Statistics Portugal

Demographic and Social Statistics Department, Living Conditions Statistics Unit

Avenida António José de Almeida, n.º 5 - 1000-043 Lisboa

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 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 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.

(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

Not applicable

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

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

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.

For aggregate outputs:

Aggregate outputs from Hospital Survey disaggregated by NUTS I, NUTS II, NUTS III and municipality are considered confidential whenever the data corresponds to less than 3 private hospitals. Furthermore, data is classified as confidential is there is a possibility of disclosure by difference, that is, if the data of a confidential cell can be calculated by subtracting the data from non-confidential cells.   

For micro-level outputs:

In the case of the Hospital Survey, the anonymization of the microdata databases for scientific purposes is based on the recoding of variables, that is, on the reduction of the number of modalities/categories. This procedure is applied to private hospitals and is based on the recoding of one of the main identifying variables, NUTS III. The aggregation of NUTS III regions is based on geographical proximity and aims to avoid disclosing data referring to less than 3 private hospitals.

A calendar for press releases is available on Statistics Portugal Website.

The press release calendar is available on Statistics Portugal website, at the following link: https://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_calendarios.

The following principles are included in the Statistics Portugal general policy for release of the data to users, and are followed by non-monetary health statistics:

• Provide the official statistical information at cost free in the Official Statistics Portal; 
• Provide objective, timely and punctual official statistical information, accompanied by the respective statistical metadata and, eventually, other information that facilitates its interpretation;
• The official statistical information should be impartial and released simultaneously to all users;
• Provide official statistical information on pre-announced calendar established based on exclusively technical-regulatory criteria and having in consideration of the quality/up-to-date commitment;
• Publicize the changes as far in advance as possible to the dissemination calendar and its justification, maintaining the home calendar accessible.

National data on health is disseminated annually. 

A press release is published every year on the occasion of the World Health Day (April 7) with the latest results of non-monetary health statistics.

The press releases are available at Statistics Portugal Website under the theme Health, in the following link:

Statistics Portugal - Web Portal (ine.pt)

Data on non-monetary health statistics is disseminate annually through an on-line publication called "Health Statistics" released on World Health Day (April 7).

The publications are available at Statistics Portugal Website under the theme Health, in the following link: Statistics Portugal - Web Portal (ine.pt)

The aggregated results of the survey are available in a Database at Statistics Portugal Website, under the theme Health, in the following link: Statistics Portugal - Web Portal (ine.pt)

According to the National Statistical System Law - article 6 - individual statistical data on natural and legal persons may only be provided for scientific purposes in an anonymized form, to accredited researchers.

The accreditation of researchers is done by the General Directorate of Education and Science Statistics.

Furthermore, Statistics Portugal has prepared files with information at observation unit level, the so-called Public Use Files (PUFs), in order to meet the users’ needs in accessing more detailed information. These files (data and metadata) contain anonymised records, processed and prepared in a way that the observation unit cannot be identified directly or indirectly, with the exception of statistical data on Public Administration. Access to these files is free and respect the principle of statistical confidentiality and personal data protection. 

The Public Use Files include Public Hospitals and Health Centers databases and are available in the following link: Statistics Portugal - Web Portal (ine.pt)

The non-monetary health statistics results are included in one multi-theme annual publications of Statistics Portugal: the Statistical Yearbook.

The main methodological aspects of non-monetary health statistics are described in methodological documents, which is mandatory for all surveys carried out in the context of the National Statistical System.

All methodological documents are freely accessed on the Internet, at Statistics Portugal website, complying with the principles defined in the “European Statistics Code of Practice”.

The European Statistics Code of Practice, a self-regulatory instrument whose main purpose is to improve trust and confidence in official statistics produced and disseminated by the statistical authorities of Member States, Candidate Countries, EFTA Members and Eurostat, reinforcing their independence, integrity and responsibility and to enhance the quality of European Statistics. (https://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_inst_codconduta&xlang=en)

Information Security Management System (ISMS), aligned with the best international practices, namely NP ISO / IEC 27001: 2013, is comprised of a set of policies and procedures that are now available to all Statistics Portugal’s procedures, and which allow the operationalization of the System.

(https://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_inst_sgsinformacao&xlang=en)

The following are noteworthy strategic documents to Statistics Portugal and made available in its Portal:

• The 2019 edition of the Quality Chart (only in PT version), which formalizes Statistics Portugal’s assumed public commitment in relation to the quality and credibility of the official statistics it produces and disseminates, to the public service it provides to the society – making it clear to all information providers, users of statistical information and to the public in general – also expressing the commitment towards information security;

• The Information Security Policy (only in PT version), which sets the general principles by which Statistics Portugal carries its mission, to the assets it manages within the scope of the ISMS, following all requirements within NP ISO/IEC 27001:2013, the applicable legislation, regulation and recommendations of the ESS (European Statistical System) and EUROSTAT in what specifically concerns information security;

• The Statistical Confidentiality Policy (only in PT version), which replaces the former Statistics Portugal´s Confidentiality Chart and is part of the ISMS and formalizes the public commitment of compliance with the Principle of Statistical Secrecy assumed by Statistics Portugal as the central body responsible for the coordination and development of the national statistical activity;

• The Personal Data and Privacy Protection Policy (only in PT version), which aims to supply the providers of data information about the nature of the collected data, its intended purpose and how the data are treated.

The Dissemination policy of Statistics Portugal lays down the fundamental principles governing the dissemination of official statistics, directly or indirectly produced under its responsibility. It should have as main reference the applicable principles of the National Statistical System: technical independence, statistical confidentiality, quality and accessibility. (https://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_inst_pdifusao&xlang=en)

To ensure process and data quality several procedures are carried out:

- The questionnaires and methodological documents follow a procedure of approval within the National Statistical System. This procedure is supervised by a coordination team, and implies the consultation of the questionnaire and methodological document by all departments, where opinions and recommendations are collected and adopted, if relevant.

- Data collection carried out via a web platform use a specific computer programs backed up with validation rules (for guarantying answers quality, coherence between related questions and the observance of the routing) and instructions for the respondents.

- The longitudinal coherence of the data collected through surveys is verified and respondents are contacted whenever necessary, in order to confirm or rectify the data provided.

- Data collected from administrative sources is also submitted to validation procedures, in order to assure coherence between reference years. 

Not available.

The main users of the non-monetary health statistics are:

 1. Internal users (of the National Statistical System):

- Statistics Portugal - Social Statistics Department, National Accounts Department and Office of Territorial Statistics

- Regional Directorates of Statistics of Região Autónoma dos Açores (SREA) and Região Autónoma da Madeira (DREM) that act as delegations of Statistics Portugal for regional data collection purposes

 2. Other national users:

- Directorate-General for Health

- Researchers

- Individual persons.

3. International users:

- Eurostat

- WHO

- OECD

- United Nations

Statistics Portugal Dissemination Policy foresees a regular monitoring and assessment of the quality and accessibility of disseminated data, in order to ensure continued improvement of dissemination activity.

This process involves:

- The different type of users are regularly surveyed on their satisfaction regarding products and services made available to them by Statistics Portugal;

- User comments, suggestions and complaints are viewed as real opportunities to further improve the dissemination activity of Statistics Portugal;

- User comments, suggestions and complaints are duly treated in accordance with the procedures established in Statistics Portugal's Quality Charter;

- User comments, suggestions and complaints, where relevant, leads to the adoption of measures to further improve the activity of Statistics Portugal, particularly in the dissemination function.

Data completeness depends on the availability of data, namely from administrative sources.

Not available.

Not applicable.

Not applicable.

At national level, data on non-monetary health statistics is disseminated in April of year n+1, with n being the year of inquiry or administrative collection.

The database indicators, press release and on-publication are released on Statistics Portugal website annually on the scheduled date.  

The non-monetary health statistics are comparable between geographical areas.

The non-monetary health statistics are comparable over time.

Not applicable.

All statistics are coherent within the dataset.

Under construction.

Statistics Portugal has a revision policy document that seeks to clarify the key factors of a revision, the typology of revision that may occur and the dimensions governing a revision’s analysis. It also explains the General and Operational Principles of the revisions policy that Statistics Portugal will consolidate in the future (https://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_inst_politrevisao&xlang=en>).

Not foreseen.

Annual.

Data collection via questionnaire is carried out based on a web platform with validation rules for guarantying answers quality and coherence between related questions.

Furthermore, the data collected in each year is compared with the previous year in order to assure coherence.

Data collection via administrative sources is also submitted to validation procedures that ensure the quality of the statistical results.

Not applicable.

Not applicable.

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