Healthcare non-expenditure statistics manual and guidelines for completing the joint questionnaire on non-monetary healthcare statistics : 2025 edition.
Date: 2025-07-15
Institutions: Eurostat
Subjects: EU Member State, EU statistics, data collection, health care profession, health expenditure, public health, user guide

Healthcare non-expenditure 
statistics manual and 
guidelines for completing 
the Joint questionnaire on 
non-monetary healthcare 
statistics

2025 edition

M A N UA L S   A N D 
G U I D E L I N E S

Healthcare non-expenditure 
statistics manual and 
guidelines for completing 
the Joint questionnaire on 
non-monetary healthcare 
statistics

2025 edition

This document should not be considered as representative of the European Commission’s official position. 

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Contents

Acknowledgements 

Abbreviations and acronyms 

  Introduction 

1.1.  Aim 

1.2.  Contacts 

1.3.  Background 

1.4.  Legal basis 

1.5.  User needs 

  Methodology 

2.1.  General information 

2.2.  Coverage 

2.3.  Data sources 

2.3.1.  Administrative sources 
2.3.2.  Other sources 

2.4.  Treatment of non-existing data and real zero 

2.5.  Reference period 

2.6.  Reporting schedule 

2.7.  Units of measurement 

  Classifications (Definitions) 

3.1.  Harmonised definitions 

3.2.  Health employment and education 

3.2.1.  Practising physicians 
3.2.2.  Professionally active physicians 
3.2.3.  Physicians licensed to practice 
3.2.4.  Practicing physicians by age and sex 
3.2.5.  Number of practising physicians by category 

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Contents

3.2.6.  Practising midwives 
3.2.7.  Professionally active midwives 
3.2.8.  Midwives licensed to practice 
3.2.9.  Nurses 
3.2.10.  Practising caring personnel (personal care workers) 
3.2.11.  Professionally active caring personnel (personal care workers) 
3.2.12.  Practising dentists (ISCO-08 code: 2261) 
3.2.13.  Professionally active dentists 
3.2.14.  Dentists licensed to practice 
3.2.15.  Practising pharmacists (ISCO-08 code: 2262) 
3.2.16.  Professionally active pharmacists 
3.2.17.  Pharmacists licensed to practice 
3.2.18.  Practising physiotherapists (ISCO-08 code: 2264) 
3.2.19.  Total hospital employment 
3.2.20.  Medical graduates 
3.2.21.  Dentist graduates 
3.2.22.  Pharmacist graduates 
3.2.23.  Midwifery graduates 
3.2.24.  Nursing graduates 
3.2.25.  Professional nursing graduates 
3.2.26.  Associate professional nursing graduates 

3.3.  Health workforce migration 

3.3.1.  Stock of doctors (physicians) by country of first qualification 
3.3.2.  Annual inflow of foreign-trained doctors 
3.3.3.  Stock of nurses by country of first qualification 
3.3.4.  Annual inflow of foreign-trained nurses by country of first qualification 

3.4.  Physical and technical resources 

3.4.1.  Total Hospitals 
3.4.2.  Hospital beds 
3.4.3.  Total hospital beds; breakdown by sector 
3.4.4.  Intensive care unit (ICU) beds and occupancy 
3.4.5.  Beds in residential long-term care facilities (Nursing beds) 
3.4.6.  Medical technology 

3.5.  Health Activities 

3.5.1.  Ambulatory care 
3.5.2.  Hospital Care (includes Hospital aggregates) 
3.5.3.  Procedures 

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Contents

3.6.  Eurostat additional data collections 

3.6.1.  Practising physicians at regional level 
3.6.2.  Hospital beds at regional level 
3.6.3.  Hospital technical resources 

3.7.  Pilot data collections 

  Data transmission and validation 

4.1.  Introduction 

4.2.  Data structure 

4.2.1.  Data structure definition 
4.2.2.  Data requests 
4.2.3.  Data types 

4.3.  The two data file formats 

4.3.1.  Excel reporting questionnaires 
4.3.2.  Hospital discharges data (HDD) 

4.4.  Data transmission 

4.4.1.  Reporting deadlines 
4.4.2.  Filling in the Excel Worksheets 
4.4.3.  Completeness 
4.4.4.  Flags 
4.4.5.  Transmission method (EDAMIS) 
4.4.6.  Datasets and file naming conventions 

4.5.  Data validation 

4.5.1.  Validation procedure in reporting countries 
4.5.2.  Automatic checks  
4.5.3.  Validation in EDAMIS 
4.5.4.  The validation feedback report 
4.5.5.  Validation by international organisations (Eurostat, OECD and WHO-

Europe) 

  National reference metadata 

5.1.  National reference metadata report structure  

5.2.  Dataset in the Metadata handler 

5.3.  How to complete the annual reference metadata 

5.3.1.  Methodological information annex 
5.3.2.  Submitting annual reference metadata 
5.3.3.  Transmission 

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Contents

  Data dissemination 

6.1.  EU aggregates 

6.2.  Dissemination products 

Annex A.  List of Mandatory Variables – correlation table 

Annex B.  List of all variables collected from reporting countries 

Annex C.  Shortlist of Surgical Procedures 

Annex D.  Validation rules 

Annex E.  Template Methodological Information Annex to the national 

reference metadata 

Annex F.  Reference Metadata in SIMS Structure 

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Acknowledgements

This manual was prepared by Eurostat unit F5: ’Education, health and social protection’. It was published for the first time in 
2023 and updated in 2025, mainly concerning hospital discharges data transmission. The manual is based on Regulation (EU) 
2022/2294 on healthcare facilities, healthcare resources, and healthcare utilisation, the ‘Guidelines for completing the OECD/
Eurostat/WHO-Europe joint questionnaire on non-monetary healthcare statistics 2022’, technical discussions and working 
group documents for the statistical domain since 2011, and was enriched with contributions from the colleagues in OECD, 
WHO-Europe, National Statistical Institutes, external experts and other European Commission services.

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Abbreviations and acronyms

Abbreviations and acronyms

ALOS 

CAT 

CONVAL 

CT 

DSD 

Average length of stay

Computerized axial tomography scanner

Content Validation Service in EDAMIS

Computed tomography scanner

Data Structure Definition

DG SANTE 

Directorate-General for Health and Food Safety

EC 

EDAMIS 

ESS-MH 

EU 

FTE 

GDPR 

HCNE 

HDD 

HC 

HP 

ICD 

ICHA 

ICT 

ICU 

ILO 

ISCO 

ISCED 

ISHMT 

ISO 

European Commission

Electronic Data Files Administration and Management Information System

European Statistical System – Metadata Handler

European Union

Full-time equivalent

General Data Protection Regulation (EU)

Healthcare non-expenditure statistics

Hospital Discharges Data

Classification of Healthcare Functions

Classification of Health Care Providers

International Classification of Diseases

International Classification for Health Accounts

Information and Communication Technologies

Intensive Care Unit

International Labour Organization

International Standard Classification of Occupations

International Standard Classification of Education

International Shortlist for Hospital Morbidity Tabulation

International Organization for Standardization

JQNMHC 

Joint Questionnaire on Non-Monetary Healthcare Statistics (OECD-Eurostat- WHO-Europe)

NUTS 

MS 

MRI 

OECD 

PET 

Nomenclature of Territorial Units for Statistics

EU Member States

Magnetic resonance imaging

The Organisation for Economic Co-operation and Development

Positron Emission Tomography

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Abbreviations and acronyms

Reporting countries 

27 EU-MS, EFTA Countries, EU candidate countries (Albania, Bosnia and Herzegovina, Georgia, 
Moldova, Montenegro, North Macedonia, Serbia, Türkiye, Ukraine) and potential candidate 
countries (Kosovo (1)).

SDMX 

SHA 

SPECT 

STRUVAL  

WHO 

Statistical Data and Metadata eXchange

System of Health Accounts

Single Photon Emission Computed Tomography

Structural Validation Service in EDAMIS

World Health Organization

(1) 

This designation is without prejudice to positions on status, and is in line with UNSCR 1244/1999 and the ICJ Opinion on the Kosovo declaration of 
independence.

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1  Introduction

1.1.  Aim

This manual provides the guidelines for reporting countries (2) when completing the OECD/Eurostat/ WHO-Europe Joint 
Questionnaire on Non-Monetary Healthcare statistics (JQNMHC). The manual covers both the mandatory and the voluntary 
data collection. These data are also known as Healthcare non-Expenditure statistics (HCNE). The manual is not a legally 
binding document but is intended as a help for countries.

The overall objective of this joint data collection is to provide internationally comparable data on key aspects of healthcare 
systems, focusing on non-monetary resources of healthcare systems. This data collection complements the existing joint 
OECD/Eurostat/WHO-Europe data collection on Health Accounts.

1.2.  Contacts

The contact point for this data collection is Eurostat, the statistical office of the European Union, OECD and WHO-Europe. 
The contact details for the respective organisations are listed below: 

•  Eurostat: ESTAT-JQNMHCS(a)ec.europa.eu 
•  OECD: JQNMHC(a)oecd.org
•  WHO-Europe: euJDC(a)who.int

1.3.  Background

1.3.1.  Overview

OECD, Eurostat and WHO-Europe have collected data on non-monetary healthcare resources for many years. The most 
important reason for joint data collection is to reduce the burden of data collection on the national authorities responsible 
for providing statistical information to the international organisations, as they have to send the data only once. Moreover, a 
joint effort promotes the use of international standards and definitions and improves the consistency of data reported by 
international organisations.

In 2010, the first Joint OECD/Eurostat/WHO-Europe Questionnaire on Non-Monetary Healthcare statistics, focused on 
healthcare resources, was launched. At that point, Eurostat requested data for two separate data collections:

(2)  Countries covered by Commission Regulation (EU) 2022/2294 implementing Regulation (EC) No 1338/2008 of the European Parliament and of the Council 

as regards statistics on healthcare facilities, healthcare human resources and healthcare utilization.

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Chapter name when there is no separator Heading 111

Introduction

•  The JQNMHC; the joint data collection with OECD and WHO-Europe on healthcare resources (human and physical) using 

one focal point for all three organisations.

•  Eurostat questionnaire; an additional separate data collection on healthcare activities.

In 2013, healthcare activities were incorporated in the joint data collection. As a result, the Eurostat data collection was split 
into:

•  The JQNMHC with OECD and WHO-Europe, on healthcare resources (human and physical) and healthcare activities (with 

some additional Eurostat variables) using one focal point for all three organisations.

•  An additional Eurostat module on regional data, hospital technical resources and physicians by detailed categories.

In 2015, a new module on health workforce migration was added to the JQNMHC responding to the growing need to have 
data on movement of healthcare personnel.

The data collection which took place in 2023, for reference year 2021, was the first collection where a set of variables were 
mandatory for reporting countries. The variables provided on voluntary basis remain important to collect annually and to 
improve.

As of 2025, for reference year 2023, the data collection involved three main parts: 

•  The JQNMHC modules with OECD and WHO-Europe, on healthcare resources (human and physical) and healthcare 
activities (with some additional Eurostat variables) and health workforce migration using one focal point for all three 
organisations.

•  Disaggregated hospital discharge data (HDD).
•  An additional Eurostat module on regional data, hospital technical resources and physicians by detailed categories.

1.4.  Legal basis

Regulation (EC) No 1338/2008 of the European Parliament and of the Council on Community statistics on public health and 
health and safety at work, implemented by Commission Regulation (EU) 2022/2294 as regards statistics on healthcare 
facilities, healthcare human resources and healthcare utilisation.

In 2009 Eurostat initiated work to develop a legal basis for collecting non-monetary healthcare data.

A Task Force chaired by Eurostat with the participation of nine Member States and DG SANTE was set up in December 2013. 
The Task Force proposed a dataset to meet the main needs on healthcare statistics at EU level. The work to improve the data 
availability and comparability continued. Eurostat launched grant actions in two rounds in order to support Member States 
in improving their data, and organised a workshop on healthcare non-expenditure statistics in which countries shared their 
experience in gathering data and making estimates.

In 2019, the Task Force on Healthcare non-Expenditure reviewed the minimum dataset foreseen to be mandatory in the 
future. An ad-hoc pilot data collection on hospital beds was made and a revised minimum dataset was discussed in the 
Technical Group Healthcare non-Expenditure. The focus is on the most policy-relevant indicators while taking into account 
data availability.

Following the discussions and consultations of Member States, the Commission adopted Commission Regulation (EU) 
2022/2294 specifying a number of mandatory variables for reporting countries covered by it (Annex A).

Derogations to the above requirements are specified in Commission Implementing Decision (EU) 2022/2306 granting 
derogations to certain Member States with respect to the transmission of statistics pursuant to Regulation (EC) No 
1338/2008 of the European Parliament and of the Council, as regards statistics on healthcare facilities, healthcare human 
resources and healthcare utilisation.

1.5.  User needs

The main users of the data are European Commission Directorates-Generals Health and Food Safety (DG SANTE), 
Employment, Social Affairs & Inclusion (DG EMPL) and Economic and Financial Affairs (DG ECFIN) in view of health policy 

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1

Introduction

papers and health strategies. Other users of the statistics include policy-makers, national administrations, researchers, media 
and the general public. The statistics cater for the need to describe, compare, and analyse healthcare resources and activities 
on national, and for some variables, regional (NUTS2) level. Users are sometimes requesting data on an even more 
disaggregated level, but this has so far not been feasible.

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2  Methodology

2.1.  General information

The joint questionnaire on non-monetary healthcare statistics consists of four joint parts and one ‘Eurostat module’:

•  Health employment and education (e.g. number of physicians, nurses, graduates, etc.).
•  Health workforce migration (e.g. stock and flow of foreign-trained physicians and nurses).
•  Physical and technical resources (e.g. number of beds, medical equipment, etc.).
•  Healthcare activities (e.g. number of consultations, hospital aggregates, surgical procedures, etc.).
•  Eurostat module (additional data related to health employment, physical and technical resources).

The data are collected in Excel reporting questionnaires with numerical data.

Disaggregated Hospital Discharges Data (HDD) shall be sent in a separate text file (.CSV); including regional and national data 
in the same file.

Pilot data collections are integrated in the above-mentioned questionnaires. To consult a list of all variables collected, please 
see Annex B.

For reference metadata, please see Chapter 5.

2.2.  Coverage

The data shall cover the whole country.

2.3.  Data sources

The data shall mainly be compiled from administrative records, as referred to in Article 17a of Regulation (EC) No 223/2009 
on European statistics.

2.3.1.  Administrative sources

Administrative data comes from the national statistics or other national authorities. The administrative sources used by 
reporting countries may vary by country and variable, but generally refer to:

•  registered health human resources and healthcare facilities. For healthcare staff, countries may use a central register for 

medical professionals, business registers or other forms of data collection. 

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2

Methodology

•  registered patients (treated or procedures applied). 

The coverage of institutions for which data collections are available may differ. In some countries, data may not yet be 
available for a subgroup of institutions (e.g. private hospitals) or professionals (e.g. practising physiotherapists). This is 
specified in the reference metadata.

2.3.2.  Other sources

When administrative records are not available or of insufficient quality or coverage, use of other sources, methods or 
innovative approaches are accepted. It is important that the sources enable the production of comparable statistics.

Concerning the variables of the JQNMHC on cancer screening survey data, statistics collected as part of the European Health 
Information Survey (EHIS) can be used.

2.4.  Treatment of non-existing data and real zero

When data are not available, the cell shall be left empty.

Data that cannot exist shall be indicated as such. For variables where data is missing because it cannot exist, the reporting 
tables shall be flagged with the M-flag. This is the case for statistics on cancer screening programmes in countries where 
such programmes do not exist. For further information, please consult Chapter 4 of this manual.

Real zero (0) is used when there are 0 observations of a particular variable although the variable exists in the country. This 
could be the case for a particular surgical procedure in a specific year, for example.

2.5.  Reference period

Calendar year.

2.6.  Reporting schedule

All data and national reference metadata for the reference year T shall be transmitted T+2 years by the dates in the table 
below for the mandatory variables (Article 6 of Regulation (EU) 2022/2294). For the non-mandatory variables, reporting 
countries are kindly requested to send all the data by end of February T+2 years or earlier, if possible. 

TABLE 1
Annual reporting schedule for mandatory variables

Data section + reference metadata

Deadline

1.  Data on Health Employment

2.  Data on Health Graduates

End of February (mandatory from reference year 2023)

End of February (mandatory from reference year 2021)

3.  Data on Hospital Beds and Beds in Residential 

End of February (mandatory from reference year 2021)

Long-Term Care Facilities

4.  Data on Devices for Medical Imaging

End of February (mandatory from reference year 2021)

5.  Data on Ambulatory Care

6.  Data on Hospital Care

7.  Data on Surgical Procedures

End of February (mandatory from reference year 2021)

End of August (mandatory from reference year 2023)

End of August (mandatory from reference year 2023)

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2.7.  Units of measurement

Number at the end of the reference (calendar) year. 

Number, headcount, at the end of the reference year.

Average number during reference year.

For some variables on health employment, number of full-time equivalent (FTE) persons is used. For some variables on 
healthcare activities, percentage (%) of those screened/immunised is used.

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3  Classifications (Definitions)

3.1.  Harmonised definitions

The definitions for all variables of the joint questionnaire on non-monetary healthcare statistics are provided here. 
Mandatory variables under Regulation (EU) 2022/2294 are identified as such. The definitions are the same as, to the largest 
extent, and rely as much as possible on the following existing international classifications:

•  International Classification for Health Accounts (ICHA), A System of Health Accounts, OECD, WHO and Eurostat 2011 – 

Revised edition 2017.

•  International Classification of Diseases (ICD), 10th Revision WHO.
•  International Shortlist for Hospital Morbidity Tabulation (ISHMT).
•  International Standard Classification of Occupations, ISCO-08, ILO.

3.2.  Health employment and education

Statistics in this section (Table 2) should reflect the situation at the end of the reference period (calendar year) and are based 
on headcount.

Mandatory variables related to health employment (e.g. physicians, midwives and nurses, dentists, pharmacists, etc.) are 
requested according to the concept:

‘Practising’ (i.e. healthcare professionals directly providing services to patients). For professions regulated 
under Directive 2005/36/EC (as amended) on the recognition of professional qualifications, all staff reported in 
the variables in Table 2 need to meet the requirements of the Directive. The definitions in the Directive are not 
based on the tasks carried out but on the educational level reached. The Directive has been modified by the Commission 
Delegated Directive (EU) 2024/782, issued on March 4, 2024, concerning the minimum training requirements for certain 
professions. Specifically, it focuses on the professions of nurses responsible for general care, dental practitioners, and 
pharmacists.

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Classifications (Definitions)

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TABLE 2
Health employment

Variable 
Number

Physicians (Head Count)

Variable Name

V1.1

Practising physicians by age group and sex

Headcount at the end of the reference period

Practising physicians by age group (less than 35, 35-44, 45-54, 55-64, 65-74, 75+) and by 
sex

Professionally active physicians: headcount at the end of reference period and by age 
group and sex

Physicians licensed to practice: headcount at the end of reference period and by age 
group and sex

V1.2

Physicians by categories

V1.2.1

V1.2.2

V1.2.3

V1.2.4

V1.2.5

V1.2.6

V1.2.7

V1.2.8

V1.2.9

Generalist medical practitioners

– General practitioners

– Other generalist (non-specialist) medical practitioners

Specialist medical practitioners

– Paediatricians

– Obstetricians and gynaecologists

– Psychiatrists

– Group of non-surgical specialists

– Group of surgical specialists

– Other specialists not elsewhere classified

Medical doctors not further defined

Midwives (Head Count)

V1.3

Practising midwives

Professionally active midwives

Midwives licensed to practice

Nurses (Head Count)

Practising nurses

V1.4

– Professional nurses, practising

– Associate professional nurses, practising

Professionally active nurses

– Professional nurses, professionally active

– Associate professional nurses, professionally active

Nurses licensed to practice

– Professional nurses, licensed to practice

– Associate professional nurses, practising

Nurses by age group and sex

Status

Mandatory

Mandatory

Mandatory

Voluntary

Voluntary

Mandatory

Mandatory

Mandatory

Mandatory

Mandatory

Mandatory

Mandatory

Mandatory

Mandatory

Mandatory

Mandatory

Voluntary

Voluntary

Voluntary

Mandatory

Voluntary

Voluntary

Voluntary

Voluntary

Voluntary

Voluntary

Voluntary

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3

Classifications (Definitions)

Variable 
Number

Variable Name

Total nurses by age group (less than 25, 25-34, 35-44, 45-54, 55-64, 65-74, 75+) and by 
sex

Professional nurses by age group (less than 25, 25-34, 35-44, 45-54, 55-64, 65-74, 75+) 
and by sex

Associate professional nurses by age group (less than 25, 25-34, 35-44, 45-54, 55-64, 
65-74, 75+) and by sex

Caring personnel (Personal care workers) (Head Count)

Practising caring personnel (personal care workers)

Professionally active caring personnel (personal care workers)

Dentists (Head Count)

V1.5

Practising dentists

Professionally active dentists

Dentists licensed to practice

Pharmacists (Head Count)

V1.6

Practising pharmacists

Professionally active pharmacists

Pharmacists licensed to practise

Physiotherapists (Head Count)

Practising physiotherapists

Status

Voluntary

Voluntary

Voluntary

Voluntary

Voluntary

Mandatory

Voluntary

Voluntary

Mandatory

Voluntary

Voluntary

Voluntary

3.2.1.  Practising physicians

Variable 1.1. Mandatory from reference year 2023, number (headcount)

DEFINITION 1

‘Practising physicians’ means medical doctors who have graduated in medicine from medical 
faculties or similar institutions and are licensed to practice. Practising physicians provide services for 
individual patients, families and communities. It also refers to interns and resident physicians who 
have graduated in medicine from medical faculties or similar institutions and who provide services 
under supervision of other medical doctors.

Only physicians meeting the requirements of Directive 2005/36/EC on the recognition of professional qualifications shall be 
included.

Includes:

•  Practising physicians who have completed studies in medicine at university level (granted by adequate diploma) and who 

are licensed to practice.

•  Interns and resident physicians (with adequate diploma and providing services under supervision of other medical doctors 

during their postgraduate internship or residency in a healthcare facility).

•  Salaried and self-employed physicians delivering services irrespectively of the place of service provision.
•  Foreign physicians licensed to practice and actively practising in the country.
•  All physicians providing services for patients, including radiology, pathology, microbiology, haematology, hygiene.

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Classifications (Definitions)

3

Further information on inclusion criteria

Countries may have national criteria concerning the minimum requirements for physicians to be considered practising. These 
criteria should be described in the reference metadata. They could include a minimum number of hours of consultations per week, 
or a minimum income from the social security insurance, and apply if the physician has other activities or is retired and receives a 
pension.

Interns and resident physicians should be included if the data are available, which can be explained in the reference metadata. 
These categories may not yet be licensed but practice under the supervision of licensed professionals.

Excludes:

•  Students who have not yet graduated.
•  Dentists, stomatologists, dental and maxillofacial surgeons.
•  Physicians working in administration, research and in other posts that excludes direct contact with patients.
•  Unemployed physicians and retired physicians.
•  Physicians working abroad.

3.2.2.  Professionally active physicians

Number (headcount)

Professionally active physicians includes practising physicians and other physicians for whom their medical education is a 
prerequisite for the execution of the job.

Includes:

•  Physicians who provide services for individual patients.
•  Physicians working in administration and management positions requiring a medical education.
•  Physicians conducting research into human disorders and illness and preventive and curative methods.
•  Physicians participating in the development and implementation of health promotion and public health laws and 

regulations.

•  Physicians preparing scientific papers and reports. 

Excludes:

•  Dentists, stomatologists, dental and maxillofacial surgeons.
•  Physicians who hold a post / job under which medical education is not required.
•  Unemployed physicians and retired physicians.
•  Physician working abroad.

3.2.3.  Physicians licensed to practice

Number (headcount)

Physicians licensed to practice includes practising and other (non-practising) physicians who are registered and entitled to 
practice as healthcare professionals.

Includes:

•  Physicians who provide services for individual patients.
•  Physicians for whom their medical education is a prerequisite for the execution of the job.
•  Physicians for whom their medical education is NOT a prerequisite for the execution of the job.
•  Physicians licensed to practice but who due to various reasons are not economically active (e.g. unemployed or retired).
•  Physicians working abroad. 

Excludes:

•  Dentists, stomatologists, dental and maxillofacial surgeons.

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3.2.4.  Practicing physicians by age and sex

Variable 1.1. Mandatory from reference year 2023; characteristics and breakdowns:

•  Practising physicians (see inclusion/exclusion above).
•  Number (headcount) at the end of the reference period.
•  Total and breakdown by age and by sex (male/female).
•  Age groups: less than 35, 35–44, 45–54, 55–64, 65–74, 75 and older.

3.2.5.  Number of practising physicians by category

Variable 1.2. Mandatory from reference year 2023; characteristics and breakdowns:

•  Practising physicians (see inclusion/exclusion above).
•  Number (headcount) at the end of the reference period.
•  Breakdown by category (see inclusion/exclusion criteria below).

DEFINITION 2

Category of ‘practising physicians’ means the predominant (main) area of practice of doctors.

Please refer to Directive 2005/36/EC on the recognition of professional qualifications for the minimum basic/specialist 
medical training of doctors of medicine.

The data collection includes three broad categories of doctors (corresponding to the ISCO-08 codes at the 4-digit level) and 
eight sub-categories (Figure 1).

Generalist medical practitioners (ISCO-08 code: 2211)

1.1.1  General practitioners

1.1.2  Other generalist (non-specialist) medical practitioners

Specialist medical practitioners (ISCO-08 code: 2212)

1.1.3  Paediatricians

1.1.4  Obstetricians and gynaecologists

1.1.5  Psychiatrists

1.1.6  Group of non-surgical specialists

1.1.7  Group of surgical specialists

1.1.8  Other specialists not elsewhere classified

Medical doctors not further defined (ISCO-08 code: 2210)

The table on physicians by categories should cover the whole physician workforce, including medical interns and 
residents as well as physicians without specialisation. Theoretically, the two first broad categories (‘Generalist medical 
practitioners’ and ‘Specialist medical practitioners’) should cover all physicians. In accordance with ISCO-08 definition, the 
last category ‘Medical doctors not further defined’ should be used only if some doctors cannot be classified under 
‘Generalist medical practitioners’ or ‘Specialist medical practitioners’. Data senders are strongly encouraged to verify that 
physicians have been properly allocated to the specific categories. The sum of the three broad categories should add 
up to the total number of (practising) physicians.

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Further information on medical interns and residents

Medical interns and residents who are pursuing postgraduate training should be allocated in their area of training. If they have not 
chosen a specialisation yet, they are considered as “Other generalist (non-specialist) medical practitioners”. Physicians in training 
who cannot be split according to the specialty in which they are training should be reported in the category “Medical doctors not 
further defined”.

FIGURE 1
Variable 1.2: Physicians by Category 

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Classifications (Definitions)

3.2.5.1.  Generalist medical practitioners (ISCO-08 Code: 2211)

Generalist medical practitioners do not limit their practice to certain disease categories or methods of treatment and may 
assume responsibility for the provision of continuing and comprehensive medical care to individuals, families and 
communities.

Includes:

•  General practitioners.
•  District medical doctors – therapists.
•  Family medical practitioners.
•  Primary healthcare physicians.
•  Medical doctors (general).
•  Medical officers (general).
•  Medical interns or residents specialising in general practice or without any area of specialisation yet.

Further information on inclusion:

Medical interns and residents who have completed basic medical university education and are undertaking postgraduate clinical 
training are included here, if they are specialising in general practice or if they have not chosen their area of specialisation yet.

Excludes:

•  Paediatricians.
•  Obstetricians and gynaecologists.
•  Specialist physicians (internal medicine).
•  Psychiatrists.
•  Clinical officers.
•  Feldschers.

The broad category ‘Generalist medical practitioners’ is split to distinguish the number of ‘General practitioners’ 
(‘family doctors’), providing continuous medical care to individuals and families most often in primary care sector, from 
‘Other generalists/non-specialists’ who may be working in hospitals.

3.2.5.1.1.  General practitioners

DEFINITION 3

‘General practitioners’ means medical doctors who assume responsibility for the provision of 
continuing and comprehensive medical care to individuals, families and communities.

Evidence of formal qualifications of general practitioners is specified in Directive 2005/36/EC, Annex V, section V.1, table 5.1.4.

Includes:

•  General practitioners.
•  District medical doctors – therapists.
•  Family medical practitioners (‘family doctors’).
•  Medical interns or residents specialising in general practice.

Further information on inclusion:

Some countries may consider ‘General practice’ and ‘Family medicine’ as medical specialisations, but these occupations should 
always be classified here.

Offices of general medical practitioners (Classified as HP.3.1.1 in SHA2011) includes establishments of doctors who hold a degree in 
medicine and are primarily engaged in the independent practice of general medicine.

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Excludes:

•  Paediatricians.
•  Other generalist (non-specialist) medical practitioners.

3.2.5.1.2.  Other generalist (non-specialist) medical practitioners

DEFINITION 4

‘Other generalist (non-specialist) medical practitioners’ means practitioners who do not limit their 
practice to certain disease categories or methods of treatment. They do not work in an area of 
specialisation.

Includes:

•  Generalists not included under general practitioners.
•  Generalist/non-specialist practitioners working in hospital or in other settings.
•  Medical interns or residents without any area of specialisation yet. 

Excludes:

•  General practitioners (‘family doctors’).
•  Paediatricians.
•  Occupational medicine physicians.

3.2.5.2.  Specialist medical practitioners (ISCO-08 Code: 2212)

Specialist medical practitioners diagnose, treat and prevent illness, disease, injury, and other physical and mental 
impairments in humans, using specialised testing, diagnostic, medical, surgical, physical and psychiatric techniques, through 
application of the principles and procedures of modern medicine.

They specialise in certain disease categories, types of patient or methods of treatment and may conduct medical education 
and research in their chosen areas of specialisation.

Includes:

•  Paediatricians.
•  Obstetricians and gynaecologists.
•  Psychiatrists.
•  Group of non-surgical specialists.
•  Group of surgical specialists.
•  Medical interns or residents training for a specific specialty. 

Excludes:

•  General practitioners.
•  Dental practitioners.
•  Dental surgeons.
•  Oral and maxillofacial surgeons.

Further information on inclusion and exclusion:

Medical interns and residents training as specialist practitioners (except general practice) are included here. Although in some 
countries, ‘stomatology’ may be considered as a medical specialisation, stomatologists should be included in dentists.

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3.2.5.2.1.  Paediatricians

DEFINITION 5

‘Paediatricians’ means medical doctors who deal with the development, care, and diseases of children.

Includes:

•  Medical interns or residents specialising in paediatrics.

Excludes:

•  Paediatric specialties (e.g. child psychiatry, child/paediatric surgery, child/paediatric gynaecology, paediatric cardiology, 

paediatric oncology, etc.).

3.2.5.2.2.  Obstetricians and gynaecologists

DEFINITION 6

‘Obstetricians’ means medical doctors who specialise in pregnancy and childbirth. ‘Gynaecologists’ 
means medical doctors who specialise in the functions and diseases specific to women and girls, 
especially those affecting the reproductive system.

Includes:

•  Child/paediatric gynaecology.
•  Reproduction medicine.
•  Genetics.
•  Medical interns or residents specialising in obstetrics and gynaecology.

3.2.5.2.3.  Psychiatrists

DEFINITION 7

‘Psychiatrists’ means medical doctors who specialise in the prevention, diagnosis and treatment of 
mental illness.

Includes:

•  Psychiatry.
•  Neuropsychiatry.
•  Adult and geronto-psychiatry.
•  Child psychiatry.
•  Psychiatry - addictive disorders / diseases.
•  Social psychiatry.
•  Psychiatric rehabilitation.
•  Medical interns or residents training in these psychiatric specialties. 

Excludes:

•  Psychologists

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3.2.5.2.4.  Group of non-surgical specialists

DEFINITION 8

‘Group of non-surgical specialists’ means medical doctors who specialise in the diagnosis and 
non-surgical treatment of physical disorders and diseases.

Includes:

•  Internal medicine.
•  Cardiology.
•  Endocrinology.
•  Gastroenterology.
•  Pulmonology.
•  Respiratory medicine.
•  Oncology.
•  Gynaecologic oncology.
•  Immunology.
•  Rheumatology.
•  Neurology.
•  Oto-rhino-laryngology.
•  Radiology.
•  Infectious diseases.
•  Microbiology-bacteriology.
•  Haematology.
•  Dermatology.
•  Pathology.
•  Occupational medicine, Community medicine (including hygiene, epidemiology and assessment medicine).
•  Medical interns or residents training in these specialties.
•  Paediatric cardiology.
•  Paediatric oncology.
•  Neonatology. 

Excludes:

•  Surgery.
•  Gynaecology and obstetrics.
•  Paediatrics.
•  Psychiatry.
•  General practice.

3.2.5.2.5.  Group of surgical specialists

DEFINITION 9

‘Group of surgical specialists’ means medical doctors who specialise in the use of surgical techniques 
to treat disorders and diseases.

Includes:

•  General surgery.
•  Neurological surgery.

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Classifications (Definitions)

•  Plastic surgery.
•  Orthopaedics.
•  Ophthalmology.
•  Urology, nephrology.
•  Other types of surgery.
•  Anaesthesiology.
•  Intensive care.
•  Accident and emergency medicine.
•  Medical interns or residents training in these specialties.
•  Child/paediatric surgery. 

Excludes:

•  Dental surgery.
•  Oral and maxillofacial surgery.

3.2.5.2.6.  Other specialists not elsewhere classified

DEFINITION 10

‘Other specialists not elsewhere classified’ means physician specialists not covered by definitions 5 to 9.

The definitions 5 to 9 are available in section SPECIALIST MEDICAL PRACTITIONERS. 

Includes:

•  Other specialists not elsewhere classified.
•  Medical interns or residents training in these other specialties.

3.2.5.3.  Medical doctors not further defined (ISCO-08 Code: 2210)

DEFINITION 11

‘Medical doctors not further defined’ means medical practitioners who cannot be classified in the 
other categories (definition 3 to 10).

The definitions 3 to 10 are available in sections GENERALIST MEDICAL PRACTITIONERS and SPECIALIST  MEDICAL 
PRACTITIONERS).

Includes:

•  Medical practitioners who cannot be classified in the other categories.
•  Medical interns or residents who cannot be classified in the other categories.

In accordance with ISCO-08 definition, this category should be used only if some doctors cannot be classified under 
‘Generalist medical practitioners’ or ‘Specialist medical practitioners.

3.2.6.  Practising midwives

Variable 1.3. Mandatory from reference year 2023, total number (headcount)

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DEFINITION 12

‘Practising midwives’ means persons who have a recognised qualification in midwifery, have a license 
to practice and provide services directly to patients. A midwife is a midwifery professional or a 
midwifery associate professional. Midwifery professionals provide care and advice to women during 
pregnancy, labour and childbirth and the post-natal period. Midwifery professionals deliver babies 
working independently or in collaboration with medical doctors, nurses and other healthcare workers 
and provide advice and assistance to parents in relation to baby care. Midwifery associate 
professionals deliver or assist doctors or midwifery professionals in the delivery of babies. Midwifery 
associate professionals provide antenatal and post-natal care and instruct parents in baby care.

Only midwives meeting the requirements of Directive 2005/36/EC on the recognition of professional qualifications shall be 
included.

Includes:

•  Midwifery professionals and midwifery associate professionals meeting the requirements of Directive 2005/36/EC on the 

recognition of professional qualifications.

•  Persons who have completed their studies/education in midwifery and who are licensed to practice and provide services 

directly to patients.

•  Salaried and self-employed midwives delivering services irrespectively of the place of service provision.
•  Foreign midwives licensed to practice and actively practising in the country. 

Excludes:

•  Students who have not yet graduated.
•  Midwives working in administration, management, research and in other posts excluding direct contact with patients.
•  Unemployed midwives and retired midwives.
•  Midwives working abroad.

Further information

To avoid double-counting of persons practising both as midwives and as nurses, countries should report by the main occupation, 
or alternatively make an estimation. Explanations should be added in the national reference metadata.

3.2.7.  Professionally active midwives

Number (headcount)

Professionally active midwives include practising and other (non-practising) midwives for whom their education is a 
prerequisite for the execution of the job.

Includes:

•  Midwifery professionals and midwifery associate professionals meeting the requirements of Directive 2005/36/EC on the 

recognition of professional qualifications.

•  Midwives providing services directly to patients.
•  Midwives working in administration, management, research and in other posts excluding direct contact with patients.

Excludes:

•  Midwives who hold a post / job under which midwifery education is not required.
•  Unemployed midwives and retired midwives.
•  Midwives working abroad.

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Classifications (Definitions)

3.2.8.  Midwives licensed to practice

Number (headcount)

Midwives licensed to practice have acquired the requisite education and qualifications to be registered and/or legally 
licensed to practice midwifery. They include both practising and other (non-practising) midwives.

Only midwives meeting the requirements of Directive 2005/36/EC on the recognition of professional qualifications shall be 
included.

Includes:

•  Midwifery professionals and midwifery associate professionals meeting the requirements of Directive 2005/36/EC on the 

recognition of professional qualifications.

•  Midwives who provide services directly to patients.
•  Midwives for whom their midwifery education is a prerequisite for the execution of the job.
•  Midwives for whom their midwifery education is NOT a prerequisite for the execution of the job.
•  Midwives licensed to practice but who due to various reasons are not economically active (e.g. unemployed or retired).
•  Midwives working abroad.

Further information

Persons licensed both as midwives and as nurses can be reported in both categories.

3.2.9.  Nurses

For the countries reporting to Eurostat, variable 1.4 corresponds to the mandatory variable, professional practising nurses, 
while all other variables related to nurses are voluntary (Figure 2). The variables on associate professional nurses are collected 
for the benefit of OECD and WHO-Europe.

FIGURE 2
Variables of nurse collected  
Note that fields in grey indicate non-mandatory variables.

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3.2.9.1.  Practising nurses

Number (headcount)

Practising nurses provide services directly to patients. 

Includes:

•  Professional nurses.
•  Associate professional nurses.
•  Foreign nurses licensed to practice and actively practising in the country. 

Excludes:

•  Midwifery professionals and midwifery associate professionals.
•  Students who have not yet graduated.
•  Nursing aids/assistants and personal care workers who do not any recognised qualification/ certification in nursing.
•  Nurses working in administration, management, research and in other posts that exclude direct contact with patients.
•  Unemployed nurses and retired nurses no longer practising.
•  Nurses working abroad.

Further information

To avoid double-counting of persons practising both as midwives and as nurses, countries should report by the main occupation 
alternatively make an estimation.

The variable includes all types of practising nurses with a specialisation on top of the general care professional qualification.

3.2.9.2.  Professionally active nurses

Number (headcount)

Professionally active nurses includes practising nurses and other nurses for whom their education is a prerequisite for the 
execution of the job.

Includes:

•  Professional nurses.
•  Associate professional nurses.
•  Nurses providing services directly to patients.
•  Nurses working in administration, management, research and in other posts excluding direct contact with patients. 

Excludes:

•  Nurses who hold a post / job under which nursing education is not required.
•  Unemployed nurses and retired nurses.
•  Nurses working abroad.

3.2.9.3.  Nurses licensed to practice

Number (headcount)

A nurse licensed to practice has completed a programme of nursing education and is qualified and authorised in his/her 
country to practice nursing. They include practising and other (non-practising) nurses.

Includes:

•  Professional nurses.
•  Associate professional nurses.
•  Nurses who provide services directly to patients.

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Classifications (Definitions)

•  Nurses for whom their nursing education is a prerequisite for the execution of the job.
•  Nurses for whom their nursing education is NOT a prerequisite for the execution of the job.
•  Nurses licensed to practice but who due to various reasons are not economically active (e.g. unemployed or retired).
•  Nurses working abroad.  

Excludes:

•  Healthcare assistants and personal care workers (nursing aids), who do not have any recognised qualification/certification 

in nursing.

Further information

Persons licensed both as midwives and as nurses can be reported in both categories.

3.2.9.4.  Professional nurses

DEFINITION 13

‘Practising nurses’ means persons who have a recognised qualification in nursing, have a license to 
practice and provide services directly to patients. A nurse is a nursing professional or a nursing 
associate professional. Nursing professionals assume responsibility for the planning and management 
of the care of patients, including the supervision of other healthcare workers, working autonomously 
or in teams with medical doctors and others in the practical application of preventive and curative 
measures. Nursing associate professionals generally work under the supervision of, and in support of 
implementation of healthcare, treatment and referrals plans established by medical, nursing and 
other health professionals.

Number (headcount)

Variable 1.4. Mandatory variable from reference year 2023, total number (headcount) (only practising professional 
nurses are mandatory; see figure 2)

The nurses fulfilling the requirements of Directive 2005/36/EC on the recognition of professional qualifications correspond to 
Variable 1.4 and shall be reported in the columns for ‘professional nurses’.

Nursing professionals assume responsibility for the planning and management of the care of patients, including supervision 
of other health care workers, working autonomously or in teams with medical doctors and others in the practical application 
of preventive and curative measures.

All nurses reported (i.e. both professional and associate professional nurses) need to fulfil the requirements of Directive 
2005/36/EC on the recognition of professional qualifications.

Includes:

•  Nurses which have an education in compliance with the EC Directive on professional qualifications (e.g. minimum 3 years 

for a general nurse) and specialist nurses with an equivalent education (or longer).

•  General care nurse.
•  Specialist nurse.
•  Clinical nurse.
•  District nurse.
•  Nurse anaesthetist.
•  Nurse educator.
•  Nurse practitioner.
•  Public health nurse.
•  Specialist nurse. 

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Excludes:

•  Healthcare assistants and personal care workers (nursing aids), who do not have any recognised qualification/certification 

in nursing.

•  Midwife (unless they work most of the time as nurses).
•  Paramedical practitioner.
•  University lecturer.
•  Vocational education teacher.
•  Associate professional nurse (see definition below).
•  Midwifery professionals and midwifery associate professionals.

Further information

To avoid double-counting of persons practising both as midwives and as nurses, countries should report by the main occupation 
alternatively make an estimation.

The variable includes all types of practising nurses with a specialisation on top of the general care professional qualification.

3.2.9.5.  Associate professional nurses (ISCO-08 Code: 3221)

Number (headcount)

Nursing associate professionals generally work under the supervision of, and in support of implementation of health care, 
treatment and referrals plans established by medical, nursing and other health professionals.

Includes:

•  Nursing associate professionals.
•  Assistant nurse.
•  Enrolled nurse.
•  Practical nurse. 

Excludes:

•  Professional nurses fulfilling, as a minimum, the requirements related to ‘nurse responsible for general care’ in Directive 

2005/36/EC on the recognition of professional qualifications.

•  Professional nurse.
•  Clinical nurse consultant.
•  Specialist nurse.
•  Midwife (unless they work most of the time as nurses).
•  Associate professional midwife.
•  Nursing aide.
•  Medical assistant (ISCO-08 code: 3256).

Countries, for which this category is not relevant, shall report ‘0’.

Please note that Eurostat will not disseminate data reported for associate professional nursing graduates; however, the 
category remains relevant to OECD and WHO.

3.2.9.6.  Nurses by age and sex

Characteristics and breakdowns:

•  Total nurses, Professional nurses and Associate professional nurses (see inclusion/exclusion above).
•  Number (headcount) at the end of the reference period.
•  Total and breakdown by age and by sex (male/female).
•  Age groups: less than 25, 25-34, 35–44, 45–54, 55–64, 65–74, 75 and older.

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Classifications (Definitions)

Professional nurses vs Associate professional nurses

In the reporting questionnaire on Health Employment and Education, EU countries should report in sheet ‘Nurses’, under the 
column ‘Professional nurses’, only nurses who have an education in compliance with the Directive 2005/36/EC on 
professional qualifications (i.e. a minimum 3 years for a general nurse) and specialist nurses with an equivalent education (or 
longer). The data reported under the column ‘Practising nurses’, sub-column ‘Professional nurses’ shall correspond to 
Variable 1.4 ‘Practising nurses’ of Regulation (EU) 2022/2294.

The column ‘Associate professional nurses’ can be used by countries for which this category is relevant, to report data. 
Countries, for which this category is not relevant, should report ‘0’.

The data reported under the column ‘Total nurses’, should be equal to the sum of the two above- mentioned categories (i.e. 
Total nurses = professional nurses + associate professional nurses).

FIGURE 3
Example of Nurses variables collected in the questionnaire

In the sheet ‘Hospital Employment’, under the column ‘Professional nurses and midwives employed in hospitals’ countries 
should report the nurses, and midwives, who meet the requirements of Directive 2005/36/EC on the recognition of 
professional qualifications. In the column ‘Associate professional nurses employed in hospitals’, countries, for which this 
category is relevant, can report data. Countries, for which this category is not relevant, should report ‘0’.

In the sheet ‘Graduates’, EU countries shall report in column ‘Nurses’, sub-column ‘Professional’, only nurses graduating with 
an education in compliance with Directive 2005/36/EC (i.e. a minimum 3 years for a general nurse) and specialist nurses with 
an equivalent education (or longer). The data reported shall correspond to Variable 2.5 ‘Number of nursing graduates’ of 
Regulation (EU) 2022/2294.

The column ‘Associate professional nurses’ can be used by countries for which this category is relevant, to report data. 
Countries, for which this category is not relevant, should report ‘0’.

In the column ‘Total nurses’, the sum of the two above-mentioned categories should be reported.

3.2.10.  Practising caring personnel (personal care workers)

Number (headcount)

The category ‘Caring personnel (personal care workers)’ includes:

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•  Healthcare assistants in institutions (ISCO-08 5321).
•  Home-based personal care workers (ISCO-08 5322).

The ISCO-08 definitions are provided to guide the data collection of ‘Caring personnel (personal care workers)’, who 
may also be referred to as “nursing aides” or given other titles in different countries.

These caregivers are not nurses, but they do provide personal care to patients in institutions or at home.

Healthcare assistants (ISCO-08 code: 5321) provide direct personal care and assistance with activities of daily living to 
patients and residents in a variety of healthcare settings such as hospitals, clinics, and residential nursing care facilities 
(HP.2.1). They generally work in implementation of established care plans and practices, and under the direct supervision of 
medical, nursing or other health professionals or associate professionals.

Includes:

•  Nursing aide (clinic or hospital).
•  Patient care assistant.
•  Psychiatric aide.
•  Foreign healthcare assistants practising in the country. 

Excludes:

•  Nurse.

Home-based personal care workers (ISCO-08 code: 5322) provide routine personal care and assistance with activities of daily 
living to persons who are in need of such care due to effects of ageing, illness, injury, or other physical or mental condition in 
private homes and other independent residential settings (institutions are not included).

Includes:

•  Home care aide.
•  Nursing aide (home).
•  Personal care provider.
•  Foreign personal care workers practising in the country.  

Excludes:

•  Nurse.
•  Social worker.

3.2.11.  Professionally active caring personnel (personal care workers)

Number (headcount)

Professionally active caring personnel includes practising caring personnel and other caring personnel for whom their 
education is a prerequisite for the execution of the job.

Includes:

•  Caring personnel providing services directly to patients.
•  Caring personnel working in administration, management, research and in other posts that exclude direct contact with 

patients. 

Excludes:

•  Unemployed caring personnel and retired caring personnel.
•  Caring personnel working abroad.

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3.2.12.  Practising dentists (ISCO-08 code: 2261)

Variable 1.5. Mandatory variable from reference year 2023, number (headcount)

DEFINITION 14

‘Practising dentists’ means persons who have a recognised qualification in dentistry, have a license to 
practice and provide services for patients. Dentists diagnose and treat diseases, injuries and 
malformations of the teeth gums and related oral structures. They restore normal oral function using a 
broad range of treatments, such as surgery and other specialist techniques, and advice on oral health. 
It also refers to interns and resident dentists who have graduated in dentistry from the faculties of 
medicine and dentistry or similar institutions and who provide services under supervision of other 
dentists.

Please refer to Directive 2005/36/EC on the recognition of professional qualifications for the minimum training requirements 
of dentists.

Includes:

•  Practising dentists who have completed studies in dentistry / stomatology at university level (granted by an adequate 

diploma) and who are licensed to practice.

•  Interns (with an adequate diploma and providing services under supervision of other dentists or dental specialists during 

their postgraduate internship in a healthcare facility).

•  Salaried and self-employed dentists delivering services irrespectively of the place of service provision.
•  Foreign dentists licensed to practice and actively practising in the country.
•  Stomatologists.
•  Dental surgeons.
•  Maxillofacial surgeons.  

Excludes:

•  Students who have not yet graduated.
•  Dentists working in administration, research and in other posts that exclude direct contact with the patients.
•  Unemployed dentists and retired dentists.
•  Dentists working abroad.

3.2.13.  Professionally active dentists

Number (headcount)

Professionally active dentists are practising dentists and other dentists for whom their education in dentistry / stomatology 
is a prerequisite for the execution of the job.

Please refer to Directive 2005/36/EC on the recognition of professional qualifications for the minimum training requirements 
of dentists.

Includes:

•  Dentists who provide services for patients.
•  Dentists working in administration and management positions requiring education in dentistry.
•  Dentists conducting research into oral health and dental care.
•  Dentists who participate in public action to maintain or improve standards of oral health and dental care.
•  Dentists preparing scientific papers and reports. 

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Excludes:

•  Dentists who hold a post/job for which education in dentistry is not required.
•  Unemployed dentists and retired dentists.
•  Dentists working abroad.

3.2.14.  Dentists licensed to practice

Number (headcount)

Dentists licensed to practice includes practising and other (non-practising) dentists, who are registered and entitled to 
practice as healthcare professionals in the field of dentistry. They include stomatologists, dental and maxillofacial surgeons.

Please refer to Directive 2005/36/EC on the recognition of professional qualifications for the minimum training requirements 
of dentists.

Includes:

•  Dentists who provide services for patients.
•  Other dentists for whom their education in dentistry / stomatology is a prerequisite for the execution of the job.
•  Other dentists for whom their education in dentistry / stomatology is NOT a prerequisite for the execution of the job.
•  Dentists registered as healthcare professionals and licensed to practice but who are not economically active (e.g. 

unemployed or retired).
•  Dentists working abroad.

3.2.15.  Practising pharmacists (ISCO-08 code: 2262)

Variable 1.6. Mandatory variable from reference year 2023, number (headcount)

DEFINITION 15

‘Practising pharmacists’ means persons who have a recognised qualification in pharmacy and have a 
license to practice. Pharmacists compound and dispense medications following prescriptions issued 
by physicians, dentists, or other authorized health practitioners. Pharmacists prepare, dispense or sell 
medicines and drugs for patients and provide advice.

Please refer to Directive 2005/36/EC on the recognition of professional qualifications for the minimum training requirements 
of pharmacists.

Includes:

•  Practising pharmacists who have completed studies in pharmacy at university level (granted by adequate diploma) and 

who are licensed to practice.

•  Salaried and self-employed pharmacists delivering services irrespectively of the place of service provision.
•  Pharmacists working in hospitals.
•  Foreign pharmacists licensed to practice pharmacy and actively practising in the country. 

Excludes:

•  Students who have not yet graduated.
•  Pharmacists working in administration, research and in other posts that exclude direct contact with the patients.
•  Pharmacists working in the pharmaceutical industry.
•  Unemployed pharmacists and retired pharmacists.
•  Pharmacists working abroad.

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3.2.16.  Professionally active pharmacists

Number (headcount)

Professionally active pharmacists are practising pharmacists and other pharmacists for whom their education in pharmacy is 
a prerequisite for the execution of the job.

Please refer to Directive 2005/36/EC on the recognition of professional qualifications for the minimum training requirements 
of pharmacists.

Includes:

•  Pharmacists who provide services for patients.
•  Pharmacists working in administration and management positions requiring a pharmacy education.
•  Pharmacists conducting research, testing drugs to determine identity, purity and strength.
•  Pharmacists participating in development of controls and regulations.
•  Pharmacists preparing scientific papers and reports. 

Excludes:

•  Pharmacists who hold a post/job for which pharmacy education is not required.
•  Unemployed pharmacists and retired pharmacists.
•  Pharmacists working abroad.

3.2.17.  Pharmacists licensed to practice

Number (headcount)

Pharmacists licensed to practice includes practising and other (non-practising) pharmacists who are registered and entitled 
to practice.

Please refer to Directive 2005/36/EC on the recognition of professional qualifications for the minimum training requirements 
of pharmacists.

Includes:

•  Pharmacists who provide services for patients.
•  Pharmacists for whom their pharmacy education is a prerequisite for the execution of the job.
•  Pharmacists for whom their pharmacy education is NOT a prerequisite for the execution of the job.
•  Pharmacists licensed to practice but who are not economically active (e.g. unemployed or retired).
•  Pharmacists working abroad.

3.2.18.  Practising physiotherapists (ISCO-08 code: 2264)

Number (headcount)

Practising physiotherapists assess, plan and implement rehabilitative programs that improve or restore human motor 
functions, maximize movement ability, relieve pain syndromes, and treat or prevent physical challenges associated with 
injuries, diseases and other impairments. They apply a broad range of physical therapies and techniques such as movement, 
ultrasound, heating, laser and other techniques.

Includes:

•  Geriatric physical therapist.
•  Paediatric physical therapist.
•  Orthopaedic physical therapist.
•  Physiotherapist. 

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Excludes:

•  Podiatrist.
•  Occupational therapist.
•  Acupressure therapist.
•  Hydrotherapist.
•  Massage therapist.
•  Physiotherapy technician.
•  Shiatsu therapist.
•  Chiropractor.
•  Osteopath.

3.2.19.  Total hospital employment

Number (headcount) and number of full-time equivalent (FTE) persons

Total hospital employment covers persons employed in general and specialised hospitals. Includes:

•  Self-employed.
•  Service contracts with non-employed health professionals on treatment of hospital patients (headcounts).

Please refer to Directive 2005/36/EC on the recognition of professional qualifications for the minimum training conditions of 
the relevant staff categories.

The main priority is to collect data on the total number of people working in hospitals on a headcount basis. Data for six 
categories of hospital workers are requested. In addition to headcounts, data are also collected on an FTE basis.

Three methods to convert headcounts into FTE data are proposed below, and national correspondents may choose one of 
them to do the conversion, depending on the availability of detailed data on actual/ usual or contractual hours of work.

•  For countries which have detailed data on actual or usual working hours

Full-time equivalent (FTE) employment should be measured by the number of hours actually or usually worked divided by 
the standard number of hours worked in full-time jobs.

For example: if the standard working hours for a full-time job in the country is 40 hours per week, and the actual or usual 
working hours of a doctor or a nurse in hospital is 30 hours, s(he) should be counted as 0.75 FTE. If s(he) works 50 hours, 
s(he) should be counted as 1.25 FTE.

•  For countries which only have detailed data on contractual working hours

A worker with a full-time employment contract should be counted as 1 FTE. Concerning workers who do not have a 
full-time employment contract, full-time equivalent should be measured by the number of hours of work mentioned in 
each contract divided by the standard number of hours worked in full-time jobs.

For example: if the standard working hours for a full-time job in the country is 40 hours per week, and if the contract of a 
nurse is 30 hours per week, s(he) should be counted as 0.75 FTE.

•  For countries which do not have any detailed information on working hours

A worker with a full-time employment contract should be counted as 1 FTE. Concerning workers with part-time contracts, 
the practice in many countries is simply to consider that 2 part-time workers = 1 FTE.

Breakdowns:

3.2.19.1.  Physicians employed in hospitals

Number of physicians employed by a hospital.

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3.2.19.2.  Professional nurses and midwives employed in hospitals

Number of professional nurses and midwives employed by a hospital. For EU countries, these are nurses and midwives 
fulfilling the requirements of Directive 2005/36/EC on the recognition of professional qualifications.

3.2.19.3.  Associate professional nurses employed in hospitals

Number of associate professional nurses (see definition of associate professional nurses above) employed in a hospital.

Countries, for which this category is not relevant, shall report ‘0’.

3.2.19.4.  Healthcare assistants employed in hospitals (ISCO-08 Code: 5321)

Number of healthcare assistants (ISCO-08 code: 5321) employed by a hospital.

3.2.19.5.  Other health service providers employed in hospitals

Includes:

•  Dentists.
•  Pharmacists.
•  Physiotherapists.
•  Psychologists.
•  Dieticians.
•  Audiologists and speech therapists.
•  Laboratory assistants.
•  Other health professionals and associate professionals.

3.2.19.6.  Other staff employed in hospitals

Other employees not elsewhere classified.

3.2.20.  Medical graduates

Variable 2.1. Mandatory variable from reference year 2021, number (headcount)

DEFINITION 16

‘Medical graduates’ means persons who have graduated in medicine from medical faculties or similar 
institutions in the reporting country, i.e., who have completed basic medical education.

Please refer to Directive 2005/36/EC on the recognition of professional qualifications for the Basic medical training for 
doctors of medicine.

Excludes:

•  Graduates in pharmacy, dentistry / stomatology, public health and epidemiology.
•  Individuals who have completed post-graduate studies or training in medicine.

3.2.21.  Dentist graduates

Variable 2.2. Mandatory variable from reference year 2021, number (headcount)

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DEFINITION 17

‘Dentistry graduates’ means persons who have obtained a recognised qualification in dentistry in the 
reporting country.

Please refer to Directive 2005/36/EC on the recognition of professional qualifications for the Basic dental training of dentists.

3.2.22.  Pharmacist graduates

Variable 2.3. Mandatory variable from reference year 2021, number (headcount)

DEFINITION 18

‘Pharmacy graduates’ means persons who have obtained a recognised qualification in pharmacy in 
the reporting country.

Please refer to Directive 2005/36/EC on the recognition of professional qualifications for the training requirements of 
pharmacists.

3.2.23.  Midwifery graduates

Variable 2.4. Mandatory variable from reference year 2021, number (headcount)

DEFINITION 19

‘Midwifery graduates’ means persons who have obtained a recognised qualification in midwifery in 
the reporting country.

Please refer to Directive 2005/36/EC on the recognition of professional qualifications for the training requirements of 
midwives.

3.2.24.  Nursing graduates

Number of students who have obtained a recognised qualification in nursing in a given year. 

Inclusion:

•  Graduates from an education programme required to become:
•  a professional nurse, including general care and specialist nurse (see definition for professional nurses).
•  an associate professional nurse (see definition for associate professional nurses). 

Exclusion:

•  Graduates from other fields of studies which do not provide a recognised foundation for the practice of nursing.
•  Graduates from a midwifery programme.

Note: If ISCED-2011 code 723 is used for the calculation of this indicator, then graduates from a midwifery programme should 
be subtracted.

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3.2.25.  Professional nursing graduates

Variable 2.5. Mandatory variable from reference year 2021, number (headcount)

DEFINITION 20

‘Nursing graduates’ means persons who have obtained a recognised qualification in nursing in the 
reporting country.

Please refer to Directive 2005/36/EC on the recognition of professional qualifications for the training requirements of nurses.

Excludes:

•  Graduates from other fields of studies which do not provide a recognised qualification for the practice of nursing.
•  Graduates from an associate professional nurse programme.
•  Graduates from a midwifery programme.

Note: In the European Union, a Directive has defined the training of nurses responsible for general care as comprising at least 
three years of study or 4600 hours of theoretical and clinical training, the duration of the theoretical training representing at 
least one-third and the duration of the clinical training at least one half of the minimum duration of the training. Member 
States may grant partial exemptions to persons who have received part of their training on courses which are of at least an 
equivalent level (article 31, Directive 2005/36/EC of the European Parliament and of the Council which has been updated 
with Directive 2013/55/EC and delegated Directive 2024/782/EC).

3.2.26.  Associate professional nursing graduates

Number of students who have obtained a recognised qualification as an associate professional nurse in a given year (see 
definition for “associate professional nurses”).

Exclusion:

•  Graduates from a professional nurse programme.

Countries, for which this category is not relevant, shall report ‘0’.

3.3.  Health workforce migration

The main purpose of this part of the Joint Questionnaire is to improve the monitoring of international health workforce 
migration through the collection of a minimum dataset that is relevant to both countries of origin and destination countries.

The main features of the data collection are that it:

•  focuses on doctors and nurses only.
•  focuses mainly on the place of training (defined as the place of first qualification).
•  collects immigration data from destination countries by all countries of origin, based on available national sources (e.g., 

professional registries, specific surveys of health personnel).

•  collects data based on measures of total stock and annual inflows. 

Data are requested according to the concept:

‘Practising’ (i.e. healthcare professionals directly providing services to patients)

If not possible, the data can be reported for professionally active physicians or physicians licensed to practise. These 
deviations from the preferred concept are to be reported in the metadata.

The number should be at the end of the calendar year.

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For professions regulated under Directive 2005/36/EC on the recognition of professional qualifications, all staff reported in the 
variables below need to meet the requirements of the Directive.

International Organization for Standardization (ISO) codes are embedded in the questionnaire and may be used for 
automated data filling.

Countries which have not submitted data yet are strongly encouraged to look at possible data sources that might be used to 
fill this gap and to provide as much as possible data by countries of origin. The data collection also allows a reporting of the 
overall number of ‘domestic-born but foreign-trained’ doctors and nurses (people born in a country who went to study in 
another country but have come back afterwards to practice in their home country) separately from the ‘foreign-born and 
foreign- trained’. All national correspondents are invited to provide this useful additional information when possible.

3.3.1.  Stock of doctors (physicians) by country of first qualification

Number (headcount) 

Breakdown:

•  Domestically trained doctors.
•  Foreign-trained doctors.
•  of which native-born but foreign-trained.
•  by country of first qualification.
•  Unknown place of training.
•  % of foreign-trained doctors.

Foreign-trained doctors means doctors who have obtained their first medical qualification (degree) in another country and 
are entitled to practice in the receiving country.

Includes:

•  Foreign-trained doctors who have obtained any type of registration to practice in the receiving country.
•  Medical interns and residents who have obtained a medical degree in another country but have not yet obtained a (full) 

registration to practice in the receiving country.

Excludes:

•  Foreign-trained doctors who are registered to practice in the receiving country but are practising in another country 

(temporarily or permanently).

3.3.2.  Annual inflow of foreign-trained doctors

Number (headcount)

Breakdown by country of first qualification

The number of doctors who have obtained their first medical qualification (degree) in another country and are receiving a 
new authorisation in a given year to practice in the receiving country.

Includes:

•  If the source is professional registers (preferred source): Foreign-trained doctors coming in the country under all types of 

registration status (full, temporary, limited, provisional or conditional registration).

•  If the source is working permits delivered to immigrants (possible alternative source): Foreign-trained doctors coming in the 

country under a permanent or temporary working permit.

•  Medical interns and residents who have obtained a medical degree in another country but have not yet obtained a (full) 

registration to practice in the receiving country.

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3.3.3.  Stock of nurses by country of first qualification

Number (headcount) 

Breakdown:

•  Domestically trained nurses.
•  Foreign-trained nurses.
•  of which native-born but foreign-trained.
•  by country of first qualification.
•  Unknown place of training.
•  % of foreign-trained nurses.

The number of nurses who have obtained a recognised qualification in nursing in another country and are working as a 
nurse in the receiving country.

Includes:

•  Foreign-trained nurses who have obtained any type of registration to practice in the receiving country.
•  Nurses who have obtained a recognised qualification in nursing in another country but have not yet obtained a (full) 

registration to practice in the receiving country.

Excludes:

•  Foreign-trained nurses who are registered to practice in the receiving country but are practising in another country 

(temporarily or permanently).

3.3.4.  Annual inflow of foreign-trained nurses by country of first qualification

Number (headcount)

Breakdown by country of first qualification

The number of nurses who have obtained a recognised qualification in nursing in another country and are receiving a new 
authorisation in a given year to practice in the receiving country.

Includes:

•  If the source is professional registers (preferred source): Foreign-trained nurses coming in the country under all types of 

registration status (full, temporary, limited, provisional or conditional registration).

•  If the source is working permits delivered to immigrants (possible alternative source): Foreign-trained nurses coming in the 

country under a permanent or temporary working permit.

3.4.  Physical and technical resources

3.4.1.  Total Hospitals

Number (at the end of the reference year) and Breakdown by sector and classification

DEFINITION 21

‘Hospitals’ means the licensed establishments that are primarily engaged in providing medical, 
diagnostic and treatment services that include physician, nursing and other health services to 
inpatients and the specialised accommodation services required by inpatients and which may also 
provide day care, outpatient and home healthcare services.

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The priority is to collect data on the total number of hospitals. 

Includes (Figure 4):

•  General hospitals (HP .1.1).
•  Mental health hospitals (HP .1.2).
•  Specialised hospitals (other than mental health hospitals) (HP .1.3).

FIGURE 4
Sectors and classifications of hospitals (not mandatory variables)

Breakdown by sector: from paragraph 3.4.1.1. to 3.4.1.3.

3.4.1.1.  Publicly owned hospitals

Hospitals (HP.1) that are owned or controlled by a government unit or another public corporation (where control is defined 
as the ability to determine the general corporate policy).

3.4.1.2.  Not-for-profit privately owned hospitals

Hospitals (HP.1) that are legal or social entities created for the purpose of producing goods and services, whose status does 
not permit them to be a source of income, profit, or other financial gain for the unit(s) that establish, control or finance them.

3.4.1.3.  For-profit privately owned hospitals

Hospitals (HP.1) that are legal entities set up for the purpose of producing goods and services and are capable of generating 
a profit or other financial gain for their owners.

Breakdown by classification (only HP.1.1 is collected):

3.4.1.4.  General hospitals (HP.1.1)

General hospitals (HP.1.1) comprise licensed establishments primarily engaged in providing general diagnostic and medical 
treatment (both surgical and non-surgical) to inpatients with a wide variety of medical conditions. These establishments 

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may provide other services, such as outpatient services, anatomical pathology services, diagnostic X-ray services, clinical 
laboratory services or operating room services for a variety of procedures, and/or pharmacy services, that are usually used by 
internal patients (intermediate outputs within the hospital treatment) but also by outside patients (see A System of Health 
Accounts, 2011 Edition).

Includes:

•  General acute care hospitals.
•  Community, county, and regional hospitals (other than specialised hospitals).
•  Army, veterans, prison and police hospitals if settled in a separate establishment (other than specialised hospitals, e.g. 

forensic hospitals).

•  Teaching hospitals, university hospitals (other than specialised hospitals).
•  General hospitals run by private companies if set up as a separate independent establishment.
•  General hospitals of private non-profit-organisations (e.g. Red Cross or Red Crescent) (other than specialised hospitals).
•  Integrated Community healthcare centres primarily engaged in inpatient service. 

Excludes:

•  Kidney dialysis centres (HP.3.4.4).

Further information

The definition above is based on SHA 2011, which does not mention exclusion criteria. If the reporting country excludes certain 
establishments, this should be clarified in the reference metadata.

3.4.2.  Hospital beds

Average number during the reference period or total number at the end of the reference period.

DEFINITION 22

‘Hospital beds’ means those beds which are regularly maintained and staffed and immediately 
available for the care of admitted patients. Both occupied and unoccupied beds are included in this 
concept. Excluded are recovery trolleys and beds for same day care (day case care and outpatient 
care), provisional and temporary beds. Hospital beds can be partitioned by category of care 
(definitions 23 and 24) and by function (definitions 25 - definition 28) of care.

The concept seeks information on the operational capacity of hospital beds, the immediately available beds. The annual 
average number gives a more stable indication of capacity, as it avoids peaks. If the total number at the end of the reference 
period is given, it can be any representative day in the last month of the reference period, to be mentioned in the national 
reference metadata. 

Includes:

•  Beds in all hospitals, including general hospitals (HP.1.1), mental health hospitals (HP.1.2), and other specialised hospitals 

(HP.1.3).

•  Occupied and unoccupied beds. 

Excludes:

•  Surgical tables, recovery trolleys, emergency stretchers, beds for same-day care, cots for healthy infants.
•  Beds in wards which were closed for any reason.
•  Provisional and temporary beds.
•  Beds in residential long-term care facilities (HP.2).

Hospital beds are allocated to two main care categories, for which data are collected (Figure 5):

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•  Somatic care beds (Variable 3.1).
•  Psychiatric care beds (Variable 3.2).

DEFINITION 23

‘Somatic care’ means healthcare relating to the body, as distinguished from psychiatric care.

DEFINITION 24

‘Psychiatric care’ means healthcare concerning the mind, e.g. dealing with mental and behavioural 
disorders.

Each category has a breakdown by function. The breakdown by function is mandatory for somatic care beds. Psychiatric 
care beds split by function are voluntary variables.

•  Curative (acute) care beds.
•  Rehabilitative care beds.
•  Long-term care beds.
•  Other hospital beds.

FIGURE 5
Breakdown of hospital beds 
Note that fields in grey indicate non-mandatory variables.

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This is consistent with the System of Health Accounts (SHA)  classification that is used internationally to collect data on 
hospital expenditure.

The functions are defined as follows.

Curative (acute) care beds

DEFINITION 25

‘Curative care’ means the healthcare services during which the principal intent is to relieve symptoms 
or to reduce the severity of an illness or injury, or to protect against its exacerbation or complication 
that could threaten life or normal function.

Curative care (acute care) beds in hospitals (HP.1) are hospital beds that are available for curative care (HC.1 in the SHA 
classification).

Includes:

•  Beds in all hospitals, including general hospitals (HP.1.1), mental health hospitals (HP.1.2) and other specialised hospitals 

(HP.1.3).

•  Beds accommodating patients where the principal clinical intent is to do one or more of the following: manage labour 
(obstetrics), cure illness or provide definitive treatment of injury, perform surgery, relieve symptoms of illness or injury 
(excluding palliative care), reduce severity of illness or injury, protect against exacerbation and/or complication of illness 
and/or injury which could threaten life or normal functions, perform diagnostic or therapeutic procedures.

•  Beds for somatic curative (acute) care and psychiatric curative (acute) care. 

Excludes:

•  Beds allocated for other functions of care (such as rehabilitation, long-term care and palliative care).

Rehabilitative care beds

DEFINITION 26

‘Rehabilitative care’ means the services to stabilise, improve or restore impaired body functions and 
structures, compensate for the absence or loss of body functions and structures, improve activities 
and participation and prevent impairments, medical complications and risks.

Rehabilitative care beds in hospitals (HP.1) are hospital beds that are available for rehabilitative care (HC.2 in the SHA 
classification).

Includes:

•  Beds in all hospitals, including general hospitals (HP.1.1), mental health hospitals (HP.1.2) and other specialised hospitals 

(HP.1.3).

•  Beds accommodating patients for services with the main intent to stabilise, improve or restore impaired body functions 
and structures, compensate for the absence or loss of body functions and structures, improve activities and participation 
and prevent impairments, medical complications and risks.

•  Beds for somatic rehabilitative care and psychiatric rehabilitative care. 

Excludes:

•  Beds allocated for other functions of care (such as curative care, long-term care and palliative care).

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Long-term care beds

DEFINITION 27

‘Long-term care (health)’ means the range of medical and personal care services that are consumed 
with the primary goal of alleviating pain and suffering and reducing or managing the deterioration in 
health status in patients with a degree of long-term dependency.

Long-term care beds in hospitals (HP.1) are hospital beds accommodating patients requiring long-term care (HC.3 in the SHA 
classification).

Includes:

•  Beds in long-term care departments of general hospitals (HP.1.1), mental health hospitals (HP.1.2) and other specialised 

hospitals (HP.1.3).

•  Beds for somatic long-term care and psychiatric long-term care.
•  Beds for palliative care. 

Excludes:

•  Beds allocated for other functions of care (such as curative care and rehabilitation).

Other hospital beds, function not elsewhere classified.

DEFINITION 28

‘Hospital beds for somatic care with function not elsewhere classified’ means beds in hospitals that 
are not classified as being for curative care, rehabilitative care or long-term care.

All other beds in hospitals (HP.1) not elsewhere classified. If this category is not relevant, i.e. if there are no beds not 
elsewhere classified, please report 0 (zero).

Includes:

•  Beds for other healthcare services not elsewhere classified.

3.4.2.1.  Number of hospital beds for somatic care

Variable 3.1. Mandatory variable from reference year 2021, average number during the reference period or total 
number at the end of the reference period.

Breakdown by function – mandatory variables:

•  ‘Curative care hospital beds for somatic care’ means beds in hospitals that are available for curative somatic care.
•  ‘Rehabilitative care beds for somatic care’ means beds in hospitals that are available for rehabilitative somatic care.
•  ‘Long-term care beds for somatic care’ means beds in hospitals that accommodate patients requiring somatic long-term care.
•  Other hospital beds, function not elsewhere classified. 

Includes:

•  Beds for somatic/physical care in general hospitals (HP.1.1) and specialised hospitals (other than mental health hospitals) 

(HP.1.3).

Excludes:

•  All beds in mental health hospitals (HP.1.2).
•  Beds in psychiatric departments of general hospitals (HP.1.1) and specialised hospitals (other than mental health hospitals) 

(HP.1.3).

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3.4.2.2.  Number of hospital beds for psychiatric care

Variable 3.2. Mandatory variable from reference year 2021, average number during the reference period or total 
number at the end of the reference period.

DEFINITION 29

‘Hospital beds for psychiatric care’ means beds in hospitals accommodating patients with mental 
health problems. Beds for social long-term care shall be excluded.

Breakdown by function – non-mandatory variables:

•  Curative (acute) care beds for psychiatric care.
•  Rehabilitative care beds for psychiatric care.
•  Long-term care beds for psychiatric care.
•  Other hospital beds for psychiatric care. 

Includes:

•  All beds in mental health hospitals (HP.1.2).
•  Beds in psychiatric departments of general hospitals (HP.1.1) and specialised hospitals (other than mental health hospitals) 

(HP.1.3).

Excludes:

•  Beds for social long-term care.
•  Beds for somatic/physical care in general hospitals (HP.1.1) and specialised hospitals (other than mental health hospitals) 

(HP.1.3).

3.4.3.  Total hospital beds; breakdown by sector

Average number of available beds over the year (where possible).

Total hospital beds (see definition 22 above) are the sum of the following categories:

•  Beds in publicly owned hospitals.
•  Beds in not-for-profit privately owned hospitals.
•  Beds in for-profit privately owned hospitals.

The sectors are defined as follows.

3.4.3.1.  Beds in publicly owned hospitals

Beds in hospitals that are owned or controlled by a government unit or another public corporation (where control is defined 
as the ability to determine the general corporate policy).

3.4.3.2.  Beds in not-for-profit privately owned hospitals

Beds in hospitals that are legal or social entities created for the purpose of producing goods and services, whose status does 
not permit them to be a source of income, profit, or other financial gain for the unit(s) that establish, control or finance them.

3.4.3.3.  Beds in for-profit privately owned hospitals

Beds in hospitals that are legal entities set up for the purpose of producing goods and services and are capable of 
generating a profit or other financial gain for their owners.

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3.4.4.  Intensive care unit (ICU) beds and occupancy

This section concerns the data collection on intensive care resources and use, variables introduced in 2021.

Although the inclusion was driven by the Covid-19 pandemic, this data collection is not restricted to Covid-19 beds and 
patients; it should cover all ICUs (for any patients needing intensive care).

The statistics collected are based on definitions proposed by the World Federation of Societies of Intensive and Critical Care 
Medicine. An intensive care unit (ICU) is an organized system for the provision of care to critically ill patients that provides 
intensive and specialised medical and nursing care, an enhanced capacity for monitoring, and multiple modalities of 
physiologic organ support to sustain life during a period of acute organ system insufficiency. Although an ICU is based in a 
defined geographic area of a hospital, its activities often extend beyond the walls of the physical space to include the 
emergency department, hospital ward, and follow-up clinic (3).

What sets intensive care apart from other clinical care in hospitals is the reference to the critical condition of patients 
requiring a higher level of care in terms of staffing ratios, equipment, and severity of case. The World Federation of Societies 
of Intensive and Critical Care Medicine proposes a classification of ICUs in three levels (primary, secondary and tertiary) based 
on a number of criteria, such as the staffing to patient ratio, or type of respiratory support equipment. Detailed information 
for defining ICUs are available in Table 3.

TABLE 3
Classification of Intensive Care Units, Level 1-3.

Level 1

Level 2

Level 3

Therapeutic 
capacity

Personnel

Physiologic stabilization and 
short-term support of mild 
organ dysfunction

Basic support of failing organ 
function

Physicians with some 
experience in critical care 
available at least during the 
day

Physicians with ICU training or 
comparable experience 
present during day and 
available at night

Experienced nurses provide 
24/7 care

Nurses have extra training or 
comparable experience in 
critical care and provide 24/7 
care

Complex, comprehensive 
support and management of 
organ dysfunction

Physicians with formal ICU 
training on call 24/7; 
immediate in-hospital 
availability of medical staff 
with ICU experience

Nursing staff with specialist 
ICU training provide 24/7 care

Other personnel available

Variable inclusion of allied 
health personnel—respiratory 
therapists, physiotherapists, 
dieticians, pharmacists, etc.—
as part of ICU care team

Allied health personnel—
respiratory therapists, 
physiotherapists, pharmacists, 
dieticians, etc.—as regular 
members of ICU team

Nurse-patient ratio higher 
than on ward; preferably 1:4 
or 1:3 (1 nurse for 4 patients)

Nurse-patient ratio appropriate 
to patient needs but usually no 
less than 1:3

Nurse-patient ratio appropriate 
to patient needs and no less 
than 1:2

(3)  Marshall et al. (2017), What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine, 

Journal of Critical Care.

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Level 1

Level 2

Level 3

Daily rounds; ad hoc 
structure

Formal daily ICU rounds with 
physicians and nurses

Variable engagement in 
critical care continuing 
professional education

Variable access to other 
medical specialties in 
hospital

Non-invasive or minimally 
invasive monitoring—
transcutaneous oxygen 
saturation, cardiac 
monitoring, urine output

Monitoring 
capacity

Unit design and 
organ support

Dedicated geographic area

Capacity for oxygen therapy 
and non- invasive respiratory 
support

Formal multidisciplinary ICU 
rounds daily and as needed 
based on patient complexity 
and acuity

Regular engagement in 
continuing medical/nursing 
education

Engagement in continuing 
professional education

Ready access to respirologists, 
nephrologists, cardiologists, 
infectious disease specialists, 
general surgeons

Rapid access to and variable 
engagement of full 
complement of medical and 
surgical consultant specialists

Invasive monitoring of blood 
pressure and central venous 
pressures as dictated by 
patient status

Blood gas analyser 
immediately available

Dedicated geographic area 
with central monitoring station

Basic mechanical ventilatory 
support, pharmacologic 
support of cardiovascular 
function, intermittent renal 
replacement therapy, 
parenteral nutrition

Advanced hemodynamic 
monitoring (cardiac 
catheterization, 
ultrasonography, etc.); 
advanced monitoring of 
pulmonary, cerebral, and other 
physiology as directed by 
clinical needs

Blood gas analyser and stat lab 
associated with ICU

Dedicated geographic area 
with individual patient care 
areas and central monitoring 
station

Advanced ventilator and 
hemodynamic support, 
continuous renal replacement 
therapy, capacity for 
tracheostomy and other basic 
surgical procedures

Capacity for isolation of 
patients needing contact or 
airborne precautions

Outreach team(s), integration 
with step-down or high-
dependency unit; close 
collaboration with emergency 
department

Formal educational programs 
for staff

Integration 
within the 
hospital

Defined geographic area 
only

Ad hoc interactions with other 
acute care areas such as 
emergency department

Research and 
education

Ad hoc activity

Organized educational 
activities for staff

Basic quality improvement 
program

Formal quality improvement 
program

Formal quality improvement 
program

Ad hoc engagement in clinical 
research

Active involvement in clinical 
research

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Level 1

Level 2

Level 3

Responsiveness 
to regional and 
societal needs

Ad hoc only, but available 
and responsive in event of 
disaster

Serves as resource for critically 
ill patients within hospital

Formal policy outlining 
criteria for patient transfer to 
higher level ICU

Training of residents and 
fellows as available

Referral resource for 
community and district 
hospitals and for other ICUs

Disaster preparedness plan 
and capacity

3.4.4.3.1.  Intensive care unit beds

Average number of available beds over the year (or number on an annual fixed date). For adult ICU and critical care 
adult beds, the maximum number is also sought.

Breakdown and characteristics:

•  Total ICU beds (covering all adult, neonatal and paediatric ICU beds).
•  Total adult ICU beds (providing intensive care of Levels 1 to 3). 
•  Of which: critical care adult beds (Levels 2 and 3).
•  Total neonatal ICU beds.
•  Total paediatric ICU beds.

3.4.4.3.2.  Intensive care unit use

These variables focus on adults but if the breakdown between adults and children is not available, total (adult + neonatal + 
paediatric) bed-days/occupancy would be accepted (with a note in the metadata).

3.4.4.3.2.1.  Total adult ICU bed-days

Number of days during which adult ICU beds were effectively occupied by inpatients.

3.4.4.3.2.2.  Total adult ICU occupancy rate

Average occupancy rate and maximum daily occupancy rate (%)

The average occupancy rate is calculated as the number of ICU beds actually occupied (bed-days) for intensive care divided 
by the number of ICU beds available (at any one time) multiplied by 365 days. The ratio is multiplied by 100.

3.4.4.3.2.3.  Number of days with ICU occupancy rate over 80% and over 95% during the year

Number between 0 and 365.

3.4.5.  Beds in residential long-term care facilities (Nursing beds)

Variable 3.3. Mandatory variable from reference year 2021, average number during the reference period or total 
number at the end of the reference period.

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DEFINITION 30

‘Residential long-term care facilities’ means the establishments that are primarily engaged in 
providing residential long-term care that combines nursing, supervisory or other types of care as 
required by the residents, where a significant part of the production process and the care provided is a 
mix of health and social services with the health services being largely at the level of nursing care in 
combination with personal care services.

DEFINITION 31

‘Beds in residential long-term care facilities’ means beds in residential long-term care facilities that 
are available to persons requiring long-term care.

Includes:

•  Long-term nursing care facilities (HP.2.1).
•  Other residential long-term care facilities (HP.2.9). 

Excludes:

•  Beds in hospitals (HP.1) dedicated to long-term care.
•  Beds in residential settings such as adapted housing that can be considered as people’s home.
•  Beds in HP.2.2 establishments.

3.4.6.  Medical technology

The data collection on medical technology includes six types of diagnostic and therapeutic technologies. Two of those are 
mandatory variables; Number of MRI units (total number) and Number of CT scanners (total numbers) (Figure 6).

Characteristics and breakdowns:

•  Total number at the end of the reference period.
•  Total number of equipment in all healthcare facilities.
•  Breakdown by sector; hospitals (HP.1) and providers of ambulatory care (HP.3 and HP.4.2). If only one of the sectors 

‘hospitals’ or ‘ambulatory care’ of the breakdown is available, please add it in the corresponding column in the reporting 
questionnaire.

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FIGURE 6
Breakdown of Medical Technology 
Note that fields in grey indicate non-mandatory variables.

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Classifications (Definitions)

3.4.6.1.  Magnetic resonance imaging units

Variable 4.1. Mandatory variable from reference year 2021, total number at the end of the reference period.

DEFINITION 32

‘Magnetic resonance imaging (MRI) units’ means machines with an imaging technique designed to 
visualise internal structures of the body using magnetic and electromagnetic fields which induce a 
resonance effect of hydrogen atoms. The electromagnetic emission created by these atoms is 
registered and processed by a dedicated computer to produce the images of the body structures.

3.4.6.2.  Computed tomography scanners

Variable 4.2. Mandatory variable from reference year 2021, total number at the end of the reference period.

DEFINITION 33

‘Computed tomography (CT) scanner’, also known as Computerized axial tomography (CAT) scanner, 
means an x-ray machine which combines many x-ray images with the aid of a computer to generate 
cross-sectional views and, if needed, three-dimensional images of the internal organs and structures 
of the body.

Excludes:

•  Single Photon Emission Computed Tomography (SPECT).

3.4.6.3.  Positron emission tomography scanners

Number of Positron Emission Tomography scanner units (PET units)

PET is a highly specialised imaging technique using short-lived radioacute substances. This technique produces three-
dimensional images which are used mainly for the assessment of cancer spread in a patient’s body.

Includes:

•  PET-CT systems using image fusion (superposition of CT and PET images).

3.4.6.4.  Gamma cameras

Number of Gamma cameras

A Gamma camera (including Single Photon Emission Computed Tomography, SPECT) is used for a nuclear medicine 
procedure in which the camera rotates around the patient to register gamma ray emission from an isotope injected to the 
patient’s body. The gathered data are processed by a computer to form a tomographic (cross-sectional) image.

Includes:

•  SPECT-CT systems using image fusion (superposition of SPECT and CT images).

3.4.6.5.  Mammographs

Number of dedicated mammography machines (those designed exclusively for taking mammograms). The code is 
ICD-9 87.37.

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3.4.6.6.  Radiation therapy equipment

Number of machines used for treatment with x-rays or radionuclide.

They include linear accelerators, Cobalt-60 units, Caesium-137 therapy units, low to orthovoltage x-ray units, high dose and 
low dose rate brachytherapy units and conventional brachytherapy units.

3.5.  Health Activities

3.5.1.  Ambulatory care

DEFINITION 34

‘Ambulatory care’ means the provision of healthcare services directly to outpatients who do not 
require inpatient services, including both care provided in offices of general medical practitioners and 
medical specialists and in establishments specialising in the treatment of day cases and in the delivery 
of home care services.

3.5.1.1.  Total doctor consultations (including teleconsultations)

Number per capita

Average number of consultations/visits with a physician per person per year. 

Includes:

•  Consultations/visits both to generalist and specialist medical practitioners.
•  Consultations/visits at the physician’s office.
•  Consultations/visits in the patient’s home.
•  Consultations/visits in outpatient departments in hospital and ambulatory health care centres.
•  Teleconsultations (see definition below). 

Excludes:

•  Visits for prescribed laboratory tests.
•  Visits to perform prescribed and scheduled treatment procedures, e.g. injections, physiotherapy etc.
•  Visits to dentists.
•  Visits to nurses.
•  Consultations during an inpatient stay or a day care treatment.

Note: If the source is administrative data, the rate should be calculated based on the average annual population.

3.5.1.1.1.  Doctor consultations (in-person)

Number per capita

Average number of in-person consultations/visits with a physician per person per year. 

Includes:

•  In-person consultations/visits both to generalist and specialist medical practitioners.
•  In-person consultations/visits at the physician’s office.
•  In-person consultations/visits in the patient’s home.
•  In-person consultations/visits in outpatient departments in hospital and ambulatory health care centres. 

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Excludes:

•  Teleconsultations.
•  Telephone and email contacts.
•  Visits for prescribed laboratory tests.
•  Visits to perform prescribed and scheduled treatment procedures, e.g. injections, physiotherapy etc.
•  Visits to dentists.
•  Visits to nurses.
•  Consultations during an inpatient stay or a day care treatment.

Note: If the source is administrative data, the rate should be calculated based on the average annual population.

3.5.1.1.2.  Doctor teleconsultations 

‘Teleconsultations with doctors’ refer to interactive telemedicine which involves direct and synchronous communication 
between providers and patients. However, a teleconsultation may also include aspects of telemonitoring (use of mobile 
devices and platforms, e.g. to conduct routine medical tests, etc.) or store and forward (as telemonitoring, but used for 
clinical data that are less time-sensitive and for which a delay between transmission and response is acceptable). 
Teleconsultations can involve public or private providers, and are regardless of the specific technology used (e.g. PC, tablet, 
fixed or mobile phone, etc.).

Number per capita

Average number of teleconsultations with a physician per person per year. 

Includes:

•  Teleconsultations with generalist and specialist medical practitioners.
•  Teleconsultations “direct-to-patient” or in dedicated facilities/GP practices where patients can access teleconsultations. 

Excludes:

•  Interventions that facilitate medical education of health care workers (e.g. physicians, nurses, etc.) at a distance via ICTs 

(e.g. tele-education or e-learning).

•  Mobile applications that do not involve any transfer of data or any patient-to-provider communication, such as self-care 

and wellness mobile applications.

•  Any intervention that does not involve clinical services, such as public health awareness campaigns. 
•  Provider-to-provider communications (sometimes called eConsults) that do not involve the patient. 
•  Teleconsultations with other health care workers (e.g. nurses, dentists, etc.).

Background

This section concerns the data collection on number of teleconsultations with a doctor.

In the context of the Covid-19 crisis, the use of telemedicine increased significantly. The previous definition for doctor 
consultations explicitly excluded telephone and email contacts, and by inference also any web-based contacts. The data 
collection on Teleconsultations aimed to fill this data gap. 

The broad concept of telemedicine is the use of Information and Communication Technologies (ICTs) to deliver health care 
at a distance.

Key elements of telemedicine are: the use of ICTs, the delivery of clinical services, and the delivery at a distance.

Three categories of telemedicine can be considered:

•  Telemonitoring is the use of mobile devices and platforms to conduct routine medical tests, communicate the results to 

healthcare workers in real-time, and potentially launch pre-programmed automated responses.

•  Store and forward is similar but is used for clinical data that are less time-sensitive and for which a delay between 

transmission and response is acceptable (e.g. store and forward is widely used in dermatology).

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•  Interactive telemedicine involves direct and synchronous communication between providers and patients (e.g. 

direct-to-patient or in healthcare facilities).

Teleconsultations refers to this third category of interactive telemedicine. However, a teleconsultation may also 
include aspects of the first two categories. This can involve public or private providers, and is regardless of the specific 
technology used (e.g. PC, tablet, fixed or mobile phone, etc.).

3.5.1.2.  Dentist consultations (in-person)

Number per capita

Average number of in-person consultations/visits with a dentist per person per year. 

Includes:

•  In-person consultations/visits with an orthodontist.
•  In-person consultations/visits with a stomatologist/dental/maxillofacial surgeon.
•  In-person consultations/visits at the dentist’s office.
•  In-person consultations/visits in the patient’s home.
•  In-person consultations/visits in outpatient departments in hospital and ambulatory health care centres.

Excludes:

•  Telephone and email contacts.
•  Visits for prescribed laboratory tests.
•  Consultations during an inpatient stay or a day care treatment.

Note: If the source is administrative data, the rate should be calculated based on the average annual population.

3.5.1.3.  Immunisation against influenza

Variable 5.1. Mandatory variable from reference year 2021

Rate of people aged 65 and older who have been immunised against influenza (%)

DEFINITION 35

‘Immunisation against influenza’ means vaccination that protects against infection by influenza 
viruses.

The rate is calculated as:

Number of people aged 65 and over who have been immunised against influenza during the reference period divided by 
the average annual population aged 65 and over.

or

Number people aged 65 and over who have been immunised against influenza for the influenza season, defined as July 1 to 
June 30, which ended in the reference period divided by the population aged 65 and over in the beginning of the reference 
period.

3.5.1.4.  Breast cancer screening

The data collection on breast cancer (mammography) screening includes a breakdown between survey data and 
programme-based data. Countries are invited to transmit both survey data and programme data when these two sources 
are available.

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3.5.1.4.1.  Breast cancer screening, survey-based data

Rate of women aged between 50 and 69 screened against breast cancer (%)

The rate is calculated as: Number of women aged 50-69 who have received a bilateral mammography within the past two 
years (or according to the specific screening frequency recommended in each country) divided by the number of women 
aged 50-69 answering survey questions on mammography.

3.5.1.4.2.  Breast cancer screening, programme-based data

Variable 5.2. Mandatory variable from reference year 2021

Rate of women aged between 50 and 69 screened against breast cancer within a national screening programme 
(%)

DEFINITION 36

‘Breast cancer screening (mammography) programme’ means an organised screening programme 
intended for the early detection of breast cancer using bilateral mammography.

The rate is calculated as: number of women aged 50-69 who have been screened against breast cancer within a national 
screening programme within 24 months before the end of the reference period (or according to the specific screening 
frequency recommended in each country) divided by the number of women aged 50-69 eligible for an organised screening 
programme. 

If a country does not have such programmes, it will deliver no value with an appropriate flag instead of the rate. A country 
that has regional programmes that together cover the whole country can combine the data to produce national statistics.

More information

Women with unilateral mastectomy can also be invited to the screening programme and be screened. In this case, the definition 
could be interpreted as a programme ‘offering bilateral mammography’, even if unilateral is done.

3.5.1.5.  Cervical cancer screening

The data collection on cervical cancer screening includes a breakdown between survey data and programme-based data. 
Countries are invited to transmit both survey data and programme data when these two sources are available.

3.5.1.5.1.  Cervical cancer screening, survey-based data

Rate of women aged 20-69 screened against cervical cancer (%)

The rate is calculated as: Number of women aged 20-69 who have been screened for cervical cancer within the past three 
years (or according to the specific screening frequency recommended in each country) divided by the number of women 
aged 20-69 answering the survey question.

3.5.1.5.2.  Cervical cancer screening, programme-based data

Variable 5.3. Mandatory variable from reference year 2021

Rate of women aged between 20 and 69 screened against cervical cancer within a national screening 
programme

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DEFINITION 37

‘Cervical cancer screening programme’ means an organised screening programme intended for the 
early detection of cervical cancer.

The rate is calculated as: number of women aged 20-69 who have been screened for cervical cancer within a national 
screening programme within 36 months before the end of the reference period (or according to the specific screening 
frequency recommended in each country) divided by the number of women aged 20-69 eligible for an organised screening 
programme.

If a country does not have such programmes, it will deliver no value with an appropriate flag instead of the rate. A country 
that has regional programmes that together cover the whole country can combine the data to produce national statistics.

3.5.1.6.  Colorectal cancer screening

The data collection concerns the proportion of target population who have undergone colorectal cancer screening based 
on the country’s colorectal cancer screening policy, which defines among others, the target age range and the screening 
method and interval.

Breakdowns:

Programme data and survey data are collected for male, female and total of both sexes. 

Excludes:

•  Persons who underwent follow-up colorectal cancer tests based on the positive result of initial colorectal cancer screening 

test are excluded from the numerator and denominator for both indicators.

If countries provide multiple screening methods as the initial colorectal cancer screening tests or use different screening 
intervals for different target age groups, they are asked to take account of differences in screening intervals specified for each 
method or target age group to calculate the indicators, as much as possible. For example, if multiple screening methods are 
available, countries can provide data such as the weighted average of the proportion of regular participants to the stool-
based tests for blood over several rounds of screening and the proportion of target population who underwent an 
endoscopic screening over the same period.

3.5.1.6.1.  Colorectal cancer screening rate, survey-based data: 

Rate of female/male/total population screened against colorectal cancer (%) The rate is calculated as follows:

Numerator: the number of survey respondents who had the initial screening test specified in the country’s colorectal cancer 
screening policy during the period specified in the policy.

Denominator: the number of survey respondents who were eligible for the initial screening test specified in the country’s 
colorectal screening policy during the period specified in the policy. Survey respondents who did not answer survey 
questions on whether s/he has undergone a colorectal cancer screening test should be excluded from the denominator.

3.5.1.6.2.  Colorectal cancer screening rate, programme-based data: 

Rate of female/male/total population screened against colorectal cancer (%) The rate is calculated as follows:

Numerator: the number of target population who had the initial screening test specified in the country’s colorectal cancer 
screening programme during the period specified in the screening programme.

Denominator: the number of target population who were eligible for the initial screening test specified in the country’s 
colorectal cancer screening programme during the period specified in the screening programme.

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Classifications (Definitions)

3.5.2.  Hospital Care (includes Hospital aggregates)

In the Hospital Care section, aggregated and disaggregated data on total hospital activities are collected, including a specific 
focus on curative care for some indicators (Table 4). This data collection also serves to collect some aggregate indicators that 
can be used in analysis of hospital efficiency or utilisation rate (e.g. occupancy rates of hospital beds).

TABLE 4
Description of variables of Hospital care

Variable

Breakdown

Transmission format

Status

6.1. Number of hospital 
inpatient discharges

6.2. Number of hospital 
inpatient bed-days

6.3. Number of hospital 
day case discharges

Inpatient care

Total number during the reference period. 
Breakdown by diagnosis, sex, age group 
and geographical dimension.

Total number during the reference period. 
Breakdown by diagnosis, sex, age group 
and geographical dimension.

Total number during the reference period  
Breakdown by diagnosis, sex, age group 
and geographical dimension.

Discharges and Average Length of Stay 
(ALOS)

Inpatient Curative acute 
care

Discharges, bed-days, ALOS and 
occupancy rate

Disaggregated data HDD 
Csv file

Mandatory from 
reference year 2023

Disaggregated data HDD 
Csv file

Mandatory from 
reference year 2023

Disaggregated data HDD 
Csv file

Mandatory from 
reference year 2023

Aggregate

Voluntary

Health Care Activities 
Excel reporting 
questionnaire

Aggregate

See Figure 8

Health Care Activities 
Excel reporting 
questionnaire

DEFINITION 38

‘Inpatient’ means a patient who receives treatment and/or care in a healthcare facility, who is formally 
admitted and who requires an overnight stay. ‘Inpatient care’ means the care of an inpatient.

DEFINITION 40

‘Day case’ means a patient who receives planned medical and paramedical services delivered in a 
healthcare facility and who is formally admitted for diagnosis, treatment or other types of healthcare 
and is discharged on the same day. ‘Day care’ is the care of a day case.

More information

Eurostat is aware that countries are identifying/defining ‘Day cases’ differently. Please be specific in the metadata on what is 
reported as inpatients and as day cases, respectively, to facilitate the validation.

Hospital discharges should cover all hospitals (HP.1). They should include deaths in hospital and transfers to another hospital, 
but exclude transfers to other care units within a same hospital.

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Countries using hospital treatment episodes as individual record units (i.e. when patients are transferred among 
departments in the same hospital, each transfer is recorded as a new admission/discharge) should make an effort to merge 
related episodes into one discharge record in order to make the data internationally comparable.

In accordance with the International Classification of Diseases (ICD), it is recommended that the main diagnosis be defined as 
the condition diagnosed at the end of the hospitalisation period, primarily responsible for the patient’s need for treatment or 
examination at the hospital. If there is more than one such condition, the one held responsible for the greatest use of 
resources should be selected. If no diagnosis was made, the main symptom, abnormal finding or problem should be 
selected as the main diagnosis.

To avoid double counting, countries submitting data according to the ICD-10 3-character classification must exclude codes 
related to the ‘external causes of morbidity and mortality’ (Chapter 20 in ICD-10 covering V, W, X and Y codes). For the 
countries using the International Shortlist for Hospital Morbidity Tabulation (ISHMT), these codes are not included in the 
code list. Discharges with unknown diagnosis should be allocated to ISHMT code 1803 (or ICD-10 code R69).

In 2022, a new group (2200) was added to the ISHMT list based on ICD-10 codes U00-U49 (‘Provisional assignment of new 
diseases of uncertain etiology or emergency use’), especially to take into account Covid-19 cases. 

From reference year 2023, inpatient discharges and day case discharges must include the geographical dimension ‘NUTS2 
region of the residence of the discharged patient’. For non-resident patients, the country of residence must be provided. 

DEFINITION 44

‘Resident’ means a usual resident of a geographical area, that is either (i) a person who has lived in 
his/her place of usual residence for a continuous period of at least 12 months before the reference 
date; or (ii) a person who arrived in his/her place of usual residence during the 12 months before the 
reference date with the intention of staying there for at least 1 year. Where the circumstances 
described in point (i) or (ii) cannot be established, ‘usual residence’ shall mean the place of legal or 
registered residence.

DEFINITION 45

‘Non-resident’ means a person who is not a resident of the reporting country.

3.5.2.1.  Hospital inpatient discharges and hospital inpatient bed-days

Variable 6.1. Total number of hospital inpatient discharges during the reference period Variable 6.2. Total 
number of hospital inpatient bed-days during the reference period. Mandatory from reference year 2023.

Characteristics and breakdowns:

•  Diagnosis by International Classification of Diseases (ICD-10) or International Shortlist for Hospital Morbidity Tabulation 

(ISHMT) code. Mental and behavioural disorders do not need to be broken down by diagnosis and can be delivered as a 
group.

•  Sex: male/female.

DEFINITION 39

‘Outpatient’ means a patient who receives medical and ancillary services in a healthcare facility and 
who is not formally admitted and does not stay overnight. ‘Outpatient care’ means the care of an 
outpatient.

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•  Age group: less than 1, 1-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 

75-79, 80-84, 85-89, 90-94, 95 and older.

•  Geographical dimension: from reference year 2023: NUTS2 region of the residence of the discharged patient (for non-

residents: country of residence).

DEFINITION 41

‘Hospital inpatient discharge’ means the discharge (formal release) of an inpatient from a hospital. 
Healthy newborns shall be excluded.

DEFINITION 42

‘Hospital inpatient bed-days’ means the days that an inpatient spends in a hospital. Healthy 
newborns shall be excluded.

Includes:

•  Discharges and bed-days from all hospitals (HP.1), including general hospitals (HP.1.1), mental health hospitals (HP.1.2), and 

other specialised hospitals (HP.1.3).

•  Emergency cases and urgent admissions when they resulted in a formal admission and an overnight stay.
•  Patients admitted as day-care patients but who have been retained overnight due to complication.
•  Deaths in hospital.
•  Transfers to another hospital.

The number of bed-days should be counted as the date of discharge minus the date of admission (for example, a patient 
admitted on the 25th and discharged on the 26th should be counted as 1 day).

Cases which are formally admitted but not staying one night (zero-night cases), should count as inpatients of 1 day. This may 
be the case when a patient dies on the same day of formal admittance.

Same day separations of inpatient cases (e.g. inpatients who die or are transferred to another hospital on the day of their 
admission) should be included in the number of discharges. The corresponding number of bed-days should be set to 1 day.

Excludes:

•  Transfers to other care units within the same hospital.
•  Discharges of healthy newborns in the group ‘Liveborn infants according to place of birth’ (ISHMT – code 2103 or ICD-10 3 

code Z38).
•  Day cases.
•  Outpatient cases (including emergency department visits).

3.5.2.2.  Hospital day case discharges

Variable 6.3. Total number during reference period. Mandatory variable from reference year 2023.

DEFINITION 43

‘Hospital day case discharge’ means the discharge of a day case. It is the release of a patient who was 
formally admitted in a hospital for receiving planned medical and paramedical services, and who was 
discharged on the same day. Healthy newborns shall be excluded.

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Characteristics and breakdowns:

•  Diagnosis by International Classification of Diseases (ICD-10) codes or International Shortlist for Hospital Morbidity 

Tabulation (ISHMT) codes. Mental and behavioural disorders do not need to be broken down by diagnosis and can be 
delivered as a group.

•  Sex: male/female.
•  Age group: less than 1, 1-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 

75-79, 80-84, 85-89, 90-94, 95 and older.

•  Geographical dimension: from reference year 2023, NUTS2 region of the residence of the discharged patient (for non-

residents: country of residence).

Includes:

•  Non-admitted patients who were subsequently admitted for day-care.

Please note that Definition 40 defines ‘Day case’ as a patient who receives planned care. If the planned care cases cannot 
be identified in your data, explain in the reference metadata how you have identified day cases.

Excludes:

•  Healthy newborns.
•  Inpatient cases.
•  Outpatient cases (including emergency department visits).
•  Patients admitted as day-care patients but who have been retained overnight due to complication.
•  Patients who die or are transferred to another hospital on the day of their admission.

More information

Eurostat is aware that countries are identifying/defining ‘Day cases’ differently. Please be specific in the metadata on what is 
reported as inpatients and as day cases, respectively, to facilitate the validation.

3.5.2.3.  Aggregated data on inpatient discharges and average length of stay

Total number during reference period.

The aggregated numbers of inpatient discharges and the average length of stay (Figure 7) are collected in the excel 
reporting questionnaire on Health Care Activities. The definitions, inclusion and exclusion criteria concerning Inpatients, 
Inpatient discharges and Inpatient bed-days above apply.

Average length of stay (ALOS) is calculated by dividing the number of bed-days by the number of discharges during the 
year. Only the overall average length of stay in all hospitals is requested (no breakdown by diagnostic categories).

National correspondents are invited to review the consistency between the inpatient aggregated data and the 
disaggregated data on hospital discharges (see section 4.5. Data validation). If there are discrepancies between the data sets, 
more information should be provided in the national reference metadata (e.g. differences in data sources, in settings/services 
coverage, etc.).

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FIGURE 7
Inpatient care breakdowns 
Note that fields in grey indicate non-mandatory variables.

3.5.2.4.  Inpatient curative (acute care) aggregates

Total number during reference period 

Mandatory variables from reference year 2023:

Variable 6.4: Number of hospital inpatient discharges for patients who have received somatic curative care.

Variable 6.5: Number of hospital inpatient bed-days for patients who have received somatic curative care.

The data on Inpatient curative care are collected in aggregated form in the excel reporting questionnaire Health Care 
Activities.

DEFINITION 25

‘Curative care’ means the healthcare services during which the principal intent is to relieve symptoms 
or to reduce the severity of an illness or injury, or to protect against its exacerbation or complication 
that could threaten life or normal function.

Includes:

•  All components of curative care of illness (including both physical and mental/psychiatric illnesses) or treatment of injury.
•  Diagnostic, therapeutic and surgical procedures.
•  Obstetric services. 

Excludes:

•  Other functions of care (such as rehabilitative care, long-term care and palliative care).

Inpatient curative care is furthermore split by somatic and psychiatric care (Definitions 23 and 24 below) (Figure 8).

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FIGURE 8
Inpatient curative care breakdowns 
Note that fields in grey indicate non-mandatory variables.

The following activity indicators are collected in aggregated form:

•  Inpatient curative acute care discharges (number): see definition 41 on inpatient discharges and definition 25 on curative 

care.

 ʱ Total, somatic care, psychiatric care.

•  Inpatient curative acute care bed-days (number): see definition 42 on hospital inpatient bed-days and definition 25 on 

curative care.

 ʱ Total, somatic care, psychiatric care.

•  Inpatient curative acute care ALOS (days): number of curative care bed-days divided by the number of curative care 

discharges. 

 ʱ Total, somatic care, psychiatric care.

•  Inpatient curative acute care occupancy rate (%): calculated by data correspondents as the number of beds effectively 

occupied (bed-days) for curative care (HC.1.1) divided by the number of beds available for curative care multiplied by 365 
days, with the ratio multiplied by 100.

 ʱ Total, somatic care, psychiatric care.

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DEFINITION 23

‘Somatic care’ means healthcare relating to the body, as distinguished from psychiatric care.

Includes:

•  General hospitals (HP.1.1) and other specialised hospitals (HP.1.3). 

Excludes:

•  Mental health hospitals (HP.1.2).
•  Psychiatric departments of general hospitals (HP.1.1) and specialised hospitals (other than mental health hospitals) (HP.1.3).
•  Cases with main diagnosis included in ICD-10 category V Mental and Behavioural Disorders (ICD-10 codes F00-F99) (these 

cases should be included in Psychiatric curative care).

DEFINITION 24

‘Psychiatric care’ means healthcare concerning the mind, e.g. dealing with mental and behavioural 
disorders.

Includes:

•  Mental health hospitals (HP.1.2).
•  Psychiatric departments of general hospitals (HP.1.1) and specialised hospitals (other than mental health hospitals) (HP.1.3).
•  Cases with main diagnosis included in ICD-10 category V Mental and Behavioural Disorders (ICD-10 codes F00-F99).

3.5.3.  Procedures

3.5.3.1.  Diagnostic exams

Number

An exam is a medical imaging session to study one (or more) body part(s) that yields one or more views for diagnostic 
purposes.

Data are collected for three variables: the number of Computed Tomography (CT) exams, Magnetic  Resonance Imaging 
(MRI) exams and Positron Emission Tomography (PET) exams. The aim is to collect data on all diagnostic exams, including 
those carried out in hospitals and outside of hospitals.

Breakdown:

•  Exams carried out in hospitals (HP.1).
•  Exams carried out by providers of ambulatory health care (HP.3) and in medical and diagnostic laboratories (HP.4.2). 

3.5.3.2.  Surgical procedures

Number

DEFINITION 46

‘Surgical procedures’ means medical interventions involving an incision with instruments usually 
performed in an operating theatre and normally involving anaesthesia and/or respiratory assistance. 
Surgical procedures can be performed either as inpatient cases, day cases or, in certain instances, as 
outpatient cases.

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The current common shortlist of surgical procedures contains 16 surgical procedures plus 4 subgroups. The mapping with 
ICD-9-CM codes is available for information in Annex C.

Breakdown for each procedure:

•  Total number of procedures:

 ʱ Inpatient cases; see definition 38 on ‘Inpatient’.
 ʱ Day cases: see definition 40 on ‘Day case’.
 ʱ For cataract surgery and tonsillectomy, the number of outpatient cases in hospital and outside hospital is also 

requested, in order to provide more complete coverage of same-day surgery.

‘Outpatient’ is defined in definition 39.

Includes:

•  Procedures performed in outpatient departments in hospitals.
•  Procedures performed in emergency departments.
•  Procedures performed outside hospitals (ambulatory sector).

Excludes:

•  Day cases.
•  Inpatient cases.

Data senders must avoid double-counting of procedures for which more than one code may be used in certain national 
classification systems.

The method to count procedures should be based on a count of the number of patients who have received a given 
procedure or on a count of only one code per procedure category for each patient.

Example 1:

A percutaneous coronary intervention with a coronary stenting is recorded as two separate codes, but it should be reported 
as only one code/procedure.

Example 2:

A cataract surgery is performed on the two eyes on the same day, but only 1 patient/procedure should be counted.

Example 3:

A patient gets the same procedure at two different times in a given year. They are counted each time, i.e. as 2 patient/
procedures.

3.5.3.3.  Cataract surgery

Variable 7.1. Mandatory variable from reference year 2023.

DEFINITION 47

‘Cataract surgery’ means a surgical procedure to remove the lens of an eye and, in most cases, to 
replace it with an artificial lens.

Breakdown: Total number, inpatient cases, day cases, outpatient cases.

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3.5.3.4.  Tonsillectomy

Variable 7.2. Mandatory variable from reference year 2023.

DEFINITION 48

‘Tonsillectomy’ means a surgical removal of the tonsils.

Includes total and partial tonsillectomy with or without adenoidectomy.

Breakdown: Total number, inpatient cases, day cases, outpatient cases.

3.5.3.5.  Transluminal coronary angioplasty

Variable 7.3. Mandatory variable from reference year 2023.

DEFINITION 49

‘Transluminal coronary angioplasty’ means a procedure that opens blocked coronary arteries to 
improve blood flow to the heart muscle.

Breakdown: Total number, inpatient cases, day cases.

3.5.3.6.  Coronary artery bypass graft

Variable 7.4. Mandatory variable from reference year 2023.

DEFINITION 50

‘Coronary artery bypass graft’ means a surgical operation where atheromatous blockages in a 
patient’s coronary arteries are bypassed with harvested venous or arterial conduits.

Breakdown: Total number, inpatient cases, day cases.

3.5.3.7.  Stem cell transplantation

A ‘Stem cell transplant’ is a procedure where the patient’s bone marrow is cleared of cells and replaced by stem cells from 
a donor with the patient’s own stem cells to form new bone marrow that produces healthy cells.

Breakdown: Total number, inpatient cases, day cases. 

3.5.3.8.  Appendectomy

An ‘appendectomy’ refers to the surgical removal of the (infected) appendix. This surgery can be performed as an open 
operation or laparoscopically. 

Breakdown:

•  Total number, inpatient cases, day cases.

 ʱ Of which: Laparoscopic appendectomy. 
 ʱ Total number, inpatient cases, day cases.

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3.5.3.9.  Cholecystectomy

Variable 7.5. Mandatory variable from reference year 2023.

DEFINITION 51

‘Cholecystectomy’ means a surgical procedure to remove the gallbladder.

Includes laparoscopic and open surgery cholecystectomy.

Breakdown: Total number, inpatient cases, day cases.

Voluntary breakdown:

•  Of which: Laparoscopic Cholecystectomy. 
•  Total number, inpatient cases, day cases.

3.5.3.10.  Repair of inguinal hernia

Variable 7.6. Mandatory variable from reference year 2023.

DEFINITION 52

‘Repair of inguinal hernia’ means a surgical correction of an inguinal hernia. An inguinal hernia is an 
opening, weakness, or bulge in the lining tissue of the abdominal wall in the groin area between the 
abdomen and the thigh.

Breakdown: Total number, inpatient cases, day cases.

Voluntary breakdown:

•  Of which: Laparoscopic repair of inguinal hernia.  
•  Total number, inpatient cases, day cases.

3.5.3.11.  Transurethral prostatectomy

A ‘Transurethral prostatectomy’ is a surgical procedure to remove tissue from the prostate using an instrument inserted 
through the urethra.

Breakdown: Total number, inpatient cases, day cases.

3.5.3.12.  Open prostatectomy

An ‘open prostatectomy’ is a surgical procedure to the prostate via open surgery or laparoscopically. 

Open prostatectomy includes open laparoscopic prostatectomy.

Breakdown: Total number, inpatient cases, day cases.

3.5.3.13.  Hysterectomy

A ‘hysterectomy’ is a surgical procedure to remove the womb (uterus) via open surgery or laparoscopically. 

Breakdown:

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•  Total number, inpatient cases, day cases.

 ʱ Of which: Laparoscopic hysterectomy. 
 ʱ Total number, inpatient cases, day cases.

3.5.3.14.  Caesarean section

Variable 7.7. Mandatory variable from reference year 2023.

DEFINITION 53

‘Caesarean section’ means a surgical procedure to deliver a baby through incisions in the abdomen 
and uterus.

Breakdown: Total number, inpatient cases, day cases.

3.5.3.15.  Hip replacement

Variable 7.8. Mandatory variable from reference year 2023.

DEFINITION 54

‘Hip replacement’ means a surgical procedure to remove damaged sections of a hip joint and to 
replace them with a prosthesis.

Breakdown: Total number, inpatient cases, day cases.

3.5.3.16.  Total knee replacement

Variable 7.9. Mandatory variable from reference year 2023.

DEFINITION 55

‘Total knee replacement’ means a surgical procedure whereby the diseased knee joint is replaced 
with a prosthesis.

Breakdown: Total number, inpatient cases, day cases.

3.5.3.17.  Partial excision of mammary gland

Variable 7.10. Mandatory variable from reference year 2023.

DEFINITION 56

‘Partial excision of mammary gland’ means surgical removal of some of the breast tissue due to an 
area of disease such as a mass/lesion, cyst, tumour, or benign or malignant neoplasm.

Breakdown: Total number, inpatient cases, day cases.

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3.5.3.18.  Total mastectomy

Variable 7.11. Mandatory variable from reference year 2023.

DEFINITION 57

‘A total mastectomy’ means a surgical removal of an entire breast.

Includes radical mastectomy and mastectomy with preservation of skin and nipple (subcutaneous mastectomy), unilateral or 
bilateral subcutaneous mammectomy with/without synchronous implant.

Breakdown: Total number, inpatient cases, day cases.

3.6.  Eurostat additional data collections

3.6.1.  Practising physicians at regional level

Total number at the end of the reference period

See definitions of ‘practising physicians’.

The practising physicians should be allocated to the place (region) where the healthcare service is provided. The 
Nomenclature of Units for Territorial Statistics (NUTS) shall be used for referencing the subdivisions of countries for statistical 
purposes. The latest classification is the NUTS2024, which is valid from 1 January 2024. The NUTS level 2 is required for this 
data collection (see Eurostat’s regional statistics). 

Breakdown:

•  Total.
•  By NUTS2 region.

3.6.2.  Hospital beds at regional level

Average number during the reference period or total number at the end of the reference period.

See definition of hospital beds in section 3.4.2.

The data collection on hospital beds aims to collect data for all functions of care, in all types of hospitals as listed in the 
International Classification of Health Accounts 2011 (including HP.1.1 General hospitals, HP.1.2 Mental health hospitals, HP.1.3 
Other specialised hospitals). National correspondents are invited to note in the reference metadata any limitation in hospital 
coverage.

The hospital beds should be allocated to the place (region) where the health care service is provided according to NUTS2 
classification. 

Breakdown:

•  Total.
•  By NUTS2 region.

3.6.3.  Hospital technical resources

Average number during the reference period or total number at the end of the reference period.

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The data collection of hospital technical resources includes six types of resources available in hospitals. The data should 
cover both public and private hospitals. Any limitation in the data coverage should be clearly explained in the reference 
metadata.

3.6.3.1.  Operation theatres in hospital

Number of operation theatres available in hospital.

3.6.3.2.  Day care places altogether

Number of all day care places (beds/seats) altogether available in hospital.

3.6.3.3.  Surgical day care places

Number of all surgical day care places (beds/seats) available in hospital.

3.6.3.4.  Oncological day care places

Number of all oncological day care places (beds/seats) available in hospital.

3.6.3.5.  Psychiatric day care places

Number of all psychiatric day care places (beds/seats) available in hospital.

3.6.3.6.  Geriatric day care places

Number of all Geriatric day care places (beds/seats) available in hospital.

3.7.  Pilot data collections

Information about the pilot indicators currently collected, as part of the JQNMHC, is available on CIRCABC. 

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and validation

4.1.  Introduction

Reporting countries must follow a certain structure for each dataset. The data structure is compliant with the Statistical Data 
and Metadata eXchange (SDMX). Information in a specific dataset is structured with dimensions - identifying and 
describing the data (e.g. country or frequency) - attributes - providing additional information about the data, such as 
whether they are estimates, and measures - representing the phenomenon to be measured (the observation value). A Data 
Structure Definition (DSD) identifies the dimensions, attributes and measures in a data set, and associates them with 
common code lists and concepts.

This allows Eurostat and other international organisations to manage and automate the process of data exchange.

4.2.  Data structure

4.2.1.  Data structure definition

The data structures can be found on the SDMX repository and have the following artefact IDs:

ESTAT+DSD_HCNE_HLTH_EMPL+X.Y 

ESTAT+DSD_HCNE_WKMG+X.Y 

ESTAT+DSD_HCNE_HLTH_ACT+X.Y 

ESTAT+DSD_HCNE_PHYS_RES+X.Y 

ESTAT+DSD_HCNE_ADD_MOD+X.Y

ESTAT+DSD_HCNE_HDD_A_+X.Y

4.2.2.  Data requests

The collection of healthcare non-expenditure statistics (Annex B) covers several types of data requests:

1.  Variables which are compulsory for reporting countries as they are statistics falling under Regulation (EU) 2022/2294.

2.  Variables transmitted on a voluntary basis; data requested by the three organisations for the commonly agreed variables 
of the JQNMHC.

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3.  The ‘Eurostat module’; additional data requested by Eurostat, to be completed by reporting countries on a voluntary 
basis.

Aggregated data are reported in reporting questionnaires, divided into four main themes, in four separate excel 
workbooks:

1. Health employment and education.
2. Health workforce migration.
3. Physical and technical resources.
4. Healthcare activities.

The aggregated data of the ‘Eurostat module’ is in a fifth excel workbook:

5. Eurostat module.

Disaggregated hospital discharges data are sent in a separate csv file. 

4.2.3.  Data types

For the data transmission, data will be transmitted as either:

•  positive integer.
•  positive real number.

No other signs are allowed in the variable cells.

Flags can be attributed to an observation value, see section 4.4.4. Flags.

4.3.  The two data file formats

4.3.1.  Excel reporting questionnaires

All Excel workbooks contain worksheets with the following titles and functions:

•  ‘Country’ – the first worksheet is designed to collect information on the country respondent/ national focal point and 
allows the respondent to provide any general or specific comment on the data collection. The country name is then 
automatically indicated on each data sheet in cell A1.

•  ‘VariablesList’ – the second worksheet serves as a table of contents, summarising the data requested in the workbook. 
This sheet contains a checklist that countries can use to follow their progress in updating the questionnaire. It may also 
provide useful information for the three organisations about the availability of some variables not completed in the initial 
submission. 

•  ‘Definitions’ – the third worksheet provides definitions for the JQ, but please note that reporting countries must use the 
definitions laid down in Regulation (EU) 2022/2294. This manual also provides all the information necessary for countries 
reporting to Eurostat. The variables collected in the JQNMHC are mapped to the variables of the Regulation (EU) 
2022/2294 in Annex A of this manual.

After these common sheets, the workbooks contain one data worksheet per main topic.

The Excel worksheets have been protected so that only cells of the time series can be filled/updated. This protection has 
been set to prevent any accidental changes in the format of the files. Changing the structure of tables, by adding or deleting 
rows or columns for example, is not allowed. Hidden rows exist and are used for structural validation. If really necessary, the 
protection can be removed easily as no password has been assigned (open the file, select the worksheet to unprotect, click 
the ‘Review’ tab on the ribbon, and click on ‘Unprotect Sheet’).

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4.3.2.  Hospital discharges data (HDD)

Reporting countries are required to submit a separate file with data on hospital discharges. The file should be in csv format 
and there should be one csv file per reference year.

The hospital discharges data (HDD) file should contain the number of annual inpatient discharges, bed-days and day case 
discharges by main diagnosis of hospitalisation, by age and sex and by the NUTS2 region of residence of the patient or the 
country of residence of the non-resident patient.

A full description of the requirements of the HDD file is available on CIRCABC.

4.4.  Data transmission

4.4.1.  Reporting deadlines

See Table 1.

4.4.2.  Filling in the Excel Worksheets

As a courtesy to reporting countries, all reporting questionnaires are pre-filled with the data provided to the three 
organisations in previous years. Reporting countries are required to check the data and update them. Countries are 
responsible for the data they transmit to Eurostat via EDAMIS.

Please fill/update only the cells of the time series, i.e. send back the Excel worksheets in exactly the same structure in which 
you receive them.

All correspondents are asked to mark updates of data in BOLD or COLOUR in the Excel worksheets. This extra step is 
extremely useful for reviewing and processing country submissions more efficiently and communicating changes in the 
data.

Please do not write any comments into the Excel data sheets. All comments should be supplied separately in the metadata 
reports (see Chapter 5). Although we are grateful for any additional supporting documentation, the data update will rely 
exclusively on the electronic files of the questionnaire received from countries.

4.4.3.  Completeness

The time series in the year of data collection should cover at least up to the reference year in question.

EXAMPLE

In the year 2025, data should be transmitted covering at least until the reference year 2023.

It is expected that data for all mandatory variables are transmitted on time, unless a derogation is in force.

If long time series are not readily available, reporting countries are invited to report the most recent data since 2000. If, in 
addition, data could be supplied in five-year intervals (1980, 1985, 1990, 1995) it would enable the construction of 
internationally comparative tables at fixed years, spanning a wider time range. 

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4.4.4.  Flags

4.4.4.1.  Allowed flags

Flags should be used to indicate important information related to the data included in the questionnaire. The Excel reporting 
questionnaires include an additional column following each data column called ‘Code’ which should be used to indicate any 
of the data issues described below, using the correct flag in capital letter:

TABLE 5
Allowed flags

B

D

E

M

P

Break in time series (further details in metadata)

Definition differs (further details in metadata)

Estimated data. Cannot be combined with the P- flag.

Data missing – data cannot exist

Provisional (only to be used for reference year and reference year +1)

The B-flag should be used when a change in the source or in the methodology has involved a significant break in the series.

The D-flag should be used to indicate that the country is not adhering to the common definition of the variable concerned.

The M-flag should be used for variables that do not exist in the country. For example, countries without screening 
programme should use the M-flag (in combination with empty value) to indicate that data on rate of screening of the 
population do not exist. The M-flag cannot be combined with another flag and can only be used with an empty cell.

The P-flag is intended for a period of maximum one year and only for the reference year which the collection concerns and 
the year after. It should be used only for provisional data that are expected to be revised and replaced by final data in the 
near future (i.e. during the current data collection or in the next round). The P-flag cannot be combined with the E-flag.

The four flags B, D, E and P can be combined in any order up to 3 flags without any separator, e.g. BD, DEB, BDE etc. The 
flags must be combined with a cell which contains a value.

4.4.4.2.  Break in time series

Breaks in time series occur with changes in sources or methodologies. While these changes in sources or methodologies 
may improve the quality of the data, they seriously limit the possibility to do any trend analysis. When adopting any new 
source or methodology, national correspondents are encouraged to revise the data for previous years to maintain a 
reasonably long time series.

Correspondents are welcome to use any appropriate methods to overcome breaks in time series, depending on the 
information available in their country. The adjusted data can be highlighted with an E-flag associated with the data (as 
described in Allowed Flags above).

If it is not possible to adjust the time series, any significant breaks should be highlighted with a B-flag associated with the 
data (with explanation for the breaks provided in the reference metadata). 

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4.4.5.  Transmission method (EDAMIS)

Reporting countries must submit datasets though the Electronic Data Files Administration and Management Information 
System (EDAMIS). EDAMIS is the single-entry point for the transmission of all regular datasets to Eurostat and it is compulsory 
since 01.07.2008. It is a user-friendly, online portal that ensures an encrypted and secure channel for the transmission of data.

The application EDAMIS can be reached at the following link (requires EU Login) where user guides and video tutorials on 
how to send data with EDAMIS are also available. 

In case of questions, you can contact your national transmission coordinator. 

You can also contact the EDAMIS support.  

4.4.6.  Datasets and file naming conventions

The EDAMIS datasets in the Table 6 must be used for transmission of the corresponding data file. It will for example not be 
possible to transmit the excel workbook with data on Health Employment and Education in the dataset made for Workforce 
Migration; the excel file will be rejected by EDAMIS.

Files transmitted via EDAMIS should follow a naming convention (Table 6):

•  CCC represents the three-character country code (ISO 3166).
•  Year must be the reference year of the data collection.

TABLE 6
File naming convention for the data collection 2025, reference year 2023

Questionnaire name

Dataset name

Examples

Health Employment and Education

JQNMHC_HEMPLOY_A

CCC_HealthEmployment_2023.xls

Workforce Migration

JQNMHC_WRKMIGX_A

CCC_WorkforceMigration_2023.xls

Physical and Technical resources

JQNMHC_PHYSRES_A

CCC_PhysicalResources_2023.xls

Health Care Activities

Eurostat Module

JQNMHC_HCACTIV_A

JQNMHC_ESTAMOD_A

CCC_HealthActivities_2023.xls

CCC_EurostatModule_2023.xls

Hospital Discharge Data

JQNMHC_HDD_A

HDD_A_CC_2023.csv

IMPORTANT INFORMATION: SELECTION OF REFERENCE YEAR

When transmitting a file via EDAMIS it is necessary to select the correct reference year of the data 
collection (Figure 9). For example, in calendar year 2025, the reference year collected is 2023.

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FIGURE 9
View of EDAMIS transmission window

After the transmission, EDAMIS sends automated notifications acknowledging the data transfer and informing the user 
when a feedback report is available. The feedback report must be consulted in EDAMIS and contains the initial validation 
result. In case of warnings or errors in the feedback report, the reporting country must take action. This is described in the 
next section.

4.5.  Data validation

4.5.1.  Validation procedure in reporting countries

Validation is a key task performed in all statistical domains. Efficient data validation is essential for high quality statistics. Data 
validation is carried out by reporting countries before transmitting data to Eurostat, and by Eurostat upon receipt of data 
from countries. These checks can be both automatic and manual.

Reporting countries do their own internal validation procedures before transmitting the data to Eurostat. Automatic data 
checks in the reporting questionnaires assist countries during the data compilation.

4.5.2.  Automatic checks 

The excel reporting questionnaires include a set of automatic checks that are designed to improve data quality and minimise 
errors. They should be considered by countries when preparing the excel questionnaires. The main purpose of the data 
checks is to verify the internal consistency in the data reported in the questionnaire. Some checks verify that data correctly 
add up in one excel sheet (e.g. for diagnostic exams), or that data are consistent across questionnaires (e.g. for physicians, 
nurses) by comparing values in the different excel workbook sheets concerned.

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Cross checking validation calculates the difference between the data concerned; theoretically, the result should be equal to 
0. Other checks verify the data consistency/reliability (e.g. the number of practising physicians should be smaller than the 
number of physicians licensed to practice; percentages should not be higher than 100%; etc.).

All data checks are calculated in the grey columns labelled ‘Data errors’ at the right of data tables. When there are errors in 
the data, they appear in bold italic and red font in the cells below the label ‘Data errors’ (see an example in the figure 10 
below).

FIGURE 10
Example of a table with data checks within the same spreadsheet: Diagnostic 
exams

The data error signs are:

•  : no error (data add up).
•  .. missing data.
•  -1/1 small rounding error.
•  Figure/text in bold, italic and red: there is an error (in the figure, data do not add up for MRI exams in 2008 and 2009).

An example of data checks across excel workbook sheets comes from the HealthEmployment workbook: In the sheets 
‘Physicians by categories’ and ‘Physicians by age and gender’, the sum of data should theoretically add up to the total 
number of practising physicians reported in the sheet ‘Physicians’.

Reporting countries are strongly encouraged to use these data checking tools and to correct any data inconsistencies 
before sending back the questionnaire or provide explanation in the metadata when the data do not add up or are not 
consistent.

For more information of cross-validation checks, please consult this document on CIRCABC.

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Data transmission and validation

4.5.3.  Validation in EDAMIS

4.5.3.1.  Pre-validation function

Several validation functions are built into EDAMIS (User guide). Therefore, reporting countries should do a pre-validation 
before transmitting data officially via EDAMIS. This is done by selecting the ‘pre-validation’ button instead of ‘official 
transmission’ when the dataset is uploaded in EDAMIS, as described in the Pre-validation User guide (also shown in red in 
Figure 9). 

When a reporting questionnaire is transmitted, EDAMIS will perform a validation of the structure (STRUVAL) and the content 
of the file (CONVAL), according to the rules defined for the questionnaire. A validation report will be made available, so that 
errors, warnings and info messages can be consulted and addressed.

Each failure of a validation rule in STRUVAL or CONVAL generates a record in the validation report. Error messages related to 
the structure are the same for all statistical domains. The validation messages related to the content are customized by 
Eurostat according to the domain.

4.5.3.2.  Structural validation

The Structural Validation Service (STRUVAL) performs the structural validation of statistical data files based on a set of 
pre-defined validation rules, contained in a Data Structure Definition (DSD).

The structural validation confirms that the transmitted reporting questionnaire corresponds to the expected reporting 
questionnaire of the dataset in EDAMIS. It checks that no sheets have been added or removed. It checks that the data 
entered correspond to those allowed, e.g. that a flag used is one of the allowed flags that is included in the code list.

If the transmitted file fails the STRUVAL validation, it is rejected and the content validation is not performed. 

The STRUVAL error codes and corresponding messages are available on the CROS portal.

4.5.3.3.  Content validation

After the structure of the file has passed the STRUVAL successfully, the Content Validation Service (CONVAL) performs certain 
validation of the content of the data file.

•  Verification of allowed observation values.
•  The completeness of mandatory variables is verified. Specific rules have been formulated for countries/variables 

combinations where a derogation exist.

•  The flags entered in the ‘Code’ field are checked against a code list of allowed flags and flag combinations.

The specific validation rules for the healthcare non-expenditure data collection are presented in Annex D.

4.5.3.4.  Severity of errors and warnings

Different degrees of severity are associated to each validation rule, listed below:

Messages from EDAMIS 

Error

Blocking. The data is rejected and the identified issue must be corrected in the before re-submission. If a blocking error has 
occurred, the file has not been officially transmitted to Eurostat.

Warning

Non-blocking. The validation process detected an issue where expert evaluation and possible correction is required before 
the acceptance of the data.

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Info

Non-blocking. Information on the data is provided.

The data provider may receive the following messages throughout the operation of the validation process via the EDAMIS 
service. The EDAMIS service may be configured to send an email to inform users of the availability of the report.

1.  Email message confirming that the data transmission is successful. The message is sent in all cases of data transmission.

2.  Email message informing the data provider that the validation process concluded, and the validation report is now 
available via the EDAMIS user interface.

In case users have to be added to or removed from the list of receivers of any of these messages, please contact EDAMIS 
support.

4.5.4.  The validation feedback report

The validation feedback report has to be retrieved in EDAMIS. It will be available in HTML and, for the SDMX Excel reporting 
questionnaires, also in Excel format. The HTML format will contain a summary and the details of any errors, warnings or info 
codes and messages. The Excel format will correspond to the file transmitted by the country, and cells where a rule violation 
is detected are highlighted in orange colour. The Error Message is displayed in a comment box attached to the cell, along 
with the Severity.

In case multiple errors are associated with a single cell, all Error Messages are listed in the same comment box.

4.5.5.  Validation by international organisations (Eurostat, OECD and WHO-
Europe)

As mentioned earlier in this chapter, when countries submit data files via EDAMIS they will receive warning notifications if 
there are any validation issues. Certain data checks cannot yet be made automatically and depends strongly on the 
experience and expertise of the validators in the international organisations receiving the data (Eurostat, OECD, and WHO 
Europe).

Therefore, a manual validation process will take place which involves manual analysis of compliance at deadline (in terms of 
completeness and timeliness of mandatory variables), checks of the data and assessing for any anomalies such as an unusual 
and unexplained increase/decrease in a certain variable, differences in the total number of healthcare staff reported under 
the different questionnaire sheets, correct use of flags, large revisions of previous data, etc.

The Sources and Methods Annex (see Chapter 5) containing detailed metadata serves as an important resource to 
understand the data and address any potential questions that arise during the manual validation process (e.g. a change in 
coverage). The validators will check that any breaks in series, and deviations from the definition are appropriately flagged in 
both the data questionnaires and explained in the metadata.

Once the international organisations have agreed on any issues or questions that arise through this process, Eurostat will 
send emails to countries with any questions. These emails will be sent from Eurostat’s functional mailbox and contain the 
validation results from the three organisations.

This process may involve multiple email being sent between Eurostat and the country to resolve any issues or queries.

The validation processed is finished once Eurostat sends the country an email informing the country that the validation 
process is closed.

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5  National reference 

metadata

In line with the European Statistical System (ESS) standards, reporting countries are required to provide reference metadata 
in electronic form, in accordance with an agreed interchange standard.

The conceptual framework agreed in the European Statistical System (ESS) is the Single Integrated Metadata Structure (SIMS) 
adopted by the European Statistical System Committee (ESSC) in 2015, in order to comply with the reporting obligations 
outlined in Article 12 of Regulation (EC) 223/2009 (4). This structure includes all statistical concepts of annual reference 
metadata and quality reports, and all concepts appear and therefore are reported only once (direct re-usability of existing 
information).

The annual reference metadata is a user-oriented report, comprising metadata, including quality metadata, that are 
intended for users of the statistical outputs, enabling them to assess whether the outputs are appropriate for the purposes 
they have in mind.

For further information on these topics, please refer to ‘The ESS Handbook for Quality and Metadata Reports (EHQMR)’ (5), a 
recognised ESS standard. It aims to promote harmonised quality reporting across statistical processes and Member States, 
and thus to facilitate cross-comparisons of processes and outputs.

(4)  Regulation (EC) No 223/2009 of the European Parliament and of the Council of 11 March 2009 on European statistics 

(5)  European Statistical System (ESS) handbook for quality and metadata reporting 2021

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FIGURE 11
Metadata process

The metadata shall be provided to Eurostat through the single-entry point (also known as the Metadata Handler) (Figure 11). 
This is a web application developed to support the production, management, exchange and dissemination of metadata. 
Eurostat analyses and validates the national files, and they are then disseminated, attached to the European metadata file in 
Eurostat’s dissemination database (Figure 12).

FIGURE 12
Example of online dissemination of national metadata in Eurostat’s 
dissemination database

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National reference metadata

5.1.  National reference metadata report structure 

The annual metadata report structure and guidelines for filling the report can be found on the Metadata Handler directly.

The information on Sources and Methods will be kept in separate word documents (hereafter ‘Methodological 
Information Annexes’) (Annex E) that shall be annexed in the ESS-MH, for the benefit of the OECD/WHO-Europe 
cooperation. Countries are requested to continue to indicate new information in the word files via track-changes. Eurostat 
will edit the documents to accept the track-changes before disseminating the Annexes online.

The template for reporting reference metadata for Healthcare non-Expenditure statistics, following the SIMS structure, is 
included in Annex F. It might look complex at a first glance, but once the concepts are understood and filled in for the first 
reference year, the information (that is still correct) can be reused in future reference years (there is a ‘reuse function’ by 
concept).

The SIMS structure splits the information required into 19 concepts with a few sub-concepts each. Eurostat proposes 
pre-filled text in a few sub-concepts with information that is generally applicable for most countries. Please note that 
prefilled text can be modified or deleted by the reporting country. Since the national reference metadata is primarily 
intended to inform the public, please write in an understandable way. 

Guidelines accompany the SIMS template to provide further explanations (Annex F); these guidelines are also available in the 
Metadata Handler.

5.2.  Dataset in the Metadata handler

The dataset in the Metadata handler for healthcare non-expenditure statistics is HEALTH_HCNENES_A_XX_2021_0000 (XX 
will be your country code, e.g., AT, the year is the reference year)

5.3.  How to complete the annual reference metadata

To access the Metadata handler, it is necessary to have an ECAS/EU-Login. The button ‘Login’ is clearly marked in the centre 
of the screen.

The metadata file from the previous reference year will be available for your country in the Metadata handler, in the dataset 
mentioned above. A new SIMS file for a given reference year can be created from the SIMS file of the previous year by 
clicking on the option ‘Copy this metadata file to create a new one’, which is available under the ‘Actions’ column in the 
ESS-MH. This creates a new file that contains all the content from the original file. The new file can then be edited to update 
with the metadata for the reference year in question.

Please refer to the Metadata handler User Guide for instructions on how to work with the Metadata handler. An explanatory 
document is also available on CIRCABC.

It is important to write clearly and address the concept you are writing about. Please add a text in all concepts, using ‘not 
applicable’ or ‘not available’ where relevant. Do not write ‘n.a.’ or ‘n.e.’ or other ambiguous abbreviations. Do not paste 
directly from MS Word or Excel but use the ‘Paste from Word’ or ‘Paste from Excel’ buttons or write directly in the text box.

If editorial errors or broken links are found, Eurostat will not edit in your reference metadata file. If editorial changes are 
needed, you will be requested to revise and retransmit the file.

Only add information related to your country, not to any other countries or EU aggregates (EU_28 and EU27_2020). 
Calculations made by Eurostat, derived units disseminated in Eurostat’s dissemination database as rates and percentages, or 
new indicators computed by Eurostat will be explained by Eurostat in the European metadata file. Therefore, please do not 
comment on them in the national metadata file.

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5.3.1.  Methodological information annex

Reporting countries are required to document the sources and methods underlying the data for each variable based on a 
common structure agreed-upon by the three organisations (Table 7). 

There are 2 Methodological information annexes (known as the Sources and Method’s file (S&M file)) which have been 
pre-filled with information that countries have already provided to the international organisations. The 2 files are: 

•  A general methodological annex covering all variables in the health employment, workforce migration, physical resources, 

health activities and Eurostat module questionnaires

•  A methodological annex for hospital discharges data (HDD) 

Correspondents are asked to use track changes mode in Word to highlight all changes to the Methodological Information. 
This forms part of the metadata report.

TABLE 7
Methodological information file structure

Source of data

1.  Indicate the data source in bold, i.e. the name of the agency and/or the complete citation 

of the publication.

2.  Indicate the full title of the original survey collection, administrative source, database or 

publication.

3.  Indicate if different sources were used for different years. 
4.  Add URL for website where more information can be found.

Reference period

Indicate the reference period (e.g. annual average, data as of December 31, etc).

Indicate the data coverage if it is less than complete (geographical, population, institutions, 
etc). 

Coverage

•  Does the data cover the entire country or only some part(s)? (Please specify if the 

geographic coverage is partial.) 

•  Does the data cover both the public and private sectors? (If not, please specify the 

limitation in coverage.) 

•  Are there any other limitations in the data coverage (e.g. military services, prisons, social 

services)?

Deviation from the 
definition

Indicate if the data supplied does not match the proposed joint definition (please specify).

Estimation method Explain if data is an estimation, interpolation or any other relevant information.

Break in time series

Indicate if there is a break in the time series (due to changing definition, source or 
calculation method).

Upload the Annexes as ‘Methodological information’ and ‘Methodological information_HDD’:

Both Annexes called ‘Methodological information’ and ‘Methodological information_HDD’ (Annex E) with information per 
variable (in track- changes for highlighting new information) should be uploaded via the tab ‘Annexes’. Please make sure to 
remove any old annexes before submitting the metadata file.

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National reference metadata

5.3.2.  Submitting annual reference metadata

Once you have filled in all the concepts and sub-concepts, click on the ‘Summary’ tab to view the final document. When you 
click on the ‘Summary’ tab, a pop-up message will appear indicating which mandatory concepts and sub-concepts still 
need to be completed, if any. You need to fill in all mandatory concepts and sub-concepts to send the file.

In the ‘Summary’ tab, the box ‘for publication’ should be ticked, indicating that the metadata document is designated for 
publishing. Please do not untick this box. Confidential information such as contact names will be marked with a lock icon to 
indicate that this information will not be available for the public in the disseminated metadata file. You can switch between 
‘Full View’ and ‘Disseminated view’; ‘Full view’ will display also concepts that are marked as ‘restricted from publication’, and 
‘Disseminated view’ will display the document as it will appear on Eurostat’s website.

If you scroll to the bottom of the page, a ‘send’ button will appear. Please click on this button to send the metadata file to 
Eurostat. Once sent, the file status will change from ‘Draft’ to ‘Ready for validation’. You will receive email notifications when 
the file changes status and when it is transmitted. If you need to make any changes to a file that has already been sent for 
validation, you can use the ‘recall’ button under actions to recall the file to draft. You can then make any necessary 
amendments and resend the file.

5.3.3.  Transmission

Transmission of data and reference metadata covered by Regulation (EU) 2022/2294 takes place annually by end February or 
end August, depending on the section (see Table 1). Eurostat encourages reporting countries to send all the data and 
reference metadata before the end of February if possible.

Data and reference metadata collected on voluntary basis in the JQNMHC shall be transmitted annually by end of February.

From the second year on, the main part of the metadata file can be reused after reviewing that the information is still 
applicable. The Methodological Information Annex shall be updated annually, in track-changes.

As of reference year 2023, there will be two different deadlines for data and reference metadata. Eurostat proposes that as 
much as possible of data and reference metadata shall be transmitted at the earlier deadline, end of February. With regards 
to metadata, this means that at least the main reference metadata file and the Methodological Information Annex with new 
information concerning the variables under the first deadline should be transmitted by end of February annually.

At the second deadline, 31 August, the Methodological Information Annex can be recalled and updated with information 
concerning the variables concerned by the second deadline and retransmitted. This also applies to the Methodological 
Information Annex for HDD, which can either be submitted at the first deadline, or the second deadline. 

Please refer to the ESS Metadata handler website for more information on reference metadata and for training opportunities.

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6  Data dissemination

6.1.  EU aggregates

EU aggregates will be produced and disseminated by Eurostat for use in publications. The absolute numbers for EU 
aggregates are the sum of the numbers provided by EU Member States.

When there is no available data for a country, estimations may be disseminated. In these cases, the calculation of the EU 
aggregate takes into account the available data in the 5 previous years for the countries for which data are missing. For the 
density rates these EU totals are divided by the corresponding total EU population. For some variables, this is not possible 
and no EU aggregate is disseminated.

6.2.  Dissemination products

Eurostat publishes and disseminates HCNE data in various formats.

•  Regular or ad-hoc news releases (on-line).
•  Statistics Explained Articles in the area of Health.

Statistics explained articles are an online publishing platform and gateway to Eurostat’s statistical information. They are 
interactive articles that allow users to seamlessly access information at various levels. They are published in all areas Eurostat 
works in and are updated regularly.

•  Eurostat’s dissemination database.

All of Eurostat’s data are published under the relevant theme in Eurostat’s dissemination database. Data collected through 
the JQNMHC are disseminated under: Population and social conditions > Health > Health care.

•  Metadata reports.

Metadata reports are published alongside statistical data.

•  No microdata are disseminated publicly.

According to Regulation (EC) 223/2009 on European Statistics, confidential microdata can be made available for research 
purposes, but strict protocols apply to external users accessing statistical microdata.

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Annex A.  List of Mandatory Variables – 

correlation table

Variable Eurostat

Variable JQNMHC

Mandatory from 
Reference Year

Transmission 
deadline

Regulation (EU) 2022/2294

OECD/Eurostat/WHO-Europe

2021

2023

(months after 
the end of the 
reference 
period)

Health Employment

1.1 Number of practising physicians by 
age and sex

1.1 Number of practising physicians by 
age and sex

1.2 Number of practising physicians by 
category

Practising physicians

Physicians by age group (under 
35, 35-44, 45-54, 55-64, 65-74, 
75 and over) and by gender.

Physicians by categories

1.2.1 General practitioners

General practitioners

1.2.2 Other generalist (non-specialist) 
medical practitioners

Other generalist (non-specialist) 
medical practitioners

1.2.3 Paediatricians

General paediatricians

1.2.4 Obstetricians and gynaecologists

1.2.5 Psychiatrists

Obstetricians and 
gynaecologists

Psychiatrists

1.2.6 Group of non-surgical specialists

Medical group of specialists

1.2.7 Group of surgical specialists

Surgical group of specialists

1.2.8 Other specialists not elsewhere 
classified

Other specialists not elsewhere 
classified

1.2.9 Medical doctors not further defined Medical doctors not further 
defined (ISCO-08 code: 2210)

1.3 Number of practising midwives (EU 
definition differs from JQ by being 
education based, not task based).

1.4 Number of practising nurses (EU 
definition differs from JQ definition by 
being education based, not task based)

Practising midwives

Practising 'professional nurses'

X

X

X

X

X

X

X

X

X

X

X

X

X

X

14

14

14

14

14

14

14

14

14

14

14

14

14

14

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Annexes

Variable Eurostat

Variable JQNMHC

Mandatory from 
Reference Year

Transmission 
deadline

Regulation (EU) 2022/2294

OECD/Eurostat/WHO-Europe

2021

2023

(months after 
the end of the 
reference 
period)

1.5 Number of practising dentists

1.6 Number of practising pharmacists

Practising dentists (ISCO-08 
code: 2261)

Practising pharmacists (ISCO-08 
code: 2262)

2.1 Number of medical graduates

Medical graduates

2.2 Number of dentistry graduates

Dentists graduates

2.3 Number of pharmacy graduates

Pharmacists graduates

2.4 Number of midwifery graduates

Midwives graduates

2.5 Number of nursing graduates

Nursing graduates

Physical Resources

3.1 Number of hospital beds for somatic 
care, breakdown by function

Somatic care beds, breakdown by 
function

3.2 Number of hospital beds for 
psychiatric care

Psychiatric care beds

3.3 Number of beds in residential long- 
term care facilities

Beds in residential long-term care 
facilities

4.1 Number of MRI units

Magnetic Resonance Imaging 
units

4.2 Number of CT scanners

Computed Tomography scanners

Health Activities

5.1 Immunisation rate of people aged 65 
and older against influenza

5.2 Rate of women aged between 50 and 
69 screened against breast cancer within 
a national breast cancer (mammography) 
screening programme

5.3 Rate of women aged between 20 and 
69 screened against cervical cancer 
within a national (cervical cancer) 
screening programme

Immunisation against influenza 
(among population aged 65 and 
over)

Breast cancer screening 
(mammography) (survey and 
programme data)

Cervical cancer screening (survey 
and programme data)

6.4 Number of hospital inpatient 
discharges for patients who have 
received somatic curative care

6.5 Number of hospital inpatient bed- 
days for patients who have received 
somatic curative care

7 Surgical procedures

Hospital aggregates: Curative 
(acute) care – Discharges (somatic 
care)

Hospital aggregates: Curative 
(acute) care – Bed-days somatic 
care

Surgical procedures (shortlist)

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

14

14

14

14

14

14

14

14

14

14

14

14

14

14

14

20

20

20

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Annexes

Variable Eurostat

Variable JQNMHC

Mandatory from 
Reference Year

Transmission 
deadline

Regulation (EU) 2022/2294

OECD/Eurostat/WHO-Europe

2021

2023

(months after 
the end of the 
reference 
period)

7.1 Cataract surgery

7.2 Tonsillectomy

7.3 Transluminal coronary angioplasty

7.4 Coronary artery bypass graft

7.5 Cholecystectomy

7.6 Repair of inguinal hernia

7.7 Caesarean section

7.8 Hip replacement

7.9 Total knee replacement

7.10 Partial excision of mammary gland

7.11 Total mastectomy

HDD File

6.1 Number of hospital inpatient 
discharges

6.2 Number of hospital inpatient bed- 
days

Hospital inpatient discharges and 
bed-days by diagnostic 
categories

X

20

6.3 Number of hospital day case 
discharges

Hospital day cases by diagnostic 
categories

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Annex B.  List of all variables collected from 

reporting countries

The list of variables is regularly updated (with pilot indicators) and available on CIRCABC.

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Annex C.  Shortlist of Surgical Procedures

Surgical procedures (shortlist): Mapping with ICD-9-CM1

Version 2007-07-22 (including minor updates in November 2013)

Label

Code

Cataract surgery

Text

Includes secondary implantation of lens and removal of lens.
ICD-9-CM (1996): 13.1--13.8

13.1
13.2
13.3
13.4
13.5
13.6
13.7
13.8

Intracapsular extraction of lens
Extracapsular extraction of lens by linear extraction technique
Extracapsular extraction of lens by simple aspiration (and irrigation) technique
Extracapsular extraction of lens by fragmentation and aspiration technique
Other extracapsular extraction of lens
Other cataract extraction
Insertion of prosthetic lens [pseudophakos]
Removal of implanted lens

Tonsillectomy
Includes total and partial tonsillectomy with or without adenoidectomy. Excludes adenoidectomy without 
tonsillectomy.

ICD-9-CM (1996): 28.2--28.4

28.2
28.3
28.4

Tonsillectomy without adenoidectomy
Tonsillectomy with adenoidectomy
Excision of tonsil tag
Transluminal coronary angioplasty
Includes percutaneous transluminal interventions (PTCA, PCI) with or without insertion of stent.
ICD-9-CM (1996): 36.01, 36.02, 36.05

36.01

36.02

Single vessel percutaneous transluminal coronary angioplasty [PTCA] or coronary atherectomy 
without mention of thrombolytic agent
Single vessel percutaneous transluminal coronary angioplasty [PTCA] or coronary atherectomy 
with mention of thrombolytic agent

36.05 Multiple vessel percutaneous transluminal coronary angioplasty [PTCA] or coronary atherectomy 
performed during the same operation, with or without mention of thrombolytic agent

Note: The above codes have been changed in later versions of ICD-9-CM:
ICD-9-CM (2006): 00.66
00.66

Percutaneous transluminal coronary angioplasty [PTCA] or coronary atherectomy

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Annexes

Label

Code

Text

Coronary artery bypass graft
ICD-9-CM (1996): 36.1
36.1

Bypass anastomosis for heart revascularization

Stem cell transplantation
Applies to recipient only. Includes bone marrow transplantation.
ICD-9-CM (1996): 41.0
41.0

Bone marrow or hematopoietic stem cell transplant

Appendectomy
Includes appendectomy and incidental appendectomy. Includes laparoscopic and other appendectomy.
ICD-9-CM (1996): 47.0, 47.1

47.0
47.1

Appendectomy
Incidental appendectomy

Of which :
Laparoscopic appendectomy
Excludes conversion from laparoscopic to open surgery.
ICD-9-CM (1996): 47.01, 47.11

47.01
47.11

Laparoscopic appendectomy
Laparoscopic incidental appendectomy

Cholecystectomy
Includes cholecystectomy and laparoscopic cholecystectomy.
ICD-9-CM (1996): 51.22, 51.23

51.22
51.23

Cholecystectomy
Laparoscopic cholecystectomy

Of which :
Laparoscopic cholecystectomy
Excludes conversion from laparoscopic to open surgery.
ICD-9-CM (1996): 51.23
51.23

Laparoscopic cholecystectomy

Repair of inguinal hernia
Includes repair of inguinal hernia and laparoscopic repair of inguinal hernia.
ICD-9-CM (1996): 53.0, 53.1

53.0
53.1

Unilateral repair of inguinal hernia
Bilateral repair of inguinal hernia

Of which :
Laparoscopic repair of inguinal hernia
Excludes conversion from laparoscopic to open surgery.
ICD-9-CM (1996, 2006): Not possible
Note: No specific codes in ICD-9-CM (1996, 2006) for laparoscopic repair of inguinal hernia, but specified in later versions: 
ICD-9-CM (2013): 17.1, 17.2

17.1
17.2

Laparoscopic unilateral repair of inguinal hernia
Laparoscopic bilateral repair of inguinal hernia

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Annexes

Label

Code

Text

Open prostatectomy
Includes radical and transvesical prostatectomy and excision of adenoma. Excludes transurethral procedures.
ICD-9-CM (1996): 60.3--60.6

60.3
60.4
60.5
60.6

Suprapubic prostatectomy
Retropubic prostatectomy
Radical prostatectomy
Other prostatectomy

Transurethral prostatectomy
Includes transurethral laser resection, electroevaporization and microwave therapy.
ICD-9-CM (1996): 60.2
60.2

Transurethral prostatectomy

Hysterectomy
Includes partial and total hysterectomy (with or without excision of adnexa) by laparatomy or vaginal or 
laparoscopic methods.
Excludes evisceration (exentration) of pelvis and caesarean hysterectomy.
ICD-9-CM (1996): 68.3--68.7; 68.9

68.3
68.4
68.5
68.6
68.7
68.9

Subtotal abdominal hysterectomy
Total abdominal hysterectomy
Vaginal hysterectomy
Radical abdominal hysterectomy
Radical vaginal hysterectomy
Other and unspecified hysterectomy

Of which :
Laparoscopic hysterectomy
Includes combination of laparoscopic and open techniques (laparoscopic assisted).
Excludes conversion from laparoscopic to open surgery.
ICD-9-CM (1996): Not possible
Note: No specific codes in ICD-9-CM (1996) for laparoscopic hysterectomy, but specified in later versions:
ICD-9-CM (2006): 68.31, 68.41, 68.51, 68.61, 68.71

Laparoscopic supracervical hysterectomy [LSH]
Laparoscopic total abdominal hysterectomy
Laparoscopically assisted vaginal hysterectomy (LAVH)
Laparoscopic radical abdominal hysterectomy
Laparoscopic radical vaginal hysterectomy 

68.31
68.41
68.51
68.61
68.71
Caesarean section
ICD-9-CM (1996): 74.0--74.2; 74.4, 74.99

74.0
74.1
74.2
74.4
74.99

Classical cesarean section
Low cervical cesarean section
Extraperitoneal cesarean section
Cesarean section of other specified type
Other cesarean section of unspecified type

Hip replacement
Includes total and partial replacement.

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Annexes

Label

Code

ICD-9-CM (1996): 81.51--81.53

81.51
81.52
81.53

Total hip replacement
Partial hip replacement
Revision of hip replacement

Text

Note: in later versions of ICD-9-CM specific codes are available for revision of hip replacement with components specified:
ICD-9-CM (2006): 00.70--00.77, 81.53

00.70
00.71
00.72
00.73
00.74
00.75
00.76
00.77
81.53

Revision of hip replacement, both acetabular and femoral components
Revision of hip replacement, acetabular component
Revision of hip replacement, femoral component
Revision of hip replacement, acetabular liner and/or femoral head only
Hip replacement bearing surface, metal on polyethylene
Hip replacement bearing surface, metal-on-metal
Hip replacement bearing surface, ceramic-on-ceramic
Hip replacement bearing surface, ceramic-on-polyethylene
Revision of hip replacement, not otherwise specified

Total knee replacement
Excludes partial knee replacement.
ICD-9-CM (1996): 81.54
81.54

Total knee replacement

Partial excision of mammary gland
Includes wedge excision and other partial excision with or without lymph node excision.
Excludes biopsy and breast reduction surgery.
ICD-9-CM (1996): 85.20--85.23

85.20
85.21
85.22
85.23

Excision or destruction of breast tissue, not otherwise specified
Local excision of lesion of breast
Resection of quadrant of breast
Subtotal mastectomy

Total mastectomy
Includes radical mastectomy and mastectomy with preservation of skin and nipple (subcutaneous mastectomy).
ICD-9-CM (1996): 85.33--85.36; 85.4

85.33
85.34
85.35
85.36
85.4

Unilateral subcutaneous mammectomy with synchronous implant
Other unilateral subcutaneous mammectomy
Bilateral subcutaneous mammectomy with synchronous implant
Other bilateral subcutaneous mammectomy
Mastectomy

1This shortlist and its mapping with ICD-9-CM was established in 2007 by Ben Scharp, Caroline Goebertus, Janet Manuel and 
Björn Smedby for the second Hospital Data Project.

The mapping was primarily to ICD-9-CM (1996), with relevant changes in later versions shown with codes from ICD-9-CM 
(2006).

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Annex D.  Validation rules

The content validation rules from EDAMIS are available in a separate excel workbook on CIRCABC:

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Annex E.  Template Methodological Information 

Annex to the national reference 
metadata

The template of the general sources and methods annex and HDD annex are available on CIRCABC.

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Annex F.  Reference Metadata in SIMS 

Structure

The SIMS structure for the reference metadata in the ESS-Metadata Handler is available on CIRCABC.

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GETTING IN TOUCH WITH THE EU

In person
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of the centre nearest you online (european-union.europa.eu/contact-eu/meet-us_en).

On the phone or in writing
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this service: 
–  by freephone: 00 800 6 7 8 9 10 11 (certain operators may charge for these calls), 
–  at the following standard number: +32 22999696, 
–  via the following form: european-union.europa.eu/contact-eu/write-us_en.

FINDING INFORMATION ABOUT THE EU

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purposes. The portal also provides access to a wealth of datasets from European countries.

Healthcare non-expenditure statistics 
manual and guidelines for completing 
the Joint questionnaire on non-
monetary healthcare statistics

The purpose of this publication is to support Member States in completing 
the OECD, Eurostat, WHO Europe Joint Questionnaire on Non-Monetary 
Healthcare Statistics (JQNMHC) in line with Commission Regulation (EU) 
2022/2294. It provides an outline of the transmission and dissemination 
processes, data structure and validation rules as well as descriptions of the 
definitions to be used by Eurostat countries completing the JQNMHC.

For more information
https://ec.europa.eu/eurostat/

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