The Public Health Agency of Sweden

Unit for Data and Registers

The Public Health Agency of Sweden
SE-171 82 Solna
Sweden

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

Availability varies across indicators. The longest requested time series is 1960-2022 and while the shortest is 2015-2022.

Not applicable

Current non-expenditure data are presented according to following units:

• Total number of health workers at NUTS2 level
• Total number of hospital beds at NUTS2 level
• Number of doctor and dentist consultations, per capita
• Number of doctor teleconsultations, per capita
• Percentage of immunisation against influenza, population aged 65 and over
• Breast cancer screening, percentage of females aged 40-74
• Cervical cancer screening, percentage of females aged 20-69
• Colorectal cancer screening, percentage of females, males and total 60-74
• Inpatient care, number of discharges and days of ALOS
• Curative care, number of discharges, number of bed-days, days of ALOS and percent of occupancy rate
• Number of several different surgical procedures (shortlist)
• Number of practising, professionally active and licensed; physicians, midwives, nurses, dentists, pharmacists, physiotherapists
• Number of physicians by age and gender
• Number of physicians by categories
• Number of medical, dentists, pharmacists, midwives and nursing graduates
• Total number of hospitals
• Number of hospitals by function
• Number of ICU beds
• Number of beds in residential long-term care facilities
• Number of several different medical technology equipment available in hospitals
• Total number of doctors by domestically-trained and foreign-trained and country
• Percentage of foreign-trained doctors
• Number of annual inflow of foreign-trained doctors by country
• Total number of nurses by domestically-trained and foreign-trained and country
• Percentage of foreign-trained nurses
• Number of annual inflow of foreign-trained nurses and country

The exact definition for the data presented for Sweden may differ slightly from the list above. For more information, see Annex at the bottom of the page.

Annually.

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 

Public Health Agency of Sweden (PHAS) is responsible for delivering the data requested by Eurostat via the Joint Questionnaire on Non-Monetary Health Care Statistics (see article 31 Ordinance with the directive for PHAS (2001:248)). Gentlemen’s agreement between national agencies and data holders, and established work processes to provide data to PHAS for reporting to the Joint Questionnaire on Non-Monetary Health Care Statistics.

The data collection to Eurostat takes place in agreement with the World Health Organisation (WHO) and the Organization of Economic Co-operation and Development (OECD).

Statistical confidentiality in Sweden is guaranteed by law, in chapter 24 article 8 in the Public Access to Information and Secrecy Act (2009:400) and article 7 in the Public Access to Information and Secrecy Ordinance (2009:641). The provision refers specifically to secrecy for the protection of individuals.

The rules applied for treating the data set to ensure statistical confidentiality and prevent unauthorised disclosure, differs depending on sources for each indicator. 

For more information, see Annex at the bottom of the page.

A majority of the data collected for Joint Questionnaire is official statistics of Sweden that is published according to the national publishing calendar.

Data that only is collected nationally for reporting to the Joint Questionnaire is not published elsewhere, for example, the indicators on medical technology.

For more information on official statistics of Sweden and publishing calendar, see https://www.scb.se/en/About-us/official-statistics-of-sweden/ , https://www.scb.se/en/finding-statistics/publishing-calendar/ and https://www.socialstyrelsen.se/statistik-och-data/statistik/publiceringskalender-for-statistik/

Data holders responsible for official statistics in Sweden publish statistics on a public webpage at a certain time, made available for all users at the same time. All this according to Official Statistics Act (2001:99). 

Most of the data are disseminated yearly on a national level, for example statistics on higher education and statistics based on the National Patient Register. Some of the data is disseminated less frequently then yearly, for example European Health Interview Survey (EHIS). For a few variables the data are disseminated for this reporting, such as data on medical technology. 

The results from the Joint Questionnaire are not published jointly in Sweden, but a majority of the indicators are published on each data holder's websites and statistical databases. See more information on 10.3 Dissemination format - online database.

Information not available. 

Data and statistics that form the basis for the reporting in the Joint Questionnaire can be found in various data holders websites and databases reports:

• The National Board of Health and Welfare - https://www.socialstyrelsen.se/en/statistics-and-data/statistics/statistical-databases/
• Swedish Association of Local Authorities and Regions - https://skr.se/skr/tjanster/statistik.46562.html
• Public Health Agency of Sweden - Influensavaccinationstäckning bland personer 65 år och äldre, per region och nationellt, säsongen 2021–2022 (folkhalsomyndigheten.se)
• Swedish Insurance Agency - https://www.forsakringskassan.se/statistik-och-analys/statistikdatabas#!/
• Nationellt Kvalitetsregister för Cervixcancerprevention on cervical cancer - https://nkcx.se/Coverage_all.htm
• Svenskt kvalitetsregister för koloskopier och kolorektalcancerscreening (SveReKKS) on colorectal cancer screening - https://statistik.incanet.se/sverekks/startsida_sverekks.html
  
• Swedish Higher Education Authority - https://www.uka.se/vara-resultat/statistik/hogskolan-i-siffror

For this reporting no microdata are reported or presented, only aggregated data. However, the possibility for government agencies to share microdata with researchers is regulated in chapter 24 section 8 of the Public Access to Information and Secrecy Act (2009:400) in Sweden. All government agencies discloses micro data in accordance with this legislation. Before an external user is allowed access to microdata for research and statistical purposes, they need to make a data request. The request must include topics like client information, form which registry and/or database data is requested, description of data, confidentiality, ethical review and details of purpose and publishing. The responsible agency reviews the request and decide whether the researcher should have access to the data or not.

Information not available. 

For the production of official statistics in Sweden there is a number of different legislations to follow and a handbook to take into consideration. Information about these documents are to be found on Statistics Sweden's webpage - https://www.scb.se/om-scb/samordning-av-sveriges-officiella-statistik/riktlinjer-och-handbocker-for-officiell-statistik/. 

Information not available. 

Data holders responsible for official statistics in Sweden meet the UN Fundamental Principles for official statistics. The operations are conducted in line with the International Statistical Institute’s (ISI) Declaration on Professional Ethics and the Swedish Statistical Association’s code of ethics for statisticians and statistical operations.

National agencies complies with the European Statistics Code of Practice, which is the cornerstone of the common quality framework of the European statistical system. The Code of Practice contains principles covering the institutional environment, statistical processes and statistical outputs.

Statistics Sweden is the national statistical institute (NSI) in Sweden and coordinate all official statistics in Sweden. Information on the quality of the statistics to the users of the statistics is reported for the quality components relevance, accuracy, timeliness and punctuality, availability and clarity as well as comparability and coherence according to Statistics Sweden’s regulations on quality in official statistics (SCB-FS 2016:17). These quality components are described in the quality handbook (A Handbook on Quality for Official Statistics of Sweden). In cooperation with international experts, Statistics Sweden has developed a system to evaluate the quality of the official statistics. The evaluations are applied to Sweden’s official statistical outputs.

Not available.

Main national users in Sweden for the national sources are policymakers, stakeholders, agencies, researchers, care givers and the public.

-The Ministry of Health and Social Affairs.

-The National Board of Health and Welfare (NBHW) which is a government agency under the Ministry of Health and Social Affairs, with a very wide range of activities and many different duties within the fields of social services, health and medical services, patient safety and epidemiology.

-The Public Health Agency of Sweden (PHAS) is a government agency under the Ministry of Health and Social Affairs that works to ensure good public health and that the population is protected against communicable diseases and other health threats. The Swedish public health policy focus on equitable health with an overarching objective of eliminating avoidable health inequalities within one generation.

-Swedish Association of Local Authorities and Regions (SALAR) which is an organisation that represents and advocates for local government in Sweden. All of Sweden's municipalities, county councils and regions are members of SALAR.

- The Swedish Regions (provide the health services) and Municipalities (provide home-based health care and social services).

Within the framework of the different national sources, there are ongoing dialogues with main users where knowledge and experience are being exchanged.

In Sweden the requested mandatory data are available. However, according to Commission Implementing Decision (EU) 2022/2306 granting derogations to certain Member States with respect to the transmission of statistics pursuant to Regulation (EC) No 1338/2008, Sweden is granted derogation concerning the deadline for delivery of data for the variables under Data on Health Employment 2023-2024.

Data sources are mainly administrative data, only a small part of the reported data come from surveys.

Not applicable.

Not applicable.

Member States are required to transmit their data to Eurostat in compliance with the transmission deadline outlined in Regulation (EC) No 1338/2008. 

For most of the data sources in Sweden the length of time between data availability and the event or phenomenon they describe are reasonable but differ depending on data sources. However, registers from different data holders are used to merge information for the variables under Data on Health Employment 2023-2024 which requires longer production time. Sweden is granted derogation concerning the deadline for delivery of data for the variables under Data on Health Employment 2023-2024. Work is underway to meet the requested time frame in producing these data. 

Data are generally release on time, according to the release calendar. For more information om official statistics of Sweden and publishing calendar, see https://www.scb.se/en/About-us/official-statistics-of-sweden/ and https://www.scb.se/en/finding-statistics/publishing-calendar/ and https://www.socialstyrelsen.se/statistik-och-data/statistik/publiceringskalender-for-statistik/.

For other statistics, there is no requirement for public release calendar. For instance data from SALAR.

For most of this reporting, population administrative data with national coverage are used and there is no problem with coverage between regions. However, when other national data sources are used there can be differences in coverage regarding regions, which is stated for each variable in the Annex at the bottom of the page. 

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

Most of the data reported is based on population administrative data with national coverage, so most of the data is consistent. However, when other national data sources are used there can be differences in coverage between regions, which is stated for each variable in the Annex at the bottom of the page. 

There are no significant inconsistencies in the statistics.

In terms of resources the Public Health Agency of Sweden (PHAS), The National Board of Health and Welfare (NBHW), and Swedish Association of Local Authorities and Regions (SALAR) allocates approximately 900 hours in total per year for the reporting of the Joint Questionnaire.

Most of the data is based on administrative data, and the costs are related to acquisition and compilation, meetings with national data holders and international work group meetings for developing measurements and variables in the survey. If new data are requested that currently isn't available nationally, the time and cost for reporting will noticeable increase. 

Most of the data is based on administrative data, so the response burden for compiling this data is small. However, the national work group for this reporting constantly tries to improve the national data collection process to minimise the burden of reporting for data holders. 

For official statistics in Sweden there is a guideline for revisions of statistics (https://scb.se/contentassets/0cd92207266d40eb8829244d51d90b94/riktlinjer_for_revideringar_-av_-statistikvarden.pdf). This provides guidance on how to do planned revisions, benchmark revisions, unplanned revisions, and revisions due to conceptual and/or methodological changes.

In general, methodological improvements applies to the total time span, while punctual data corrections could occur (new data sources, updated statistical information based on surveys or administrative sources, errors discovered in the data compilation). When a new source of information is identified and used, the data for previous years are revised, if possible. Corrected data are delivered to Eurostat once a year, in connection with each year's data collection.

Information om revisions made is stated for each variable in the Annex at the bottom of this page.

Most of the statistics for this survey is based on administrative data. Data sources for the different variables are given in the Annex at the bottom of the page.

Annually for most of the data.

The Swedish data for JQNMNHCS are mainly based on official statistics. It also includes data from SALAR:s database on business statistics for regions and municipalities and data from national quality registries. The main data holders in this reporting are The National Board of Health and Welfare (NBHW), and the Swedish Association of Local Authorities and Regions (SALAR). The Public Health Agency of Sweden (PHAS) is responsible for compiling the data and sending it to Eurostat.

Data are collected through the Joint Questionnaire on Non-Monetary Health Care Statistics (JQNMHCS) that countries submit to Eurostat annually. There is a mandatory deadline to send the JQNMHCS questionnaire for the reference year by the 28th of February. The JQNMHCS is coordinated in agreement with the World Health Organisation (WHO) and the Organization of Economic Co-operation and Development (OECD). Countries submit data to Eurostat 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 healthcare facilities, healthcare human resources and healthcare utilisation.

National agencies responsible for the reported data complies with the European Statistics Code of Practice, which contains principles covering the institutional environment, statistical processes and statistical outputs. Information on the quality of the statistics to the users of the statistics is reported for the quality components relevance, accuracy, timeliness and punctuality, availability and clarity as well as comparability and coherence according to Statistics Sweden’s regulations on quality in official statistics (SCB-FS 2016:17). These quality components are described in the quality handbook (A Handbook on Quality for Official Statistics of Sweden). 

The JQNMHCS includes a number of features which allow national data correspondents to perform various quality checks before submitting the data. Checks like consistency of the data between tables and consistency of the data within tables are embedded in each excel file. 

Data validation is also performed when the national data correspondents send the files to Eurostat via the EDAMIS system. Two different validations of each file is made, one structural validation and one content validation. The structure validations consists of checks for use of correct excel questionnaire, allowed flags and allowed characters/signs. Content validation consists of checks for mandatory cells filled, allowed combination of flags and values and countries derogations special rules. 

Most of the data for this survey is based on administrative data, and no imputation or design weights are used. 

Not applicable.

None.