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For any question on data and metadata, please contact: Eurostat user support |
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1.1. Contact organisation | Istituto Nazionale di Statistica (Istat) |
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1.2. Contact organisation unit | Department for Statistical Production Directorate for National Accounts (DCCN) Division “Supply of goods and services and institutional sectors accounts” |
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1.5. Contact mail address | Italian National Institute of Statistics (Istat) Via Agostino Depretis 74B - 00184 Roma, Italy |
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2.1. Data description | |||
Health care expenditure quantifies the economic resources dedicated to health functions, excluding capital investment. Healthcare expenditure concerns itself primarily with healthcare goods and services that are consumed by resident units, irrespective of where that consumption takes place (it may be in the rest of the world) or who is paying for it. As such, exports of healthcare goods and services (to non-resident units) are excluded, whereas imports of healthcare goods and services for final use are included. It provides a set of revised classifications of health care functions, providers of health care goods and services and financing schemes. The SHA is currently used as a basis for a joint data collection by OECD, Eurostat and WHO on health care expenditure. The manual sets out in more detail the boundaries, the definitions and the concepts of health accounting – responding to health care systems around the globe with very different organisational and financing arrangements. Accounting period: Health expenditure and financing data pertain to the calendar year (1 January to 31 December).
The Italian National Institute of Statistics transmits data for the reference year T and, on voluntary basis, T+1 with the same level of details, by April T+2. The time coverage of this Quality report is 2012 to 2017 reference years. |
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2.2. Classification system | |||
Healthcare expenditure is recorded in relation to the international classification for health accounts (ICHA) defining:
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2.3. Coverage - sector | |||
1. Household individual consumption on health, including the collective consumption with two exceptions: |
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2.4. Statistical concepts and definitions | |||
SHA concept is the consumption of health care goods and services. Summary tables provide data on:
Cross-classification tables refer to:
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2.5. Statistical unit | |||
Commission Regulation 2015/359 concerns the collection of data on "current expenditure on healthcare" which is defined as the "final consumption expenditure of resident units on health care goods and services". |
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2.6. Statistical population | |||
SHA focuses on the consumption of health care goods and services by the resident population irrespective of where this takes place. This implies the inclusion of imports (from non-resident providers) and the exclusion of exports (health care goods and services provided to non-residents). |
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2.7. Reference area | |||
The data aims at providing a complete overview of expenditure on health care goods and services consumption of services and goods by the resident population on the national territory of a country. |
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2.8. Coverage - Time | |||
2012 onwards (until year T, under SHA 2011 methodology, disseminated by Eurostat). |
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2.9. Base period | |||
Not applicable. |
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3.1. Source data | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Several data sources are used: - Surveys/census: 3 - Public administrative records: 9 - Financial reports: 2 - Other: 4
Surveys/censuses
Public administrative records
Financial reports
Other
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3.2. Frequency of data collection | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Annual. |
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3.3. Data collection | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Data are collected through the joint health accounts questionnaire (JHAQ) that countries submit to Eurostat during the annual data collection exercise. There is a voluntary deadline to send the JHAQ questionnaire for the calendar year T by the 31st of March T+2. The joint health accounts questionnaire (JHAQ) is coordinated in agreement with the World Health Organisation (WHO) and the Organization of Economic Co-operation and Development (OECD).These three international organisations are known collectively as the International Health Accounts Team (IHAT). Countries submit data to Eurostat on the basis of Commission Regulation (EU) 2015/359 of 4 March 2015 implementing Regulation (EC) No 1338/2008 of the European Parliament and of the Council as regards statistics on healthcare expenditure and financing.
The sources used by Italian National Institute of Statistics (Istat) for the production of SHA 2011 data include both surveys, and administrative data. A large part of these data is already collected annually, through a web-based tool, for the purpose of National Accounts and GFS/EDP compilation. The main sources of the administrative data used to estimate public health care expenditure are provided by the Ministry of Health using a web-based tool and by e-mail. Information on health and social care interventions for the provision of assistance to adult persons with psychiatric problems and to their families are available in the report published on the website of the Ministry of Health. Information on the use of drugs and patients under treatments are available in the Annual Report to the Parliament on the Status of Drug Addiction in Italy based on National Information Dependency System (SIND) published on-line. The main data source for the Household out-of-pocket expenditure is the Household Budget Survey (HBS), supplied by other divisions of Istat. Report for medical products are published on the website of Italian Medicines Agency (AIFA). Data for voluntary insurance are transmitted by the Institute for the Supervision of Insurance (IVASS) by e-mail. Residual data are collected on Internet. |
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3.4. Data validation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
The 2018 JHAQ includes a number of features which allow national data correspondents to perform various quality checks before submitting the data. The embedded programmes allow the verification of:
2- Consistency of the data within tables,
Entries in the tables cannot be negative as they refer to the consumption of goods and services.
The atypical entries check provides information whether the data tables contain values in cells which are – if at all – only reported by very few countries and are thus atypical for health accounting.
3- The growth rates against the previous year and the magnitude of revisions as compared to previously submitted data. Results are grouped into three different categories:
The Italian National Institute of Statistics carries out several in depth controls of the SHA data, before the transmission of JHAQ. Data are compared with information from other independent sources. The consistency between the data, of the year and of previous editions is checked and evaluated. The available time series are analyzed and double-checked, looking for trends and anomalies; finally the adequacy of the estimates is assessed and compared to the definitions provided by SHA2011 manual. |
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3.5. Data compilation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
SHA data is compiled both by a bottom-up approach as well as by a top-down approach, depending on the data source. Compilation is done by financing schemes and by different health care functions/task areas. The results of the several calculations are then aggregated. To gain the differentiation between the different SHA-dimensions (especially HC and HP) quotas and pro-rating and utilisation keys are applied on some spending items. For some spending items it is necessary to extra-/interpolate data as there is no up-to-date data available or data is missing for certain years. For some other spending items, estimation methods have to be applied.
Several methods are normally used for estimations:
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3.6. Adjustment | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
No adjustment are performed. |
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4.1. Quality assurance | |||
Authorities responsible for SHA data collection are working to ensure that the statistical practices used to compile national health accounts are in compliance with SHA methodological requirements and that good practices in the field are being followed, according to the methodology underlined in the SHA 2011 Manual and European Statistics Code of Practice respecting professional independence of the statistical authorities. Procedures are in place to plan and monitor the quality of the health care expenditure statistical production process.
Since the 90s Istat adopted a systematic approach to ensure quality in both statistical information and service to the community. For this purpose, the Italian National Institute of Statistics has defined a quality policy providing itself with appropriate tools as well as management changes to carry it out. Istat quality policy is coherent with the European framework developed by Eurostat, taking up its main principles and definitions. The European Statistics Code of Practice establishes the principles to follow in order to ensure and strengthen both accountability and governance of the European Statistical System and the National Statistical Systems inside it. Essential point of Istat quality policy are: For details: https://www.istat.it/en/organisation-and-activity/institutional-activities/quality-commitment |
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4.2. Quality management - assessment | |||
The overall quality assessment for SHA is positive. The long experience of Italy in carrying out expenditure estimations for National Accounts according to European rules established in Regulations has been fundamental to reduce quality problems. The main strengths of SHA are:
Out of Pocket data are compiled starting from National Account data already subjected to quality check. |
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5.1. Relevance - User Needs | |||
SHA data provide key information for economic policy monitoring and decision making, for forecasting, for administrative purposes, for informing the general public (directly or indirectly via news agencies), and as input for economic research. The main users are public administrations as the Ministry of Economy and Finance (mainly interested on long term care and private health expenditure) and the Ministry of Health. Main non-public users are research institutions, and independent researchers working on public and private health care expenditure. Users usually ask information on the difference between the health expenditure under SHA methodology and the data on health expenditure reported in other National accounts statistics. Among the most requested indicators, it is possible to find health expenditure in general, public and private expenditure on long term care, and expenditure on hospitals. The main users’ unsatisfied need is the Regional break down of health expenditure under SHA methodology. |
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5.2. Relevance - User Satisfaction | |||
Istat is constantly interested in understanding who are the users of the statistics produced, what are their information needs and whether these correspond to the outputs, and if the statistics produced satisfy the users. To this end, alongside the analysis of user requests received via the Web Contact Center service, direct consultation tools have been developed such as the annual online survey of Customer satisfaction and indirect tools such as the analysis of accesses and paths of site navigation and information search methods. To complete the Istat user involvement strategy, the Statistical Information Users Commission (Cuis) was established in 2011, with the aim of assisting the Institute in recognizing the statistical information demand expressed by the public and private institutions and by society as a whole. The Commission currently consists of about 50 members, represented by associations, bodies and institutions that use official statistical information. It deals with evaluating the compliance of official data with users' needs and reporting any information gaps, proposing solutions to fill them. |
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5.3. Completeness | |||
Among the compulsory variables of the HF categories, the category HF4 “Rest of the world financing schemes (non-resident)” is missing because the data are not available. HF.2.1 “Voluntary health insurance schemes” data are related to voluntary non-life insurance (sickness claims) and don’t report components on supplementary/complementary health insurance. This last category, existing in Italian health system, is not reported because detailed information, to give an exhaustive representation of it in National Accounts and in SHA data, are not available. For the category HF.2.3 “Enterprise financing schemes”, the data are partially missing since the estimates reported are related only to occupational health outsourced (contracted out to offices of medical specialists), that in National Accounts are included in intermediated consumption. The occupational health care can be also provided in-house but, currently, sources to estimate it are not identified. Enterprises can also finance or provide directly health care services as a part of the overall benefits for employees; also in this case, at the moment, there is not an estimate of this kind of services due to the lack of detailed information in data sources. The HC and HP compulsory categories are complete. |
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5.3.1. Data completeness - rate | |||
Table HCx HF = 90% Table HPx HF = 90% Table HCxHP = 100% |
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6.1. Accuracy - overall | |||
SHA data for Italy are the result of an integration process of data from different data sources, starting from National Accounts data. The coherence of SHA data with the National Accounts data according to the SEC2010 increase the accuracy of the estimations. |
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6.2. Sampling error | |||
Not applicable. |
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6.2.1. Sampling error - indicators | |||
Not applicable. |
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6.3. Non-sampling error | |||
This section is not relevant. |
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6.3.1. Coverage error | |||
Consistent with National Accounts, SHA data include informal payments. Health care goods and services by non residents are excluded according to resident concept required by SHA definitions. |
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6.3.1.1. Over-coverage - rate | |||
Not applicable. |
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6.3.1.2. Common units - proportion | |||
Not applicable. |
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6.3.2. Measurement error | |||
Not applicable. |
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6.3.3. Non response error | |||
Not applicable. |
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6.3.3.1. Unit non-response - rate | |||
Not applicable. |
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6.3.3.2. Item non-response - rate | |||
Not applicable. |
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6.3.4. Processing error | |||
Not applicable. |
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6.3.4.1. Imputation - rate | |||
Not applicable. |
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6.3.5. Model assumption error | |||
Not applicable. |
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6.4. Seasonal adjustment | |||
Not applicable. |
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6.5. Data revision - policy | |||
In principle, the revision follows the same policy of the General Government consolidated account in accordance with European rules concerning EDP statistics (Council Regulation No 3605/93). Then with the transmission, in the year T+2, of reference year T there could be revisions till the year T-2 data. |
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6.6. Data revision - practice | |||
The data are revised once a year and are coherent with General Government data (EDP Notification April T+2) and National Accounts data released in March T+2. |
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6.6.1. Data revision - average size | |||
The average size of revisions of the total current health expenditure is 0,19% (calculated using Relative Mean Absolute Revision - RMAR). |
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7.1. Timeliness | |||
Member States are required to transmit their data to Eurostat in compliance with the Commission Regulation 359/2015 transmission deadlines. The Italian National Institute of Statistics transmits data for the year T and T+1 with the same level of details by April T+2. At same time, Istat transmits also the updated data for the previous years, if necessary. |
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7.1.1. Time lag - first result | |||
Istat publishes provisional figures for the year T+1 in June of year T+2. |
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7.1.2. Time lag - final result | |||
Final data for the year T are published in June of year T+2. |
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7.2. Punctuality | |||
The transmissions were late of one day in year 2016 and two days in 2017. In year 2018 the deadline was respected. |
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7.2.1. Punctuality - delivery and publication | |||
See point 7.2. |
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8.1. Comparability - geographical | |||
Not applicable at national level. |
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8.1.1. Asymmetry for mirror flow statistics - coefficient | |||
Not applicable. |
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8.2. Comparability - over time | |||
Data according to SHA 2011 methodology are available only from 2012 to 2017 (T+1), without any break. |
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8.2.1. Length of comparable time series | |||
6 years (2012-2017). |
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8.3. Coherence - cross domain | |||
The boundaries, the methodologies, and the purposes of the health care expenditure of SHA and ESSPROS statistics are different; for example, SHA is based on the final consumption, while ESPROSS on the total current expenditure. Istat transmits ESSPROS data on General Government health expenditure accordingly to the definition of the Part 1 chapter 2.2 point 16 and of chapter 2.3.4 point 23 of the ESSPROS Manual 2016, with the consequence that only the public expenditure is considered compliant with the definition provided. Istat compiles the SHA data using different methodologies than ESSPROS. The item General Government total current health expenditure, is reconciled across various domains (National Accounts-COFOG, ESSPROS, SHA). These reconciliation tables are for internal analysis and for institutional users. |
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8.4. Coherence - sub annual and annual statistics | |||
Not applicable. |
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8.5. Coherence - National Accounts | |||
In general, the SHA data are coherent with National Accounts. The consistency between HF.1 “Government schemes and compulsory contributory health care financing schemes” reported in SHA data and final consumption expenditure by COFOG, class 7, is assured. Out of Pocket expenditure are coherent with household expenditure on health estimated in National Accounts, classified by COICOP. However, conceptual differences exist between COICOP and SHA but sources allow transposing COICOP definitions into SHA framework. In National Accounts health expenditure financed by insurance is included in household final consumption expenditure, whereas according to SHA it is reclassified from HF.3 to HF.2.1. Moreover, National Accounts refers to the domestic concept whereas SHA refers to the resident concept. This implies that the total amount of expenditure in health goods and services on SHA does not match with National Accounts. |
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8.6. Coherence - internal | |||
The internal coherence of SHA tables is checked with statistical procedures and assured before the transmission to EUROSTAT. |
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9.1. Dissemination format - News release | |||
Only with the first dissemination at national level of SHA data Istat published a press release: Statistiche Report - Il sistema dei conti della sanità per l’Italia - Anni 2012-2016. https://www.istat.it/it/archivio/201944 A shorter version in English is available at the following link |
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9.2. Dissemination format - Publications | |||
Rapporto Osservasalute (2017, 2018). Stato di salute e qualità dell’assistenza nelle regioni italiane, Osservatorio nazionale sulla salute nelle regioni italiane. “La sanità italiana nel confronto europeo” https://www.osservatoriosullasalute.it/rapporto-osservasalute |
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9.3. Dissemination format - online database | |||
The data are disseminated online both in Italian and English language on I.Stat the warehouse of statistics currently produced by the Italian National Institute of Statistics. |
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9.3.1. Data tables - consultations | |||
In the period June-December 2018, there were 2,333 consultations of the subdomain System of Health Accounts in I.Stat. |
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9.4. Dissemination format - microdata access | |||
Not applicable. |
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9.5. Dissemination format - other | |||
The total current health care expenditure and long term care expenditure for General Government under SHA methodology are published every year in “Le tendenze di medio-lungo periodo del sistema pensionistico e socio-sanitario” by the Ministry of Economy and Finance. The link for the 2016 English version is the following: |
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9.6. Documentation on methodology | |||
The methodology used to estimate SHA data is reported in Italian language in the section “Nota Metodologica” of press release Statistics-Report - The System of Health accounts in Italy. Years 2012-2016. Edition: 2017, Reference period for data: Years 2012-2016; https://www.istat.it/it/archivio/201944 Methodology used is also described (both in Italian and in English language) in I.Stat, alongside the data, at the following link: http://dati.istat.it/OECDStat_Metadata/ShowMetadata.ashx?Dataset=DCCN_SHA&Lang=en |
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9.7. Quality management - documentation | |||
The Istat Information System on Quality (SIQual) (http://siqual.istat.it/SIQual/lang.do?language=UK) contains metainformation on the statistical production processes carried out by Istat. It includes metadata on process content, its operational characteristics (process phases and operations) and the quality considered both in terms of activities of prevention, monitoring and evaluation of errors (quality actions). For details on SHA: http://siqual.istat.it/SIQual/visualizza.do?id=8889051&refresh=true&language=EN |
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9.7.1. Metadata completeness - rate | |||
Not applicable. |
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9.7.2. Metadata - consultations | |||
Data not available. |
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Restricted from publication |
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11.1. Confidentiality - policy | |||
The Regulation (EC) No 223/2009 on European statistics (recitals 23-27, 31-32 and Articles 20-26) applies. In Italy, according to the article n. 9 of the Legislative Decree n. 322 of 6 September 1989 data collected by statistical offices within the statistical surveys included in the National Statistical Programme may not be disclosed other than in aggregated form such that no reference to identifiable people can be extracted. Furthermore, they may be used only for statistical purposes. Data may not be communicated or disseminated neither to any external subject, public or private, nor to any department of the public administration other than in aggregate form and using modalities which prevent the identification of the people involved. In any case, data cannot be used to identify again the people involved. The Code of Conduct annexed to the Legislative Decree no. 196 of 30 June 2003 (Personal Data Protection Code) provides special rules concerning the processing of personal data for statistical purposes within Sistan. In order to make statistical secrecy and protection of personal data effective, Istat is currently taking appropriate organisational, logistical, methodological and statistical measures in accordance with internationally established standards. In accordance with the Personal Data Protection Code, respondents are informed of their rights and obligations with regard to the provision of information, and they are assured that the information they provide will be used for statistical purposes only. |
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11.2. Confidentiality - data treatment | |||
Only aggregated data or statistics are used in the SHA estimation process without personal information, and then no additional confidentiality procedures are applied. |
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There are no additional comments. |
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