Croatian Institute of Public Health

Division of Public Health

Rockefeller St. 7, Zagreb, Croatia

Statistics on healthcare non-expenditure provides information on healthcare human resources, healthcare facilities, and healthcare utilisation:

- 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 and private health care sector.

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 utilisation. 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

According to the Regulation, reference year for the first mandatory transmission, for selected variables, is 2022. Data for previous years, subject to gentleman's agreement, was provided depending on the availability of sources, most from 2009 onwards.

Not applicable

Absolute number at the end of reference period.

Rate of phenomenon per reference population.

Calendar year - for majority of variables

Influenza season - for variable Immunisation against influenza

Screening programme cycle - for screening programmes

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 

EUROSTAT Gentlemen’s agreement

Law on Official Statistics (Official Gazette 25/20)

Program of statistical activities of the Republic of Croatia 2021 - 2027 (Official Gazette 29/22)

Annual Implementation Plan of Statistical Activities of the Republic of Croatia 2022 (Official Gazette 42/22)

Law on Health Care (Official Gazette 100/18)

Law on Data and Information in Healthcare (Official Gazette 14/19)

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

The Official Statistics Act deals with statistical confidentiality and data protection issues. Internal CIPH regulations define the contractual obligations of staff carrying out tasks specific workplace and compensation in cases of non-compliance with contractual obligations.

To further ensure the confidentiality CIPH allows access to databases only participants in input, control and data processing. There are mechanisms restricted access between different stakeholders within the data processing, with appropriate technical protection.

Division for Health Informatics and Biostatistics in CIPH provides formalised data access grants, monitors activities on databases, servers and local networks, conducts automatic backup procedures six days a week on site, as well as distanced monthly and yearly backup

There are several CIPH documents dealing data protection: Procedure for dealing with personal data, Procedure in case of personal data violation, Procedure of personal data protection when issuing microbiological results, electronic correspondence and documents archiving; for example, it is mandatory to record workers' access to electronic personal data and their authorizations, access to personal data stored in electronic form (electronic database) is enabled only by using the assigned username and password from an authorized person, the signing of the confidentiality statement by all CIPH employees who are involved in the processing of personal data is mandatory. It is recommended to reduce the amount of personal data and the scope of data during processing to the minimum possible extent by analyzing the personal data that is collected and assessing whether it is really necessary.

Croatian Institute of Public Health does not publish a release calendar on the website, however we are obliged to respect deadline for dissemination specified in Annual implementing plan of statistical activities in Croatia.

For all the routine health and statistical research, The Annual Implementation Plan of Statistical Activities of the Republic of Croatia defines the content of research, data collection, collection periods, the level of publishing the results, limits the release of the results as well as relevant national and international standards.  

Annual Implementation Plan of Statistical Activities of the Republic of Croatia 2022 (Official Gazette 42/22)

https://narodne-novine.nn.hr/clanci/sluzbeni/2022_04_42_519.html

Croatian Institute of Public Health (CIPH) publishes results of statistical researches in the form of a Yearbook and separated bulletins on the CIPH official website: https://www.hzjz.hr/. All stated forms of published results contain the information about the methodology of the statistical processes and the quality of their outputs (for example data source, inclusion and exclusion criteria). All data are published and available to all users free of charge.

Pursuant to the Act on the Right to Access to Information (OG 25/13, 85/15 i 69/22) there is an increasing number of enquiries from the users for the information which require the analysis of indicators which do not belong to the routine data processing. CIPH submits the data within the legal deadline. Legal templates for the users are published on CIPH's official website: https://www.hzjz.hr/ostvarivanje-prava-na-pristup-informacijama/ .

All templates are according to the Act on the Right to Access to Information and listed on the official website as follows: Request for access to information, Request for supplement or correction of information and Request for re-use of information.

Yearly.

Data on healthcare non-expenditure is published under Croatian Health Statistical Yearbook and and individual thematic reports yearly on internet site of Croatian Institute of Public Health. 

Croatian Health Statistical Yearbook 2022, Croatian Institute of Public Health, 2022; https://www.hzjz.hr/statisticki-podaci/hrvatski-zdravstveno-statisticki-ljetopis-za-2022-g-tablicni-podaci/

Health Care Utilisation within the Family (General) Medicine Service in Croatia in 2022, Croatian Institute of Public Health, 2022; https://www.hzjz.hr/wp-content/uploads/2023/07/OM-CEZIH-2022.pdf

Health Care Utilisation within the Pre-School Children’s Medicine Service in Croatia in 2022, Croatian Institute of Public Health, 2022; https://www.hzjz.hr/wp-content/uploads/2023/06/CEZIH-PED-2022.pdf

Health Care Utilisation within the Women's Health Service in Croatia in 2022, Croatian Institute of Public Health, 2022; https://www.hzjz.hr/wp-content/uploads/2023/12/GIN-OPS-CEZIH-2022-1.pdf

Report - Operation of hospitals in Croatia in 2022, Croatian Institute of Public Health, 2022; https://www.hzjz.hr/wp-content/uploads/2023/12/Bilten-Rad-bolnica-2022-3.pdf

Not available.

Croatian Institute of Public Health, generally, disseminate only aggregated data. 

Croatian Institute of Public Health delivers data to several international organizations (EUROSTAT, WHO, UN), whereby the data is anonymized and, generally, aggregated.

There are no individual documents dealing with methodology, but when publishing data, used methodology is always stated in each individual publication. One example is calculation of several indicators from primary health care after changing data source. Namely, change of data source also required different ways of calculating individual indicators, which affected the comparability of data from previous years. For example, when calculation the number of examinations in family (general) medicine service we use the codes for diagnostic and therapeutical procedures so we list all the used ones. In statistical researches in CIPH definitions and classifications which are in accordance with the corresponding European standards are applied. When preparing data for international institutions, given methodology is applied, and if this is not possible, it is always noted about deviations from the given methodology. 

There are no official documents concerning quality management of healthcare non-expenditure data.

The quality segment in CIPH and in other healthcare institutions is primarily regulated by the Law on Healthcare Quality (OG 118/18). Other aspects of quality, outside of this Law, are handled by the Quality Committee, which is made up of representatives of each specialty in CIPH. There is an internal act called the Rules of Procedure of the Committee for Quality. One of the aspects of the work of this Committee is the recognition of the need for constant improvement of the statistical indicators produced by CIPH, so the participation of CIPH in the EU Morbidity Statistics project is one of the recommendations given by this Committee.

Most statistical research that CIPH is currently conducting have a two-level quality control and first is implemented in the county public health institutes. Those units are part of national public health network. They collect statistical data from reporting units in the area of their county, and control them. If they found unsatisfactory quality report they returned them to correction. The second level of quality control is in the CIPH. One part of the quality control is automatized and implemented in IT applications, but some carried out by CIPH staff. Official instructions for reporting units have been published on the CIPH website https://www.hzjz.hr/suradnici/.

We have well defined (although not formalised) procedures which we follow in order to assess and assure the quality of the data we collect. Here are some examples:

-              We use Eurostat's logic control implemented in excel data template to identify problematic data which we are then investigating further

-              When available, we compare the data we receive with the other published data (such as annual reports) – this is regularly applied for Croatian Health Insurance Fund data and occasionally for other data from other reporting units such as Ministry of Health, counties, non-governmental organisations, etc.)

 -  Also, one example regarding health care institutions is comparing and checking the data on status of entities in health system (active or closed etc.) with Court register as the access is easily possible on the web.

The majority of healthcare non-expenditure data for Croatia are collected using "bottom-up" approach - individual data from administrative data sources are collected and compiled according to EUROSTAT methodology.

Data users at the national level are Ministry of Health, regional institutes of public health as well as researchers and analysts in the area of health care.

Since CIPH publishes all the results of statistical research, it can not have an insight into all data users. The direct contact is most often made with competent authorities which usually use data, the Ministry of Health and regional institutes of public health so they have opportunity to give its opinion from the user point of view.

Pursuant to the Act on the Right to Access to Information (OG 25/13, 85/15 i 69/22) there is an increasing number of enquiries from the users for the information which require the analysis of indicators which do not belong to the routine data processing. When the data are available, Croatian Institute of Public Health submits the data within the legal deadline. Legal templates for the users are published on CIPH's official website: https://www.hzjz.hr/ostvarivanje-prava-na-pristup-informacijama/ .

The overall accuracy healthcare non-expenditure data depends on the accuracy of the data used to compile them. In general, since mostly data are derived from administrative data sources they are accurate.

Not applicable.

Not applicable.

According to Annual implementing plan of statistical activities in Croatia, preliminary data are available by the end of June for the previous year.

CIPH publishes the data according to Annual implementing plan of statistical activities in Croatia.

The comparability is insured by using the same data sources for all country.

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

None.

The data are consistent.

Croatia does not have data revisions policy and it is not formalised in the form of official document. Data revisions are not done in regular time periods, but whenever it is needed.

In case of revision of already published data, note the data of revision.

Source data for the different variables are given in the Annex at the bottom of the page.

Monthly, for most variables.

Croatian Institute for Public Health collects statistics on health non-expenditure via following sources:

- National Register of Health Care Providers 

- Hospital structure and function database

- Medical Equipment Database

- Medical Procedures Database

- Databases on Primary Health Care and Outpatient Specialist Health Care

- Immunisation against influenza database

- National Breast Cancer Screening Programme

- National Colorectal Cancer Screening Programme

Data on national level are collected in Croatian Institute of Public Health. Some of them are being sent directly to CIPH, and some of them are first being collected at county level (county institutes of public health). CIPH improved the method of collecting a large part of the data and almost completely switched to the electronic way of data collection (instead of papers). Most statistical researches that CIPH is currently conducting have a two-level quality control and first is implemented in the county public health institutes. Those units are part of national public health network. They collect statistical data from reporting units in the area of their county, and control them. If they found unsatisfactory quality report they returned them to correction. The second level of quality control is in the CIPH. One part of the quality control is automatized and implemented in IT applications, but some carried out by CIPH staff. 

Comparing the statistics with previous years, checking for logical mistakes.

The absolute numbers for country aggregates are the sum of numbers from each reporting unit.

In case of errors, they are corrected, but always in contact with the data source.

No further comments.