Specialist health service

Name: Specialist health service
Topic: Health

Division for Health, care and social statistics

The statistics are presented at national level, health regional level and health trust level.

The statistics are published annually at the following times:

• Distance to nearest maternity ward: January/February
• Population in service areas: March
• Full-time equivalents (FTEs): March/April
• Accounts: June
• Activity and capacity: June
• Ambulance services: June

Parts of the statistics are reported to OECD, Eurostat, WHO and NOMESCO.

Collected and revised data are stored securely by Statistics Norway in compliance with applicable legislation on data processing.

Statistics Norway can grant access to the source data (de-identified or anonymised microdata) on which the statistics are based, for researchers and public authorities for the purposes of preparing statistical results and analyses. Access can be granted upon application and subject to conditions. Refer to the details about this at Access to data from Statistics Norway.

The system for assuring the quality of Norwegian official statistics is based on quality requirements in the Statistics Act and in the European Statistics Code of Practice.The annual report on the quality of official statistics assesses compliance with the quality requirements for all official statistics as a whole.

The National programme for official statistics sets the framework for the areas Statistics Norway and other public authorities produce statistics on. The programme defines and outlines official statistics.

Further information about the system for quality in official statistics can be found at ssb.no

The purpose of the statistics is to present the following:

• Resource use, measured in costs and personnel

• Capacity, measured by inpatient beds, personnel and number of ambulances

• Activity, measured amoung other things by bed-days, outpatient consultations and number of ambulance assignments

• Provide information on the population in the health trusts’ service areas

The current statistics for the specialist health services mainly cover the period from 2002, when the state assumed responsibility for the services.

The main users of the statistics are public health authorities such as the Ministry of Health and Care Services, the Norwegian Directorate of Health, and the Regional Health Authorities. Journalists, researchers and students are also important users of the statistics.

The statistics are used, among other things, to monitor developments in capacity, activity and resource use in the specialist health services, and to enable comparisons between the four regional health authorities.

The Ministry of Health and Care Services (HOD) is formally the owner of the underlying data on accounts and inpatient beds, which Statistics Norway collects from the Health trusts. HOD therefore has access to these underlying data before SSB publishes the statistics. As a subordinate agency to HOD, the Norwegian Directorate of Health has an agreement with SSB on cooperation regarding quality assurance of the underlying data.

No other external users have access to statistics before they are released at 8 a.m. on ssb.no after at least three months’ advance notice in the release calendar. This is one of the most important principles in Statistics Norway for ensuring the equal treatment of users.

Statistics from SSB

The statistics Patients in the specialist health services provide information on patients who have received treatment in somatic hospitals or in adult mental health services. The patient statistics show, among other things, the number of inpatient days and outpatient contacts. The figures differ somewhat from the statistics for the specialist health services. This is because the patient statistics only include persons registered as residents in Norway. In addition, the patient statistics include healthy newborns, whereas these are excluded from the statistics for the specialist health services.

Full-time equivalents (FTEs) in the specialist health services are part of Statistics Norway’s overall Statistics on health care personnel.

The accounts collected from the health trusts are used as underlying data for Statistics Norway’s Statistics on general government revenues and expenditures.

The health accounts, which are part of the National Accounts, show Norway’s expenditure on health purposes. The health accounts have a different purpose and use different data sources than the statistics for the specialist health services. These statistics are therefore not directly comparable.

Statistics from the Norwegian Directorate of Health

The data collected by Statistics Norway are also included in the Norwegian Directorate of Health’s statistics on the specialist health services. In the accounting statistics, there are two methodological differences that result in discrepancies between the figures from the Directorate of Health and Statistics Norway.

First, some forms of wage subsidies are treated differently. Statistics Norway classifies certain types of wage subsidies (account codes 570, 571, 579 and 583) as revenue, whereas the Directorate of Health treats these subsidies as reductions in costs.

Second, there are methodological differences in the adjustment for transfers/purchases between health trusts when summarising accounts to national and regional levels. Both Statistics Norway and the Directorate of Health adjust the figures to avoid double counting when health trusts have provided subsidies or purchased services from each other. While Statistics Norway adjusts for patient revenue and income reported by private providers with commissioning agreements from Regional Health Authorities/health trusts, the Directorate of Health adjusts for patient treatment costs and subsidies reported by Regional Health Authorities/health trusts.

Norwegian Patient Register at the Norwegian Institute of Public Health

The Norwegian Patient Register (NPR) is used as the data source for activity statistics such as the number of outpatient consultations and the number of inpatient days/bed-days in the statistics for the specialist health services. The Norwegian Patient Register also publishes its own statistics and reports.

The data are collected by Statistics Norway on behalf of the Ministry of Health and Care Services pursuant to the Act relating to specialist health services etc. of July 1999 No. 61, section 5-6.

Statistics Norway will, pursuant tothe Act of 21 June 2019 No. 32 relating to official statistics and Statistics Norway, Section 10 (1), also use the data for the development, production and dissemination of official statistics.

Not relevant

The statistics provide annual time series from the introduction of the Hospital Reform in 2002 onwards.

The statistics cover publicly funded specialist health services. The Act relating to Specialist Health Services etc. of 1999 defines what is included.

The specialist health services include somatic hospitals, mental health services, private rehabilitation institutions, ambulance services, substance use treatment, and contract specialists (privately practising medical doctors and psychologists with operating agreements).

The statistics cover health trusts, private entities with commissioning documents, and private providers operating under agreements with the Regional Health Authorities.

Forms and data extracts

Statistics Norway (SSB) collects data extracts from the health trusts and private entities with commissioning documents.

Data on capacity, such as beds, available beds, number of ambulances, etc., are collected using questionnaires.

Questionnaires and data extracts are submitted via Altinn or ssb.no.

Administrative registers

Data on full-time equivalents (FTEs) are collected through a joint reporting solution called "A-ordningen", from 2015 onwards. "A-ordningen" gathers the reporting from the employers to Statistics Norway, the Norwegian Labour and Welfare administration and the Tax Administration. The data form an official employment register. Statistics on FTEs in the specialist health services are derived from this register. In the statistics, FTEs are aggregated by health trust for all entities included in the specialist health services.

Norwegian Patient Register

The Norwegian Patient Register (NPR) at the Norwegian Institute of Public Health (NIPH) is the source for statistics on activity in the specialist health services. The NPR provides data on the number of bed-days, day treatments, discharges and outpatient consultations used in the statistics.

Air Ambulance Service Trust

Statistics Norway receives data on activity in the air ambulance service from the Air Ambulance Service Trust.

Data collection

Data are collected once a year. The questionnaires are submitted through ssb.no or altinn.no. The reporting deadline is 20th February for capacity data (number of beds, inpatient places, etc.), 1th April for accounting data from health trusts and private entities with commissioning documents, and 15th April for Regional Health Authorities.

The remaining data, which are supplied by other divisions within Statistics Norway, the Norwegian Patient Register (NPR), and the Air Ambulance Service Trust, are received each spring prior to publication in June.

Data editing

Editing is defined here as checking, examining and amending data.

The questionnaires include automated validation checks that are performed before respondents can submit their responses. If the checks identify potential issues, respondents are notified and given the opportunity to correct the questionnaire or provide an explanation in the comments field. Statistics Norway carries out additional validation of the data after submission.

The submitted data are checked by analysing changes over time. Respondents are contacted if one or more variables differs substantially from that of other respondents, and Statistics Norway is not aware of the reason.

Statistics Norway performs quality checks on all variables that are published. In some cases, data are collected at a more detailed level than they are published.

Statistics Norway cooperates with the Norwegian Directorate of Health on the quality assurance of accounting data and data on the number of inpatient places.

Calculations

The data are aggregated to health trust level, health region level and national levels in the Statistics Bank.

Accounting statistics: To avoid double counting when the figures are aggregated, adjustments are made for financial flows between reporting units. In the tables of accounts, the figures at regional and national level are adjusted for inter-entity transactions, revenue from cross-boundary patient treatment and other transfers. Similarly, in the balance sheet tables, liabilities to other health trusts are eliminated when the figures are aggregated to the national level.

Expences are converted to constant prices. The price index used is the price index for central government production of health services, compiled by the National Accounts Division.

Personnel statistics: Agreed full-time equivalents (FTEs) = contractual percentage of full-time employment ÷ 100. The contractual percentage of full-time employment is the agreed working time as specified in the employment contract.

Up to and including 2014, the variable contractual percentage of full-time employment was not available. Agreed FTEs were therefore calculated by comparing the agreed weekly working hours with the standard full-time working hours. The calculations took into account that, for some occupational groups, a full-time position consists of fewer than 37.5 hours per week, for example for employees working shifts.

Not relevant

Employees of Statistics Norway have a duty of confidentiality.

Statistics Norway does not publish figures if there is a risk of the respondent’s contribution being identified. This means that, as a general rule, figures are not published if fewer than three units form the basis of a cell in a table or if the contribution of one or two respondents constitutes a very large part of the cell total.

Statistics Norway can make exceptions to the general rule if deemed necessary to meet the requirements of the EEA agreement, if the respondent is a public authority, if the respondent has consented to this, or when the information disclosed is openly accessible to the public.

More information can be found on Statistics Norway’s website under Methods in official statistics, in the ‘Confidentiality’ section.

Changes in organisational structure

Organisational restructuring may make it difficult to compare statistics over time. During the period covered by these statistics, regional health authorities and health trusts have been merged, and new health trusts have been established. In 2007, the South-Eastern Norway Regional Health Authority was formed through the merger of the South Norway Regional Health Authority and the Eastern Norway Regional Health Authority.

New services

The specialist health services have gradually been expanded to include new services. The most important expansion took place in 2004, when the regional health authorities assumed responsibility for specialised substance abuse treatment (TSB). When comparing total figures for the specialist health services, such expansions create breaks in the time series.

Accounting data

The Hospital Reform of 2002 resulted in such substantial changes to the accounting data that figures for the specialist health services as a whole cannot be compared before and after the reform.

Full-time equivalents (FTEs)

There is a break in the time series for full-time equivalents (FTEs) in the specialist health services due to a change in data source in 2008. Prior to 2008, FTE data were collected through questionnaire surveys. From 2008 onwards, the statistics have been based on administrative registers.

The quality of the statistics depends on the quality of the data reported to Statistics Norway. Statistics Norway has validation procedures in place to ensure the quality of the data received. In addition, errors may occur during the processing of the statistics, such as coding errors.

Measurement and processing errors

The statistics are based on data from administrative registers, as well as data extracts and questionnaires reported to Statistics Norway.

Statistics Norway collaborates with the health trusts to ensure high data quality in administrative registers, such as the Central Register of Establishments and Enterprises (CRE).

Data extracts are generated directly from the respondents' administrative systems, while questionnaires are completed manually before being submitted to Statistics Norway. Measurement errors may occur, for example, if figures are reported using incorrect units. For questionnaire-based reporting, unclear wording or misunderstandings may also result in incorrect data. Both the data extract and questionnaire reporting schemes include built-in validation checks that provide automatic feedback before submission. In addition, all data are subject to further validation after they have been received by Statistics Norway.

Statistics Norway also maintains regular cooperation with the regional health authorities on questionnaire design and data quality.

Non-response errors

The statistics cover the entire population of health trusts. Reporting to Statistics Norway is mandatory, and reminder procedures are in place to ensure complete reporting. As a result, non-response in these statistics is negligible.

Not relevant.