Definitions
Introduction
In the following, the main definitions of and comments on the 15 main indicators are given.
The sources of the data are the annual publications: Health Statistics in the Nordic Countries (can be found in pdf format at http://nomesco-eng.nom-nos.dk/) and Social Protection in the Nordic Countries (http://nososco-eng.nom-nos.dk/). The publications available on the web are the latest issues, where you can find further information. You will also find more detailed figures on the Statistics page.
The main sources of all data are the national statistical authorities in the respective fields. In the section Further information in Health Statistics in the Nordic Countries and Social Protection in the Nordic Countries, you will find the addresses of the responsible authorities. On the Links page at www.nom-nos.dk, you will find links to the web pages of these authorities.
For each indicator you will find some main definitions and comments.
Should you have any questions or need further information please contact NOMESCO and NOSOSCO at: mail@nom-nos.dk.
Main Social and Health Statistics Indicators
The database consists of 15 main indicators:
1. Vital Statistics
2. Income Distribution
3. Illness
4. Treatment
5. Medicine
6. Causes of Death
7. Capacity in the Health Sector
8. Health Care Expenditure
9. Families and Children
10. Unemployment
11. Sickness Benefits
12. Old Age, Disability and Survivors
13. Housing
14. Social Exclusion
15. Social Expenditure
1. Vital Statistics
Definition: Vital statistics include all the main information from the population registers of the Nordic countries. As defined in this database, some information from the national clinical registers, such as information from the abortion registers and the national clinical registers on birth, are also given.
a. Population
b. Births and Total Fertility Rate
c. Abortions
d. Deaths
e. Life Expectancy
a. Population
Definition: You will find information on the population in the Nordic countries, broken down by aggregated age groups and sex, for the period of 1995 to 2003. The source of the data is the population registers of the Nordic countries. These registers include foreigners, who have been granted a residence permit, but exclude citizens born abroad.
b. Births and Total Fertility Rate
Definition: You will find information on number of births, total and broken down by mothers' ages, as well as the total fertility rate, for the years 1995-2003. The source of these data is the national population registers. The definition of total fertility rate is the number of births given by 1 000 women provided they live to be 50 years, calculated from the age specific fertility rates of the current period.
c. Abortions
Definition: You will find information on number of abortions, total and broken down by mothers' ages, as well as the total abortion rate, for the years 1995-2003. The source of these data is the national abortion registers. The definition of total abortion rate is the number of abortions performed on 1 000 women, provided they live to be 50 years, calculated from the age-specific fertility rates of the current period.
d. Deaths
Definition: You will find information on the total number of deaths, broken down by sex and age in aggregated age groups. The source is the national population registers.
e. Life Expectancy
Definition: You will find data on average life expectancy for the age groups 0; 15; 45; 65 and 80 years. The definition of average life expectancy is the average further number of years which a person in a given age group can be expected to live, assuming that mortality rates remain constant.
2. Income Distribution
The figures concerning income distribution are based on representative segments of the population in each of the countries. Based on these population segments, calculations have been made on income distribution. Data have been retrieved in respect of each individual population segment from administrative records and special surveys on income, tax, social benefits and services, family type, etc.
A household consists of adults and any children living at one and the same address, irrespective of the children´s ages.
The basis for the calculations can be seen in appendix 1 in Social Protection in the Nordic Countries (www.nom-nos.dk/nososco.htm) and you will find all the main figures on the spreadsheet on the Statistics page at www.nom-nos.dk/nososco.htm.
3. Illness
Under Illness the following indicators are shown:
• Cancer, men: Total and for Testis, Prostate and Lungs.
• Cancer, women: Total and for Mamma, Cervix uteri and Lungs.
• Tuberculosis for men and women.
• Hepatitis (B and C) for both men and women.
The figures for cancer refer to ICD10 with the following numbers: Total: C00-97, Testis: C62; Prostate: C61, Lungs: C33-34, Mamma: C50 and Cervix uteri: C53.
The rates are age-standardized according to the World standard population.
In the Nordic countries there is an obligation to register all cases of tuberculosis and hepatitis. The figures shown are registered cases.
4. Treatment
Under treatment, the following indicators are shown:
• Discharges for cancer: C00-D48
• Discharges for diseases of the circulatory system, total: I00-I99
• Discharges for diseases of the circulatory system, certain groups: I20-I25, I60-I69
• Discharges for lung diseases: J00-J99
• Discharges for gastrointestinal diseases, total: K00-K93
• Discharges for gastrointestinal diseases, certain groups: K25-K28, K35-K38, K50-K51
• Discharges for diseases of the muskoloskeletal system: M00-M99
Sources of the data are the in-patient registers in the Nordic countries.
The other groups are the following 16 major surgical procedure groups:
• Coronary bypass operations, excl. PTCA (FNA; FNB; FNC; FND and FNE)
• Percutaneous expansion of coronary artery (PTCA) (FNG 02 and FNG 05)
• Partial and total thyroid excision (BAA 20-60)
• Kidney transplant (KAS 10-20)
• Hysterectomy (including supravaginal hystrectomy and exenteration of pelvis) (LCC 10-20; LCD; LCE; LEF 13)
• Prostatectomy, transurethral procedures (KED 22-72)
• Radical prostatectomy (KED 00;96)
• Hip replacement (NFB; NFC)
• Mastectomy (women) (HAC 10-25; HAC)
• Partial excision of mammary gland (women) (HAB)
• Appendectomy (JEA)
• Disc operations (ABC 01-26)
• Cholecystectomy (JKA 20-21)
• Caesarean section (MCA)
• Open prostatectomy (KED 00 and KED 96)
• Cataract surgery (CJC, CJD, CJE, CJF00, CJF10)
Remark: The number in brackets refers to NCSP version 1.7 (NOMESCO: Classification of surgical procedures) NOMESCO 65:2003.
Comments
It should be noted that there is a certain variation in diagnostics and coding from one Nordic country to another, in spite of the fact that they use the same classification system.
The statistics concerning discharges are calculated according to the main diagnostic groups. This means that the patient statistics do not show all of the individual cases of illness at the time of admittance, but only the diagnosis that was the main reason for a patient's admittance to/treatment in a hospital.
Finally, Norway registers discharges from hospitals while the other countries register discharges from hospital departments, and for that reason the Norwegian figures are underestimated in relation to the other countries.
As to operations, there are some differences from one country to another in the counting of operations.
5. Medicine
Sales of medicine are shown in relation to DDD/1 000 inhabitants per day by ATC groups and calculated in pharmacy retail prices (million euro) per ATC-group.
The ATC groups are:
• A: Alimentary tract and metabolism
• B: Blood and blood-forming agents
• C: Cardiovascular agents
• D: Dermatologicals
• G: Genito-urinary system and sex hormones
• H: Systemic hormonal preparations, excl. sex hormones
• J: General anti-infectives for systemic use
• L: Antineoplastic and immunomodulating agents
• M: Muscolo-skeletal system
• N: Nervous system
• P: Antiparasitic products, insecticides and repellents
• R: Respiratory system
• S: Sensory system
• V: Various
Source: The Nordic countries' registers for sales of medicine.
Comments
All medicine is classified according to the ATC Classification (Anatomical, Therapeutic, Chemical classification system). The ATC system divides the medicinal substances for human use into 14 main anatomical groups (1st level).
Medical sales measured in amounts of active substance are expressed in Defined Daily Doses (DDDs), as defined and assigned by the WHO: The DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults.
6. Causes of Death
For causes of death the following indicators are shown:
• Deaths from diseases in the circulatory system ICD10: I00-I99
• Malignant neoplasm/cancer ICD10: C00-C97
• Suicides and accidents ICD10: V01-X84
• All causes ICD10
Note: The source is the Nordic countries' registers for causes of death.
Comments
The statistics on causes of death are based on The International Classification of Diseases (ICD). The most recent, tenth revision (ICD-10) was adopted by the WHO in 1990 but was not adopted in most of the countries until several years later. In the Nordic countries the ICD-10 was introduced for mortality coding in Denmark in 1994, in Finland, Iceland and Norway in 1996 and in Sweden in 1997.
Revisions of the classification impede statistical comparisons over time and between countries using different versions of the ICD. The recent revision has above all meant an increase in the level of detail in the ICD. A great number of new diagnoses has been added as a result of developments in medicine. Also, certain diseases or groups of diseases have been transferred from one chapter to another in order to reflect new medical knowledge.
Another potential source of error is the fact that certain rules and guidelines for the use of the ICD have also changed in connection with a new revision.
With reference to the mortality statistics, certain rules for the selection of the underlying cause of death have been altered which may, for example, affect the frequency of pneumonia as a cause of death.
For the above reasons the data presented here should obviously be interpreted with care.
7. Capacity in the Health Sector
The following indicators of capacity in the health sector are shown:
• Number of hospitals broken down by ordinary, specialized, psychiatric and other hospitals and number of beds
• Number of hospital beds broken down by speciality
• Working physicians
• Working qualified nurses
Note: The source of number of hospitals and hospital beds is the national boards of health. The main source for health personnel is partly the national boards of health and partly information from the unions. But are now classified according to NACE 85.1 and 85.3 (Classification of occupation).
Comments
In recent years, small hospitals have been closed down in the Nordic countries, and resources have been gathered at fewer hospitals. There is also a trend towards psychiatric hospitals being closed down, however, at varying speed.
The hospitals are divided into ordinary hospitals, specialized hospitals, psychiatric hospitals and other hospitals.
Ordinary hospitals are hospitals with several specialities that primarily provide somatic short-term treatment, but also include short-term psychiatric treatment. Specialized hospitals include hospitals that only have one speciality within somatic treatment. Psychiatric hospitals are hospitals that only treat psychiatric patients. Other hospitals include hospitals with geriatric and psychiatric nursing and/or long-term treatment at health centres with mixed medical and surgical wards. These health centres are seen in Greenland, Iceland and Finland, and for Finland and Iceland this results in a larger number of beds in relation to inhabitants than in the other countries.
The statistical information about the staff load in the health services is very incomplete, and it is therefore difficult to give a comparable picture of the conditions in the various Nordic countries. For some countries, the statistics include information about the number of employees, whereas in other countries they include information about the number of people trained within the respective categories of staff.
8. Health Care Expenditure
For health care expenditure, the following indicators are shown:
• Health care total
• Per capita in euro
• As per cent of the GDP
Note: The source for Denmark, Finland, Iceland, Norway and Sweden is the OECD database, for Greenland, Faroe Islands and Åland figures are based on national calculations.
Comments
There is a number of difficulties in connection with the comparison of international health costs.
In order to get more comparable international data on the health sector, the OECD has performed a thorough revision of what should be included as health costs. The most important difference is that the OECD includes the social services provided to the elderly and the disabled as expenditure under the health care system.
The OECD data differ from what is nationally defined as health care costs, but the OECD data are, however, the most frequently cited source of international comparisons.
9. Families and children
For families and children, the following indicators are shown:
• Recipients of daily cash benefits in the event of pregnancy, childbirth or adoption
• Disposable income for an APW while receiving maternity benefit as a percentage of the disposable income when working, for a single parent with a newborn baby, a couple with only a newborn baby and for a couple with two children + the newborn
• Children enrolled in day-care institutions and family day-care by age
• Children and young people placed outside of their own homes during the year, by age
• Social expenditure on families and children
Note: The source of the data is the publication Social Protection in the Nordic Countries for the respective year.
Comments
Concerning recipients of daily cash benefits in the event of pregnancy, childbirth or adoption, it should be noted that the Swedish figures are not comparable with those from the other countries, as the benefit is payable for more days per child than is the case in the other countries. Besides, parents in Sweden are entitled to daily cash benefits until a child reaches the age of 8. The large increase from 2002 to 2003 for Denmark was a result to the new rules on prolonged leave not entering completely into force until 2003.
The calculations of the compensation levels are based on so-called typical cases. All the detailed figures as well as the description of the calculations are available at www.nom-nos.dk/nososco.htm (see under Statistics + appendix 2 in Social Protection in the Nordic Countries). APW stands for an Average Production Worker, calculated by the OECD.
The data on children enrolled in day-care institutions do not include after-school-club schemes for schoolchildren. More and more children are enrolled in such schemes instead of day-care institutions.
For children and young people placed outside of their own homes the legislation differs from one country to another and that affects the number of children and young people placed in institutions.
The social expenditure is calculated according to the ESSPROS-system (ESSPROS stands for European System of Integrated Social PROtection Statistics), which is the classification used by all EU-countries reporting to the EUROSTAT. The ESSPROS calculates the expenditure net, which means minus user charges and investments.
10. Unemployment
For unemployment, the following figures are shown:
• Number of unemployed people broken down by sex, of whom males and females 16-24 years old
• The population aged 16-64 years by activity
• Disposable income while receiving unemployment benefit as percentage of disposable income while being employed for a single person without children and for a single person with one child, for a couple without children and for a single non-insured person without children and for a non-insured person with one child.
• Social expenditure on unemployment
Note: The source of the data is Social protection in the Nordic Countries for the respective years.
Comments
The data on unemployment are based on the national labour-force surveys.
The calculations of the disposable incomes are, like those for families and children, based on typical cases.
The social expenditure is also based on the ESSPROS-system.
11. Sickness Benefit
For illness, the following figures are shown:
• Number of sickness-benefit periods of at least 15 days broken down by duration (15-29 days; 30-59 days; 60-119 days; 120--359 days and 360+ days).
• Compensation levels in the event of illness for a couple without children, a single person without children and for a single person with one child.
• Social expenditure on illness.
Note: The source of the data is Social Protection in the Nordic Countries for the respective years.
Comments
With the exception of Sweden the normal period for receiving sickness benefit is one year, but in some cases the period can be prolonged in the other countries.
The compensation levels are based on typical cases and the calculation of the expenditure is based on the ESSPROS system.
It should be noted that there are remarkable differences between what is here recorded as services (health care expenditure) and what is recorded under indicator 8, where health care expenditure is calculated according to the OECD-definition and the OECD-manual, A System of Health Accounts.
12. Old Age, Disability and Survivors
On old age, disability and survivors, the following figures are shown:
• Total number of pension recipients, broken down by age.
• Recipients of old-age pension.
• Pensioners receiving special old-age/partial retirement pension broken down by sex and age.
• Pensioners receiving disability pension broken down by age.
• Compensation level for singles and couples receiving old age pension.
• Compensation level for a single person receiving disability pension.
• People aged 65/67+ living in institutions.
• Disabled people aged <65/67 living in institutions.
• Total social expenditure on the elderly, the disabled and survivors.
Note: The source of the data is Social Protection in the Nordic Countries for the respective years.
Comments
The total number of pensioners do not include child pensioners, partial retirement pensioners or recipients of survivor's pension.
The recipients of old-age pension are people receiving basic/minimum and/or employment pension.
Basic/minimum pension is the guaranteed minimum pension to all people who have been resident in the country for at least 3 years. Employment pension is only payable to former labour-market employees.
There are no available data on people receiving supplementary pension according to collective agreements.
The people receiving special old-age/partial-retirement pension are covered by many different schemes with special rules varying from country to country.
The compensation levels for old-age and disability pensioners are based on typical cases for an APW.
As to institutions, several different kinds of institutions are covered, such as nursing homes, homes for the long-term ill, old peoples' homes, sheltered homes, service flats, collective housing and housing where special care is provided.
The social expenditure on the elderly, the disabled and survivors is calculated according to the ESSPROS-system.
13. Housing
For housing, the following indicators are shown:
• Housing benefits to families
• Housing benefits to pensioners
• Social expenditure on housing
Note: The source of the figures is Social Protection in the Nordic Countries for the respective years.
Comments
Housing benefits to families are only given to families living in rented accommodation in Denmark and Iceland, while housing benefits in the other countries may also be granted to families who own their own accommodation.
Housing benefits to pensioners depend on a pensioner's personal income, the amount of the rent, etc.
The expenditure is calculated according to the ESSPROS-system. For Finland, the expenditure on housing for the elderly is part of the pension system, and for that reason the expenditure is included in services to pensioners.
14. Social Exclusion
For social exclusion, the following indicators are shown:
• Individuals receiving social assistance during the year, by age
• Individuals receiving social assistance at the end of the year
• Number of refugees received by the country who have been granted residence permits
• Total social expenditure on social exclusion
Note: The source of the data is Social Protection in the Nordic Countries for the respective years.
Comments
Social assistance is granted to people who do not have any other income or sufficient income. However, the cases in which social assistance is granted differ from one country to another. In Denmark, most of the recipients receive the benefit instead of other benefits or income, while a major part of recipients in Finland and Sweden receive the benefit as a supplement to other insufficient benefits.
The number of people granted resident permits varies from year to year from one country to another, first of all due to refugees from Ex-Yugoslavia who were first granted temporary residence permits and then later granted residence permits.
The social expenditure on social exclusion is calculated according to the ESSPROS-system
15. SocialEexpenditure
For the total social expenditures the following indicators are shown:
• Total social expenditure 1995-2003 at fixed prices
• Total social expenditure per capita
• Total social expenditure as a percentage of the GDP
• Financing of the social expenditure
Note: The source of the data is Social Protection in the Nordic Countries for the respective years.
Comments
The total social expenditure is a summary of the expenditure shown in the other indicators based upon the ESSPROS-system.
As to financing, other financing signifies property income.
