National Institute of Romania

Demography, Health, Culture and Justitice Statistics Unit - Office of Studies, Demographic Projections and Population Census

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.

Registered health professionals or health care facility categories, hospital beds categories, discharged patients, doctor consultations or dentist consultations, immunisations against influenza, screening services, diagnostic exams, surgical procedures, medical technology

(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

The data availability differs across data sets: e.g total number of public owned hospitals and beds, main categories of medical personnel (physicians, dentists, pharmacists, midwives) from 1980.

Not applicable

Absolute numbers, number per capita, percentage, number of days (ALOS)

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

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

The Regulation (EC) No 223/2009 on European statistics (recitals 23-27 and Articles 20-26) applies.

National normative regarding confidentiality in statistics (only in romanian)

For the non-expenditure data collection INS uses administrative sources and own data, from the INS annual exhaustive survey "'The activity of the medical and healthcare protection network" (SAN).

Administrative data used is aggregated and publicly available (healthcare units and survey data) and no personal information is used thus no confidentiality procedures are applied.

INS own data collection follows the principle of confidentiality nationally regulated by Law no. 226/2009 regarding the organization and operation of official statistics in Romania, with subsequent amendments and additions. On each SAN questionnaire used for data collection, the following warnings were printed: "Confidential" and "Only for statistical research purposes" and it was specified that "In data collection, the provisions of Regulation (EU) 2016/679 of the European Parliament and of the Council are respected of April 27, 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data".

The confidentiality of the healthcare unit providing the data is ensured from the moment of its collection until its dissemination. The statistical questionnaires containing the data provided by the reporting units are confidential, access to the web portal for the online retrieval of e-SOP statistical data is allowed only to authorized statistical personnel based on "username" and "password".

INS is responsible with the dissemination of data from its own annual data collection: press releases (July 1st for reference year N-1), publication (July 1st for reference year N-1), online database (end of July for reference year N-1), Romanian Statistical Yearbook (February for reference year N-2)

INS diseminates through the Romanian Statistical Yearbook (February for reference year N-2) and its online database (end of October for reference year N-1), from administrative sources, data on discharged patients by classes of diseases (source: the National School of Public Health and Health Management). Other data from administrative sources provided through the JQNMHCS are not disseminated by the INS.

Statistical publication catalogue 2024 - https://insse.ro/cms/files/catalog/Catalogul_publicatiilor_INS_2024.pdf

Press release calendar 2024 - https://insse.ro/cms/en/comunicate-de-presa-view?field_categorie_value_i18n%5B%5D=18&field_cuvinte_cheie_value=&created=1&items_per_page=10

Data from the INS own exhaustive survey on the ''The activity of the medical and healthcare protection network" is disseminated yearly at the beginning of July. A publication and a press release are made available to all users at the same time.

Press release calendar 2023 - https://insse.ro/cms/en/comunicate-de-presa-view?field_categorie_value_i18n%5B%5D=18&field_cuvinte_cheie_value=&created=1&items_per_page=10

Statistical publication catalogue 2023 - https://insse.ro/cms/files/catalog/Catalogul_publicatiilor_INS_2024.pdf

Annually

2023 Press release for the results of INS survey ''The activity of the medical and healthcare protection network" - SAN, reference year 2022- https://insse.ro/cms/en/content/activity-sanitary-and-healthcare-network-2022

Publication on the activity of the sanitary and healthcare network in 2021 - https://insse.ro/cms/en/content/activity-sanitary-and-healthcare-network-2022-0

INS online database - http://statistici.insse.ro:8077/tempo-online/#/pages/tables/insse-table

INS provide access to anonymised microdata for researchers through a Microdata Center. Application conditions for microdata are described here: https://insse.ro/cms/en/content/safe-centre-located-nis-headquarter

Data are provided on demand to users:

Statistical data from INS own survey on the activity of sanitary units and from administrative data are provided based on legal acts or on demand to Eurostat and other international organisations (WHO, OECD, UNECE. UN, national statistical institutes etc.)

Metadata regarding the INS own survey on the the activity of the sanitary and healthcare network: http://80.96.186.4:81/metadata/viewStatisticalResearch.htm?locale=en&researchId=5503

Not available

INS conducts annually an exhaustive survey regarding the activity of sanitary units (SAN). The process of preparing, collecting and disseminating the data is established through the Annual National Statistical Programme. INS collaborates with other health administration institutions in order to ensure the relevancy and quality of the collected data. INS is starting to use the international standard for quality, GSBPM, on its surveys.

 Other data sources for the JQNMHCS collection are the Ministry of Health (National Institute of Public Health - INSP), the National House of Health Insurance (CNAS), the National School of Public Health and Health Management (presently the National Institute for Management of Health Care Services - INMSS) and health personnel professional organisations (e.g. College of Physicians). INS communicates with data providers in order to insure data quality and comparability.

While performing the activity of sanitary units survey, the NIS general quality policy are applied. Aspects regarding quality insurance are present in all stages of the survey.

While designing the SAN questionnaire steps are taken to ensure that data collected are in compliance with European regulations and requests. During the period Romania provided data for the non-expenditure statistics, the SAN questionnaire was updated (e.g. collection of healthcare personnel by age groups). This changes are introduced taking into consideration other available data and if the changes in the questionnaire could mean increasing the burden on the data providers.

Administrative data used for the JQNMHCS is accompanied by methodological notes and, if necessary, INS perform additional quality checks by requesting other methodological information.

The main international users of the data on the activity of sanitary units performed annually by INS are:

• Statistical users in Eurostat or in Member States National Statistical Institutes
• General users – including the media - interested in health statistics in the EU.

The Activity of the Sanitary Units provides the necessary information for analysing the situation of the public and private health care network Romania.

 For national purposes, the main categories of users are:

• The policymakers: the Romanian Government, the Parliament;
• The ministries with responsibilities in financing, developing and implementing strategies and policies on health, labour, social protection;
• Institutes tasked to monitor the national health care network and its activities
• The policymakers with responsibilities in elaborating development plans at local level within Local Councils;
• Research institutes and universities;  
• Mass-media;
• Students and scholars.

Currently there is no specific user satisfaction accounting

For some indicators, national legislation is not aligned with the methodological requirements for the JQNMHC collection. See point 13.1

Overall the accuracy of JQNMHCS data provided is good.

Some deviations in the are connected with:

- the national target population for cervical cancer screening is women aged between 24 and 64 years of age

- breast cancer screening and colorectal cancer screening did not have a nationwide application. Related legislation and organised programmes are being closely followed in order to asses if the indicators could be provided

- teleconsultations are a new concept for Romania and INS is in contact with national health administration institute in order to evaluate the application of the teleconsultations services and when data will be available

Not applicable.

Not applicable.

Member States are required to transmit their data to Eurostat in compliance with the Commission Regulation 2022/2294 transmission deadlines.

The National Institute of Romania complies with the Commission Regulation 2022/2294 transmission deadlines.

The JQNMHCS indicators that are requested at regional level (practicing physicians and hospital beds) are comparable as the data source is the same, the INS annual data collection SAN.

Changes in methodology in the collection phase or changes of data sources are marked in the data set and explained in the Metadata file in the Annex.

The indicators reported are mainly collected by INS and other data providers responsible for different collections. Between the data collections steps are taken to avoid increasing the burden on data providers. For example, INS collects, through the SAN survey, data on ambulatory health care providers from the Territorial Public Health Directorates (DTS) as the DTSs own registers and data collected directly form the ambulatory healthcare providers.

Any internal inconsistencies in the different datasets are analysed before transmission.

INS is beginning to implement a system for accounting the cost of data collections and information will be available in the future regarding INS own activities.

According to NIS revision policy, revisions for previously transmitted data are sent together with data for the reporting year.

Data revisions are performed regarding new sources or unforeseen revisions due to errors.

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

Annual.

INS survey data sources:

1. INS - exhaustive survey on the Activity of Sanitary Units (SAN)

Data are collected through a questionnaire (https://insse.ro/cms/ro/content/statistica-sanatatii - only in romanian).

The collecting and validating process is designed and established through the National Annual Programme. Data is collected at unit level for the sanitary units with beds and at aggregated level for the ambulatory health care providers. The ambulatory data is collected through the Territorial Public Health Departments (DTS) from their own registers and databases. Validations are made by INS in collaboration with the Statistical Department of the National Institute of Public Health that is responsible for the methodological coordination of the DTSs.

2. INS - Health Interview Survey (HIS) - for screening data from surveys

The HIS is organised on the basis of European Regulations implementing Regulation (EC) No 1338/2008 on public health and health and safety at work. HIS was conducted in 2008, 2014, 2019 and will be organised in 2025. Data collection is through the face-to-face CAPI method and validation is made in three steps: validation in real time through check on the electronic questionnaire, validation at territorial level and final validation at INS level.

 Administrative sources:

3. Ministry of Health - the National Institute of Public Health - National Center for Surveillance and Control of Communicable Diseases for immunisation against influenza

Data cover seasonal immunisations of persons aged 65 years and older from the population group considered to be at risk, immunised against influenza free of charge by Ministry of Health. Data is collected as part of the national immunisation programme.

4. Ministry of Health - the National Institute of Public Health (INSP) -CT, RMI exams in hospital care, PET - exams in hospital and outpatient care

Data is collected as part of the regular collections performed at the INSP and are compulsory for the sanitary units.

5. The National Institute for Health Services Management - NIHSM (former National School of Public Health and Health Management - SNSPMPDSB) data on hospital discharges, length of stays, surgical procedures and hospital aggregates

NIHSM is the institution collecting and processing of data on hospital medical services, provided to the insured persons and carries out analysis and monitoring of health services.

6. College of Physicians - for data on physicians licensed to practice and workforce migration; Order of Nurses, Midwives and Medical Assistants in Romania - for data on nurses and midwives licensed to practice and workforce migration; College of the Dental Practitioners - for data on dentists licensed to practice; College of the Pharmacists- for data on pharmacists licensed to practice

Legally health personnel are obliged to register in the professional organisations and to obtain the right to practice. Data is provided from the professional registers or databases. Legal changes to the rules of obtaining the licence to practice and changes to the registers are being analysed as are implemented as changes in the data series are observed.

INS survey data sources:

1. INS - exhaustive survey on the Activity of Sanitary Units (SAN)

The collecting and validating process is designed and established through the National Annual Programme. Data is collected at unit level for the sanitary units with beds and at aggregated level for the ambulatory health care providers. The ambulatory data is collected through the Territorial Public Health Departments (DTS) from their own registers and databases. Validations are made by INS in collaboration with the Statistical Department of the National Institute of Public Health that is responsible for the methodological coordination of the DTSs.

2. INS - Health Interview Survey (HIS) - for screening data from surveys

Data collection is through the face-to-face CAPI method and validation is made in three steps: validation in real time through check on the electronic questionnaire, validation at territorial level and final validation at INS level.

 Administrative sources:

Aggregated data received from administrative sources are validated through a methodological analysis consisting in updating the national legislation and norms and comparing them with the Eurostat methodology and through an analysis of the data series.

JQNMHCS data is compiled from the INS surveys and administrative sources and its preparation is starting once the INS main health data collection on the activity of sanitary units is validated. Requests from the administrative data providers are launched and once all data are received, the validation and compilation process of the non-expenditure data collection is conducted.

Not applicable

Not applicable