Health care activities (hlth_act)

Reference Metadata in Euro SDMX Metadata Structure (ESMS)

Compiling agency: Eurostat, the statistical office of the European Union

Eurostat metadata
Reference metadata
1. Contact
2. Metadata update
3. Statistical presentation
4.Unit of measure
5. Reference Period
6. Institutional Mandate
7. Confidentiality
8. Release policy
9. Frequency of dissemination
10. Dissemination format
11. Accessibility of documentation
12. Quality management
13. Relevance
14. Accuracy
15. Timeliness and punctuality
16. Comparability
17. Coherence
18. Cost and Burden
19. Data revision
20. Statistical processing
21. Comment
Related Metadata
Annexes (including footnotes)

For any question on data and metadata, please contact: EUROPEAN STATISTICAL DATA SUPPORT


1. Contact Top
1.1. Contact organisation

Eurostat, the statistical office of the European Union

1.2. Contact organisation unit

F5: Education, health and social protection

1.5. Contact mail address

2920 Luxembourg LUXEMBOURG

2. Metadata update Top
2.1. Metadata last certified 10/09/2014
2.2. Metadata last posted 10/09/2014
2.3. Metadata last update 25/06/2014

3. Statistical presentation Top
3.1. Data description

Non-expenditure health care data provide information on institutions providing health care in countries, on resources used and on output produced in the framework of health care provision.

Data on health care form a major element of public health information as they describe the capacities available for different types of health care provision as well as potential 'bottlenecks' observed. The quantity and quality of health care services provided and the work sharing established between the different institutions are a subject of ongoing debate in all countries. Sustainability - continuously providing the necessary monetary and personal resources needed - and meeting the challenges of ageing societies are the primary perspectives used when analysing and using the data.

The output-related data ('activities') refer to contacts between patients and the health care system, and to the treatment thereby received. Data are available for hospital discharges of in-patients and day cases, average length of stay of in-patients and medical procedures performed in hospitals.

Annual national and regional data are provided in absolute numbers and in population-standardised rates (per 100 000 inhabitants).

Wherever applicable, the definitions and classifications of the System of Health Accounts (SHA) are followed, e.g. International Classification for Health Accounts - Providers of health care (ICHA-HP). For hospital discharges, the International Shortlist for Hospital Morbidity Tabulation (ISHMT) is used.

Health care data on activities are largely based on administrative data sources in the countries. Therefore, they reflect the country-specific way of organising health care and may not always be completely comparable.

3.2. Classification system


Patient related definitions follow the System of Health Accounts (SHA) whenever applicable. Common definitions for hospital patients were agreed with OECD and WHO. The detailed definitions are available in CIRCABC.

Discharges by diagnosis refer to the principal diagnosis, i.e. 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).

Two different data sets for hospital discharges by diagnosis are available:

- For data from 2000 onwards: according to the International Classification for Hospital Morbidity Tabulation (ISHMT). This shortlist for statistical comparison of hospital activity analysis was adopted in 2005 by Eurostat, the OECD (Organisation for Economic Co-operation and Development) and the WHO-FIC (Family of International Classifications) Network.

- For data covering the period 1989-2002: according to a Eurostat shortlist of some 60 selective diseases based on ICD-10 (see Annex at the bottom of the page).

The surgical operations and procedures performed in hospitals are listed and presented according to the classification ICD-9-CM (Clinical Modification). However, at national level, different classifications are used for coding operations and procedures, e.g. the ICPM (International Classification of Procedures in Medicine) or ICD-9-CSP (ICD-surgical procedures), and it is not always possible to convert the data directly into ICD-9-CM and preserving the original meaning of the diagnosis or procedure category. Moreover, the ICD-9-CM includes a series of additions, which are not available in the ICD or in some of the national classifications like NOMESCO (Nordic Medico-Statistical Committee), OPCS4-UK (Classification of Surgical Operations and Procedures), CDAM France (Catalogue des Actes Médicaux), OPS301 Germany (Systematik des Operationenschlüssels) etc. 

The new table on procedures present data according to the list proposed by the Hospital Data Project II.

- Regional data are following the geographical classification NUTS2.  

3.3. Coverage - sector

Public Health

3.4. Statistical concepts and definitions

Health care activities' statistics describe the process of providing health care services in countries by referring to the services provided. Service-related data aim at quantifying directly elements of the health care delivery process.

The respective data are, due to their heterogeneity, collected, stored and disseminated via different tables. They are based on different, mainly administrative sources. This may lead to differences in the coverage of time series and/or in the geographical coverage; data validity, reliability and comparability may vary. Furthermore, it may not always be possible to have the health care system, implicitly underpinning the data collection, being consistently defined across data sources.

Non-expenditure health care activities data are grouped as follows:

Hospital patients: data refer to (1) hospital discharges of in-patients and day cases by age, sex, and selected (groups of) diseases; (2) average length of stay of in-patients; (3) a selection of medical procedures applied in hospitals.

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 health care 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.

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 case: day care comprises medical and paramedical services (episode of care) delivered to patients who are formally admitted for diagnosis, treatment or other types of health care 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.

Average length of stay (ALOS) is computed 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 problem.

Next to absolute numbers, density rates are provided for health care statistics.

Density rates are used to describe the frequency of services rendered, expressed in per 100 000 inhabitants. They are calculated by dividing the absolute number of health care resources available or services rendered in a given period by the respective population in the same period and then multiplied by 100 000.

3.5. Statistical unit

Administrative data sources refer to registered patients treated or procedures applied. The underlying totality of institutions, for which data collections are available, may differ. In some countries, data may not be available for a subgroup of institutions (e.g. private hospitals).

3.6. Statistical population

Depending on the data set, the target populations are all discharges or procedures performed in all hospitals.

3.7. Reference area

EU-28, the former Yugoslav Republic of Macedonia, Serbia, Turkey, Iceland, Norway, Switzerland.

3.8. Coverage - Time

For several data sets, time series for the EU-28, the former Yugoslav Republic of Macedonia, Turkey, Iceland, Norway and Switzerland are available from 1960 onwards. However, the availability of the data varies across countries and data sets.

3.9. Base period

Not applicable

4. Unit of measure Top

The data are published in absolute numbers and rate per 100,000 inhabitants.

5. Reference Period Top

Calendar year; depending on the reporting Member State, the reference period refers to the annual average or as reported by 31st December.

6. Institutional Mandate Top
6.1. Institutional Mandate - legal acts and other agreements

Countries submit data to Eurostat on the basis of a gentlemen's agreement established in the framework of the Eurostat Working Group on "Public Health Statistics".

Regulation on Community statistics on public health and health and safety at work (EC) No 1338/2008 was signed by the European Parliament and the Council on 16 December 2008. This Regulation is the framework of the data collection on the domain. Within the context of this framework Regulation, a specific Implementing Measure is currently being developed - within the ESS - on Causes of Death statistics and, according to forthcoming agreement with the member States, Implementing Measures for other domains will follow.


6.2. Institutional Mandate - data sharing

Data on hospital activities (hospital discharges, surgical procedures, ...) are collected by Eurostat apart from the Joint questionnaire on health care resources. Further work on definition and classification harmonisations needs to be done among the three international organisations before the inclusion of the statistics in the joint questionnaire. 

Definitions and data specifications are available in CIRCABC.

7. Confidentiality Top
7.1. Confidentiality - policy

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.

7.2. Confidentiality - data treatment

Not applicable

8. Release policy Top
8.1. Release calendar

Not applicable

8.2. Release calendar access

Not applicable

8.3. Release policy - user access

In line with the Community legal framework and the European Statistics Code of Practice Eurostat disseminates European statistics on Eurostat's website (see item 10 - 'Dissemination format') respecting professional independence and in an objective, professional and transparent manner in which all users are treated equitably. The detailed arrangements are governed by the Eurostat protocol on impartial access to Eurostat data for users.

9. Frequency of dissemination Top


10. Dissemination format Top
10.1. Dissemination format - News release

News releases on-line.

10.2. Dissemination format - Publications

Health Statistics - Key data on health 2002
Health in Europe - Pocketbook
Statistics Explained

For more information on publications, see also the Health dedicated section on Eurostat website.

10.3. Dissemination format - online database

Please consult free data on-line or refer to contact details.

10.4. Dissemination format - microdata access

Not applicable

10.5. Dissemination format - other

Eurostat website

European Social Statistics 2013

11. Accessibility of documentation Top
11.1. Documentation on methodology

Detailed footnotes, see Annex at the bottom of the page.

11.2. Quality management - documentation

Not available

12. Quality management Top
12.1. Quality assurance

Not available

12.2. Quality management - assessment

The quality of the data is subject to the way in which health care provision is organised in countries, and which information is available to and collected by the respective institutions.

The quality, comparability and coverage are discussed at biannual technical meetings of the Techincal Group Care and at the annual Eurostat's Working Group "Public Health Statistics".

It is also subjected to annual discussions with OECD and WHO at annual trilateral meetings concerning the Joint Questionnaire on Health Care Non Monetary Statistics, which is the basis for the data collection.

13. Relevance Top
13.1. Relevance - User Needs

The main users of the data are DG Health & Consummers (Sanco) and DG Employment in view of health policy papers and health strategies. The data also contribute to monitor the Europe 2020 strategy on Health as requested by the Council in December 2013 in the conclusions on the "Reflection process on modern, responsive and sustainable health systems" and to the Joint Assessment Framework for Health (JAF) which was agreed by the Social Protection Comitee in November 2013.      

13.2. Relevance - User Satisfaction

Not available

13.3. Completeness

Administrative data sources refer to registered patients treated or procedures applied. The underlying totality of institutions, for which data collections are available, may differ. In some countries, data may not be available for a subgroup of institutions (e.g. private hospitals).

14. Accuracy Top
14.1. Accuracy - overall

Not available

14.2. Sampling error

Not applicable

14.3. Non-sampling error

Not applicable

15. Timeliness and punctuality Top
15.1. Timeliness

Eurostat asks for the submission of final data for the year N at N+15 months.

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

15.2. Punctuality

Not available

16. Comparability Top
16.1. Comparability - geographical

The comparability of the data across different countries is limited by the fact that the quality of the country data is subject to the way, in which health care provision is organised in countries, and which information is available to and collected by the respective institutions.

Some countries are unable to cover all providers of care (the inclusion of private providers seems particularly difficult) or are only able to provide data for selective regions.

Sometimes regional data cannot be made available as the available breakdown does not coincide with the NUTS classification.

Ongoing work to increase quality, comparability and coverage is reported to Eurostat's Working Group "Public Health Statistics".

16.2. Comparability - over time

The comparability of the data over time is checked before dissemination.

Some countries may have a change in their data collection and so a break in series. These break in series are flagged and some information (if available) are given in the annexes of the metadata.

17. Coherence Top
17.1. Coherence - cross domain

Health care data on activities are also available in the database "Regions".

17.2. Coherence - internal

Internal coherence is ensured by the annual validation processes.

18. Cost and Burden Top

The data collection is based on administrative national sources with no additional burden.

19. Data revision Top
19.1. Data revision - policy

Only final data published.

19.2. Data revision - practice


20. Statistical processing Top
20.1. Source data

Health care non-expenditure data are mainly derived from administrative sources, and these sources may vary by country and by variable, eg. hospital administrative sources, health workers associations, family centers and private practises.  

Please note that the data sources used may not have been created initially for statistical purposes, and that the initial purpose of a data source may differ across countries. Both facts may influence the validity and comparability of results.

20.2. Frequency of data collection


20.3. Data collection

Administrative data from the national statistics authorities. The dta are collected annually.

20.4. Data validation

Consistency checks: comparing the statistics with previous years, investigating inconsistencies in the statistics, performing macro data editing, outlier detection. Comparison of validation results with OECD and WHO in view of data collected by the Joint Questionnaire on Non Monetary Health Care.

20.5. Data compilation

The absolute numbers for EU aggregates are the sum of the country numbers. For the density rates these EU totals are divided by the corresponding total EU population.

20.6. Adjustment

Data as reported by countries. No adjustments are made by Eurostat.

21. Comment Top

See Footnotes in the Annex at the bottom of the page for:

Hospital patients:

- Main surgical operations and procedures performed in hospitals (by ICD-9-CM) (1997-2007)

- All surgical operations and procedures performed in hospitals (by ICD-9-CM) (2005 onwards)

- Percentage of non-residents among all hospital discharges

- Hospital discharges by diagnosis (ISHMT)

- Examinations by medical imaging techniques (CT, MRI and PET)

- End-stage failure (ESRF) patients

Related metadata Top

Annexes Top