Statistical Service of Cyprus (CYSTAT)

Population, Social Statistics and Tourism

Statistical Service of Cyprus

CY-1444

Nicosia

Cyprus

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 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

Government controlled areas of the Republic of Cyprus.

A few indicators are available from 1980, some other indicators are available from later years.

Not applicable

Absolute numbers at end of reference period. The reference period is for most indicators the 31st December YYYY.

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

National Legislation

Article 3 of the national Official Statistics Law, No. 25(I) of 2021 defines the functions of the Statistical Service of Cyprus regarding the production and dissemination of official statistics. Moreover, Article 13, explicitly stipulates the mandate for data collection and introduces a mandatory response to statistical enquiries by stipulating the obligation of respondents to reply to surveys and provide the data required. This relates not only to national but also to European statistics which, by virtue of Article 8 of the said Law, are incorporated in the annual and multiannual programmes of work without any further procedure.

Joint Questionnaire on Non-Monetary Health Care Statistics, which is carried by Eurostat, OECD and WHO-Europe.

Official statistics are released in accordance to all confidentiality provisions of the following:

• National Official Statistics Law No. 25(I) of 2021 (especially Article 16 on statistical confidentiality).
• Regulation (EC) No 223/2009 of the European Parliament and of the Council of 11 March 2009 on European statistics and its later amendments (especially Chapter 5 on statistical confidentiality).
• European Statistics Code of Practice (especially Principle 5 on statistical confidentiality).
• CYSTAT's Code of Practice for the Collection, Publication and Storage of Statistical Data.

Links to all of the above documents should be attached (or the actual documents):

• Statistics Law No. 25(I) of 2021:

https://www.cystat.gov.cy/en/StaticPage?id=1074  

• Regulation (EC) No 223/2009 on European statistics (consolidated text):

http://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:02009R0223-20150608&qid=1504858409240&from=EN

• European Statistics Code of Practice:

http://ec.europa.eu/eurostat/web/products-manuals-and-guidelines/-/KS-32-11-955

• Code of Practice for the Collection, Publication and Storage of Statistical Data:

 https://www.cystat.gov.cy/en/StaticPage?id=1066

The treatment of confidential data is regulated by CYSTAT's Code of Practice for the Collection, Publication and Storage of Statistical Data.

• Code of Practice for the Collection, Publication and Storage of Statistical Data:

https://www.cystat.gov.cy/en/StaticPage?id=1066

There is an annual release for all the data disseminated by CYSTAT, which is announced during the 4th quarter of the year, includes provisional dates of publication for the following year, which are finalized the week before publication. By the date of submission of the report, the release date of health statistics was not included in the release calendar. However, one week before publication, the health statistics will be added in the calendar.

Link to release calendar: https://www.cystat.gov.cy/en/AnnouncementList

Link to CYSTAT’s release calendar: https://www.cystat.gov.cy/en/AnnouncementList

According to the Dissemination and Pricing Policy of the Statistical Service of Cyprus (section 2.3) CYSTAT΄s main channel for dissemination of statistics is the website, which offers the same conditions to everyone and is updated at the same time every working day (12:00 noon). Privileged pre-released access (of no more than 1 day in advance) has been granted to a few selected users for specific statistics. These are specified in the Dissemination Policy (section 2.3).

In addition to the annual release calendar, users are informed of the various statistical releases through the “Alert” service provided by CYSTAT.

Link to the Dissemination and Pricing Policy should be attached (or the actual document):

• Dissemination Policy of the Statistical Service of Cyprus: https://www.cystat.gov.cy/en/StaticPage?id=1064

Some of the indicators included in this data collection are disseminated at national level on an annual basis (publication "Health and Hospital Statistics"). Specifically, data for year n are disseminated in May n+2. 

PRESS RELEASE HEALTH AND HOSPITAL STATISTICS 2021:

https://www.cystat.gov.cy/en/KeyFiguresList?s=38

Annual publication "Health and Hospital Statistics". Published from the Statistical Service of Cyprus.

https://www.cystat.gov.cy/en/PublicationList?s=38 (link to published pdf document and excel tables)

https://library.cystat.gov.cy/NEW/HEALTH_HOSPITAL_STATS-2020-EN-120123.pdf

CYSTAT-DB 

Domain: Health

• In-patients
• Out-patient Attendances
• Deaths by Cause of Death

Link to the national database:

https://cystatdb.cystat.gov.cy/pxweb/en/8.CYSTAT-DB/8.CYSTAT-DB__Health__

Statistical micro-data from CYSTAT’s surveys are accessible for research purposes only and under strict provisions as described below:

Under the provisions of the Statistics Law, CYSTAT may release microdata for the sole use of scientific research. Applicants have to submit the request form "APPLICATION FOR DATA FOR RESEARCH PURPOSES" giving thorough information on the project for which micro-data are needed.

The application is evaluated by CYSTAT’s Confidentiality Committee and if the application is approved, a charge is fixed according to the volume and time consumed for preparation of the data. Micro-data may then be released after an anonymisation process which ensures no direct identification of the statistical units but, at the same time, ensures usability of the data. The link for the application is attached below.

Link to the application for access to microdata on CYSTAT's website:

https://www.cystat.gov.cy/en/DataRequestContactForm?fid=7

Applicants for tailor-made data must submit the following electronic form:

https://www.cystat.gov.cy/en/DataRequestContactForm?fid=7

Depending on the request, a charge is fixed according to the volume and time consumed for the preparation of the tailor-made data. Applicants are informed about the total charges and the output is produced as soon as the applicants accept the specified costs.

The methodology applied for the compilation of health indicators, as well as the data sources used, are presented in the pdf document published in CYSTAT's website. It can be found at the following link:

2020:

https://library.cystat.gov.cy/NEW/HEALTH_HOSPITAL_STATS-2020-EN-120123.pdf

2021:

https://library.cystat.gov.cy/NEW/HEALTH_HOSPITAL_STATS-2021-EN-080923.pdf

The quality of statistics in CYSTAT is managed in the framework of the European Statistics Code of Practice which sets the standards for developing, producing and disseminating European Statistics as well as the ESS Quality Assurance Framework (QAF). CYSTAT endorses the Quality Declaration of the European Statistical System. In addition, CYSTAT is guided by the requirements provided for in Article 11 of the Statistics Law No. 25(I) of 2021 as well as Article 12 of Regulation (EC) No 223/2009 on European statistics, which sets out the quality criteria to be applied in the development, production and dissemination of European statistics.

The quality of statistics in CYSTAT is managed in the framework of the European Statistics Code of Practice which sets the standards for developing, producing and disseminating European Statistics as well as the ESS Quality Assurance Framework (QAF). CYSTAT endorses the Quality Declaration of the European Statistical System. In addition, CYSTAT is guided by the requirements provided for in Article 11 of the Statistics Law No. 25(I) of 2021 as well as Article 12 of Regulation (EC) No 223/2009 on European statistics, which sets out the quality criteria to be applied in the development, production and dissemination of European statistics.

The codification of the diagnosis during discharge is performed from specially trained coders. For any discrepancies found in the data during the processing and analysis phase, CYSTAT goes back to the owners of the data and asks for clarifications. 

Peer Reviews

Peer reviews form part of the European Statistical System (ESS) strategy to monitor the implementation of the European Statistics Code of Practice. Their objective is to review the compliance/alignment of the ESS with the Code and to help the statistical authorities making up the ESS to further improve and develop the national statistical systems.

The first round of peer reviews took place during the period 2006 - 2008, the second round during the period 2013 - 2015 and the third round during the period 2021 - 2023.

In Cyprus, the first round took place in December 2006, the second round in March 2015 and the third round in March 2023. With the completion of the third peer review a list of improvement actions was compiled, on the basis of the conclusions of the evaluation included in the compliance report. A timetable for the implementation of these actions was also set, while their implementation is monitored by Eurostat on an annual basis.

The compliance reports as well as the improvement actions for each country can be accessed at Eurostat's website. The files regarding Cyprus are also available below (relevant files).

The third peer review for the National Statistical System of Cyprus took place in March, 2023.

• European Statistics Code of Practice:

http://ec.europa.eu/eurostat/web/products-manuals-and-guidelines/-/KS-32-11-955

• ESS Quality Assurance Framework (QAF):

http://ec.europa.eu/eurostat/documents/64157/4392716/ESS-QAF-V1-2final.pdf/bbf5970c-1adf-46c8-afc3-58ce177a0646

• Quality Declaration of the European Statistical System:

http://ec.europa.eu/eurostat/documents/4031688/8188985/KS0217428ENN_corr.pdf/116f7c85-cd3e-4bff-b695-4a8e71385fd4

• Statistics Law No. 25(I) of 2021:

https://www.cystat.gov.cy/en/StaticPage?id=1074

• Regulation (EC) No 223/2009 on European statistics (consolidated text):

http://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:02009R0223-20150608&qid=1504858409240&from=EN

Links to the peer reviews:

https://library.cystat.gov.cy/NEW/PEER_REVIEW_CY_2006-EN-160311.pdf

https://library.cystat.gov.cy/NEW/Evaluation_Code_of_Practice_2015-EN-290915.pdf

https://library.cystat.gov.cy/NEW/Code_of_Practice_Improvement_Actions_2015-EN-290915.pdf

https://library.cystat.gov.cy/NEW/Evaluation_Code_of_Practice-2023-EN-151123.pdf.pdf

• Users of data consist of Ministries (Ministry of Health), researchers, academics, health care professionals, students, companies conducting studies for the health care system in Cyprus

• The Ministry of Health needs the data for the policy making, researchers and academics needs the data for supporting their studies, students use health statistics for supporting their thesis statements, private companies assigned the conducting of studies regarding the health sector need data in order to support the outcomes of their work. 

• Up to 2020, the data does not cover the whole health care system due to lack of information for several indicators as regards the private sector. However the situation has been improved in 2021, with the introduction of the General Health System (GHS), since the data coverage has been improved. The coverage is expected to improve further in the coming years, since more health care institutions are expected to be enrolled to the GHS.

Since 2008 (with the exception of 2010, 2013 and 2020) CYSTAT carries out an annual online “Users Satisfaction Survey”. The results of the surveys are available on CYSTAT’s website at the link attached below.

Overall, there is a high level of satisfaction of the users of statistical data published by CYSTAT.

• Results of CYSTAT’s User Satisfaction Surveys: https://www.cystat.gov.cy/en/StaticPage?id=1144

Any deviations from definitions mainly due to coverage issues are listed by variable in the Methodological Document which is annexed.

In practice, CYSTAT uses the methodological guidelines provided by Eurostat to a large extend, in terms of definitions, calculation methods suggested, coverage, etc. Any weaknesses of the data provided in terms of deviations from definitions are documented by variable in the methodological document annexed.

Not applicable.

Not applicable.

The provisions of the Regulation are met in terms of timeliness, i.e. most of the indicators for reference year n will be provided 14 months after the end of the reference period. A few of the indicators on hospital inpatient discharges might not be available 14 months after the end of the reference period, but they'll be available by 20 months after the end of the reference period, as requested from the regulation.

Primary data are obtained either in paper form, or in electronic form, i.e. tables or micro-data. After the data are received from CYSTAT, they are further processed, tabulated and analysed in order to compile the requested indicators. In order to reduce the time lag between the availability of data and the reference period they describe, efforts are made for eliminating the collection of data in paper form and for promoting the collection of data in electronic form. Moreover, the introduction of the General Health System enables the collection of hospital data on in-patient discharges centrally from 1 data owner, the Health Insurance Organisation. This speeds up the whole process of obtaining and processing the data, permitting for the elimination of the time lag between data availability and the reference period. 

The timeframes set by the Regulations are met.    

Government controlled areas of the Republic of Cyprus. 

The Geographical Regions do not apply for the case of Cyprus.

The comparison of data over time should be made with caution, since several break in series occur throughout the years. Break in series occur either due to change in the data source leading to non-comparable data, or due to major changes in the Health Care System leading to differences in the coverage of the data.

The breaks in time series for each variable are justified and explained in the methodological document annexed.

Statistics are reconcilable with those obtained through other statistical domains, as soon as they refer to the same definitions.

The data are internally consistent.

Costs:

As already mentioned, efforts are made for eliminating the collection of data in paper form and for promoting the collection of data in electronic form. This will reduce the time needed for processing the data leading to reduction of the costs.

In parallel, the changes in the health care system with the introduction of the GHS affected the whole process of data collection, since it has been centralised as regards the data obtained from the HIO and the SHSO. This change is expected to reduce the time required for data collection. Moreover, the quality of the data obtained is expected to increase, reducing the time needed for further call backs with the data owners for data validation.

Data for the needs of the Commission Regulation (EU) 2022/2294 is collected in parallel with the data needed for the national annual publication Health and Hospital Statistics. The request is usually addressed to the data owners in April of each year, asking for sending the data in a 2-month period. In case the data are not sent in time, we call back to the owners asking for the data. Moreover, in case the data is not comparable with previous years' data and this is not justified, we also contact the owners asking for feedback. This process, as well as the tabulation of the data collected, the further processing, analysis and compilation of the requested data and metadata requires four months of full time employment for 1 Statistics Officer A'.

Burden: 

In general, CYSTAT takes measures in order to minimize the burden on respondents and ensure that the available resources are efficiently used. With the introduction of the General Health System in 2021, the data requests are performed centrally when that applies, in order to avoid different requests addressed to the several data owners. Specifically the hospital patient data is requested centrally from the Health Insurance Organisation, whereas the data requests addressed to the medical institutions of the State Health Services Organisation (SHSO) are also addressed centrally to the SHSO. Moreover, the requests on health personnel are now addressed to the several services of the Ministry of Health, i.e. nursing services, medical services, pharmaceutical services, etc instead of sending the requests to the several hospitals and health centres.

A data revision policy is in place at CYSTAT. It is published on CYSTAT’s website, at the following link:

CYSTAT also publishes a list of scheduled revisions (regular or major revisions), also published on its website, at the following link:

https://www.cystat.gov.cy/en/StaticPage?id=1072

The usual case is that there are no revisions to report. However, in case an individual figure needs to be slightly revised, normally this is performed during next year's submission, if the change does not affect significantly the indicator.

In case of provisional data, as soon as the final data are available, they are sent to Eurostat. 

Source data for the different variables are given in the methodological document which is annexed to the current report.

Annual.

The data requests are addressed to the several data owners through letters, informing them about the data collection and the necessity of data provision. Attached to the letters are special statistical forms (tables) for completion. For owners preferring to complete the tables in electronic form, the letter as well as the excel tables are also sent via email.

For cases where micro-data files are requested, the letter informs about all the variables to be included in the file and their description. As regards the micro-data files, the data availability, as well as the quality of the data source have been assessed in advance in order to ensure the adequacy of the data.

Throughout the data collection phase and specifically during the data entry, the data obtained are compared with previous years' data and in cases where comparability issues are raised we call back the data owners and ask for justifications. 

For better reference as regards the data collection, 2 sample letters as well as the statistical forms used for the data collection for reference year 2022 are annexed (all in Greek).

According to the Commission Regulation (EU) 2022/2294 CYSTAT is obliged to provide both data and quality reporting. Quality reporting can be considered as a self-assessment tool, since it includes the calculation of several indicators and the measurement of specific parameters related to quality, i.e. sampling errors (calculation of the coefficients of variation, the standard errors and the confidence intervals for specific core variables), non-sampling errors (coverage errors, measurement errors, non-response errors). Through the quality reporting, the results of different surveys are being compared, in order to ensure the coherence of the data, i.e. the percentage of women having a mammography is compared to the respective percentage as obtained from administrative sources, etc. 

Up to reference year 2020, when no implementing regulation was in place, metadata was accompanying the data, including all the necessary information on the definitions applied, the coverage, the data sources used, any deviations from the definitions, revisions etc.

Additionally, all the validation and consistency checks which are embedded in the excel files to be submitted to Eurostat are automatically applied and any errors displayed are explored further.

During the compilation phase, several validation checks which are embedded in the tables to be completed run, in order to maintain the comparability of the data through the years, as well as the internal consistency of the several tables to be prepared.

During the submission of the data through Edamis, structural validations are performed automatically from the application. 

The quality assessment performed by Eurostat on the data submitted is quite comprehensive. Specifically, Eurostat performs detailed analysis of the data in terms of quality, completeness, comparability, alignment with the definitions, estimation methods used if applicable, etc. The validation of the data is performed in various rounds. At the end of each round Eurostat sends a validation report asking for feedback with a specific deadline, this continues until all issues are resolved.

Imputation is not applied since the compiled data is based on actual data. 

Data from different sources is usually combined in order to get the best outcome possible. If the different sources refer to micro-data files, a variable that is common and unique for each case in both datafiles is used in order to link the different data sources.

The hospital aggregates are calculated from the micro-data file of in-patient discharges, based on the given definitions of in-patient, curative care, somatic curative care, psychiatric curative care, day case, bed-day, average length of stay, etc.

Not applicable.

Detailed information about each variable in terms of coverage, deviation from definition or occurence of break in series can be found in the methodological document, that is annexed in the current report.