Centraal Bureau voor de Statistiek (Statistics Netherlands)

Team Health and Care

P.O. Box 24500

2490 HA The Hague

Netherlands

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://circabc.europa.eu/ui/group/c1b49c83-24a7-4ff2-951c-621ac0a89fd8/library/6ff71dd5-8200-4fe4-a610-a7707cd47c4d )

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.

Registered health professionals or health care facility categories.

(1) all health care staff

(2) all available beds or equipment in hospitals or in nursing and residential care facilities

(3) all discharges or procedures performed in all hospitals

Complete national territory

(1) all health care staff: 

Physicians - practising: 2014-2022; professionally active: 1999-2013; licensed: 1960-1991 and 1998-2022

Physicians at NUTS2 level - 1999-2022

Dentists - practising: 1999-2022; professionally active: 1995 and 1999-2016; licensed: 1980-2022

Pharmacists - practising: 1980-2022; professionally active: 1999-2022; licensed: 1998-2022

Physiotherapists - practising: 1999-2022

Midwives - practising: 1980-2022; professionally active: 1999-2013; licensed: 1999-2022

Nurses - practising: 2002-2008 and 2014-2022; professionally active: 1999-2013; licensed: 1999-2022

Caring personnel - practising: 2001-2022

Total hospital employment - 1980-2022

Graduates - medical, dentist, pharmacist: 1983-1985 and 1987-2022; midwives: 1987-2022; nursing: 1983-1985 and 1987-2022

Stock of doctors by country of first qualification - 2001-2022

Inflow of foreign-trained doctors by country of first qualification - 2002-2022

Stock of nurses by country of first qualification - 2001-2022

Inflow of foreign-trained doctors by country of first qualification - 2002-2022

(2) all available beds or equipment in hospitals or in nursing and residential care facilities

Hospitals - 1987-2022

Hospital beds (function) - total: 1965-2022; curative, rehabilitative, long-term, other: 2015-2022

Hospital beds (sector) - 1980-2022

Hospital beds at NUTS2 level - 1993-2002

Intensive care unit beds and use - 2015-2022

Beds in residential long-term care facilities - 1990-2022

Medical technology - 1981, 1984, 1986, 1988, 1990-1997, 2000, 2004-2022

Hospital technical resources - operation theatres: 2015-2022; day care places: 2015-2022

(3) all discharges or procedures performed in all hospitals

In-person consultations - doctor: 1966-1968 and 1980-2022; dentist: 1963, 1968-1970, 1979, 1981, 1983-2022

Teleconsultations - 2015-2022

Immunisation against influenza - 2000-2020

Breast cancer screening - survey: 2000-2019; programme: 2000-2022

Cervical cancer screening - survey: 2000-2019; programme: 2000-2019

Colorectal cancer screening - survey: 2014-2019; programme: 2014-2022

Hospital aggregates - inpatient care: 1990-2010; curative (acute) care: 1990-2010 and 2015-2022

Diagnostic exams - CT exams: 2008-2011 and 2014-2022; MRI exams: 2008-2011 and 2014-2022; PET exams: 2009-2012, 2014, 2017-2022

Procedures (total) -

cataract surgery: 1995-2010 and 2012-2019;

tonsillectomy: 1995-2010 and 2012-2019;

transluminal coronary angioplasty: 2005-2010 and 2012-2019;

coronary artery bypass graft: 1995-2010 and 2012-2019;

stem cell transplantation: 1992-2010 and 2011-2019;

appendectomy: 2005-2010 and 2012-2019;

laparoscopic appendectomy: 2005-2010 and 2012-2019;

cholecystectomy: 1995-2010 and 2012-2019;

laparoscopic cholecystectomy: 1995-2010 and 2012-2019;

repair of inguinal hernia: 1995-2010 and 2012-2019;

laparoscopic repair of inguinal hernia: 2005-2010 and 2012-2019;

transurethral prostatectomy: 1995-2010 and 2012-2019;

open prostatectomy: 1995-2010 and 2012-2019;

hysterectomy: 1995-2010 and 2012-2019;

laparoscopic hysterectomy: 2005-2010 and 2012-2019;

caesarean section: 1990-2010 and 2012-2019;

hip replacement: 1995-2010 and 2012-2019;

total knee replacement: 1995-2010 and 2012-2019;

partial excision of mammary gland: 2005-2010 and 2012-2019;

total mastectomy: 1995-2010 and 2012-2019

Hospital discharges of non-resident patients - 2010-2022

Not applicable

(1) all health care staff

Absolute number of people (head count).

(2) all available beds or equipment in hospitals or in nursing and residential care facilities

Absolute number of hospitals, beds, medical technology (e.g. CT scanners), hospital resources (e.g. operation theatres).

(3) all discharges or procedures performed in all hospitals

Rate of phenomenon per reference population (e.g. per 100 000 inhabitants) for consultations, immunisation against influenza, screening

Absolute number of discharges, days of care, exams, procedures.

Calendar 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 out by Eurostat, OECD and WHO-Europe.

The Regulation (EC) No 223/2009 on European statistics (recitals 23-27, 31-32 and Articles 20-26) applies.

The CBS Law of 2003 is available in English and Dutch. The public can find it at the CBS website (https://www.cbs.nl/nr/rdonlyres/bbd8113d-7ee5-4be4-8879-685253b31882/0/statisticsnetherlandsactjune2013.pdf).

Confidentiality is guaranteed. Individual data are never published without consent.

In order to guarantee confidentiality of personal/enterprise data, only aggregated data are published (observation units are not recognizable either directly or indirectly). 

The (updated) indicators are released once a year by Eurostat.

Dates of data release are disseminated on Eurostat's website.

See the Publication Calendar of Statistics Netherlands.

In line with the Community legal framework and the European Statistics Code of Practice Eurostat disseminates European statistics on Eurostat's website (see item 10 - 'Accessibility and clarity') respecting professional independence and in an objective, professional and transparent manner in which all users are treated equitably. The detailed arrangements are governed by the Eurostat protocol on impartial access to Eurostat data for users.

Annually through Eurostat.

Not available

Not available

Workforce (updated in first quarter of T+2): 

https://opendata.cbs.nl/#/CBS/nl/dataset/84760NED/table

https://opendata.cbs.nl/#/CBS/nl/dataset/84777NED/table

https://opendata.cbs.nl/#/CBS/nl/dataset/84779NED/table

https://opendata.cbs.nl/#/CBS/nl/dataset/84776NED/table

https://opendata.cbs.nl/#/CBS/nl/dataset/84778NED/table

Hospital beds (updated in second quarter of T+2): 

https://opendata.cbs.nl/statline/?dl=37883#/CBS/nl/dataset/37852/table

Consultations (Health Interview Survey; updated in second quarter of T+1):

https://opendata.cbs.nl/statline/#/CBS/en/dataset/83005ENG/table

Medical specialist care (procedures; updated in second quarter of T+2):

https://opendata.cbs.nl/statline/#/CBS/nl/dataset/82470NED/table

Micro data is available for researchers under strict regulations. The accessed data can be used only for research purposes.

None.

The metadata are enclosed in the tables. Data sources and estimation methods are available in the annex.

Work force: https://www.cbs.nl/nl-nl/onze-diensten/methoden/onderzoeksomschrijvingen/korte-onderzoeksbeschrijvingen/arbeidspositie-van-medisch-geschoolden

Health Survey (as of 2014): https://www.cbs.nl/nl-nl/onze-diensten/methoden/onderzoeksomschrijvingen/korte-onderzoeksbeschrijvingen/gezondheidsenquete-vanaf-2014

Medical specialist care (2008-2016): https://www.cbs.nl/nl-nl/onze-diensten/methoden/onderzoeksomschrijvingen/korte-onderzoeksbeschrijvingen/DIS-medisch-specialistische-somatische-zorg-behandelingen-dbc-s

Medical specialist care (as of 2017): https://www.cbs.nl/nl-nl/onze-diensten/methoden/onderzoeksomschrijvingen/korte-onderzoeksbeschrijvingen/Vektis-medisch-specialistische-somatische-zorg-behandelingen-dbc-s

Not available.

There are different policies and procedures guaranteeing quality. Statistical improvements are reviewed by an independent methodology department.

CBS is certified for quality, information security and privacy protection: https://www.cbs.nl/en-gb/about-us/organisation/privacy/iso-certification-and-privacy-certification

The general quality of the published data is considered good. 

Statistics on health care staff, available beds and equipment in (health) care facilities, and discharges or procedures in hospitals are widely used for planning, monitoring and evaluating programmes by different users (European Commission, OECD, WHO, national governments, analysts in [private] companies).

Not available.

The Netherlands has been granted a derogation for full coverage of variables under point 6. Data on Hospital Care (COMMISSION IMPLEMENTING DECISION (EU) 2022/2306). Other Eurostat requirements are fulfilled.

The main sources of the estimation errors are sampling errors (for the Health Survey), non-response errors and measurement errors. Most of the data sources used are public administrative records (e.g. insurance claims) and financial reports with very high coverage. Remaining unit non-response is covered by grossing-up methods. For dealing with item non-response, imputation methods are used. Measurement errors can arise from respondents not understanding the questions, not knowing the answer or typing errors. These errors are minimised by comparing parameters (of panels) over time and within the same observation period.

Information on sampling error in the Health Survey: https://www.cbs.nl/en-gb/onze-diensten/methods/surveys/korte-onderzoeksbeschrijvingen/health-survey-as-of-2014

Not available.

(1) all health care staff: 

Availability T+2

(2) all available beds or equipment in hospitals or in nursing and residential care facilities

Availability T+2

(3) all discharges or procedures performed in all hospitals

Availability T+2; procedures are available in T+3.

The data were transmitted to Eurostat on 29 February 2024.

Regions are well comparable.

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

There are methodological differences between the variables, so comparison is not completely possible. See Annex at the bottom of the page for potential deviations from the definition for each variable.

Aggregates are consistent with sub-aggregates. Small differences may exist due to rounding.

The statistics are mostly secondary, the burden on data providers or respondents is the one from the sources. Additional: some data from the Health Interview Survey. 

Data revision - policy: The data of the last period is provisional. After adding the next period, they become final.

For the Eurostat publications the same revision policy is carried out.

Revisions should be small or zero since estimates are mostly based on (almost complete) administrative data.

 (1) all health care staff

Register of (para) medical professions (BIG):

Data refer to physicians who are licensed to practice, and live and work in the Netherlands. Their license requires that they have been practising in the past five years. This is combined with the SSB database, a micro-integrated database of Statistics Netherlands with data from municipal register, tax register, social security, business register). 

Older (see annex): Registratiecommissie Geneeskundig Specialisten, NIVEL, KNMG

(2) all available beds or equipment in hospitals or in nursing and residential care facilities

Annual reports social accounts (DigiMV): 

Statements are checked in terms of accuracy, consistency and completeness. Missing and incorrect data are estimated on the basis of available annual reports, survey data from earlier periods or survey data from comparable institutions.  The missing data from large institutions are estimated at the level of the individual institution. For small institutions, missing observations are imputed using the sample means of the respective stratum. A stratum is classified using SIC class and number of persons employed. The institutions have also been linked to the Business register of Statistics Netherlands, and the business register has been checked and updated if necessary.

Older (see annex): Prismant survey, Statistics Netherlands npoSurvey, Survey "Jaarenquête Beeldvormende Diagnostiek", Health Council, Nationale Raad voor de Volksgezondheid

(3) all discharges or procedures performed in all hospitals

Health Interview Survey:

Every year this sample survey is checked for plausible results, internal consistency and completeness. To correct for differences between the composition of the net sample and the total population, a weighting factor is applied based on the following characteristics: gender, age, migration background, marital status, urban environment, province, province, household size, income, wealth, and survey season, and as of 2018, target group. In 2020 and 2021, the observation of the Health Survey was disrupted by corona(measures). An attempt has been to correct for the partial loss of face-to-face observations. 

Hospital Discharge Register (HDR, the 'Landelijke Basisregistratie Ziekenhuiszorg' and its predecessor the ‘Landelijke Medische Registratie’ of Dutch Hospital Data):

Since 2013 all discharges have been registered in the HDR, but diagnosis information for some of the discharges has been missing. If information on diagnoses is missing, the available microdata on specialism, case type, age, sex, country of origin, mortality, length of stay, urgency of the admission and the type of hospital are used, to impute the  diagnosis variables. In 2013, diagnoses were imputed for 16% of the inpatient discharges and 31% of the day cases. In 2015 the proportion of diagnoses imputed dropped to <1% and 14% respectively. From 2016 onwards all inpatient discharges were registered completely (so imputation was no longer necessary), but the percentage of day cases with imputed diagnoses increased to 32% in 2021. The fact that imputation of diagnoses is (still) needed, may affect the accuracy of this information. From 2005-2012 the HDR in the Netherlands suffered from a degree of non-response. The non-response (as a percentage of all discharges) increased from 1% in 2004 to 25% in 2012. The figures are corrected for the non-response by record imputation, based on known characteristics of the missing records. For the missing records only specialism, case type and region was known, all other information like diagnoses, age, sex, length of stay, etc. was imputed. The dataset is linked to the Social Statistical Database of Statistics Netherlands, in order to be able to produce the statistics with breakdowns to age, gender, region and residents/non-residents. 

Diagnosis Treatment Combinations Somatic Specialist Care register (DTC-SSC):

The DTC-SSC data of the health insurance companies (collected by Vektis) have the same coverage as the DTC-SSC data of the Dutch Healthcare Authority except that the Vektis data do not include some small groups with special insurances (military, prisoners and asylum seekers), which comprise approximately 0,3% of the total of DTCs. In addition, DTC-SSC care that is not reimbursed by the Dutch basic health care insurance and care to foreigners that do not have a Dutch health care insurance is not covered in the Vektis data and may partly be included in the data of the Dutch Healthcare Authority. However, in general the number of surgical procedures that are not covered in the Vektis data compared to the data of the Dutch Healthcare Authority are estimated to be very low. The Vektis data used are approximately complete, so no correction for incompleteness of the register is applied. To derive case types for the surgical procedures the same procedure is used as described in the annex (under 'Surgical procedures (shortlist' for the DTC-SSC data of the Dutch Healthcare Authority. 

External sources: NIVEL Primary care Database, Monitor Population survey Breast cancer (IKNL), National Evaluation Team for cervix cancer screening (IKNL), Monitor Population survey Colorectal cancer (IKNL)

Annual.

Data are collected through the Joint Questionnaire on Non-Monetary Health Care Statistics, which is carried by Eurostat, OECD and WHO-Europe. Countries submit data to Eurostat during the annual data collection exercise.

Data validation is performed as a final step before releasing/disseminating the data.

1. Statistical researcher checks coverage and response rates.

2. Aggregates are consistent with sub-aggregates. Small differences may exist due to rounding.

3. Independent statistician evaluates validity of the results by comparing with data for previous cycles and with expectations.

Most of the data sources used are public administrative records (e.g. insurance claims) and financial reports with very high coverage. Remaining unit non-response is covered by grossing-up methods. For dealing with item non-response, imputation methods are used. See 18.1 Source data (and Annex at the bottom of the page) for more detailed information on imputation-methods for the various sources used.

No corrections.

None.