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For any question on data and metadata, please contact: Eurostat user support |
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1.1. Contact organisation | Statistics Portugal |
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1.2. Contact organisation unit | National Accounts Department / Unit for Satellite Accounts and Quality Assessment of the National Accounts |
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1.5. Contact mail address | Av. António José de Almeida, 5 |
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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. Accounting period: Health expenditure and financing data pertain to the calendar year (1 January to 31 December). The time coverage of this Quality report is 2000 to 2016 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:
In relation to the European System of Accounts (ESA), healthcare expenditure compilation process is also used: general industrial classification of economic activities, NACE Rev. 2; classification of institutional sectors. |
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2.3. Coverage - sector | |||
1. Household individual consumption on health, including the collective consumption with two exceptions: 2. Health care financing schemes: HF1 Government schemes and compulsory contributory health care financing schemes; HF2 - voluntary health care payment schemes; 3. NACE rev. 2: section Q, human health and social work activities; part of section O, Public administration and defence; part of section G, retail trade. 4. Health care financing agents (voluntary): FA1 - General government; FA2 - Insurance corporations; FA3 - Corporations (other than insurance corporations); FA4 - Non-profit institutions serving households (NPISH); FA5 - Households; FA6 - Rest of the world. |
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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. Portuguese territory includes:
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2.8. Coverage - Time | |||
2000-2016. |
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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: 9 - Public administrative records: 5 - Financial reports: 7 - Other: 2
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. Under regulation, data and reference metadata for the reference year N should be transmitted by 30 April N+2. National data collection: - Annual financial statements online available are extracted from the official websites of the entities. When they are not available, emails are sent to the entities requesting the submission. - The collection of information related to National Health Service, including the Public-private partnerships (PPPs), is carried out by the Ministry of Health. Under a protocol with Statistics Portugal, the Ministry of Health provides data according to the requested details and classifications of SHA (transfers, financing of NHS providers, costs of production of NHS providers, subcontracts/conventions, reimbursements and payments under international conventions) and also compiles the functional structures of NHS providers. Aggregate financial data (financing and cost of producion of NHS entities) to compile preliminary year N-1 are also available. - Data from National Pharmacy and Medicines Institute (INFARMED) are, usually, available on the official website. These data are also under a protocol with Statistics Portugal. INFARMED collects economic data related to the pharmeceutical sector in Portugal. - Simplified Business Information (SBI) - The SBI results from the integration in a single act of the provision of tax information, the accounting and statistical data from corporations. The SBI is sent electronically to the Ministry of Finance. After the validation process, data are centralized and storaged in relational data bases (Oracle) that are share with Statistics Portugal, Central Bank (Banco de Portugal), Ministry of Justice and Ministry of Economy (since 2015). - Statistics data collected and compiled by Statistics Portugal integrated in SHA: 1) National Accounts data (derivated statistics) 2) Survey on International Tourism (ITI) - Survey carried out by Statistics Portugal in cooperation and financial assistance from Turismo de Portugal, I.P. The survey took place at air, road and sea borders and collected detailed information on tourist demand (including expenditure). 3) Hospitals Survey - The physical data of the hospitals (Mainland) are collected by Statistics Portugal. In the case of hospitals belonging to the National Health Service, the Ministry of Health collaborates. Regional Statistics Service of the Azores and Regional Directorate of Statistics of Madeira also collect data from their hospitals. 4) Consumer prices index - Prices are collected on a monthly basis in retail outlets and service providers, using paper collection forms and price collection software. Housing rents prices are collected directly from households using the same method or by phone interview. Some prices (such as administered prices and fuels) are centrally collected, by phone or internet. The outlets are chosen to represent the existing trade and services network. 5) Mutual aid associations survey - Survey carried out by Statistics Portugal. - Budgets and Accounts of Private Institutions of Social Solidarity (OCIP) - Since 2010, Private Institutions of Social Solidarity and similar institutions have obligatorily submitted their financial information, electronically, to Social Security. Since 2011, Statistics Portugal has accessed to the database that centralizes the individual financial data of these instituions namely: Balance Sheet, Cash flows, Statement of Results, Statement of Results by Social Response. - Ministry of Finance - The total amount of income tax deductions related to health care services and retirement homes is, anually, provided by the Ministry of Finance. - Information on the use of credit cards by residents and non-residents - Information on non-resident cards used in Portugal for credits and resident cards used abroad for debits are collected by the corporation (SIBS) which controls the entire electronic payment system. - Balance of Payments (BoP) - Banco de Portugal is the entity responsible for the collection. The Balance of Payments systematically records, for a given period of time (usually a month, a quarter or a year), all economic transactions between Portugal and the Rest of the World according to the methodological principles contained in the Manual of the IMF's balance of payments. The current statistical system of external transactions is characterized essentially by the gathering of information from the following sources: bank reporting, direct reporting, General Directorate of the Treasury, Statistics Portugal and Banco de Portugal. - Single report - The information on the company's social activity (Single Report) is collected, annually, by the Office of Strategic Studies of the Ministry of Economy. The report must be submitted by all employers (financial and non-financial corporations, Households, general administration and non-profit institutions). - Statistical information on health insurance from Portuguese Association of Insurers (APS) - Survey is carried out, annually, by the Portuguese Association of Insurers (APS) collecting a set of variables from health insurances companies. - Statistical information on health insurance from the Autoridade de Supervisão de Seguros e Fundos de Pensões (ASF) (the supervisory body for the insurance and pension funds sector) is extracted from the official website. The ASF collect annually financial information and physical data from all insurances companies. |
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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: 1- Consistency of the data between tables, 2- Consistency of the data within tables, Any detected inconsistencies are listed by variable code together with an indication of which total is not equal to the sum of its subcomponents as well as the numerical difference. A positive figure indicates that the total is greater than the reported sub-components, and vice versa.
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:
National data validation: manual validation is performed throughout the compilation process to ensure the consistency and completeness of the final results. For instance:
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3.5. Data compilation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Several methods are normally used for estimations:
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3.6. Adjustment | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Not applicable. |
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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. Statistics Portugal began a systematic quality approach in 1996, when it was decided, by its Board, to implement a Quality Management System. Currently there is a Unit responsible for quality management (the Planning, Control and Quality Unit), which reports directly to the Board. Another Unit (the Methodological Unit) also deals with aspects related to product/survey quality.The three main objectives of Statistics Portugal Quality Management System then defined and still present today are: to continuously improve the quality of: i) the products; ii) the services rendered to customers; and iii) the work and inter-department relations at all levels of the organization. Quality audits, documentation of processes and surveys of users’ satisfaction were significant activities of this system, as the experience shows. It also deals with aspects related to the implementation of the European Statistics Code of Practice and maintains a close relation to the ESS at this level of interest. This system comprises a wide range of instruments, methods and activities covering process documentation, performance assessment and user relations, such as:• Internal and external audits;• Performance indicators and management tools, particularly in the context of the Public Administration, as well as a specific set of quality monitoring criteria;• User and respondent satisfaction questionnaires, considering the different services provided; • Suggestions and complaints management system; • Documentation system (E.g. methodological documentation, internal procedures, quality reports and the Statistical Production Process Handbook). The last round of peer review took place in 2015 to assess the implementation of the European Statistics Code of Practice in Portugal in the context of the second round of Peer Reviews to Member States. According to the Peer Review Report, the main conclusions of the last peer review are mirrored in the resulting recommendations, which cover: the different roles and responsibilities of the actors of the National Statistical System (NSS), including the access to administrative data; budget procedures and constraints and the availability of human resources; quality documentation, particularly in regard to quality reports and process description, and quality audits; and dissemination issues, mainly related to data and microdata accessibility, statistical literacy and the visibility of the NSS. The reviewers’ recommendations resulted into an Improvement Actions Plan, properly scheduled and involving both Statistics Portugal and Other National Authorities (ONA). It comprises the current situation in the context of each of the reviewers’ recommendations, the associated improvement actions and the timeline for their implementation. This implementation is regularly monitored by Statistics Portugal and reported to EUROSTAT, and is expected to be fully completed by 2019. |
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4.2. Quality management - assessment | |||
The SHA data are exhaustive, relevent, coherent, accurate, reliable, comparable and consistent with national accounts. Improvements in the estimations of households out-of-pocket and long term care (health) are expected in the coming years. |
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5.1. Relevance - User Needs | |||
The main users of the SHA data are: the Ministry of Health, reseachers, journalists, academia and an information platform (PORDATA). In general, the following information needs were recorded: 1. conceptual and methodological clarifications - coverage and borderlines of the SHA data, criteria of classification, concepts and definitions, etc.; 2. SHA data available: calendar, SHA data breakdown, etc. |
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5.2. Relevance - User Satisfaction | |||
At the national level, Statistics Portugal performs a online user satisfaction survey to evaluate their level of satisfaction with the statistical information produced as well as the information available on its website at the level of content and usability. |
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5.3. Completeness | |||
SHA data not available: HF.4; HP.0; HC.3.2; HC.3.3. For HF.4 and HP.0 an estimate is missing due to a lack of data sources. For HC.3.2 and HC.3.3 an estimate is missing and reported in HC.1.2/HC.2.2 and HC.1.3/HC.2.3, respectively. |
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5.3.1. Data completeness - rate | |||
Table HPxHF = 79,5% Table HCxHP = 86,7% Table HCxHF = 75,8% |
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6.1. Accuracy - overall | |||
In general, the accuracy is good. However, any update of the main financing agents data implies a revision in household expenditures estimates, since they are estimated as a residual value. |
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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 | |||
Not applicable. |
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6.3.1. Coverage error | |||
Not applicable. |
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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 a general way, the Portuguese Health Accounts are reviewed and updated when the national accounts implement a new benchmark year. In each year, the Portuguese Health Accounts follow the Portuguese National Accounts release calendar, i.e., the results are final in T-3, provisional in T-2 and preliminary in T-1. |
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6.6. Data revision - practice | |||
Under the 2018 SHA JQ, Portugal submitted revised data for the years 2015-2016, replacing the previous version (submitted in 2017). Data for 2015 and 2016 were revised due to the incorporation of the updated and final data sources. Additionally, preliminary data for 2017 was presented. The data available submitted are final for the year 2015, provisional for the year 2016 and preliminary for the year 2017. |
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6.6.1. Data revision - average size | |||
Not available. |
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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. |
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7.1.1. Time lag - first result | |||
At the national level: 18 months (provisional data for T+2). |
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7.1.2. Time lag - final result | |||
At the national level: 30 months (final data for T+3). |
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7.2. Punctuality | |||
Statistics Portugal complies the Commission Regulation 359/2015 transmission deadlines. |
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7.2.1. Punctuality - delivery and publication | |||
Deadlines respected. |
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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 | ||||||||||||
There are no breaks in 2000-2016 series. |
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8.2.1. Length of comparable time series | ||||||||||||
All data series 2000-2016 are comparable. |
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8.3. Coherence - cross domain | ||||||||||||
SHA data are consistent with the principles, concepts, definitions and classifications adopted in the Portuguese National Accounts, ensuring the harmonization of methodologies and comparability of data. Coherence between SHA and ESSPROS has not been considered. |
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8.4. Coherence - sub annual and annual statistics | ||||||||||||
Not applicable. |
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8.5. Coherence - National Accounts | ||||||||||||
In statistics Portugal, the SHA data are compiled closely and linked with National Accounts. Despite the metodological differences between SHA and National Accounts (in terms of borderlines: occupational health care and Household provision of health (and social) care), the definitions, data sources, the criteria of classification and accounting methods are the same in both systems. Main differences with national accounts: - There is no direct correspondence between SHA data and the final consumption expenditure of residents on human health activities estimated by national accounts. SHA data covers the administration of financing and regulation of health systems, as well as includes part of social support activities with housing. - SNA recommends evaluating the output of retailers by trade and distribution margins. In SHA data, the expenditure of retail providers (HP.5) considered the value of sales in goods and products valued at acquisition prices. - SHA recommends following the standard SNA rules for drawing the production boundary of health care services, albeit with two exceptions: Occupational health care is included in the national totals of health care spending. In SNA, this item is recorded as ancillary services and part of intermediate production of enterprises; Part of the cash transfers to private households for care givers of home care for the sick and disabled are treated as the paid household production of health care. |
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8.6. Coherence - internal | ||||||||||||
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9.1. Dissemination format - News release | |||
At the national level, annual news release has regular published. Information is published on the Statistics Portugal's website at the following link: https://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_destaques&DESTAQUESdest_boui=314638731&DESTAQUESmodo=2 |
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9.2. Dissemination format - Publications | |||
At the national level, no paper or electronic publications are produced. |
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9.3. Dissemination format - online database | |||
The online national database is available on the Statistics Portugal's website at the following link: The following cross tables are disseminated, for the period 2000-2016: - Current Expenditure by Function of Care and Financing Agent - Current Expenditure by Provider Industry and Financing Agent - Current Expenditure by Function of Care and Provider Industry |
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9.3.1. Data tables - consultations | |||
The number of consultations of SHA data tables on Statistics Portugal's website is not available. The SHA data are located in a specific dossier and this accounting requires additional work, which is not possible due to the ongoing technical reformulation process on the website of Statistical Portugal. As a proxy information, the number of consultations of the last SHA Press Release, published in 2016 and 2017, was: 2016: 1.580 2017: 2.252 |
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9.4. Dissemination format - microdata access | |||
Not applicable. |
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9.5. Dissemination format - other | |||
On the Statistics Portugal's website, infographies based on SHA data are also published (https://www.ine.pt/xportal/xmain?xpgid=ine_infografias&xpid=INE). |
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9.6. Documentation on methodology | |||
SHA methodological document (portuguese version) is available on the Statistics Portugal's website at the following link: https://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_docmetodsec2010_cn&contexto=cs&perfil=220674570 Integrated metadata system can be accessed in: http://smi.ine.pt/?LANG=EN |
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9.7. Quality management - documentation | |||
Quality documentation is not available. |
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9.7.1. Metadata completeness - rate | |||
Information not available. |
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9.7.2. Metadata - consultations | |||
Information 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. The official statistical activity and the application of the principle of statistical confidentiality are carried out in strict compliance with the established i) in the Constitution of the Portuguese Republic, ii) in Law no 22/2008, of 13 of May, which establishes the principles the norms and the structure of the NSS (SEN Law), iii) Law 67/98 of 26 October, Law on the Protection of Personal Data and iv) Regulation (EC) 223/2009 of the European Parliament and of the Council of 11 (European Statistics Regulation) and in accordance with the principles agreed between EU Member States, transposed into the European Statistics Code of Conduct, namely Principle 5 concerning Statistical Confidentiality. Violation of statistical confidentiality, whether intentional or not (willful or negligent), is severely punished, constituting a very serious offense; breach of the obligation of professional secrecy entails disciplinary and criminal offense (a crime punishable by up to 5 years' imprisonment), pursuant to Articles 25 and of the National Statistical System Law. |
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11.2. Confidentiality - data treatment | |||
Since SHA data are derivative statistics in Portugal, confidentiality is not a common problem. However, in case it takes place, Eurostat is warned of the confidential nature of data, so that public dissemination does not occur. |
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