20 October 2011

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.

Activities

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 CIRCA.

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.

Public Health

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.

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).

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

EU-27, Croatia, the former Yugoslav Republic of Macedonia, Turkey, Iceland, Norway, Switzerland.

For several data sets, time series for the EU-27, Croatia, 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.

Not applicable

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

Calendar year; depending on the data set this can be annual average data or data as reported by 31st December.

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".

A 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.

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 CIRCA.

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.

Not applicable

Not applicable

Not applicable

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.

Annual

News releases on-line.

Health Statistics - Key data on health 2002
Health in Europe - Pocketbook
For more information on publications, see also Eurostat website.

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

Not applicable

http://ec.europa.eu/eurostat

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

Not available

Not available

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

Not available

Not available

Not available

Not available

Not applicable

Not applicable

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.

Not available

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".

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.

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

Not available

Not available

None

None

Health care non-expenditure data are mainly derived from administrative sources, and these sources may vary by country and by variable. 

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.

Annual

Mainly administrative data

Consistency checks; comparison with OECD and WHO data.

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.

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

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

Hospital patients:
- Hospital discharges by diagnosis (ISHMT)
- Percentage of non-residents among all hospital discharges
- 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).