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.
Directorate for Social and Welfare Statistics (DCSW)
Division “Integrated Statistics on Health care and welfare”
1.3. Contact name
Confidential because of GDPR
1.4. Contact person function
Confidential because of GDPR
1.5. Contact mail address
Viale Liegi 13, 00198 Rome, Italy
1.6. Contact email address
Confidential because of GDPR
1.7. Contact phone number
Confidential because of GDPR
1.8. Contact fax number
Confidential because of GDPR
2.1. Metadata last certified
4 March 2024
2.2. Metadata last posted
4 March 2024
2.3. Metadata last update
28 February 2025
3.1. Data description
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 hospital discharges the classification system used by Italy for diagnoses and medical/surgical procedures is the International Classification of Disease, IX revision, Clinical Modification (ICD-9-CM). The Italian Ministry of Health adopted different versions of ICD-9-CM. Since 2001 until 2005 the 1997 version was used; since 2006 until 2008 the 2002 version was used; since 2009 onwards, the 2007 version was used.
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.
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: see Annex at the bottom of the page.
National definition deviating from Regulation (EU) 2022/2294: Cervical cancer screening. % of female aged 20-69 screened. Italian data refer to women aged 25-64 because in the national screening programme this is the target population for Pap smear test to be performed every 3 years. Most Italian Regions are nowadays moving to HPV test for women aged 30/35-64 years old.
3.5. Statistical unit
Registered health professionals or health care facility categories.
3.6. Statistical population
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.
3.7. Reference area
Complete national territory
3.8. Coverage - Time
Employment: Physicians 2000 onwards (entitled to practice 1985; by age and gender 2005); Dentists and Pharmacists 2013 (entitled to practice 1986); Midwives 2013 onwards (entitled to practice 2000); Nurses 2003 onwards (entitled to practice 2000); Caring personnel and Physiotherapists 2011 onwards; Hospital employment 2003 onwards; Graduates 2001-2002 onwards.
Physical resources: Hospitals beds 2000 onwards; Residential health care beds 2000 onwards; Medical technology 1997 onwards.
Activities: Consultations 1991, 1994, 1999, 2000, 2005, 2013, since 2014 yearly; Immunisation 2000 onwards; Screening breast and cervical cancer 2004 onwards, colorectal cancer 2014 onwards; Hospital aggregates 1996 onwards; Diagnostic exams 2013 onwards; Procedures 2001 onwards.
Data are provided in absolute numbers except consultations (number per capita), immunisation against influenza and screening (percentage of target population), average length of stay (average number of days), hospital bed occupancy rate (percentage).
For most variables calendar year. For Health Employment: 31st December
6.1. Institutional Mandate - legal acts and other agreements
Joint Questionnaire on Non-Monetary Health Care Statistics, which is carried by Eurostat, OECD and WHO-Europe.
7.1. Confidentiality - policy
Several national legal acts guarantee the confidentiality of data requested for statistical purposes. In Italy, according to art. 9, paragraph 1 of the Legislative Decree n. 322 of 1989 (concerning the statistical system), statistical data cannot be disseminated but in aggregated form, in order to make it impossible to identify the person to whom the information relates. The data collected can only be used for statistical purposes.
Official statistics must also safeguard the rights, basic freedoms, and dignity of respondents, in particular with regard to the right of confidentiality and personal identity.
Istat assures the protection of personal data according to the General Data Protection Regulation (Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, repealing Directive 95/46/EC) and, as national legislation, Italian Data Protection Code (Legislative Decree no. 196/2003) and Code of conduct and professional practice applying to the processing of personal data for statistical and scientific research purposes within the framework of the national statistical system.
In order to make statistical secrecy and protection of personal data effective, Istat is currently taking appropriate organizational, logistical, methodological and statistical measures in accordance with internationally established standards.
Moreover, Legislative Decree n. 322 of 1989, art. 6 and 6 bis provides that the exchange of microdata and personal data within the National Statistical System (Sistan) is possible if it is necessary to fulfil requirements provided by the National Statistical Programme.
Finally, in implementation of art. 5-ter of the legislative decree 14 March 2013, no. 33, the new "Guidelines for the access for scientific purposes to the elementary data of the National Statistical System" establish the conditions under which the bodies and offices of the National Statistical System can allow researchers to access their own elementary data for scientific purposes.
7.2. Confidentiality - data treatment
Protection of confidentiality
Data on physical resources (hospital, hospital beds, medical technology, residential health care beds) are not personal data.
Data on health personnel and activities (consultations, screening, hospital discharges, diagnostic exams, immunisation) are personal data.
The processing of personal data and sensitive data in administrative sources and surveys is carried out in compliance with current legislation on the data protection.
Data transmitted to Eurostat are aggregated, therefore without any risk for disclosure.
8.1. Release calendar
Istat press releases are issued according to a fixed press release calendar, however, statistics on healthcare non-expenditure are not disseminated through press releases and are not reported in the calendar.
According to its mission, Istat disseminates statistical information in order to make it accessible and usable to everyone and to remove any barriers to the use of data. All data releases are posted on Istat website on the basis, as regards press releases with short-term data and annual data of strong interest for the country, of an annual release calendar set and published in the December preceding the reference year. Time series are available on IStatData (data warehouse) and users can choose information according to their needs, building customised tables or downloading prepackaged datasets. Data are always accompanied by meta-information - methodologies, classifications, definitions. Microdata files are released free of charge and in compliance with the principle of statistical secrecy and data protection. Books, press releases, datasets and infographics are also available on Istat web site; moreover main contents are disseminated through Istat Official Twitter account and other social networks. All Istat information are available free of charge and data are reusable providing the source.
Information system on quality (SIQual) is Istat’s information system on quality. 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, as from reference year 2021.
11.1. Quality assurance
Since the 90s Istat has adopted a systematic approach to ensure the quality of statistical information and of its services to the community.
With the aim of strengthening the commitment to quality, in 2020 Istat set up the Quality Committee, for overseeing all quality initiatives in the Statistical Institute. In addition the role of Quality Manager was formally established.
In 2021 a new quality policy for statistical production was adopted. It is consistent with the European quality framework developed by Eurostat, and transposes its main principles and definitions.
The overall quality assessment for most variables (both those in the Regulation and those provided on voluntary basis) is positive.
Employment: Italy has made a major investment in statistical data on the health system workforce with the aim of having statistics compliant with international definitions and covering all health sectors (public and private). An integrated data system on health personnel based on individual data has been set up. Currently, Italy provides all variables according to the definitions of the methodological manual Healthcare non-expenditure statistics of Eurostat. There is still some difficulty in calculating the availability of staff in hospitals in full-time equivalents (FTE).
Physical resources: Data on hospitals, hospital beds, medical technology (in hospitals and ambulatory sector) and beds in residential long-term care facilities are of high quality.
Activities: Good quality for data on Immunisation against influenza, Screening of cancer, Hospital aggregates and Procedures.
Quality of data on consultations, estimated by different data sources, could be improved. The estimation of “out of pocket” consultations is difficult because of missing administrative data.
Quality of data on diagnostic exams could be improved too: actual data sources do not allow the distinction between exams in hospitals and exams in ambulatories; out-of-pocket exams performed in ambulatories are missing.
Workforce migration: Data on workforce migration are still of poor quality, both because they refer to doctors and nurse entitled to practice and not to practicing, and because the share of professionals whose country of graduation is unknown is high.
Hospital Discharge Data (HDD) file: Very high quality for hospital discharge data.
12.1. Relevance - User Needs
Non-monetary health care statistics, together with SHA data, allow to monitor health system, provide key information for public health policies and decision makers, for planning future needs. These statistics are relevant also for researchers and for the general public (directly or indirectly via news, publications, online data).
12.2. Relevance - User Satisfaction
Istat is constantly interested in understanding who the users of the statistics it produces are, what the information needs are, whether they match production and if the statistics produced satisfy users. To this aim, together with the analysis of user requests received through the Web Contact Center service, tools for direct consultation were developed, such as the annual online survey of customer satisfaction and indirect tools such as analysis of accesses and of users' browsing paths on the web site.
12.3. Completeness
The data for Italy have a high degree of completeness. The only variables not yet released are: Hospital employment by FTE; Colorectal cancer screening based on survey data by sex; diagnostic exams by type of provider (hospital or ambulatory).
13.1. Accuracy - overall
The overall accuracy for variables under Regulation (EU) 2022/2294 is high.
Data on health personnel are currently provided using a new integrated data system based on individual data. Figures are compliant with the definition and future improvements will allow to have better data also on physicians by specialties, workforce migration and full time equivalent.
Accuracy of data on medical technology and beds in residential long-term care facilities has to be improved concerning private facilities not accredited with the National Health System (NHS).
Accuracy is more limited for some variables provided on voluntary basis because appropriate data sources are still missing. This is the case for diagnostic exams (the distinction between hospital and ambulatory care is still missing), consultations with doctors or dentists paid by patients out of pocket (the estimation has to be improved), workforce migration (referred to entitle to practice professionals), intensive care unit beds and use (different definition used and data partially available), doctor teleconsultations (not yet available).
13.2. Sampling error
Not applicable.
13.3. Non-sampling error
Not applicable.
14.1. Timeliness
The whole variables are updated to year T-2 except variables on workforce migration updated to year T-1.
14.2. Punctuality
Concerning variables under Regulation (EU) 2022/2294, Italy is compliant with the transmission deadlines. Mandatory variables are provided by 28th of February (14 months after the reference year). Also Hospital Discharges Data (HDD) and surgical procedure data (deadline August 31st) are transmitted to Eurostat by 28th of February.
Variables on voluntary basis are transmitted to Eurostat by 28 February.
15.1. Comparability - geographical
Most of the variables of the Joint Questionnaire on Non Monetary Health Care (JQNMHC) are the result of many years of collaboration between Eurostat and the Member States. Italy participated to the Task Force (TF) that defined the variables to be included in the current Regulation. For each variable the TF assessed the level of comparability between countries. Therefore, the variables of the Regulation have a high degree of comparability. The remaining variables of the JQ on a voluntary basis in some cases still present problems of comparability (workforce migration, caring personnel, physioterapists, consultations, hospitals, pilot variables).
15.2. Comparability - over time
The comparability of data over time is high. Breaks in time series occur mainly for variables with long time series.
Breaks in time series occur:
Data on physicians entitled to practice previous 2000 included dentists too.
Data on physicians by age and gender previous 2012 were referred to entitled to practice.
For the availability of new data sources: for health professionals new integrated data system is available since 2021; for beds in residential health care facilities the linkage between two data sources allows to have data compliant with the definition since 2018; for doctor and dentist consultations the integration of different data sources allows to have annual data since 2014.
15.3. Coherence - cross domain
Definitions of variables of the JQNMHC are based, when applicable, on the System of Health Accounts - SHA 2011 methodology and classifications. This ensure a high level of coherence cross monetary and non-monetary statistics.
15.4. Coherence - internal
The internal coherence among variables of the Joint Questionnaire is checked and assured before the transmission to Eurostat.
Coherence is verified for time series calculating annual variation ratios.
Coherence between variables is verified for some domains: among practicing, professionally active and licensed to practice data for health professionals; number of hospital beds and discharges provided in different tables has to be coherent.
Restricted from publication
17.1. Data revision - policy
The data revision regards provisional figures referred to year T-1; they are revised next year to provide final data.
When a break in time series occurs, time series is checked backwards to the first available year.
17.2. Data revision - practice
Data are revised once a year.
Provisional data are replaced with final data and, occasionally, small changes are made to the data for the last two or three years.
18.1. Source data
Source data for the different variables are given in the Annex at the bottom of the page.
18.2. Frequency of data collection
Annual.
18.3. Data collection
Data are collected through the Joint Questionnaire on Non Monetary Health Care (JHNMHC) that every year countries send to Eurostat. Starting from 2023 countries submit data to Eurostat also on the basis of Commission Regulation (EU) 2022/2294 implementing Regulation (EC) No 1338/2008 of the European Parliament and of the Council as regards statistics on healthcare facilities, healthcare human resources and healthcare utilisation.
The sources used by Italy to provide data are mainly administrative data, but, in case administrative data are missing, survey data are used.
A large part of these data are already collected for other statistical purposes, but in some case data sources are required specifically for the compilation of the JQ. This is the case for migration of doctors and nurses, doctor and dentist consultations.
Main sources of administrative data are provided by the Ministry of Health. Other data sources are provided by the Federations of health professional associations, the Ministry of Education, private companies.
Concerning sample surveys, the National Institute of Statistics (ISTAT) uses the Labour Force survey data for caring personnel; the Household Budget survey and the Monthly Survey of Consumer Prices data to estimate out of pocket doctor and dentist consultations.
Variables on cancer screening based on survey data are calculated by the National Institute of Health using PASSI surveillance Survey.
18.4. Data validation
The JQNMHC includes a number of formula which allow national data correspondents to perform consistency checks within tables before submitting the data. Italy carries out several in depth controls of data before the transmission of JQNMHC. Data are compared with information from other independent sources. The consistency between the data, of the year and of previous editions is checked and evaluated. Time series are analysed and double-checked, looking for trends and anomalies; the adequacy of the estimates is assessed.
Any detected inconsistencies is solved before sending data.
Atypical entries are checked. If atypical entries are identified, compilers verify the figures and, if they are correct, a description of the reasons are included in the Sources and Methods Metadata file. The magnitude of revisions as compared to previously submitted data is checked too.
18.5. Data compilation
The variables compiled by Ministry of Health data sources are updated directly by the Ministry, while ISTAT compiles remaining variables (health employment except hospital employment, workforce migration, regional data for physicians, beds in residential long-term care facilities only for private facilities not accredited with NHS, doctor and dentist consultations). The two bodies work together to cooperate in case of coverage or definition problems, in order to find the most appropriate solution. Thanks to this close cooperation, it has been possible to estimate some variables that were not available before. The estimation methodology is agreed in order to have data as close as possible to the definition provided in the Eurostat Methodological manual.
ISTAT and the Ministry of Health request also data to other institutions by means of official letters.
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).
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: see Annex at the bottom of the page.
National definition deviating from Regulation (EU) 2022/2294: Cervical cancer screening. % of female aged 20-69 screened. Italian data refer to women aged 25-64 because in the national screening programme this is the target population for Pap smear test to be performed every 3 years. Most Italian Regions are nowadays moving to HPV test for women aged 30/35-64 years old.
Registered health professionals or health care facility categories.
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.
Complete national territory
For most variables calendar year. For Health Employment: 31st December
The overall accuracy for variables under Regulation (EU) 2022/2294 is high.
Data on health personnel are currently provided using a new integrated data system based on individual data. Figures are compliant with the definition and future improvements will allow to have better data also on physicians by specialties, workforce migration and full time equivalent.
Accuracy of data on medical technology and beds in residential long-term care facilities has to be improved concerning private facilities not accredited with the National Health System (NHS).
Accuracy is more limited for some variables provided on voluntary basis because appropriate data sources are still missing. This is the case for diagnostic exams (the distinction between hospital and ambulatory care is still missing), consultations with doctors or dentists paid by patients out of pocket (the estimation has to be improved), workforce migration (referred to entitle to practice professionals), intensive care unit beds and use (different definition used and data partially available), doctor teleconsultations (not yet available).
Data are provided in absolute numbers except consultations (number per capita), immunisation against influenza and screening (percentage of target population), average length of stay (average number of days), hospital bed occupancy rate (percentage).
The variables compiled by Ministry of Health data sources are updated directly by the Ministry, while ISTAT compiles remaining variables (health employment except hospital employment, workforce migration, regional data for physicians, beds in residential long-term care facilities only for private facilities not accredited with NHS, doctor and dentist consultations). The two bodies work together to cooperate in case of coverage or definition problems, in order to find the most appropriate solution. Thanks to this close cooperation, it has been possible to estimate some variables that were not available before. The estimation methodology is agreed in order to have data as close as possible to the definition provided in the Eurostat Methodological manual.
ISTAT and the Ministry of Health request also data to other institutions by means of official letters.
Source data for the different variables are given in the Annex at the bottom of the page.
Annual
The whole variables are updated to year T-2 except variables on workforce migration updated to year T-1.
Most of the variables of the Joint Questionnaire on Non Monetary Health Care (JQNMHC) are the result of many years of collaboration between Eurostat and the Member States. Italy participated to the Task Force (TF) that defined the variables to be included in the current Regulation. For each variable the TF assessed the level of comparability between countries. Therefore, the variables of the Regulation have a high degree of comparability. The remaining variables of the JQ on a voluntary basis in some cases still present problems of comparability (workforce migration, caring personnel, physioterapists, consultations, hospitals, pilot variables).
The comparability of data over time is high. Breaks in time series occur mainly for variables with long time series.
Breaks in time series occur:
Data on physicians entitled to practice previous 2000 included dentists too.
Data on physicians by age and gender previous 2012 were referred to entitled to practice.
For the availability of new data sources: for health professionals new integrated data system is available since 2021; for beds in residential health care facilities the linkage between two data sources allows to have data compliant with the definition since 2018; for doctor and dentist consultations the integration of different data sources allows to have annual data since 2014.
