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.
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 data are provided in absolute numbers or as a rate of a relevant population.
Some of the data is based on statistical surveys, while others are based on administrative data. The source data for the different variables are given in the attached document.
3.2. Classification system
For the collection of 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 are applied.
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.
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.
National deviations: see Annex at the bottom of the page.
3.3. Coverage - sector
Public health.
3.4. Statistical concepts and definitions
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
National changes of statistical concepts and national definitions deviating from Regulation (EU) 2022/2294 are described in the attached document.
3.5. Statistical unit
Registered health professionals or health care facilities.
3.6. Statistical population
Depending on the dataset, the target populations are
All health care staff.
All available beds or equipment in hospitals or in nursing and residential care facilities.
All discharges or procedures performed in all hospitals.
The population includes all legal persons who have a valid activity license for the provision of health care services.
3.7. Reference area
Estonia as a whole.
3.8. Coverage - Time
Health employment data: years 1980 - 2023
Number of practising physicians by age, gender, category: years 2013 - 2023
Number of beds: years 1998 - 2023
Number of MRI units and CT scanners: years 2005 - 2023
Hospital aggregates: years 2013 - 2023
Surgical procedures mostly for the years 2003 - 2023
Immunisation against influenza: years 2008 - 2023
Screening programme data: breast cancer for the years 2003 - 2023, cervical cancer 2007 - 2023, colorectal cancer 2016 - 2023.
3.9. Base period
Not applicable
Absolute numbers: health employment at the end of November; hospital beds - average number during the reference year; long-term care beds, medical devices, hospital aggregates, surgical procedures at the end of reference year.
Data as a rate of a relevant population are expressed as percentages (data on immunisation, screening programmes).
Calendar year.
6.1. Institutional Mandate - legal acts and other agreements
Health Services Organisation Act, passed 09 May 2001.
Regulation of the Minister of Social Affairs of Estonia No 51 of 7 December 2012 on requirements for the compilation of reports on health care statistics and health-related economic activity, data composition and submission procedure.
6.2. Institutional Mandate - data sharing
Joint Questionnaire on Non-Monetary Health Care Statistics, which is carried by Eurostat, OECD and WHO-Europe.
At the national level, the data sharing service is regulated according to the Official Statistics Act (§ 201).
7.1. Confidentiality - policy
The confidentiality of data is ensured in accordance with the requirements set out in the Official Statistics Act.
7.2. Confidentiality - data treatment
In publishing statistics, confidentiality is granted. Data are published or forwarded without any characteristics that would allow to identify the data subject.
The data of the data subject is published only upon the written consent of the data subject.
8.1. Release calendar
The publication dates of health statistics are pre-announced in the release calendar, which is publicly accessible on the website of NIHD. The release calendar for the upcoming year is published on September 30 of each year.
8.2. Release calendar access
Release calendar for 2025 is available on the NIHD website
8.3. Release policy - user access
All users have equal access to health statistics: publication dates are pre-announced, and no user category is provided access before the publication date.
Health statistics are first published in the public Health Statistics and Health Research Database on the NIHD website. In the case of a press release, it is published simultaneously with the publication of data in the statistical database.
All important data updates are announced on the NIHD website, on the website of the database and in social media (NIHD Facebook page, database Twitter page, health statistics newsletter).
Yearly
10.1. Dissemination format - News release
Press releases linked to the data are published on the website of NIHD in Estonian.
The data are available in micro-data form only with the consent of data providers.
10.5. Dissemination format - other
Indicators calculated on the basis of health statistics are used as measures in development plans.
The Department of Health Statistics of NIHD regularly forwards health and health care related statistical data to international organisations:
Eurostat - OECD - WHO -- Joint Health Accounts Questionnaire and Joint Questionnaire on Non-Monetary Health Care Statistics;
WHO -- for the Health for All Database;
OECD -- Health Data Questionnaire for OECD Health Database.
10.6. Documentation on methodology
Metadata are available with the data presented in the Health Statistics and Health Research Database.
10.7. Quality management - documentation
The statistical information is produced by following the principles of European Statistics Code of Practice.
The Single Integrated Metadata Structure (SIMS), which is the standard for quality reporting, is published in the Eurostat Database for every variable pertaining to the Joint, non-Monetary Health Care questionnaire.
11.1. Quality assurance
To assure the quality of processes and products, the principles of European Statistics Code of Practice are followed.
11.2. Quality management - assessment
The overall assessment of data quality is good. Data quality is in accordance with principles of accuracy and relevance, timeliness and punctuality, coherence and compatibility.
12.1. Relevance - User Needs
Main users of health and health care statistics are Ministry of Social Affairs, other ministries and state authorities, politicians, local governments, research and educational institutions, professional medical associations, providers of health care services, media, and international organisations like Eurostat, OECD, WHO.
Unmet national need for regional health statistics by patients' place of residence will become possible after the change in the methodology of compiling health statistics. This means a change in the data source: a transition from aggregated data collected with statistical reports to individual medical records data from the health information system.
12.2. Relevance - User Satisfaction
A health statistics user survey is carried out every three years. The use of the Health Statistics and Health Research Database is annually monitored, and feedback is collected using the feedback form on the website of the database.
12.3. Completeness
All the relevant data required by Regulation (EU) 2022/2294 are provided.
13.1. Accuracy - overall
The overall accuracy of the results can be assessed as very good.
The data collected with annual statistical surveys from health service providers are mainly used as a data source. All licensed healthcare service providers are surveyed. The overall unit response rate is almost 100%.
13.2. Sampling error
Not applicable.
13.3. Non-sampling error
Not applicable.
14.1. Timeliness
Deadline for health service providers to submit non-monetary health data questionnaires to NIHD: 2 months after the end of the reference year.
Data dissemination in the public Health Statistics and Health Research Database: within 11 months after the end of the reference year.
14.2. Punctuality
Data are published at national level according to the release calendar and transmitted to Eurostat via EDAMIS on time, within 14 months after the end of the reference year.
15.1. Comparability - geographical
Data are comparable.
15.2. Comparability - over time
Breaks in time series are flagged and breaks for each variable are described in the Annex.
15.3. Coherence - cross domain
Data is compared and reconciled with available data sources.
15.4. Coherence - internal
Statistics are internally coherent.
Restricted from publication
17.1. Data revision - policy
No regular revisions planned.
17.2. Data revision - practice
Data will be corrected in case of mistakes.
All corrections made to data tables are reflected as footnotes under the table in the Health Statistics and Health Research Database. Notes regarding corrections are stored for one year after making the corrections.
18.1. Source data
The data source for many HCnE variables is an annual statistical survey. All health care service providers having a valid activity license are included in the survey.
In addition, administrative data is used as a data source for some variables as well as for imputation or data validation:
Estonian Education Information System as a data source for graduates data;
the Estonian Communicable Diseases Registry under the administration of the Health Board as a data source for influenza vaccination;
the Estonian Health Insurance Fund data include information on treatment invoices of service providers who are EHIF's contractual partners, covering only a part of services. From the reference year 2022, treatment invoices are the data source for compiling hospital discharge data (HDD) as hospital services are mostly reimbursed by EHIF;
the Estonian Health Insurance Fund data is also used as a data source for pilot data on emergency departments;
the data of the Estonian National Health Information System: data coverage and quality of which are not sufficient to produce reliable statistics.
Source data for the different variables are given in the Annex.
18.2. Frequency of data collection
Annual.
18.3. Data collection
Data collection from health care providers is based on a statistical register. All health care service providers, who have a valid activity license, are included in the survey. During the data collection, the activeness of service providers is adjusted.
Various questionnaires are used to collect data, such as health care provider reports on health care personnel, surgical procedures, medical devices, also hospital reports on hospital discharges, beds and bed-days etc. The health care providers submit reports through web-based data submission channel Aveeb where is possible to apply data checks. Questionnaires and their completing instructions are available in Estonian on the website AVeeb: Esileht (sm.ee)
Administrative data are available on the data holder's website or based on a data request or contract. The data of Estonian Health Insurance Fund is available on the basis of a contract.
18.4. Data validation
NIHD uses the web-based data submission channel Aveeb where the automatic checks are added. This provides an opportunity to check the correctness, compatibility and comparability of data and to correct the errors before submitting the questionnaire. There are mostly arithmetical checks to ensure data completeness and internal consistency.
In data processing phase the data editing continues by using a lot of logical and arithmetical — completeness, internal consistency, plausibility — checks. The data are also compared with related data from other reports or other data sources, with data from previous year on individual and aggregated level. In case of non-response, imputation is applied.
18.5. Data compilation
Completeness of collected data is evaluated, data are checked for errors and summed up according to the classification, additional indicators are calculated.
18.6. Adjustment
Data refer to calendar year; no seasonal adjustment or other adjustment methods are applied.
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 data are provided in absolute numbers or as a rate of a relevant population.
Some of the data is based on statistical surveys, while others are based on administrative data. The source data for the different variables are given in the attached document.
28 February 2025
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
National changes of statistical concepts and national definitions deviating from Regulation (EU) 2022/2294 are described in the attached document.
Registered health professionals or health care facilities.
Depending on the dataset, the target populations are
All health care staff.
All available beds or equipment in hospitals or in nursing and residential care facilities.
All discharges or procedures performed in all hospitals.
The population includes all legal persons who have a valid activity license for the provision of health care services.
Estonia as a whole.
Calendar year.
The overall accuracy of the results can be assessed as very good.
The data collected with annual statistical surveys from health service providers are mainly used as a data source. All licensed healthcare service providers are surveyed. The overall unit response rate is almost 100%.
Absolute numbers: health employment at the end of November; hospital beds - average number during the reference year; long-term care beds, medical devices, hospital aggregates, surgical procedures at the end of reference year.
Data as a rate of a relevant population are expressed as percentages (data on immunisation, screening programmes).
Completeness of collected data is evaluated, data are checked for errors and summed up according to the classification, additional indicators are calculated.
The data source for many HCnE variables is an annual statistical survey. All health care service providers having a valid activity license are included in the survey.
In addition, administrative data is used as a data source for some variables as well as for imputation or data validation:
Estonian Education Information System as a data source for graduates data;
the Estonian Communicable Diseases Registry under the administration of the Health Board as a data source for influenza vaccination;
the Estonian Health Insurance Fund data include information on treatment invoices of service providers who are EHIF's contractual partners, covering only a part of services. From the reference year 2022, treatment invoices are the data source for compiling hospital discharge data (HDD) as hospital services are mostly reimbursed by EHIF;
the Estonian Health Insurance Fund data is also used as a data source for pilot data on emergency departments;
the data of the Estonian National Health Information System: data coverage and quality of which are not sufficient to produce reliable statistics.
Source data for the different variables are given in the Annex.
Yearly
Deadline for health service providers to submit non-monetary health data questionnaires to NIHD: 2 months after the end of the reference year.
Data dissemination in the public Health Statistics and Health Research Database: within 11 months after the end of the reference year.
Data are comparable.
Breaks in time series are flagged and breaks for each variable are described in the Annex.
