In December 2024, Statistics Netherlands (CBS) published the revised figures for health and social care expenditure (hereafter: Health and Social Care Accounts) for the years 2021 to 2023, including two new tables containing a breakdown of expenditure by care type. In principle, the revision of the Health and Social Care Accounts takes place every five years, at the same time as the revision of the National Accounts. This publication describes the main changes arising from this revision and provides a guide for interpreting the figures.

The Health and Social Care Accounts present national health and social care expenditure broken down by groups of healthcare providers and financing schemes. The Health and Social Care Accounts also provide the basis for the figures on expenditure on healthcare in accordance with the internationally agreed definition, with a breakdown by healthcare provider, financing scheme and function based on international standards (System of Health Accounts). 

The most important innovation within this revision is the addition of the breakdown by care type. Previously, the figures were only broken down by healthcare provider and financing scheme. However, many healthcare providers supply more than one type of care, a fact which remains entirely obscured in the intersection between healthcare providers and financing schemes. For example: hospitals’ revenues under the Healthcare Insurance Act (‘Zorgverzekeringswet’) are not only spent on medical specialist care, but also on patient transport, medicaments, dental care, perinatal care, etc. The creation of wide-ranging care conglomerates has contributed to the diversity of provision. Breaking down the figures by care type brings that diversity into focus.

The revision has also prompted an update to the presentation on StatLine. A clearer distinction has been made between companies within the Health and Social Care section and those outside it, such as pharmacists and secondary providers of healthcare. The terminology has also been amended; the term ‘care expenditure in the broad sense’ has been replaced by the term ‘health and social care expenditure’ in order to better express the fact that it includes more than merely healthcare in the narrow sense. 

Finally, the revision has also led to a more complete coverage of care expenditure, a better demarcation of care versus non-care and a better breakdown of care expenditure by financing scheme.

All of the changes have been enabled by the use of new data sources and improved use of existing sources. The most important new source takes the form of claims submitted under the Healthcare Insurance Act (Zvw) and the Long-term care Act (’Wet langdurige zorg’; Wlz) per healthcare provider, supplied by Vektis. Without this source, the breakdown by healthcare type and the improvement of the breakdown by financing would not have been possible. 

An important impulse for the revision was the fact that since the 2021 reporting year, CBS has been required to provide detailed statistics on revenues and costs for all components of the Human Health and Social Work Activities section (SBI divisions 86, 87, 88) as part of the Structural Business Statistics (SBS). Among other things, this has resulted in a much more intensive use of fiscal data and public annual reports of healthcare providers. As a result, data are now available for components of the Human Health and Social Work Activities section for which there were previously little or no data available.

Other data sources used for the first time include the government’s open data on government subsidies, data from the Central Bureau for Fundraising (CBF) on charities, data from the National Health Care Institute on personal contributions under the Healthcare Insurance Act and the Vektis data management (AGB) register.