Eurostat, the statistical office of the European Union

F5: Education, health and social protection

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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).

Wherever applicable, the definitions and classifications of the System of Health Accounts (SHA) are followed, e.g. International Classification for Health Accounts - Providers of health care (ICHA-HP). For hospital discharges, the International Shortlist for Hospital Morbidity Tabulation (ISHMT) is used.

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.

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 CIRCABC.

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.

Public Health.

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.

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.

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.

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.

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.

Definitions and data specifications are available in CIRCABC.

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.

Not applicable.

Not applicable.

Not applicable.

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.

Annual.

News releases on-line.

Statistics Explained: Health

Health in the European Union – facts and figures

Health Statistics Illustrated

For more information on publications, see also the Health dedicated section on Eurostat website.

Please consult free data on-line or refer to contact details.

Not applicable.

Eurostat database: Population and social conditions>Health>Health care>Preventice services

Europe in figures - Eurostat yearbook

Eurostat regional yearbook

For the comprehensive metadata of each variable/country, see the Detailed footnotes at the bottom of the page.

Not available.

Not available.

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.

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.      

Not available.

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).

Not available.

Not applicable.

Not applicable.

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.

Not available.

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.

Health care data on activities are also available in the database "Regional Statistics".

Internal coherence is ensured by the annual validation processes.

The data collection is based on administrative national sources with no additional burden.

Only final data published.

None.

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.

Administrative data from the national statistics authorities. The data are collected annually.

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.

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.

Data as reported by countries. No adjustments are made by Eurostat.

See Footnotes in the Annex at the bottom of the page for:

- Breast cancer screening

- Cervical cancer screening