Eurostat, the statistical office of the European Union.
F5: Education, health and social protection
European Commission, Eurostat F.5, L-2920 Luxembourg, LUXEMBOURG
Healthcare data play a crucial role in public health, detailing the available resources for various types of care and identifying potential bottlenecks. The quantity and quality of healthcare services provided and the work sharing established between the different institutions are subjects of ongoing debate. Healthcare data are primarily used to assess sustainability in healthcare, ensuring there are sufficient financial and human resources. They also help address the challenges presented by aging populations.
Data on hospital discharges by diagnosis can be used to monitor/analyse/measure healthcare provision and services as well for epidemiological purposes. Data are available by main diagnosis at discharge for hospital discharges of in-patients and day cases, as well as inpatient bed-days and average length of stay of in-patients.
A hospital discharge occurs when a hospital patient is formally released after an episode of care. The reasons for discharge include finalisation of treatment, signing out against medical advice, transfer to another healthcare institution, or because of death. The data cover all types of hospitals, including general hospitals, mental health hospitals and other specialised hospitals, with some national variations that can be consulted in the section ‘Annex’. All types of diagnosis and treatment are covered, excluding discharges of healthy new-borns. The diagnosis refers to the principal diagnosis, in other words, the main condition diagnosed at the end of a patient's hospitalisation. The main condition is the one primarily responsible for the patient's need for treatment or investigation.
Annual national and regional data by NUTS2 region of residence of the patient are provided in absolute numbers, percentages, and in population-standardised rates (per 100 000 inhabitants). For non-resident patients, country of residence is reported.
Hospital discharge data are split into datasets based on residency (residents and non-residents, inpatient discharges, day cases, bed-days and average length of stay. EU-aggregates can be calculated for total discharges (resident + non-resident), but splitting between resident and non-resident categories is complex as non-residents in one EU country might be residents in another EU country or resident outside the EU.
Data are provided by age-groups to limit the need for suppression of data due to small counts. Suppressed cells are flagged ‘c’ for ‘confidential’. For hospital discharges, the International Shortlist for Hospital Morbidity Tabulation (ISHMT) is used to disseminate data, aggregating diagnoses into groups.
These healthcare data are based on administrative data sources in the countries. Therefore, they reflect the country-specific way of organising healthcare and may not always be completely comparable (please consult the national reference metadata in the section ‘Annex’).
Hospital discharges
Definitions and collected variables are laid down in Commission Regulation (EU) 2022/2294 and further explained in the Eurostat manual on healthcare non-expenditure statistics.
Data refer to all discharges from hospitals classified as HP.1 in the System of Health Accounts (SHA). This includes general hospitals (HP.1.1), mental health hospitals(HP.1.2) and Specialised hospitals (other than mental health hospitals) (HP.1.3).
Discharges by diagnosis refer to the principal diagnosis, i.e. the main condition diagnosed at the end of the hospitalisation (in-patients) or day treatment (day cases). The main condition is the one primarily responsible for the patient's need for treatment or investigation (for additional details, see International statistical Classification of Diseases and related health problems - ICD-10 Volume 2).
The data are aggregated according to the International Classification for Hospital Morbidity Tabulation (ISHMT). This shortlist for statistical comparison of hospital activity analysis was adopted in 2005 by Eurostat, the OECD (Organisation for Economic Co-operation and Development) and the WHO-FIC (Family of International Classifications) Network. It was updated in 2021 to include discharges of COVID-19; for more information, please see section 19.
Regional data follow the EU classification known as NUTS (Nomenclature of territorial units for statistics) at NUTS2 level of detail.
Hospital discharge data covers all discharges from all hospitals under classification HP.1. In some countries, data may not be available for a subgroup of institutions (e.g. private hospitals) or for services not covered by the national health insurance fund. Additionally, some countries cannot provide data from hospitals linked to prisons, military or other specific sectors. This information is available in the national reference metadata in the section ‘Annex’.
The data cover hospital discharges by diagnosis, inpatients, day-cases and bed-days.
‘Inpatient’ means a patient who receives treatment and/or care in a healthcare facility, who is formally admitted and who requires an overnight stay.
‘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.
‘Hospital inpatient discharge’ means the discharge (formal release) of an inpatient from a hospital. Healthy newborns are excluded.
‘Hospital inpatient bed-days’ means the days that an inpatient spends in a hospital. Healthy newborns are excluded.
‘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 are excluded.
‘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.
‘Non-resident’ means a person who is a not a resident of the reporting country.
‘Average length of stay’ (ALOS) is computed by dividing the number of hospital days (or bed-days or in-patient days) from the date of admission in an in-patient institution (date of discharge minus date of admission) by the number of discharges (including deaths) during the year.
The respective data are based on different, mainly administrative sources. This may lead to differences in the coverage of time series and/or in the geographical coverage; data validity, reliability and comparability may vary. Furthermore, it may not always be possible to have the healthcare system, implicitly underpinning the data collection, being consistently defined across data sources.
Data on hospital discharges are collected according to the region of residence of the patient discharged (by NUTS2 regions). Data are disseminated in datasets aggregated by residents, non-residents.
Next to absolute numbers, density rates are provided for hospital discharges. Density rates are used to describe the frequency of services rendered, expressed in per 100 000 inhabitants. They are calculated by dividing the absolute number of hospital discharges in a given period by the respective population in the same period and then multiplied by 100 000.
Administrative data sources refer to registered patients treated and discharged, this excludes healthy newborns. Data are collected on diagnosis, sex, 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), and geographical dimension (NUTS2 region of patient, unless specified otherwise or country of residence for non-resident patients).
The underlying totality of institutions, for which data collections are available, may differ.
If the combination of a referance area/region, sex, age group and diagnosis has no records (i.e. there were no discharges or 0 discharges) the value shown is ‘:’ = not available (for datasets related to total population and resident population).
The target population for hospital discharges is all discharges performed in all hospitals (HP.1); some countries are not able to cover the whole HP.1 category. Information on country-specific coverage is available in the national reference metadata in the section ‘Annex’.
EU Member States, Iceland, Liechtenstein, Norway, Switzerland, Montenegro, North Macedonia, Albania, Moldova, Serbia and Turkey.
Transmission of data on hospital discharges are voluntary for candidate countries.
Time series for the EU Member States, Iceland, Liechtenstein, Norway, Switzerland, Montenegro, North Macedonia, Albania, Moldova, Serbia and Turkey are available from reference year 2023 onwards, when hospital discharge data became mandatory under Commission Regulation (EU) 2022/2294.
Historical datasets on hospital discharges are available and can be found in the folder Health care activities – historical data (hlth_act_h). The availability of the data varies across countries and datasets.
Not applicable.
The data are published in absolute numbers and rate per 100,000 inhabitants. Data on non-residents among all hospital discharges are published as percentages.
The EU aggregates are computed as the sum of the country numbers.
Calendar year.
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, provides the framework for regulating the European Public Health statistics. Specifications on the health care domain are included under annex II.
Countries submit hospital data to Eurostat on the basis of Commission Regulation (EU) 2022/2294 on statistics on healthcare facilities, healthcare human resources and healthcare utilisation.
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.
Data are shared with OECD and with WHO-Europe for countries where there is an agreement to do so.
Regulation (EU) 2024/3018 of the European Parliament and of the Council of 27 November 2024, amending Regulation (EC) No 223/2009 on European statistics, stipulates the use of strict legal, technical and procedural safeguards and guarantees, including applying a high level of security, confidentiality and respect for privacy.
No microdata are collected on hospital discharges, the data are provided by sex, age groups, and diagnosis.
Confidential data are treated in Eurostat's secure environment and disseminated as aggregated data according to a shortlist.
However, data on hospital discharges may contain confidential cells which have been suppressed in the dissemination datasets. The suppression method has been agreed in the Technical Group Healthcare non-Expenditure statistics, a subgroup of the Eurostat Expert Group on 'Public Health Statistics'.
The data collected from countries and the EU aggregates are released annually according to Eurostat's release calendar, normally in December.
In line with the Community legal framework and the European Statistics Code of Practice Eurostat disseminates European statistics on Eurostat's website (see item 10 - 'Accessibility and clarity') respecting professional independence and in an objective, professional and transparent manner in which all users are treated equitably. The detailed arrangements are governed by the Eurostat protocol on impartial access to Eurostat data for users.
Annual.
Statistics Explained: Hospital discharges and length of stay statistics
Health in the European Union – facts and figures
For more information on publications, see also the Health dedicated section on Eurostat website.
Data are disseminated on Eurostat's online dissemination database.
Not applicable; microdata are not collected for hospital discharges. Data are collected by 5-year age groups and under 1 year.
Data on healthcare non-expenditure are used in other Eurostat publications, such as the Regional Yearbook
Methodological information on how hospital discharge data is collected can be found in the Eurostat Guidelines for completing the Joint questionnaire on non-monetary healthcare statistics.
Detailed information on the validation rules and confidentiality policy applied are reported on CIRCABC (registration required).
For the comprehensive metadata of each country, see the national reference metadata in the section ‘Annex’.
National quality reports will be requested from countries periodically.
Eurostat offered online training of countries concerning the data and metadata in January 2023. A Eurostat manual on healthcare non-expenditure statistics has been produced and is available on Eurostat's website. It provides guidance to reporting countries and information to users.
Eurostat applies automatic and manual validation checks to the data and metadata provided by countries. The outcome is documented internally and used for the compliance assessment. The compliance is reported annually in Eurostat's Expert Group Directors of Social statistics.
The quality of the data is subject to the way in which healthcare provision is organised in countries, and which information is available to and collected by the respective institutions.
The quality, comparability and coverage are discussed at annual technical meetings of the ‘Technical Group Healthcare non-Expenditure statistics’ and at the annual Eurostat's Expert Group ‘Public Health Statistics’ (EG PHS).
It is also subjected to annual discussions with OECD and WHO-Europe at annual trilateral meetings concerning the Joint Questionnaire on Health Care Non-Monetary Statistics, which is the basis for the data collection.
National quality reports will be requested from countries periodically and disseminated together with the national metadata.
The main users of the data are European Commission DG Health and Food Safety (SANTE) and DG Employment, Social Affairs & Inclusion (EMPL) in view of health policy papers and health strategies. Secondly, national policy-makers and statistical offices use the data for country comparisons. Researchers and the general public are also using the data.
Eurostat carries out an annual User satisfaction survey on a central level, see the latest results here.
For the Health domain, 263 out of 291 respondents ranked the Health data quality as Very good, Good or Adequate.
Administrative data sources refer to registered health care facilities. The underlying totality of institutions for which data collections are available may differ. In some countries, data may not be available for a subgroup of institutions (e.g. private hospitals). More information on national coverage and completeness can be found in the country-specific Methodological information in the Annex.
It is expected that data for all mandatory variables are transmitted on time, unless a derogation is in force. Derogations were granted to some countries which requested them, and were issued by the Comission implementing decision (EU) 2022/2306 of 23 November 2022.
Data with unknown sex or age-group are included in the main aggregates but not disseminated with the breakdowns by sex and age due to low counts.
The accuracy of healthcare non-expenditure is dependent on the accuracy of the data received from the countries. Data sources are mainly administrative and register-based data. Accuracy concerns may arise from issues of coverage and deviations from the definitions outlined in Commission Regulation (EU) 2022/2294 and the Eurostat manual on healthcare non-expenditure statistics. For the detailed information on accuracy by countries, see the national reference metadata in the section ‘Annex’.
Accuracy and harmonisation issues are regularly discussed at the annual Technical Group on Healthcare non-expenditure meeting. The Technical Group continues to work on improving the harmonisation of hospital discharge data.
Not applicable as the data are based on administrative data and not on surveys.
Not applicable as the data are based on administrative data and not on surveys.
Regulation (EU) 2022/2294 fixes the deadline for data delivery of hospital discharge data at N+20 months for the year N.
There is no binding release date for hospital discharge data on European level. The statistics are normally released in December.
The comparability of the data across different countries may be limited by the fact that the quality of national data is subject to the way in which healthcare provision is organised in countries, and which information is available to and collected by the respective institutions. The periodically updated Eurostat manual on healthcare non-expenditure statistics assists countries in harmonising their data.
Some countries are unable to cover all providers of care (the inclusion of private providers seems particularly difficult).
Sometimes regional data cannot be made available as the available breakdown does not coincide with the requested NUTS2 classification level of detail. Countries without NUTS2 breakdowns should still provide the NUTS2 code for the patient.
Some countries are not able to provide the NUTS2 region of residence of the patient or the country of residence for non-resident patients. They may instead provide the residence of the hospital. For countries not able to report non-resident patients by country of residence, these cases are reported as unknown country of residence. More information on national coverage and definitions can be found in the national reference metadata in the section ‘Annex’.
Ongoing work to increase quality, comparability and coverage is reported to Eurostat's Expert Group ‘Public Health Statistics’.
Currently, no comparability checks are conducted for this data collection, as data are only available for a few reference years following the adoption of the implementing regulation. Comparability checks over time will be developed when longer time series have become available.
Data coherence is dependent on the national sources used and depending on how the healthcare systems are set up in the countries. More information on national sources, coverage and definitions can be found in the national reference metadata in the section ‘Annex’.
Different checks are carried out including plausibility checks such as for diagnoses that are more likely to occur in the male/female population, or diagnoses more likely to occur in specific age groups.
The checks developed by Eurostat are shared with the reporting countries on CIRCABC (registration required), in some cases they integrate suggestions made by countries on specific checks.
Data with unknown sex or age-group are included in the main aggregates but not disseminated with the breakdowns by sex and age due to low counts.
Therefore:
This is a joint data collection together with other international organisations, in order to limit the cost and burden on reporting countries.
The general Eurostat revision policy applies to this domain.
All reported errors (once validated) result in corrections of the disseminated data.
Reported errors are corrected in the disseminated data as soon as the correct data have been validated.
European aggregates are updated for consistency with new country data if possible and where necessary.
Whenever new data are provided and validated, the already disseminated data are updated as soon as possible.
Major revisions have not been carried out, nor are major revisions foreseen to be carried out for the disseminated data of this domain.
Hospital discharge data are mainly derived from administrative sources, such as hospital registries and national insurance reimbursements; these sources may vary by country and by variable. Some countries are unable to cover all providers of care (for private providers or care provided and military institutions may not be included for some countries). Sources for each country are mentioned in the national reference metadata in the section ‘Annex’.
Please note that the data sources used may not have been created initially for statistical purposes, and that the initial purpose of a data source may differ across countries. Both facts may influence the validity and comparability of results.
Annual.
Hospital discharge data forms part of the OECD/Eurostat/ WHO-Europe Joint Questionnaire on Non-Monetary Healthcare statistics (JQNMHC).
Countries submit hospital discharge data via EDAMIS in the form of a csv file. There should be one csv file per reference year and the 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.
Metadata is collected via the European Statistical System (ESS) Metadata Handler. Countries submit a single metadata file covering all aspects of the JQNMHC, one covering hospital discharge data and one covering the remaining data. These annex files include variable-specific coverage and source information. More information on the metadata for the JQNMHC can be found in the National Refence Metadata file for Health care resources. The national reference metadata files for hospital discharge data can be found in the section ‘Annex’.
Eurostat communicates any issues or questions with the data with national correspondents via email.
Eurostat applies automatic and manual validation checks to the data and metadata provided by countries.
Plausibility checks are carried out to check for age or sex-specific diagnoses, or diagnoses that cannot or may be unlikely to occur in a specific age and/or sex group.
The absolute numbers for EU aggregates are the sum of the country numbers. For the density rates these EU totals are divided by the corresponding total EU population.
No adjustments are made by Eurostat.
Since reference year 2020, all the hospital discharges tables that are available in Eurostat’s dissemination database include the hospital discharges having COVID-19 as principal diagnosis. Detailed information on discharges with COVID-19 as principal diagnosis can be found in the tables that include a breakdown by diagnosis. There are 25 tables in total in the following Eurobase folders:
However, some countries have not declared COVID-19 as principal diagnosis, as the inpatients with COVID-19 have been discharged with another principal diagnosis (i.e. pneumonia). Therefore, for some countries, only very few or no hospital discharges are recorded with COVID-19 as principal diagnosis at discharge.