EHIS wave 2 - 2014




Euro-SDMX Metadata Structure (ESMS)

European health interview survey
Contact
Contact organisation

National Statistical Institute

Contact organisation unit

"Health and Justice Statistics" Department

Contact name

Evelin Yordanova

Contact person function

Head of department

Contact mail address

2, P. Volov Str.; 1038 Sofia, Bulgaria

Contact email address

ejordanova@nsi.bg

Contact phone number

+359 2 9857 459

Contact fax number
Metadata update
Metadata last certified25 January 2017
Metadata last posted25 January 2017
Metadata last update25 January 2017
Statistical presentation
Data description

The survey is a part of the European Health Survey System in the framework of the European Statistical System. The EHIS aims at measuring on a harmonised basis and with a high degree of comparability among EU Member States, the health status, life style (health determinants) and health care services use of the EU citizens.

EHIS wave 1

The survey was carried out by NSI based on harmonized instruments in 2008. The questionnaire for the first round of the EHIS (2007 - 2008) was adopted on 22 November 2006 by the Eurostat Working Group on Public Health Statistics.

The topics included in the questionnaire are developed in order to meet main needs as for the management of health care systems, as well as in science. Within these needs, EHIS questions are aimed at meeting the basic needs of information at EU level. They do not cover all detailed aspects of health which can better be carried out via specific surveys at national level.

The questionnaire consists of four modules.

  • Health status;
  • Health care;
  • Health determinants (life style);
  • Background module.

In addition, in order to meet the information needs of the European Commission`s DGs "Health and Consumers" (SANCO) and "Employment, Social Affairs and Inclusion (EMPL), 26 indicators which cover the three topics - Health status, Health care and Health determinants are calculated. Indicators are calculated using respondent`s answers during the interview. No documents are required, proving the correctness of answers and no measurements are done. All the indicators are calculated for the population aged 15 and over, except in case a specific age is indicated.

EHIS wave 2

In 2014 BNSI participated in the EHIS wave 2 in accordance with the Commission Regulation (EU) No 141/2013 implementing Regulation (EC) No 1338/2008 requrements. The survey was carried out by using the harmonized questionnaire proposed by Eurostat. The questionnaire consists of the same four modules used in 2008. In order to reduce the responce burden the number of questions in the 2014 harmonized questionnaire is reduced. In addition, some of the questions are partly or fully changed. 

All persons aged 15 and over living within the selected non-institutionalised households are covered.

EHIS includes the following topics:

Health status
This topic includes different dimensions of health status and health-related activity limitations:

  • General health status (Minimum European health module): self-perceived health, chronic morbidity and activity limitation
  • Disease-specific morbidity
  • Accidents and injuries
  • Health-related absenteeism from work
  • Physical and sensory functional limitations
  • Difficulties in personal care activities / activities of daily living (such as eating and washing) and help received/needed
  • Household activities / Instrumental activities of daily living (such as preparing meals and shopping) and help received/needed
  • Pain
  • Aspect of mental health (psychological distress and mental well-being in the first wave, depressive symptoms in the second wave).

 

Health care

  • Hospitalisation (in-patient and day care)
  • Consultations with doctors and dentists
  • Visits to specific health professionals (such as physiotherapists or psychologists)
  • Use of home care and home help services
  • Use of medicines (prescribed and non-prescribed)
  • Healthcare preventive actions (such as influenza vaccination, breast examination, cervical smear test and blood tests)
  • Unmet needs for health care.

 

Health determinants

  • Height and weight
  • Physical activity
  • Consumption of fruits, vegetables and juice
  • Smoking behaviour and exposure to tobacco smoke
  • Alcohol consumption
  • Social support.

 

Background variables on demography and socio-economic status.

Classification system

EHIS - wave 1

  • National Classification of Occupations and Duties-2005 (NCOD-2005) - consistent with the International Standard Classification of Occupations ISCO-88 (COM);
  • Classification of Economic Activities (CEA-2008, for international use NACE.BG -2008) - consistent with the European classification NACE Rev. 2;
  • Classification of Territorial Units for Statistical Purposes in Bulgaria (NUTS);
  • International Standard Classification of Education, 1997 revision (ISCED 1997).

 

EHIS - wave 2

  • National Classification of Occupations and Duties-2011 - consistent with the International Standard Classification of Occupations ISCO-08;
  • Classification of Economic Activities (CEA-2008, for international use NACE.BG -2008) - consistent with the European classification NACE Rev. 2;
  • Classification of Territorial Units for Statistical Purposes in Bulgaria (NUTS);
  • International Standard Classification of Education, 2011 revision (ISCED 2011).
Sector coverage

All persons aged 15 and over living within the selected non-institutionalised households are covered.

In accordance with the EHIS methodology people living in institutionalized households as residencies for students or workers, medical or social institutions, prisons are excluded from the target population.

Statistical concepts and definitions

Diseases - self-reported prevalence:

EHIS - wave 1

Percentage of persons reporting:

  • to have the selected disease,
  • the disease was diagnosed by a medical doctor,
  • the disease occurred during the past 12 months.

The indicator is calculated for five diseases: diabetes, chronic depression, chronic bronchitis, chronic obstructive pulmonary disease, emphysema, asthma, incl. allergic and high blood pressure (hypertensive diseases).

EHIS - wave 2

Proportion of the population reporting a chronic condition in the past 12 months. Statistics on 15 diseases or chronic conditions are presented:

A. Asthma (allergic asthma included)

B. Chronic bronchitis, chronic obstructive pulmonary disease, emphysema

C. Myocardial infarction (heart attack) or chronic consequences of myocardial infarction

D. Coronary heart disease or angina pectoris

E. High blood pressure (hypertension)

F. Stroke (cerebral haemorrhage, cerebral thrombosis) or chronic consequences of stroke

G. Arthrosis (arthritis excluded)

H. Low back disorder or other chronic back defect

I. Neck disorder or other chronic neck defect

J. Diabetes

K. Allergy, such as rhinitis, hay fever, eye inflammation, dermatitis, food allergy or other allergy (allergic asthma excluded)

L. Cirrhosis of the liver

M. Urinary incontinence, problems in controlling the bladder

N. Kidney problems

O. Depression

 

Injury by accidentat home, school or leisure accident, road traffic accidentPercentage of persons reporting to have had an accident during the past 12 months, which resulted in injury.

 

Self-reported visits to general practitioner, dentist or orthodontist, medical specialistPercentage of persons having consulted a doctor during the last 4 weeks.

 

Medicine use

EHIS - wave 1

Percentage of persons reporting to take medication prescribed by a physician for a specific disease during the past 2 weeks for diabetes; chronic depression; chronic bronchitis, chronic obstructive pulmonary disease, emphysema; asthma, incl. allergic and high blood pressure.

EHIS - wave 2

Self-reported use of prescribed and non-prescribed medicines: Proportion of the population who used medicines prescribed and non-prescribed by a doctor in the past 2 weeks.

 

Breast cancer screeningPercentage of women aged 50-69 years, who have undergone a mammography.

Cervical cancer screeningPercentage of women aged 20-69 years, reporting to have undergone a cervical cancer screening test.

 

Body Mass Index (BMI): Percentage of persons aged 18 and over with specific BMI. The indicator is calculated as ratio of weight (kg) and the square of height (m) - kg/m2. The following subdivision is used:

  • underweight (less than 18.5 kg/m2)
  • normal weight (between 18.5 and less than 24.99 kg/m2 )
  • overweight (between 25.00 and less than 29.99 kg/m2)
  • obese (equal or greater than 30.00 kg/m2)

 

Daily cigarettes smokers: Percentage of persons reporting to smoke cigarettes (manufactured and hand-rolled) daily. 

Hazardous alcohol consumption (EHIS - wave 1) Percentage of persons who drink 6 and more alcohol drinks for one occasion, during the past 12 months, by frequency of use.

 

Statistical unit

Persons aged 15 and over living in non-institutionalised households.

Statistical population

All persons aged 15 and over living in non-institutionalised households are covered.

In accordance with the EHIS methodology people that live in institutionalised households as residencies for students or workers, medical or social institutions, prisons are excluded from the target population.

Reference area

The territory of the Republic of Bulgaria.

Time coverage

EHIS wave 1 - 2008

EHIS wave 2 - 2014

Base period

Not applicable.

Unit of measure

Relative share

Reference period

EHIS wave 1

The survey was carried out in October and November 2008. According to the character of the questions the reference period is two or four weeks, six or twelve months.

EHIS wave 2

The survey was carried out in the period October 2014 - January 2015. According to the character of the questions the reference period is two or four weeks, six or twelve months, weekdays or weekend.

Institutional mandate
Legal acts and other agreements

EHIS wave 1

  • Regulation (EC) No 1338/2008 of the European Parliament and of Council of 16 December 2008 on Community statistics on public health and health and safety at work;
  • Law on Statistics.

EHIS wave 2

  • Regulation (EC) No 1338/2008 of the European Parliament and of Council of 16 December 2008 on Community statistics on public health and health and safety at work;
  • Commission Regulation (EU) No 141/2013 implementing Regulation (EC) No 1338/2008 of the European Parliament and of the Council on Community statistics on public health and health and safety at work, as regards statistics based on the European Health Interview Survey (EHIS);
  • Law on Statistics.
Data sharing
Confidentiality
Confidentiality - policy
  • Law on Statistics;
  • Regulation (EC) No 223/2009 on European statistics (recital 24 and Article 20(4)) of 11 March 2009 (OJ L 87, p. 164), stipulates the need to establish common principles and guidelines ensuring the confidentiality of data used for the production of European statistics and the access to those confidential data with due account for technical developments and the requirements of users in a democratic society.
Confidentiality - data treatment

Individual data are not published in accordance with article 25 of the Law on Statistics. The publishing of individual data can be performed only in accordance with article 26 of the same law.

For the purposes of dissemination of aggregated data the following rules are applied:

  • An estimate should not be published if it is based on fewer than 20 sample observations or if the non-response for the item concerned exceeds 50%.
  • An estimate should be published with a flag "low reliability" if it is based on 20 to 49 sample observations or if non-response for the item concerned exceeds 20% and is lower or equal to 50%.
  • An estimate shall be published in the normal way when based on 50 or more sample observations and the item's non-response does not exceed 20%.
Release policy
Release calendar

The date of the statistical information release is shown in the Release Calendar presenting the results of the statistical surveys carried out by the National Statistical Institute.

Release calendar access

The calendar is available on the NSI website: http://www.nsi.bg/en/node/480

User access

Data on European health interview survey is published on the NSI website, section Health in accordance with the Law on Statistics and the European Statistics Code of Practice respecting the professional independence and aimed at objectivity, transparency and equal treatment of all consumers.

Frequency of dissemination

The final EHIS wave 2 data are disseminated after the finalization of the data validation procedure.

Accessibility and clarity
News release

Press release.

Publications

EHIS - wave 1

Bulgaria - Statistical Panorama

On-line database

Data on European health interview survey are available to all users of the NSI website under the heading Health - Health interview survey: http://www.nsi.bg/en/node/5630

Online database of Eurostat:

http://epp.eurostat.ec.europa.eu/portal/page/portal/health/public_health/data_public_health/database

Micro-data access

Anonymised individual data can be provide for scientific and research purposes by individual request, according to the Rules for the provision of anonymised individual data for scientific and research purposes.

Other

Information service on request, according to the Rules for the dissemination of statistical products and services in NSI.

Documentation on methodology

EHIS wave 1

  • European Health Interview Survey questionnaire (2007-2009);
  • Conceptual translation cards and guidelines;
  • Quality Categories and Criteria for Delivery Data to EHIS;
  • European Health Interview survey methodological sampling guidelines (Task force III report);
  • Guidelines for the development and criteria for the adoption of Health Survey instruments.

EHIS wave 2

  • European Health Interview Survey (EHIS wave 2), Methodological manual, Eurostat, 2013 edition;
  • EHIS wave 2 Validation rules; 
  • EHIS wave 2 Data delivery guidelines.
Quality documentation

EHIS wave 1

Summary report on the application of criteria for quality assessment of the European Health Interview - Eurostat.

EHIS wave 2

Quality report

Quality management
Quality assurance

According to the Regulation 1338/2008 on Community statistics on public health and health and safety at work EHIS is to be conducted every five years. EHIS wave 2 was conducted according to the Commision Regulation 141/2013 as regards statistics based on the European Health Interview Survey (EHIS).

EHIS aims at achieving an input standardisation. A model questionnaire (questions, answer categories, filters, etc.) as well as conceptual guidelines and rationales were prepared. Conceptual translation into all EU languages was requested. By using the Methodological manual 'European Health Interview Survey (EHIS wave 2)' the harmonizad questionnaire a standard translation protocol as well as Conceptual translation cards and guidelines were applied.

National data entry tool is elaborated according to the Validation rules and Data delivery guidelines proposed by Eurostat. Data validation tool EDIT is used in order to prevalidated the national microdata before sending them to Eurostat.

Quality assessment

The implementation of the uniform methodological documents, rules and procedures at all stages of the study provides high quality of the data.

Relevance
User needs

The produced information answers to needs as for the management of health care systems, as well as in science. In framework of these needs, EHIS questions are aimed at meeting the basic needs of information at EU level, as they do not cover all detailed aspects of health, which can better be carried out via specific surveys at national level.

User satisfaction

Not applicable.

Completeness

Persons aged 15 and over living in private households are covered. Persons up to 14 years of age as well as those living in institutionalized households, as residencies for students or workers, medical or social institutions, prisons are generally excluded from the target population.

Accuracy and reliability
Overall accuracy

The minimum effective sample size as is set out in Annex II of the Commission Regulation (EU) No 141/2013 is achieved. The proxy interview rate is 11.1%. 

Sampling error

The standard error for 3 indicators was calculated.

  • Relative share of respondents in good or very good health;
  • Relative share of respondents with a longstanding illness or health problem;
  • Relative share of respondents that were severely limited in activities people usually do because of health problems for at least the past 6 months.

Imputation techniques of missing values and calibration methods are not applied.

Non-sampling error

Coverage errors:

A two stage stratified cluster sample on national and regional level is used. The sample is stratified by using the administrative regions in the country and persons' place of residence (town, village). As a result of the stratification 56 strata are designed. At the first stage clusters are selected with a probability proportional to their size, separately for 28 districts and for urban and village population. At the second stage, through a systematic selection 5 households are identified. All persons aged 15 and over in selected households were interviewed.

EHIS wave 1

The survey applies the principle of the voluntary participation. A substitution is not allowed. By face to face interview (PAPI) 5 661 persons from 8 393 are interviewed. The response rate is 73.8%.

EHIS wave 2

The survey applies the principle of the voluntary participation. A substitution is not allowed. By face to face interview (PAPI) 6 410 persons from 8 839 are interviewed. The response rate is 72.5%.

 

In order to provide maximum opportunities for analyzing survey data additional information is available:

  • Original sample size (Eligible + Not eligible)
  • Interviewed respondents - fully or partially completed questionnaire;
  • Non-interviewed respondents - respondent was not found, refusal;
  • Not eligible - deceased, does not live at the address, non-existent address / building / dwelling.

Measurement and processing errors:

These are errors in the interview stage of collection of data, understanding of the issues by the respondents, sometimes wrong answers, and errors in data codification. The data entry program has been designed as to guarantee correctness and consistency of the data (logical controls, acceptable value, etc.), to be minimize this type of error. The program performs further checks for data accuracy with SPSS scripts.

Timeliness and punctuality
Timeliness

T+12 months

Punctuality

Micro-data are sent according to the COMMISSION REGULATION (EU) No 141/2013 requirements.

The data for publishing statistical data is shown in the Release Calendar presenting the results of the statistical surveys carried out by the National Statistical Institute.

 

Coherence and comparability
Comparability - geographical

Due to sample type of the survey, the data are representative at district level only for part of indicators.

International comparison - EHIS aims at achieving an input standardisation (questions, answers, filters, etc.) through conceptual translation into all EU languages. Each of the questions and response categories are accompanied by a detailed description, so that their meaning is identical in all Member States. Should be taken into account that not all countries have fully implemented the questionnaire or some questions were modified.

Comparability - over time

Due to changing the EHIS wave 2 questionnaire some of the questions are partly or not comparible.

Coherence - cross domain

Not applicable.

Coherence - internal

Not applicable.

Cost and burden

Not applicable.

Data revision
Data revision - policy

Not applicable.

Data revision - practice

Not applicable.

Statistical processing
Source data

Sampling frame

The Census 2011 DataBase is used. The sampling frame is updated annualy based on current demographic statistics as of 31.12. 2014 data are used.

Survey population

 

A) Total coverage

 6204002

B) Estimate (in %) of the resulting percentage of under-coverage (a proportion of units not accessible via the sampling frame that belong to the target population)

 0.5%

C) Estimate (in %) of the resulting percentage of over-coverage (a proportion of units accessible via the sampling frame that do not belong to the target population)

 0.0%

D) Population groups that may be excluded even though they belong to sampling frame (e.g. people with hearing problems in case of CATI)

 None.

E) Non-target population -
     population (number of individuals) younger than 15 years 

 998 196 (as of 31.12.2014)

Sampling design

A two stage stratified cluster sample on national and regional level is used. The sample is stratified by using the administrative regions in the country and persons' place of residence (town, village). As a result of the stratification 56 strata are designed. At the first stage clusters are selected with a probability proportional to their size, separately for 28 districts and for urban and village population. At the second stage, through a systematic selection 6 households are identified. All persons aged 15 and over in selected households were interviewed.

 

Summary table on participation and non-participation

Number of households

Number of individuals

1

Total released sample cases

The number of sampling units initially selected from the sampling frame.

►   [1] = [2] + [3] + [6]

 4505

9720 

2

Ineligible sample cases / out-of-scope units

381 

881 

2.1

Non-existent units

(house/building not existing, no one living in the building/on the address)

20 

2.2

Changes in status

373 

861 

2.3

Out of target units

2.4

Other ineligible

3

Eligible sample cases / in-scope units

The unit belongs to the population of interest for the survey (both non-response and response cases).

►   [3] = [4] + [5]

4124 

8839 

4

Non-response cases / Non-participation

1014

2429 

4.1

Non-contact

614 

1376 

4.2

Refusal

392 

1043 

4.3

Inability to respond

e.g. selected household or individual was unable to participate due to language barriers or cognitive or physical incapacity to respond (and no proxy interview was conducted).

10 

4.4

Rejected interviews

e.g. the selected household/individual did take part but the survey form cannot be used (poor quality - e.g. strong inconsistencies; unacceptable item-response – e.g. individual left most of the questions unanswered; survey form got lost and interview cannot be repeated; etc.).

4.5

Other non-response

5

Response cases / Participation

3110 

6410 

5.1

A fully completed interview

All relevant questions answered by the respondent or by a proxy interview.

(a) Variables not recommended to be completed by proxy respondents if the interview was conducted with a proxy respondent and (b) variables for which derogations were granted, are not taken into account when evaluating completeness.

3110 

6410 

5.2

A partly completed interview

Not all relevant but at least some technical variables (PID, HHID, PRIMSTRAT, PSU, WGT, PROXY, REFYEAR, REFMONTH, INTMETHOD), sex and age and at least 50 % of all other variables (to be answered and) answered by the respondent or by a proxy interview.

6

Unknown eligibility

 -

 

Number and structure of target and response population

Target population

Response

Number

%

Number

%

Total

6204002

100.0 

6410

100.0

Women

 3215275

51.8 

 3344

52.2

Men

2988727

48.2 

 3066

47.8

Age (women)

 3215275

100.0 

3344

100.0

15-24

 348193

10.8 

 285

8.5

25-34

 469599

14.6 

 358

10.7

35-44

 520600

16.2 

 514

15.4

45-54

487664

15.2 

 499

14.9

55-64

 531726

16.5 

 620

18.5

65-74

 474797

14.8 

 631

18.9

75-84

300277

9.3 

 342

10.2

85+

 82419

2.6 

 95

2.8

Age (men)

 2988727

100.0 

 3066

100.0

15-24

370080

12.4 

 364

11.9

25-34

 505290

16.9 

 439

14.3

35-44

 554442

18.6 

 487

15.9

45-54

 497724

16.7 

 515

16.8

55-64

 478355

16.0 

 553

18.0

65-74

 356601

11.9 

 451

14.7

75-84

 183921

6.2 

 213

6.9

85+

 42314

1.4 

 44

1.4

Educational attainment level (ISCED 2011)

6216600

100.0 

 6409

100.0

ISCED 0-2

 1752900

28.2 

2194

34.2

ISCED 3-4

 3108900

50.0 

 3016

47.1

ISCED 5-8

 1354800

21.8 

 1199

18.7

Current labour status (self-declared)

 6216600

100.0 

 6406

100.0

Employed

 2963100

47.7 

 2636

41.1

Unemployed

 627900

10.1 

 934

14.6

Retired

 1619700

26.1 

 2066

32.3

Students

 462000

7.4 

 408

6.4

Other inactive

 543900

8.7 

 362

5.7

Data source on Target population by sex and age is Current demographic statistics as of 31.12.2014.

Data source on Target population by Educational attainment level (ISCED 2011) and Current labour status (self-declared) is LFS 2014.

Frequency of data collection

Every 5 years

Data collection

A face to face PAPI interview and self-administered part.

Interviewers

All interviewers are internal staff with experience in health/social surveys.

Ratio interviews / interviewers - 53

Interviewer training method and support 

The training session was conducted at the end of September 2014. The representatives from Regional Statistical Offices were trained as trainers. They are experienced in conducting the household’s surveys. Some of them participated in the EHIS wave 1.

The training programme included:

  • Aims and tasks of the survey. Background and explanation of the rationale of the EHIS;
  • General presentation as well as presentation in details of the survey modules. General concept of the questions, definitions, use of classifications, use of proxy interview, self-completion forms;
  • Work in groups with different examples, which described the difficulties and specific features of the instrument cases that may occur. Discussion of the results and the interviewer’s opinions. How to respond to Frequently Asked Questions;
  • Presentation and detailed discussion of the content of the template for interviewers notes, which are to be filled in by each interviewer after conducting the interview;
  • Organization of the survey.

As a part of the training, the interviewers were provided with the detailed guideline manual for the fieldwork, containing all aspects necessary to execute the survey correctly, the questionnaire with the Showcards and the Self-completion forms as well as the Notes for the interviewers.

Quality control during the fieldwork

Method used for the prenotification or first contact of respondents - letter.

Use of incentives - no.

Theoretical minimal number of contacts with a respondent before declaring a nonparticipation (i.e. the number of attempts that an interviewer is asked to do for interviewing a respondent) - up to two visits for distant clusters and up to 4 visits in close clusters from the RSO location.

Interview duration for the EHIS questions:

  • Average: 30 minutes 
  • Minimum: 5 minutes 
  • Maximum: 65 minutes 

Techniques used to control interviewer performance - A review of questionnaires and Interviewers’ notes was carried out by the supervisors in RSO in order to check whether the questionnaires were correctly filled in. Individual contacts were regularly established. Weekly reports on survey participations was provided in NSI by suprvisiors.

Ratio interviewers / field supervisors - 4.

Were (some of) the respondents contacted for quality control? - No.

Were additional studies performed in relation to the nonparticipation? - No.

Questionnaire

Development of the questionnaire

The survey was carried out in Bulgarian. The translation protocol proposed by Eurostat is used.

Were the modules pre-tested? EHIS wave 1 questionnaire was tested, EHIS wave 2 - no. 

Design of the questionnaire

The recommended order of modules and sub-modules is followed.

Modified EHIS questions in comparison with the model questionnaire and conceptual guidelines - AC2, PL6, HO1, AM7, PA1, AL1, AL6. All questions are modified in accordance with the Eurostat Methodological manual - "European Health Interview Survey (EHIS wave 2)" 

Content of alcohol of the “national standard” drink (in grams) used in AL sub-module = 14 g.

Data validation

EHIS wave 1

The data are validated by Eurostat. Common rules for checking and consistency checks are applied.

EHIS wave 2

The proposed by Eurostat harmonized instrumentarium according to the "EHIS wave 2 Methodological manual" is used. Conceptual guidelines and translation protocol is also applied. Common rules for checking and consistency checks in accordance with the requirements of the Commission Regulation (EU) No 141/2013 implementing Regulation (EC) No 1338/2008 are applied. Proposed by Eurostat EDIT validation tool is used before sending the microdata file. 

Data compilation

Data checking, cleaning and editing is done in accordance with the EHIS wave 2 Methodological manual, EHIS Validation rules as well as EHIS wave 2 Data delivery guidelines. 

Imputation, adjustment for non-response and calibration is not applied.
The current demographic data as of 31 December 2014 for the total population is used for weighting.
Adjustment

The current demographic data as of 31 December 2014 for the total population is used for weighting.

Information on the variability of final weights

average divided by minimum = 2.71
maximum divided by average = 2.55
coefficient of variation = 0.32

Comment
Download in SDMX file format: European health interview survey
Metadata Structure Definition: ESMS_MSD+BNSI+2.0+SDMX.2.0.xml


ESS Standard for Quality Reports Structure (ESQRS)

European health interview survey
Contact
Contact organisation

National Statistical Institute

Contact organisation unit

"Health and Justice Statistics" Department

Contact name

Evelin Yordanova

Contact person function

Head of department

Contact mail address

2, P. Volov Str.; 1038 Sofia, Bulgaria

Contact email address

ejordanova@nsi.bg

Contact phone number

+359 2 9857 459

Contact fax number
Statistical presentation
Data description

The survey is a part of the European Health Survey System in the framework of the European Statistical System. The EHIS aims at measuring on a harmonised basis and with a high degree of comparability among EU Member States, the health status, life style (health determinants) and health care services use of the EU citizens.

EHIS wave 1

The survey was carried out by NSI based on harmonized instruments in 2008. The questionnaire for the first round of the EHIS (2007 - 2008) was adopted on 22 November 2006 by the Eurostat Working Group on Public Health Statistics.

The topics included in the questionnaire are developed in order to meet main needs as for the management of health care systems, as well as in science. Within these needs, EHIS questions are aimed at meeting the basic needs of information at EU level. They do not cover all detailed aspects of health which can better be carried out via specific surveys at national level.

The questionnaire consists of four modules.

  • Health status;
  • Health care;
  • Health determinants (life style);
  • Background module.

In addition, in order to meet the information needs of the European Commission`s DGs "Health and Consumers" (SANCO) and "Employment, Social Affairs and Inclusion (EMPL), 26 indicators which cover the three topics - Health status, Health care and Health determinants are calculated. Indicators are calculated using respondent`s answers during the interview. No documents are required, proving the correctness of answers and no measurements are done. All the indicators are calculated for the population aged 15 and over, except in case a specific age is indicated.

EHIS wave 2

In 2014 BNSI participated in the EHIS wave 2 in accordance with the Commission Regulation (EU) No 141/2013 implementing Regulation (EC) No 1338/2008 requrements. The survey was carried out by using the harmonized questionnaire proposed by Eurostat. The questionnaire consists of the same four modules used in 2008. In order to reduce the responce burden the number of questions in the 2014 harmonized questionnaire is reduced. In addition, some of the questions are partly or fully changed. 

All persons aged 15 and over living within the selected non-institutionalised households are covered.

EHIS includes the following topics:

Health status
This topic includes different dimensions of health status and health-related activity limitations:

  • General health status (Minimum European health module): self-perceived health, chronic morbidity and activity limitation
  • Disease-specific morbidity
  • Accidents and injuries
  • Health-related absenteeism from work
  • Physical and sensory functional limitations
  • Difficulties in personal care activities / activities of daily living (such as eating and washing) and help received/needed
  • Household activities / Instrumental activities of daily living (such as preparing meals and shopping) and help received/needed
  • Pain
  • Aspect of mental health (psychological distress and mental well-being in the first wave, depressive symptoms in the second wave).

 

Health care

  • Hospitalisation (in-patient and day care)
  • Consultations with doctors and dentists
  • Visits to specific health professionals (such as physiotherapists or psychologists)
  • Use of home care and home help services
  • Use of medicines (prescribed and non-prescribed)
  • Healthcare preventive actions (such as influenza vaccination, breast examination, cervical smear test and blood tests)
  • Unmet needs for health care.

 

Health determinants

  • Height and weight
  • Physical activity
  • Consumption of fruits, vegetables and juice
  • Smoking behaviour and exposure to tobacco smoke
  • Alcohol consumption
  • Social support.

 

Background variables on demography and socio-economic status.

Classification system

EHIS - wave 1

  • National Classification of Occupations and Duties-2005 (NCOD-2005) - consistent with the International Standard Classification of Occupations ISCO-88 (COM);
  • Classification of Economic Activities (CEA-2008, for international use NACE.BG -2008) - consistent with the European classification NACE Rev. 2;
  • Classification of Territorial Units for Statistical Purposes in Bulgaria (NUTS);
  • International Standard Classification of Education, 1997 revision (ISCED 1997).

 

EHIS - wave 2

  • National Classification of Occupations and Duties-2011 - consistent with the International Standard Classification of Occupations ISCO-08;
  • Classification of Economic Activities (CEA-2008, for international use NACE.BG -2008) - consistent with the European classification NACE Rev. 2;
  • Classification of Territorial Units for Statistical Purposes in Bulgaria (NUTS);
  • International Standard Classification of Education, 2011 revision (ISCED 2011).
Sector coverage

All persons aged 15 and over living within the selected non-institutionalised households are covered.

In accordance with the EHIS methodology people living in institutionalized households as residencies for students or workers, medical or social institutions, prisons are excluded from the target population.

Statistical concepts and definitions

Diseases - self-reported prevalence:

EHIS - wave 1

Percentage of persons reporting:

  • to have the selected disease,
  • the disease was diagnosed by a medical doctor,
  • the disease occurred during the past 12 months.

The indicator is calculated for five diseases: diabetes, chronic depression, chronic bronchitis, chronic obstructive pulmonary disease, emphysema, asthma, incl. allergic and high blood pressure (hypertensive diseases).

EHIS - wave 2

Proportion of the population reporting a chronic condition in the past 12 months. Statistics on 15 diseases or chronic conditions are presented:

A. Asthma (allergic asthma included)

B. Chronic bronchitis, chronic obstructive pulmonary disease, emphysema

C. Myocardial infarction (heart attack) or chronic consequences of myocardial infarction

D. Coronary heart disease or angina pectoris

E. High blood pressure (hypertension)

F. Stroke (cerebral haemorrhage, cerebral thrombosis) or chronic consequences of stroke

G. Arthrosis (arthritis excluded)

H. Low back disorder or other chronic back defect

I. Neck disorder or other chronic neck defect

J. Diabetes

K. Allergy, such as rhinitis, hay fever, eye inflammation, dermatitis, food allergy or other allergy (allergic asthma excluded)

L. Cirrhosis of the liver

M. Urinary incontinence, problems in controlling the bladder

N. Kidney problems

O. Depression

 

Injury by accidentat home, school or leisure accident, road traffic accidentPercentage of persons reporting to have had an accident during the past 12 months, which resulted in injury.

 

Self-reported visits to general practitioner, dentist or orthodontist, medical specialistPercentage of persons having consulted a doctor during the last 4 weeks.

 

Medicine use

EHIS - wave 1

Percentage of persons reporting to take medication prescribed by a physician for a specific disease during the past 2 weeks for diabetes; chronic depression; chronic bronchitis, chronic obstructive pulmonary disease, emphysema; asthma, incl. allergic and high blood pressure.

EHIS - wave 2

Self-reported use of prescribed and non-prescribed medicines: Proportion of the population who used medicines prescribed and non-prescribed by a doctor in the past 2 weeks.

 

Breast cancer screeningPercentage of women aged 50-69 years, who have undergone a mammography.

Cervical cancer screeningPercentage of women aged 20-69 years, reporting to have undergone a cervical cancer screening test.

 

Body Mass Index (BMI): Percentage of persons aged 18 and over with specific BMI. The indicator is calculated as ratio of weight (kg) and the square of height (m) - kg/m2. The following subdivision is used:

  • underweight (less than 18.5 kg/m2)
  • normal weight (between 18.5 and less than 24.99 kg/m2 )
  • overweight (between 25.00 and less than 29.99 kg/m2)
  • obese (equal or greater than 30.00 kg/m2)

 

Daily cigarettes smokers: Percentage of persons reporting to smoke cigarettes (manufactured and hand-rolled) daily. 

Hazardous alcohol consumption (EHIS - wave 1) Percentage of persons who drink 6 and more alcohol drinks for one occasion, during the past 12 months, by frequency of use.

 

Statistical unit

Persons aged 15 and over living in non-institutionalised households.

Statistical population

All persons aged 15 and over living in non-institutionalised households are covered.

In accordance with the EHIS methodology people that live in institutionalised households as residencies for students or workers, medical or social institutions, prisons are excluded from the target population.

Reference area

The territory of the Republic of Bulgaria.

Time coverage

EHIS wave 1 - 2008

EHIS wave 2 - 2014

Base period

Not applicable.

Statistical processing
Source data

Sampling frame

The Census 2011 DataBase is used. The sampling frame is updated annualy based on current demographic statistics as of 31.12. 2014 data are used.

Survey population

 

A) Total coverage

 6204002

B) Estimate (in %) of the resulting percentage of under-coverage (a proportion of units not accessible via the sampling frame that belong to the target population)

 0.5%

C) Estimate (in %) of the resulting percentage of over-coverage (a proportion of units accessible via the sampling frame that do not belong to the target population)

 0.0%

D) Population groups that may be excluded even though they belong to sampling frame (e.g. people with hearing problems in case of CATI)

 None.

E) Non-target population -
     population (number of individuals) younger than 15 years 

 998 196 (as of 31.12.2014)

Sampling design

A two stage stratified cluster sample on national and regional level is used. The sample is stratified by using the administrative regions in the country and persons' place of residence (town, village). As a result of the stratification 56 strata are designed. At the first stage clusters are selected with a probability proportional to their size, separately for 28 districts and for urban and village population. At the second stage, through a systematic selection 6 households are identified. All persons aged 15 and over in selected households were interviewed.

 

Summary table on participation and non-participation

Number of households

Number of individuals

1

Total released sample cases

The number of sampling units initially selected from the sampling frame.

►   [1] = [2] + [3] + [6]

 4505

9720 

2

Ineligible sample cases / out-of-scope units

381 

881 

2.1

Non-existent units

(house/building not existing, no one living in the building/on the address)

20 

2.2

Changes in status

373 

861 

2.3

Out of target units

2.4

Other ineligible

3

Eligible sample cases / in-scope units

The unit belongs to the population of interest for the survey (both non-response and response cases).

►   [3] = [4] + [5]

4124 

8839 

4

Non-response cases / Non-participation

1014

2429 

4.1

Non-contact

614 

1376 

4.2

Refusal

392 

1043 

4.3

Inability to respond

e.g. selected household or individual was unable to participate due to language barriers or cognitive or physical incapacity to respond (and no proxy interview was conducted).

10 

4.4

Rejected interviews

e.g. the selected household/individual did take part but the survey form cannot be used (poor quality - e.g. strong inconsistencies; unacceptable item-response – e.g. individual left most of the questions unanswered; survey form got lost and interview cannot be repeated; etc.).

4.5

Other non-response

5

Response cases / Participation

3110 

6410 

5.1

A fully completed interview

All relevant questions answered by the respondent or by a proxy interview.

(a) Variables not recommended to be completed by proxy respondents if the interview was conducted with a proxy respondent and (b) variables for which derogations were granted, are not taken into account when evaluating completeness.

3110 

6410 

5.2

A partly completed interview

Not all relevant but at least some technical variables (PID, HHID, PRIMSTRAT, PSU, WGT, PROXY, REFYEAR, REFMONTH, INTMETHOD), sex and age and at least 50 % of all other variables (to be answered and) answered by the respondent or by a proxy interview.

6

Unknown eligibility

 -

 

Number and structure of target and response population

Target population

Response

Number

%

Number

%

Total

6204002

100.0 

6410

100.0

Women

 3215275

51.8 

 3344

52.2

Men

2988727

48.2 

 3066

47.8

Age (women)

 3215275

100.0 

3344

100.0

15-24

 348193

10.8 

 285

8.5

25-34

 469599

14.6 

 358

10.7

35-44

 520600

16.2 

 514

15.4

45-54

487664

15.2 

 499

14.9

55-64

 531726

16.5 

 620

18.5

65-74

 474797

14.8 

 631

18.9

75-84

300277

9.3 

 342

10.2

85+

 82419

2.6 

 95

2.8

Age (men)

 2988727

100.0 

 3066

100.0

15-24

370080

12.4 

 364

11.9

25-34

 505290

16.9 

 439

14.3

35-44

 554442

18.6 

 487

15.9

45-54

 497724

16.7 

 515

16.8

55-64

 478355

16.0 

 553

18.0

65-74

 356601

11.9 

 451

14.7

75-84

 183921

6.2 

 213

6.9

85+

 42314

1.4 

 44

1.4

Educational attainment level (ISCED 2011)

6216600

100.0 

 6409

100.0

ISCED 0-2

 1752900

28.2 

2194

34.2

ISCED 3-4

 3108900

50.0 

 3016

47.1

ISCED 5-8

 1354800

21.8 

 1199

18.7

Current labour status (self-declared)

 6216600

100.0 

 6406

100.0

Employed

 2963100

47.7 

 2636

41.1

Unemployed

 627900

10.1 

 934

14.6

Retired

 1619700

26.1 

 2066

32.3

Students

 462000

7.4 

 408

6.4

Other inactive

 543900

8.7 

 362

5.7

Data source on Target population by sex and age is Current demographic statistics as of 31.12.2014.

Data source on Target population by Educational attainment level (ISCED 2011) and Current labour status (self-declared) is LFS 2014.

Frequency of data collection

Every 5 years

Data collection

A face to face PAPI interview and self-administered part.

Interviewers

All interviewers are internal staff with experience in health/social surveys.

Ratio interviews / interviewers - 53

Interviewer training method and support 

The training session was conducted at the end of September 2014. The representatives from Regional Statistical Offices were trained as trainers. They are experienced in conducting the household’s surveys. Some of them participated in the EHIS wave 1.

The training programme included:

  • Aims and tasks of the survey. Background and explanation of the rationale of the EHIS;
  • General presentation as well as presentation in details of the survey modules. General concept of the questions, definitions, use of classifications, use of proxy interview, self-completion forms;
  • Work in groups with different examples, which described the difficulties and specific features of the instrument cases that may occur. Discussion of the results and the interviewer’s opinions. How to respond to Frequently Asked Questions;
  • Presentation and detailed discussion of the content of the template for interviewers notes, which are to be filled in by each interviewer after conducting the interview;
  • Organization of the survey.

As a part of the training, the interviewers were provided with the detailed guideline manual for the fieldwork, containing all aspects necessary to execute the survey correctly, the questionnaire with the Showcards and the Self-completion forms as well as the Notes for the interviewers.

Quality control during the fieldwork

Method used for the prenotification or first contact of respondents - letter.

Use of incentives - no.

Theoretical minimal number of contacts with a respondent before declaring a nonparticipation (i.e. the number of attempts that an interviewer is asked to do for interviewing a respondent) - up to two visits for distant clusters and up to 4 visits in close clusters from the RSO location.

Interview duration for the EHIS questions:

  • Average: 30 minutes 
  • Minimum: 5 minutes 
  • Maximum: 65 minutes 

Techniques used to control interviewer performance - A review of questionnaires and Interviewers’ notes was carried out by the supervisors in RSO in order to check whether the questionnaires were correctly filled in. Individual contacts were regularly established. Weekly reports on survey participations was provided in NSI by suprvisiors.

Ratio interviewers / field supervisors - 4.

Were (some of) the respondents contacted for quality control? - No.

Were additional studies performed in relation to the nonparticipation? - No.

Questionnaire

Development of the questionnaire

The survey was carried out in Bulgarian. The translation protocol proposed by Eurostat is used.

Were the modules pre-tested? EHIS wave 1 questionnaire was tested, EHIS wave 2 - no. 

Design of the questionnaire

The recommended order of modules and sub-modules is followed.

Modified EHIS questions in comparison with the model questionnaire and conceptual guidelines - AC2, PL6, HO1, AM7, PA1, AL1, AL6. All questions are modified in accordance with the Eurostat Methodological manual - "European Health Interview Survey (EHIS wave 2)" 

Content of alcohol of the “national standard” drink (in grams) used in AL sub-module = 14 g.

Data validation

EHIS wave 1

The data are validated by Eurostat. Common rules for checking and consistency checks are applied.

EHIS wave 2

The proposed by Eurostat harmonized instrumentarium according to the "EHIS wave 2 Methodological manual" is used. Conceptual guidelines and translation protocol is also applied. Common rules for checking and consistency checks in accordance with the requirements of the Commission Regulation (EU) No 141/2013 implementing Regulation (EC) No 1338/2008 are applied. Proposed by Eurostat EDIT validation tool is used before sending the microdata file. 

Data compilation

Data checking, cleaning and editing is done in accordance with the EHIS wave 2 Methodological manual, EHIS Validation rules as well as EHIS wave 2 Data delivery guidelines. 

Imputation, adjustment for non-response and calibration is not applied.
The current demographic data as of 31 December 2014 for the total population is used for weighting.
Adjustment

The current demographic data as of 31 December 2014 for the total population is used for weighting.

Information on the variability of final weights

average divided by minimum = 2.71
maximum divided by average = 2.55
coefficient of variation = 0.32

Quality management
Quality assurance

According to the Regulation 1338/2008 on Community statistics on public health and health and safety at work EHIS is to be conducted every five years. EHIS wave 2 was conducted according to the Commision Regulation 141/2013 as regards statistics based on the European Health Interview Survey (EHIS).

EHIS aims at achieving an input standardisation. A model questionnaire (questions, answer categories, filters, etc.) as well as conceptual guidelines and rationales were prepared. Conceptual translation into all EU languages was requested. By using the Methodological manual 'European Health Interview Survey (EHIS wave 2)' the harmonizad questionnaire a standard translation protocol as well as Conceptual translation cards and guidelines were applied.

National data entry tool is elaborated according to the Validation rules and Data delivery guidelines proposed by Eurostat. Data validation tool EDIT is used in order to prevalidated the national microdata before sending them to Eurostat.

Quality assessment

The implementation of the uniform methodological documents, rules and procedures at all stages of the study provides high quality of the data.

Relevance
User needs

The produced information answers to needs as for the management of health care systems, as well as in science. In framework of these needs, EHIS questions are aimed at meeting the basic needs of information at EU level, as they do not cover all detailed aspects of health, which can better be carried out via specific surveys at national level.

User satisfaction

Not applicable.

Completeness

Persons aged 15 and over living in private households are covered. Persons up to 14 years of age as well as those living in institutionalized households, as residencies for students or workers, medical or social institutions, prisons are generally excluded from the target population.

Data completeness - rate

Not applicable.

Accuracy and reliability
Overall accuracy

The minimum effective sample size as is set out in Annex II of the Commission Regulation (EU) No 141/2013 is achieved. The proxy interview rate is 11.1%. 

Sampling error

The standard error for 3 indicators was calculated.

  • Relative share of respondents in good or very good health;
  • Relative share of respondents with a longstanding illness or health problem;
  • Relative share of respondents that were severely limited in activities people usually do because of health problems for at least the past 6 months.

Imputation techniques of missing values and calibration methods are not applied.

Sampling errors - indicators

EHIS wave 2

Standard errors of key indicators

Indicator/sub-indicator (variable(s) from which the indicator is derived)

Number of respondents - n

(unweighted)

Estimated proportion - p

(weighted)

Standard error - SE

Confidence interval

95% lower limit,

in %

95% upper limit, 

in %

Respondents aged 15 years or over in good or very good health (HS1)

Total

3568

66.6

0.8

65.1

68.2

Male

1760

70.2

0.9

68.4

72.1

Female

1808

63.5

1.0

61.5

65.5

Respondents aged 15 years or over with a longstanding illness or health problem (HS2)

Total

3110

44.6

0.8

42.8

46.3

Male

1337

40.3

0.4

38.2

42.3

Female

1773

48.5

1.0

46.4

50.5

Respondents aged 15 years or over that were severely limited in activities people usually do because of health problems for at least the past 6 months (HS3)

Total

466

6.4

0.3

5.7

7.1

Male

194

5.9

0.4

4.9

6.8

Female

272

7.0

0.4

6.1

7.8

Respondents aged 15 years or over declaring having been hospitalized in the past 12 months (HO1) (men and women)

701

10.0

0.4

9.1

10.7

Respondents aged 18 years or over who are obese (BMI>=30, where BMI = BM2 in kg/(BM1 in m* BM1 in m) (men and women)

836

14.8

0.6

13.6

15.9

 

 

Non-sampling error

Coverage errors:

A two stage stratified cluster sample on national and regional level is used. The sample is stratified by using the administrative regions in the country and persons' place of residence (town, village). As a result of the stratification 56 strata are designed. At the first stage clusters are selected with a probability proportional to their size, separately for 28 districts and for urban and village population. At the second stage, through a systematic selection 5 households are identified. All persons aged 15 and over in selected households were interviewed.

EHIS wave 1

The survey applies the principle of the voluntary participation. A substitution is not allowed. By face to face interview (PAPI) 5 661 persons from 8 393 are interviewed. The response rate is 73.8%.

EHIS wave 2

The survey applies the principle of the voluntary participation. A substitution is not allowed. By face to face interview (PAPI) 6 410 persons from 8 839 are interviewed. The response rate is 72.5%.

 

In order to provide maximum opportunities for analyzing survey data additional information is available:

  • Original sample size (Eligible + Not eligible)
  • Interviewed respondents - fully or partially completed questionnaire;
  • Non-interviewed respondents - respondent was not found, refusal;
  • Not eligible - deceased, does not live at the address, non-existent address / building / dwelling.

Measurement and processing errors:

These are errors in the interview stage of collection of data, understanding of the issues by the respondents, sometimes wrong answers, and errors in data codification. The data entry program has been designed as to guarantee correctness and consistency of the data (logical controls, acceptable value, etc.), to be minimize this type of error. The program performs further checks for data accuracy with SPSS scripts.

Coverage error

Overall quality of the sampling frame:

The Census 2011 DataBase is used as a sampling frame. The information is updated based on the current demographic statistics data as of 31.12. 

Over-coverage - rate

Not applicable.

Common units - proportion

Not applicable.

Measurement error

In accordance with the methodological recommendations proxy interview is allowed only due to health problems of the respondent. There are two possibilities: either the respondent is unable to complete the interview due to physical or mental problems or when the person is hospitalized. Proxy interview was allowed limited to the questions specified in the Eurostat guidelines.

Non response error

Non-response rate -  27.5%.

Methods used for reducing unit non-response 

1. The respondents’ address information was sent to the Regional Statistical Offices for checking after the sample selection.

2.Household invitation letter was prepared and signed by the President of the NSI. In this letter we explain the aim of the survey and how the sample was drawn. The importance to participate is stressed. The households were informed that the interviewers are staff of the Regional statistical offices and will identify himself (herself) by an identity card. We assure the persons that their answers will remain confidential.

3.Additional visits to the households - there were allowed second visits for the distant clusters and up to 4 visits in close clusters from the RSO location. 

Substitution is not allowed.

 

Unit non-response - rate
Item non-response - rate

Item non-response

 

A) Item non-response rate across the health variables (un-weighted and before imputation)

Min: 0.00%

Max: 15.62% (MH1F)

Average: 6.3%

 

B) Total item non-response (un-weighted)

(number of completed values / expected values over all variables of all respondents taking into account filtering and derogations granted)
(link to data completeness rate / substitution rate)

 8.82% - total item non-response rate (proxy are excluded)

C) For which variables the item response (i.e. before imputation) was below 90 %?

 

AL1         87.22%

AL2         88.17%

AL3         88.63%

AL4         88.17%

AL5         88.64%

AL6         87.41%

AW2        88.80%

BM1        87.08%

BM2        85.99%

FV1         88.30%

FV2         88.00%

FV3         88.28%

FV4         87.93%

HA3        88.64%

HS1         88.85%

IC1          88.44%

IC2          88.78%

IC3          87.71%

MD1        88.83%

MD2        88.72%

MH1A     85.88%

MH1B     86.32%

MH1C     87.21%

MH1D     87.43%

MH1E     86.54%

MH1F     84.38%

MH1G    85.46%

MH1H    84.96%

PA1        87.78%

PA2        87.49%

PA3        85.62%

PA4        85.66%

PA5        87.50%

PA6        87.43%

PA7        87.66%

PA8        86.4%

PC3        88.77%

PE1        88.25%

PE2        86.68%

PE3        88.1%

PE4        88.47%

PE5        88.78%

PE6        88.56%

PE7        88.69%

PE8        88.44%

PN1       88.56%

PN2       88.44%

SK4       85.6%

SS1        88.16%

SS2        87.46%

SS3        86.02%

UN1A    88.47%

UN1B    88.60%

UN2A    88.49%

UN2B    88.38%

UN2C    88.46%

UN2D    88.14%

For all of them proxy is not allowed.

 

Processing error

LimeSurvey 2.00 + build 131.022 was used for data entry.

 
The coding, initial data checking and data entry were carried out at the Regional Statistical Offices (RSO). The data tools framework (programme for data entry) was designed with additional controls and filters. There were added also extra checking rules by comparing the entered information between different related questions in order to confront possible inconsistent answers. 
During the data entry experts from RSOs, who met difficulties or problems contacted experts in Head Office for solutions. Some general decisions or emerged special features were spread to all RSOs as extensions of the methodology. 
After finishing the work at regional level, the data was checked and validated again in the Head Office. Some mistakes emerged mainly at coding, and were corrected at the database. Additional verifications were made at record level.
Data checking, cleaning and editing was done in accordance with the EHIS wave 2 Validation rules as well as EHIS wave 2 Data delivery guidelines. 
 
Variables' post-coding

Post-coding of NACE and ISCO was done in RSOs under supervision of the regional coordinators. As the interviewers are participating in other social surveys (SILC, LFS, AES, etc.) they are experienced in identifying occupations and economical activities. 

At Head Office were made some additional checks for consistency and relevance of the post coded variables using related variables.

 

Imputation - rate

Imputation techniques or calibration methods are not applied.

Model assumption error

Not applicable.

Seasonal adjustment

Not applicable.

Data revision - policy

Not applicable.

Data revision - practice

Not applicable.

Data revision - average size

Not applicable.

Timeliness and punctuality
Timeliness

T+12 months

Time lag - first results

Preliminary data are available 11 months after the field work.

Time lag - final results

The final data are disseminated after finalization of data validation procedure by Eurostat. 

Punctuality

Micro-data are sent according to the COMMISSION REGULATION (EU) No 141/2013 requirements.

The data for publishing statistical data is shown in the Release Calendar presenting the results of the statistical surveys carried out by the National Statistical Institute.

 

Punctuality - delivery and publication
Coherence and comparability
Comparability - geographical

Due to sample type of the survey, the data are representative at district level only for part of indicators.

International comparison - EHIS aims at achieving an input standardisation (questions, answers, filters, etc.) through conceptual translation into all EU languages. Each of the questions and response categories are accompanied by a detailed description, so that their meaning is identical in all Member States. Should be taken into account that not all countries have fully implemented the questionnaire or some questions were modified.

Asymmetry for mirror flows statistics - coefficient

Not applicable.

Comparability - over time

Due to changing the EHIS wave 2 questionnaire some of the questions are partly or not comparible.

Length of comparable time series

Not applicable.

Coherence - cross domain

Not applicable.

Coherence - sub annual and annual statistics

Preliminary analysis on the cohernce with other survey data in the field of health statistics are carried out as follow:

  • Morbidity data – prevalence of persons with asthma; chronic bronchitis, chronic obstructive pulmonary disease, emphysema; myocardial infarction; stroke; diabetes;
  • Hospital discharge data;
  • Mortality data;
  • SILC data - Concerning MEHM questions the questionnaires are fully comparible.

Additional data analysis will be carried out further.

Coherence - National Accounts

Not applicable.

Coherence - internal

Not applicable.

Accessibility and clarity
News release

Press release.

Publications

EHIS - wave 1

Bulgaria - Statistical Panorama

On-line database

Data on European health interview survey are available to all users of the NSI website under the heading Health - Health interview survey: http://www.nsi.bg/en/node/5630

Online database of Eurostat:

http://epp.eurostat.ec.europa.eu/portal/page/portal/health/public_health/data_public_health/database

Data tables - consultations

Not applicable.

Micro-data access

Anonymised individual data can be provide for scientific and research purposes by individual request, according to the Rules for the provision of anonymised individual data for scientific and research purposes.

Other

Information service on request, according to the Rules for the dissemination of statistical products and services in NSI.

Metadata - consultations

Not applicable.

Documentation on methodology

EHIS wave 1

  • European Health Interview Survey questionnaire (2007-2009);
  • Conceptual translation cards and guidelines;
  • Quality Categories and Criteria for Delivery Data to EHIS;
  • European Health Interview survey methodological sampling guidelines (Task force III report);
  • Guidelines for the development and criteria for the adoption of Health Survey instruments.

EHIS wave 2

  • European Health Interview Survey (EHIS wave 2), Methodological manual, Eurostat, 2013 edition;
  • EHIS wave 2 Validation rules; 
  • EHIS wave 2 Data delivery guidelines.
Metadata completeness – rate

100%

Quality documentation

EHIS wave 1

Summary report on the application of criteria for quality assessment of the European Health Interview - Eurostat.

EHIS wave 2

Quality report

Cost and burden

Not applicable.

Confidentiality
Confidentiality - policy
  • Law on Statistics;
  • Regulation (EC) No 223/2009 on European statistics (recital 24 and Article 20(4)) of 11 March 2009 (OJ L 87, p. 164), stipulates the need to establish common principles and guidelines ensuring the confidentiality of data used for the production of European statistics and the access to those confidential data with due account for technical developments and the requirements of users in a democratic society.
Confidentiality – data treatment

Individual data are not published in accordance with article 25 of the Law on Statistics. The publishing of individual data can be performed only in accordance with article 26 of the same law.

For the purposes of dissemination of aggregated data the following rules are applied:

  • An estimate should not be published if it is based on fewer than 20 sample observations or if the non-response for the item concerned exceeds 50%.
  • An estimate should be published with a flag "low reliability" if it is based on 20 to 49 sample observations or if non-response for the item concerned exceeds 20% and is lower or equal to 50%.
  • An estimate shall be published in the normal way when based on 50 or more sample observations and the item's non-response does not exceed 20%.
Comment
Download in SDMX file format: European health interview survey
Metadata Structure Definition: ESQRS_MSD+BNSI+2.0+SDMX.2.0.xml
  • Friday, 15 June 2018 - 11:00

    The number of health establishments for hospital aid as of 31.12.2017 was 346 with 52 744 beds. 322 of them were hospitals with 50 519 beds.

    The number of out-patient health establishments was 2 043 with 1 263 beds and other health establishments were 144 with 2 179 beds in them.

    At the end of 2017 30 078 physicians were in practice under the basic labour contracts in health establishments. Dentists were 8 355, as 7 456 worked in practices that had signed contract with National Health Insurance Fund. Medical specialists on ‘Health cares’ who worked on a basic labour contract in health establishments were 46 702. 30 955 of them were nurses and 3 207 - midwives.

  • Friday, 27 April 2018 - 11:00

    The number of detached crèches and groups in kindergartens functioning in the country as of 31.12.2017 was 837 with 32 970 places in them.

    The number of children accommodated in crèches at the end of the year was 32 429. 16 738 of them were boys, and 15 691 - girls.

    The total number of places in crèches per 100 children aged up to 3 years as of 31.12.2017 was 16.9 and the coverage of children brought up in crèches - 16.6 per 100 children aged up to 3 years.

  • Friday, 16 June 2017 - 11:00

    The number of health establishments for hospital aid as of 31.12.2016 was 345 with 51 816 beds. 321 of them were hospitals with 49 589 beds.

    The number of out-patient health establishments was 2 029 with 1 163 beds and other health establishments were 140 with 2 193 beds in them.

    At the end of 2016 29 539 physicians were in practice under the basic labour contracts in health establishments. Dentists were 8 011, as 7 174 worked in practices that had signed contract with National Health Insurance Fund. Medical specialists on 'Health cares' who worked on a basic labour contract in health establishments were 46 930. 30 976 of them were nurses and 3 254 - midwives.

  • Friday, 12 May 2017 - 11:00

    The number of detached crèches and groups in kindergartens functioning in the country as of 31.12.2016 was 829 with 32 611 places in them. The number of places in the country has increased with 571, or with 1.8% compared to the previous year.

    The number of children accommodated in crèches at the end of the year was 32 476. 16 851 of them were boys, and 15 625 - girls.

    The total number of places in crèches per 100 children aged up to 3 years as of 31.12.2016 was 16.5 and the coverage of children brought up in crèches - 16.4 per 100 children aged up to 3 years.

  • Monday, 5 December 2016 - 11:00

    The survey is a part of the European Health Survey System in the framework of the European Statistical System. The EHIS aims at measuring on a harmonized basis and with a high degree of comparability among EU Member States, the health status, life style (health determinants) and health care services use of the EU citizens.

    NSI presents final results based on the conducted in 2014 EHIS.

  • Friday, 17 June 2016 - 11:00

    According to the preliminary data of the NSI the number of health establishments for hospital aid as of 31.12.2015 was 348 with 51 933 beds. 322 of them were hospitals with 49 028 beds.

    The number of out-patient health establishments was 1 915 with 1 044 beds and other health establishments were 136 with 2 394 beds in them.

    At the end of 2015 29 093 physicians were in practice under the basic labour contracts in health establishments. Dentists were 7 513 and medical specialists on 'Health cares' - 47 349.

  • Thursday, 12 May 2016 - 11:00

    The number of detached crèches and groups in kindergartens functioning in the country as of 31.12.2015 was 812 with 32 040 places in them. The number of places in the country has increased with 1 516, or with 5.0% compared to the previous year.

    The number of children accommodated in crèches at the end of the year was 32 124. 16 497 of them were boys, and - 15 627 girls.

  • Friday, 19 June 2015 - 11:00

    The number of health establishments for hospital aid as of 31.12.2014 was 349 with 51 505 beds. 323 of them were hospitals with 48 680 beds.

    The number of out-patient health establishments was 1 931 with 956 beds and other health establishments were 145 - 3 160 beds in them.

    At the end of 2014 28 842 physicians were in practice under the basic labour contracts in health establishments.

    For the first time the National Statistical Institute is publishing data on distribution of practicing physicians by sex and age.

    As of 31.12.2014 it was as follow: 
    12 827 (44.5%) were males and 16 015 (55.5%) - females.
    The largest was the share of physicians in the age group 45 - 54 years - 10 301 persons or 35.7%.
    The young physicians aged up to 35 years were 2 356 persons or 8.2%, while the elderly (aged 65 and over) - 3 557 or 12.3%. 
     
  • Tuesday, 12 May 2015 - 11:00

    The number of detached crèches and groups in kindergartens functioning in the country as of 31.12.2014 was 794 with 30 524 places in them. The number of places in the country has increased with 404, or with 1.3% compared to the previous year.

    The number of children accommodated in crèches at the end of the year was 31 489. 16 167 of them were boys, and - 15 322 girls.

    The coverage of children brought up in crèches at the end of 2014 was 15.8%.

  • Friday, 3 April 2015 - 11:00

    At the end of 2014 in Bulgaria there are 29 Homes for medico-social care for children with total capacity of 2 199 places. 975 children are accommodated there - 537 boys (55.1%) and 438 girls (44.9%).

Pages

  • Statistical Yearbook 2017 in infographics
    The National Statistical Institute of Bulgaria offers a different view of the statistical information included in the 85th edition of the Statistical Yearbook of the Republic of Bulgaria.

    The publication is intended for a wider audience as statistical data are presented in a plain and easy understandable way.

    The current state and changes in the socio-economic and cultural life in the country are presented not in the traditional way in tables and text, but through infographics - images, graphics and other visualization tools.

  • Statistical Yearbook 2017
    The National Statistical Institute (NSI) has the pleasure to present to the attention of national and foreign users of statistical information the 84th edition of the ‘Statistical Yearbook of the Republic of Bulgaria’ in printed and electronic format.

    It provides current statistical information about the demographic, economic and social development of the country for 2012 - 2016 in different territorial and classification aggregations and breakdowns.

  • Bulgaria 2018
    The National Statistical Institute presents the bilingual (Bulgarian/English) brochure Bulgaria 2018 to users of statistical information. The brochure is addressed to a wide range of users (international institutions, business, students, experts etc.) and changes the traditional presentation of statistical information by offering an innovative structure with a parallel translation in English. The publication contains topical statistical information about the demographic, social and economic development of the country over the 2013 - 2017 period.
  • Health Services 2017
    The National Statistical Institute informs users of statistical information in the field of social statistics that the annual publication Health Services 2017 (in Bulgarian only) is already available.

    The publication Health Services is a joint edition of the National Statistical Institute and the National Centre for Public Health and Analyses at the Ministry of Health.

    The data sources are the statistical surveys carried out by the both institutions.

    In the publication data are systematized as follows:

  • Bulgaria 2017
    The National Statistical Institute presents the bilingual (Bulgarian/English) brochure Bulgaria 2017 to users of statistical information. The brochure is addressed to a wide range of users (international institutions, business, students, experts etc.) and changes the traditional presentation of statistical information by offering an innovative structure with a parallel translation in English. The publication contains topical statistical information about the demographic, social and economic development of the country over the 2012 - 2016 period.
  • Statistical Yearbook 2016
    The National Statistical Institute (NSI) has the pleasure to present to the attention of national and foreign users of statistical information the 84th edition of the ‘Statistical Yearbook of the Republic of Bulgaria’ in printed and electronic format.

    It provides current statistical information about the demographic, economic and social development of the country for 2011 - 2015 in different territorial and classification aggregations and breakdowns.

  • Health Services 2016
    The National Statistical Institute informs users of statistical information in the field of social statistics that the annual publication Health Services 2016 (in Bulgarian only) is already available.
    The publication Health Services is a joint edition of the National Statistical Institute and the National Centre for Public Health and Analyses at the Ministry of Health.

    The data sources are the statistical surveys carried out by the both institutions.

  • Bulgaria 2016
    The National Statistical Institute presents the bilingual (Bulgarian/English) brochure Bulgaria 2016 to users of statistical information. The brochure is addressed to a wide range of users (international institutions, businessmen, students, experts etc.) and changes the traditional presentation of statistical information by offering an innovative structure with a parallel translation in English. The publication contains topical statistical information about the demographic, social and economic development of the country over the 2011 - 2015 period.
  • Statistical Yearbook 2015
    The National Statistical Institute (NSI) has the pleasure to present to the attention of national and foreign users of statistical information the 83rd edition of the ‘Statistical Yearbook of the Republic of Bulgaria’ in printed and electronic format.

    It provides current statistical information about the demographic, economic and social development of the country for 2010 - 2014 in different territorial and classification aggregations and breakdowns.

  • Health Services 2015
    The National Statistical Institute informs users of statistical information in the field of social statistics that the annual publication Health Services 2015 (in Bulgarian only) is already available.
    The publication Health Services is a joint edition of the National Statistical Institute and the National Centre for Public Health and Analyses at the Ministry of Health.

    The data sources are the statistical surveys carried out by the both institutions.

Pages