National Institute for Health Development (NIHD)

Department of Health Statistics

Paldiski mnt 80, 10617, Tallinn, Estonia

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 statistical survey.

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.

The Eurostat manual on healthcare non-expenditure statistics provides an overview of the classifications, both for mandatory variables and variables provided on voluntary basis.

Where possible, the statistics are separated by sex (male/female), age group.

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.

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 are described in the Annex.

Registered health professionals or health care facilities.

(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

The population includes all legal persons who have a valid activity license for the provision of health care services.

Estonia as a whole

Health employment data: years 1980 - 2022

Number of practising physicians by age, gender, category: years 2013 - 2022

Number of beds: years 1998 - 2022

Number of MRI units and CT scanners: years 2005 - 2022

Hospital aggregates: years 2013 - 2022

Surgical procedures mostly for the years 2003 - 2022

Immunisation against influenza: years 2008 - 2022

Screening programme data: breast cancer for the years 2003 - 2022, cervical cancer 2007 - 2022, colorectal cancer 2016 - 2022.

Not applicable

Absolute numbers: health employment at the end of November; hospital beds - average number during the reference period; long-term care beds, medical devices, hospital aggregates, surgical procedures at the end of reference year.

Data as a rate of a relevant population are expressed as percentages (data on immunisation, screening programmes).

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 level:

Health Services Organisation Act, passed 09.05.2001.

Regulation of the Minister of Social Affairs of Estonia No 51 of 7 December 2012 on requirements for the compilation of reports on health care statistics and health-related economic activity, data composition and submission procedure.

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

At the national level, the data sharing service is regulated according to the Official Statistics Act (§ 20¹).

The use and dissemination of confidential data is guided by the requirements provided in the Official Statistics Act.

In publishing statistics, confidentiality is granted. Data are published or forwarded without any characteristics that would allow to identify the data subject, as consolidated data of at least three data subjects.

The data of the data subject is published only upon the written consent of the data subject.

The publication dates of health statistics are pre-announced in the release calendar, which is publicly accessible on the website of NIHD. The release calendar for the upcoming year is published on September 30 of each year.

Release calendar for 2024 is available on the NIHD website https://statistika.tai.ee/Resources/Info/ReleaseCalendar2024.pdf

All users have equal access to health statistics: publication dates are pre-announced, and no user category is provided access before the publication date.

Health statistics are first published in the public Health Statistics and Health Research Database on the NIHD website. In the case of a press release, it is published simultaneously with the publication of data in the statistical database.

All important data updates are announced on the NIHD website, the website of the database and in social media (NIHD Facebook page, database Twitter page, health statistics newsletter).

Yearly

Press releases linked to the data are published on the website of NIHD in Estonian.

All publications are available on the website of NIHD Väljaanded | Tervise Arengu Instituut (tai.ee)

Some of them: Health expenditure Tervishoiukulud_2020_3.pdf (tai.ee)

Home injuries in Estonia Koduvigastused_2016_2021.pdf (tai.ee)

Public health yearbook of NIHD TAI aastaraamat 2023_veeb_mai2023.pdf

Health Statistics and Health Research Database https://statistika.tai.ee/index_en.html 

The data are available in micro-data form only with the consent of data provider.

Indicators calculated on the basis of health statistics are used as measures in development plans.

The Department of Health Statistics of NIHD regularly forwards health and health care related statistical data to international organisations:

Eurostat - OECD - WHO Joint Health Accounts Questionnaire and Joint Questionnaire on Non-Monetary Health Care Statistics; 

WHO for the Health for All Database;

OECD -- with the Health Data Questionnaire for OECD Health Database.

Metadata are available with the data presented in the Health Statistics and Health Research Database.

Not applicable

To assure the quality of processes and products, the principles of European Statistics Code of Practice are followed.

The overall assessment of data quality is good. Data quality is in accordance with principles of accuracy and reliability, timeliness and punctuality, coherence and compatibility.

Main users of data are Ministry of Social Affairs, other ministries and state authorities, politicians, local governments, research and educational institutions, professional medical associations, providers of health care services, media and international organisations like Eurostat, OECD, WHO.

Unmet national need for regional health statistics by patients' place of residence will become possible after the change in the methodology of compiling health and health care statistics. This means a change in the data source: a transition from aggregated data collected with statistical reports to individual medical records data from the health information system.

A health statistics user survey is carried out every three years. The use of the Health Statistics and Health Research Database is annually monitored, and feedback is collected using the feedback form on the website of the database.

All the relevant data required by Regulation (EU) 2022/2294 are provided.

The overall accuracy of the results can be assessed as very good. 

The data collected with annual statistical surveys from health service providers are mainly used as a data source. All licensed healthcare service providers are surveyed. The overall unit response rate is almost 100%.

Not applicable.

Not applicable.

Deadline for health service providers to submit non-monetary health data questionnaires to NIHD: 2 months after the end of the reference year.

Data dissemination in the public Health Statistics and Health Research Database: within 11 months after the end of the reference year.

Data are published at national level according to the release calendar and transmitted to Eurostat via EDAMIS on time, within 14 months after the end of the reference year.

Data are comparable.

Breaks in time series for each variable are described in the Annex.

Not applicable.

No inconsistencies.

No regular revisions planned.

Data will be corrected in case of mistakes.

All corrections made to data tables are reflected as footnotes under the table in the Health Statistics and Health Research Database. Notes regarding corrections are stored for one year after making the corrections.

The data source for most HCnE variables is annual statistical survey. Census survey is used. All health care service providers having a valid activity license are included in the survey.

In addition, administrative data is used as data source for some variables as well as for imputation or data validation:

- Estonian Education Information System as a data source for graduates data;

- the Estonian Communicable Diseases Registry under the administration of the Health Board as a data source for influenza vaccination;

- the Estonian Health Insurance Fund (EHIF) data include information on treatment invoices of service providers who are EHIF's contractual partners, covering only a part of services. From the reference year 2022, treatment invoices are the data source for compiling hospital discharge data (HDD) as hospital services are mostly reimbursed by EHIF;

- the data of the Estonian National Health Information System, data coverage and quality of which are not sufficient to produce reliable statistics.

Source data for the different variables are given in the Annex.

Annual.

Data collection basis on the statistical register on health care providers. Census survey is used. All health care service providers, who have a valid activity license, are included in the survey. During the data collection, the activeness of service providers is adjusted.

A number of questionnaires are used for data collection, such as health care provider reports on health care personnel, surgical procedures, medical devices, also hospital report on hospital discharges, beds and bed-days etc. The health care providers submit reports through web-based data submission channel Aveeb where is possible to apply data checks. Questionnaires and their completing instructions are available in Estonian on the website AVeeb: Esileht (sm.ee)

Administrative data are available from a public database or based on a data request or contract. The data on medical bills of Estonian Health Insurance Fund is available on the basis of a contract. 

NIHD uses the web-based electronic data submission channel Aveeb where the automatic checks are added. This gives a possibility to check the correctness of the data and to correct the errors before submitting questionnaire. There are mostly arithmetical checks to ensure data completeness and internal consistency.

In data processing phase the data editing continues by using a lot of arithmetical — completeness, internal consistency, plausibility — checks. The data are also compared with related data from other reports or other data sources, with data from previous years on individual and aggregated level. In case of non-response, imputation is applied.

Completeness of collected survey data is evaluated, data are checked for errors and summed up according to the classification, additional indicators are calculated.

Data refer to calendar year; no seasonal adjustment or other adjustment methods are applied.

No further comments.