QATAR NATIONAL HEALTH ACCOUNTS

Transcription

1 QATAR NATIONAL HEALTH ACCOUNTS REPORT

2

3 QATAR NATIONAL HEALTH ACCOUNTS REPORT 2014

4 2016 Ministry of Public Health Ministry of Public Health, Qatar P.O. Box 42 Doha, Qatar Printed in Qatar, 2016.

5 table of contents FOREWORD //4 ACKNOWLEDGEMENTS //5 ABBREVIATIONS //7 SUMMARY //8 CHAPTER 1 INTRODUCTION // INTRODUCTION TO QNHA SERIES // REPORT STRUCTURE //12 CHAPTER 2 HEALTHCARE SYSTEM IN QATAR 2014: OVERVIEW AND DEVELOPMENTS // DEMOGRAPHIC AND ECONOMIC DEVELOPMENT // HEALTHCARE SYSTEM IN QATAR: ORGANIZATION, GOVERNANCE AND FINANCING //18 CHAPTER 3 METHODOLOGY // METHODOLOGY OVERVIEW // DATA SOURCES AND ASSUMPTIONS // CHALLENGES AND WAY FORWARD //28 REFERENCES //60 FOOTNOTES //61 ANNEXES //62 KEY SHA 2011 CONCEPTS //62 SHA MATRIX 1: FS X HF (IN QAR MILLION) //68 SHA MATRIX 2: FS X FA (IN QAR MILLION) //70 SHA MATRIX 3: FA X HF (IN QAR MILLION) //72 SHA MATRIX 4: HF X HP (IN QAR MILLION) //74 SHA MATRIX 5: HF X HC (IN QAR MILLION) //76 SHA MATRIX 6: HP X HC (IN QARMILLION) //79 SHA MATRIX 7: HP X FP (IN QAR MILLION) //82 SHA MATRIX 8: CAPITAL ACCOUNT //83 CHAPTER 4 QATAR SYSTEM OF HEALTH ACCOUNTS 2014: FINDINGS //30 SUMMARY // FINANCING HEALTHCARE: SOURCES, REVENUES AND AGENTS // USES OF FUNDS: HEALTHCARE FUNCTIONS AND PROVIDERS // FACTORS OF HEALTH CARE PROVISION // GROSS CAPITAL FORMATION //51 CHAPTER 5 DISCUSSION //54

6 4 Qatar National Health Accounts Report 2014 foreword The Qatar National Health Accounts Report 2014 provides healthcare policy makers, healthcare providers, health insurance companies and the population of Qatar with the most comprehensive information on healthcare financing in Qatar. The National Health Accounts provide an all-inclusive review and analysis, both static and dynamic, of the financial flows through the healthcare system in Qatar. The current report follows a sound methodology developed in previous years and provides detailed answers to how healthcare was financed and how resources were utilized. The results show that total health funding increased to 20.8 billion QAR in 2014, or by 14.0 per cent compared to The report also highlights that while healthcare expenditure continued to grow, the growth rate slowed down considerably from 10.3 per cent per annum in 2013 to 3.1 per cent in 2014 when measured in per capita terms. This is a strong indication of normalization in healthcare expenditure growth. As in the previous years, a significant share, or 86.8 per cent, of healthcare expenditure was financed directly by the Government of Qatar. The general government expenditure on health which includes parastatal organizations reached 89.2 percent. This reflects the commitments and efforts of the State of Qatar Government to provide comprehensive healthcare services to all residents. The Qatar National Health Accounts Report 2014 was produced in close collaboration between the Supreme Council of Health (SCH) and its partners. This report would not have been possible without dedicated contributions from many organizations and individuals, representing both private and public healthcare and non-healthcare sectors. Information provided by the participants of the household health surveys, healthcare providers, governmental organizations and health insurance companies is gratefully acknowledged. We look forward to continuing support from all stakeholder organizations in the production of future reports.

7 foreword and acknowledgements 5 acknowledgements The Qatar National Health Accounts Report 2014 was produced with the close collaboration and support of many individuals and organizations. The overall project of establishment and institutionalization of the Qatar National Health Accounts was made possible due to the support of His Excellency Abdulla bin Khalid Al Qahtani, the Minister of Public Health. His Excellency Al Qahtani secured political support at the highest level and issued a Ministerial Decree to form the Steering Committee to cement the foundations of the National Health Accounts. Dr. Faleh Mohamed Hussain Ali, Assistant Secretary General for Policy Affairs provided leadership, guidance and support in the production of this report. Health Financing and Insurance Department (HFID) is responsible for the annual production of the Qatar National Health Accounts. Dr. Renata Hasanova, Manager of Health Economics, HFID, led and prepared the QNHA 2014 Report. Mrs. Eman Habib Sailani, Mr. Razick Abdulla Nariyankand and Mrs. Fadela Al-Mansouri formed QNHA technical team and Mrs. Lolwa Al-Kuwari provided administrative support. The QNHA team received valuable support from SCH departments, including the Policy Coordination and Innovation Unit (PCIU), Health Planning and Assessment Department (HPA), Finance Department (FD), National Health Strategy Project Management Office (NHS PMO) and the Translation Department (TD). Thorough review and feedback on the draft QNHA Report was provided by the healthcare sector experts: Mr. Husein Reka, Manager Health Insurance, HFID, SCH; Dr. Mohammed Bin Hamad Al-Thani, Director of Public Health, SCH; Mr. Steven Archer, Program Support Manager, NHS PMO, SCH; Dr. Tarik Mohammed Hassan, Specialist in Regulation and Policy, HFID, SCH; Mr. Steven Emery, Assistant Managing Director for Strategy and Business Development, Primary Health Care Corporation; and Dr. Declan O'Neill, Executive Director, Strategic Clinical Planning, Hamad Medical Corporation. Finally, the QNHA team is particularly grateful to all organizations who participated in the QNHA 2014 round for their support in data provision, dedicated discussions and continuous collaboration - all of which were crucial for the production of this report.

8 6 Qatar National Health Accounts Report 2014 acknowledgements PUBLIC HEALTHCARE PROVIDERS AND FINANCING AGENTS Aspetar - Orthopaedic and Sports Medicine Hospital Hamad Medical Corporation Ministry of Finance Ministry of Interior National Health Insurance Company naufar Primary Health Care Corporation Qatar Armed Forces and Amiri Guard Qatar Petroleum Qatar Red Crescent Society Sidra Medical and Research Center Supreme Council of Health Zakat Fund PRIVATE HEALTH INSURANCE PROVIDERS Al-Khaleej Takaful Group Al Koot Insurance & Reinsurance Company (partner with AXA) Allianz Worldwide Care Products American Life Insurance Company (MetLife) Arabia Insurance Company Daman Health Insurance Doha Bank Assurance Company Doha Insurance Company Libano-Suisse Insurance Company Medgulf Takaful B.S.C Qatar General Insurance and Reinsurance Qatar Islamic Insurance Company Qatar Life & Medical Insurance Company Qatar Takaful Insurance SEIB Insurance and Reinsurance Company Takaful International Co. PRIVATE HEALTHCARE PROVIDERS Al-Ahli Hospital Al Emadi Hospital Al Jaber Opticians Al Jazeera Medical Center Al Kayyali Medical Center Al Razi Dental Clinic Al Reem Dental Center Al-Wehda Dental Center Al-Wehda Medical Center American Hospital Cedar Dental Center Dilja Dental Center Doha Clinic Hospital Dr.Mamoun Hasan Chalabi Clinic Gulf Dental Center Icon Medical W.L.L Magrabi Center for Eye, ENT & Dental Magrabi Optical Naseem Al Rabeeh Medical Centre QDENT Dental Complex Sham Dental Center Teba Specialised Dental Center Zircon Dental Center NON-HEALTHCARE ORGANIZATIONS: STATISTICAL AND SURVEYING INSTITUTIONS, CAPITAL WORKS DEVELOPERS Ministry of Development Planning and Statistics Private Engineering Office Public Works Authority - Ashghal Social and Economic Survey Research Institute (SESRI) - Qatar University

9 acknowledgements and abbreviations 7 abbreviations AG CHE FA FP FS GCC GCF GDP GGEH HA HC HF HH HMC HP HUES MC MDPS MoF MoI MoPH n.e.c NHIC NHIS-Seha NPISH OECD OOP OTC PHCC PHI PPP QAF QCON QHFMP QNHA QHR QRCS SCH SCH AR SESRI SHA TA TCAM THE VHI WHO Amiri Guard Current health expenditure Financing Agents Factors for health care provision Revenues of health financing schemes Gulf Cooperation Council Gross capital formation Gross Domestic Product General Government expenditure on health Health accounts Health care functions Financing schemes Household Hamad Medical Corporation Health care providers Health utilization and expenditure survey Medical Commission Ministry of Development, Planning and Statistics Ministry of Finance Ministry of Interior Ministry of Public Health not elsewhere classified National Health Insurance Company National Health Insurance Scheme - Seha Non-for profit institution serving household Organization for Economic Cooperation and Development Out-of-pocket (health expenditure) Over-the-counter Drugs Primary Health Care Corporation Private health insurance Purchasing Power Parity Qatar Armed Forces Qatar Certificate of Need Qatar Healthcare Facilities Master Plan Qatar National Health Accounts (Report) Qatar Health Report Qatar Red Crescent Society Supreme Council of Health SCH Annual Report Social and Economic Survey Research Institute, University of Qatar System of Health Accounts Treatment abroad Traditional, complementary and alternative medicine Total health expenditure Voluntary health insurance World Health Organization

10 8 Qatar National Health Accounts Report 2014 summary The Qatar National Health Accounts (QNHA) Report is the prime source of information on healthcare expenditure estimates for the State of Qatar (Qatar). Understanding financial flows through the system is particularly important when the healthcare system goes through deep and rapid structural reform. The Health Accounts provide detailed information on current and capital expenditure, sources of funding and use of resources. The Report traces the development of expenditure statistics, aggregates and indicators through time and draws comparisons with relevant countries and regions. The Qatar National Health Accounts - built on the internationally adopted and standardized classification - provides the platform to understand and evaluate the financial impact of healthcare reform and is therefore important for policy-makers, healthcare providers and patients. The main findings of QNHA-2014: TOTAL EXPENDITURE ON HEALTH (THE) In 2014 Qatar spent 20.8 billion QAR in total on healthcare provision and investments. This represents an increase by 14.0% from 2013 estimate (18.3 billion QAR). The per capita expenditure has increased from 9,114 QAR in 2013 to 9,395 QAR in 2014 (an increase by 3.1%). The expenditure on healthcare provision current healthcare provision (CHE) was estimated at 18.2 billion QAR, or 87.4% of the total expenditure on health. The remaining 2.6 billion QAR (12.6%) was spent on gross capital formation (GCF). Overall, general government expenditure on health (GGEH), including funding through the parastatal organizations, amounted to 18.6 billion QAR or 89.5% of the total health expenditure. GGEH financed 16.0 billion QAR of current health expenditure (88.0% of CHE) and 2.58 billion QAR of capital formation (97.9% of GCF). CURRENT HEALTH EXPENDITURE (CHE) Healthcare Financing Schemes Government financed 15.8 billion QAR (86.7%) of CHE including: 14.9 billion QAR through internal transfers and grants; 0.9 billion QAR through transfers to the National Health Insurance Scheme Seha on behalf of the insured Qatari population. Private health insurance (voluntary prepayments by employers and individuals) financed 1.2 billion QAR or 6.4% of all revenues and CHE. Other domestic revenues financed 1.3 billion QAR (6.9% of CHE), including: Households financed 1.03 billion QAR, or 5.7% of CHE through the direct out-ofpocket expenditure and marginal charitable contributions; and Corporations contributed further 0.2 billion QAR (1.2% of CHE). The current healthcare expenditure from the government financing schemes were managed by the following entities: Supreme Council of Health was responsible for 2.9 billion QAR (16.1% of CHE); Hamad Medical Corporation absorbed 9.3 billion QAR (51.0% of CHE); Primary Health Care Corporation accounted for another 1.5 billion QAR (8.1% of CHE); The Ministry of Interior, Qatar Armed Forces and Amiri Guard managed 0.3 billion QAR (1.4% of CHE); National Health Insurance Company purchased 0.9 billion QAR (4.9% of CHE) of healthcare services; Aspire Zone Foundation, Qatar Foundation and Qatar Petroleum managed 1.2 billion QAR (6.4% of CHE).

11 summary 9 Services (Healthcare Functions) financed The 18.2 billion QAR of current healthcare expenditure was allocated to the following services: Curative inpatient care: 7.7 billion QAR (42.5%); Curative outpatient care: 4.2 billion QAR (23.3%); Ancillary services: 2.1 billion QAR (11.5%); Day curative and rehabilitative care: 0.6 billion QAR (3.4%); Long-term and home-based curative care: 0.2 billion QAR (1.1%); GROSS CAPITAL FORMATION (GCF) Investment in capital infrastructure, medical equipment and intellectual property was estimated at 2.63 billion in 2014 (3.2 billion QAR in 2013): 1.9 billion QAR (71.8%) of GCF was related to investment in physical healthcare infrastructure; 0.6 billion QAR (22.3%) was invested in equipment; and 0.2 billion QAR (5.9%) in intellectual property. Government revenues financed 2.58 billion QAR (97.9% of GCF). Preventive care: 0.2 billion QAR (1.3%); Medical goods: 1.7 billion QAR (9.6%); Governance and financing administration: 1.1 billion QAR (6.3%). Financing of healthcare providers The 18.2 billion QAR CHE was distributed to the following healthcare providers: Hospitals: 10.8 billion QAR (59.5%); Providers of ambulatory care: 2.8 billion QAR (15.3%); Providers of ancillary services: 0.7 billion QAR (3.6%); Retailers and other providers of medical goods: 0.4 billion QAR (2.0%); Providers of health care system administration and financing: 1.1 billion QAR (6.3%); Rest of the world (Treatment Abroad): 2.4 billion QAR (13.1%).

12 10 Qatar National Health Accounts Report 2014 introduction

13 1. introduction introduction to QNHA series The Supreme Council of Health (SCH) commenced the analysis of healthcare expenditure in the Qatar healthcare system through the System of Health Accounts (SHA) framework in The first Qatar National Health Accounts (QNHA) Report covered both calendar years and was based on the System of Health Accounts (SHA) 1.0 classification. Beginning from 2011, QNHAs transitioned to an updated SHA 2011 Edition developed by the Organization for Economic Cooperation and Development (OECD), World Health Organization (WHO) and the Eurostat [1]. The QNHA 2014 Report continues with the wellestablished methodology developed through previous QNHA rounds and extends where feasible. For QNHA 2014, the health expenditure data were collected from 1 : Healthcare providers, both private and public, including: Hamad Medical Corporation (HMC), Primary Health Care Corporation (PHCC), Aspetar Sports Orthopaedic and Medicine Hospital (Aspetar); Qatar Red Crescent Society (QRCS), private hospitals (Al Emadi, Al Ahli, Doha Clinic, and American Hospitals); and nineteen private outpatient clinics 2 ; Ministry of Finance as the financing agent; and the Supreme Council of Health as the financing agent, regulator of the health system and healthcare provider; Other governmental agencies involved in the provision of healthcare: Ministry of Interior, Qatar Armed Forces and Amiri Guard; parastatal organizations: Qatar Petroleum (QP) and Qatar Foundation (QF) through Sidra Medical and Research Center; The National Health Insurance Company (NHIC) and Private Health Insurance companies (PHI) registered and providing healthcare insurance to the residents in the State of Qatar during the reporting period; Population through the Health Utilization and Expenditure Survey (HUES) 2014; Public Works Authority Ashghal (Ashghal) and Private Engineering Office (PEO) as developers and construction agents for the healthcare sector capital formation; Relevant domestic and international macro and microeconomic indicators were sourced from the Ministry of Development, Planning and Statistics (MDPS) State of Qatar; WHO; World Bank (WB); and OECD. The Qatar National Health Accounts report summarizes the financial flows in the healthcare sector of Qatar in 2014, by: sources of financing, the use of funds, the agents involved in the collection, pooling and further purchasing of healthcare services. This information is processed and analyzed to understand the performance, efficiency and issues impacting the Qatar healthcare system.

14 12 Qatar National Health Accounts Report report structure HEALTHCARE SYSTEM IN QATAR: OVERVIEW AND DEVELOPMENTS This section provides a general background to the healthcare system in Qatar and outlines structural changes relevant to the financial architecture which took place during METHODOLOGY This section provides a description of improvements made in the application of SHA 2011 to construction of Qatar National Health Accounts; challenges faced by the QNHA team in data collection and processing; solutions and underlying assumptions to address those challenges and limitations that remain to be addressed in the future. QATAR SYSTEM OF HEALTH ACCOUNTS: FINDINGS This section outlines the main findings of QNHA Each dimension of health financing interface (financing, provision and consumption) is discussed with reference to: Box 1. Defining Healthcare Expenditure Health expenditure includes all expenditure for activities where the primary purpose is to restore, improve and maintain health of the individuals during a defined period of time (2014 calendar year). This definition applies regardless of the type of institution or entity providing or paying for the health activity and thereby covers all public and private healthcare providers. The total health expenditure are derived as a sum of current and capital expenditure on health. Unless stated otherwise, the expenditure are reported at current prices, with no adjustment for inflation; and are interpreted as 'nominal expenditure'. This implies that changes reflect the combined effect of price and volume changes. healthcare sector reform and development in 2014; comparison to the previous years funding; and comparison to the OECD and GCC relevant indicators. DISCUSSION This section extends the findings with an assessment of Qatar healthcare system performance against key financing indicators. Comparative analysis against selected countries and regions is given where relevant. Key reform implementation issues and their implications on healthcare expenditure are highlighted. ANNEXES Annexes contain definitions of the System of Health Accounts and core detailed SHA matrices.

15 1. introduction 13

16 14 Qatar National Health Accounts Report 2014 healthcare system in Qatar 2014: overview and developments

17 2. healthcare system in Qatar 2014: overview and developments demographic and economic development During 2014 Qatar maintained its position among the cluster of countries with very high level of human development, taking 32 nd position according to the United Nations Human Development Index [2]. The World Bank classifies Qatar among the High income non-oecd countries with Gross National Income (GNI) per capita rising from 89,210 US$ in 2013 to 92,200 US$ in 2014 [3]. As documented in previous SCH publications [4] [5], Qatar had been experiencing one of the fastest population growths in the world: the growth rate over period averaged at 11.0 per cent per annum [4] and population size more than tripled since 2000 (from thousand in 2000 to 2,316.2 thousand in 2014 [5] [6]). The population growth, together with the underlying demographical structure and population turnover, continue to pose substantial challenges to the design and provision of healthcare, fast and easy access, and efficient mechanisms of healthcare financing. Box 2. Qatar Selected Demographic Indicators The demographic structure of Qatar differs significantly from the rest of the world; OECD and high income countries in particular. The population is dominated by young males, resulting in high ratio of males to females, and large working age component. This is due to the large share of expatriate employees and has implications for health provision and planning. In 2013, the proportion of the population of working age (15-64 years old) was 84.1%. The age dependency ratio of 18.9 was considerably lower in comparison to the OECD average age-dependency ratio at 51.6, or 40.5 for the high income non-oecd countries. During 2014, the socio-demographic structure did not exhibit any substantial qualitative change. continued on page 16 Given the uniqueness of the population structure, QNHA developed the notion and model of the adjusted population in order to compare meaningfully the key performance indicators between Qatar and the rest of the world, including OECD countries. A statistical model, based on an imputation procedure, was used to produce an adjusted male population aged 25 to 60 years [7]. The extension of this model was followed in the subsequent reports, resulting in total adjusted population of 1,239 thousand for 2014.

18 16 Qatar National Health Accounts Report 2014 Box 2. continued The extraordinary population growth presents the first set of challenges to the healthcare system: the facilities and workforce must be carefully planned to meet current and future demand for healthcare. The underlying heterogeneous health profiles of population groups add another dimension to the challenge: although, on average, the population in Qatar is relatively young, the life-style factors are leading to worsening chronic conditions, including high obesity rates, high prevalence of diabetes and cardio- vascular diseases. In addition, the expatriate labour force (nearly three quarters of total population) is dominated by a young male population with a substantial proportion employed in high-risk occupational industries. Finally, high turnover rates of the migrant population generate profound effects on healthcare demand projections. Source: Qatar National Health Accounts 2013 [5] and references therein Non - Qatari Qatari % 15% 10% 5% 0% 0% 5% 10% 15% 20% Percent of total Non-Qatari population Female Male Percent of total Qatari population Female Male Figure B2.1: Population Pyramid 2014, Qatari and Non-Qatari Population Source MDPS

19 2. healthcare system in Qatar 2014: overview and developments 17

20 18 Qatar National Health Accounts Report healthcare system in Qatar: organization The Qatar National Health Accounts 2013 Report discussed in detail the Qatar healthcare system organization, governance and principles of financing [5]. There were no structural changes in the healthcare system organization, governance and financing during Box 3 provides a summary of QNHA 2013 discussion. The remainder of this section provides updates where relevant to Public and Semipublic Healthcare Provision and Funding Qatar has a long-standing tradition of public health care provision, with two main public providers: Hamad Medical Corporation (HMC) and Primary Health Care Corporation (PHCC). The history of healthcare sector development has been well documented in QNHAs 2009 to 2011 ([7] [8]). In 2014 HMC managed eight hospitals, five pediatric emergency centers, National Ambulance Services, Enaya Specialized (long-term) Care Center and home healthcare services. PHCC managed 21 healthcare clinics which provide a wide range of services, including preventative, curative, diagnostics, and home care. Both HMC and PHCC report to the Minister of Public Health. In 2014, HMC was responsible for 71.4 per cent of all hospital admissions in the country, 59.1 per cent of outpatient services and 81.2 per cent of accidents and emergency visits system wide [9]. PHCC provided 58.6 per cent of primary care visits (as a share of public and semi-public providers) [9]. In 2014, the public healthcare providers (HMC and PHCC) were funded through the State Government budget, while continuing the shadow-billing under the National Health Insurance Scheme (NHIS-Seha). According to the current analysis, the expenditure by HMC and PHCC accounted for 52.2 per cent and 8.2 per cent of the current health expenditure respectively. Given that both HMC and PHCC continued the shadow-billing arrangements under the National Health Insurance Scheme, the Ministry of Finance (MoF) was the ultimate financing agent for the public healthcare provision during Other public health care providers include Qatar Armed Forces (QAF), Amiri Guard (AG) and the Ministry of Interior (MoI), all of which operate employee clinics. The Qatar Petroleum (QP) classified as parastatal organization also runs clinics for its employees as well as employees of other organizations. The Qatar Red Crescent Society (QRCS) a not-for-profit organization operates workers primary health care centres on behalf of the SCH. In 2014 the expenditure of these entities, excluding capital formation, were 3.3 per cent of the current healthcare expenditure. Other semi-public, or parastatal, providers are Qatar Orthopaedic and Sports Medicine Hospital (Aspetar) part of the Aspire Zone Foundation, and the Sidra Medical and Research Centre (Sidra) the entity of the Qatar Foundation. Aspetar is a fully functional specialized hospital which provides both inpatient and outpatient services together with sophisticated diagnostics. While Sidra has not yet been operational in its capacity of providing specialized maternity and children services during 2014, its highly qualified specialists were contributing to the healthcare provision across the public healthcare system. The organizations were financed by the Aspire Zone Foundation and the Qatar Foundation respectively. The expenditure of these specialized hospitals, excluding capital formation, were 5.2 per cent of the current healthcare expenditure. Private Healthcare Provision and Funding The private providers in Qatar include hospitals, clinics and polyclinics, providers of ancillary services, pharmacies and others. In 2014 there were 4 private hospitals, around 300 medical and dental clinics and polyclinics, 32 diagnostic centers, and over 300 pharmacies and medicine stores [9].

21 2. healthcare system in Qatar 2014: overview and developments 19 Box 3. Healthcare system in Qatar: strategic development Healthcare is an important part of the present and future of Qatar. It is one of the cornerstones of Human, Social and Economic Development and is reflected in the Qatar National Development Vision (QNV) In order to achieve the Goals of the Vision, the Supreme Council of Health (SCH) Qatar s highest health authority developed the National Health Strategy (NHS) articulating the Health Sector contribution to the QNV. The NHS is a comprehensive and holistic package of reform and it is a tool to transform the health sector to provide the people of Qatar with the best possible care [19]. Alongside the NHS, SCH and its partners in the healthcare sector developed parallel strategies focusing on specific areas. By 2014 the following strategies were developed: - National Cancer Strategy ; - Qatar National Cancer Research Strategy; - National Primary Health Care Strategy ; - National Laboratory Integration and Standardization Strategy ; - Qatar National Mental Health Strategy Supreme Council of Health: role and responsibility The Supreme Council of Health guides the process of national reform in the health sector and ensures progress towards internationallyrenowned care. As a steward of health, SCH develops strategies, policies and programs to improve population health. It also monitors and evaluates progress towards achieving national goals. SCH entrusts responsibility for health care provision to public, semi-public and private providers, regulates all service providers, and is responsible for the planning of health care services and designing the principles of financial architecture. During 2014 private providers generated revenues from patients (out-of-pocket expenditure), private health insurance and the National Health Insurance Scheme-Seha, if a provider was a member of the NHIS-Seha network. Estimated expenditure of the private providers, excluding capital formation, were 11.6 per cent of the current healthcare expenditure. National Health Insurance Scheme - Seha During 2014 NHIS-Seha continued its expansion in membership, provided services and providers network: - Covered members: on 30 April 2014 the NHIS-Seha was extended to all Qatari citizens, after successful completion of the pilot stage 3 ; - Covered services: on 30 April 2014 the schedule of benefits was extended to full healthcare service coverage and complemented with the dental package in June 2014; - Provider network 4 was expanded significantly to be able to provide Qatari nationals with comprehensive healthcare coverage, as was defined by the schedule of benefits; to maintain the choice of the providers and to improve competition. The private provider membership had increased from 8 at the end of 2013 to 177 by the end of 2014 [10]. In addition, 7 out of 8 HMC hospitals and 2 out of 21 PHCC centers were accepted to the network [10]. Further details of healthcare system organization and governance; up-to-date structural changes and challenges can be found in the SCH Annual Reports [10] [11] and Qatar Health Reports [4][9]. Sources: Qatar National Health Accounts Report 2013 [5], Supreme Council of Health Annual Report 2014 [10] and references therein

22 20 Qatar National Health Accounts Report 2014 CAPITAL EXPENDITURE Qatar's healthcare sector is going through a tremendous capital expansion phase, in line with the overall economic development of the country. According to the SCH Annual Report, during 2014, SCH, HMC and PHCC advanced the design, planning and construction of 73 new health facilities and 45 renovation projects. The scope of construction and renovation was wide and included 10 hospitals, 25 health centers, 7 Medical Commission centers, 17 specialized facilities, and 13 support facilities. It is projected that by 2022 the number of hospital beds will grow to 4,701 from 2,100 in 2014 [10]. The healthcare infrastructure needs were first holistically articulated by the Qatar Healthcare Facilities Master Plan (QHFMP) QHFMP is the 20-year blueprint which provides a detailed and comprehensive vision for the future of health facilities in Qatar [12] [13]. The Qatar Certificate of Needs (QCON) provides further regulatory framework for major healthcare infrastructure and investments. Box 4 discusses QHFMP and QCON in greater detail. It is expected that Qatar will continue expanding its healthcare capital formation at the pace needed to meet the demand. Similar to 2013, a significant number of healthcare facilities were designed, developed and constructed by the Public Works Authority Ashghal (21 facilities) and the Private Engineering Office (6 facilities). Capital projects of these organizations were financed directly by the Ministry of Finance with total capital expenditure estimated at 2.63 billion QAR Construction Design Planning Total Figure 2.2: Healthcare Expansion, Facilities Sources: from SCH AR 2013 [14]; 2014 from SCH AR 2014 [10]

23 2. healthcare system in Qatar 2014: overview and developments 21 Box 4. Qatar Healthcare Facilities Master Plan (QHFMP) and Qatar Certificate of Needs (QCON) 2,100 2,629 2,789 3,522 4,701 The Qatar Healthcare Facilities Master Plan (QHFMP) is a strategic plan, which provides a detailed and comprehensive vision for the future of health facilities in Qatar. The project was completed in November 2013 and launched in September 2014 [12]. The QHFMP provided the first set of estimates for the growth and composition of key healthcare infrastructure for the next two decades. The project delivered the numbers, types, location and illustrative costs for hospitals, primary health care centers, pharmacies and major medical equipment required up to The cost estimates produced by the QHFMP are being continuously updated as projected facilities are refined. The Qatar Certificate of Needs (QCON) Programmes is another important element to shape capital formation in the healthcare sector. The QCON regulates major healthcare infrastructure and investments and aims at: review and rationalization of health care facilities costs alongside with coordinated planning of services and construction of new facilities, thereby improving access to and quality of healthcare provision; regulation of healthcare provision by facilitating sufficient capacity to meet demonstrated healthcare needs, and Hospital Beds, Health Centers, Hospitals, Figure 2.3: Healthcare Expansion, public sector, projections ( ) Source SCH AR 2014 [10] increasing access to care for patients by making the right services available in the right place at the right time. Sources: Qatar National Health Accounts Report 2013 [5] and references therein

24 22 Qatar National Health Accounts Report 2014 methodology

25 3. methodology overview The QNHA 2014 followed the same methodological advancements developed in QNHA 2013 with the following modifications and refinements: 1. Estimation of out-of-pocket (OOP) expenditure in QNHA 2014 was based on the healthcare providers information and cross-referenced with Health Utilization and Expenditure Survey (HUES) of In addition to being consistent with QNHA 2013, this approach provides a greater degree of accuracy compared to OOP estimates in QNHA 2011 and 2012 [5]. Reported patients revenues from large healthcare providers (HMC, PHCC, all private hospitals, Aspetar, Qatar Red Crescent Society workers clinics, QP clinics) formed the major bulk of OOP estimations. Notwithstanding the improvements in data collection from the private sector clinics and policlinics (discussed in 3 below), the HUES information was used for OOP estimation at the private small healthcare sector providers (clinics, pharmacies, over-the-counter medication and medical devices). While use of the survey based information introduces an uncertainty in the OOP estimation 7 and therefore overall healthcare expenditure, repeated use of consistent information sources allows for reliable understanding of trends in healthcare expenditure. Contrary to the previous rounds, QNHA 2014 separates cost-sharing associated with the public healthcare provision from the OOP sustained at the direct contact with healthcare system. 2. Consistent with the QNHA 2013, overhead costs associated with healthcare providers administration were allocated in proportion to the expenditure of the direct cost centers. This approach is attuned with the Costing Standards 8 mandated in 2013 and will be refined as providers improve their capabilities to apportion administration costs with better accuracy. 3. Building on QNHA 2013, the 2014 data collection round was further extended to cover private polyclinics and other smaller providers. Compared to QNHA 2013, both the response rate and the coverage were improved substantially: 19 out of 51 surveyed clinics provided partial or complete information. The provided information allowed for: greater specificity in defining factors of provision distribution for the private outpatient sector; and additional cross-referencing with the NHIS and private insurance instruments. 4. Building on the QNHA 2013, capital formation data was collected from both public sector capital works developers (Ashghal and PEO) and private sector healthcare providers (hospitals and polyclinics). 5. QNHA 2014 extended information collected from the private health insurers to understand cost-sharing policy of the private health insurance market. Estimated value of deductables, co-payments and co-insurance was provided by 3 out of 16 companies. Given the low rate of response and insufficient coverage, estimates of the cost-sharing with the private health insurance market were not included in the QNHA The accuracy and comprehensiveness of private health insurance cost-sharing policies will be addressed by subsequent QNHA rounds. 6. Contrary to the previous QNHA rounds, QNHA 2014 does not report financing from the rest of the world. QNHAs 2011 and 2013 applied the rest of the world concept to balance the gap between the value of healthcare services financed through the private health insurance as reported by the private hospitals with the expenditure counterpart as reported by the private health insurers. The availability of NHIS data allowed for the first time to understand the reasons behind the gap explained by the length of claims processing cycles, resubmissions, claims audits and recoveries. This finding eliminated the need to rely on rest of the world for triangulation purposes.

26 24 Qatar National Health Accounts Report data sources and assumptions GENERAL NOTES NOTES ON DATA SOURCES Financial information on expenditure and revenues was collected from health care providers, health insurance companies, governmental agencies and the general population. Demographic and macroeconomic trends were sourced from the official national statistical offices. In the absence of official information, sources used in previous QNHA reports were used to ensure continuity and consistency. In order to achieve granularity required by the SHA classification, estimation of some data points required set of assumptions. This was particularly relevant to the healthcare functions mapping to classifications. The details are explained below. QNHA team received financial information for both fiscal and calendar years 9. Where possible, suppliers of the information provided quarterly data disaggregation for 2014 and 2015 in order to arrive at calendar year estimates. The calendar year approximations were particularly challenging where information providers relied on cash, rather than accrual, basis during the reporting period. International information was sourced from the OECD Health Statistics [15] for the OECD countries and WHO for the GCC region [16]. PUBLIC FINANCING AGENTS AND PROVIDERS Ministry of Finance (MoF) Similar to the previous years, information received from the Ministry of Finance provided the breakdown of expenditure at the high levels of expenditure: remuneration to the labour force (wages and salaries), services and materials used and capital expenditure. The information was also limited to the direct financing of the healthcare sector agents. The MoF information was used for triangulation purposes to ensure consistency with the information received from public healthcare providers. Supreme Council of Health (SCH) In addition to its role as a supervisor and the regulator of healthcare provision, SCH also directly financed the expenditure for: Treatment Abroad programme; Operations of Qatar Red Crescent Society on behalf of the SCH in workers healthcare clinics; Expenditure related to the construction of naufar 10 a new highly specialized mental health care facility; and Prevention programs such as screening services provided through the SCH Medical Commission, vaccination campaigns, awareness campaigns and others.

27 3. methodology 25 Ministry of Interior, Qatar Armed Forces and Amiri Guard Expenditure related to treatment abroad (TA) was allocated to specialized inpatient curative care (HC.1.1.2) received from the overseas providers. This is based on the fact that the Medical Commission Committee for Treatment Abroad (currently operated by the HMC) approves treatment overseas based on the urgency of healthcare required and availability of highly specialized healthcare in Qatar. The analysis of household information (HUES 2014) also confirmed that treatment abroad was mainly for satisfying the demand for highly specialized healthcare. QNHA 2014 maintained classification FP.M for the factors of provision by the providers (HP.9) from the rest-of-the-world (RoW). While preparing this Report, the QNHA team had become aware of a number of preventative healthcare initiatives and programmes conducted within SCH. Many of these programs were initiated late early Due to the challenges associated with accurate separation of the preventative care provision from the administrative and regulatory roles of the SCH departments, and in line with the practice of previous rounds, allocation of all SCH expenditure to the healthcare system administration and governance function (HC.7.1) was maintained. The QNHA will address this limitation in the subsequent reports and will be supported by the advanced outputs of the NHS projects, including: Preventative Health Governance (NHS project 3.1), SCH Capacity Build-Up (NHS project 5.1), and Budgeting Process for Public Health Sector Spending (NHS project 6.1). Similar to the previous years, the provided data were reported at high-level aggregates of expenditure. Employed professional staff numbers were used as allocation keys to estimate outpatient functions (general, dental and specialized). Capital Projects: Public Works Authority Ashghal and Private Engineering Office The QNHA 2013 surveyed the Ashghal and the PEO for the first time. For QNHA 2013 Ashghal submitted the information as requested and PEO expenditure were estimated based on the SCH databases. For QNHA 2014 both organizations submitted the information, however different underlying methodologies were applied. Ashghal provided data based on certified works a close approximation to accrual based reporting required by the SHA classifications. PEO submitted actual or cash-based expenditure. Therefore a direct comparison of total capital expenditure estimates with QNHA 2013 should be treated with caution. Public Providers: HMC and PHCC Hamad Medical Corporation and Primary Health Care Corporation were extensively consulted with throughout the process. Two main types of information were provided: general ledger for healthcare expenditure, including minor capital works; and patient revenues for the refinement of the OOP estimations. The general ledger data required a careful approach to the allocation of expenditure to the healthcare functions and was the most time-intensive part of the QNHA 2014 compilation. Both organizations reported information based on the calendar year. Out-of-pocket expenditure sustained at these providers were allocated to specialized outpatient, inpatient (including dental) and ancillary services in line with the Law No. 7 of 1996 Organizing Medical Treatment and Health Services within the State [17].

28 26 Qatar National Health Accounts Report 2014 PARASTATAL PROVIDERS QNHA collected information from Sidra Medical and Research Center (Sidra), Aspetar Orthopaedic and Sports Medicine Hospital (Aspetar) and Qatar Petroleum clinics (QP). During 2014 these organizations were funded by a mix of direct Government funding and through their umbrella organizations Qatar Foundation, Aspire Zone Foundation and Qatar Petroleum respectively all under public control. There were no changes in classifications applied to Aspetar and QP healthcare provision compared to QNHA 2014 used Sidra expenditure for healthcare services provision only. In light of this finding, QNHA 2014 uses NHIS and private health insurance expenditure information as the upper ceiling for private sector providers revenues derived from the insurance schemes. Other information reported by the hospitals patients revenues, healthcare functions distribution, capital expenditure, factors of provision enter the current report without any additional adjustments. This also implies that the RoW financing schemes and revenues (HF.4, FS.7, FA.6) do not form a part of the QNHA Finally, 3 out of 4 private hospitals provided sufficient information for detailed allocation of factors of provision. Private Clinics PRIVATE PROVIDERS Private Hospitals All private hospitals provided information aggregated to the levels and classifications required for the QNHA All hospitals supplied expenditure and revenues information. The revenues information reported by sources National Health Insurance (NHIS), private health insurance, direct payments by patients and the employers allowed for appropriate allocation to the financing schemes and financing agents. The availability of NHIS data allowed us, for the first time, to understand the reason behind the gap consistently found when triangulating the private health insurance expenditure for services provided by private hospitals and revenues of private hospitals from the private insurance 11. The analysis of the NHIS data confirmed that hospitals tend to report higher revenues (2-15 per cent) than the insurance counterpart. This difference is due to claims processing cycles, resubmissions, claims audits and recoveries. Fifty one selected private outpatient healthcare providers with services in general, specialized, dental, optical and rehabilitative fields, were sent the requests for the information. The selection was based on providers relative sizes according to the NHIS claims volumes and values. Nineteen providers returned fully or partially completed instruments. Similar to private hospitals, information was crossreferenced with the NHIS claims data. Compared to private hospitals, the degree of deviation on average was smaller, with both positive and negative deviations observed. QNHA 2014 therefore used a similar approach to that applied for private hospitals in relying on private health insurance and NHIS financing of private outpatient sector. The reported factors of provision were averaged out for dental and medical clinics. The overall expenditure for the private sector was estimated based on insurance and HUES 2014 information. QNHA team will continue working closely with the private healthcare sector, including extending data collection to the pharmacies and diagnostic centers, in the coming QNHA rounds.

29 3. methodology 27 FINANCING AGENTS LANDSCAPE IN 2014 Consistent with QNHA 2013, the current report recognizes the funding position of the SCH by integrating HMC, PHCC, QRCS and nuafar under the SCH (financing agent FA.1.1.1), which is equivalent to the Ministry of Health in other international reporting. Most of the expenditure associated with the SCH functioning remained to be classified as HC.7 Governance, Health System and Financing Administration and HP.7 Providers of Healthcare System Administration and Financing. As discussed above, QNHA 2014 did not extract the expenditure on preventive care with sufficient degree of accuracy for reliable reporting. The expenditures of QRCS, PHCC and HMC fit under the categories of HC.1 HC.6 for the curative, preventative and rehabilitative care. Both National Health Insurance Company and private health insurers enter the QNHA as per established classifications. In addition to standardized private health insurance instrument, QNHA 2014 attempted to collect information on deductables, copayments and coinsurance policies. Three out of 16 insurers provided approximations to those estimates. Due to coverage and insufficient accuracy, these estimates were excluded from the computations. This will be addressed in the subsequent rounds of the QNHA. Households as a financing agent (FA.5) entered the QNHA as per previously established classifications with one exception: QNHA 2014 has been able to separate the cost-sharing expenditure by the households for public healthcare provision (contribution in a form of health card). The Aspire Zone Foundation, Ministry of Interior, Qatar Armed Forces and Amiri Guard, Qatar Foundation and Qatar Petroleum remain classified as financing agents under appropriate FA codes. This is based on the underlying arrangements where the entities receive financial resources from the state budget directly and manage those resources to finance provision of healthcare services by a wide range of relatively autonomous (managerially) clinics or hospitals under their control. In addition to the central government budget, Aspetar and QP clinics derive their revenues from the private health insurance companies, and direct payments by the households.

30 28 Qatar National Health Accounts Report challenges and way forward QNHAs are progressively providing more comprehensive and detailed information with increasing accuracy. Nevertheless, there are persistent challenges and newly identified complexities which are to be addressed in the subsequent rounds. These include: Analysis of healthcare expenditure by the beneficiaries characteristics (age and gender composition); Identifying structure of healthcare expenditure by diseases; Separation of medical research and social programs expenditure from the healthcare expenditure; Better separation of long term and rehabilitative care from curative care; Development and implementation of methodology for capital consumption; refinement of capital formation estimation; Identifying households contribution in a form of cost sharing with the private health insurers; Improving coverage of semi-public and private healthcare sector, including large employers, outpatient clinics, pharmacies and diagnostic centers. Accurate reflection of healthcare expenditure on preventive care. This includes comprehensive assessment and estimation of preventative care efforts by the SCH, healthcare providers (both public and private), but also reflecting the role of nonhealthcare providers such as Qatar Diabetes Association, large employers and other;

31

32 30 Qatar National Health Accounts Report 2014 Qatar system of health accounts 2014: findings

33 4. Qatar system of health accounts 2014: findings 31 summary In 2014 the healthcare system mobilized and spent billion QAR. This represents an increase of 14.0% compared to Current expenditure on health (CHE) increased to billion QAR, or by 20.4% since Investments in healthcare infrastructure and equipment (Gross capital formation GCF) were estimated at 2.63 billion QAR. Growth in total expenditure on health exceeded population growth of 10.6%. Similar trends were observed in previous years. It is worthwhile to note that 2014 is the second consecutive year showing slowdown in the healthcare expenditure growth rates. A major driver of healthcare expenditure increase was a growth in current expenditure for the provision of healthcare services. The estimated lower investments in healthcare infrastructure should be interpreted with caution due to the nature of capital formation and differences in reporting compared to 2013 (see Section 3). Government directly financed billion QAR (86.7%) of current health expenditure and 2.58 billion QAR (97.9%) of gross capital formation. General government expenditure on health (GGEH 12 ) reached billion QAR (89.2% of total health expenditure), while private financing contributed 2.19 billion QAR (10.8% of total health expenditure). Most of the expenditure was directed towards inpatient curative care 7.72 billion QAR (42.5% of the current health expenditure) with government contributing 7.30 billion (or 94.6% of inpatient curative care). Hospitals were the major recipients of funding receiving billion QAR (59.5% of current health expenditure) with government financing 9.97 billion QAR (92.2% of hospital financing). Qatar THE (Total Health Expenditure) CHE (Current Health Expenditure) GHF (Gross Capital Formation) 2013 Billion QAR Figure 4.1: Healthcare Expenditure: Billion QAR The section presents Qatar SHA results for 2014 across the following dimensions: Financing arrangements. This outlines the structure of health care revenues and expenditure by financing schemes and financing agents, including analysis and cross country comparison. Use of funds. This outlines the structure of health care expenditure by healthcare functions and healthcare providers, including analysis and cross country comparison Factors of health care provision. This outlines the structure of health care expenditure by factors of provision. Gross Capital Formation (GCF). Growth % The findings presented in this section are subject to the limitations discussed in Section 3.3.

34 32 Qatar National Health Accounts Report financing healthcare: sources, revenues and agents FINANCING HEALTHCARE: SOURCES Three financing arrangements were in charge of mobilizing, managing and/or purchasing (Figures ): Qatar 2013 Billion QAR 2014 Billion QAR Growth % Governmental financing schemes (HF.1) accounted for billion QAR of expenditure, or 86.7% of CHE an increase of 26.6 % compared to This is inclusive of Government Schemes (HF.1.1) and Compulsory contributory health insurance schemes (NHIS Seha) (HF.1.2). Voluntary healthcare payment schemes (HF.2) contributed 1.38 billion QAR, or 7.6% of CHE and an increase of 3.0% from HF.1 Government HF.2 Voluntary payments HF.3 Household OOP Figure 4.2: Healthcare Financing Schemes (HF): Household (HH) Out of Pocket (OOP) schemes (HF.3) accounted for billion QAR, or 5.6% of CHE an absolute contribution remaining stable compared to % HF.1.2 NHIS-Seha 5.6% HF.3 Household OOP 7.6% HF.2 Voluntary healthcare payment 5.6% 4.9% 81.8% 81.8% HF.1.1 Government schemes 7.6% Figure 4.3: Structure of healthcare financing by schemes

35 4. Qatar system of health accounts 2014: findings 33 FINANCING HEALTHCARE: REVENUES The Government was the major source of revenue (FS.1) contributing billion (86.7%) to the CHE and billion QAR (88.2 %) to the overall funding. Similar to the previous years, almost all funds allocated to GCF came from the Government (2.58 billion QAR or 97.9%). Revenues of schemes FS.1 Government FS.5 Voluntary Prepayment FS.6 Other Domestic Revenues Share of (%) Revenues of the financing scheme (HF) by financing sources (FS) FS.1.1 Internal Transfers and Grants FS.1.2 Transfers by Government on behalf of specific groups FS.1.4 Other transfers from government domestic revenue FS.5.9 Other Voluntary prepaid revenues FS.6.1 Households FS.6.2 Corporations Total CHE THE HF.1 Government 14, , % 75.8% HF.1.1 Government Schemes HF.1.2 Compulsory contributory health insurance schemes (SEHA) HF.2 Voluntary healthcare payment 14, , % 71.5% % 4.3% , , % 6.6% HF.3 Household OOP , , % 4.9% HF.4 Rest of the world Current expenditure on health (CHE) 14, , , , % 87.4% 81.1% 4.9% 0.8% 6.4% 5.7% 1.2% 100% Gross capital formation (GCF) Total health expenditure (THE=CHE+GCF) 2, , % 17, , , , % 83.2% 4.3% 0.6% 5.6% 4.9% 1.3% 100.0% Figure 4.4: Healthcare expenditure by revenues and financing schemes (in Million QAR)

36 34 Qatar National Health Accounts Report 2014 FINANCING HEALTHCARE: AGENTS Voluntary healthcare payment schemes (HF.2) at 1.38 billion QAR contributed 7.6% of the CHE with revenues from: voluntary health insurance premiums (FS.5.9) at 1.16 billion QAR (83.5% of HF.2 or 6.4% of CHE); enterprise financing scheme (FS.6.2) 0.22 billion QAR (16.2% of HF.2 or 1.2% of CHE) and a marginal contribution from the Households (FS.6.1) channeled through the charity organizations. Household OOP (HF.3) were financed entirely by the households revenues (FS.6.1) at 1.03 billion, or 5.6% of the CHE. SHA Matrix 1 (Annex) provides further details. The financing agents landscape includes General Government (FA.1), insurance corporations (FA.2), corporations (FA.3), non-profit institutions serving households (FA.4) and households (FA.5). Consistent with previous years, general government (FA.1) as an agent managed and financed a substantial share of current health expenditure 14.8 billion QAR or 81.5% of CHE. This includes: - the provision of healthcare services by the HMC, PHCC, SCH, other Ministries and Military forces; and - insurance services provided by the National Health Insurance Company for the Qatari population. Insurance corporations (FA.2), other corporations (FA.3), households (FA.5) financed 1.16, 1.17 and 1.03 billion QAR respectively. Zakat Fund (FA.4) managed the financing of 5.1 million QAR. 12.0% Other Agents (FA.2, FA.4, FA.5, FA.6) Figures 4.5 and 4.6 provide details of the relative distribution of financing agents activities in % Commercial Insurance Companies 0.03% Non-Profit (Zakat Fund) 5.6% Households 6.4% 12.0% 81.5% 9.9% PHCC 6.0% NHIC 1.7% Other Ministries 81.5% General Government 62.5% HMC 19.8% SCH 6.4% Corporations 1.6% Aspire Zone Foundation General Government (FA.1) 3.6% Qatar Foundation Corporations (FA.3) 1.2% Qatar Petroleum Other Agents (FA.2, FA.4, FA.5, FA.6) Figure 4.5: Structure of the current healthcare expenditure (CHE) by financing agents

37 4. Qatar system of health accounts 2014: findings 35 The government revenues (FS.1) 15.8 billion QAR for current healthcare expenditure were managed by the HMC, PHCC, SCH, other Ministries and the NHIC. HMC was responsible for managing and delivering 9.3 billion QAR of services directly financed by the government (58.8% of FS.1 and 51.0% of CHE). The second highest share of funding was managed by the SCH with 2.9 billion QAR (18.6% out of FS.1 and 16.1% of CHE). PHCC managed 1.5 billion QAR (9.3% of FS.1 and 8.1% of CHE). In April 2014, NHIS-Seha was rolled out to all Qatari Nationals and was financed by the Government as per the Social Health Insurance Law No.7 of NHIC, as an organization responsible for administration of the Scheme, managed 0.9 billion QAR (4.9% of CHE). Figures 4.6 and 4.7 shows a further breakdown of expenditure by financing agents and schemes. Revenues of schemes Revenues of Schemes (FS) and Financing Agents (FA) FS.1.1 Internal Transfers and Grants FS.1 Government FS.1.2 Transfers by Government on behalf of specific groups FS.5 Voluntary Prepayment FS.5.9 Other Voluntary prepaid revenues FS.6.1 Households FS.6 Other Domestic Revenues FS.6.2 Corporations Total CHE Share of (%) THE FA.1 General Government 13, , % 71.2% FA.1.1 Central Government 13, , % FA Supreme Council of Health 13, , % FA Other Ministries and Public Units % FA Ministry of Finance FA Ministry of Interior % FA Armed Forces and Amiri Guard % FA National Health Insurance Agency - NHIC % FA.2 Insurance Corporations - - 1, , % 5.6% FA.2.1 Commercial Insurance Companies - - 1, , % FA.3 Corporations (other than insurance corporations) FA.3.2 Corporations (other than providers of health services) , % 5.6% , % FA Aspire Zone Foundation % FA Qatar Foundation % FA Qatar Petroleum % FA.4 Non-Profit Institutions serving households (NPISHs) % 0.02% FA.4.1 Zakat Fund % FA.5 Households , , % 4.9% Current Financing Schemes 14, , , , % Capital Formation 2, , % Total Financing Schemes 17, , , , % Figure 4.6: Healthcare revenues by revenues of schemes and agents (in million QAR)

38 36 Qatar National Health Accounts Report 2014 In addition to that already discussed, SCH, HMC and PHCC managed 0.7 billion QAR of capital formation. This is inclusive of IT, ICT, major medical equipment, major repairs and similar capital formation items. The buildup of the major facilities infrastructure hospitals and medical centers estimated at 1.8 billion QAR during 2014 was financed directly by the Ministry of Finance (FA ) through two main construction developers: the Public Works Authority Ashghal and the Private Engineering Office. The direct financing of construction of Sidra Medical and Research Center hospital by the MoF is also included in 1.8 billion. Financing Schemes HF.1 Government Financing Agents HF.1.1 Government Schemes HF.1.2 Compulsory Contributory Health Insurance Schemes HF.2 Voluntary healthcare payment HF.3 Household OOP CHE GCF THE FA.1 General Government 13, , , ,381.1 FA.1.1 Central Government 13, , , ,381.1 FA Supreme Council of Health 13, , ,390.9 FA Other Ministries and Public Units , ,090.6 FA Ministry of Finance , ,816.8 FA Ministry of Interior FA Armed Forces and Amiri Guard FA National Health Insurance Agency - NHIC FA.2 Insurance Corporations - - 1, , ,156.0 FA.2.1 Commercial Insurance Companies - - 1, , ,156.0 FA.3 Corporations (other than insurance corporations) , ,252.4 FA.3.1 Health Management and provider corporations FA.3.2 Corporations (other than providers of health services) , ,197.5 FA Aspire Zone Foundation FA Qatar Foundation FA Qatar Petroleum FA.4 Non-Profit Institutions serving households (NPISHs) FA.4.1 Zakat Fund FA.5 Households , , ,027.2 FA.6 Rest of the World Total Financing Schemes 14, , , , , ,821.8 Figure 4.7: Healthcare expenditure by financing schemes and agents (in million QAR)

39 4. Qatar system of health accounts 2014: findings 37 FINANCING HEALTHCARE: TRENDS Total health care financing increased by 14.0% from18.26 billion QAR in 2013 to billion QAR in Substantially higher growth rates were observed in previous years: 20.6% and 25.3% for 2013 and 2012 respectively. Similar to previous years, most of the growth in 2014 was due to the expansion of current health expenditure by 20.4% from billion QAR to billion QAR. Estimate of gross capital formation was lower in 2014 at 2.63 billion QAR 13 (compared to 3.15 billion in 2013). The dynamics over 2013 and 2014 suggests that expenditure growth had slowed down to 14.0% in 2014 from 25.3% in The per capita indicators show a similar trend (see section 5 of the current report). Similar to previous years, the healthcare expenditure growth was met through an increase in financing from government sources (from to billion QAR, or 16.4%). Absolute contributions from employers and households remained stable at 1.44 and 1.03 billion QAR respectively. 25,000 20,822 20,000 18,261 1,031 1,436 15,143 1,038 1,460 15,000 12,088 1,294 1,186 10,000 9,376 9,530 1,507 1, ,665 1,116 5,000 Government Employers Households 7,158 7,166 9,307 12,663 15,763 18,356 Total health expenditure (THE=CHE+GCF) Figure 4.8: Comparison of healthcare financing by schemes and years (in million QAR)

40 38 Qatar National Health Accounts Report 2014 FINANCING HEALTHCARE: COMPARISON WITH OECD Qatar differs significantly from all OECD countries with a high share of gross capital formation (GCF) in total health expenditure (THE). This is in line with continued healthcare infrastructure expansion. The share of voluntary private health insurance in Qatar (6.4% of CHE) was comparable with the average of OECD (6.6% of CHE) and in line with past observations. Consistent with previous years and reflecting the Qatar Government efforts in financing healthcare, the share of out-of-pocket expenditure (5.6% of CHE) was lower than OECD average (19.7%) Household Out-of-Pocket (% CHE) Private Insurance (% CHE) Qatar Lowest 5 observations Average, OECD Highest 5 observations 0.0 Qatar Lowest 5 observations 0.4 Average, OECD Highest 5 observations Figure 4.9: Gross Capital Formation (% THE): Qatar (2014) and OECD (2014 or latest available) Source: Current report, OECD [15] Figure 4.10: Household out-of-pocket payments and private insurance (% CHE): Qatar (2014) and OECD (2014 or latest available) Source: Current report, OECD [15]

41 4. Qatar system of health accounts 2014: findings uses of funds: healthcare functions and providers HEALTHCARE FUNCTIONS Similar to previous years and as expected, the expenditure on curative care (HC.1) was the most significant: billion QAR, or 68.1% of CHE. Medical goods (HC.5) at 1.75 billion QAR and Ancillary services (HC.4) at 2.09 billion QAR contributed another 9.6% and 11.5% respectively. The Governance and Financing Administration (HC.7) of the Healthcare system was estimated at 1.14 billion QAR, or 6.3% of CHE. Qatar HC.1 Curative care HC.2 Rehabilitative care 2013 Billion QAR 2014 Billion QAR Growth % Compared to 2013, most of the healthcare functions specific expenditure have increased. Long-term care (HC.3) recorded a marginal decrease. Within curative care, expenditure on inpatient services (HC.1.1) were estimated at 7.72 billion QAR (42.4% of CHE), a growth by 0.96 billion QAR (14.1%) from Expenditure on outpatient curative care were estimated at 4.23 billion QAR (23.3% of CHE), an increase by 0.47 billion QAR (12.6%) from The Government Schemes (HF.1) financed billion QAR of all healthcare functions (86.7 % of CHE). HC.3 Long-term care HC.4 Ancillary services HC.5 Medical goods HC.6 Preventive care HC.7 Governance & Administration Figure 4.11: Expenditure by Healthcare Functions (HC): % HC.9 Other health care services not elsewhere classified (n.e.c) 68.1% Curative Care 4.5% Other Care 42.5% 9.6% 9.6% 11.5% 6.3% 4.5% 68.1% HC.1.1 Inpatient curative care HC.1 Curative care 23.3% HC.1.3 Outpatient curative care 1.7% HC.1.2 Day curative care 0.7% HC.1.4 Home-based curative care HC.5 Medical goods 1.8% HC.2 Rehabilitative care HC.4 Ancillary services 1.3% HC.6 Preventive care 0.4% HC.3 Long-term care (Health) HC.7 Governance and health system and financing administration Other services (HC.2, HC.3, HC.6, HC.9) Figure 4.12: Current health expenditure structure by healthcare functions

42 40 Qatar National Health Accounts Report 2014 Healthcare financing schemes (HF) SHA CODES and Health Care Functions HF.1.1 Government schemes HF.1.2 Compulsory contributory health insurance schemes HF.2 Voluntary health care payment schemes HF.3 Household out-of-pocket payment Total HF Central governmental schemes HF Social health insurance schemes HF Other primary coverage scheme HF NPISH financing schemes (excluding HF.2.2.2) HF Enterprises (except Health care providers) financing schemes HF.3.1 Out-ofpocket excluding cost sharing HF.3.2 Cost sharing with third-party payers HC.1 Curative care 10, ,392.6 HC.1.1 Inpatient curative care 7, ,723.7 HC General inpatient curative care HC Specialised inpatient curative care 6, ,518.1 HC Inpatient care not specified HC.1.2 Day curative care HC.1.3 Outpatient curative care 3, ,233.7 HC General outpatient curative care 1, ,406.9 HC Dental outpatient curative care HC Specialised outpatient curative care ,032.8 HC Outpatient care not specified HC.1.4 Home-based curative care HC.1.5 Curative care n.e.c HC.2 Rehabilitative care HC.3 Long-term care (Health) HC.4 Ancillary services (not specified by function) 1, ,086.4 HC.5 Medical goods (not specified by function) 1, ,749.2 HC.6 Preventive care HC.7 Governance and health system and financing administration HC.9 Other health care services not elsewhere classified (n.e.c) , Current expenditure on health (CHE) 14, , ,188.2 Figure 4.13: Current healthcare expenditure by healthcare functions (HC) and healthcare financing schemes (HF) (in Million QAR)

43 4. Qatar system of health accounts 2014: findings 41 The Government Schemes HF.1 financed billion QAR of all healthcare functions (86.7 % of CHE) including billion QAR of all curative care (HC.1) (90.1% of all curative care, or 61.3% of CHE). Further to that government schemes financed: billion QAR, or 94.6% of all inpatient curative services (HC.1.1); billion QAR, or 81.1% of all outpatient curative services (HC.1.3); billion QAR, or 87.7% of all ancillary services outside inpatient encounters (HC.4); billion QAR, or 69.9% of all medical goods consumed in other than inpatient settings (HC.5); billion QAR, or 96.7% of preventative care (HC.6); and billion QAR was spent on health system governance and financing administration (HC.7) 14. Inpatient curative care was the largest expenditure item in government financing schemes followed by outpatient care at (46.3% and 21.8% of HF.1 respectively). Households (HF.3) and Private Health Insurers (HF ) financed 2.18 billion QAR (12.0% of CHE) of healthcare functions. Together households and private health insurance financed: billion QAR, or 5.4% of inpatient services (HC.1.1) billion QAR, or 16.6% of outpatient services (HC.1.3) billion QAR, or 9.2% of ancillary services (HC.4) billion QAR, 29.0% of medical goods (HC.5) billion QAR was spent on financing private health insurance administration. Contrary to government schemes, outpatient curative care and medical goods were the biggest expenditure items for non-government financing schemes (33.2% and 21.8% respectively). Enterprises and non-profit financing schemes financed the remaining 0.23 billion QAR of healthcare services.

44 42 Qatar National Health Accounts Report 2014 HEALTHCARE PROVIDERS The structure of healthcare providers financing remained stable compared to 2013, with an increasing role of the social health insurance scheme: the NHIS-Seha paid 0.89 billion QAR worth of services to the healthcare providers in Qatar, or 4.9% of CHE. Hospitals (HP.1) financing historically dominated the healthcare landscape: in 2014, 10.8 billion QAR (59.5% of CHE) was directed towards hospitals network with 9.56 billion QAR (88.5% of total hospital financing) financed by the Government Schemes (HF.1.1) and additional 0.4 billion QAR (3.6%) by the NHIS-Seha (HF.1.2). The expenditure at the providers of ambulatory care (HP.3) amounted to 2.79 billion QAR (15.3% of CHE) with 1.93 billion QAR financed by the Government Schemes (69.2% of total ambulatory care providers) and additional 0.3 billion QAR (10.4%) by the NHIS-Seha. Providers of Ancillary services (HP.4) and retailers and other providers of Medical goods (HP.5) utilized 0.65 billion QAR (3.6% of CHE) and 0.36 billion QAR (2.0% of CHE) respectively. 0.3% HP.Nsk Providers not specified by kind 13.1% HP.9 Rest of the world 6.3% HP.7 Administration and financing 59.5% HP.1 Hospitals 2.0% HP.5 Retailers and medical goods 3.6% HP.4 Ancillary services 15.3% HP.3 Ambulatory health care Figure 4.14: Structure of current healthcare expenditure by healthcare providers

45 4. Qatar system of health accounts 2014: findings 43 Figure 4.15 shows detailed distribution of healthcare functions across healthcare providers and Figure 4.17 relates healthcare providers to the financing schemes. Healthcare Providers Healthcare Functions (HC) by Healthcare Providers (HP) HP.1 Hospitals HP.2 Residential long-term care facilities HP.3 Providers of ambulatory health care HP.4 Providers of ancillary services HP.5 Retailers and other providers of medical goods HP.6 Providers of preventive care HP.7 Providers of health care system administration and financing HP.9 Rest of the world HP. Nsk Providers not specified by kind Total % of CHE HC.1 Curative care 8, , , , % HC.1.1 Inpatient curative care HC General inpatient curative care HC Specialised inpatient curative care HC Inpatient care not specified HC.1.2 Day curative care HC.1.3 Outpatient curative care HC General outpatient curative care HC Dental outpatient curative care HC Specialised outpatient curative care HC Outpatient care not specified HC.1.4 Homebased curative care 5, , , % % 4, , , % % % 2, , , % 1, , , % % , % % % HC.2 Rehabilitative care % HC.3 Longterm care (Health) HC.4 Ancillary services (not specified by function) HC.5 Medical goods (not specified by function) % 1, , % , % HC.6 Preventive care % HC.7 Governance and health system and financing administration HC.9 Other health care services not elsewhere classified (n.e.c) Current expenditure on health (CHE) , , % % 10, , , , ,188.2 % of CHE 59.5% 0.002% 15.3% 3.6% 2.0% 0.003% 6.3% 13.1% 0.3% 100.0% 100.0% Figure 4.15: Current health expenditure by healthcare functions (HC) and healthcare providers (HP) (in Million QAR)

46 44 Qatar National Health Accounts Report 2014 Hospitals in Qatar provide a full spectrum of healthcare functions. The expenditure on inpatient curative care (HC.1.1) at 5.41 billion QAR represented a half (50.0%) of healthcare expenditure at the hospitals (29.7% of CHE); outpatient (HC.1.3) and day care (HC.1.2) amounted to total 2.58 billion QAR (23.9%, or 14.2% of CHE). The expenditure on inpatient and outpatient specialized curative care provided in hospital setting amounted to 4.94 billion QAR (45.6%, or 27.1% of CHE). Ancillary services (HC.4) and Medical goods (HC.5) amounted to 1.16 and 0.94 billion respectively (see Figures 4.15 and 4.16 for details). 8.7% HC.5 Medical goods (not specified by function) 6.7% Other Care (HC.2, HC.3, HC.6 & HC.9) Government schemes (HF.1) financed 63.2% of revenues on hospitals (HP.1), 14.1% on providers of ambulatory care (HP.3) and 13.7% on providers abroad (HP.9). 10.7% HC.4 Ancillary serivces (not specified by function) 50.0% HC.1.1 Inpatient curative care Households spent 0.45 billion (43.4%) on services from hospitals, and 0.14 billion (13.5%) on providers of ambulatory services. Combining with findings presented in Figure 4.13 where 0.37 billion QAR (36.2%) of expenditure under HH OOP scheme was allocated to outpatient curative care, suggests that there are incentives to obtain outpatient services from hospitals rather than from ambulatory care providers. This was observed in previous QNHA rounds [5]. 21.1% HC.1.3 Outpatient curative care 2.7% HC.1.2 Day curative care Figure 4.16: Structure of expenditure of HP.1 Hospitals

47 4. Qatar system of health accounts 2014: findings 45 Healthcare financing schemes (HF) SHA CODES and Health Care Functions HF.1.1 Government schemes HF.1.2 Compulsory contributory health insurance schemes HF.2 Voluntary health care payment schemes HF.3 Household out-of-pocket payment Total Share (%) of CHE HF Central governmental schemes HF Social health insurance schemes HF Other primary coverage scheme HF NPISH financing schemes (excluding HF.2.2.2) HF Enterprises (except Health care providers) financing schemes HF.3.1 Out-ofpocket excluding cost sharing HF.3.2 Cost sharing with third-party payers HP.1 Hospitals 9, , % HP.1.1 General hospitals 5, , % HP.1.2 Mental health hospitals HP.1.3 Specialised hospitals (other than mental health hospitals) 3, , % HP.1.9 Hospitals not specified % HP.2 Residential long-term care facilities HP.3 Providers of ambulatory health care % 1, , % HP.3.1 Medical practice % HP.3.2 Dental practice % HP.3.4 Ambulatory health care centres HP.3.5 Providers of home health care services 1, , % % HP.4 Providers of ancillary services % HP.4.1 Providers of patient transportation and emergency rescue HP.4.2 Medical and diagnostic laboratories HP.5 Retailers and other providers of medical goods % % % HP.6 Providers of preventive care % HP.7 Providers of health care system administration and financing , % HP.9 Rest of the world 2, , % HP. Nsk Providers not specified by kind % Current expenditure on health (CHE) 14, , ,188.2 Figure 4.17: Current health expenditure by financing schemes (HF) and healthcare providers (HP) (in Million QAR)

48 46 Qatar National Health Accounts Report 2014 TRENDS IN THE USE OF FUNDS During 2014, the expenditure on inpatient curative care increased from 6.77 to 7.72 billion QAR, or 14.2% growth; The expenditure on outpatient care increased from 3.76 to 4.23 billion QAR, or 12.6% growth; Ancillary services and Medical goods increased from 3.02 to 3.84 billion QAR, or 26.9% growth. 25,000 20,000 2, ,253 15,000 3, ,142 3,254 3,836 10,000 5,000 1, ,015 2,447 2,097 1, ,083 2,253 2,214 2, ,851 3,007 3, ,946 4,092 3,023 3,760 4,551 6, ,234 7, Inpatient (HC.1.1) Outpatient (HC.1.3) Ancillary services & Medical goods (HC.4 & HC.5) Governance & administration (HC.7) Rest of healthcare functions (HC.1.2, HC.2, HC.3, HC.6) Gross capital formation Figure 4.18: Comparison of healthcare financing by healthcare functions and years (in million QAR)

49 4. Qatar system of health accounts 2014: findings 47 Figure 4.19 illustrates changes in the structure of the total health expenditure by healthcare functions between 2009 and Compared to 2013, the structure of the THE remained stable, with slight increase in the role of traditionally smaller healthcare functions, such as day care, rehabilitation and prevention. This is in line with gradual shift from curative to other care types. Figure 4.20 illustrates the trend in current health care expenditure by health care providers. Similar to previous years, 2014 growth in financing of all providers was considerable: hospitals received an additional 19.5% of funding (from all sources), ambulatory providers 34.4% and providers of ancillary services and retailers received another 9.9%. 100% 80% 18.4% 5.8% 5.9% 14.5% 9.6% 7.2% 17.6% 4.9% 6.4% 21.5% 2.9% 5.6% 17.3% 3.9% 4.6% 12.6% 6.0% 5.5% 60% 15.3% 12.9% 16.6% 18.4% 21.5% 21.9% 40% 20% 0% 20.6% 24.9% 27.0% 26.1% 23.6% 22.4% 23.2% 31.0% 30.1% 37.0% % 37.1% 2014 Inpatient (HC.1.1) Outpatient (HC.1.3) Ancillary services & Medical goods (HC.4 & HC.5) Governance & administration (HC.7) Rest of healthcare functions (HC.1.2, HC.2, HC.3, HC.6) Gross capital formation Figure 4.19: Structure of total healthcare expenditure by healthcare functions and years 20,000 1,142 15, , ,131 2,786 10, ,073 3,239 5, ,161 1, ,196 1,094 2,117 1,427 3,122 Hospitals Ambulatory providers Ancillary, retailers and other providers 4,754 5,036 5,651 4,754 9,053 10,817 Administration and financing Figure 4.20: Comparison of current healthcare expenditure by healthcare providers and years (in million QAR)

50 48 Qatar National Health Accounts Report 2014 USE OF FUNDS: COMPARISON WITH OECD Compared to the OECD countries, the financing of hospital providers versus ambulatory providers is skewed toward in-hospital provision of all type of curative care. In 2014 hospitals in Qatar provided 10.8 billion QAR of all services, or 59.5% out of current health expenditure, compared to 38.2% OECD on average. Financing of ambulatory care providers amounted to 2.8 billion QAR, or 15.3% of CHE, compared to average of 28.8% in OECD. More detailed analysis of the services provided by hospitals indicates that hospitals in Qatar spend 29.7% of CHE on inpatient care and 12.6% of CHE on outpatient care. This is compared to 25.8% and 7.3% to hospitals provision in OECD respectively (on average). This is also consistent with the hypothesis of population preferences for hospital provision of outpatient services in Qatar. It is noteworthy that similar distributions have been observed in the previous years indicating existence of structural differences % of current health expenditure % of current health expenditure Qatar Lowest 5 Observations OECD: Average Highest 5 Observations Qatar Lowest 5 Observations OECD: Average Highest 5 Observations Payments to Hospitals Payments to Ambulatory Care providers Inpatient Care Outpatient Care Figure 4.21: Payments to Hospitals and Ambulatory care providers (% of CHE): Qatar (2014) and OECD (2014 or latest year) Source: Current report, OECD [15] Figure 4.22: Share of Inpatient and Outpatient services (% of CHE) provided by hospitals: Qatar (2014) and OECD (2014 or latest year) Source: Current report, OECD [15]

51 4. Qatar system of health accounts 2014: findings factors of health care provision In 2014, the Qatar healthcare system provided billion QAR worth of healthcare services inside Qatar (CHE-TA) and 2.38 billion QAR was spent on treatment abroad programs (TA). For the provision of healthcare services within Qatar, the healthcare system spent: billion QAR to compensate for labour inputs (FP.1), or 66.7% of CHE-TA; Qatar FP.1 & FP.2 Compensation of Employees and Self-Employed FP.3 Materials and Services Used 2013 Billion QAR 2014 Billion QAR Growth % billion QAR for health- and nonhealth related services and materials (FP.3), or 28.0% of CHE-TA; billion QAR for capital consumption (FP.4), or 3.3% of CHE-TA. The estimates suggest that compensation to labour inputs increased by 29.9%, to materials and services by 11.2% and consumption of fixed capital 15 increased by 40.9%. FP.4 Consumption of Fixed Capital FP.5 Other items 3.3% FP.4 Consumption of fixed capital Figure 4.23: Factors of Healthcare Provision (FP): % FP.5 Other items of spending inputs 28.0% FP.3 Materials and services used 66.7% FP.1 & FP.2 Compensation of employees Figure 4.24: Factors of Provision (% of CHE, excluding Treatment Abroad)

52 50 Qatar National Health Accounts Report 2014 Healthcare Providers Factors of Provisions (FP) and Healthcare Providers (HC) HP.1 Hospitals HP.2 Residential long-term care facilities HP.3 Providers of ambulatory health care HP.4 Providers of ancillary services HP.5 Retailers and other providers of medical goods HP.6 Providers of preventive care HP.7 Providers of health care system administration and financing HP.nsk Providers not specified by kind HP.9 Rest of the world Total Share (%) of CHE Share (%) of CHE - FP.M FP.1 Compensation of employees FP.1.1 Wages and salaries FP.1.2 Social contributions FP.1.3 All other costs related to employees FP.2 Self-employed professional remuneration FP.3 Materials and services used FP.3.1 Health care services FP.3.2 Health care goods FP Pharmaceuticals FP Other health care goods FP.3.3 Nonhealth care services FP.3.4 Nonhealth care goods FP.4 Consumption of fixed capital FP.5 Other items of spending on inputs 7, , , % 66.7% 4, , , % 42.7% % 0.3% 3, , % 23.7% % 0.03% 2, , % 28.0% % 0.4% 1, , % 15.6% , % 8.2% , % 7.4% , % 9.2% % 2.8% % 3.3% % 2.0% FP.M Factors of provision by the RoW , , % Current expenditure on health (CHE) 10, , , , , % 100.0% Figure 4.25: Expenditure of healthcare providers (in Qatar) by type of providers and factors of provision (in Million QAR)

53 4. Qatar system of health accounts 2014: findings gross capital formation Estimated gross capital formation was 2.63 billion QAR in 2014, with 77.0% of this relating to investment in hospitals and 15.7% for ambulatory healthcare providers. This structure reflects well the 2014 healthcare facilities expansions. Similar to previous years, government sources financed most of the gross capital formation (2.58 billion QAR, or 97.9% - see Section 4.1). Healthcare providers (HP) Gross Capital Formation (HK) by Healthcare Providers (HP) HP.1.1 General hospitals HP.1 Hospitals HP.1.3 Specialised hospitals (other than mental health hospitals) HP.2 Residential long-term care facilities HP.3 Providers of ambulatory health care HP Offices of general medical practitioners HP All other ambulatory centres HP.7 Providers of health care system administration and financing HP.7.1 Government health administration agencies HP.7.2 Social health insuracne agencies Total Share (%) of GCF HK.1 Gross capital formation 1, ,633.7 HK.1.1 Gross fixed capital formation 1, , % HK Infrastructure , % HK Residential and nonresidential buildings , % HK Other structures % HK Machinery and equipment % HK Medical equipment % HK Transport equipment % HK ICT equipment % HK Machinery and equipment n.e.c % HK Intellectual property products % HK Computer software and databases HK Intellectual property products n.e.c % % HK.1.2 Changes in inventories % Gross capital formation (%) 46.8% 30.2% 6.2% 0.1% 15.6% 0.9% 0.2% 100.0% Figure 4.26: Expenditure on gross capital formation by healthcare providers (in Million QAR)

54 52 Qatar National Health Accounts Report 2014 Unlike Current Health Expenditure, Gross Capital Formation is driven by future healthcare demand. The first significant increase in capital formation was observed in 2012 from 2.12 billion QAR in 2011 to 3.25 billion QAR. In 2014 Qatar invested an additional 2.63 billion QAR. Similar to previous years, most of capital formation continued to focus on the buildup of infrastructure: 1.89 billion QAR (71.8% of GCF) was invested in building hospitals and medical centers. As reported by the SCH AR 2014 [10], in 2014 there were 31 new infrastructure projects under construction, including hospitals, Medical Commission facilities, health centers. Estimated capital expenditure suggest that Qatar invested an additional 1.36 billion QAR in hospitals construction and 0.36 billion QAR in ambulatory health facilities. Compared to 2013, the investments in machinery and equipment (HK.1.1.2) increased from 0.28 billion QAR to 0.59 billion QAR, or from 8.7% of GCF to 22.3% of GCF. This likely reflects increased demand for new facilities medical equipment fit out. It is expected that Qatar will continue expanding its healthcare capital formation at the pace needed to meet the demand. The forthcoming SCH Annual Report 2015 [11] provides an updated status of health infrastructure expansion.

55 4. Qatar system of health accounts 2014: findings 53

56 54 Qatar National Health Accounts Report 2014 discussion

57 5. discussion 55 By the end of 2014 the Qatar healthcare system had passed the mid-point of implementing its inaugural strategic health plan. The output completion rate of the National Health Strategy (NHS) had reached 56% [10]. During 2014: The public healthcare system advanced construction of 73 new facilities and 45 renovation projects and provided 38 million key services [10]; The National Health Insurance Scheme was extended to all Qatari Nationals, providing a comprehensive healthcare package, including dental and optical services; through the expanded provider network of 177 providers [10]; The National Clinical Coding Committee was established to supervise and manage the introduction of new, and the refinement of existing, clinical coding practices; The public healthcare providers (HMC and PHCC) commenced or continued the roll out of the clinical information systems; The number of registered hospitals admissions per 100,000 of population increased by 40.4% across the entire healthcare system. Bed occupancy rates decreased by 13.5%, accompanied by reduction in the average length of stay (all hospitals) from 4.5 to 4.1 days. Outpatient visits at hospital facilities increased by 14.6% [9]. The transformation of the healthcare system was being supported by the financing mechanisms to ensure better quality and outcomes are achieved. During 2014 this included: Further advancement of the Performance Based Budgeting for the public healthcare sector in addition to expansion of the National Health Insurance Scheme for more efficient and outcome driven healthcare financing; E-Health strategy design and implementation of the clinical information systems across the network of public healthcare providers for significant improvements in data capture and management. These and other comprehensive initiatives and projects under the NHS and stand-alone strategies aim to align the healthcare supply and providers behaviour with the demand for healthcare to achieve the goals of effective and affordable healthcare provision accessible to all residents. Over the past 4 years health expenditure has been rising at double digit growth rates. The underlying fundamentals high rates of population growth and heterogeneous demographic structure continued to shape the demand for healthcare services adding to the challenges of transformation. Sustaining the scope and complexity of transformation (coupled with fast growing demand for healthcare) required significant commitments and substantial investment in human and capital development. During 2014, total health expenditure in Qatar increased by 14.0% from billion QAR to billion QAR. In macroeconomic terms this represented a rise from 2.5% of GDP in 2013 to 2.7% in Similar indicators for the GCC region and OECD in 2014 were 3.3% and 9.1% of GDP respectively 16. The total health expenditure per capita adjusted for the purchasing power parity (USD PPP) was 3,753 in 2014, having increased by 4.5% from 3,591 in Similar indicators for the GCC (2013) and OECD ( ) were 2,096 and 3,468 USD PPP respectively. While the direct comparison should be approached with care 18, it is noteworthy that 2014 was the first year when Qatar total health expenditure per capita (USD PPP) converged towards the OECD average. As in the previous years, the Government of Qatar financed the lion's share of healthcare expenditure to support the transition and to ensure the commitment to universal health coverage of a rapidly growing population. The share of general government expenditure in total health expenditure was close to 90 per cent, compared to OECD average of 70 per cent. The substantial financial contribution from the Government eases pressure on the households: in 2014 household out-of-pocket expenditure financed less than 5 per cent of total healthcare spend (16.7 per cent in OECD), or 185 USD (PPP) compared to average of 610 USD (PPP) in OECD.

58 56 Qatar National Health Accounts Report 2014 Parameters and indicators QAR USD USD PPP QAR USD USD PPP GDP (in millions of currency) 739, , , , , ,499 General government total expenditure (in millions of currency) 204,659 56,225 80, ,821 67,259 97,794 Current health expenditure (CHE) (in millions of currency) 15,111 4,151 5,955 18,188 4,997 7,265 Gross capital formation (GCF) (in millions of currency) 3, ,241 2, ,052 Total health expenditure (THE)(in millions of currency) 18,261 5,017 7,196 20,822 5,720 8,317 General Government expenditure on health (GGHE)(in millions of currency) 16,043 4,407 6,322 18,579 5,104 7,421 Private expenditure on health (PvtHE) (in millions of currency) 2, , HH OOP healthcare expenditure (in millions of currency) 1, , Population 2,003,700 2,216,180 Population Adjusted 1,120,087 1,238,865 Figure 5.1: Key Expenditure Indicators by currencies Per capita indicators Qatar, 2013 Qatar, 2014 OECD, 2014 GCC, 2013 Based on actual population estimates QAR USD USD PPP QAR USD USD PPP USD PPP USD PPP GDP 369, , , ,097 94, ,849 General Government expenditure 102,141 28,061 40, ,470 30,349 44,127 Current health expenditure (CHE) 7,542 2,072 2,972 8,207 2,255 3,278 3,497 N/A Gross capital formation (GCF) 1, , N/A Total health expenditure (THE) 9,114 2,504 3,591 9,395 2,581 3,753 3,468 2,096 General Government expenditure on health (GGHE) 8,007 2,200 3,155 8,383 2,303 3,349 2,571 1,622 Private expenditure on health (PvtHE) 1, HH OOP Healthcare expenditure Based on adjusted population estimates Total health expenditure (THE) 16,303 4,479 6,425 16,807 4,617 6,714 Current health expenditure (CHE) 13,491 3,706 5,316 14,681 4,033 5,864 General Government expenditure on health (GGHE) 14,323 3,935 5,644 14,997 4,120 5,990 HH OOP Healthcare expenditure Health expenditure ratios Qatar, 2013 Qatar, 2014 OECD, 2014 GCC, 2013 Total health expenditure, as % of GDP 2.5% 2.7% 9.1% 3.3% GGEH, as % of THE 87.9% 89.2% 70.2% 75.8% GGEH as % of General government expenditure 7.8% 7.6% N/A 7.3% HH OOP healthcare expenditure as % of THE 5.7% 4.9% 16.7% 14.6% HH OOP healthcare expenditure as % of CHE 6.8% 5.6% 17.4% N/A Figure 5.2: Key per capita indicators: Qatar, OECD and GCC

59 5. discussion 57 The statistics for healthcare activity for 2014 indicate that hospital admissions increased by 40.4% (adjusted for the population growth). Outpatient visits (hospitals) increased by 14.6% [9]. While these statistics continue to point to increasing pressure on in-hospital services provision (see QNHA 2013 [5]), a substantial increase in the registered hospital services also reflects significantly better coding capabilities and therefore greater data accuracy in the healthcare system. Reliable and high quality data were one of the objectives of healthcare reform. Indeed, in 2014 both PHCC and HMC reported considerable improvements to reported service data [10]. Over the last three years healthcare expenditure had been growing at a two-digit growth rates. At the same time, the expenditure dynamics over the past two years (2013 and 2014) provided strong indication that the growth rate had started to slow down. Given consistency in data collection and processing, this points to healthcare expenditure growth normalization. Taken together with a significant increase in registered utilization of healthcare services, slower growth in healthcare expenditure is suggestive of improving allocative efficiency of resources. These trends will be continuously monitored and analyzed. 25,000 25,000 20,000 20,000 absolute indicators (million QAR) 15,000 10,000 5,000 15,000 10,000 5,000 per capita indicators (QAR) THE (in millions QAR) CHE (in millions QAR) THE per capita (QAR) CHE per capita (QAR) Figure 5.3: Total (THE) and Current (CHE) healthcare expenditure: absolute and per capita 40% 20% 10% 0% 25.5% 21.1% 18.4% 12.8% 10.3% 16.3% 3.1% 8.8% THE per capita growth CHE per capita growth Figure 5.4: Annual growth in per capita financing: Total (THE) and Current (CHE) healthcare expenditure

60 58 Qatar National Health Accounts Report 2014 COMMITMENT TO AFFORDABLE HEALTH CARE Historically the healthcare sector in Qatar has been predominantly funded by the Government. Over the past years the financial role of the Government has increased. In 2014 the General Government Expenditure on Health reached 89.2% of total health expenditure. In turn, the role of household revenues 19 in healthcare financing has been declining. Its absolute contribution to the healthcare financing stabilized at 1.03 billion QAR during 2013 and The relative contribution of out-of-pocket expenditure reduced from 13.8 percent (of the total health expenditure) in 2011 to 4.9 per cent in The declining contributions from the households and increasing role of the government funding reflect the healthcare policies aimed at reducing financial burden on households when accessing healthcare and minimizing incidents of catastrophic out-pf-pocket expenditure. During 2014 the policies included extension of NHIS-Seha to all Qatari nationals for a comprehensive schedule of benefits; and improved use of health cards to access public healthcare providers by non-qatari population [9]. Over the coming years SCH will continue designing and refining the policies of sustainable and affordable cost-sharing of healthcare financing with financing agents in Qatar. 2,500 2,000 2,279 2,236 2,066 2, % 80% 76.9% 83.6% 87.9% 89.2% 1,500 1,650 60% 1, ,294 1,028 1,038 1,156 1,031 40% % 13.8% 8.5% 5.7% 4.9% 0% Private health insurance Household out-of-packet Total General government expenditure on health (% THE) Household out-of-pocket expenditure (% THE) Figure 5.5: Structure of healthcare financing scheme: private revenues (million QAR) Figure 5.6: Shares of General government and Household out-of-pocket expenditure in Total health expenditure ( )

61 5. discussion 59

62 60 Qatar National Health Accounts Report 2014 references [1] OECD, Eurostat, WHO, A System of Health Accounts, OECD Publishing, [2] United Nations Development Programme, "Trends in the Human Development Index, ," [Online]. Available: [Accessed 06 January 2016]. [3] The World Bank, "GNI per capita, Atlas Method (current US$)," The World Bank, [Online]. Available: worldbank.org/indicator/ny.gnp.pcap. CD. [Accessed 06 January 2016]. [4] Supreme Council of Health, "Qatar Health Report 2013," Supreme Council of Health, Doha, [5] Supreme Council of Health, "Qatar National Health Accounts Report 2013," Supreme Council of Health, Doha, [6] Ministry of Development Planning and Statistics, "Window on Economic Statistics of Qatar: 12th Issue Q (July 2015)," Ministry of Development Planning and Statistics, Doha, [7] Supreme Council of Health, "Qatar National Health Accounts Report," Supreme Council of Health, Doha, [8] Supreme Council of Health, "Qatar National Health Accounts 2011 Report," Supreme Council of Health, Doha, [9] Supreme Council of Health, "Qatar Health Report 2014," Supreme Council of Health, Doha, 2016 forthcoming. [10] Supreme Council of Health, "SCH Annual Report 2014," Supreme Council of Health, Doha, [11] Supreme Council of Health, "SCH Annual Report 2015," Supreme Council of Health, Doha, 2016 forthcoming. [12] "Healthcare Master Plan Shows Shape of Things to Come," Supreme Council of Health, 01 October [Online]. Available: [Accessed 06 January 2016]. [13] Supreme Council of Health, "Qatar Healthcare Facilities Master Plan ," Supreme Council of Health, Doha, [14] Supreme Council of Health, "SCH Annual Report 2013," Supreme Council of Health, Doha, [15] Organization for Economic Co-operation and Development, "Health expenditure and financing 2015," OECD, EUROSTAT and WHO, [Online]. Available: Index.aspx?DataSetCode=SHA#. [Accessed 06 January 2016]. [16] World Health Organization, "Global Healtgh Expenditure Database," WHO, [Online]. Available: nha/database. [Accessed 06 January 2016]. [17] State of Qatar, "Organizing Medical Treatment and Health Services within the State," [Online]. Available: downloads/$file/law%20no.7%20of% %20English.pdf. [18] R. Rannan-Eliya, "Estimating out-of-pocket spending for national health accounts," World Health Organization, Geneva, [19] Supreme Council of Health, "National Health Strategy - Transforming Healthcare," Supreme Council of Health, Doha, [20] World Bank, "PPP conversion factor, GDP (LCU per international $)," The World Bank, [Online]. Available: data.worldbank.org/indicator/pa.nus.ppp. [Accessed ].

63 references and footnotes 61 footnotes 1 The healthcare expenditure for the organizations which have not provided the required information on time have been estimated using historical and projected data available at the SCH at the time of writing this report. 2 The Acknowledgement provides the full list of private outpatient providers contributed to the QNHA 2014 data collection. 3 The NHIS-Seha was launched on 17th July 2013, following immediately the Law No. 7 of July 2013 on Social Health Insurance. The pilot stage focused on Qatari female population age 12 and above and provided coverage for women health, maternity and newborn health care services. 4 In order to be admitted to the NHIS-Seha providers network, healthcare providers had to satisfy a number of requirements, including availability of services, coding and claiming capabilities. This explains staged acceptance of providers, both private and public, to the network. 5 QNHA 2013 reported capital expenditure at 3.15 billion QAR. The decline in the reported capital projects value should not be taken literally due to the nature of capital formation and different reporting in 2014 (see Section 3.2 for details). 6 Conducted by the SCH and SESRI in April- May Rannan-Eliya (2010) shows that the discrepancy between expenditure estimates based on the surveys and on national accounts for selected countries varies between 1% and 73% [18]. 8 The Costing Standards were developed based on the bottom-up costing (2011) for all inpatient services provided nation-wide. 9 Up until 2016, fiscal year in Qatar commenced on 1 April and finished on 31 March. From 2016, the fiscal year will coincide with the calendar year. 10 The naufar is a long-term care facility which will be specializing in providing the mental health and substance abuse care services; it is expected to be fully functioning in The gap private insurance revenues as reported by hospitals were exceeding expenditure reported by insurance companies. By default, all QNHA allocated this gap to the RoW utilization of Qatar healthcare system [5]. 12 In addition to direct financing by the government, GGEH includes financing by the parastatal organizations, such as Qatar Petroleum and similar. 13 Refer to Section 3 for differences in methodology. 14 As discussed in Section 3, administrative function HC.7 includes some elements of preventative care (HC.7). 15 Similar to previous years, consumption of fixed capital is measured by the depreciation as reported by the providers, and therefore does not fully reflect the economic value of capital consumption. 16 Due to very high of GDP per capita in Qatar and most GCC countries, a direct comparison of healthcare expenditure as a share of GDP with the OECD countries should be exercised with caution or latest available; limited to period. 18 OECD average was evaluated based on 2014 or nearest available year (see footnote 17), as reported by the OECD health expenditure and financing statistics [15]. The underlying PPP conversion factors for Qatar were derived from the World Bank Development Indicators database [20] as valid end-2015; PPP factors underlying OECD database refer to July Household revenues financing schemes include out-of-pocket expenditure (predominant) and contributions to the charitable organizations (marginal) financing healthcare.

64 62 Qatar National Health Accounts Report 2014 annexes KEY SHA 2011 CONCEPTS Term Definitions Basic price The amount receivable by the producer from purchaser for a unit of goods or services produced as output minus tax payable and plus any subsidy receivable on the produces as a consequence of its production or sale. Consumption of fixed capital The consumption of fixed capital is defined as the decline, during the accounting period, in the current value of the stock of fixed assets owned by health care providers. The consumption of fixed capital is the result of physical deterioration, normal obsolescence or normal accidental damage. Current health expenditure Final consumption expenditure of resident units on health care goods and services irrespective of where the consumption takes place: it implies the inclusion of imports (from non-resident providers) and the exclusion of exports (provided to non-residents). Day care Planned medical and paramedical services delivered to patients who have been formally admitted for diagnosis, treatment or other types of health care but with the intention to discharge the patient on the same day. Exports (of health care goods and services) Health care goods and services acquired by non-residents from resident providers Factors of provision (FP) Inputs used by [health care] providers to produce the goods and services consumed or the activities conducted in the system. Final consumption (of health care goods and services) Health care goods or services produced and imported in the economic territory and used by a resident to satisfy an individual or collective need. Final consumption equals to the total uses of health goods and services minus intermediate consumption by health care providers ( factors of provision ), gross capital formation and exports (goods and services consumed by non-residents).

65 annexes 63 Term Definitions Final consumption expenditure (FCE) Same as Current health expenditure (CHE). Includes three type of expenditure: Household final consumption expenditure General government final consumption expenditure NPISH final consumption expenditure Financing agents (FA) Institutional units that administer health financing schemes in practice: collect revenues and/or purchase services. Financing scheme (HF) Health care financing schemes are structural components of health care financing systems: they are the main types of financing arrangements through which people obtain health services. Health care financing schemes include direct payments by households for services and goods and third-party financing arrangements. Third party financing schemes are distinct bodies of rules that govern the mode of participation in the scheme, the basis for entitlement to health services and the rules on raising and then pooling the revenues of the given scheme. Health Care Function (HC) Relates to the type of need a transaction or group of transactions aims to satisfy or the kind of objective pursued; it explains the health purpose of transactions in health care. Gross capital formation (in health care) (HK) Acquisition of produced assets (assets intended for use in the production of other goods and services over a period of one year or more) by health care providers; measured by the total value of this assets that providers of health services have acquired during the accounting period (less the values of the disposals of assets of the same type). It includes the following three components: Gross fixed capital formation Changes in inventories Acquisitions less disposal of valuables

66 64 Qatar National Health Accounts Report 2014 Term Definitions Home based care Comprises medical, ancillary and nursing services that are consumed by patients at their home and involve the provider s physical presence. Household final consumption expenditure Expenditure incurred by resident households for the individual consumption of goods and services, including consumption of goods and services acquired abroad. Inpatient care Formal admission into a health care facility for treatment and/or care that is expected to constitute an overnight stay. Intermediate consumption (of health care goods and services) Health care goods and services that are consumed (used-up or transformed) in the production process of other health care goods and services. Long term care A range of medical and personal care services that are consumed with the primary goal of alleviating pain and suffering or managing the deterioration in health status in patients with a degree of longterm dependency. Mode-of-provision categories Mode-of-provision refers to specific organizational and technological arrangements of the services consumed and consists of four categories: inpatient, day care, outpatient and home-based care. Non-market providers Entities that provide services (or goods) either for free of charge or at prices that are not economically significant (when prices cover less than half the full cost of production), opposite to market providers providing services at economically relevant prices.

67 annexes 65 Term Definitions Out of Pocket Out of Pocket Payments (OOP) show the direct burden of medical costs that households bear at the time of service use based on the willingness and ability to pay of the individual or household. It is a voluntary payment based on the decision of the household to use the services, and therefore to pay for them. A payment by the individual is not always accounted as OOP because it may be reimbursed by voluntary insurance or covered by the Government (conditional cash transfers) or a domestic or foreign NGO. In these cases, the payment for the healthcare is technically made by the household, but not from the households pocket. Outpatient care Any care offered to a non-admitted patient regardless of where it occurs except the patient s place of residence (the outpatient serviced may be delivered in the outpatient ward of a hospital, a dedicated hospital outpatient center, an ambulatory care center, a physician s private office, or a health care practice with a work place, school or prison, or even on the street). Prevention (health boundaries) The health boundary for preventive services is defined as having the primary purpose of risk avoidance, of acquiring diseases or suffering injuries, which can frequently involve a direct and active interaction of the consumer with the health care system. Prevention, primary Involves specific measures aimed at avoiding diseases and risk factors in order to reduce the onset of a disease, diminish the number of new cases, and anticipate the emergence and lessen the severity of disease. Prevention, secondary Involves specific interventions aimed at the detection of disease and then therapy as early as possible.

68 66 Qatar National Health Accounts Report 2014 Term Definitions Prevention, tertiary Specific measures aiming at reducing the negative impact of an already established disease or injury by an attempt to avid worsening and complication. Providers (HP) Health care providers encompass organizations and actors that deliver health care goods and services as their primary activity, as well as those for which health care provision is only one among a number of activities. Providers, health care system administration and financing Establishments that are primarily engaged in the regulation of the activities of agencies that provide health care and in the overall administration of the health care sector, including the administration of health financing. Providers, primary Primary providers are those whose principal activity is to deliver health care goods and services as defined in the core functional classification. Providers, secondary Those that deliver health care services in addition to their principal activities, which might be partially or not at all related to health. Purchaser s price The amount payable by the purchaser, excluding any deductible VAT or similar deductible tax, in order to take delivery of a unit of good or service at the time and place required by the purchaser. Revenues of financing schemes (RS) Revenue is an increase in the funds of a health care financing scheme, through specific contribution mechanisms. The categories of the classification are the particular types of transaction through which the financing schemes obtain their revenues. The objective of this classification is to group types of revenues of health financing schemes into mutually exclusive classes.

69 annexes 67 Term Definitions Social health insurance Financing arrangement that ensures access to health care based on a payment of a non-risk-related contribution by or on behalf of the eligible person. Social protection scheme A distinct body of rules, supported by one or more institutional units, governing the provision of social protection benefits and their financing. Total health expenditure Total Health Expenditure (THE) can be defined as the sum of current health expenditure and the expenditure related to the acquisition (less disposals) on capital goods. In the report the term THE is used to depict the sum of these two aggregates. The term of THE was used in SHA 1.0 as well representing the sum of "current expenditure on health" and "gross capital formation". While the term is not recommended any more in SHA 2011 but still is used in international databases used for comparison purposes (WB, WHO, etc.), QNHA 2013 maintained this terminology. Transactions are valued activities that take place between different actors or organizations. Economic flow of a kind of formalized relationship between various units acting in the health care sector, that is, between consumers and providers, providers and financing units, or consumers and financing units. The following types of transactions can be distinguished in SHA: Transaction Transactions in products (i.e. final consumption of health care goods and services) Distributive transactions (transfers granted to households for the specific purpose of providing health care services to family members) Financial transactions (acquisitions and disposals in financial assets and liabilities) Other flows related to the consumption of fixed capital and acquisitions (less disposals). Transactions, valued Transactions under which payments are made to providers in exchange for health care goods and services received by consumers.

70 68 Qatar National Health Accounts Report 2014 SHA MATRIX 1 FSXHF : REVENUES OF THE FINANCING SCHEME BY FINANCING SOURCES Financing sources (FS) Revenues of the financing scheme (HF) by financing sources (FS) FS.1.1 Internal transfers and grants FS.1 Government FS.5 Voluntary prepayment FS.6 Other domestic revenues n.e.c. FS.1.2 Transfers by government on behalf of specific groups FS.1.4 Other transfers from government domestic revenue FS.5.9 Other voluntary prepaid revenues n.e.c FS.6.1 Other revenues from households n.e.c. FS.6.2 Other revenues from corporations n.e.c. FS.7 Direct foreign transfers FS.7.3 Other direct foreign transfers (n.e.c.) Total HF.1 Government schemes and compulsory contributory health care financing schemes 14, ,776.9 HF.1.1 Government schemes 14, ,883.0 HF Central governmental schemes 14, ,883.0 HF State/regional/local governmental schemes HF.1.2 Compulsory contributory health insurance schemes HF Social health insurance schemes HF Compulsory private insurance schemes HF.1.3 Compulsory Medical Saving Accounts (CMSA) HF.2 Voluntary health care payment schemes , ,384.0 HF.2.1 Voluntary health insurance schemes , ,156.0 HF Primary/substitutory health insurance schemes , ,156.0 HF Employer-based insurance (other than enterprises schemes) HF Government-based voluntary insurance HF Other primary coverage schemes , ,156.0 HF Complementary/supplementary insurance schemes HF Community-based insurance HF Other complementary/supplementary insurance HF.2.2 NPISHs financing schemes HF NPISH financing schemes (excluding HF.2.2.2) HF Resident foreign government development agencies schemes

71 annexes 69 SHA MATRIX 1 FSXHF : REVENUES OF THE FINANCING SCHEME BY FINANCING SOURCES Continued Financing sources (FS) SHA CODES and Financing agents (FA) FS.1.1 Internal transfers and grants FS.1 Government FS.5 Voluntary prepayment FS.6 Other domestic revenues n.e.c. FS.1.2 Transfers by government on behalf of specific groups FS.1.4 Other transfers from government domestic revenue FS.5.9 Other voluntary prepaid revenues n.e.c FS.6.1 Other revenues from households n.e.c. FS.6.2 Other revenues from corporations n.e.c. FS.7 Direct foreign transfers FS.7.3 Other direct foreign transfers (n.e.c.) Total HF.2.3 Enterprises financing schemes HF Enterprises (except Health care providers) financing schemes HF Health care providers financing schemes HF.3 Household out-of-pocket payment , ,027.2 HF.3.1 Out-of-pocket excluding cost sharing HF.3.2 Cost sharing with third-party payers HF Cost sharing with government /CCHI schemes HF Cost sharing with voluntary insurance schemes HF.4 Rest of the world financing schemes (non resident) HF.4.1 Compulsory schemes (non-resident) HF Compulsory health insurance schemes (non-resident) HF Other compulsory schemes (non-resident) HF.4.2 Voluntary schemes (non-resident) HF Voluntary health insurance schemes (non-resident) HF Other schemes (non-resident) HF Philanthropy / international NGOs schemes HF Foreign Development agencies schemes HF Enclaves (e.g., international organizations or embassies) Current expenditure on health (CHE) 14, , , ,188.2 Gross capital formation (GCF) 2, ,633.7 Total health expenditure (CHE + GCF) 17, , , ,821.8

72 70 Qatar National Health Accounts Report 2014 SHA MATRIX 2 FSXFA : REVENUES BY SOURCES AND FINANCING AGENTS Financing sources (FS) SHA CODES and Financing agents (FA) FS.1.1 Internal transfers and grants FS.1 Government FS.5 Voluntary prepayment FS.6 Other domestic revenues n.e.c. FS.1.2 Transfers by government on behalf of specific groups FS.1.4 Other transfers from government domestic revenue FS.5.9 Other voluntary prepaid revenues n.e.c FS.6.1 Other revenues from households n.e.c. FS.6.2 Other revenues from corporations n.e.c. FS.7 Direct foreign transfers FS.7.3 Other direct foreign transfers (n.e.c.) Total FA.1 General Government 13, ,830.2 FA.1.1 Central government 13, ,830.2 FA Supreme Council of Health (SCH, HMC, PHCC, QRCS) 13, ,682.9 SCH 2, ,804.9 HMC 9, ,272.7 PHCC 1, ,474.3 FA Other Ministries and public units FA Ministry of Finance FA Ministry of Interior FA Armed Force and Amiri Guard FA National Health Service Agency FA National Health Insurance Agency - NHIC FA.1.2 State /Regional / Local government FA.1.3 Social security agency FA Sickness funds FA Other social insurance funds FA.1.9 All other general government units FA.2 Insurance corporations , ,156.0 FA.2.1 Commercial insurance companies , ,156.0 FA.2.2 Mutual and other non-profit insurance organizations

73 annexes 71 SHA MATRIX 2 FSXFA : REVENUES BY SOURCES AND FINANCING AGENTS Continued Financing sources (FS) SHA CODES and Financing agents (FA) FS.1.1 Internal transfers and grants FS.1 Government FS.5 Voluntary prepayment FS.6 Other domestic revenues n.e.c. FS.1.2 Transfers by government on behalf of specific groups FS.1.4 Other transfers from government domestic revenue FS.5.9 Other voluntary prepaid revenues n.e.c FS.6.1 Other revenues from households n.e.c. FS.6.2 Other revenues from corporations n.e.c. FS.7 Direct foreign transfers FS.7.3 Other direct foreign transfers (n.e.c.) Total FA.3 Corporations (other than insurance corporations) ,169.7 FA.3.1 Health management and provider corporations FA Aspire Zone Foundation FA.3.2 Corporations (other than providers of health services) FA Qatar Foundation FA Qatar Petroleum FA Other Corporations FA.4 Non-profit Institutions serving households (NPISHs) FA.4.1 Zakat Fund FA.5 Households , ,027.2 FA.6 Rest of the World FA.6.1 International organizations FA.6.2 Foreign governments FA.6.3 Other foreign entities Current expenditure on health (CHE) 14, , , ,188.2 Gross capital formation (GCF) 2, ,633.7 Total health expenditure (CHE + GCF) 17, , , ,821.8

74 72 Qatar National Health Accounts Report 2014 SHA MATRIX 3 FAXHF : REVENUES BY THE FINANCING SCHEME BY FINANCING AGENTS Financing Agents (FA) FA.1 General Government FA.2 Insurance corporations FA.3.1 Health management and provider corporations FA.3.2 Corporations (other than providers of health services) FA.4 Non-profit Institutions serving households (NPISHs) FA.6 Rest of the World FA.5 Households SHA CODE and Financing schemes Total FA Supreme Council of Health FA MOI FA Armed Force FA National Health Insurance Agency FA.2.1 Commercial insurance companies FA Aspire Zone Foundation FA Qatar Foundation FA Qatar Petroleum FA.4.1 Zakat fund FA.6.3 Other foreign entities HF.1 Government schemes and compulsory contributory health care financing schemes 13, ,776.9 HF.1.1 Government schemes 13, ,883.0 HF Central governmental schemes 13, ,883.0 HF State/regional/local governmental schemes HF.1.2 Compulsory contributory health insurance schemes HF Social health insurance schemes HF Compulsory private insurance schemes HF.1.3 Compulsory Medical Saving Accounts (CMSA) HF.2 Voluntary health care payment schemes , ,384.0 HF.2.1 Voluntary health insurance schemes , ,156.0 HF Primary/substitutory health insurance schemes , ,156.0 HF Employer-based insurance (other than enterprises schemes) HF Government-based voluntary insurance HF Other primary coverage schemes , ,156.0 HF Complementary/supplementary insurance schemes HF Community-based insurance HF Other complementary/ supplementary insurance HF.2.2 NPISHs financing schemes HF NPISH financing schemes (excluding HF.2.2.2) HF Resident foreign government development agencies schemes HF.2.3 Enterprises financing schemes HF Enterprises (except Health care providers) financing schemes

75 annexes 73 SHA MATRIX 3 FAXHF : REVENUES BY THE FINANCING SCHEME BY FINANCING AGENTS Continued Financing Agents (FA) FA.1 General Government FA.2 Insurance corporations FA.3.1 Health management and provider corporations FA.3.2 Corporations (other than providers of health services) FA.4 Non-profit Institutions serving households (NPISHs) FA.6 Rest of the World FA.5 Households SHA CODE and Financing schemes Total FA Supreme Council of Health FA MOI FA Armed Force FA National Health Insurance Agency FA.2.1 Commercial insurance companies FA Aspire Zone Foundation FA Qatar Foundation FA Qatar Petroleum FA.4.1 Zakat fund FA.6.3 Other foreign entities HF Health care providers financing schemes HF.3 Household out-of-pocket payment , ,027.2 HF.3.1 Out-of-pocket excluding cost sharing HF.3.2 Cost sharing with third-party payers HF Cost sharing with government/cchi schemes HF Cost sharing with voluntary insurance schemes HF.4 Rest of the world financing schemes (non resident) HF.4.1 Compulsory schemes (non-resident) HF Compulsory health insurance schemes (non-resident) HF Other compulsory schemes (non-resident) HF.4.2 Voluntary schemes (non-resident) HF Voluntary health insurance schemes (non-resident) HF Other schemes (non-resident) HF Philanthropy / international NGOs schemes HF Foreign Development agencies schemes HF Enclaves (e.g., international organizations or embassies) Current expenditure on health (CHE) 13, , , ,188.2 Gross capital formation (GCF) Total health expenditure (CHE + GCF) 14, , , ,169.8

76 74 Qatar National Health Accounts Report 2014 SHA MATRIX 4: HFXHP : EXPENDITURES BY HEALTHCARE FINANCING SCHEMES AND PROVIDERS Healthcare financing schemes (HF) HF.1.1 Government schemes HF.1.2 Compulsory contributory health insurance schemes HF.2 Voluntary health care payment schemes HF.3 Household outof-pocket payment HF.4 Rest of the world financing schemes (non resident) SHA CODES and Health Care Providers Total HF Central governmental schemes HF Social health insurance schemes HF Other primary coverage scheme HF NPISH financing schemes (excluding HF.2.2.2) HF Enterprises (except Health care providers) financing schemes HF Health care providers financing schemes HF.3.1 Out-of-pocket excluding cost sharing HF.3.2 Cost sharing with third-party payers HF Voluntary health insurance schemes (non-resident) HP.1 Hospitals 9, ,817.0 HP.1.1 General hospitals 5, ,757.5 HP.1.2 Mental health hospitals HP.1.3 Specialised hospitals (other than mental health hospitals) 3, ,056.5 HP.1.9 Hospitals not specified HP.2 Residential long-term care facilities 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 1, ,785.9 HP.3.1 Medical practice HP Offices of general medical practitioners HP Offices of medical specialists (other than mental medical specialists) HP.3.2 Dental practice HP.3.3 Other health care practitioners HP.3.4 Ambulatory health care centres 1, ,404.7 HP Family planning centres HP Ambulatory mental health and substance abuse centres HP All other ambulatory centres 1, ,404.7 HP.3.5 Providers of home health care services

77 annexes 75 SHA MATRIX 4: HFXHP : EXPENDITURES BY HEALTHCARE FINANCING SCHEMES AND PROVIDERS Continued Healthcare financing schemes (HF) HF.1.1 Government schemes HF.1.2 Compulsory contributory health insurance schemes HF.2 Voluntary health care payment schemes HF.3 Household outof-pocket payment HF.4 Rest of the world financing schemes (non resident) SHA CODES and Health Care Providers Total HF Central governmental schemes HF Social health insurance schemes HF Other primary coverage scheme HF NPISH financing schemes (excluding HF.2.2.2) HF Enterprises (except Health care providers) financing schemes HF Health care providers financing schemes HF.3.1 Out-of-pocket excluding cost sharing HF.3.2 Cost sharing with third-party payers HF Voluntary health insurance schemes (non-resident) 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 HP.5 Retailers and other providers of medical goods HP.5.1 Pharmacies HP.5.2 Retail sellers and other suppliers of durable medical goods and medical appliances HP.5.9 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 ,141.8 HP.7.1 Government health administration agencies HP.7.3 Private health insurance administration agencies HP.7.9 Other administration agencies HP.8 Rest of economy HP.9 Rest of the world 2, ,382.0 HP. Nsk Providers not specified by kind Current expenditure on health (CHE) 14, , ,188.2 Gross capital formation (GCF) 2, ,633.7 Total health expenditure (CHE + GCF) 17, , ,821.8

78 76 Qatar National Health Accounts Report 2014 SHA MATRIX 5: HFXHC : EXPENDITURES BY HEALTHCARE FINANCING SCHEMES AND HEALTHCARE FUNCTIONS Healthcare financing schemes (HF) HF.1.1 Government schemes HF.1.2 Compulsory contributory health insurance schemes HF.2 Voluntary health care payment schemes HF.3 Household outof-pocket payment HF.4 Rest of the world financing schemes (non resident) SHA CODES and Health Care Functions Total HF Central governmental schemes HF Social health insurance schemes HF Other primary coverage scheme HF NPISH financing schemes (excluding HF.2.2.2) HF Enterprises (except Health care providers) financing schemes HF Health care providers financing schemes HF.3.1 Out-of-pocket excluding cost sharing HF.3.2 Cost sharing with third-party payers HF Voluntary health insurance schemes (non-resident) HC.1 Curative care 10, ,392.6 HC.1.1 Inpatient curative care 7, ,723.7 HC General inpatient curative care HC Specialised inpatient curative care 6, ,518.1 HC Inpatient care not specified HC.1.2 Day curative care HC General day curative care HC Specialised day curative care HC Day care not specified HC.1.3 Outpatient curative care 3, ,233.7 HC General outpatient curative care 1, ,406.9 HC Dental outpatient curative care HC Specialised outpatient curative care ,032.8 HC Outpatient care not specified HC.1.4 Home-based curative care HC.1.5 Curative care n.e.c 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.2.5 Rehabilitative care n.e.c HC.3 Long-term care (Health) HC.3.1 Inpatient long-term care (health) HC.3.2 Day long-term care (health) HC.3.3 Outpatient long-term care (health) HC.3.4 Home-based long-term care (health) HC.3.5 Long-term health care - LTHC n.e.c

79 77 SHA MATRIX 5: HFXHC : EXPENDITURES BY HEALTHCARE FINANCING SCHEMES AND HEALTHCARE FUNCTIONS Continued Healthcare financing schemes (HF) HF.1.1 Government schemes HF.1.2 Compulsory contributory health insurance schemes HF.2 Voluntary health care payment schemes HF.3 Household outof-pocket payment HF.4 Rest of the world financing schemes (non resident) SHA CODES and Health Care Functions Total HF Central governmental schemes HF Social health insurance schemes HF Other primary coverage scheme HF NPISH financing schemes (excluding HF.2.2.2) HF Enterprises (except Health care providers) financing schemes HF Health care providers financing schemes HF.3.1 Out-of-pocket excluding cost sharing HF.3.2 Cost sharing with third-party payers HF Voluntary health insurance schemes (non-resident) HC.4 Ancillary services (not specified by function) 1, ,086.4 HC.4.1 Laboratory services (2) HC Laboratory diagnostics (2) HC Blood, sperm and organ bank services HC Laboratory services not specified HC.4.2 Imaging services HC.4.3 Patient transportation HC.4.4 Ancillary services non specified by function n.e.c HC.5 Medical goods (not specified by function) 1, ,749.2 HC.5.1 Pharmaceuticals and other non durable goods 1, ,497.9 HC Prescribed medicines 1, ,464.5 HC Over the counter medicines HC Other medical non-durable goods HC.5.2 Therapeutic appliances and other medical goods HC Glasses and other vision products HC Hearing aids HC Other orthopaedic appliances and prosthetics (excluding glasses and hearing aids) HC All other medical durables, including medical technical devices HC.5.3 medical goods non specified by function n.e.c

80 78 Qatar National Health Accounts Report 2014 SHA MATRIX 5: HFXHC : EXPENDITURES BY HEALTHCARE FINANCING SCHEMES AND HEALTHCARE FUNCTIONS Continued Healthcare financing schemes (HF) HF.1.1 Government schemes HF.1.2 Compulsory contributory health insurance schemes HF.2 Voluntary health care payment schemes HF.3 Household outof-pocket payment HF.4 Rest of the world financing schemes (non resident) SHA CODES and Health Care Functions Total HF Central governmental schemes HF Social health insurance schemes HF Other primary coverage scheme HF NPISH financing schemes (excluding HF.2.2.2) HF Enterprises (except Health care providers) financing schemes HF Health care providers financing schemes HF.3.1 Out-of-pocket excluding cost sharing HF.3.2 Cost sharing with third-party payers HF Voluntary health insurance schemes (non-resident) 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 programmes HC.6.6 Preparing for disaster and emergency response programmes HC.6.9 Preventive care not specified HC.7 Governance and health system and financing administration ,141.8 HC.7.1 Governance and health system administration HC.7.2 Administration of health financing HC Health administration and health insuracne. Social insurance HC Health administration and health insuracne. Private insurance HC.7.3 Other administrative costs not specified by kind (n.s.k.) HC.9 Other health care services not elsewhere classified (n.e.c) Current expenditure on health (HC) 14, , ,188.2 Gross capital formation (GCF) 2, ,633.7 Overall health expenditure (CHE + GCF) 17, , ,821.8

81 annexes 79 SHA MATRIX 6: HPXHC : EXPENDITURES BY HEALTHCARE PROVIDERS AND HEALTHCARE FUNCTIONS Healthcare providers (HP) SHA CODES and Health Care Functions HP.1 Hospitals HP.2 Residential long-term are facilities HP.3 Providers of ambulatory health care HP.4 Providers of ancillary services HP.5 Retailers and other providers of medical goods HP.7 Providers of health care system administration and financing HP.1.1 General hospitals HP.1.3 Specialised hospitals (other than mental health hospitals) HP.1.9 Hospitals not specified HP.2.1 Long-term nursing care facilities HP.2.2 Menatl health and substance abuse facilities HP.2.9 Other residential long-term care facilities HP.6 Providers of preventive care HP.9 Rest of the world HP. Nsk Providers not specified by kind HP.3.1 Medical practice HP.3.4 Ambulatory health care centres HP Offices of general medical practitioners HP Offices of medical specialists (other than mental medical specialists) HP.3.2 Dental practice HP.3.3 Other healthcare practitioners HP Family planning centres HP Ambulatory mental health and substance abuse centres HP All other ambulatory centres HP.3.5 Providers of home health care 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 HP.5.1 Pharmacies HP.5.2 Retail sellers and other suppliers of durable medical goods and medical appliances HP.5.9 All other miscellaneous sellers and other suppliers of pharmaceuticals and medical goods 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 Total HC.1 Curative care 5, , , , ,392.6 HC.1.1 Inpatient curative care 2, , , ,723.7 HC General inpatient curative care HC Specialised inpatient curative care 2, , , ,518.1 HC Inpatient care not specified HC.1.2 Day curative care HC General day curative care HC Specialised day curative care HC Day care not specified HC.1.3 Outpatient curative care 1, , ,233.7 HC General outpatient curative care 1, ,406.9 HC Dental outpatient curative care HC Specialised outpatient curative care ,032.8 HC Outpatient care not specified HC.1.4 Home-based curative care HC.1.5 Curative care n.e.c 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.2.5 Rehabilitative care n.e.c

82 80 Qatar National Health Accounts Report 2014 SHA MATRIX 6: HPXHC : EXPENDITURES BY HEALTHCARE PROVIDERS AND HEALTHCARE FUNCTIONS Continued Healthcare providers (HP) SHA CODES and Health Care Functions HP.1 Hospitals HP.2 Residential long-term are facilities HP.3 Providers of ambulatory health care HP.4 Providers of ancillary services HP.5 Retailers and other providers of medical goods HP.7 Providers of health care system administration and financing HP.1.1 General hospitals HP.1.3 Specialised hospitals (other than mental health hospitals) HP.1.9 Hospitals not specified HP.2.1 Long-term nursing care facilities HP.2.2 Menatl health and substance abuse facilities HP.2.9 Other residential long-term care facilities HP.6 Providers of preventive care HP.9 Rest of the world HP. Nsk Providers not specified by kind HP.3.1 Medical practice HP.3.4 Ambulatory health care centres HP Offices of general medical practitioners HP Offices of medical specialists (other than mental medical specialists) HP.3.2 Dental practice HP.3.3 Other healthcare practitioners HP Family planning centres HP Ambulatory mental health and substance abuse centres HP All other ambulatory centres HP.3.5 Providers of home health care 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 HP.5.1 Pharmacies HP.5.2 Retail sellers and other suppliers of durable medical goods and medical appliances HP.5.9 All other miscellaneous sellers and other suppliers of pharmaceuticals and medical goods 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 Total HC.3 Long-term care (Health) HC.3.1 Inpatient long-term care (health) HC.3.2 Day long-term care (health) HC.3.3 Outpatient longterm care (health) HC.3.4 Home-based longterm care (health) HC.3.5 Long-term health care - LTHC n.e.c HC.4 Ancillary services (not specified by function) ,086.4 HC.4.1 Laboratory services HC Laboratory diagnostics HC Blood, sperm and organ bank services HC Laboratory services not specified HC.4.2 Imaging services HC.4.3 Patient transportation HC.4.4 Ancillary services non specified by function n.e.c HC.5 Medical goods (not specified by function) ,749.2 HC.5.1 Pharmaceuticals and other non durable goods ,497.9 HC Prescribed medicines ,464.5 HC Over the counter medicines HC Other medical non-durable goods HC.5.2 Therapeutic appliances and other medical goods HC Glasses and other vision products HC Hearing aids

83 annexes 81 SHA MATRIX 6: HPXHC : EXPENDITURES BY HEALTHCARE PROVIDERS AND HEALTHCARE FUNCTIONS Continued Healthcare providers (HP) SHA CODES and Health Care Functions HP.1 Hospitals HP.2 Residential long-term are facilities HP.3 Providers of ambulatory health care HP.4 Providers of ancillary services HP.5 Retailers and other providers of medical goods HP.7 Providers of health care system administration and financing HP.6 Providers of preventive care HP.9 Rest of the world HP. Nsk Providers not specified by kind HP.3.1 Medical practice HP.3.4 Ambulatory health care centres HP.1.1 General hospitals HP.1.3 Specialised hospitals (other than mental health hospitals) HP.1.9 Hospitals not specified HP.2.1 Long-term nursing care facilities HP.2.2 Menatl health and substance abuse facilities HP.2.9 Other residential long-term care facilities HP Offices of general medical practitioners HP Offices of medical specialists (other than mental medical specialists) HP.3.2 Dental practice HP.3.3 Other healthcare practitioners HP Family planning centres HP Ambulatory mental health and substance abuse centres HP All other ambulatory centres HP.3.5 Providers of home health care 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 HP.5.1 Pharmacies HP.5.2 Retail sellers and other suppliers of durable medical goods and medical appliances HP.5.9 All other miscellaneous sellers and other suppliers of pharmaceuticals and medical goods 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 Total HC Other orthopaedic appliances and prosthetics (excluding glasses and hearing aids) HC All other medical durables, including medical technical devices HC.5.3 medical goods non specified by function n.e.c 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 programmes HC.6.6 Preparing for disaster and emergency response programmes HC.6.9 Preventive care not specified HC.7 Governance and health system and financing administration ,141.8 HC.7.1 Governance and health system administration HC.7.2 Administration of health financing HC Health administration and health insuracne. Social insurance HC Health administration and health insuracne. Private insurance HC.7.3 Other administrative costs not specified by kind (n.s.k.) HC.9 Other health care services not elsewhere classified (n.e.c) Current expenditure on health (CHE) 6, , , , ,188.2 Gross capital formation (GCF) 1, ,633.7 Total health expenditure (CHE + GCF) 7, , , , ,821.8

84 82 Qatar National Health Accounts Report 2014 SHA MATRIX 7: HPXFP : EXPENDITURES BY HEALTHCARE PROVIDERS AND FACTORS OF PROVISION Healthcare providers (HP) HP.1 Hospitals HP.2 Residential longterm care facilities HP.3 Providers of ambulatory health care HP.4 Providers of ancillary services HP.5 Retailers and other providers of medical goods HP.7 Providers of health care system administration and financing HP.1.1 General hospitals HP.1.3 Specialised hospitals (other than mental health hospitals) HP.1.9 Hospitals not specified 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.6 Providers of preventive care HP.9 Rest of the world HP. Nsk Providers not specified by kind Total SHA CODES and Factors of provision (FP) HP.3.1 Medical practice HP.3.4 Ambulatory health care centres HP Offices of general medical practitioners HP Offices of medical specialists HP.3.2 Dental practice HP.3.3 Other healthcare practitioners HP Family planning centres HP Ambulatory mental health and substance abuse centres HP All other ambulatory centres HP.3.5 Providers of home health care 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 HP.5.1 Pharmacies HP.5.2 Retail sellers and other suppliers of durable medical goods and medical appliances HP.5.9 All other miscellaneous sellers and other suppliers of pharmaceuticals and medical goods 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 FP.1 Compensation of employees 4, , , ,536.6 FP.1.1 Wages and salaries 2, , , ,752.8 FP.1.2 Social contributions FP.1.3 All other costs related to employees 1, , ,743.2 FP.2 Self-employed professional remuneration FP.3 Materials and services used 1, ,425.5 FP.3.1 Health care services FP.3.2 Health care goods 1, ,459.9 FP Pharmaceuticals ,289.0 FP Other health care goods ,171.0 FP.3.3 Non-health care services ,461.1 FP.3.4 Non-health care goods FP.4 Consumption of fixed capital FP.5 Other items of spending on inputs FP.5.1 Taxes FP.5.2 Other items of spending FP.nsk Other items not classified FP.M Factors of provision by the RoW , ,382.0 Total factors of provision 6, , , ,806.1 Current expenditure on health (CHE) 6, , , , ,188.2

85 83 SHA MATRIX 8 : CAPITAL ACCOUNT Healthcare providers (HP) SHA CODES and Categories HP.1 Hospitals HP.3 Providers of ambulatory health care HP.4 Providers of ancillary services HP.7 Providers of health care system administration and financing Total HP.1.1 General hospitals HP.1.3 Specialised hospitals (other than mental health hospitals) HP.1.9 Hospitals not specified HP.2 Residential long-term care facilities HP Offices of general medical practitioners HP.3.2 Dental practice HP All other ambulatory centres HP.3.5 Providers of home health care 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 HP.5 Retailers and other providers of medical goods HP.6 Providers of preventive care HP.7.1 Government health administration agencies HP.7.2 Social health insurance agencies HP.7.9 Other administration agencies HP.9 Rest of the world HP. Nsk Providers not specified by kind HK.1 Gross capital formation 1, ,633.7 HK.1.1 Gross fixed capital formation 1, ,633.1 HK Infrastructure ,891.1 HK Residential and nonresidential buildings ,839.9 HK Other structures HK Machinery and equipment HK Medical equipment HK Transport equipment HK ICT equipment HK Machinery and equipment n.e.c HK Intellectual property products HK Computer software and databases HK Intellectual property products n.e.c HK.1.2 Changes in inventories HK.1.3 Acquisitions less disposals of valuables HK.1.1.c Consumption of fixed capital HK.1.1.n Net capital formation HK.1.9 Capital Formation HK.2 Non-produced non-financial assets HK.2.1 Land HK.2.2 Other non-produced non-financial assets