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Accuracy check: Norwegian health expenditure data

29 March 2019 Eoin Ryan

The recent publication of Norway's Statistik Sentralbyrå (SSB) annual healthcare and pharmaceutical expenditure statistics confirms the accuracy of IHS Markit's healthcare forecasts. Our 2018 forecast for total healthcare spending growth was within 0.3 percentage points of the actual spending growth for 2018.

The SSB system of health accounts show total current healthcare expenditure grew by 4.2% year-on-year (y/y) in 2018 to NOK359,987 million. This represents an overall slowdown in growth, when measured against average annual increases of 6.3% over the previous five-year period (2014-2018), according to the SSB.

IHS Markit's healthcare forecast for the Norwegian market in 2018 predicted that spending would increase by 4.5% y/y to NOK358,239 million. This reflects the closeness of IHS Markit projections with the actual SSB figures, in terms of both the nominal value of current healthcare expenditure and underlying growth rate.

While the agency is careful to describe recent annual figures as "provisional" major revisions are rarely necessary. Norway is a best-in-class performer when it comes to publishing timely and transparent healthcare statistics. Few other European or Western economies can match the level of detail and consistency that the Norwegian statistical agency achieves. It is especially noteworthy that Norway manages to provide an historical data edge for the preceding year. This is by no means a common occurrence, even for other advanced healthcare systems.

We have already considered the juxtaposition between IHS Markit forecasts for healthcare expenditure and validated SSB statistics. But other relevant comparators are equally applicable, including per capita spending, general government spending, private household expenditure and national insurance.

Per capita healthcare spending was estimated by Norway's statistics agency to reach NOK67,770 in 2018, an increase of 3.6% y/y. Increases in total per capita healthcare spending averaged 4.6% during the period 2014 to 2018. This compares favourably to IHS Markit's expected 3.5% y/y gain to NOK66,918.

IHS Markit and the SSB also mirror each other on the question of private household out-of-pocket (OOP) expenditure. SSB analysis points to a 4.2% y/y gain to NOK52,261 million or equivalent to 14.5% of total healthcare spending. This dovetails nicely with our forecast of 4.2% annual growth to NOK51,817 million. This represents 14.4% of total healthcare expenditure, according to our model. The outlook for private healthcare spending during 2019/2020 also bodes well, with IHS Markit seeing mid-single digit growth as reasonably likely. More broadly, consumer spending growth will be driven by real wage gains, alongside relatively healthy labour and housing markets. In addition, historically low interest rates have elevated household real disposable income and credit growth.

IHS Markit's forecast accuracy is also evident from an analysis of the patterns of public healthcare expenditure in 2018. General government expenditure (including social health insurance) rose by 4.2% to NOK307,725 million - representing 85.4% of total healthcare expenditure - according to the SSB. For perspective, IHS Markit estimated a 4.5% y/y increase in public spending on health to NOK305,148 million, meaning government spending equalled 85.1% as a proportion of all healthcare expenditure in Norway.

Norway's data provides a unique opportunity to verify IHS Markit's healthcare forecast methodology. But a degree of caution should be injected here, since the reality is that the national expenditure figures that are available in most other countries do not come close to Norway's reliability.

Posted 29 March 2019 by Eoin Ryan, Senior Analyst

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