxFS RCxHP HCxHF HCxHP HPxHF HFxFS RCxHP HCxHF HCxHP HPxHF HFxFS RCxHP HCxHF HCxHP HPxHF HFxFS RCxHP Preliminary estimates HCxHF HCxHP HPxHF HFxFS RCxHP Methodology Table 1 System of Health Accounts (SHA) Joint OECD, Eurostat, and WHO Data Collection JHAQ: ARCHIVE Years/Tables 2003 2004 2005 2006 2007 2008 Country Australia R R R R R R R R R R R R R R R R N N N N R Austria O O O O O O R R R N N N R Belgium O O O O O O O O O O O O O O R R R R N N N N R Bulgaria O O O O O O O O R R R N R R R N N N O Canada R R R R R R R R R R R R R R R R R R R R N N N N N r Cyprus R R R R R R R R R R R R R R R R R R O O R R R N N N r Czech Republic R R R O R R R R R R R R R R R R R R N N N N N r Denmark O O O O O O O O O O O O O O O Expected r Estonia O O O O O O O O O O O O O O O O O O O R R R R R N N N N N r Finland O O O O O R R R R R R R R R R R R R R R R R R R R N N N N N r France R R R R R R R R R R R R R R R R R R R R N N N N r Germany R R R R R R R R R R R R R R R N N N r Hungary O O O O O O O O O O O R R R R R R R R N N N N r Iceland R R R R R R R R R R R R R R R N N N N R Israel N N N Italy N N N N N N N N N N N N N Japan O O O O O O O O O O O O O O O O N N N N O Korea R R R R R R R R R R R R R R R R R R R R N N N N N r Latvia O O O O O O O O O N N N Lithuania O O O O O O O O O O R R R R R R R R R R N N N N N r Luxembourg R R R R R R R R R R R R R R R N N N N N N N N N N N N N N N O Netherlands O O O O O O O O O O O O O O O O O O O O R R R N N N N N R New Zealand R R R R R N R R R R R R R R R N N N N R Norw ay O O O O O O O O O O O O r Poland R R R O R R R O R R R O R R R R R R R R N N N N r Portugal O O O O O O O O O O O O Romania R R R R R R R R R R R R R R R R R R R R N N N N r Slovak Republic O O O O O O O O O O N N N Slovenia R R R R R R R R R R R R R R R R R R R R N N N N N r Spain R R R R R R R R R R R R R R R N N N O Sw eden O O O O O O O O O O O O R R R N N N R Sw itzerland O O O O O O O O O O O O O O O O R R R R N O Turkey N N N N N United States O O O O O O O O O O R R R R R R R R R R R R R R R N N N N N R O Archive R Revised n New submission Current expenditure broken down by ICHA-HP provider was reported on average by 30.4 countries at the 1 st digit level - coverage rate of 98% - and slightly up on 2009. The other main categories are reported by all countries except HP.2 Nursing and residential care facilities and HP.7 (Other industries) which are reported by 97% and 90% of countries respectively. At the 2 nd digit level of detail, around 74% of categories are being provided on average down 2.6% on last year s figures. For hospital providers 27 out of the 31 countries included information on General hospitals, while expenditure on Mental health and substance abuse hospitals or Speciality (other than mental health and substance abuse hospitals) was reported by 24 countries. Among ambulatory providers (HP.3) more than 90% of the countries report some degree of detail at the 2 nd level. Individual gaps among ambulatory providers again may reflect the non-existence of the category in the health system rather than any lack of data. Among Other Industries, there are more substantial gaps with 30% of countries not providing data on Households (HP.7.2) and a quarter giving no response on secondary producers (HP.7.9). With respect to the breakdown by ICHA-HC function; excluding a single country that cannot report any item of the functional breakdown, at the 1 st digit level there has been no change over 2009 while coverage at the second digit level recorded a slight decrease as compared to last year. Taking the services of curative and rehabilitative care (HC.1; HC.2) first: only one country does 9

not provide the breakdown into in-patient and out-patient care; 6 out of 30 do not provide estimates on day or home care services. On the further 3 rd digit breakdown of out-patient care, three countries are not able to report the breakdown, with a further two not reporting specialist services (HC.1.3.3) separately. Regarding LTC (HC.3), twelve countries have no information on Day cases of long-term nursing care and four do not report Long-term nursing care: home care. For Ancillary services (HC.4), four countries provide no breakdown or only a single component. For the categories of Clinical laboratory (HC.4.1) and Diagnostic imaging (HC.4.2), which often cannot be separated from other curative services, the response rates has been around 77% in 2010. The item, Medical goods (HC.5), shows an almost complete breakdown (28 out of 30 countries) into Pharmaceuticals (HC.5.1) and Therapeutic appliances (HC.5.2). The important separation into Prescribed and OTC medicines is now reported by 27 out of 30 countries. Public health and prevention (HC.6) has no breakdown for 4 countries only. The 2010 data collection recorded an additional, although moderate, increase in the number of countries reporting the FSxHF table (13 vs. 12 in 2009). All 13 countries provide the FS categories at the 1 st digit level and 12 out of the 13 have also information at the 2 nd digit breakdown. Table 2 Completeness and coverage of responses: 2010 vs. 2009 JHAQ ICHA 1 st digit HF 2 nd digit 1 st digit HP 2 nd digit 1 st digit HC 2 nd digit 1 st digit FS 2 nd digit OECD Member States EU-NON OECD Countries OECD & EU-NON OECD Countries 2009J HAQ 2010J HAQ Diff. 2009J HAQ 2010J HAQ Diff. 2009J HAQ 2010J HAQ Diff. Average 24 24.5 0.5 6 6-30 30.5 0.5 Coverage Rate 100% 98.0% -2.0% 100% 100% - 100% 98.4% -1.6% Average 21.4 19.6-1.8 5.9 5.6-0.3 27.3 25.3-2.0 Coverage Rate 89.1% 78.5% -10.6% 97.9% 93.8% -4.2% 90.8% 81.5% -9.4% Average 22.9 24.4 2 6 6-28.9 30.4 2 Coverage Rate 95.2% 97.7% 2.5% 100.0% 100.0% - 96.2% 98.2% 2.0% Average 17.9 17.9-6.0 6.0-23.9 23.9 - Coverage Rate 74.5% 71.6% -3.0% 100.0% 100.0% - 79.6% 77.1% -2.6% Average 23.8 23.8-6 6-29.8 29.8 - Coverage Rate 99.3% 99.3% - 100.0% 100.0% - 99.4% 99.4% - Average 18.1 17.8-0.3 6 6-24.1 23.8-0.3 Coverage Rate 75.6% 74.1% -1.4% 100.0% 100.0% - 80.5% 79.3% -1.1% Average 9 10 1 3 2-1 12 12 - Coverage Rate 100% 90.9% -9.1% 100% 100% - 100% 92% -7.7% Average 8.0 9.0 1.0 3 2-1 11.0 11.0 - Coverage Rate 88.9% 81.8% -7.1% 100.0% 100.0% - 91.7% 84.6% -7.1% Dissemination of the results from the 2010 collection 29. A synthesis of the validated SHA tables with relevant methodological information is made available on OECD Health Accounts web-page, while the full SHA database is available in the OECD.Stat data-warehouse. For the first time, the OECD aimed at synchronising the release of the validated SHA tables with the publication of the OECD- Health Database: by the time the fall edition of the OECD Health database is released, the corresponding SHA information is made available on the OECD.stat datawarehouse. Main conclusions from the 2010 collection 30. We can conclude that the fifth OECD-Eurostat-WHO joint data collection has made a few additional positive steps towards achieving its main aims: the reduction in the burden of data collection for 10

the national authorities, the increase of the use of international standards and the harmonisation of national health accounting practices. 31. With 31 countries submitting the questionnaire and the prospect of three more countries next year, the vast majority of OECD and EU countries will be providing harmonised and comparable health expenditure and financing data. 32. The average validation time has been drastically reduced. For the first time the average length of the process has been less than the stated aim of two months. The timeliness, of the dissemination of data from the joint data collection, depends both on compliance with the deadlines for data submission, and on the duration of the validation process. 33. The detailed reporting of the ICHA classifications for the three basic tables has registered a slight reduction in coverage rates, while a moderate improvement has been registered, once again, in the number of countries compiling the FSxHF table. Changes in the coverage rates are attributable essentially to the turnover of reporting counties which has characterised the 2010 exercise: two countries reported the JHAQ for the first time and another two countries, which had temporarily interrupted the compilation of SHA, had also resumed their participation in the joint collection again this year. At the same time, three countries could not compile the questionnaire due to benchmarking undertaken by the respective national accounts departments. 34. Next year, the data collection will continue to focus on the areas of major interest for policy analysis for which some gaps remain, such as a breakdown of cost-sharing, full information of pharmaceuticals and capital formation. 11

ANNEX 1. AVAILABILITY OF DATA FROM THE 2010 JOINT OECD, EUROSTAT AND WHO HEALTH ACCOUNTS DATA COLLECTION 12

Australia 1 Austria 2 Belgium Bulgaria Canada Cyprus Czech Republic Estonia Finland France Germany Hungary Iceland Israel 2 Italy Japan 1 Korea Latvia 1 Lithuania Luxembourg Netherlands New Zealand Poland Romania Slovak Republic Slovenia Spain Sweden Switzerland 1 Turkey 1 United States Table A1.1 2010 JHAQ: Variables of ICHA-HF reported by country HF.1 General government 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HF.1.1 General government (excl. social security) = Territorial government 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HF.1.1.1 Central government 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HF.1.1.1.1 Ministry of Health 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HF.1.1.1.2 Other Ministries 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HF.1.1.2 States / provincial governments 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HF.1.1.3 Locals / municipal governments 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HF.1.2 Social security funds 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HF.2 Private sector 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HF.2.1 Private social insurance 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HF.2.2 Private insurance (other than social insurance) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HF.2.1-HF.2.2 Private insurance 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HF.2.3 Private households out-of-pocket exp. 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HF.2.3.1 out-of-pocket excluding cost-sharing 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Cost-sharing: central government; state / provincial HF.2.3.2-HF.2.3. government; Local / municipal government; Social security funds 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HF.2.3.6-HF.2.3. Cost-sharing: Private insurance 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HF.2.3.9 All other cost-sharing 1 1 1 1 1 1 1 1 1 1 1 1 1 HF.2.4 Non-profit institutions serving households 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HF.2.5 Corporations (other than health insurance) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HF.3 Rest of the world 1 1 1 1 1 1 1 1 1 1 1 1 1 HF.0 n.e.c. 1 1 1 1 1 1 1 1 1 1 Current health care expenditure HF.1-HF.3 * 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Note: 1 latest year available 2007 2 latest year available 2006 13

Belgium Bulgaria Canada Cyprus Czech Republic Estonia Finland France Germany Hungary Iceland Italy Korea Lithuania Luxembourg Netherlands New Zealand Poland Romania Slovak Republic Slovenia Spain Sweden United States Table A1.3 2010 JHAQ: Variables of ICHA-HC reported by country Australia 1 Austria 2 HC.1;HC.2 Services of curative and rehabilitative care 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.1 Services of curative care 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.2 Services of rehabilitative care 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.1.1;HC.2.1 In-patient curative and rehabilitative care 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.1.1 In-patient curative care 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.2.1 In-patient rehabilitative care 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.1.2;HC.2.2 Day cases of curative and rehabilitative care 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.1.2 Day cases of curative care 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.2.2 Day cases of rehabilitative care 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.1.3;HC.2.3 Out-patient curative and rehabilitative care 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.1.3 Out-patient curative care 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.1.3.1 Basic medical and diagnostic services 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.1.3.2 Out-patient dental care 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.1.3.3 All other specialised health care 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.1.3.9 All other out-patient curative care 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.2.3 Out-patient rehabilitative care 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.1.4;HC.2.4 Services of curative home and rehabilitative home care 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.1.4 Services of curative home care 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.2.4 Services of rehabilitative home care 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.3 Services of long-term nursing care 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.3.1 In-patient long-term nursing care 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.3.2 Day cases of long-term nursing care 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.3.3 Long-term nursing care: home care 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.4 Ancillary services to health care 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.4.1 Clinical laboratory 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.4.2 Diagnostic imaging 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.4.3 Patient transport and emergency rescue 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.4.9 All other miscellaneous ancillary services 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.5 Medical goods dispensed to out-patients 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.5.1 Pharmaceutical and other medical non-durables 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.5.1.1 Prescribed medicines 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.5.1.2 Over-the-counter medicines 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.5.1.3 Other medical non-durables 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.5.2 Therapeutic appliances and other medical durables 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.5.2.1 Glasses and other vision products 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.5.2.2 Orthopaedic appliances and other prosthetics 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.5.2.3 Hearing aids 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.5.2.4 Medico-technical devices, including w heelchairs 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.5.2.9 All other miscellaneous medical durables 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.6 Prevention and public health services 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.6.1 Maternal and child health; family planning and counselling 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.6.2 School health services 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.6.3 Prevention of communicable diseases 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.6.4 Prevention of non-communicable diseases 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.6.5 Occupational health care 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.6.9 All other misc. public health services 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.7 Health administration and health insurance 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.7.1 General government administration of health 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.7.1.1 General government administration of health (except social security) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.7.1.2 Administration, operation and support activities of social security funds 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.7.2 Health administration and health insurance: private 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Israel 2 Japan 1 Latvia 1 Switzerland 1 Turkey 1 HC.7.2.1 Health administration and health insurance: social insurance 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.7.2.2 Health administration and health insurance: other private 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.9 Not specified by kind 1 1 1 1 1 1 1 1 1 1 1 1 1 Current health care expenditure HC.1-HC.9 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.R.1 Capital formation of health care provider institutions 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Total expenditure HC.1-HC.9; HC.R.1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.R.2 Education and training of health personnel 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.R.3 Research and development in health 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.R.4 Food, hygiene and drinking w ater control 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.R.5 Environmental health 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Administration and provision of social services in kind to HC.R.6 assist living w ith disease and impairment 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.R.6.1 Social services of LTC (LTC other than HC.3) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 HC.R.6.9 All other services classified under HC.R.6 1 1 1 1 1 1 1 1 1 1 1 1 HC.R.7 Administration and provision of health related cash-benefits 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Memorandum items: 1 1 1 M.1(HC) Other (Non-health care/health-related) goods and services 1 1 1 1 1 1 1 M.2(HC) Total pharmaceuticals and other medical non-durables (including in-patient and other w ays of provision) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 M.3(HC) Total of ancillary services (including in-patient) 1 1 1 1 1 1 1 1 1 1 1 Note: 1 latest year available 2007 2 latest year available 2006 15

Australia 1 Belgium Estonia Finland France Japan 1 Korea Lithuania Luxembourg Poland Slovenia Switzerland 1 United States Table A1.4 2010JHAQ: Variables of ICHA-FS reported by country FS.1 General government units 1 1 1 1 1 1 1 1 1 1 1 1 FS.1.1 Territorial governments 1 1 1 1 1 1 1 1 1 1 1 FS.1.2 All otrher public units 1 1 1 1 1 1 1 1 1 FS.2 Private sector 1 1 1 1 1 1 1 1 1 1 1 1 FS.2.1; FS.2.3 Corporations and NPISHs 1 1 1 1 1 1 1 1 1 1 1 1 FS.2.2 Households 1 1 1 1 1 1 1 1 1 1 1 1 FS.3 Rest of the w orld 1 1 1 1 1 1 1 1 Total Current 1 1 1 1 1 1 1 1 1 1 1 Total 1 1 1 1 1 1 16

ANNEX 2. EXAMPLE OF AN INITIAL VALIDATION SHEET AS PART OF THE 2010 VALIDATION PROCEDURE 17