The statistics which CBS publishes annually on health and social care expenditure are stand-alone statistics. The Health and Social Care Accounts do not correspond exactly with the part of the National Accounts that relate to care. However, the Health and Social Care Accounts and National Accounts figures have been aligned as closely as possible. The figures on care expenditure published in the Health and Social Care Accounts are far more detailed than those in the National Accounts. Another important difference is that the National Accounts cover only that portion of total care that falls within SBI divisions 86-88 (Human Health and Social Work Activities section), whereas the Health and Social Care Accounts describe all care consumption in the Netherlands, i.e. including care produced outside that section. The bulk of the latter is made up of medicaments and medical goods, but it also includes patient transportation by taxi firms, home help supplied by companies whose main activity is not care, care consumed abroad, care delivered within the Ministry of Defence and the Ministry of Justice and Security, etc. The linking of claims registers to the CBS business register has revealed that care is supplied from unsuspected sectors of the economy. 

The Health and Social Care Accounts are structured in accordance with the methodology of the System of Health Accounts (SHA). In the SHA, care expenditure is broken down by three axes: provider, financing and function. The standard output consists of the three two-dimensional tables generated by intersecting the three axes (i.e. provider*function, provider*financing  and function*financing ). CBS also publishes these three tables for the internationally defined demarcation of ‘Health Expenditure’. The classifications used for providers, financing and function have been agreed internationally (OECD-Eurostat-WHO) and are therefore a compromise aimed at achieving international comparability. 

The Health and Social Care Accounts differ from the SHA on a few points:

1. The Health and Social Care Accounts feature a much broader demarcation of ‘expenditure on care’: the SHA relates only to healthcare, whereas the Health and Social Care Accounts also include social care (including children's day care, social services). Furthermore, the Health and Social Care Accounts comprise the totality of long-term care, whereas in the SHA, social care, such as home care financed under the Social Support Act (‘Wet maatschappelijke ondersteuning’, Wmo) is only included as a health-related memorandum item. In the international demarcation, that care is not counted as ‘health care’ but as ‘social care’. R&D expenditure and training are also not counted as expenditure according to the SHA, but they are included in the Health and Social Care Accounts. 
2. The classification of provider categories differs on several points, see annex 2.
3. For that part of the care that falls outside the SHA definitions, no breakdown by care type was provided in the statistics before the revision. 

Traditionally, the ‘Providers*Financing ’ table has been central to the Health and Social Care Accounts. The main shortcoming of this table is that it does not reflect the fact that the provider categories in the table are based on a classification by principal activity, whereas providers often supply multiple forms of care. However, the names of these categories, such as ‘Providers of ... care’ create the impression that they limit themselves to one type of care. For instance, ‘General medical practices’ provide not only GP care but also – albeit to a limited extent – medicaments. Similarly, alongside medical specialist care, ‘Providers of medical specialist care’ also provide other services, such as mental health care, ambulance care, nursing home care and medicaments. A particularly striking example is the fact that while the providers of nursing and care primarily provide elderly care, they also provide maternity care. This is because maternity care is often provided by home care institutions which principally provide elderly care. In order to address this point, two new tables have been developed: ‘Providers*Care types ’ and ‘Financing*Care types ’. This effectively completes the alignment with the methodology of the System of Health Accounts by adding a third axis (care type) to the two axes already published (provider category and financing scheme). 

Another limitation of the “Providers*Financing” table was that prior to the revision, the classification of the providers in categories was not seamlessly aligned with the Standard Business Classification (SBI), which is used for virtually all economic statistics within CBS. This made proper comparison of the Health and Social Care Accounts with other economic statistics impossible. This problem arises primarily because a significant proportion of the care is provided by companies that do not belong to the Human Health and Social Work Activities section. Examples include cleaning firms that offer home help, fitness centres that provide physiotherapy, government agencies such as the Ministry of Defence and the Ministry of Justice and Security that provide their own care, beauty salons that provide cosmetic care, educational consultancies that offer youth care, etc. In the figures before revision, this care was often grouped under the type of provider the company in question most closely resembled. For instance, care provided by cleaning firms under the Social Support Act (Wmo) was assigned to the ‘Providers of nursing and care’ category. With this revision, we have moved to a classification based on providers from the Human Health and Social Work Activities section on the one hand and providers from the ‘rest of the economy’ on the other. Moreover, within the latter category, we draw a distinction between providers who supply care as their principal activity (pharmacies, suppliers of medical goods) and providers who supply care as a secondary activity.

A third limitation of the Health and Social Care Accounts before revision was that the Human Health and Social Work Activities section (SBI divisions 86, 87, 88) was not fully covered. For instance, the ‘Psychologists’ and ‘Other paramedical’ subclasses and the ‘Other providers’ categories in divisions 86 and 88 were not fully covered, due to the lack of reliable figures. This issue is particularly relevant to components of the Human Health and Social Work Activities section where a relatively large amount of uninsured care is provided.

Finally, developments in recent years have revealed the need for a stronger focus on the prevention of double counting which can occur when goods/services are supplied by one healthcare provider to another, or through the use of self-employed persons by healthcare providers and as a result of financing constructions such as integrated care and medical specialist companies. A phenomenon which has gained momentum in recent years and has attracted a lot of attention as a result is the growth in the number of self-employed persons working in the Human Health and Social Work Activities section, which increased from 88,000 in 2016 to 134,000 in 2022, a rise of slightly over 50%.  And the ‘Cost of agency staff and other temporary contract workers’ of the major care institutions (hospitals, care for the disabled, mental health services, youth care, shelter care and nursing and care) rose from €2.0 billion in 2016 to €4.8 billion in 2022. Here, too, there is a risk of double counting: the revenues of these self-employed persons are also included in the revenues of the companies that hire them and submit claims for the care provided to the insurance companies. 

With the revision, an improved methodology has been introduced in order to identify and correct the different forms of double counting as far as possible.