Healthcare non-expenditure statistics - methodology

Latest update of text: February 2015

This background article explains non-expenditure healthcare statistics, a data set concerning healthcare resources (such as personnel, beds and medical equipment) and healthcare activities (such as information on surgical operations and procedures and hospital discharges) in the European Union (EU).

The article provides information on the main features of these data, their historical development and current legal basis, some main methodological features, information concerning data quality and finally an overview of the uses of the data that come from this source.

This article is one of a set of online background articles concerning the methodology for the production of health statistics in the EU and accompanies a number of statistical articles which make up an online publication on health statistics.

Full article

Main features

Statistical objectives

Non-expenditure healthcare statistics provide information on access to health care.

Data on non-expenditure healthcare subjects form a major element of public health information as they describe the capacities available for different types of healthcare provision as well as potential ‘bottlenecks’ that may be observed in healthcare systems.

These data support healthcare policies which place particular emphasis on the access to, and the quality and sustainability of health care. Data on access to health care and the introduction of technological progress complement financial indicators available from healthcare expenditure statistics.

Scope of the data

Information on the non-expenditure component of health care can be divided into two broad groups of data.

  1. Resource-related healthcare data:
    • personnel (healthcare staff): physicians, dentists, nursing and caring professionals, pharmacists and physiotherapists;
    • availability of facilities: hospital beds, beds in nursing and residential care facilities, day care places in hospitals, operating theatres and medical technology.
  2. Activity or output-related data (contacts between patients and the healthcare system and the treatment thereby received):
    • consultations;
    • procedures and treatment; cancer screening;
    • immunisation against influenza;
    • use of medical technology;
    • curative care bed occupancy rate;
    • length of stay;
    • hospital discharges.

Note that data on some aspects of non-expenditure healthcare statistics are also available from the European health interview survey (EHIS) and EU statistics on income and living conditions (EU-SILC).

Coverage

All public and private hospitals should be covered.

Data on healthcare staff, in the form of human resources available for providing healthcare services, are provided irrespective of the sector of employment (in other words, regardless of whether the personnel are independent, employed by a hospital, or any other healthcare provider).

Data on the availability of beds should ideally cover all hospitals (including general hospitals, mental health and substance abuse hospitals, and other specialty hospitals) as well as nursing and residential care facilities.

Data on the availability of other facilities as well as healthcare activities mainly refer to hospitals only.

Development and legal basis

Development and history

In order to arrive at common definitions, a first meeting on this area of statistics took place between Eurostat and the Organisation for Economic Co-operation and Development (OECD) in April 2006: the World Health Organisation (WHO) was invited but could not participate. A list of items common to the Eurostat and the OECD annual data request was established, and for each item existing definitions used by Eurostat, the OECD and the WHO were compared. Based on this material and discussions, definitions were compiled and agreed for those items that are routinely collected by Eurostat and the OECD. Further meetings involving also the WHO took place in March 2007 and April 2008 and at the latter it was agreed to create a joint questionnaire on non-expenditure data. Subsequently these three organisations met twice a year to discuss the choice of variables and the questionnaire structure.

Since 2010, Eurostat, the OECD and the WHO have been jointly collecting data on healthcare resources and in addition, Eurostat collected data on healthcare activities. Since 2013, healthcare activities have been incorporated in the joint data collection and Eurostat has introduced a separate module on the number of physicians by speciality, regional data and hospital technical resources.

Legal basis

Data are submitted to Eurostat on the basis of a gentlemen’s agreement, in other words, without a legal obligation.

A Regulation on Community statistics on public health and health and safety at work (EC) No 1338/2008 exists, but at the time of writing there is no implementing legislation in the area of non-expenditure health statistics.

Methodology

Main sources

Non-expenditure healthcare data are mainly based on national administrative sources and reflect the country-specific way of organising health care. A few countries compile this information from surveys.

Statistical units

Non-expenditure data mainly relate to resources and activities within healthcare institutions.

Main concepts and definitions

Reference period: data generally refer to the calendar year or the situation at the end of the year.

Wherever applicable, the definitions are in line with the system of health accounts (SHA). The SHA is a framework for the systematic description of the financial flows related to health care.

Three main concepts are used for health professionals: practising, professionally active and licensed to practise. Practising physicians provide services directly to patients; professionally active physicians include those who practise, as well as those working in administration and research with their medical education being a pre-requisite for the job they carry out; physicians licensed to practise are those entitled to work as physicians plus, for example, those who are retired. Eurostat gives preference to the concept of ‘practising physicians’, as it best describes the availability of healthcare resources.

Hospital bed numbers provide information on healthcare capacities, in other words, on the maximum number of patients who can be treated by hospitals. Hospital beds (occupied or unoccupied) are those which are regularly maintained and staffed and immediately available for the care of admitted patients.

Curative care (or acute care) beds are those that are available for curative care; these form a subgroup of total hospital beds, alongside psychiatric care beds, long-term care beds and other hospital beds.

An in-patient is a patient who is formally admitted (or ‘hospitalised’) to an institution for treatment and / or care and stays for a minimum of one night or more than 24 hours in the hospital or other institution providing in-patient care.

Day cases: day care comprises medical and paramedical services (episode of care) delivered to patients who are formally admitted for diagnosis, treatment or other types of healthcare with the intention of discharging the patient on the same day. An episode of care for a patient who is admitted as a day-care patient and subsequently stays overnight is classified as an overnight stay or other in-patient case.

Discharges, rather than admissions, are used because hospital abstracts for in-patient care are based on information gathered at the time of discharge. A (hospital) discharge is the formal release of a patient from a hospital after a procedure or course of treatment (episode of care). A discharge occurs anytime a patient leaves because of finalisation of treatment, signs out against medical advice, transfers to another healthcare institution or because of death. A discharge can refer to in-patients or day cases. Healthy newborns should be included. Transfers to another department within the same institution are excluded.

Discharges by diagnosis refer to the principal diagnosis, in other words the main condition diagnosed at the end of the hospitalisation (in-patients) or day treatment (day cases). The main condition is the one primarily responsible for the patient’s need for treatment or investigation (for additional details, see International statistical Classification of Diseases and related health problems — ICD-10 Volume 2).

The average length of stay is calculated by dividing the number of hospital days (or bed-days or in-patient days) from the date of admission in an in-patient institution (date of discharge minus date of admission) by the number of discharges (including deaths) during the year.

Procedures are all types of medical interventions with the intention of achieving a result in the care of persons with health problems.

Main classifications

For surgical operations and procedures the International Classification of Diseases — clinical modification (ICD-9-CM) is used.

For hospital discharges, the International Shortlist for Hospital Morbidity Tabulation (ISHMT) is used for data from 2000 onwards. The complete list is also available as part of the joint questionnaire. For data for the period 1989–2002 a Eurostat shortlist of some 60 selective diseases based on the International Classification of Diseases (ICD) was used.

For regional data, the classification of territorial units for statistics (NUTS) is used for EU Member States and the classification of statistical regions outside the EU is used for EFTA and candidate countries.

Further methodological information

Common definitions for many non-expenditure healthcare indicators were agreed with the OECD and the WHO in the context of the joint questionnaire on non-monetary healthcare statistics.

Further definitions (as well as country specific notes are also available for some data sets:

  1. Personnel
  2. Beds
  3. Availability of facilities
  4. Surgical operations and procedures
  5. Use of medical technology
  6. Hospital discharges

Data quality

The comparability of data over time is checked before dissemination. Some countries may have a change in their data collection and so a break in series. These breaks in series are flagged and (where available) information is given in the metadata accompanying the data.

The comparability of data across EU Member States is limited by the fact that national data is subject to the way in which information is available.

While data on the number of beds should include public as well as private sector establishments, some EU Member States provide data only for the public sector, as is the case in Denmark (psychiatric beds), Ireland (total and curative beds), Cyprus (curative and psychiatric beds) and the United Kingdom.

Data dissemination

Published data

Statistical data are available in various formats. Statistics Explained articles and publications provide data and analysis, while Eurobase provides a set of multi-dimensional databases and information in a simpler format as main tables.

Time coverage

All data are annual.

The length of the time series varies between individual datasets.

Data set Oldest data
Personnel, physicians, health graduates 1980
Hospital beds 1960
Long-term care beds 1980
Day care places and operating theatres 2000
Availability of medical technology 1980
Procedures and treatment; use of medical technology 1990
End-stage renal failure patients 1980
Curative care bed occupancy rate 1960
Hospital discharges 1970 (detailed data from 2000)
Length of stay / number of days 1960 (detailed data from 1999)
Consultations 1960
Breast cancer and cervical cancer screenings; vaccination against influenza 2000

Geographical coverage

Data are generally available for all EU Member States as well as EFTA and candidate countries.

For all indicators national data are provided. For some indicators (health personnel, hospital beds, long-term care beds, hospital discharges and length of stay) regional data are also available, normally at levels 1 and 2 of the NUTS 2010 classification.

Further analysis / classifications

As well as a geographical analysis (see below for details), depending on the indicator, a variety of other classifications are used to analyse the data. The table below gives a summary — precise details can be found in each dataset.


Data set Additional analysis
Personnel Type of personnel
Physicians Type of specialisation; age and sex
Health graduates Type of personnel
Hospital beds Type of care, type of ownership
Long-term care beds
Day care places Type of care
Operating theatres
Availability of medical technology Type of technology, type of provider
Procedures and treatment Type of medical procedure, type of patient
Use of medical technology Type of technology, type of provider
End-stage renal failure patients Type of procedure
Curative care bed occupancy rate Type of patient
Hospital discharges Type of patient, age, sex, selected (groups of) diseases; resident status
Length of stay / number of days Age, sex, selected (groups of) diseases
Consultations Type of personnel
Breast cancer and cervical cancer screenings Type of data source (survey or programme data)
Vaccination against influenza

Units

Data on the length of stay are presented in terms of the number of days.

For most other indicators data are provided in absolute numbers and per 100 000 inhabitants (population-standardised rates, also referred to as density rates or the frequency of services rendered).

Data on the number of personnel are provided not only as simple head counts (how many doctors, nurses and so on) but also converted into full-time equivalents to improve comparability. As well as being provided in numbers and per 100 000 inhabitants, data on personnel may also be provided as an inverse figure, for example, the number of inhabitants per healthcare worker.

Timing of data release

Eurostat asks for the submission of final data for the year N at N + 14 months, for example data for the year 2013 are requested to be provided by the end of February 2015.

A number of countries still face difficulties with these timetables and deliver data at their earliest convenience.

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Health care resources (hlth_res)
Health care staff (hlth_staff)
Health care facilities (hlth_facil)
Health care activities (hlth_act)
Hospital discharges and length of stay for inpatient and curative care (hlth_co_dischls)
Curative care bed occupancy rate (hlth_co_bedoc)
Non-residents among all hospital discharges, % (hlth_co_dischnr)
Hospital discharges - National data (hlth_hosd)
Hospital discharges - Regional data (hlth_hosd_r)
Length of stay in hospital (hlth_hostay)
Operations, procedures and treatment (hlth_oper)
Consultations (hlth_consult)
Self-reported consultation of a medical professional by sex, age and educational attainment level (%) (hlth_ehis_hc5)
Self-reported consultation of a psychologist or physiotherapist by sex, age and educational attainment level (%) (hlth_ehis_hc6)
Consultation of a medical doctor (in private practice or as outpatient) per inhabitant (hlth_hc_phys)
Consultation of a dentist per inhabitant (hlth_hc_dent)
Preventive services (hlth_prev)
Self-reported breast examination by X-ray by educational attainment level among women aged 50-69 (%) (hlth_ehis_hc2)
Self-reported cervical smear test by educational attainment level among women aged 20-69 (%) (hlth_ehis_hc3)
Self-reported colorectal cancer screening test by sex, age and educational attainment level among people aged 50-74 (%) (hlth_ehis_hc4)
Self-reported vaccination against influenza by sex, age and educational attainment level (%) (hlth_ehis_hc1)
Breast cancer and cervical cancer screenings (hlth_ps_scre)
Vaccination against influenza of population aged 65 and over (hlth_ps_immu)