Content
About the statistics
Definitions
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Name and topic
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Name: Municipal health care service
Topic: Health
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Responsible division
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Division for Health, care and social statistics
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Definitions of the main concepts and variables
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Man-year
These data are intended to embrace all kinds of activities within the home based services and the institutions, and are not only restricted to health care functions. The data also contain administration and management personnel and as far as the institutions are concerned, kitchen and cleaning functions etc. The personnel are registered on the basis of their formal education by December 31st. The figures are reported in man-years, which means that the total numbers of part-time employees are converted into number of full time employees. Thus the total number of man-years is based on the assumption of stability among the personnel during the year. Employees without the specified education are recorded in collective groups.
Man-years - positions
For personnel, the recording unit is hours per week, and applies to hours set for those with permanent full-time or part-time positions. The number of hours per week is recalculated into man-years (full-time positions) by dividing the number of contract working hours per week. In practice this means that we have divided by 36 hours for physiotherapists and 37.5 hours for Doctors, and 35.5 for the other occupational groups.
Organisation
Organisation means the forms of association the individual physicians and physiotherapists have with the municipality. Municipalities offer practitioners four possible forms of association. The two most common forms are fixed salary and contract.
Physicians and physiotherapists with fixed salaries
Physicians and physiotherapists with fixed salaries are municipal employees, in municipal medical officer or physiotherapist positions advertised by the municipality. These positions may be full or part-time. The municipalities cover all expenses of the positions, but the National Insurance scheme provides fixed grants to the municipalities per position. The duties of these fixed-salary physicians and physiotherapists are set by municipal instructions.
Physicians and physiotherapists with municipal contracts
Physicians and physiotherapists with municipal contracts are basically private practising physicians and physiotherapists who sign an agreement with the municipality or borough. The provisions of this agreement are based on an agreement between the Norwegian Association of Local Authorities, Ministry of Health and Care Services and the physicians' and physiotherapists' organizations. The agreement implies that all physicians are obliged to participate in the medical duty service and municipal responsibilities such as care of the elderly and preventive medicine. How much the individual doctor is to perform these duties and the opening hours of the curative practice are defined in the specific agreements between the individual practitioner and the municipality/borough. The basis of the income of physicians and physiotherapists with municipal agreements is National Insurance reimbursements, patient co-payments and a fixed amount (operating grant) from the municipality as compensation for the agreement. Physicians and physiotherapists with combinations of fixed salary part-time positions and part-time contract practice are regarded as practitioners with a municipal contract.
Physicians and physiotherapists without municipal contracts
There are also practitioners with private practices who do not have a contract with the municipality. For the individual patient, it is of no financial significance if you go to a mandatory practitioner, doctor with fixed salary or doctor with a municipal contract. Physicians without a municipal contract may, with certain limitations, take as high a co-payment as the patient is willing to pay.
Following changes in sections 5-4, 5-7 and 5-8 of the National Insurance Act of 1 July 1998, national insurance reimbursements are no longer to be paid to private practising health professionals who do not have an operating agreement with the municipality or county. Exceptions have been made for general practitioners pending the introduction of the regular GP scheme.
Vacant authorised posts/ positions
Authorised posts or fixed-salary positions that are vacant at December 31st due to leave, illness or other reasons, are regarded as filled if the absence is less than four months, otherwise it is regarded as vacant.
Overtime
From the statistical year 1994, data on man-years worked by physicians also include hours worked under extended working time agreements pursuant to the central union federation special agreement between the Norwegian Association of Local Authorities and the Norwegian Medical Association. This agreement permits, for up to one year at a time, the signing of an agreement on extended working hours beyond 37.5 hours per week. Overtime work beyond this is not included.
Users of home based services
The figures cover all users of home help and home nursing or both services that were registered as active users at the end of the year. In general every person receiving services is regarded as one user, with one exception; households consisting of two or more persons receiving help are regarded as one user.
Institutions
These are defined as a group of buildings where parts of the floorage are shared between residents, the household is common and care personnel are present 24 hours a day. This definition embraces all kinds of institutions falling under the law mentioned above and are as follows: nursing homes, old peoples homes, combined nursing and old peoples homes and in addition various municipal dwellings with full-time services.
Dwellings for the aged and disabled
This category includes other kinds of municipal dwellings reserved for persons in need of help because of old age or handicap. They are also offered to mentally retarded persons who have left the traditional institutions according to a major reform concerning this group of disabled in 1991. These dwellings are not included in the institution-category, as they do not have a full-time service offer, and the residents own or pay rent for the dwelling. Some of them have care and nursing services during parts of the day. The other dwellings do not have this offer, and the residents are instead users of the home based services in the same way as other ordinary users. Many of these flats are adjusted for functionally disabled residents and some of them do also have to some extent common floorage and household.
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Standard classifications
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The 429 municipalities are grouped into 16 groups by population and economic conditions. The classification is based on Audun Langørgen and Rolf Aaberge (2011): Classification of municipalities by population and economic conditions of 2008. Report 2011/8, Statistics Norway. In the calculation of average figures for the county, municipalities are divided into 19 counties by the current standard for municipality classification (two first digit).
Regional statistics
The counties are divided into five groups. The classification is identical to subdivisions of counties in health regions apart from that there is established a separate group for Oslo.
Administrative information
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Regional level
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Municipality, and for Oslo: parts of town.
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Frequency and timeliness
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Annual.
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International reporting
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Figures are annualy delivered to OECD.
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Microdata
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The web addresses are http://www.ssb.no/helsetjko and http://www.ssb.no/pleie .
The statistics are published twice a year, preliminary figures are published in June and yearly figures in March the succeeding year.
Official statistics of Norway, Nursing and Care statistics and Municipal Health Services, was published yearly/each second year. From 2003, these publications are replaced by a common Municipal Health and Care services. Some figures are also published yearly in "Health Statistics in the Nordic Countries by NOMESCO and in "Social protection in the Nordic Countries" by NOSOSCO.
Background
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Background and purpose
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These statistics are supposed to meet the increasing need for information among the central authorities for planning purposes, supervision and evaluations of the municipalities' health and care services. In addition, the municipalities themselves are in need of comparable figures on county and national level to evaluate their own services. The statistics embrace an overview of the total input of the recourses in the general practitioners services, physiotherapist services, midwife services, school health services, and maternal and child health centre services. It also embrace all kinds of activities within the home based services and the institutions, and are not only restricted to nursing and care functions. The data also contain administration and management personnel and as far as the institutions are concerned, kitchen and cleaning functions etc.
he Municipal Health Services Act was enacted in 1982 and took effect in 1984. The purpose of the law was to strengthen the primary health services. From 1 January 1998 the law was expanded to include prison health services and county nursing homes. Under the act, the municipalities were given responsibility for board of health activities and user groups such as the mentally retarded and psychiatric patients. Municipal health service statistics provides the health authorities' with data for planning and supervisory purposes. They shall provide knowledge about the staff situation and about delivery of health care in the local health service.
From the 1st of January 2012 the Municipal Health Services Act is replaced by “Lov om kommunale helse- og omsorgstjenester m.m”
The statistics for the different parts of the municipal health and care service are based on annual data from the municipalities. For the first year, 1984, the data were basically limited to information about staff resources. From 1985 the statistics were expanded to include the maternal and child health centres and school health service. Staff without background as a health professional was included in the statistics for the school health service and maternal and child health centres in 1988 (maternal and child health centres) and 1994 (the school health service).
Since 1995, data on vaccinations in the school health service and maternal and child health centres were removed entirely from the questionnaires. Since then, they have been collected by the Norwegian Board of Health through a individual-based system (SYSVAK).
The official statistics of the public care and nursing services were for the first time collected in one data gathering and publishing routine in 1989. The background for this was the transfer of the responsibility for the nursing homes from the counties to the municipalities. Thus the total responsibility for all these services was transferred to the municipalities, and the administrative distinction between social (municipality services) and health services (county services) was abolished.
The statistical basis has undergone major changes since the statistical routine was established. This makes it difficult to follow the developments over time.
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Users and applications
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The Ministry of Health and Care Services, the Directorate of Health,
the Ministry of Local Government and Regional Development, the municipalities, research institutes and media.
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Equal treatment of users
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Not relevant
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Coherence with other statistics
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The statistics can be viewed in the context of several other KOSTRA areas and specialist health services.
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Legal authority
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For aggregated data (KOSTRA forms): The data are collected by Statistics Norway on behalf of the Ministry of Health and Care Services pursuant System Act (Act of 18 May 2001 No. 24) § 10
Statistics Norway also uses the information to the production of official statistics under the Statistics Act (Act of June 16, 1989 No. 54) § 2-2.
For individual data (pseudonym register for Individual-based Nursing and Care Statistics, IPLOS): System Act § 9, of IPLOS Regulations (17 February 2006 No. 204) § 2-1.The register-based statistics personnel is authorized by the Statistics Act § 3-2.
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EEA reference
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Not relevant.
Production
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Population
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The statistics are based on the registration of health care services in all municipalities, including all municipal health care institutions, both private and public.
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Data sources and sampling
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The statistics are based on the registration of health care services in all municipalities, including all municipal health care institutions, both private and public.
Health and care statistics are based on the following data sources:
- Annual submission of three electronic questionnaires to all municipalities and institutions for the elderly and persons with disabilities through KOSTRA (Municipality-State-Reporting)
- Annual submission of data about users and seekers of health care services at the individual level to IPLOS Register
- Statistics Norway's register-based employment statistics.
- General practitioner register from the directorate for health is data source for statistics on general practitioners and list length. The statistics cover all municipalities and districts in Oslo.
- The statistics also includes all users and seekers of health and care services and all institutions within the municipal health care services, see Law on health and care services § 3-2 and regulations on the health care institution.
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Collection of data, editing and estimations
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Collection of data
The statistics of the municipal health services is partly based upon annual dispatch of three questionnaires to all municipalities in Norway. These municipalities deliver electronic questionnaires that are included in the national statistics for the municipal health and care services. From 2002, all municipalities report by the KOSTRA system (Municipality - National authorities - Report).
Data are also collected through different data filing systems. For instance are the man-year data mainly based upon data filing systems for health personnel (From 2015: A-ordningen).
Register-based employment statistics: From 2015 onwards
From 2015 onwards a new joint reporting solution called a-ordningen gathers the reporting from the employers to the Ee-register, produced by the Norwegian Labour and Welfare Administration, as well as some reports to the Tax Administration and Statistics Norway. A-ordningen is a coordinated digital collection of data on employment, income and tax deductions to the Tax Administration, the Norwegian Labour and Welfare Organization and Statistics Norway. This new joint collection provides Statistics Norway with information on wages and employed persons directly from a-meldingen, which is the electronic message containing all the information collected, rather than the multiple sources used until 2014. You can find more information about the new reporting at www.altinn.no/en/a-ordningen.
A-ordningen has replaced the Register of Employers and Employees and the Register of End of the Year Certificates (Register of Wage Sums). In addition to a-ordningen other registers provide additional information, the most important is the Register for Personal Tax Payers administered by the Directorate of Taxes, the Register of Conscripts from the Armed Forces Personnel and National Service Centre and The Central Coordinating Register for Legal Entities.
The registers mentioned above are still being used to assure the quality of the data, to consolidate the consistency between different data sources as well as choosing the right main job and to classify people as employed. A few additional registers are also being used for these purposes, where the ARENA-register produced by the Norwegian Labour and Welfare Organization is one example. It provides data on unemployed and people engaged in labour market projects.
2018-figures compared with earlier figures
Statistics Norway has adopted a new method that provides better information on settled percentage of full-time equivalent (FTE) in 2018. The new method affects the calculation of man-years, and changes in the number of man-years, for example from 2017 to 2018 is thus not real. The new method is under development. Statistics Norway intends to publish final figures for man-years for the years 2015-2019 by new method through KOSTRA in March 2020. Read more about the new method here: https://www.ssb.no/arbeid-og-lonn/artikler-og-publikasjoner/ny-metode-gir-bedre-informasjon-om-arbeidstid
Quality control and revision
The new data are compared with data from the preceding year and various relative figures. In any case of conspicuous deviation from preceding years, the data basis is further checked and the figures are corrected as far as possible. Besides these controls, there are ordinary logical and validity controls intending to secure the logical relation between the items in the complemented questionnaires. In spite of an extensive revision of data some reservations must be taken concerning the figures presented on municipal level.
Upon the release of final figures, municipalities failing to give data will be included with figures from the preceding year.
A-ordningen: Controls are carried out at several stages. For information: http://www.ssb.no/en/arbeid-og-lonn/statistikker/regsys/aar/2016-05-27?fane=om#content
Estimations
In the case of non-response from either municipalities or institutions the questionnaires are completed with information from the previous year or by other methods of estimation.
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Seasonal adjustment
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Not relevant
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Confidentiality
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For IPLOS special rules apply for confidentiality. To protect the individual against detection, numbers less than five are being anonymised. In tables with row and column sums there are also a second anonymity used to prevent that one can calculate up to the numbers that are dotted.
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Comparability over time and space
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The statistical basis has undergone major changes since the statistical routine was established, but the Statistics Norway is able to present time-series for the most important health care variables back to 1987, and for nursing and care back to 1991.The statistical basis has undergone major changes since the statistical routine was established, but the Statistics Norway is able to present time-series for the most important health care variables back to 1987, and for nursing and care back to 1991.
From 2007 IPLOS is the source for statistics on users of care services in the municipalities. This means that the number of users of care services in 2007 are not directly comparable with previous years.
Accuracy and reliability
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Sources of error and uncertainty
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In the case of non-response from either municipalities or institutions the questionnaires are completed with information from the previous year or by other methods of estimation.
Another source of error is connected with the fact that the delivery of health care is extremely diverse, so the form does not always fit all municipalities. A lack of correspondence between the registrations, and the actual situation of which the form was meant to survey may consequently occur.
Sources of error can apply to many parts of the statistics, as described below:
Man-years of physicians with operating agreements
According to the instructions the figures shall show the number of hours per week on which the agreement with the municipality is based. Sometimes the hours actually worked by the doctor are entered, even though they exceed the hours on which the agreement is based.
Man-years of fixed-salary physicians
The instructions state that overtime is not to be included. Some municipalities have nevertheless included "overtime". This has been removed insofar as the municipalities have been informed that such work is included.
Physicians and physiotherapists without municipal agreement
Work performed by physicians and physiotherapists without agreements shall be reported to the medical consultant/chief municipal medical officer. Experience shows that municipalities and boroughs do not have a full overview of these operations. The labour input of practitioners without an agreement may therefore be somewhat underestimated.
Breakdown into areas of activity
It may happen that the distribution of man-years in the various areas of activity is not given for physicians, physiotherapists and auxiliaries. When this is suspected, the municipality is contacted for update.
Man-years
In the basic material from the municipalities the amount of work is given in hours per week. Recalculation to man-years is undertaken at publication. There seems, however, to be differences among the municipalities as to the hours of a full-time position in the various occupational groups.
A new data source; A-ordningen:
From 2015 onwards the register based employment statistics will be based on a new data source for employees. Until the end of 2014, the main data source was the Employees register, produced by the Norwegian Labour and Welfare Organization. In 2015 this reporting was coordinated with the reporting of earnings and personnel data to the Tax Administration and Statistics Norway. This common reporting system is called a-ordningen. A-ordningen provides a better data basis compared to the Ee-register, as it is more accurate on the individual level in addition to covering a greater number of employments. Furthermore, it provides more frequent statistics for wage earners and will supply highly detailed figures on the development in the labour market. These include numbers on the municipal level by age and industry. This new data source means a change in the time series.
For more information, read About the Statistics: http://www.ssb.no/en/arbeid-og-lonn/statistikker/regsys/aar/2016-05-27?fane=om#content
Data from 2018 and comparability with previous years:
Statistics Norway has adopted a new method that provides better information on settled percentage of full-time equivalent (FTE) in 2018. The new method affects the calculation of man-years, and changes in the number of man-years, for example from 2017 to 2018 is thus not real. The new method is under development. Statistics Norway intends to publish final figures for man-years for the years 2015-2019 by new method through KOSTRA in March 2020. Read more about the new method here: https://www.ssb.no/arbeid-og-lonn/artikler-og-publikasjoner/ny-metode-gir-bedre-informasjon-om-arbeidstid
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Revision
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Not relevant