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Reference metadata

Reference metadata describe statistical concepts and methodologies used for the collection and generation of data. They provide information on data quality and, since they are strongly content-oriented, assist users in interpreting the data. Reference metadata, unlike structural metadata, can be decoupled from the data.

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Health care resources (hlth_res)

Reference Metadata in Euro SDMX Metadata Structure (ESMS)

Compiling agency: Eurostat, the statistical office of the European Union.

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Non-expenditure healthcare data provide information on institutions providing healthcare in countries, on resources used and on output produced in the framework of healthcare provision.

Data on healthcare form a major element of public health information as they describe the capacities available for different types of healthcare provision as well as potential 'bottlenecks' observed. The quantity and quality of healthcare services provided and the work sharing established between the different institutions are a subject of ongoing debate in all countries. Sustainability - continuously providing the necessary monetary and personal resources needed - and meeting the challenges of ageing societies are the primary perspectives used when analysing and using the data.

The resource-related data refer to both human and technical resources, i.e. they relate to:

Health care staff: 'manpower' active in the health care sector (doctors, dentists, nurses, etc.);

Heath workforce migration: migration movements of doctors and nurses;

Healthcare facilities: technical capacity dimensions (hospital beds, beds in nursing and residential care facilities, etc.).

The output-related data ('activities') refer to contacts between patients and the healthcare system, and to the treatment thereby received. Data are available for hospital discharges of in-patients and day cases, average length of stay of in-patients, consultations with medical professionals, and medical procedures performed in hospitals.

Annual national and regional data are provided in absolute numbers, percentages, and in population-standardised rates (per 100 000 inhabitants).

Wherever applicable, the definitions and classifications of the System of Health Accounts (SHA) are followed, e.g. International Classification for Health Accounts - Providers of health care (ICHA-HP). For hospital discharges, the International Shortlist for Hospital Morbidity Tabulation (ISHMT) is used. Surgical procedures are classified according to a shortlist mapped to ICD-9-CM.

These healthcare data are largely based on administrative data sources in the countries. Therefore, they reflect the country-specific way of organising healthcare and may not always be completely comparable.

11 July 2024

Healthcare resources' statistics describe the process of providing healthcare services in countries by referring to the participating institutions. Institution-related data are mostly related to and derived from available resources and so focus primarily on a capacity dimension.

Health care activities' statistics describe the process of providing health care services in countries by referring to the services provided. Service-related data aim at quantifying directly elements of the healthcare delivery process.

The respective data are, due to their heterogeneity, collected, stored and disseminated via different tables. They are based on different, mainly administrative sources. This may lead to differences in the coverage of time series and/or in the geographical coverage; data validity, reliability and comparability may vary. Furthermore, it may not always be possible to have the healthcare system, implicitly underpinning the data collection, being consistently defined across data sources.

Non-expenditure healthcare resources data are grouped as follows:

Healthcare staff: data refer to human resources available for providing health care services in the country, irrespective of the sector of employment (i.e. whether they are independent, employed by a hospital or any other health care provider). 'Manpower' categories focus on health care professionals (physicians, dentists, nursing and caring professionals, pharmacists, physiotherapists); socio-demographic elements (age, sex) are partly included.

Three different concepts are used to present the number of health care professionals:
- 'practising', i.e. health care professionals providing services directly to patients;
- 'professionally active', i.e. 'practising' health care professionals plus health care professionals for whom their medical education is a prerequisite for the execution of the job;
- 'licensed to practice', i.e. health care professionals who are registered and entitled to practice as health care professionals.

There is also a table on health workforce migration, which presents data on the number and annual inflow of foreign trained doctors and nurses.

Healthcare facilities: data refer to available beds in hospitals (HP.1) and subcategories (such as curative care beds, rehabilitative care beds, etc.) and available beds in nursing and residential care facilities (HP.2) as well as medical technology and technical resources in hospitals (HP.1).

Total hospital beds (HP.1) are all hospital beds which are regularly maintained and staffed and immediately available for the care of admitted patients. Total hospital beds are broken down as follows:
- Curative care (acute care) beds;
- Rehabilitative care beds;
- Long-term care beds (excluding psychiatric care beds);
- Other hospital beds.

Beds in nursing and residential care facilities (HP.2) are available beds for people requiring ongoing health and nursing care due to chronic impairments and a reduced degree of independence in activities of daily living (ADL) in establishments primarily engaged in providing residential care combined with either nursing, supervision or other types of care as required by the residents. The care provided can be a mix of health and social services. 

The definition of healthcare facilities follows the International Classification for Health Accounts - Providers of health care (ICHA-HP) of the System of Health Accounts (SHA).

Hospital patients: data refer to (1) hospital discharges of in-patients and day cases by age, sex, and selected (groups of) diseases; (2) average length of stay of in-patients; (3) a selection of medical procedures applied in hospitals.

A (hospital) discharge is the formal release of a patient from a hospital after a procedure or course of treatment (episode of care). A discharge occurs anytime a patient leaves because of finalisation of treatment, signs out against medical advice, transfers to another health care institution or because of death. A discharge can refer to in-patients or day cases. Healthy newborns should be included. Transfers to another department within the same institution are excluded.

An in-patient is a patient who is formally admitted (or 'hospitalised') to an institution for treatment and/or care and stays for a minimum of one night or more than 24 hours in the hospital or other institution providing in-patient care.

Day case: day care comprises medical and paramedical services (episode of care) delivered to patients who are formally admitted for diagnosis, treatment or other types of health care with the intention of discharging the patient on the same day. An episode of care for a patient who is admitted as a day-care patient and subsequently stays overnight is classified as an overnight stay or other in-patient case.

Average length of stay (ALOS) is computed by dividing the number of hospital days (or bed-days or in-patient days) from the date of admission in an in-patient institution (date of discharge minus date of admission) by the number of discharges (including deaths) during the year. 

Procedures are all types of medical interventions with the intention of achieving a result in the care of persons with health problem.

Next to absolute numbers, density rates are provided for healthcare statistics.

Density rates are used to describe the availability of resources or the frequency of services rendered, expressed in per 100 000 inhabitants. They are calculated by dividing the absolute number of health care resources available or services rendered in a given period by the respective population in the same period and then multiplied by 100 000. For Luxembourg the density rates are calculated dividing the absolute number of healthcare services rendered in a given period by the resident population covered by the statutory health insurance scheme and then multiplied by 100 000.

The availability of resources may also be expressed by an inverse figure - e.g. the number of inhabitants per physician - which is selectively used here.

Administrative data sources refer to registered patients treated or procedures applied. The underlying totality of institutions, for which data collections are available, may differ. In some countries, data may not be available for a subgroup of institutions (e.g. private hospitals).

Depending on the data set, the target populations are (1) all healthcare staff or (2) all available beds or equipment in hospitals or in nursing and residential care facilities or (3) all discharges or procedures performed in all hospitals.

EU Member States, Iceland, Liechtenstein, Norway, Switzerland, Montenegro, North Macedonia, Albania, Serbia and Turkey.

Calendar year; depending on the data set this can be annual average data or data as reported by 31st December.

For medical graduates, the academic year may be used by some countries e.g. data for 2022 may refer to the academic year 2021-2022.

One exception is the influenza vaccination programme data, which can be reported according to the influenza season. In this case, data refer to the season preceeding the reference year, e.g. 2022 data refer to influenza season 2021/2022. 

Not available.

The data are published in absolute numbers and rate per 100,000 inhabitants. The data may also be expressed by an inverse figure - e.g. the number of inhabitants per physician.

The absolute numbers for EU aggregates are the sum of the country numbers. When there is no available data for a country, the calculation of the EU aggregate takes into account the available data in the 5 previous years for the countries for which data is missing. For the density rates these EU totals are divided by the corresponding total EU population.

Health care non-expenditure data are mainly derived from administrative sources, and these sources may vary by country and by variable. Sources for each variable/country are mentioned in the national metadata reports attached to this European metadata report.

Please note that the data sources used may not have been created initially for statistical purposes, and that the initial purpose of a data source may differ across countries. Both facts may influence the validity and comparability of results.

Annual.

Regulation (EU) 2022/2294 fixes the deadline for data delivery at N+14 months for the year N for the mandatory variables relating to

  • Health graduates,
  • Hospital beds and beds in residential long-term care facilities,
  • Devices on medical imaging,
  • Data on ambulatory care.

Data for health employment, hospital care and surgical procedures will become mandatory for countries to transmit from reference year 2023 with a deadline of N+20 months.

The comparability of the data across different countries is limited by the fact that the quality of the country data is subject to the way in which healthcare provision is organised in countries, and which information is available to and collected by the respective institutions. The newly produced Eurostat Manual assists countries in harmonising their data.

Some countries are unable to cover all providers of care (the inclusion of private providers seems particularly difficult) or are only able to provide data for selective regions.

Sometimes regional data cannot be made available as the available breakdown does not coincide with the NUTS classification.

Ongoing work to increase quality, comparability and coverage is reported to Eurostat's Working Group "Public Health Statistics".

The comparability of the data over time is checked before dissemination.

Some countries may have a change in their data collection resulting in a break in series. These break in series are flagged (b-flag) and some information are given in the annexes of the metadata.