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FINAL REPORT
(Prepared by Dace Krievkalne, the Central Statistical Bureau of Latvia,
Culture, Education, Science and Health Statistics Section)
Grant Contract No. 2004.19100.022 – signed between the European Community,
represented by the Commission of the European Communities, which is represented by
Eurostat and the Central Statistical Bureau of Latvia (CSB) entered into force in 28
December 2004. The implementation of the Action entitled “Phare Multi-Beneficiary
Statistical Cupertino Programme in 2003 - Technical Assistance” started on 1 November
2004. In Latvia the work on building up the HLA has started within this project. The
CSB carries out the first investigation of the potential data sources and looks for partners
and interested institutions in Latvia.
The Central Statistical Bureau has taken the responsibility for the pilot study of the HLA
implementation and it co-ordinates this work during the project. Contact persons are:
Ms. Maranda Behmane, Director of Social Statistics department
[email protected]
Phone +371 7 366878
1, Lačplēša Str., Riga, LV-1301, Latvia
Ms. Dace Krievkalne, Deputy Head of Culture, Education, Science and Health Statistics Section
[email protected]
Phone +371 7 366691
1, Lačplēša Str., Riga, LV-1301, Latvia
Ms. Lija Luste, Senior Officer of Labour Statistics Section
[email protected]
Phone +371 7 366917
1, Lačplēša Str., Riga, LV-1301, Latvia
As potential co-operation partners can be mentioned the Ministry of Health and an
agency under its subjection - the Health Statistics and Medical Technology State Agency
(HSMTSA). The HSMTSA is responsible for health statistics on the national level
including data on manpower, morbidity, hospital discharges etc., but it does not compile
data on financial indicators. This Agency is a holder of the Register of Medical staff, the
Register of Medical Institutions and other annual reports. As a potential co-operation
partner related to data sources for HP.4 – a provider of retail sale of medical goods - can
be mentioned the Pharmacy Department of the Ministry of Health (till 2003) and the
State Agency of Medicines (from 2004). The CSB of Latvia receives summary annual
reports on operation of pharmacies, medicine wholesale enterprises and medicine
production enterprises, which include the number of employees. Every year this agency
sends to the CSB questionnaires for approval and in the future the CSB can make
changes in these questionnaires if necessary.

The aim of the project was:
-
to evaluate the current situation in the data collection on manpower;
-
to develop and establish methodology for the compilation of the HLA prototype data;
-
to establish and maintain the Health Labour Account system for a routine use.
It was envisaged to produce the following outputs within the project:

Inception report on the quality of the existing data and possibilities to use them,
on the problems, the solution of which needs the assistance of Eurostat experts.
This report was sent to Eurostat in 31 January 2005 and we drew attention to the
fact that human resources in the health sector in Latvia could be analysed from
several points of view using different variables and data sources. The CSB in its
publications and data collections uses aggregated data and definitions from the
Health Statistics and Medical Technology State Agency (under the Ministry of
Health). The registration system of medical personnel is based on the registration
of individual persons (head counting). Employment indicators by National
Accounts are published only in the breakdown by branch "N" that shows the total
employment in the branch "Health and Social Care". The analytical units are
employed persons, jobs (full-time and part-time just only from 2004), hours
worked, wages, salaries and other payments. As attachments, 2 documents with a
detailed description of different data sources were sent – one from the Health
Statistics and Medical Technology State Agency, the second – all data sources
available and proposals of the CSB of Latvia.

Interim Report on the prepared methodological materials
This report was sent to Eurostat in 30 April 2005. During the analysis of data
sources from the Health Statistics and Medical Technology Sate Agency two of
them seemed most convenient: the Register of Medical Staff and the Annual
Statistical Report on Medical Staff in main job. However, data from this agency
do not contain financial information, do not include information on other staff
(non-specialists), the ISCO classification is not applicable for this data source yet
and we do not have information about persons who have a second job in the
mentioned enterprises or establishments (“jobs”). That is why we are looking for
a possibility to obtain data from annual reports and different surveys of the CSB
databases. There are about 9 data sources that could be used in data collection.
During the analysis of these data sources 4 of them seemed most convenient: the
Labour Force Survey, the Structural Business survey, the Quarterly survey on
employment and wages and the Occupations survey. The next step will be to
estimate the quality of these data sources by using real figures and to compare the
results with other data sources.

Background information on the new developments in the HLA methodology
It is clear that this new system or approach of health manpower (HLA) will be
based on the existing statistics and data sources. In the course of this project it
was possible to recognise missing indicators and characterising variables that are
needed to improve the data quality in the further work process and to find new
data sources if necessary. Within the project the CSB has established the National
Health Labour Accounts based on the methodological concept of the “System of
Health Accounts (SHA), namely, ICHA-HP classification drafted by OECD. The
same classification was used for building national SHA.
The CSB already applies successfully in its work different international
classifications (NACE Rev.1, ISCED, ISCO etc). The analytical units are:
employed persons, jobs (full-time and part-time just only from 2004), hours
worked, wages, salaries and other payments, etc.
Pilot Health Labour accounts data collection was performed on the basis of the
information of the year 2003.
During the work process a list of national health care actors (providers) has been
constructed. In Latvia a previously established full list of providers, called "Local
register of HP", has already being used. It can be noted that this register includes
approximately 3400 health care providers.
During the project it was possible to arrange the health providers by ICHA-HP,
for the most part, in a two-digit level. An attempt was made to divide HP.3.4 and
HP.3.9 in a 3-digit level.
Information is not available on HP.3.4.2 – Out-patient mental health and
substance abuse centres have started working in Latvia only from 2005, so it will
be possible to obtain employment variables in the future, HP.3.4.3 – Freestanding ambulatory surgery centres (not applicable in Latvia), HP.3.4.4 –
Dialysis care centres. Information on HP.3.6 – Providers of home health care
services is available only partly, since receivers of home health care services are
not sorted by the level of care needed, that is, if they receive help with basic
activities of daily living or help with housework. Thereby, both are included in
the sum of service receivers. It is possible to find out only the total number of
caretakers (3666).
It is necessary to pay more attention to HP.4.4 – Retail sale and other suppliers of
medical appliances and HP.6.4 – Other (private) insurance, so as to perceive the
precise share of insurance devoted to health services. At this point we need
further investigations on possibilities of separating health insurance from other
types of insurance. For the moment, the only thing known is that health insurance
takes up 14% from all insurance services provided.
Information on HP.2 at the moment is limited, but in 2005 the construction of a
social services providers registers has begun that will facilitate data collection.
Social services providers will be registered by type of services provided and by
service receivers. Information on the number of employees and their qualification
will also be gathered. But at the moment the register does not contain
classifications (ESCO; ISCED; NACE, etc.)
During the project 20 information sources were noted, but only 10 were used
consistently (see Annex 1, the list of information sources). The Statistical
Business register, the Register of Medical staff, the Labour Force Survey were
used only as supplementary data sources for cross checking, but the Statistical
Business register – to create and engage the Local Register of Health providers.
In this project the primarily used sources were: the Structural Business Survey,
the Survey on Occupations, the Annual statistical report on medical staff in main
job, the Summary on operation of pharmacies, medicine wholesales enterprises
and medicines production enterprises, the Summary on social care institutions for
adult persons (specialised state social care institutions), the Summary on social
care institutions for children (specialised state social care institutions) and the
Review of income declarations of physical persons.
In order to evaluate data sources and to decide which counting unit could be used
better, we tried to compare variables from 3 main data sources: the Structural
Business Survey (SBS), the Survey on Occupations (SO) and the annual statistical
Report on medical staff in the main job. Statistical data on HP.1 providers were
used at the first stage because hospital statistics are more comparable for this
reason. Results of the SBS and the SO show that these data sources could be
combined. The SBS has a bigger sample size, so the coverage of health providers
is better, but nevertheless the SO covers more HLA criteria or dimensions – 9
(Annex 1, table 6).
Structural Business
Survey
Survey on Occupations
Annual statistical
Report on medical staff
in the main job
Number of employees
in the main job
Number of employees
in the main job
Number of HRHC in
the main job
Number of HRHC in the
main job
HP.1
25477
25798
12661
14470
HP.1.1
17529
17103
8982
10542
HP.1.2
3300
3765
1339
1312
HP.1.3
4648
4930
2023
2261
The number of HRHC in the main job (head count) is even more different when
we compare the SO and the annual Report on medical staff. In order to compare
head-counts HRHC (the number of HRHC in the main job) from different data
sources, we used the Survey on Occupations ISCO-88 (groups 2221, 2222, 2224,
2225, 223, 3221-3226, 3228, 3229, 3231, 3232 and 324) and the annual statistical
Report on medical staff (assuming that HRHC = professionals, namely:
physicians, physicians in service training and residents, specialists with higher
medical professional education, pharmacists and assistants of pharmacists, dental
technicians, nurses with higher education, medical personnel with secondary
medical education). The results differ more vividly, which show that there might
be problems with coding: the way in which ISCO-88 is used for directive and
department indicator coding compared to physicians coding where a physician
may be also an institution's director or advisor.
Data input in table 1 was very difficult concerning providers of ambulatory health
care (HP.3.1 – HP.3. 4). The Survey on Occupations due to different reasons
(sample size, the fact that this survey covers only establishments and enterprises
but not offices of physicians or self-employed persons, survey was carried out
only once a year - in October, etc.) could not been used successfully.
At the end we made a decision to use for table 1 the Structural Business Survey
and the Report on medical staff in the main job as primary data sources
supplementing them with other relevant information.

Problems solved during the project
The HLA will be based on the existing statistics that could be improved if
necessary. For reasons of filling gaps a linkage of other possible data sources
might be used. For the first time the CSB surveys could be used for annualising
the health provider approach.
The linkage of different databases of health providers has been solved partly. It is
necessary to improve the approach and compare these data sources and annual
statistical reports for different health providers. The implementation of the HLA
is a long-term process. A long-term co-operation is necessary with data keepers
(the Health Statistics and Medical Technology State Agency) in order to be able
to solve problems with a linkage of different databases.
Co-operation with all the mentioned institutions was a positive and good
experience. It is clear that the HLA in Latvia will be created from different data
sources. They usually belong to different information holders and only in cooperation with these institutions it is possible to improve the data quality on
national HLA.
Co-operation with the State Agency of Medicines relating to data sources for
HP.4 – a provider of retail sale of medical goods – was a positive experience. The
CSB of Latvia receives annual reports of Summary on operation of pharmacies;
medicine wholesales enterprises and medicine production enterprises, which
include the number of employees. Every year this agency sends questionnaires
for approval and in the future the CSB can make changes in these questionnaires
if necessary.

Solving the problems will need additional efforts in the future
To implement the HLA on annual basis, the CSB has planned to finance this
project from the 2007 budget.
Notable boundary problems are:
 Social care;
 Spa (sanatoriums);
 Providers of home care;
 Providers of occupational health services.
Another methodological challenge is the lack of political support (not enough
discussion about the HLA approach at a ministerial level). Co-operation should
be improved with the Ministry of Health that makes the health care policy in
Latvia. The rapid change of health care policy and the new masterplan of service
providers may bring changes in the adopted SHA and HLA in the future.
Lack of time for analysis of the positive and negative experiences, as well as not
enough time to change the existing national statistical report system.
Methodological problems: definitions, clear guidelines, assistance in the
evaluation of data sources and analysis of data in order to estimate, which data
sources are better, that have regular exchange of information and practices steps
in other countries and expert point of view, workshops etc.