Health interventions: health services

The total number of practising nursing and caring professionals by 31 December of a given calendar year, per 100,000 inhabitants (end of year population). Practising nurses provide services directly to patients. Practising nurses include:

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

For more detailed definitions: see references (definitions and data collection specifications on health care statistics (non-expenditure data), available in CIRCA).

Calculation

The total number of practising nursing and caring professionals by 31 December of a given calendar year, per 100,000 inhabitants (end of year population). Practising nursing and caring professionals provide services directly to patients. Nursing and caring professionals include midwives, qualified nurses, associate nurses and caring personnel (e.g. nursing aids, assistants). A nurse is a person who has completed a programme of basic nursing education and is qualified and authorised in his/her country to practise nursing in all settings. For more detailed definitions: see references (definitions on health care statistics (non-expenditure data), available in CIRCA).

Relevant dimensions and subgroups

Calendar year
Country
Region (according to ISARE recommendations; see data availability)

Preferred data type and data source

Preferred data type

Administrative sources

Preferred data source

Eurostat

Data availability

Data are available as of 2000 for Denmark, Estonia, Latvia, Lithuania, Hungary, the Netherlands, Austria, Portugal, Romania, Slovakia, United Kingdom, Croatia, Norway and Switzerland, though not for all countries the series are complete. For the Czech Republic annual data are available as of 1985. Data on practising nurses and midwives (i.e. a subgroup of nursing and caring professionals) by region are available in Eurostat (NUTS II level), though coverage is not optimal, as with the national level data. The ISARE project on regional data has collected data on number of nurses (indicators: number of nurses (including midwives) per 100,000 population, number of nurses (excluding midwives) per 100,000 population, number of midwives per 100,000 population).

Data periodicity

Data are being updated annually. Eurostat asks Member States to deliver the data for year N at N + 18 months, but some Member States have difficulties with this time table and deliver the data at their earliest convenience.

Rationale

Indicator widely used in assessments of accessibility and efficiency of health care services. It describes availability of staff for the whole country and the distribution of staff across the country. Time trends may help to identify e.g. staff shortages due to demographic developments such as migration.

Remarks

‘Nurses and midwives per 100,000 inhabitants’ is one of the (context) indicators of the indicators of the health and long term care strand of the Social Protection Committee (Open Method of Coordination).
Common definitions for the different categories of health care professionals were agreed with OECD and WHO. Three different concepts are used to present the number of health care professionals:

'practising', i.e. health care professionals providing services directly to patients;
'professionally active', i.e. 'practising' health care professionals plus health care professionals for whom their medical education is a prerequisite for the execution of the job;
'licensed to ', i.e. health care professionals who are registered and entitled to practise as health care professionals.

In the context of comparing health care services across Member States, Eurostat and ECHIM give preference to the concept 'practising', as it best describes the availability of health care resources.
Eurostat metadata: “Health care staff data refer to human resources available for providing health care services in the country, irrespective of the sector of employment (i.e. whether they are independent, employed by a hospital or any other health care provider)”.
Eurostat metadata: “Some countries are unable to cover all providers of care (the inclusion of private providers seems particularly difficult) or are only able to provide data for selective regions”.
Eurostat metadata: “For health care staff, countries may use a central register for medical professionals, business registers or other forms of data collection (including sample surveys)”. “…the quality of the country data is subject to the way, in which health care provision is organised in countries, and which information is available to and collected by the respective institutions”. Comparability of the data between countries is therefore limited.
Eurostat data on health care staff are based on head count rather than on FTEs. The latter would provide a more precise estimate of available human resources. However, data availability is currently very limited.
The Eurostat data on physicians are not fully harmonised with regard to the reference period; some countries provide annual averages rather than end of year estimates. See references (annex describing original sources in the Member States) for more details. However, the reference period is not described for all countries in the annex.
As of 2010 Eurostat, OECD and WHO-Europe carry out a joint data collection in the field of health care non expenditure (human and physical resources). Publication of the (meta-)data is expected shortly).

References

Work to do

Check with ISARE their precise indicator definition; do they also apply ‘practising nursing and caring professionals’?
Consider adapting the indicator’s definition once availability of data based on FTEs has improved.
Monitor publication of (meta-)data collected in joint Eurostat/WHO/OECD questionnaire and update documentation sheet accordingly.

European Commission - Public Health: healthindicators.org

Definition