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.
Eurostat, the statistical office of the European Union
1.2. Contact organisation unit
F5: Education, health and social protection
1.3. Contact name
Restricted from publication
1.4. Contact person function
Restricted from publication
1.5. Contact mail address
2920 Luxembourg LUXEMBOURG
1.6. Contact email address
Restricted from publication
1.7. Contact phone number
Restricted from publication
1.8. Contact fax number
Restricted from publication
2.1. Metadata last certified
11 January 2021
2.2. Metadata last posted
11 January 2021
2.3. Metadata last update
11 January 2021
3.1. Data description
Non-expenditure health care data provide information on institutions providing health care in countries, on resources used and on output produced in the framework of health care provision.
Data on health care form a major element of public health information as they describe the capacities available for different types of health care provision as well as potential 'bottlenecks' observed. The quantity and quality of health care services provided and the work sharing established between the different institutions are a subject of ongoing debate in all countries. Sustainability - continuously providing the necessary monetary and personal resources needed - and meeting the challenges of ageing societies are the primary perspectives used when analysing and using the data.
The output-related data ('activities') refer to contacts between patients and the health care system, and to the treatment thereby received. Data are available for hospital discharges of in-patients and day cases, average length of stay of in-patients and medical procedures performed in hospitals.
Annual national and regional data are provided in absolute numbers and in population-standardised rates (per 100 000 inhabitants).
Health care data on activities are largely based on administrative data sources in the countries. Therefore, they reflect the country-specific way of organising health care and may not always be completely comparable.
3.2. Classification system
Activities
Patient related definitions follow the System of Health Accounts (SHA) whenever applicable. Common definitions for hospital patients were agreed with OECD and WHO. The detailed definitions are available in the annex below.
Discharges by diagnosis refer to the principal diagnosis, i.e. the main condition diagnosed at the end of the hospitalisation (in-patients) or day treatment (day cases). The main condition is the one primarily responsible for the patient's need for treatment or investigation (for additional details, see International statistical Classification of Diseases and related health problems - ICD-10 Volume 2).
The data is available according to the International Classification for Hospital Morbidity Tabulation (ISHMT). This shortlist for statistical comparison of hospital activity analysis was adopted in 2005 by Eurostat, the OECD (Organisation for Economic Co-operation and Development) and the WHO-FIC (Family of International Classifications) Network.
The surgical operations and procedures performed in hospitals are listed and presented according to the classification ICD-9-CM (Clinical Modification). However, at national level, different classifications are used for coding operations and procedures, e.g. the ICPM (International Classification of Procedures in Medicine) or ICD-9-CSP (ICD-surgical procedures), and it is not always possible to convert the data directly into ICD-9-CM and preserving the original meaning of the diagnosis or procedure category. Moreover, the ICD-9-CM includes a series of additions, which are not available in the ICD or in some of the national classifications like NOMESCO (Nordic Medico-Statistical Committee), OPCS4-UK (Classification of Surgical Operations and Procedures), CDAM France (Catalogue des Actes Médicaux), OPS301 Germany (Systematik des Operationenschlüssels) etc.
The table on procedures present data according to the list proposed by the Hospital Data Project II.
Regional data are following the geographical classification NUTS2.
Health care activities' statistics describe the process of providing health care services in countries by referring to the services provided. Service-related data aim at quantifying directly elements of the health care delivery process.
The respective data are, due to their heterogeneity, collected, stored and disseminated via different tables. They are based on different, mainly administrative sources. This may lead to differences in the coverage of time series and/or in the geographical coverage; data validity, reliability and comparability may vary. Furthermore, it may not always be possible to have the health care system, implicitly underpinning the data collection, being consistently defined across data sources.
Non-expenditure health care activities data are grouped as follows:
Hospital patients: data refer to (1) hospital discharges of in-patients and day cases by age, sex, and selected (groups of) diseases; (2) average length of stay of in-patients; (3) a selection of medical procedures applied in hospitals.
A (hospital) discharge is the formal release of a patient from a hospital after a procedure or course of treatment (episode of care). A discharge occurs anytime a patient leaves because of finalisation of treatment, signs out against medical advice, transfers to another health care institution or because of death. A discharge can refer to in-patients or day cases. Healthy newborns should be included. Transfers to another department within the same institution are excluded.
An in-patient is a patient who is formally admitted (or 'hospitalised') to an institution for treatment and/or care and stays for a minimum of one night or more than 24 hours in the hospital or other institution providing in-patient care.
Day case: day care comprises medical and paramedical services (episode of care) delivered to patients who are formally admitted for diagnosis, treatment or other types of health care with the intention of discharging the patient on the same day. An episode of care for a patient who is admitted as a day-care patient and subsequently stays overnight is classified as an overnight stay or other in-patient case.
Average length of stay (ALOS) is computed by dividing the number of hospital days (or bed-days or in-patient days) from the date of admission in an in-patient institution (date of discharge minus date of admission) by the number of discharges (including deaths) during the year.
Procedures are all types of medical interventions with the intention of achieving a result in the care of persons with health problem.
Next to absolute numbers, density rates are provided for health care statistics.
Density rates are used to describe the frequency of services rendered, expressed in per 100 000 inhabitants. They are calculated by dividing the absolute number of health care resources available or services rendered in a given period by the respective population in the same period and then multiplied by 100 000. For Luxembourg the density rates are calculated dividing the absolute number of health care services rendered in a given period by the resident population covered by the statutory health insurance scheme and then multiplied by 100 000.
3.5. Statistical unit
Administrative data sources refer to registered patients treated or procedures applied. The underlying totality of institutions, for which data collections are available, may differ. In some countries, data may not be available for a subgroup of institutions (e.g. private hospitals).
3.6. Statistical population
Depending on the data set, the target populations are all discharges or procedures performed in all hospitals.
3.7. Reference area
EU Member States, Iceland, Liechtenstein, Norway, Switzerland, Montenegro, the former Yugoslav Republic of Macedonia, Albania, Serbia and Turkey.
3.8. Coverage - Time
For several data sets, time series for the EU Member States, Iceland, Liechtenstein, Norway, Switzerland, Montenegro, the former Yugoslav Republic of Macedonia, Albania, Serbia and Turkey are available from 1960 onwards. However, the availability of the data varies across countries and data sets.
3.9. Base period
Not applicable.
The data are published in absolute numbers and rate per 100,000 inhabitants.
Calendar year; depending on the reporting Member State, the reference period refers to the annual average or as reported by 31st December.
6.1. Institutional Mandate - legal acts and other agreements
Countries submit data to Eurostat on the basis of a gentlemen's agreement established in the framework of the Eurostat Working Group on "Public Health Statistics".
A Regulation on Community statistics on public health and health and safety at work (EC) No 1338/2008 was signed by the European Parliament and the Council on 16 December 2008. This Regulation is the framework of the data collection on the domain. Within the context of this framework Regulation, a specific Implementing Measure is currently being developed - within the ESS - on Causes of Death statistics and, according to forthcoming agreement with the member States, Implementing Measures for other domains will follow.
6.2. Institutional Mandate - data sharing
Data on hospital activities (hospital discharges, surgical procedures...) are collected throw the Joint Questionnaire on Non-Monetary Health Care Statistics, which is carried by Eurostat, OECD and WHO-Europe.
7.1. Confidentiality - policy
Regulation (EC) No 223/2009 on European statistics (recital 24 and Article 20(4)) of 11 March 2009 (OJ L 87, p. 164) stipulates the need to establish common principles and guidelines ensuring the confidentiality of data used for the production of European statistics and the access to those confidential data with due account for technical developments and the requirements of users in a democratic society.
7.2. Confidentiality - data treatment
Not applicable.
8.1. Release calendar
Not applicable.
8.2. Release calendar access
Not applicable.
8.3. Release policy - user access
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.
For the comprehensive metadata of each variable/country, see the Detailed footnotes at the bottom of the page.
10.7. Quality management - documentation
Not available.
11.1. Quality assurance
Not available.
11.2. Quality management - assessment
The quality of the data is subject to the way in which health care provision is organised in countries, and which information is available to and collected by the respective institutions.
The quality, comparability and coverage are discussed at biannual technical meetings of the Techincal Group Care and at the annual Eurostat's Working Group "Public Health Statistics".
It is also subjected to annual discussions with OECD and WHO at annual trilateral meetings concerning the Joint Questionnaire on Health Care Non-Monetary Statistics, which is the basis for the data collection.
12.1. Relevance - User Needs
The main users of the data are DG Health and Food Safety's (SANTE) and DG Employment, Social Affairs & Inclusion (EMPL) in view of health policy papers and health strategies. The data also contribute to monitor the Europe 2020 strategy on Health as requested by the Council in December 2013 in the conclusions on the "Reflection process on modern, responsive and sustainable health systems" and to the Joint Assessment Framework for Health (JAF) which was agreed by the Social Protection Comittee in November 2013.
12.2. Relevance - User Satisfaction
Not available.
12.3. Completeness
Administrative data sources refer to registered patients treated or procedures applied. The underlying totality of institutions for which data collections are available may differ. In some countries, data may not be available for a subgroup of institutions (e.g. private hospitals).
13.1. Accuracy - overall
Not available.
13.2. Sampling error
Not applicable.
13.3. Non-sampling error
Not applicable.
14.1. Timeliness
Eurostat asks for the submission of final data for the year N at N+15 months.
A number of countries still face difficulties with this timetable and deliver data at their earliest convenience.
14.2. Punctuality
Not available.
15.1. Comparability - geographical
The comparability of the data across different countries is limited by the fact that the quality of the country data is subject to the way in which health care provision is organised in countries, and which information is available to and collected by the respective institutions.
Some countries are unable to cover all providers of care (the inclusion of private providers seems particularly difficult) or are only able to provide data for selective regions.
Sometimes regional data cannot be made available as the available breakdown does not coincide with the NUTS classification.
Ongoing work to increase quality, comparability and coverage is reported to Eurostat's Working Group "Public Health Statistics".
15.2. Comparability - over time
The comparability of the data over time is checked before dissemination.
Some countries may have a change in their data collection and so a break in series. These breaks in series are flagged and some information (if available) are given in the annexes of the metadata.
15.3. Coherence - cross domain
Health care data on activities are also available in the database "Regional Statistics".
15.4. Coherence - internal
Internal coherence is ensured by the annual validation processes.
The data collection is based on administrative national sources with no additional burden.
17.1. Data revision - policy
These historical data are no longer updated nor revised
17.2. Data revision - practice
These historical data are no longer updated nor revised
18.1. Source data
Health care non-expenditure data are mainly derived from administrative sources, and these sources may vary by country and by variable, eg. hospital administrative sources, health workers associations, family centers and private practises.
Please note that the data sources used may not have been created initially for statistical purposes, and that the initial purpose of a data source may differ across countries. Both facts may influence the validity and comparability of results.
18.2. Frequency of data collection
Annual.
18.3. Data collection
Administrative data from the national statistics authorities. The data are collected annually.
18.4. Data validation
Consistency checks: comparing the statistics with previous years, investigating inconsistencies in the statistics, performing macro data editing, outlier detection. Comparison of validation results with OECD and WHO in view of data collected by the Joint Questionnaire on Non-Monetary Health Care Statistics.
18.5. Data compilation
The absolute numbers for EU aggregates are the sum of the country numbers. When there is no available data for a country, the calculation of the EU aggregate takes into account the available data in the 5 previous years for the countries for which data is missing. For the density rates these EU totals are divided by the corresponding total EU population.
18.6. Adjustment
Data as reported by countries. No adjustments are made by Eurostat.
See Footnotes in the Annex at the bottom of the page for:
Non-expenditure health care data provide information on institutions providing health care in countries, on resources used and on output produced in the framework of health care provision.
Data on health care form a major element of public health information as they describe the capacities available for different types of health care provision as well as potential 'bottlenecks' observed. The quantity and quality of health care services provided and the work sharing established between the different institutions are a subject of ongoing debate in all countries. Sustainability - continuously providing the necessary monetary and personal resources needed - and meeting the challenges of ageing societies are the primary perspectives used when analysing and using the data.
The output-related data ('activities') refer to contacts between patients and the health care system, and to the treatment thereby received. Data are available for hospital discharges of in-patients and day cases, average length of stay of in-patients and medical procedures performed in hospitals.
Annual national and regional data are provided in absolute numbers and in population-standardised rates (per 100 000 inhabitants).
Health care data on activities are largely based on administrative data sources in the countries. Therefore, they reflect the country-specific way of organising health care and may not always be completely comparable.
11 January 2021
Health care activities' statistics describe the process of providing health care services in countries by referring to the services provided. Service-related data aim at quantifying directly elements of the health care delivery process.
The respective data are, due to their heterogeneity, collected, stored and disseminated via different tables. They are based on different, mainly administrative sources. This may lead to differences in the coverage of time series and/or in the geographical coverage; data validity, reliability and comparability may vary. Furthermore, it may not always be possible to have the health care system, implicitly underpinning the data collection, being consistently defined across data sources.
Non-expenditure health care activities data are grouped as follows:
Hospital patients: data refer to (1) hospital discharges of in-patients and day cases by age, sex, and selected (groups of) diseases; (2) average length of stay of in-patients; (3) a selection of medical procedures applied in hospitals.
A (hospital) discharge is the formal release of a patient from a hospital after a procedure or course of treatment (episode of care). A discharge occurs anytime a patient leaves because of finalisation of treatment, signs out against medical advice, transfers to another health care institution or because of death. A discharge can refer to in-patients or day cases. Healthy newborns should be included. Transfers to another department within the same institution are excluded.
An in-patient is a patient who is formally admitted (or 'hospitalised') to an institution for treatment and/or care and stays for a minimum of one night or more than 24 hours in the hospital or other institution providing in-patient care.
Day case: day care comprises medical and paramedical services (episode of care) delivered to patients who are formally admitted for diagnosis, treatment or other types of health care with the intention of discharging the patient on the same day. An episode of care for a patient who is admitted as a day-care patient and subsequently stays overnight is classified as an overnight stay or other in-patient case.
Average length of stay (ALOS) is computed by dividing the number of hospital days (or bed-days or in-patient days) from the date of admission in an in-patient institution (date of discharge minus date of admission) by the number of discharges (including deaths) during the year.
Procedures are all types of medical interventions with the intention of achieving a result in the care of persons with health problem.
Next to absolute numbers, density rates are provided for health care statistics.
Density rates are used to describe the frequency of services rendered, expressed in per 100 000 inhabitants. They are calculated by dividing the absolute number of health care resources available or services rendered in a given period by the respective population in the same period and then multiplied by 100 000. For Luxembourg the density rates are calculated dividing the absolute number of health care services rendered in a given period by the resident population covered by the statutory health insurance scheme and then multiplied by 100 000.
Administrative data sources refer to registered patients treated or procedures applied. The underlying totality of institutions, for which data collections are available, may differ. In some countries, data may not be available for a subgroup of institutions (e.g. private hospitals).
Depending on the data set, the target populations are all discharges or procedures performed in all hospitals.
EU Member States, Iceland, Liechtenstein, Norway, Switzerland, Montenegro, the former Yugoslav Republic of Macedonia, Albania, Serbia and Turkey.
Calendar year; depending on the reporting Member State, the reference period refers to the annual average or as reported by 31st December.
Not available.
The data are published in absolute numbers and rate per 100,000 inhabitants.
The absolute numbers for EU aggregates are the sum of the country numbers. When there is no available data for a country, the calculation of the EU aggregate takes into account the available data in the 5 previous years for the countries for which data is missing. For the density rates these EU totals are divided by the corresponding total EU population.
Health care non-expenditure data are mainly derived from administrative sources, and these sources may vary by country and by variable, eg. hospital administrative sources, health workers associations, family centers and private practises.
Please note that the data sources used may not have been created initially for statistical purposes, and that the initial purpose of a data source may differ across countries. Both facts may influence the validity and comparability of results.
Annual.
Eurostat asks for the submission of final data for the year N at N+15 months.
A number of countries still face difficulties with this timetable and deliver data at their earliest convenience.
The comparability of the data across different countries is limited by the fact that the quality of the country data is subject to the way in which health care provision is organised in countries, and which information is available to and collected by the respective institutions.
Some countries are unable to cover all providers of care (the inclusion of private providers seems particularly difficult) or are only able to provide data for selective regions.
Sometimes regional data cannot be made available as the available breakdown does not coincide with the NUTS classification.
Ongoing work to increase quality, comparability and coverage is reported to Eurostat's Working Group "Public Health Statistics".
The comparability of the data over time is checked before dissemination.
Some countries may have a change in their data collection and so a break in series. These breaks in series are flagged and some information (if available) are given in the annexes of the metadata.
