Metadata (SHA 2011) Respondent. To be returned: By: 31/03/2017 To: OECD Eurostat WHO

Metadata (SHA 2011) Country Croatia Respondent To be returned: By: 31/03/2017 To: OECD SHA.Contact@oecd.org Eurostat ESTAT-SHA@ec.europa.eu WHO NHA@who.int General remarks and metadata concerning the tables

I. Data sources and estimation methods Please provide information on the data sources used to compile the three core tables (HCxHF, HCxHP, HPxHF) as well as the additional tables (HFxFS, HPxFP, HKxHP). I.1. Administrative and statistical data sources Source name Brief description of source (e.g. coverage, reference year, etc) Type of data source Primary SHA variable(s) using this data source Time period Timeliness (Number of months covered by this after the end of the data source accounting period) Frequency (e.g monthly, quarterly, annual, irregular) Processing (e.g. brief description of any adjustments, correction or distribution applied to the original data sources) Example : Statistics of National Health Insurance Annual records on activity and spending financed by NHI; coverage 100% of all activity of NHI Public administrative records HF.1.2 (financing all HC (except HC.3 and HC.1.3.2) provided by all HP (except HP.2 and HP.3.2)) 2003-2013 11 months Annual Contains 80 SHA-relevant spending items; 60 can be attributed to a single HC and single HP; other 20 items are distributed to more than one HC and/or HP using distribution keys Contains around 100 SHA-relevant spending items for HF.1.2 Annual record on activity and spending (70 which can be attributed to a single HC and HP and 30 which Statistics of Croatian Health Insurance Fund (CHIF) financed by CHIF; coverage 100% of compulsory health insurance (CHIF is the only compulsory insurer in Croatia); covers Public administrative records complete HF.1.2.1 + part of HF 2.1.2 (financing all HC provided by all HP) 2011-2015 Annual are distributed to more than one HC and/or HP using distribution keys); also contains around 75 SHA-relevant spending items for HF.2.1.2 (60 of which can be attributed to a also part of voluntary health insurance single HC and single HP and 15 which are distributed to more than one HC and/or HP using distribution keys). Statistics of Ministry of Health Annual record on activity and spending financed by Ministry of Health Public administrative records HF.1.1 (financing HC.6 provided by HP.6 and HP.7 and HK.1.1 in HP.1 and HP.3) 2011-2015 Annual Contains 15 SHA-relevant spending items (8 can be attributed to a single HC/HK and single HP, and 7 are distributed to more than one HC/HK and/or HP). HF.1.1 (financing HC.1.3.1 provided in HP.1 and by Statistics of Ministry of Defense Annual record on activity and spending financed by Ministry of Defense HP.8.2 - ambulatory health care providers employed Public administrative records inside army, HC.4.1 in HP.4.2, HC.5.1.1 in HP.5.1, 2011-2015 Annual HC.5.1.3 in HP.5.9, HC.5.2.9 in HP.5.9 and HC.6.2 Contains 8 SHA-relevant spending items which can be attributed to a single HC/HK and single HP. and HC.6.3 in HP.6) Statistics of Ministry of Justice Annual record on activity and spending financed by Ministry of Justice Public administrative records HF.1.1 (financing all HC (except HC.3) provided by all HP) 2011-2015 Annual Contains 19 SHA-relevant spending items which can be attributed to a single HC/HK and single HP. Statistics of counties and Annual records on activity and spending City of Zagreb (21 financed by counties and City of Zagreb regional units) Public administrative records HF.1.1 (data for regional government expenditures) 2011-2015 Annual Contains between 5 and 40 SHA-relevant spending items (for each out of 21 regional units) which can be attributed to a single HC/HK and HP, except expenditures from subsidies (for one regional unit) which are distributed to more than one HC and/or HP using distribution keys. Statistics of Ministry of Finance Ministry of Finance Report with Aggregated Data on Achieving Budget 2011-2015 Financial reports HF.1.1 (data for local government expenditures) 2011-2015 Annual Contains 10 SHA-relevant spending items which can be attributed to a single HC and HP. Statistics of private health insurance companies (6 companies) Annual records on activity and spending financed by private health insurance companies Public administrative records HF.2.1.2 (financing all HC provided by all HP) 2011-2015 Annual Contains between 10 and 30 SHA-relevant spending items (for each out of 6 private health insurances) which can be attributed to a single HC and HP. Croatian Bureau of Statistics Household Budget Survey Surveys/censuses HF.3 (only data for HC.1.1, HC.1.3.1, HC.1.3.2, HC.1.3.9, HC.2.1, HC.3.1, HC.4.1, HC.4.2, HC.5.1, HC.5.2 available) 2011-2015 Annual Contains 9 SHA-relevant spending items which are distributed to more than one HC and/or HP using distribution keys. Non-governmental organisations and Annual record on activity and spending Public administrative records HF.2.2 2014-2015 Annual foundations (8 for 2014, 9 for 2015) Contains 10 SHA-relevant spending items which can be attributed to a single HC and HP. Statistics of Croatian Report on number of preventive medical Institute of Public Health examinations in occupational health and and Pricelist of Croatian pricelist of health services in occupational Chamber of Medical health Doctors Reports HF.2.3, HC.6.4 2014-2015 Annual Contains 1 SHA-relevant spending item which can be attributed to a single HC and HP. Statistics of Croatian Health Insurance Fund (CHIF) Annual record on losses of hospitals owned by the state Public administrative records HF.1.2.1, all HC provided by HP.1.1 2014-2015 Annual Contains 1 SHA-relevant spending items which are distributed to a single HP and more than one HC using distribution keys. Statistics of Croatian Health Insurance Fund (CHIF) Annual record on losses of Croatian Health Insurance Fund on prescribed medicines Public administrative records HF.1.2.1, HC.5.1 in HP.5.1 2014 Annual Contains 1 SHA-relevant spending item which can be attributed to a single HC and HP. * Insert more rows if required. Please provide further information on the SHA variables - that are covered by the above listed data sources but can only be reported by applying estimation methods, adjustments, corrections or distributions to the original sources. - that are not available from the above listed data sources but are included in the health accounts via a special estimation method. I.2. Estimation methods SHA variable(s) Main method (see comment box for definitions) Brief description of methodology Example : HP2xHF3 splitting HC31/HC33 Balancing item/residual method Total revenue of LTC facilities (HP2) providing inpatient LTC (HC31) and outpatient LTC (HC33) is based on official LTC statistics which are available every 3 years; The split into HC31 and HC33 is done via expert estimation. Out-ofpocket spending for HC31 is estimated subtracting all inpatient LTC financing included in administrative records. HF2/HP2/HC33 is calculated as residual. For missing years the total revenues is extrapolated and actual spending of other sources subtracted. HF.1.1 (counties)/hc.7.1 Several counties estimated these costs according to percentage of personnel and their working hours on health topics (county offices for health are usually combined with social policy and/or education) HF.1.1/HC.3.1/HP.2 Only three regional authorities were able to provide nursing care expenditures for in-patient long-term care in nursing homes (which are actually combination of nursing homes and residential homes because they, besides nursing care departments, also have pure residential parts) separately from total expenditures for such homes. Majority of regional authorities were only able to provide total expenditures for nursing homes (including both nursing care and residential departments), so we estimated nursing care expenditures from total expenditures for them by using average percentage of share of nursing care in total expenditures for these homes which we calculated for those counties which had it available (25%). HF.3 Interpolation/Extrapolation Estimation of household expenditures in 2015 was prepared by extrapolation of Household Budget Survey data from 2014 (Household Budget Survey was not executed in 2015, therefore there are no direct data for 2015 available from this survey). Estimation for 2015 was done so that all data from 2014 Survey for all HC and HP categories were increased for % which was GDP increase in Croatia in 2015 (1,745%). HF.3 Due to lack of harmonisation between SHA and data on health care expenditures from Household Budget Survey, the following estimations were done on the data from Household Budget Survey: data for HC.5.1 were devided into HC.5.1.1 and HC.5.1.2 according to the information from published articles that HC.5.1.2 presents around 10% of total HC.5.1 in Croatia; data on laboratory and imaging services (aggregated data in Household Budget Survey) were devided into HC.4.1 and HC.4.2 in ratio 50%:50%; data on hospitalisations were devided into HC.1.1 and HC.3.1 and into HP.1.1 and HP.1.3 according to shares of these categories in HF.1.2; for 2014 data on long-term care from Household Budget Survey were included in SHA for the first time - as it contains aggregated long-term care data which include both health and social long-term care, the same ratio as described for HF.1.1/HC.3.1/HP.2 was used to estimate the share of health component (25%) HF.2.3 Costs of enterprises financing schemes were calculated by multiplying number of preventive medical examination in occupational health paid by enterprises in specific year with cost of such examinations according to the pricelist of Croatian Chamber of Medical Doctors HC.1.1 and HC.1.2/HF.3 Total expenditure for sum of HC.1.1 and HC.1.2 in HF.3 which contained both HC.1.1 and HC.1.2, was divided into HC.1.1 and HC.1.2 using ratio between HC.1.1 and HC.1.2 in the sum of HF.1 and HF.2 as a distribution key. HC.2.1 and HC.2.2/HF.3 Total expenditure for sum of HC.2.1 and HC.2.2 in HF.3 which contained both HC.2.1 and HC.2.2, was divided into HC.2.1 and HC.2.2 using ratio between HC.2.1 and HC.2.2 in the sum of HF.1 and HF.2 as a distribution key. Please select... * Insert more rows if required.

II. Data comparability Please indicate if health expenditure and financing data are based on SHA 2011, SHA 1.0 or other non-sha sources. II.1. Historical information SHA 2011 based accounts SHA 1.0 based accounts Other non-sha sources (e.g. national health expenditure accounts, national accounts, etc) From 2013 2011 Please select To 2015 2012 Please select Do the reported data pertain to the calendar year (1 January to 31 December) or a financial/fiscal year (which differs from the calendar year)? II.2. Accounting period Accounting period From (if Financial/fiscal year) To (if Financial/fiscal year) Calendar year (from 1/1 to 31/12) Please provide a brief description of the items indicated as atypical entries in the submitted data files. II.3. Atypical entries Year(s) Atypical entry Example : 2006-2013 HC.2.3xHP.6 This refers to providers that are predominantely providing preventive care but in some cases they also provide outpatient rehabilitative care. 2014-2015 HC.3.4 x HP.6 palliative care provided to cancer patients in their homes by Croatian League Against Cancer - non-governmental organisation whose main activites are raising awareness and prevention of cancer (but they do provide to a lesser extent also palliative care) 2011-2015 HC.7.1 x H.P6 HC.7.1 HP.6 contains expenditure for activities of public health institutes in monitoring of health needs, health resources monitoring, official health statistics and participation in planning and development of health strategies 2015 HC.2.3 x HP.6 rehabilitative outpatient care provided to patients by non-governmental organisations whose main activites are raising awareness and prevention (but they do provide to a lesser extent also rehabilitative care) 2013-2015 HP.7.2 x HF.2 Social Insurance Fund (Croatian Health Insurance Fund - the only provider of obligatory health insurance which is state-owned) provides also complementary voluntary health insurance. * Insert more rows if required. Please list all the breaks in time series (resulting from methodological changes) you are aware of. II.4. Breaks in time series Year Example : 2010 Example : 2004 Items affected by the break HC.3 and HCR.1 financed by all HF, CHE HC.1.3.1, HC.1.3.3 With the switch to SHA 2011 in 2010 the methodology for splitting LTC into LTC (health) and LTC (social) has been revised. As a result, expenditure has been shifted from LTC (social) to LTC (health) affecting increasing the level of HC.3 and therefore current From 2004 health expenditure is calculated in more detail. Until then the majority of outpatient health expenditure had been allocated to HC.1.3.1. Due to detailed examination thereafter, larger amounts of health expenditure have been classified under HC.1.3.3. 2013 HC.1.1, HC.3.1 in HP.1 Starting with data for 2013 all expenditures for hospitalisations in hospital departments with beds classified as long-term care beds in JQ on Non-monetary Statistics (departments for chronic pulmonary diseases, chronic mental diseases, chronic diseases in children and extended treatment) have been reclassified from HC.1.1 to HC.3.1 in order to synchronize data in SHA and Non-monetary JQs 2013 HC.2.1 in HP.2 We included for the first time data on expenditures from regional authorities for in-patient long-term care in nursing homes (which are actually combination of nursing homes and residential homes because they, besides nursing care departments, also have pure residential parts) - for majority of regional authorities we were only able to obtain total expenditures for nursing homes, so we estimated nursing care expenditures from total expenditures. 2013 HC.7 in HF.1.2 and HF.2.1 For the first time, expenditures of administration, operation and support activities of social security fund (Croatian Health INsurance Fund) for complementary voluntary health insurance were calculated separately and not included in HF.1.2 2013 HC.1.1, HC.1.2 and HC 1.3 in HF.3 Estimated expenditures in HF.3/HC.1.1 were further devided into HC.1.1, HC.1.2 and HC.1.3 by estimation based on HF.1.1 2014 HP.2 and HP.3.5 in HF.3 Data on expenditures for long-term care in residential long-term care facilities and by providers of home health care services estimated from Household Budget Survey were included for the first time in HF.3 2014 HF.2.2 and HF.2.3 HF.2.2 and HF.2.3 included for the first time * Insert more rows if required. Are you aware of any other issues know to affect the overall comparability of data (e.g. capital formation included in current health expenditure, inclusion of medical costs for non-residents, items known to be overestimated/underestimated, etc)? II.5. Other comparability issues

III. Current state of implementing the core classifications For each of the HF, HC and HP categories listed below, please indicate if there are any deviations from SHA definitions or missing data by selecting the relevant item from the drop-down list. If the category as reported in your health accounts complies with the definitions and classification at hand, nothing needs the be filled in: Deviation from SHA definition: Select this item if a category is reported in your health accounts but differs from the definitions provided by the SHA 2011 manual (and additional guidelines). Please provide further clarification on the nature of the deviation in the "" column, including a general description of the deviation, information whether the deviation refers to the entire category or only individual items and an indication which years are affected (e.g. for 2005-2010, cost-sharing with compulsory insurance schemes is reported under HF.1, this refers to all functions and providers except HC.5.1 provided by HP.5.1). Category does not exist: Select this item if a category does not exist in your health system (e.g. when there is no HF.1.2 Compulsory contributory health insurance scheme). Any further clarification should be provided in the "" column. Missing (data not available): Select this item if a category exists in your health system but it is not reported in your health accounts because data are not available (e.g. HC.3.3 Outpatient long-term care (health) exists in the nation Missing (category reported elsewhere): Select this item if a category is not reported but it is included with another category in your health accounts (e.g. HC.1.2 Day curative care is reported together with HC.1.1 Inpatient curative III.1. Current state of ICHA-HF implementation ICHA-HF Code HF.1 Government schemes and compulsory contributory health care financing schemes HF.1.1 Government schemes Deviation from SHA definition Data on expenditures for HP.2 by Ministry of Social Policy and Youth have been officially asked for every year, but so far we have not succeeded to obtain these data HF.1.2/1.3 Compulsory contributory health insurance schemes/cmsa HF.1.2.1 Social health insurance schemes HF.1.2.2 Compulsory private insurance schemes HF.1.3 Compulsory Medical Savings Accounts (CMSA) HF.2 Voluntary health care payment schemes HF.2.1 Voluntary health insurance schemes Missing (data not available) HF.2.2 NPISH financing schemes Missing (data not available) Expenditure data for 1 out of 6 private health insurers were delivered only once (for 2011) and data for 2012, 2013, 2014 and 2015 were not delivered Expenditure data for 2014 and 2015 were received from 14 out of 78 non-governmental organosation and foundations which were contacted HF.2.3 Enterprise financing schemes HF.3 Household out-of-pocket payment HF.3.1 Out-of-pocket excluding cost-sharing Missing (data not available) HF.3.2 Cost-sharing with third-party payers Missing (data not available) HF.4 Rest of the world financing schemes (non-resident) HF.4.1 Compulsory schemes (non-resident) Missing (data not available) HF.4.2 Voluntary schemes (non-resident) Missing (data not available) III.2. Current state of ICHA-HC implementation ICHA-HC Code HC.1 Curative care HC.1.1 Inpatient curative care HC.1.2 Day curative care HC.1.3 Outpatient curative care HC.1.3.1 General outpatient curative care HC.1.3.2 Dental outpatient curative care HC.1.3.3 Specialised outpatient curative care HC.1.3.9 All other outpatient curative care HC.1.4 Home-based curative care HC.2 Rehabilitative care HC.2.1 Inpatient rehabilitative care HC.2.2 Day rehabilitative care HC.2.3 Outpatient rehabilitative care HC.2.4 Home-based rehabilitative care HC.3 Long-term care (health) HC.3.1 Inpatient long-term care (health)

HC.3.2 Day long-term care (health) Missing (category reported elsewhere) reported in HC.3.1 (HC.3.2 is probably very minor compared to HC.3.1) HC.3.3 Outpatient long-term care (health) Missing (category reported elsewhere) reported in HC.3.1 (HC.3.3 is probably very minor compared to HC.3.1) HC.3.4 Home-based long-term care (health) HC.4 Ancillary services (non-specified by function) HC.4.1 Laboratory services HC.4.2 Imaging services HC.4.3 Patient transportation HC.5 Medical goods (non-specified by function) HC.5.1 Pharmaceuticals and other medical non durable goods HC.5.1.1 Prescribed medicines HC.5.1.2 Over-the-counter medicines HC.5.1.3 Other medical non-durable goods HC.5.2 Therapeutic appliances and other medical durable goods HC.6 Preventive care HC.6.1 Information, education and counseling programmes HC.6.2 Immunisation programmes HC.6.3 Early disease detection programmes HC.6.4 Healthy condition monitoring programmes HC.6.5 Epidemiological surveillance and risk and disease control HC.6.6 Preparing for disaster and emergency response programmes HC.7 Governance and health system and financing administration HC.7.1 Governance and health system administration HC.7.2 Administration of health financing Reporting items: HC.RI.1 Total pharmaceutical expenditure (TPE) Missing (data not available) HC.RI.2 Traditional, Complementary and Alternative Medicines (TCAM) Missing (data not available) HC.RI.3 Prevention and public health services (According to SHA 1.0) Missing (data not available) Health care related items: HCR.1 Long-term care (Social) Missing (data not available) HCR.2 Health promotion with multisectoral approach Missing (data not available) III.3. Current state of ICHA-HP implementation ICHA-HP Code HP.1 Hospitals HP.1.1 General hospitals HP.1.2 Mental health hospitals HP.1.3 Specialised hospitals (other than mental health hospitals) HP.2 Residential long-term care facilities Missing (data not available) Data on expenditures for HP.2 by Ministry of Social Policy and Youth have been officially asked for every year, but so far we have not succeeded to obtain these data. HP.2.1 Long-term nursing care facilities HP.2.2 Mental health and substance abuse facilities HP.2.9 Other residential long-term care facilities HP.3 Providers of ambulatory health care HP.3.1 Medical practices

HP.3.2 Dental practices HP.3.3 Other health care practitioners HP.3.4 Ambulatory health care centres HP.3.5 Providers of home health care services HP.4 Providers of ancillary services HP.4.1 Providers of patient transportation and emergency rescue HP.4.2 Medical and diagnostic laboratories HP.4.9 Other providers of ancillary services Missing (category does not exist) HP.5 Retailers and other providers of medical goods HP.5.1 Pharmacies HP.5.2 HP.5.9 Retail sellers and other suppliers of durable medical goods and medical appliances All other miscellaneous sellers and other suppliers of pharmaceuticals and medical goods HP.6 Providers of preventive care HP.7 Providers of health care system administration and financing HP.7.1 Government health administration agencies HP.7.2 Social health insurance agencies HP.7.3 Private health insurance administration agencies HP.7.9 Other administration agencies HP.8 Rest of the economy HP.8.1 Households as providers of home health care HP.8.2 All other industries as secondary providers of health care HP.9 Rest of the world

IV. Current state of implementing the additional classifications For each of the FS, FP and HK categories listed below, please indicate if there are any deviations from SHA definitions or missing data by selecting the relevant item from the drop-down list. If the category as reported in your health accounts complies with the definitions and classification at hand, nothing needs the be filled in: Deviation from SHA definition: Select this item if a category is reported in your health accounts but differs from the definitions provided by the SHA 2011 manual (and additional guidelines). Please provide further clarification on the nature of the deviation in the "" column, including a general description of the deviation, information whether the deviation refers to the entire category or only individual items and an indication which years are affected. Category does not exist: Select this item if a category does not exist in your health system. Any further clarification should be provided in the "" column. Missing (data not available): Select this item if a category exists in your health system but it is not reported in your health accounts because data are not available. Any further clarification should be provided in the "" column. Missing (category reported elsewhere): Select this item if a category is not reported but it is included with another category in your health accounts. Please explain in the "" column where in your health account IV.1. Current state of ICHA-FS implementation ICHA-FS Code FS.1 Transfers from government domestic revenue Missing (data not available) FS.1.1 Internal transfers and grants Missing (data not available) FS.1.2 Transfers by government on behalf of specific groups Missing (data not available) FS.1.3 Subsidies Missing (data not available) FS.1.4 Other transfers from government domestic revenue Missing (data not available) FS.2 Transfers distributed by government from foreign origin Missing (data not available) FS.3 Social insurance contributions Missing (data not available) FS.3.1 Social insurance contributions from employees Missing (data not available) FS.3.2 Social insurance contributions from employers Missing (data not available) FS.3.3 Social insurance contributions from self-employed Missing (data not available) FS.3.4 Other social insurance contributions Missing (data not available) FS.4 Compulsory prepayment (other than FS.3) Missing (data not available) FS.5 Voluntary prepayment Missing (data not available) FS.6 Other domestic revenues n.e.c. Missing (data not available) FS.7 Direct foreign transfers Missing (data not available) FS.7.1 Direct foreign financial transfers Missing (data not available) FS.7.2 Direct foreign aid in kind Missing (data not available) IV.2. Current state of ICHA-FP implementation ICHA-FP Code FP.1 Compensation of employees Missing (data not available) FP.1.1 Wages and salaries Missing (data not available) FP.1.2 Social contributions Missing (data not available) FP.1.3 All other costs related to employees Missing (data not available) FP.2 Self-employed professional remuneration Missing (data not available) FP.3 Materials and services used Missing (data not available) FP.3.1 Health care services Missing (data not available) FP.3.2 Health care goods Missing (data not available) FP.3.3 Non-health care services Missing (data not available) FP.3.4 Non-health care goods Missing (data not available) FP.4 Consumption of fixed capital Missing (data not available) FP.5 Other items of spending on inputs Missing (data not available) FP.5.1 Taxes Missing (data not available) FP.5.2 Other items of spending Missing (data not available)

IV.2. Current state of implementing the capital account Code HK.1.1.1 Infrastructure HK.1.1.2 Machinery and equipment HK.1.1.3 Intellectual property products HK.1.1 Gross fixed capital formation

V. Revisions If your data submission includes revised data tables replacing previously submitted data, please provide a brief overview of the revisions (reason for revision, affected items, etc). V.1. Revised data Revised data for 2011, 2012, 2013 and 2014 are also included in this submission. Revisions for 2011, 2012 and 2013 are minor and due to subsidies paid from regional government to hospitals to cover losses incurred during these years. Revision for 2014 is major: according to your instructions we have for the first time included losses derived in 2014 in SHA data although they have not been covered yet by any subsidies (and we do not know when they will actually get paid). When these losses actually get paid some further corrections will probably be needed (although we do not expect very significant changes). We were also able for the first time to include data for HF.2.2 and HF.2.3 in SHA data for 2014 (although amounts in these categories are very small as expected) Please provide a description of your general revision policy (how often is data revised, how many years, for what reasons, etc). V.2. General revision policy HTA data undergo revision whenever new or corrected data on certain health care expenditure become available for a certain year. One of the main problems with SHA data is the fact that health care providers owned by the state (mostly hospitals) accumulate losses which get covered only several years after they were generated and which can not be so precisely devided into HC categories as it is possible for expenditures which actually get paid (therefore estimations are needed).