1. Methodology background


 Frequency  Annual
 How compiled  Administrative data: HM Treasury, Department of Health, Health and Social Care Information Centre, the devolved administrations, LaingBuisson, ONS Consumer Trends
 Geographic coverage  UK
 Last revised  25 October 2017

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2. Executive summary

Health accounts are an analysis of healthcare expenditure, published for the first time in the UK in May 2016. The UK’s health accounts are produced to internationally standardised definitions – the System of Health Accounts 2011 (SHA 2011), which have been developed by the Organisation for Economic Co-operation and Development (OECD), Eurostat – the statistical office of the European Union – and the World Health Organisation (WHO). These definitions are to be used by all European Economic Area (EEA) and almost all OECD member states from 2016, enabling consistent international comparisons of UK healthcare spending with other European and OECD countries.

The health accounts will be produced annually, providing a figure for total UK current healthcare expenditure and analysing this expenditure by three dimensions:

  • financing scheme – the source of funding for healthcare. Categories include government- funded, private out-of-pocket payments and private healthcare insurance

  • provider organisation – the type of healthcare provider in which care is carried out; categories include hospitals, residential and nursing homes, and ambulatory providers

  • Function – the type of care and mode of provision; categories include curative and rehabilitative care, long-term care and preventative care

The definition of healthcare used in health accounts is somewhat broader than that used in previous UK healthcare expenditure analyses, as the international definitions include health-related social services, which are typically considered as social care in the UK.

The health accounts estimates have been compiled from a large range of sources, including the Online System for Central Accounting and Reporting (OSCAR) dataset, NHS reference costing returns, Health and Social Care Information Centre (HSCIC) data on social care expenditure, national accounts household final consumption expenditure, and data series produced by healthcare market consultants LaingBuisson.

The health accounts will be produced on an annual basis for the year t-2 (that is, 2014 data will be published in 2016, 2015 data in 2017, and so forth), and are provided in current prices.

More information about the definitions, categorisation system and methods used in health accounts, is included in the introduction to health accounts guidance note. Further information on the methodology used within health accounts can be found in the following sections.

This document contains the following sections:

  • Output quality

  • About the output

  • How the output is created

  • Validation and quality assurance

  • Concepts and definitions

  • Other information, relating to quality trade-offs and user needs

  • Sources for further information or advice

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3. Output quality

This report provides a range of information that describes the quality of the data and details any points that should be noted when using the output.

We have developed Guidelines for Measuring Statistical Quality; these are based upon the five European Statistical System (ESS) quality dimensions. This report addresses these quality dimensions and other important quality characteristics, which are:

  • relevance

  • timeliness and punctuality

  • coherence and comparability

  • accuracy

  • output quality trade-offs

  • assessment of user needs and perceptions

  • accessibility and clarity

More information is provided about these quality dimensions in the following sections.

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4. About the output

Relevance

(The degree to which statistical outputs meet users’ needs.)

Due to differences in the organisation of healthcare provision between nations, national data sources on healthcare expenditure vary greatly between countries. Differences between nations in how healthcare expenditure is defined and in the classification systems used for analysis, have prevented consistent international comparisons of health spending.

To address this issue, the Organisation for Economic Co-operation and Development (OECD) published a set of guidelines in 2000, the System of Health Accounts (version 1.0), to provide a standardised set of definitions and practices for measuring healthcare expenditure. Following the adoption of these guidelines by a number of OECD nations, the OECD, in collaboration with Eurostat (the EU’s statistical agency) and the World Health Organisation (WHO), published an updated set of guidelines – the System of Health Accounts 2011 (SHA 2011).

The System of Health Accounts 2011 guidelines improved the clarity of the health accounts definitions and set out the three main purposes of health accounts:

  • to provide a framework of the main aggregates relevant to international comparisons of health expenditures and health systems analysis

  • to provide a tool, expandable by individual countries, which can produce useful data in the monitoring and analysis of the health system

  • to define internationally harmonised boundaries of health care for tracking expenditure on consumption

To ensure the availability of consistent healthcare expenditure statistics across Europe, Regulation (European Commission (EC)) Number 1338/2008 requires all EU and European Economic Area (EEA) member states to produce health accounts compliant with the System of Health Accounts 2011 guidelines annually from 2016. Along with a number of other nations, the UK has some derogations from the full regulation, meaning that the analysis of non-government expenditure by the provider dimension and by function and provider, will not be published in 2016, although they are planned for future years.

The health accounts form the basis of the healthcare expenditure data published by the OECD in the OECD statistical database and the annual publication, Health at a glance. Eurostat also publishes the health accounts data within the Eurostat database, and has used the data for various analysis and forecasting purposes.

The UK health accounts draw together data from sources across the health and social care system, at the whole-UK level. The main data sources for government expenditure include the OSCAR dataset, the NHS reference costs, Health and Social Care Information Centre’s (HSCIC) Personal Social Services: Expenditure and Unit Costs data series, while the main data sources for non-government expenditure include LaingBuisson, the national accounts, the National Council of Voluntary Organisations and the Living Costs and Food Survey.

More information on the use of these sources can be found in “How the output is created” section and in the supporting documentation.

Timeliness and punctuality

(Timeliness refers to the lapse of time between publication and the period to which the data refer. Punctuality refers to the gap between planned and actual publication dates.)

Health accounts are published annually on a calendar year basis for the reference time period t-2. This means that the 2014 health accounts will be available in 2016, the 2015 health accounts in 2017 and so on. The first set of UK health accounts were published in May 2016 and it is intended that future health accounts will be published annually in April.

While the health accounts international guidelines mandate that data must be produced on a calendar year basis, many of the sources that are used in health accounts are published on a financial year basis. The later availability of financial year data increases the time delay before production work on health accounts can begin, and prevents an earlier publication date. All financial year data sources are converted to a calendar year basis as part of the production process.

For more details on related releases, the GOV.UK release calendar is available online and provides 12 months’ advance notice of release dates. In the unlikely event of a change to the pre-announced release schedule, public attention will be drawn to the change and the reasons for the change will be explained fully at the same time, as set out in the Code of Practice for Official Statistics.

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5. How the output is created

Due to the range of healthcare-providing organisations covered in health accounts, these statistics have been developed using a large range of different sources for each type of financing scheme. The information in this section provides a high-level summary of how health accounts have been produced. More detailed information is available in An introduction to health accounts and UK health accounts guidance.

Government healthcare expenditure

The main source for measuring total government expenditure in health accounts is the OSCAR dataset. The OSCAR dataset covers all UK government expenditure and is compiled by HM Treasury. OSCAR data are analysed using the internationally standard (Classification of the Functions of Government (COFOG)) system. UK expenditure on COFOG 7 (healthcare) is used as the core of the total government expenditure in health accounts. However, to create a government expenditure measure consistent with the System of Health Accounts 2011 (SHA 2011) definitions, a number of additions, deductions and adjustments are made to the OSCAR data.

The most substantial addition for health accounts is the inclusion of local authority social services where these include personal care services provided for health-related reasons, including nursing and residential care, home care and direct payments.

Some of the other adjustments to comply with the SHA 2011 definitions include:

  • expenditure on future workforce education and research and development is deducted from healthcare expenditure

  • Carer’s Allowance is included in health accounts

  • healthcare expenditure provided by non-health government bodies, including the armed forces and the police are included

  • costs recovered by the NHS from public bodies such as local authorities under the compensation recovery scheme are included

Due to the high-level nature of some of the data in the OSCAR dataset, the analysis of government healthcare expenditure by the function and provider categories of health accounts makes use of more detailed data sources, including the NHS reference costs. This analysis was developed by Office for National Statistics (ONS) in conjunction with the Department of Health, Scottish Government, Welsh Government, Public Health Wales, Northern Ireland Executive and NHS England.

The analysis of healthcare expenditure by the health accounts function and provider categories is reconciled to the total government healthcare expenditure figure. Due to an absence of suitable data for analysing some elements of non-NHS provision by the health accounts categories, an element of spending that makes up the difference between total healthcare expenditure and healthcare expenditure analysed by the health accounts classifications is allocated to the “not elsewhere classified” category.

Non-government healthcare expenditure

Table 1: Main data sources for calculating healthcare expenditure by each non-government financing scheme

Financing scheme
Main data sources
Voluntary health insurance
LaingBuisson
Association of British Insurers
National accounts

Non-profit institutions serving households (NPISH)
National Council of Voluntary Organisations dataset and original ONS research
Enterprise financing
National accounts supply use tables
LaingBuisson
Out-of-pocket spending
ONS Consumer Trends
LaingBuisson
Living Costs and Food Survey

The definition of the boundaries of healthcare used for non-government expenditure is the same as that for government healthcare expenditure. As a result, out-of-pocket and non-profit institutions serving households (NPISH) spending on long-term care services such as nursing care and home care is included within healthcare expenditure.

Further information on the methodology used to produce a measure of healthcare expenditure that complies with SHA 2011 can be found in An introduction to health accounts and UK health accounts guidance.

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6. Validation and quality assurance

Accuracy

(The degree of closeness between an estimate and the true value.)

Due to the large number of data sources used in the production of health accounts, it is not possible to produce statistical measures of accuracy, such as variances and confidence intervals for health accounts.

To maximise the accuracy of the health accounts, considerable quality assurance was undertaken during the development of health accounts. The health accounts figure for total government healthcare expenditure was reconciled back to the two other measures of healthcare expenditure produced using the OSCAR dataset – HM Treasury’s Public Expenditure Statistical Analysis (PESA) data series, and the national accounts-based measure of healthcare expenditure used in the earlier Office for National Statistics (ONS) publication Expenditure on Healthcare in the UK. While now superseded by health accounts, data series used in the Expenditure on Healthcare in the UK publication are also used to validate the results of the private sector healthcare expenditure series.

The development of health accounts involved quality assurance of the methodology by main data providers and a number of external experts, including from the Health Foundation, Centre of Health Economics at the University of York and the Personal Social Services Research Unit at London School of Economics. The Organisation for Economic Co-operation and Development (OECD) health accounts team also undertook quality assurance of the UK methods prior to the first publication, and produced a report approving the UK health accounts as compliant with the System of Health Accounts 2011 (SHA 2011) definitions and Regulation (EC) Number 1338/2008.

The main source for the production of total government healthcare expenditure, the OSCAR dataset, is processed on a monthly basis, enabling the construction of calendar year health expenditure figures consistent with international requirements. However, many of the other data sources used are available only on a financial year basis, particularly those used in the analysis of government healthcare expenditure by the function and provider categories of health accounts. Where only financial year data is available, two sets of financial year figures are apportioned to produce a calendar year figure.

As a result of these differences in the time period coverage of data sources used for the total measure of government healthcare expenditure and the data sources used for the analysis of spending by function and provider, there is a possibility that for some years the total expenditure in the analysis of spending may slightly exceed expenditure in the OSCAR-based total measure. In the event of this occurring, expenditure in the analysis of healthcare will be scaled down to match the expenditure of the control total.

In addition, it should be noted that while data from the Department of Health, LaingBuisson and the Health and Social Care Information Centre (HSCIC) is available to apportion much of the NHS’s purchases of healthcare from non-NHS providers by function and provider, a proportion of this spending has not been possible to estimate and has been allocated to the “not elsewhere classified” category.

Coherence and comparability

(Coherence is the degree to which data that are derived from different sources or methods, but refer to the same topic, are similar. Comparability is the degree to which data can be compared over time and domain, for example, geographic level.)

The health accounts differ from previous measures of healthcare expenditure produced by ONS and other UK organisations such as the HM Treasury.

In particular, the health accounts figures cannot be compared with those included in ONS’s earlier Expenditure on Healthcare in the UK series which ran from 1997 to 2013. An introduction to health accounts explains the differences between the old Expenditure on Healthcare and the new health accounts measure in detail.

As a result of Regulation (European Commission (EC)) Number 1338/2008 health accounts will be produced on a SHA 2011 basis across all EU and European Economic Area (EEA) nations from 2016, and will be available on the OECD database from summer 2016 onwards. A number of additional OECD member states (outside the EEA) are also adopting, or have already adopted the SHA 2011 definitions meaning that the UK data will be internationally comparable with a considerable numbers of countries.

While the data sources used to produce health accounts are generally comparable across 2013 and 2014, it should be noted that there is a difference in the data for adult social care services in England between these years. This is a result of the change in the HSCIC data collection for expenditure on these services, from the Personal Social Services Expenditure (PSS-EX1) collection to the Adult Social Care Financial Return (ASC-FR) collection. While a similar method for allocating expenditure from the ASC-FR return has been developed to that used for the PSS-EX1 data, the division of this spending by the categories of inpatient and home-based care is not fully comparable between the 2 years.

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7. Concepts and definitions

(Concepts and definitions describe the legislation governing the output and a description of the classifications used in the output.)

The UK health accounts have been developed in accordance with the concepts and definitions of the System of Health Accounts 2011 (SHA 2011) manual, jointly produced by the Organisation for Economic Co-operation and Development (OECD), Eurostat and the World Health Organisation (WHO).

Regulation (European Commission (EC)) Number 1338/2008 requires all EU and European Economic Area (EEA) nations to contribute to the three “core” SHA 2011 analysis tables: cross-tabulating healthcare function by financing scheme, healthcare function by healthcare provider, and healthcare provider by financing scheme.

The UK health accounts will include all three analysis tables, although due to derogations from certain elements of the regulation, the UK is not required to produce data analysed by provider for the voluntary insurance, non-profit institutions serving households (NPISH) and out-of-pocket financing schemes until 2018. In addition, derogations mean that the UK is not required to produce the healthcare function by healthcare provider table for any financing schemes other than government schemes until 2019.

The methodology developed by the UK for the first health accounts publication in 2016 was quality assured by the OECD health accounts team, who confirmed the UK methodology as compliant with the SHA 2011 definitions and the relevant European Commission regulation. In addition health accounts data delivered by the UK and other countries to the OECD, Eurostat and WHO are validated by the OECD annually to ensure continued compliance with the definitions.

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8. Other information

Output quality trade-offs

(Trade-offs are the extent to which different dimensions of quality are balanced against each other.)

Health accounts are produced annually on a t-2 basis (that is, 2015 health accounts produced in 2017) using a combination of calendar year and financial year data (for more information see the “Timeliness and punctuality” section). Due to the late availability of some elements of financial year data used in the health accounts, it is not possible to produce health accounts at an earlier stage. Producing health accounts on a t-1 basis (that is, 2016 health accounts produced in 2017) would require a large proportion of the data sources to be forecast.

Assessment of user needs and perceptions

(The processes for finding out about users and uses, and their views on the statistical products.)

Health accounts have been produced for the first time in 2016, and we have received interest in the statistics from policymakers and academic researchers across the field of health and social care.

We intend to undertake more stakeholder engagement work once the first set of health accounts statistics are available, to better understand who the users of health accounts are, what they require from healthcare expenditure statistics and how the health accounts could be further developed to meet these needs. We intend to hold a user event in late 2016 to enhance engagement with users. Anyone in the field of health and social care research or policy analysis with an interest in attending such an event is strongly encouraged to contact us at healthaccounts@ons.gov.uk.

The 2012 edition of Expenditure on Healthcare in the UK – the predecessor publication to health accounts – included an online user survey and the responses were used to improve the 2013 edition of the article. We also intend to hold user surveys on the health accounts publication in future, and any feedback or questions on the health accounts are welcome at healthaccounts@ons.gov.uk.

For more information on the existing uses of health accounts by international organisations – the Organisation for Economic Co-operation and Development (OECD), Eurostat and the World Health Organisation (WHO) – see the section on “Relevance”.

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9. Sources for further information or advice

Accessibility and clarity

(Accessibility is the ease with which users are able to access the data, also reflecting the format in which the data are available and the availability of supporting information. Clarity refers to the quality and sufficiency of the release details, illustrations and accompanying advice.)

Our recommended format for accessible content is a combination of HTML web pages for narrative, charts and graphs, with data being provided in usable formats such as CSV and Excel. We also offer users the option to download the narrative in PDF format. In some instances other software may be used, or may be available on request. Available formats for content published on our website but not produced by us, or referenced on our website but stored elsewhere, may vary. For further information please contact us at healthaccounts@ons.gov.uk.

For information regarding conditions of access to data, please refer to the following links:

Useful links

Other information and documentation on the topic of health accounts is also available:

  1. System of Health Accounts 2011 (OECD, Eurostat, WHO)

  2. An introduction to health accounts (ONS, 2015)

  3. System of Health Accounts 1.0 (OECD, 2000)

  4. Organisation for Economic Co-operation and Development (OECD) health statistics database

  5. Health at a Glance 2015 (OECD)

  6. Eurostat health statistics database

  7. Health accounts supporting methodology documentation:

  8. UN Classifications of the Functions of Government

  9. Expenditure on Healthcare in the UK 2013

  10. Personal Social Services: Expenditure and Unit Costs, England – 2013 to 2014 (HSCIC, 2014)

  11. Personal Social Services: Expenditure and Unit Costs, England – 2014 to 2015 (HSCIC, 2015)

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Contact details for this Methodology