The Institute of Health Information and Statistics of the Czech Republic (“ÚZIS ČR” or “IHIS CR“ or “the Institute“)

Palackého nám. 375/4 
P. O. Box 60
128 01 Praha 2 – Nové Město
Czech Republic

Statistics on healthcare non-expenditure provide information on healthcare human resources, healthcare facilities, and healthcare utilisation.
- The people active in the healthcare sector (doctors, dentists, nurses, etc.) and their status (graduates, practising, migration of doctors and nurses, etc.);
- The available healthcare technical resources and facilities (hospital beds, beds in residential care facilities, medical technology, etc.);
- The health activities or patient contacts undertaken (hospital discharges, surgical procedures, ambulatory care data, etc.).
Annual national and regional data are provided in absolute numbers or as a rate of a relevant population.
Data are based mainly on administrative records (see section 18.1 ‘Source data’ for more information).

For the collection data on healthcare non- expenditure, the classifications used in the System of Health Accounts (SHA) and its related set of International Classification for the Health Accounts (https://www.oecd.org/health/health-systems/1841456.pdf ) are applied.

For hospital discharges, the International Shortlist for Hospital Morbidity Tabulation (ISHMT) is used. (https://ec.europa.eu/eurostat/ramon/nomenclatures/index.cfm? TargetUrl=LST_NOM_DTL&StrNom=ISHMT_2005& StrLanguageCode=EN&IntPcKey=& StrLayoutCode=HIERARCHIC )

For Health Employment, the Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005 on the recognition of professional qualifications apply (https://eur-lex.europa.eu/eli/dir/2005/36/2020-04-24 ).

Definitions of mandatory variables are laid down in Commission Regulation (EU) 2022/2294.

Where possible, the statistics are separated by sex (male/female), age group and NUTS2 region.

The Eurostat manual on healthcare non-expenditure statistics provides an overview of the classifications, both for mandatory variables and variables provided on voluntary basis.

National deviations: see Annex at the bottom of the page.

Public health.

The healthcare non-expenditure statistics describe the public health sector from a non-monetary perspective. The statistics explain the number or rate of different healthcare resources, facilities and utilisations. A wide range of indicators are collected from a multitude of sources and therefore, details pertaining to individual variables are given in the Annex.

Definitions of mandatory variables are laid down in Commission Regulation (EU) 2022/2294.

The Eurostat manual on healthcare non-expenditure statistics provides an overview of the classifications, both for mandatory variables and variables provided on voluntary basis.

National changes of statistical concepts and national definitions deviating from Regulation (EU) 2022/2294: see Annex at the bottom of the page.

Healthcare professional

Hospital bed

Medical technology

Individuals in the population (immunised/screened)

Hospital inpatient discharge

Surgical procedure

Healthcare professionals practicing within the Czech public health insurance system
Hospital beds available within the Czech public health insurance system
Medical technology available in hospitals and selected healthcare providers (general and specialised outpatient clinics, labs, etc.) in the Czech Republic
Individuals in the population covered by the Czech public health insurance system
Hospital inpatient discharge in all inpatient providers in the Czech Republic
Surgical procedure performed within the Czech public health insurance system / in the Czech Republic respectively, see Annex

Complete national territory.

Administrative division of the Czech Republic. The Czech Republic is divided into fourteen regions. The regional level corresponds to the division of the Czech Republic into NUTS III statistical territorial units. NUTS II regions are made up of one to three NUTS III units. They were created for the needs associated with the coordination and implementation of economic and social cohesion policy by Act No. 248/2000 Coll., on the support of regional development, and are referred to as cohesion regions. The NUTS I unit consists of the territory of the entire Czech Republic.

No overseas territories are applicable.

In general, data provided cover the period since 2010 in most cases (National Registry of Reimbursed health care Services), some data are available for earlier years (Hospitals and hospital beds since 2005, Medical Technology since 2004)

More details are covered in Annex

Not applicable

Absolute numbers (beds, operation theatres, hospitals)
Absolute numbers of persons (consultations, discharges)
Health care professionals are reported as head counts
Number of days (average length of stay)
Occupancy rate (in %)
Share (in %) of population (screening, influenza vaccination)
Share (in %) of foreign trained physicians

More details are covered in Annex

Calendar year.

Regulation on Community statistics on public health and health and safety at work (EC) No 1338/2008
(https://eur-lex.europa.eu/legal- content/EN/ALL/?uri=OJ%3AL%3A2008%3A354%3ATOC)
Commission Regulation (EU) 2022/2294 on statistics on healthcare facilities, healthcare human resources and healthcare utilisation http://data.europa.eu/eli/reg/2022/2294/oj

Regulation on Community statistics on public health and health and safety at work (EC) No 1338/2008

Commission Regulation (EU) 2022/2294 on statistics on healthcare facilities, healthcare human resources and healthcare utilisation http://data.europa.eu/eli/reg/2022/2294/oj

The institutional conditions for the professional independence of the Institute of Health Information and Statistics of the Czech Republic (hereinafter referred to as the Institute) for the performance of the state statistical service are anchored in Act No. 89/1995 on the State Statistical Service and EU Regulation No. 223/2009 on European Statistics.
The Institute was established by Act No. 372/2011, on health services, and fulfills tasks in the area of ensuring the National Health Information System according to this Act and Act No. 89/1995, on the State Statistical Service.
The status and competences of the Institute and its director are further defined in the Articles of Incorporation and the Statute.
Links to publicly available documents:
Act No. 89/1995 on the State Statistical Service
Act No. 372/2011 on health services
Founding charter of the Institute of Health Information and Statistics of the Czech Republic
Statute of the Institute of Health Information and Statistics of the Czech Republic
Decrees of the CZSO on the Program of Statistical Surveys
Available on the web site: Homepage - ÚZIS ČR (uzis.cz)

Joint Questionnaire on Non-Monetary Health Care Statistics, which is carried by Eurostat, OECD and WHO-Europe.

The Institute is a part of the State Statistical Service (as an organizational component of the State authorized by the Ministry of Health to fulfill its tasks) and performs this activity in accordance with Act No. 89/1995 Coll., on the State Statistical Service, as amended. In this area, the Institute cooperates with the authorities of the State Statistical Service, especially with the Czech Statistical Office. The Institute and other bodies of the State Statistical Service regularly transfer data on a contractual basis. In the field of European statistics, cooperation consists in the preparation and coordination of the unified position of the Czech Republic. The institute cooperates actively and widely at the national and international level. At the international level, in the field of health statistics, it is mainly cooperation with Eurostat, DG Sante, DG Empl, ECDC, OECD and WHO. At the national level, this involves cooperation especially with the CZSO (generally within the departmental coordination group for statistics and specifically in the field of health statistics), the Ministry of Health and other ministries and bodies of state administration and self-government (National Institute of Public Health, regional authorities). It also involves cooperation with health insurance companies, representatives of health service providers and professional medical companies. The Institute is also involved in cooperation with scientific and academic workplaces.

The protection of confidential statistical data is legally required by Act No. 89/1995 Coll., on the State Statistical Service. When dealing with personal data of the NZIS, the Institute ensures the role of administrator in the sense of Regulation (EU) 2016/679 of the European Parliament and of the Council on the protection of natural persons in connection with the processing of personal data and on the free movement of such data. Based on valid legislation, employees of the Institute performing the State Statistical Service sign a promise of confidentiality and may be sanctioned for breaching this promise. The principles of information protection and the establishment of a system of responsibility, management and management of effective security practices and procedures are the subject of the organizational directive Security Policy of the ÚZIS CR. The directive on the processing and protection of personal data regulates the principles, rules and procedures in the processing and protection of personal data in accordance with the implemented ISO/IEC 27701 standard within the Institute and related activities. The Institute has an established system for assessing requests for data.

You can also refer to the CODE OF ETHICS for employees of the Institute of Health Information and Statistics of the Czech Republic. The code sets the standards of behavior and actions of employees. It is the basic ethical norm for their behavior. It follows on from the basic rights and obligations of employees stated in the Labor Code and in other legal regulations, organizational and work regulations of the Institute and other internal regulations.
Code of ethics (in Czech):
https://www.uzis.cz/index.php?pg=o-nas--dokumenty-uzis

Directive on the processing and protection of personal data
This directive establishes policies, rules and procedures for employees and other natural and legal entities persons in the processing and protection of personal data within the Institute of Health Information and statistics of the Czech Republic, as well as in other activities involving the processing of this related data. The subject of this directive is the processing of personal data carried out by employees of the ÚZIS CR in fulfillment of their work duties and by other natural and legal persons they process personal data based on the contract with ÚZIS CR. This directive is based on Regulation (EU) No. 2016/679 of the European Parliament and of the Council on protection natural persons in connection with the processing of personal data and the free movement of such data and o repeal of Directive 95/46/EC (General Data Protection Regulation) (hereinafter referred to as "GDPR") and of Act No. 110/2019 Coll., on the processing of personal data, with the fact that it supplements and elaborates some of its provisions for the regulation of relations within the ÚZIS CR and establishes organizational solutions within the ÚZIS of the Czech Republic, arresting their implementation.
Individual data from the registers are not publicly accessible. Data are provided to users only in aggregated form (e.g. for territories, kinds of health establishments, groups of diagnoses or individual diagnoses). 

Anonymized individual data are available for selected databases with accordance GDPR.

There is a schedule of outputs to be published for internal purposes. Usually, the outputs are disseminated in the second half of year (T+1)

Official release calendar is being prepared as a part of national strategy of data opening.

Every year, the Institute prepares annual reports, which provide a summary overview of developments in the key areas of its activity.

The outputs are provided as research reports, data summary reports or open datasets. Outputs are available through the webpage of institute and National Health Information Portal.

Transmission of data to certain users is determined by contractual obligations, data is then transferred in accordance with the terms set here.

The creation of datasets and publication outputs is based on the requirements of national and international data users. The requests and comments of users are discussed in management meetings.
Presentation of data through the Open Data Catalog with an indication of the update frequency.
https://opendata.mzcr.cz/
Statistical outputs of ÚZIS: www.uzis.cz/index.php?pg=vystupy

National Health Information Portal: https://www.nzip.cz/.

Data from the National Health Information System (NHIS) are provided based on written requests sent by mail or e-mail. Answers to received requests are sent in writing to the applicants within the statutory periods. Personal data with identification are not provided in principle.
The request may be written on the form Request for providing data.
https://www.uzis.cz/index-en.php?pg=contact--provision-of-information.

The publication of outputs is done continuously according to the processing of individual agendas. With the introduction of departmental reference statistics under the Health Services Act, a fixed timetable will be set for selected statistical outputs. In the field of European statistics, the required mandatory data are always transmitted within the deadlines defined by the relevant legislation.
The periodicity of publication of statistical outputs is usually annual, which is also largely determined by the method of data collection.
The publication of provisional data is becoming more frequent in the context of the expanding possibilities of data sources and the requirements to improve the timeliness of statistical output

There are no regular press releases, ad hoc communication is listed here: https://www.uzis.cz/index.php?pg=aktuality

General web page with statistical outputs https://www.uzis.cz/index.php?pg=vystupy

National Health Information Portal.

https://www.nzip.cz/

Selected statistics available at https://pzu.uzis.cz/

Relatively new, number of accesses was not evaluated so far.

Data from the National Health Information System (NHIS) are provided based on written requests sent by mail or e-mail. Answers to received requests are sent in writing to the applicants within the statutory periods. Personal data with identification are not provided in principle.
The request may be written on the form Request for providing data.
Principles for the provision of information from NHIS
https://www.uzis.cz/index-en.php?pg=contact--provision-of-information

Individual data from the registers are not publicly accessible. Data from the registers are provided to users only in aggregated form (e.g. for territories, kinds of health establishments, groups of diagnoses or individual diagnoses). Anonymized individual data are available for selected databases with accordance GDPR.

The institute cooperates with the bodies of the state statistical service, especially with the Czech Statistical Office. Data between two institutions are transferred regularly, based on the contract. Data provided to CZSO are published in Annual Statistical Yearbook.
Data are regularly reported to Ministry of Health and to regional institutions.
At the same time, data is used for evaluation of policy strategies (Health 2030).
Selected statistics are published on several dedicated web portals.

Following dedicated web portals are available, for example:
https://www.uzis.cz/index.php?pg=vystupy
https://psychiatrie.uzis.cz/cs/psychiatrie-v-datech/
https://www.uzis.cz/
https://www.nzip.cz/

Regularly, data is transmitted to Eurostat (Joint Questionnaire), WHO, OECD, ECDC and EMCDDA

Each data source has its own methodological document / handbook for data providers and users.

All relevant methodological documents are published here https://www.uzis.cz/index.php?pg=nzis

Methodological manuals:

National Register of Reimbursed Health Services https://www.uzis.cz/index.php?pg=registry-sber-dat--narodni-registr-hrazenych-zdravotnich-sluzeb#dokumenty

National Register of Hospitalized Patients https://www.uzis.cz/index.php?pg=registry-sber-dat--narodni-zdravotni-registry--narodni-registr-hospitalizovanych#dokumenty

National Register of Health Services Providers https://www.uzis.cz/index.php?pg=registry-sber-dat--narodni-registr-poskytovatelu-zdravotnich-sluzeb#dokumenty

In the introduction to publication outputs for the respective year, a methodical and qualitative description of the data collection results is described.

The policy of the integrated quality and information security management system defines the general strategy of the Institute in the areas of information quality and security management. The Institute's organizational quality management and information security systems have been repeatedly checked and found to be in accordance with ISO requirements. The authorized department ensures the fulfillment of tasks in the area of safety and quality in accordance with the established security policy of the Institute. Other authorized departments are responsible for quality assurance at the level of data reception and processing and for the publication and dissemination of results. The Institute has a dedicated position of internal auditor. The evaluation of the quality management system takes place once a year. In general, an evaluation of the quality of data collection and their processing is carried out. The Institute fulfills all legislative requirements for quality reports for collections organized within the ESS and provides the required metadata for other collections within the ESS. Mechanisms for internal reminder procedures and approval procedures are set up. The Institute's organizational quality management and information security systems have been repeatedly checked and found to be compliant with the requirements of ISO 9001:2015 and ISO / IEC 27001:2013.
Available on the web site: https://www.uzis.cz/index.php?pg=o-nas--dokumenty-uzis#rizeni-kvality

Evaluation of methodological compliance is currently being performed by the Czech Statistical Office.

The key legislative texts (laws, decrees) undergo extensive comment procedures involving all key health system stakeholders.

The Institute cooperates with the bodies of the state statistical service, especially with the CZSO, ensures links between the NZIS and individual health facilities and cooperates with operators of information systems of other organizations in the Ministry of Health and beyond. The institute cooperates with hospital associations, medical associations, professional medical societies, health insurance companies and other organizations, especially on refining the content of the NZIS and the use of collected data. At the international level, the Institute cooperates mainly with WHO, OECD and EUROSTAT. The Institute monitors website traffic and monitors the press. Requests for adjustments to collections within the Program of Statistical Surveys are taken into account and discussed as part of internal comment procedures and approved by the Ministry of Health and subsequently go through an interdepartmental comment procedure. The creation of datasets and publication outputs is based on the requirements of national and international data users. As an example of meeting the needs of users on the output side, the significant expansion of freely available data sources related to COVID-19 can be cited.

Links to publicly available documents:
Statistical outputs of the Institute: www.uzis.cz/index.php?pg=vystupy

Constant monitoring of the needs of cooperating entities and users is an important activity of UZIS and the stimuli obtained in this way they are the basis for planning the development of the institute.
This is done through:
• identification of requirements and comments from all authorized entities and users;
• discussion of complaints and comments as part of the institute's meetings;

Requirements for statistical outputs is generally given by the founding charter of UZIS. More elaborated set of key statistics will be given by the decree on departmental reference statistics, which is being prepared

Control processes are set up within the Institute and data are checked at the input, during and at the output of processing. The review is carried out in terms of confidentiality, availability, integrity, completeness, and correctness of the data. The validation methodology is available to users. Systematic revisions are not in place and publication of preliminary data is not entirely common. For the needs of European and international data collection, ad hoc revisions are carried out, either in the event of a change in definitions by international organizations or in the event of a change in the data source or modification of the methodology in the Czech Republic.
For healthcare professionals, hospital beds, rate of immunized and screened and selected surgical procedures, the data come from the National Registry of Reimbursed Health Services and therefore relate to public health insurance system. Their accuracy regarding entire Czech population is regarded as very high, as the coverage of public health insurance in the Czech population is almost 100%.

Not applicable.

Not applicable.

Length differs for different data sources, however, usually data is available within 6 -9 months after the end of reference period (year)For example, the frequency is shorter from National registry of Reimbursed Care, data is available every 3 months (with 6 months delay)
Data from National Registry of Health care providers are updated on the daily basis.

There is no release schedule, it is not possible to evaluate non-punctual releases. However, for each data source the completeness is evaluated at the end of reference period.
The timeliness of release of the data depends on the complexity of validation processes.

Currently, we are planning to release of the schedule, it should be available in 2024, as a part of finalizing and publishing the decree on departmental reference statistics.

European and national statistics are compiled to maximize consistency and comparability across regions. The Institute endeavors to use, as far as possible, uniform methodologies for data collection, processing and quality assessment. Even so, local variations may occur, but these can be considered rather minor.

We do not observe any major differences between regions. If so, this is due to the representation of the type of providers in a given region, possibly with respect to the long-standing problematic individual approach of some providers in a given year or with respect to provider staff changes and the quality of the hospital information system provider.

See Annex at the bottom of the page for potential breaks in time series for each variable.

There are no significant inconsistencies in the statistics.

There are no significant inconsistencies in the statistics.

The annual report, published every year, provides an evaluation of the Institute's management. In-house accounting is used for the purposes of evaluating and controlling the costs incurred in individual departments of the Institute. The internal audit, including financial and thematic control, is carried out on the basis of internal regulations by an authorized employee. Planning, preparation, implementation and evaluation of financial expenditures and grant projects at the Institute are governed by internal guidelines. A separate department is responsible for the maintenance and development of NHIS information systems in the field of information technology. The planning and development of the ICT infrastructure is carried out according to the needs for meeting the requirements for data outputs. Negotiations are underway with data owners (mainly health insurance companies) and other state administration institutions on the possibilities of exchanging data and reducing the burden on respondents (newly, for example, providing data on reimbursements for health care from the Institute's sources to the CZSO to ensure the international agenda of the SHA). The possibilities of linking data managed by the Institute are continuously evaluated. The Institute is continuously working on updating and further harmonizing the methodologies and codes used for data collection implemented within the NZIS and participates in the development of the Data Standard for data transfer between information systems of healthcare facilities. The Institute provides education and support in the field of methodology.

Necessary revisions are proposed by the Department of Data Analysis and approved for dissemination by the UZIS managerial board. Usually, provisional data is not reported. When necessary, revision of data is made and clearly explained to users.
Systematic revisions are not in place and publication of preliminary data is not entirely common. For the needs of European and international data collection, ad hoc revisions are carried out, either in the event of a change in definitions by international organizations or in the event of a change in the data source or modification of the methodology in the Czech Republic.

Selected statistics reported to Eurostat underwent revisions, which are clearly indicated, for reasons of improvement of definitions to comply with the new regulation (e.g. hospital beds), or due to continuous updates of the administrative data sources (e.g., cancer screening).

Several sources of data were used, namely
1) Registries and administrative sources – National registry of reimbursed health services, National registry of healthcare providers, National registry of hospitalizations, National registry of health professionals
2) Annual reports (census of all health care providers) – physical resources (CT, MRI, …), selected health professionals
3) Data from external sources - Ministry of Education, Czech Republic, Ministry of Labour and Social Affairs
Source data for the different variables are given in the Annex at the bottom of the page.

Annual reports are collected annually.
Registries and administrative sources are collected continuously, with timeliness defined by the ministerial decree.

More details: Decree No. 373/2016 Coll. on the transmission of data to the National Health Information System

Detailed methodology
https://www.uzis.cz/index.php?pg=registry-sber-dat

Administrative data sources and registries

The data are collected electronically, either by transmitting data batches (according to a prescribed data interface) or via web forms. Data are entered into the registry by healthcare providers. Access to the registers is handled by assigning access rights. Data transmission is mandatory according to the law.

The list of mandatory items must be populated, bindings between variables are applied. In case of incompleteness or error, the data is rejected and must be completed or corrected. The system automatically evaluates the error of each sub-item. A list of errors is generated and transmitted to the provider. Input data is validated against internal codebooks

The National Registry of Reimbursed Health Services (NRRHS) collects data reported by all health service providers to health insurers. The data collection uses the already implemented data collection by health insurance companies, which then transmit the data to the NRRHS.

Annual reports
Census of healthcare providers.
The Departmental Statistical Survey is implemented by the Institute in accordance with the legislation in force, in particular in accordance with the Decree of the Czech Statistical Office No. 404/2021 Coll., on the Statistical Survey Programme for 2022. The Statistical Survey Programme is compiled in accordance with the Act on the State Statistical Service.

The electronic form monitors the completeness of all variables in a given row of the report.

Annual reports
The submission of annual reports is checked in relation to registered reporting units with the obligation to complete the electronic form. Potential errors concerning the completeness or comparability of data with the previous period or between providers are communicated by telephone or e-mail directly with the person who completed the report. An overall statistical check of data quality compared to the previous period and between providers is carried out. Outliers are checked and selected statistics are checked against other registers.

Health registries
The extent of the number of records for a given time period, usually month and year, for each registered health service provider is compared to the previous year. The continuity of the time series in the processing of specific data is checked.
The hospitalization registry data are compared both to the NRRHS and often to other specialized registers in order to cross-validate or complement information on patients with the disease under study and the range of health services provided.

National registry of reimbursed health services
A complex range of checks is performed, from syntactic and basic semantic checks (primary and foreign keys, unique values, required value formats and ranges, etc.) to advanced validations of the structure and trends of the transmitted data to detect dropouts and duplicates, inconsistencies, etc.

For annual reports, data adjustments are made only in exceptional cases of significant incompleteness; imputations are usually made by deriving values from previous years.

Estimations have been used for derivation of the structure of physicians by age and gender and by categories. Since 2019, the structure according to age and gender of physicians with known working position is taken from the National Register of Health Professionals and it is adjusted to the total number of practicing physicians estimated from the National Registry of Reimbursed Health Services. Since 2019, the structure according to fields of activity of practicing physicians (full-time equivalents) is taken from the statistical surveys on workers in providers of healthcare services and is adjusted to the total number of practicing physicians estimated from the National Registry of Reimbursed Health Services.

Annex HEALTH_HCNENES_A_CZ_2021_0000_an1 with specification of metadata and data sources is enclosed.