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.
Centraal Bureau voor de Statistiek (Statistics Netherlands)
1.2. Contact organisation unit
Team Health and Care
1.3. Contact name
Confidential because of GDPR
1.4. Contact person function
Confidential because of GDPR
1.5. Contact mail address
P.O. Box 24500
2490 HA The Hague
Netherlands
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
28 February 2025
2.2. Metadata last posted
28 February 2025
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).
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.
Confidentiality is guaranteed. Individual data are never published without consent.
7.2. Confidentiality - data treatment
In order to guarantee confidentiality of personal/enterprise data, only aggregated data are published (observation units are not recognizable either directly or indirectly).
8.1. Release calendar
Each Friday, Statistics Netherlands publishes the publication planning for its upcoming releases.
Statistics Netherlands (CBS)’ mission is to compile official statistics and to publish the results. CBS makes these results accessible to the public through various channels. All statistics are also published as tables in the StatLine databank and released at or after midnight (00:00 hours).
Prior to publication of a release, CBS reserves the right to grant pre-release access under embargo to relevant government departments, institutions and news organisations. For a number of specific releases, routine preview access under embargo is granted to various Dutch ministries, the Netherlands Bureau for Economic Policy Analysis (CPB) and the Dutch central bank (DNB). This is no earlier than at 12:00 noon on the working day preceding publication day and only if the news release or product becomes available on time.
Further information can be found in the Publication Policy of Statistics Netherlands.
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
There are different policies and procedures guaranteeing quality. Statistical improvements are reviewed by an independent methodology department.
The general quality of the published data is considered good.
12.1. Relevance - User Needs
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).
12.2. Relevance - User Satisfaction
There are no available national data on user satisfaction. Eurostat carries out an annual User satisfaction survey on a central level
12.3. Completeness
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.
13.1. Accuracy - overall
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.
All available beds or equipment in hospitals or in nursing and residential care facilities: Availability T+2.
All discharges or procedures performed in all hospitals: Availability T+2; procedures are available in T+3.
14.2. Punctuality
The data were transmitted to Eurostat on 28 February 2025.
15.1. Comparability - geographical
Regions are well comparable.
15.2. Comparability - over time
See Annex at the bottom of the page for potential breaks in time series for each variable.
15.3. Coherence - cross domain
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.
15.4. Coherence - internal
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.
17.1. Data revision - policy
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.
17.2. Data revision - practice
Revisions should be small or zero since estimates are mostly based on (almost complete) administrative data.
18.1. Source data
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, amicro-integrated database of Statistics Netherlands with data from municipal register, tax register, social security, business register).
Older (see annex): Registratiecommissie Geneeskundig Specialisten, NIVEL, KNMG
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
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).
18.2. Frequency of data collection
Annual.
18.3. Data collection
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.
18.4. Data validation
Data validation is performed as a final step before releasing/disseminating the data.
Statistical researcher checks coverage and response rates.
Aggregates are consistent with sub-aggregates. Small differences may exist due to rounding.
Independent statistician evaluates validity of the results by comparing with data for previous cycles and with expectations.
18.5. Data compilation
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.
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.
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
Calendar year.
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.
All health care staff
Absolute number of people (head count).
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).
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.
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.
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, amicro-integrated database of Statistics Netherlands with data from municipal register, tax register, social security, business register).
Older (see annex): Registratiecommissie Geneeskundig Specialisten, NIVEL, KNMG
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
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).
Annually through Eurostat.
All health care staff: Availability T+2.
All available beds or equipment in hospitals or in nursing and residential care facilities: Availability T+2.
All discharges or procedures performed in all hospitals: Availability T+2; procedures are available in T+3.
Regions are well comparable.
See Annex at the bottom of the page for potential breaks in time series for each variable.
