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.
Directorate for Health Information and Research, Ministry for Health and Active Ageing.
1.2. Contact organisation unit
National Hospital Information System
1.3. Contact name
Confidential because of GDPR
1.4. Contact person function
Confidential because of GDPR
1.5. Contact mail address
Directorate for Health Information and Research
95, Gwardamangia Hill,
Gwardamangia
PTA 1313
1.6. Contact email address
Confidential because of GDPR
1.7. Contact phone number
Confidential because of GDPR
1.8. Contact fax number
Confidential because of GDPR
2.1. Metadata last certified
20 February 2025
2.2. Metadata last posted
20 February 2025
2.3. Metadata last update
20 February 2025
3.1. Data description
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, 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 annex at the end of the document for source of data).
3.2. Classification system
For the collection of 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 are applied.
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.
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.
National deviations: see Annex at the bottom of the page.
3.3. Coverage - sector
Public and Private health.
Data submitted aims to cover all areas of the National health care system (such as: public and private health care, etc.).
For more information on coverage for specific variables, refer to respective headings in the annexed document.
3.4. Statistical concepts and definitions
The healthcare non-expenditure statistics describe the public and private 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 (see annex at the end of the document).
Definitions of mandatory variables are laid down in Commission Regulation (EU) 2022/2294.
Joint Questionnaire on Non-Monetary Health Care Statistics, which is carried by Eurostat, OECD and WHO-Europe on a yearly basis.
7.1. Confidentiality - policy
All data is collected and processed in accordance with the General Data Protection Regulation adopted in the Data Protection Act No. XX of 2018, published on the 28th May, 2018.
7.2. Confidentiality - data treatment
No identifiable data is is disclosed outside the Directorate for Health Information and Research. Only aggregate data is published and available online.
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.
Access to microdata relating to procedures in hospitals and Hospital aggregates is only possible after a request is made to our Directorate which vets the requests and may refuse or accept (after seeking further permission e.g. data protection, ethical approval).
For coding procedures the ICD-9 CM Classification of Procedures is used.
A Standard Operation Procedure is available which details all the steps involved to complete the Joint Questionnaire Non-Monetary Health Statistics.
10.7. Quality management - documentation
The Single Integrated Metadata Structure (SIMS), which is the standard for quality reporting, is published in the Eurostat Database for every variable pertaining to the Joint, non-Monetary Health Care questionnaire, as from reference year 2021.
11.1. Quality assurance
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.
During the whole process of data compilation and dissemination any differences in the data from previous years is assessed and updated in the questionnaire and reference metadata.
For coding procedures the ICD-9 CM Classification of Procedures is used.
11.2. Quality management - assessment
Not available.
12.1. Relevance - User Needs
Non-Monetary Health Statistics are used by International organisations, namely, EUROSTAT, WHO and OECD.
Local users also require Non-Monetary Health Statistics for policy making by the Ministry of Health and Active Ageing and for Research.
12.2. Relevance - User Satisfaction
There are no available national data on user satisfaction. Eurostat carries out an annual User satisfaction survey on a central level, see the latest results here.
12.3. Completeness
Completeness of mandatory variables for reference year 2023 stands at 100%.
Completeness of non-mandatory variables for reference year 2023 stands at around 83.5%.
Survey data on Breast Cancer Screening and Cervical Cancer Screening is not available annually but every 5 to 6 years. Therefore data has been submitted for the year 2020.
Completeness for the variables: Hospital Aggregates (Inpatient and Curative care), Surgical Procedures and Hospital Discharge Data are for the reference year 2022.
13.1. Accuracy - overall
Liaison with the institutions/divisions providing the data for the Joint Questionnaire on non-Monetary Health care Statistics is done regularly throughout the process of data compilation, to ensure that the data provided is accurate. Any differences in figures from one year to the next are discussed with the institutions/divisions providing the data.
However no formal assessment is done.
13.2. Sampling error
Not applicable.
13.3. Non-sampling error
Not applicable.
14.1. Timeliness
Data on Health Employment, workforce migration, physical resources, immunisations, screening, doctor consultations, visits to the emergency departments, diagnostic exams and Hospital Technical Resources in the EUROSTAT module for the year N are returned within 14 months, according to the Eurostat Regulation deadline.
Hospital discharge data, hospital aggregates and surgical procedures are returned within 20 months from end of reference year, according to the Eurostat Regulation deadline.
Survey data on Cancer Screening survey data is provided every 5 years from the European Health Interview Survey (EHIS).
14.2. Punctuality
Data on Health Employment, workforce migration, physical resources, immunisations, screening, doctor consultations, visits the the emergency department, diagnostic exams and Hospital Technical Resources in the EUROSTAT module for the year N are returned within 14 months, according to the Eurostat Regulation deadline.
Hospital discharge data, hospital aggregates and surgical procedures are returned within 20 months from end of reference year, according to the Eurostat Regulation deadline.
15.1. Comparability - geographical
Data for Malta is submitted as a whole because Malta is a small country and figures for regions will result in small figures.
15.2. Comparability - over time
See annex at the end of the document for potential breaks in series and deviations from definitions for each variable.
15.3. Coherence - cross domain
No cross-domain coherence issues.
15.4. Coherence - internal
Any differences in figures from one year to the next are discussed with the institutions/divisions providing the data for the Joint non-Monetary Health Statistics questionnaire.
The data to complete the questionnaire is not readily available. To complete the questionnaire, the appointed personnel within the Directorate for Health Information and Research has to liaise with various personnel within the various health institutions/departments to either provide aggregate data or case based data. If any missing variables in the case based data are noted or any discrepancies in the annual aggregate data is noted, the Directorate for Health Information and Research discusses the data with the appointed personnel within the various health institutions/divisions. Finally, the appointed personnel within the Directorate for Health Information and Research has to put the data and metadata together to submit the questionnaire by the stipulated deadline.
The diagnosis and procedures of the case-based hospital discharge data has to be validated and coded.
Annex at the end of the document provides a breakdown for the Sources for each variable in the questionnaire.
The cost associated with the compilation of the questionnaire is mainly attributed to the number of personnel required to compile the questionnaire. There are 4 personnel within the Directorate for Health Information and Research who work on compiling the questionnaire, with the cost amounting to around €144,307.
Once the questionnaire has been submitted and structure and content are validated by EUROSTAT users, the data is revised depending on the validation report feedback provided by EUROSTAT.
Data on previous years is occasionally revised if health institutions/divisions, gather more accurate data.
18.1. Source data
Source data for the different variables are given in the Annex at the end of the document.
18.2. Frequency of data collection
Annual.
18.3. Data collection
Survey data on Breast Cancer Screening, Cervical Cancer Screening and Colorectal Cancer Screening is obtained through the European Health Interview Survey conducted every 5 years.
The rest of the questionnaire data is gathered through administrative sources. Data is gathered from the respective health institutions/divisions. The health institutions/divisions provide the personnel within the Directorate for Health Information and Research with either aggregate data or case-based data.
Case-based data is obtained from hospitals so as to compile surgical procedures, hospital aggregates on inpatient care and curative care and Hospital Discharge Data. Individual data is also obtained from the Medical Council pertaining to data on Physicians and Dentists.
Aggregate data is gathered from the various health institutions whereby personnel within the Directorate for Health Information and Research compile these figures to obtain the required totals. Data for other variables are provided to the Directorate for Health Information and Research as totals.
18.4. Data validation
After compilation of data into the questionnaire, the data for reference year is compared with the figures of previous years and any discrepancies are discussed with the respective health institutions/division. Figures are sometimes ammended by the health institution or division and, consequently updated in the questionnaire. Any reasons for the discrepancies or changes of data in the previous years, are noted and recorded in the sources and methods.
Before submitting the questionnaire, the personnel appointed to compile the data for the questionnaire within the Directorate for Health Information and Research validates the data inputted by revisiting the coding and calculations done, particularly to the case-based data and makes sure that all is in accordance with the guidelines and definitions of each variable.
Once Eurostat send the validation feedback, any necessary arrangements are done and the data and metadata are re-submitted to EUROSTAT.
18.5. Data compilation
The aggregate data received is compiled in the questionnaire according to the definitions and guidelines provided by the International Organisations.
Calculations are also done for Full time Equivalence (FTE) for most of Health Employment figures.
For further detail on how each variable was compiled, see annex at the end of the document.
For coding procedures the ICD-9 CM Classification of Procedures is used.
Calculations using the case-based data are also done to obtain the hospital aggregates on Inpatient care and curative care. See annex at the end of the document.
18.6. Adjustment
For most of the variables falling under Health Employment, the Full Time Equivalence is calculated, rather than providing Headcount, so as not to inflate figures.
Immunisation rate for the private sector is not readily available. Therefore an estimate of the percentage of persons aged over 65 years who were immunised against influenza was based on the number of persons immunised in the public sector together with an estimate of the percentage of persons who were immunised in the private sector based on EHIS figures.
Adjustments have been done to calculate the hospital occupancy rate. In the private sector inpatient beds and day care beds are used interchangeably and therefore the number day care beds for these establishments are calculated using the proportion of LOS of inpatient discharges and the number of day cases within that establishment during the year of reference.
For further details, see annex at the end of the document.
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, 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 annex at the end of the document for source of data).
20 February 2025
The healthcare non-expenditure statistics describe the public and private 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 (see annex at the end of the document).
Definitions of mandatory variables are laid down in Commission Regulation (EU) 2022/2294.
National changes of statistical concepts and national definitions deviating from Regulation (EU) 2022/2294: see Annex at the end of the document.
Registered health professionals or health care facility categories.
All health care staff.
All health activities such as screening, immunisation, consultations and emergency visits.
All available beds in hospitals, equipment in hospitals and the ambulatory sector and beds in nursing and residential care facilities.
All discharges, diagnositic exams and procedures performed in all hospitals.
Complete national territory.
Calendar year for all the variables except Infuenza Vaccination and Graduates. Please refer to annex for variable specific reference periods.
Liaison with the institutions/divisions providing the data for the Joint Questionnaire on non-Monetary Health care Statistics is done regularly throughout the process of data compilation, to ensure that the data provided is accurate. Any differences in figures from one year to the next are discussed with the institutions/divisions providing the data.
However no formal assessment is done.
Absolute number at the end of reference period.
Exceptions:
Full time Equivalence (FTE's) are used for most of the Health Employment figures.
Immunisation and Screening rates are calculated as a percentage of the eligible population.
Doctor consultations are calculated per capita
Occupancy rate of Curative (acute) care beds is calculated as a percentage of the curative care beds available in the year of reference.
Average length of stay (ALOS) of total inpatient care beds and curative inpatient care beds provided as an average.
Total adult ICU occupancy rate calculated as a percentage
The aggregate data received is compiled in the questionnaire according to the definitions and guidelines provided by the International Organisations.
Calculations are also done for Full time Equivalence (FTE) for most of Health Employment figures.
For further detail on how each variable was compiled, see annex at the end of the document.
For coding procedures the ICD-9 CM Classification of Procedures is used.
Calculations using the case-based data are also done to obtain the hospital aggregates on Inpatient care and curative care. See annex at the end of the document.
Source data for the different variables are given in the Annex at the end of the document.
Annual Dissemination
Data on Health Employment, workforce migration, physical resources, immunisations, screening, doctor consultations, visits to the emergency departments, diagnostic exams and Hospital Technical Resources in the EUROSTAT module for the year N are returned within 14 months, according to the Eurostat Regulation deadline.
Hospital discharge data, hospital aggregates and surgical procedures are returned within 20 months from end of reference year, according to the Eurostat Regulation deadline.
Survey data on Cancer Screening survey data is provided every 5 years from the European Health Interview Survey (EHIS).
Data for Malta is submitted as a whole because Malta is a small country and figures for regions will result in small figures.
See annex at the end of the document for potential breaks in series and deviations from definitions for each variable.
