Hospital discharges by diagnosis (ISHMT) - Eurostat

Eurostat – Hospital patients 

Hospital discharges by diagnosis (ISHMT) 

Hospital discharges A (hospital) discharge is the formal release of a patient from a hospital after a procedure or course of 

treatment (episode of care). 

A discharge occurs anytime a patient leaves because of finalisation of treatment, signs out against medical 

advice, transfers to another health care institution or because of death. A discharge can refer to in-patients 

or day cases. 

Inclusion 

- Healthy newborns 

Exclusion 

- Transfers to another department within the same institution. 

In-patient cases An in-patient is a patient who is formally admitted (or 'hospitalised') to an institution for treatment and/or care 

and stays for a minimum of one night or more than 24 hours in the hospital or other institution providing inpatient 

care. 

Day cases Day care comprises medical and paramedical services (episode of care) delivered to patients that are 

formally admitted for diagnosis, treatment or other types of health care with the intention of discharging the 

patient on the same day. An episode of care for a patient who is admitted as a day-care patient and 

subsequently stays overnight is classified as an overnight stay or other in-patient case. 

Hospital days A hospital day (or bed-day or in-patient day) is a day during which a person admitted as an in-patient is 

confined to a bed and in which the patient stays overnight in a hospital. 

Inclusion 

- Hospital days of healthy newborns. 

Exclusion 

- Day cases (patients formally admitted for a medical procedure or surgery in the morning and released 

before the evening). 

ISHMT: International Classification for Hospital Morbidity Tabulation. 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. 

In-patient average length of stay of in-patients (ALOS): Average length of stay 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 data refer to all discharges during the year (unless otherwise indicated). 

Country specific notes 

Belgium, Bulgaria, Czech Republic, Denmark, Germany, Estonia, Ireland, Greece, Spain, 

France, Italy, Cyprus, Latvia, Lithuania, Luxembourg, Hungary, Malta, Netherlands, Austria, 

Poland, Portugal, Romania, Slovenia, Slovakia, Finland, Sweden, United Kingdom, Croatia, 

former Yugoslav Republic of Macedonia, Turkey, Iceland, Norway, Switzerland. 

Belgium 

Source: The Federal Public Service Health, Food Chain Safety and Environment, Directorate 

1 - Minimal Clinical Data. 

Reference period: during the year 

Coverage: 

1

The Federal Public Service Health, DG 1 "Organisation of health institutions" is responsable 

for the registration of the Minimal Hospital Data. 

The website for the Minimal Hospital Data is 

http://www.health.belgium.be/eportal/Healthcare/Healthcarefacilities/Registrationsystems/ind 

ex.htm (Click: Résumé Clinique Minimum & Résumé Hospitalier Minimal or Click: 

Publications, Liste de référence, Applications informatiques, Directives) 

Hospital days for inpatients concerns only acute admissions in acute hospitals (with at least 1 

overnight stay in the hospital) - Patient data in psychiatric hospitals are NOT included. 

Long lasting stays are removed (more than 6 months or 184 days) 

Are witheld: stays without data errors and deceased patients are included. 

Liveborn infants according to place of birth ("healthy newborn babies") 

This concerns V30-V39 codes in acute admissions. Admissions in Maternity, Neonatal 

Intensive Care are excluded in our selection. 

This explains the small figures in inpatient cases and hospital days for inpatients 

Hospital days for in-patients concern only acute admissions in acute hospitals (with at least 1 

overnight stay in the hospital). Long lasting stays are removed (more than 6 months or 184 

days). All stays without data errors and deceased patients are taken into account. 

Notes updated: 2011 

Bulgaria 

Source of data: Natonal Center for Health Information at the Ministry of Health 


Coverage: Number of in-patient cases includes discharged and deceased patients from 

hospitals. 


Czech Republic 

Source: Institute of Health Information and Statistics of the Czech Republic. National 

Registry of Hospitalized Patients. 


Coverage: 

Definition of one case of hospitalization: a termination of each stay of one patient in one 

hospital, encompassing termination home, to other institution or death. 

Definition of day case of hospitalization: a case with the same date of admission and 

discharge, excluding deaths in the first day. But only patients registered as hospitalized 

patients are included, that is patients admitted to and discharged from a bed care department 

of health care establishment. 

* Data from Hospitals and Specialized therapeutic institutes (all bedcare health 

establishments excluding Balneologic institutes and Convalescent homes for children). 

* Hospitalized foreigners are included. 

Deviation from the definition: 

Day cases encompass only day cases inpatients registered as hospitalized patients, that is 

patients admitted to and discharged from a bed care department of health care establishment. 


Denmark 

Source: National Board of health, The National Patient Register. 

The data cover somatic patients and includes newborns. 

Both Danish nationals, foreigners resident in Denmark and foreigners in need of 

hospitalisation while visiting are included. 

2


Germany 

Source of data: 

Federal Statistical Office, Hospital statistics - Diagnostic data of the hospital patients 

http://www.destatis.de or http://www.gbe-bund.de 


Coverage: 

The number of discharges includes deaths in hospitals, but excludes same-day separations and 

transfers to other care units within the same institutions. 

Up to and including reporting year 2002 data only include discharges in general hospitals and 

mental health hospitals. 

As of reporting year 2003 data include additionally discharges in preventive and rehabilitative 

hospitals, however discharges of these institutions with less than 100 beds are not included. 

The total number of all diagnosis (0000) does not include patients with unknown diagnosis 

(9999). Patients with unknown age and/or sex are included. 

From reporting year 2004 live-born infants according to place of birth coded with ICD-10 

Z38 (2103) and patients coded with ICD-10 D90 “Immunocompromisation after radiation, 

chemotherapy and other immunosuppressive measures” (0300, 0302) are included. 

From reporting year 2005 patients coded with ICD-10 U00-U99 "Codes for special purposes" 

(8888) are included. 

As of reporting year 2000 discharges have been collected according to the International 

Classification of Diseases, 10th revision. In 2000, ICD-9-coded cases are included (about 

2%). 

The implementation of the German DRG-System led to wide changes in the coding practice 

of the physicians especially concerning the diagnoses “complications during labour and 

delivery” (1504), “single deliveries” (1505) and “other delivery” (1506). 

Caution: 

In German health statistics publications the number of hospital cases includes the number of 

in-patients as well as the number of daycases. Therefore the total number of hospital cases in 

these publications is higher. 

Furthermore, for each daycase one hospital day is calculated. Since the average length of stay 

(ALOS) is the quotient of hospital days and hospital cases, the ALOS in these publications is 

lower then when calculated on the basis of only in-patients and hospital days for in-patients. 

Break in time series: 

Up to and including reporting year 2002 data only include discharges in general hospitals and 

mental health hospitals. 

As of reporting year 2003 data include additionally discharges in preventive and rehabilitative 

hospitals, however discharges of these institutions with less than 100 beds are not included. 

The years before 2003 are therefore not comparable to the following years. 


Estonia 

Source of data: Ministry of Social Affairs, Department of Health Information and Analysis, 

routinely collected aggregate hospital statistics 

Since 1.01.2008 National Institute for Health Development, Department of Health Statistics 

Reference period: calendar year 

Coverage: 

Estonia collects aggregated data on hospital discharges and day cases. Therefore the data 

cannot be presented in such detailed level as asked. 

3

Data collection at individual level is planned when nationwide E-health record is 

implemented. 

ICD-10 is used for data collection. 

Discharges by ICD: 

Data on discharges are collected in two ways: 1) Discharges according to ICD-10 main 

chapters by sex and age groups include deceased patients but not bed-days; 2) Hospital 

discharges by selected ICD-10 subgroups/single diagnoses and corresponding bed-days 

Discharges from hospital do not include cases transferred to another hospital or considered 

healthy, neither healthy newborns. 

Estonian age groups match to Eurostat's age groups till age of 25. Starting from age of 25 the 

age groups are divided on the 10 years basis, and the last age group until 2006 is 75+ and 

from 2007 85+. 

A bed-day- a day during which a person admitted as an in-patient is confined to a bed and in 

which the patient stays overnight in a hospital. Number of bed-days do not include bed-days 

of deceased till 2004. 

Day case - a person is admitted to hospital in the morning and leaves during the same day. 

The data include information only about day cases performed in day care departments 

locating in hospitals. 

Day-patient is admitted either to day care or to day surgery department. 

Also data about day cases are collected in two ways: 1) Day cases according to ICD-10 main 

chapters by sex and age groups; 2) Day cases by selected ICD-10 subgroups/single diagnoses 

are collected without sex-age distribution. 

All hospitals, public and private (except military forces) are covered. 

The only change in data collection in 2000-2004 was that since 2001 prison hospital is also 

included, therefore comparability over time is good. 

Since 2005 hospital bed-days include also bed-days of deceased cases, therefore the 

comparability of ALOS with previous years is affected. 

Since 2005 day care data include day care cases in hospitals (according HP1), while in 2000- 

2004 day care data did not have full coverage of day care by HP1. 

Break in time series: From 2005 bed-days include data on both discharged and deceased 

cases. 


Ireland 


The data presented are derived from the HIPE (Hospital In-Patient Enquiry) data set, which 

records data on discharges from all publicly funded acute hospitals. HIPE is operated by the 

Economic and Social Research Institute (ESRI). 

Reference period: Data are based on the year of discharge 

Coverage: 

"HIPE data covers all in-patients and daycases receiving curative and rehabilitative care in 

publicly funded acute hospitals in the State. The data coverage in HIPE exceeds 96%, i.e. 

overall less than 4% of activity in publicly funded acute general hospitals is missing from 

HIPE. 

For historical reasons, a small number of non-acute hospitals are included in the NHDDB. 

This activity represents less than 0.5% of total activity in the NHDDB. 

The NHDDB does not include private hospitals. Activity data for private hospitals is not 

available, however based on a household survey carried out by the Central Statistics Office in 

2007 it is estimated that approximately 15% of all hospital inpatient activity in Ireland is 

4

undertaken in private hospitals. It should be emphasized that this is an estimate only and so 

should be interpreted with caution. 

Data for Psychiatric in-patients and day-cases receiving curative and rehabilitative care in 

specialist psychiatric hospitals have not been included. It is maintained on a separate database 

which uses ICD 10 for coding diagnosis and also includes long-stay patients. This activity 

accounts for approximately 2% of all Irish hospital activity. Psychiatric patients in acute 

general hospitals are recorded in the NHDDB." 

Estimation method: 

A daycase is defined as a patient who is formally admitted with the intention of discharging 

the patient on the same day, and where the patient is in fact discharged as scheduled (ie. 

excluding deaths and emergency transfers) on the same day. Patients who are admitted or 

discharged as emergencies on the same day are considered inpatients. 

Data for 1995 to 2004 were classified using ICD-9-CM. All HIPE discharges from 2005 are 

now coded using ICD-10-AM (The Australian Modification of ICD-10 incorporating the 

Australian Classification of Health Interventions). 

Although we are using the ISHMT, there are still some minor changes in the classification of 

diagnoses. The HMT shortlist is based on ICD-9 and ICD-10 codes, but we have changed 

from ICD-9-CM to ICD-10-AM including the Australian Coding Standards. This means that 

for certain categories comparison with previous years is difficult. 

The Irish Coding Standards direct that Healthy Newborn Babies are not coded in HIPE. 

Therefore there are no inpatients or daycases in category 2103 [Liveborn infants according to 

place of birth]. 

From 2006 the HIPE system includes data on daycase patients admitted for dialysis in 

dedicated dialysis units. These episodes were previously excluded from HIPE. This has 

resulted in a substantial increase in the number of daycases in ISHMT category 2105 [Other 

factors influencing health status and contact with health services]. 

Note also that in 2006, batch coding was introduced to facilitate more complete coding of 

radiotherapy. This has resulted in an increase in the number of daycases in category 2104 

[Other medical care (including radiotherapy and chemotherapy sessions)]. 

Note that in Ireland, codes from ISHMT category 1501 (Medical Abortions) are only assigned 

for patients admitted to hospital with a complication following a legal abortion in another 

state. 

Break in time series: There is a break in the time series between 2004 and 2005 due to the 

change in classification systems from ICD-9-CM to ICD-10-AM in 2005. 


Greece 

Source: National Statistical Service of Greece. 


Spain 


For inpatient cases: the source of data is the National Statistics Institute based on Hospital 

Morbidity Survey. 

For day cases: National Hospital Discharges Database (Patient Minimun Data Set). Ministry 

of Health and Social Policy 

Reference period: 

For in-patient cases: data as of December 31 

Coverage: 

For in-patient cases: full coverage (100%) from all hospitals (public, private and military) 

5

Data for ICD-9 codes V30-V39 (group 2103) are not available as they are not considered 

main diagnoses by the National Health System in Spain 

ISHMT version 24/11/06 is used on data for the years 2004-2006. ISHMT version 19/01/2008 

is used on data for the year 2007. ISHMT version 10/11/2008 is used since 2008. 

For day cases: collection started in 2004 (partial coverage gradually increasing from 85% in 

2004). In 2007 100% of major ambulatory surgery for Public Hospitals is covered and 95 

general private hospitals data set have been included. 


France 

Source of data: National databases from the "programme de médicalisation des systèmes 

d'information (PMSI)" 

Reference period: calendar year 

Coverage: 

French data cover residents of Metropolitan France and/or overseas Departments 

(Guadeloupe, Martinique, French Guyana and Réunion Island but not Mayotte), who were 

hospitalized in the public and private hospitals of the same area. They refer to hospitalizations 

(and no to patients) in the units delivering acute care in medicine, medical specialties, surgery, 

surgical specialties, gynaecology and obstetrics (MCO). Database contains all in-patient 

hospitalizations, including iterative care, and ambulatory cases except haemodialysis, 

chemotherapy, radiotherapy and other iterative treatments. 

Pooling the hospital stays follows strictly the ISHMT Short List. Diagnosis of the 

hospitalization is the main diagnosis determined at the end of the stay, as the diagnosis most 

demanding in terms of medical and nursing load. When the ICM10 permits to code either 

manifestation (*) or etiology (†) of the pathology, code of the manifestation was used. 

In 1997, stays are linked to the region of the patient's hospitalization. Since 1998, they are 

linked to the region of the patient's place of residence. 

Since 2006, additional ICD10 codes have been allocated to: 

J09 (Proved avian flu): Group 1001 

O94 (Complications after-effects of pregnancy, delivery and/or puerperium): Group 1508 

U04 (Severe Acute Respiratory Syndrome - SARS): Group 1804 

Since 2009 there are two changes in data collection in France: 

1- Added to the public and private hospitals, are the data from the military hospitals 

2- Determined at the end of the stay, the main diagnosis is the health condition responsible for 

the hospitalization; when ICM10 permits to code either manifestation (*) or etiology (†) of 

the pathology, choice has to be the code fitting at best with use of resources. 


Italy 

Source of data: Ministry of Health - D.G. of Health Information System; Office of Statistics 


Estimation method: In tables "discharges by ISHMT" and "discharges by age", the section "all 

patient discharges" also counted records with error in gender 

"1) Please note that impossible and untypical combinations ICD-age-sex are not excluded in 

Tables 2b and 2c. 

2) ICD-sex combinations considered not possible have an incidence very low (minor than 

0.05% on total discharges of respective diagnosis groups) 

3) Among ICD-sex considered very untypical the only one that has a significant incidence is 

the disorders of breast diagnosis in male patients: in 2004 the incidence of these discharges is 

6

the 12.8% on total discharges of this diagnosis group; this percentage is analogous to the one 

registered for previous years. 

4) The ISHMT code 2103 for age group 1+ has an incidence very low (about 0.05% on total 

discharges of this diagnosis group). 

5) ICD-age combinations considered very untypical have an incidence not particularly 

significant (between 0.05 and 1.5 on total discharges of respective diagnosis groups) 

6) Clinical data gathered in the hospital discharges database are coded with the following 

versions: until 2005 with ICD9-CM version 1997, from 2006 to 2008 with ICD9-CM version 

2002, since 2009 with the ICD9-CM version 2007." 

Break in time series: The ISHMT version 2008-01-19 is applied from 2003 to 2005. The 

ISHMT version 2008-11-10 is applied since 2006 


Cyprus 

Source of data: Statistical Service of Cyprus, Source: "In-patients' Discharges", Public sector, 

Administrative Sources 


Coverage: 

In-patient: A person who has gone through the full admission procedure in one of the 

general/rural hospitals and for whom a "patient´s file" has been made and remained at the 

hospital for treatment for at least one night. An infant born in hospital is not counted as a 

separate in-patient, unless treated as a "special care baby". 

Discharge: The conclusion of a period of in-patient care, irrespective of whether the patient 

returned home, was sent to another hospital, left or taken against medical advice or died. Data 

does not relate to individual records. This means that a single patient may therefore account 

for more than one discharge during the year. 

Day-case: Patients admitted and discharged on the same day. 

Records with missing diagnosis have been assigned code "-1". 

If a patient has been admitted in one department e.g. general medicine and has been moved to 

another department during his stay in hospital, he is only recorded once, under the department 

he is discharged from. 

If a patient was admitted to one hospital and was transferred to another hospital without firstly 

being discharged from the first, then only the hospital where he was officially discharged 

from is recorded. 

eviation from the definition: 

Information on discharges refers to public sector hospitals only. 

Healthy Newborn Babies (Z38) are excluded in the discharges. 


Latvia 

Source of data: Health Payment Centre (former Health Compulsory Insurance State Agency). 


Coverage: 

The data covers all HP.1 providers of health care, which have a contract with the Health 

Payment Centre, and all activities of inpatient care financed by state. 


Lithuania 

Source: Lithuanian Health Information Centre, data from Compulsory Health Insurance 

Database. 

7

Data are available from 2001. Health insurance database cover about 97.5% of all hospital 

discharges. 

Number of day cases is calculated from Compulsory Health Insurance Database as alive 

patient formally admitted and discharged the same day. 

As this database is quite new, there are some problems with data (e g. a big number of 

unknown age, especially in 2001). 


Luxembourg 

Source of data: fichiers de la sécurité sociale 

Exploitation des statistiques : Inspection générale de la sécurité sociale 


Coverage: 

Data is for acute hospitals with direct access. Data from establishments whose main activity 

consists in providing medium and long term care are excluded. 

Data on functional rehabilitation and readaptation and on psychiatric care are only included 

when allocated in acute care hospitals (HP. 1.1 and HP. 1.3). 

Palliative care is included. 

Les enfants nés en bonne santé (Z 38) ne sont pas enregistrés comme patients par les 

hôpitaux, donc aucun diagnostic de sortie n’est établi. 

Estimation method: classification ICD-10. 

Admissions at hospital with discharge on the same day before midnight are considered as day 

cases. 

Before 2002: no breakdown available for age after 90. 


Hungary 

Source of data: National Institute for Strategic Health Research (ESKI). 



The data are calculated from the itemised data of the inpatient care finance report submitted 

by the National Health Insurance Fund. 

1. We provided case number for hospital discharge, rather than case number for department. 

2. If the hospital case involved nursing in several departments, then the hospital case is 

assigned the major diagnosis of the department case whose DRG classification had the highest 

weight number. 

3. Day case is considered a hospital case where the date of admission and the date of 

discharge are identical, and during the hospital stay a medical intervention was performed that 

appears on the list of allowed day case interventions. Patients who passed away on the day of 

admission are always counted among inpatient cases. 

4. Hospital discharges given by diagnoses includes about 70 thousand discharge cases less 

than the patient migration. The cause of which is that we did not count in the number of 

hospital discharges given by diagnosis those hospital cases the main diagnosis of which was 

considered deficient, either because of a codifying error or because of the deficient or 

incomplete code stock utilized by us. 


Malta 

Source of data: Hospital activity figures on Hospital activity analysis datatbases for St. Luke's 

Hospital and Gozo General Hospital. 

8

2007: Hospital activity figures on Hospital activity analysis datatbases for Mater Dei 

Hospital/St. Luke's Hospital and Gozo General Hospital. 

2009: Hospital activity analysis figures from ALL state hospital (5 in all). 

2010: Hospital activity analysis figures from ALL state and private hospitals 


Coverage: 

Figures in this table for 2006 represent 69% of episodes of care in State acute general 

hospitals. Figures are representative of about 48% of episodes of care in acute hospitals at 

National level. 

For 2007, episodes (inpatients and day cases) together with relevant LOS with an ISHMT 

diagnosis in Table Discharges by diagnosis (40597 episodes in all between inpatients and day 

cases) represent 61.1% of all admissions to State acute hospitals. 

In Table Discharges by age, all recorded episodes in the Hospital Activity Analysis databases, 

including those without a recorded diagnosis are included. Thus the total figure of admissions 

recorded (44030) represents 66.3% of all admissions to acute State. 

For 2008, the total number of data records for episodes of care i.e. 53766 represents circa 74% 

of HP.1.1 State hospital admissions. The number of records with a valid diagnosis code i.e. 

45083, represent 60% of HP.1.1 State hospital admissions. 

For 2009: Discharges data collated from all state hospitals (HP.1) 

For 2010: Discharges data was collated from all state and private hospitals (HP.1) 


Episodes with no diagnosis are included in a separate category with ICD diagnosis by shortlist 

"3000". This code does not exist in ISHMT. 

Episodes listed in "Diagnosis by ICD shortlist - 0000" DO INCLUDE diagnosis with V, W, 

X, Y codes as these are considered as valid diagnosis in Malta. Totals here also include 

episodes where no diagnosis was captured i.e. diagnosis by shortlist - 3000. 

Diagnosis with ICD codes V, W, X, Y are included with ICD diagnosis by shortlist "1911" 

Diagnosis by ICD shortlist - 2103 - liveborn infants born in hospital is not captured by major 

state hospital. 

For 2007: 

Data from the main State hospital is not subdivided into inpatient and day care episodes. Day 

care episodes are extracted using the following criteria: 1): booked admission to wards where 

day cases are "admitted", 2): discharge on medical advice, 3): Length of stay 

For 2008: Babies born in hospital (ICD10 code Z38) are still not recorded as episodes of care 

by the major State general hospital. Hence data for this category is still not available. 

Since the opening of the new State Hospital in Malta, there has been a very significant 

increase in the percentage of admissions to State hospitals and a corresponding marked 

decrease in admissions to private institutions. 

2009: Healthy newborn infants are included in the discharges for this year. Data collection has 

been carried out from all state hospitals for 2009. 

2010: All discharges from state and private hospitals, including healthy newborn infants, are 

included in the data submission. 


Netherlands 

Source of data: The Hospital Discharge Register (HDR, the 'Landelijke Medische Registratie' 

of Dutch Hospital Data) is the source of data on hospital discharges by ages, sex, and ISHMT 

diagnoses (including HDD file). 

Reference period: All hospital discharges during the calender year are included 

Coverage: 

9

In the Hospital Discharge Register of the Netherlands diagnoses of hospital discharges are 

registered according to the ICD9-CM. 

Only the principal diagnoses are included. 

Discharges in Dutch hospitals of non-residents of the Netherlands are included in the figures. 

Impossible combinations of ICD – age – sex rarely occur, and when they occur these numbers 

are excluded from the tables (empty cells) 

However, these (very small) numbers do count in the totals. Therefore in the case of empty 

cells the subtotals do not always precisely add up to the totals at higher levels of aggregation. 

From 2005 onwards the HDR in the Netherlands suffers from a substantial degree of nonresponse. 

The non-response (as a percentage of all discharges) increased from 1% in 2004 to 3% in 

2005, 10% in 2006 and 13% in 2009 

Therefore we raised the figures by imputation of data for the non-responding hospitals. This 

results in less accuracy of the figures from 2005 onwards. 

The HDR covers only short-stay hospitals. 'The hospitals included are all general and 

university hospitals, and specialty hospitals with the exception of epilepsy clinics and longstay 

centres for rehabilitation and asthma treatment. 

The register therefore does not cover all hospitals of the HP.1 category. The differences are: 

Category HP.1.2 (mental health and substance abuse hospitals) is not included at all. 

Category HP.1.3 (specialty hospitals other than hospitals for mental health and substance 

use): 

- Excluded are epilepsy clinics and long-stay centres for rehabilitation and asthma treatment. 

- Excluded are also (semi-)private hospitals; these hospitals mainly have outpatients and day 

cases. 

Some treatments in category HP.1. hospitals are excluded: 

- Part-time psychiatric treatments in general or university hospitals with a psychiatric ward are 

not recorded in the HDR. 

- Cases of rehabilitation day-treatment are not registered in the HDR. 

- Non-inpatient admissions for normal deliveries (mother planned to be in hospital for less 

then 24 hours) are not registered in the HDR. 


Austria 

Source of data: Statistics Austria, Hospital discharge database; raw data: Austrian Ministry of 

Health 

Reference period: December 31st 

* The Austrian hospital discharge database covers all in-patient institutions classifiable als 

HP.1 according to SHA/OECD. 

* The database includes all in-patient discharges and daycases. 

Daycases are all cases admitted and discharged at the same day (before midnight). 

Inpatients include discharges to home, other inpatients-institutions and deaths in hospitals. 

* Concerning hospital days for in-patient cases: please note that long-term inpatients are 

included; 

some patients are for many years hospitalised, what influences the hospital days overall. 

Break in time series: ICD-9 code was used from 1989-2000, ICD-10 from 2001 on. 


10

Poland 

Source: National Institute of Public Health-National Institute of Hygiene (NIPH-NIH) for 

2003-2004 general hospitals data only. For 2005-2009 NIPH-NIH and through NIPH-NIH 

also Institute of Psychiatry and Neurology (combined general and psychiatric hospitals) 

Two databases in 2005-2009: General Hospital Morbidity Study (GHMS) and Psychiatric Inpatient 

Morbidity Study (PIMS); in 2003-2004 GHMS DB only 


Coverage: 

Discharges in 2003-2004 - non-estimated data for general hospitals only provided by 85% and 

87% hospitals, respectively. For 2005-2009 non-estimated data from General (nonpsychiatric) 

Hospital Morbidity Study provided by 91% hospitals in 2005, 93% in 2006, 92% 

in 2007, 88% in 2008, 93% in 2009 and by all psychiatric hospitals. Military and Ministry of 

Internal Affairs hospitals are not included. 


Portugal 

Source of data: Direcção-Geral da Saúde - Health Ministry 

The information is taken from the "Diagnosis related groups" database, which includes only 

public hospitals of the National Health Service 


Deviation from the definition: The information respects to hospitals of the "National Health 

Service" (public sector), only. 

The used codes correspond to ICD- 9 CM. 


Romania 

Source of data: Ministry of Health; National Centre of Statistics and Informatics in Public 

Health for the period 2000 – 2008; National School of Public Health and Health Management 

- Bucharest for 2009 and 2010. 

Reference period: during the 

Coverage: 

The data concerning discharges cover only the hospitals from the Ministry of Public Health 

network (public sector) for the period 2000 - 2008 

The data concerning discharges cover all the hospitals (public and private sector) for 2009 and 

2010. 

Estimation method: For 2009 and 2010: the differences in "Date check" between tables „Total 

by age vs total by diagnosis for all patients”, ”Total by age vs total by diagnosis for males”, 

„Total by age vs total by diagnosis for females” come and are equal of cases disposed of by 

the condition "A00-Z99 (Excluding V, W, X and Y codes)" imposed in the table "Discharges 

by Diagnosis" for among "All Causes" total and by gender 


Slovenia 

Source of data: Institute of Public Health of the Republic of Slovenia; National Hospital 

Health Care Statistics Database 


Coverage: Data include: 

- in-patient and day-cases care and long-term care in all hospitals (public and private) 

- all newborns (from 2003) 

11

- paliative care in hospitals 

Note: In 2007 there were 13 in-patient cases and 23 hospital days for in-patient cases where 

gender was unknown or indefinable. 

In 2009 there were 11 in-patient cases and 313 hospital days for in-patient cases where gender 

was unknown or indefinable. 

Deviation from the definition: Data also include transfers to another department within the 

same institution (2.2% of all discharges in the year 2008, 2.0 % of all discharges in the year 

2009). 


Slovakia 

Source of data: National Health Information Centre 



Length of stay over 180 days is mainly by psychiatric patients who were discharged in given 

year after long-term length of stay. 


Finland 

Source of data: National Institute for Health and Welfare (THL); Hospital Discharge Register 


Coverage: 

Data for the number of day cases has been revised since the year 2000. In the current data the 

day cases have admitted and discharged during the same day. 

Data for the number of inpatient cases has been revised since the year 2000. In the current 

data the care periods where admission day differs from that of discharge day has been 

involved. 

Data has been revised since the year 2000 taking into account the exclusion criteria of 

transfers to another department within the same institution. 


Sweden 

No methodological notes available. 


United Kingdom 


Data has been aggregated by the NHS Information Centre for Health and Social Care from the 

following sources: 

England: Hospital Episode Statistics (HES); Inpatients, The NHS Information Centre for 

health and social care, England. 

Wales: Patient Episode Database Wales (PEDW), NHS Wales Informatics Service. 

Scotland: Information Services Division, National Health Service Scotland (SMR01 records). 

Northern Ireland: Hospital Inpatient System, Department of Health, Social Services and 

Public Safety. 

Reference period: 

England, Wales and Scotland: Data is based on Financial Discharge Years 1st April to 31st 

March 

Northern Ireland: Procedures have been tabled by calendar year 

12

Includes records for discharge dates occurring in the reference year, regardless of admission 

date 

Coverage: 

England, Wales, Northern Ireland: Inpatient data covering activity in English NHS Hospitals 

and English NHS commissioned activity in the independent sector. 

Scotland: data also includes returns from private hospitals, hospices and nursing homes 

relating to NHS activity. http://www.datadictionaryadmin.scot.nhs.uk/isddd/9075.html 

England: Outpatients are excluded. 

Scotland: Data includes all patients treated within Scotland. This includes patients from 

resident from out with Scotland and patients with no fixed abode. 

Wales: Includes all patients discharged from Welsh hospitals (including those NHS patients 

treated in private hospitals). 

Northern Ireland: Includes all patients treated in HSC hospitals. 


England: A discharge episode is the last episode during a hospital stay (a spell), where the 

patient is discharged from the hospital (this includes transfer to another hospital). Discharge 

episodes may be double-counted in a table if they appear in more than one row of the 

microcube, e.g. against two different diagnoses. Restricted to ordinary admissions, day cases 

and mothers/babies using delivery facilities (classpat = 1, 2 or 5). Regular day and night 

attenders not included. 

Wales: Discharge episode is the last episode during the hospital spell. Where a patient has 

received more than one treatment within a range of codes it has only been counted once. 

Scotland: The basic unit of analysis for these figures is a Continuous Inpatient Stay (CIS) in 

hospital. Probability matching methods have been used to link together individual SMR01 

hospitals episodes for each patient, thereby creating “linked” patient stay histories. 

Approximately 20% of Inpatient stays and 0.5% of daycase stays are multi episode cases. 

External Causes data was not available as these codes cannot be recorded as a main diagnosis 

on our data returns. They can only be recorded in a secondary diagnosis position. 

Northern Ireland: A discharge episode is the last episode during a hospital stay (a spell), 

where the patient is discharged from the hospital (this includes transfer to another hospital). 

Episodes where Primary diagnosis is not coded have been excluded. 


Data are ungrossed (i.e. they are not adjusted for shortfalls) in England, Northern Ireland & 

Wales 

Total discharges does not include any records where a valid ICD10 code was not recorded 

Break in time series: 

England: National data is recorded by financial years, therefore the data has been presented in 

financial years. The data provided covers the period 01/04/2009 to 30/03/2010. Due to 

changes from calendar years (in the previous data supplies) to financial years there maybe 

slight variations in the number of recorded episodes. Typically the difference in total episodes 

recorded between the figures based on financial year and those based on calendar years is 

minimal (approx. 0.6 per cent). 


Croatia 

No methodological notes available. 


Former Yugoslav Republic of Macedonia 

Source: Republic Institute for Health Protection, Skopje. 

13


Turkey 

Source of data: From 2007 onwards: Information Technology Coordination Unit 


Coverage: 

This data refer all of hospitals in Turkey. 

Discharge occurs anytime a patient leaves because of finalisation of treatment, signs out 

against medical advice, transfers to another health care institution or because of death. A 

discharge can refer to in-patients and day cases. We couldn't separate day cases from 

inpatients cases. 


Iceland 

Source of data: Directorate of Health in Iceland. Hospital data registry. 


Coverage: Data cover whole country. 

Included: somatic and psychiatric inpatient hospital units, all dicharges with a length of stay 

(LOS)


Switzerland 

Source of data: FSO Federal Statistical Office, Neuchâtel; Medical Statistics of Hospitals 

Reference period: Annual census 

Coverage: 

Full coverage of hospitals; sufficient (nearly full) coverage of inpatient and day cases since 

2002 

Due to a modification of the legislation, day cases are not collected in 2009 anymore 


The definition and delimitation of day cases is subject to local heterogeneity; figures should 

be treated with caution (some patients with multiple episodes of day-cases are recorded only 

once, leading to an underestimation of actual day-cases) 

Estimation method: Discharges without a valid ICD-code are not accounted for (mostly 

negligible) 

Break in time series: There is a high number (20%) of invalid ICD-codes for day-cases in 

2005 

The gradual change of diagnosis classification since 2008 from ICD-10 WHO to ICD-10 GM 

(German modification) may lead to breaks for some categories 

Day cases not available in 2009 


15

Hospital discharges by diagnosis (ISHMT) - Eurostat

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?