Directorate for Health Information and Research, Ministry for Health and Active Ageing.

National Hospital Information System

Directorate for Health Information and Research

95, Gwardamangia Hill,

Gwardamangia

PTA 1313

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, 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.

Data are based mainly on administrative records (see annex at the bottom of the page for source of data).

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. 

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) and age group.

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 and Private health.

The healthcare non-expenditure statistics describe the public and private 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.

Registered health professionals or health care facility categories.

(1) all health care staff

(2) all health activities such as screening and immunisation

(3) all available beds in hospitals, equipment in hospitals and the ambulatory sector and beds in nursing and residential care facilities

(4) all discharges, diagnositic exams and procedures performed in all hospitals

Complete national territory.

See concept's annex.

Not applicable.

Absolute number at the end of reference period.

Exceptions:

• Full time Equivalence (FTE's) are used for most of the Health Employment figures.
• Immunisation and Screening are calculated as a percentage of the target popualtion.
• Occupancy rate of Curative (acute) care beds is calculated as a percentage of the curative care beds available in the year of reference.

End of reference year.

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 

Gentlemen’s agreement

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

All data is collected and processed in accordance with the General Data Protection Regulation adopted in the Data Protection Act No. XX of 2018, published on the 28th May, 2018.

No identifiable data is is disclosed outside the Directorate for Health Information and Research. Only aggregate data is published and available online. 

Not available.

Not available.

Not available.

Annual Dissemination

Eurostat News

International Publications which include the data for Malta collected in the Joint Questionnaire for Non-Monetary Health Care Statistics are:

OECD: Health at a Glance 2021 : OECD Indicators | Health at a Glance | OECD iLibrary (oecd-ilibrary.org)

Health Systems in Transition: Malta (Vol. 19 No. 1 2017) (who.int)

Health System Performance Assessment (gov.mt)

Statistics Explained:

Health - Statistics Explained (europa.eu)

International Databases which inlude the data for Malta collected in the Joint Questionnaire Non-Monetary Health Statistics are:

Eurostat database

WHO Health for all Database

The World Bank Database

Access to microdata relating to procedures in hospitals and Hospital aggregates is only possible after a request is made to our Directorate which vets the requests and may refuse or accept (after seeking furthur permission e.g. data protection, ethical approval).

Requests are made through the https://dhir.gov.mt/en/data-protection-policy/

Not available.

For coding of Diagnosis and External Causes of Injury the ICD-10 International Statistical Classification of Diseases and Related Health Problems is used.

For coding procedures the ICD-9 CM Classification of Procedures is used.

A Standard Operation Procedure is available which details all the steps involved to complete the Joint Questionnaire Non-Monetary Health Statistics.

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.

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.

During the whole process of data compilation and dissemination any differences in the data from previous years is assessed and updated in the questionnaire and reference metadata.

For coding of Diagnosis and External Causes of Injury the ICD-10 International Statistical Classification of Diseases and Related Health Problems is used.

For coding procedures the ICD-9 CM Classification of Procedures is used.

Not available.

Non-Monetary Health Statistics are used by International organisations, namely, EUROSTAT, WHO and OECD.

Local users also require Non-Monetary Health Statistics for policy making by the Ministry of Health and Active Ageing and for Research.

Not available.

Completeness of mandatory variables for reference year 2022 stands at 100%. Survey data on Breast Cancer Screening and Cervical Cancer Screening is not available annually but every 5 to 6 years. Therefore data has been submitted for the year 2020

Completeness of non-mandatory variables for reference year 2022 stands at around 66.2%. Completeness for the variables: Hospital Aggregates (Inpatient and Curative care), Surgical Procedures, Hospital Discharges are for the reference year 2021.

Liaison with the institutions/divisions providing the data for the Joint Questionnaire on non-Monetary Health care Statistics is done regularly throughout the process of data compilation, to ensure that the data provided is accurate. Any differences in figures from one year to the next are discussed with the institutions/divisions providing the data.

However no formal assessment is done.

Not applicable.

Not applicable.

Data on Health Employment, workforce migration, physical resources, immunisations, screening and diagnostic exams and Hospital Technical Resources in the EUROSTAT module for the year N are returned at year N+1.

Hospital discharges, hospital aggregates, surgical procedures and outpatient consultations are returned with a 2 year delay.

This delay was due to the COVID-19 pandemic with most of the health personnel focusing their duties on the priorities of the country at the time.

Survey data on Cancer Screening survey data is provided every 5 years from the European Health Interview Surevey (EHIS). 

Data on Health Employment, workforce migration, physical resources, immunisations, screening and diagnostic exams and Hospital Technical Resources in the EUROSTAT module for reference year 2022 is being returned according to the regulation.

Data on hospital discharges, hospital aggregates, surgical procedures and outpatient consultations for reference year 2021 is being returned with a 2 year delay.

The questionnaire and reference metadata is transmitted to Eurostat annually by the deadline which is the 29th February according to the Regulation (EU) 2022/2294.

Data for Malta is submitted as a whole because Malta is a small country and figures for regions will result in small figures. 

See annex at the bottom of the page for potential breaks in series and deviations from definitions for each variable.

Not applicable.

Any differences in figures from one year to the next are discussed with the institutions/divisions providing the data for the Joint non-Monetary Health Statistics questionnaire.

The data to complete the questionnaire is not readily available. To complete the questionnaire, the appointed personnel within the Directorate for Health Information and Research has to liaise with various personnel within the various health institutions/departments to either provide aggregate data or case based data. If any missing variables in the case based data are noted or any discrepancies in the annual aggregate data is noted, the Directorate for Health Information and Research discusses the data with the appointed personnel within the various health institutions/divisions. Finally, the appointed personnel within the Directorate for Health Information and Research has to put the data and metadata together to submit the questionnaire by the stipulated deadline. 

Annex at the bottom of the page provides a breakdown for the Sources for each variable in the questionnaire.

The cost associated with the compilation of the questionnaire is mainly attributed to the number of personnel required to compile the questionnaire. There are 4 personnel within the Directorate for Health Information and Research who work on compiling the questionnaire, with the cost amounting to around €144,307.  

Not available at national level.

EUROSTAT Revision Policy is refered to.

Once the questionnaire has been submitted and structure and content are validated by EUROSTAT users, the data is revised depending on the validation report feedback provided by EUROSTAT.

Data on previous years is occasionally revised if health institutions/divisions, gather more accurate data.

Source data for the different variables are given in the Annex at the bottom of the page.

Annual.

Survey data on Breast Cancer Screeing, Cervical Cancer Screening and Colorectal Cancer Screening is obtained through the European Health Interview Survey conducted every 5 years.

The rest of the questionnaire data is gathered through administrative sources. Data is gathered from the respective health insitutions/divisions. The health insitutions/divisions provide the personnel within the Directorate for Health Information and Research with either aggregate data or case-based data.

Case-based data is obtained from hospitals so as to compile surgical procedures, hospital aggregates on inpatient and curative care and Hospital Discharge Data. Individual data is also obtained from the Medical Council pertaining to data on Physicians and Dentists.

Aggregate data is gathered from the the various health instutions pertaining to the nurses, midwives, caring personel, hospital and nursing beds, hospsital technical resources, medical technology and diagnostic exams within the various institutions whereby personnel within the Directorate for Health Information and Research compile these figures to obtain the required totals. Data for other variables are provided to the Directorate for Health Information and Research as totals.

After compilation of data into the questionnaire, the data for reference year is compared with the figures of previous years and any discrepencies are discussed with the respective health instituions/division.  Figures are sometimes ammended by the health insitution or division and, consequently updated in the questionnaire. Any reasons for the discrepencies or changes of data in the previous years, are noted and recoreded in the sources and methods.

Before submitting the questionnaire, the personnel appointed to compile the data for the questionnaire within the Directorate for Health Information and Research validates the data inputted by revisiting the coding and calculations done, particularly to the case-based data and makes sure that all is in accordance with the guidelines and definitions of each variable.

Once Eurostat send the validation feedback, any necessary arrangements are done and the data and metadata are re-submitted to EUROSTAT.

The aggregate data received is compiled in the questionnaire according to the definitions and guidelines provided by the International Organisations.

Calculations are also done for Full time Equivalence (FTE) for most of Health Employment figures.

The case-based data:

For coding of Diagnosis and External Causes of Injury the ICD-10 International Statistical Classification of Diseases and Related Health Problems is used.

For coding procedures the ICD-9 CM Classification of Procedures is used.

Calculations using the case-based data are also done to obtain the hospital aggregates on Inpatient and curative care.

For most of the variables falling under Health Employment, the Full Time Equivalence is calculated, rather than providing Headcount, so as not to inflate figures.

Immunisation rate for the private sector is not readily available. Therefore an estimate of the percentage of persons aged over 65 years who were immunised against influenza was based on the number of persons immunised in the public sector together with an estimate of the percentage of persons who were immunised in the private sector based on EHIS figures.

None