Health System Performance Assessment Framework for Estonia

Annex E. Detailed list of the Estonian HSPA indicators

Table A E.1. Area: Health status

Domains and sub-domains	Indicator title	Indicator custodian	Disaggregation	Primary use of the indicator	Data source	Comments and/ or known limitations
Healthy life expectancy	Healthy life expectancy at birth	Statistics Estonia	Gender, County, Nationality, Education level	NHP 2020‑301 “Estonia 2035” development strategy2	Survey: EU-SILC	Associated with the Equity domain of the HSPA framework.
	Healthy life expectancy at 65	Statistics Estonia	Gender, County, Nationality, Education level	NHP 2020‑301	Survey: EU-SILC	Associated with the Equity domain of the HSPA framework.
Life expectancy	Life expectancy at birth	Statistics Estonia	Gender, County, Nationality, Education level	“Estonia 2035” development strategy2	Administrative, Statistics Estonia	Associated with the Equity domain of the HSPA framework.
	Life expectancy at 65	Statistics Estonia	Gender, County, Nationality, Education level	NHP 2020‑301	Administrative, Statistics Estonia	Associated with the Equity domain of the HSPA framework.
Self-reported health status	Adults (aged 16 and older) rating their own health as good or very good	Statistics Estonia	Gender, County, Education level, Income level	Mental Health Action Plan 2023‑263	Survey: EU-SILC	Associated with the Equity domain of the HSPA framework.
	Elderly people (aged 65 and older) rating their health good or very good	Statistics Estonia	Gender, County, Nationality, Education level	Mental Health Action Plan 2023‑263	Survey: EU-SILC	Associated with the Equity domain of the HSPA framework.

1. NHP 2020‑30: https://www.sm.ee/rahvastiku-tervise-arengukava-2020-2030

2. “Estonia 2035” development strategy: https://valitsus.ee/en/estonia-2035-development-strategy/strategy/strategic-goals

3. Mental Health Action Plan 2023‑26: https://sm.ee/tervise-edendamine-ravi-ja-ravimid/vaimne-tervis/vaimse-tervise-abi#valdkondlikud-raamdo

Table A E.2. Area: Outcomes

Domains and sub-domains	Indicator title	Indicator custodian	Disaggregation	Primary use of the indicator	Data source	Comments and/ or known limitations
1. Health Outcomes
1.1. Self-reported well-being, disabilities and morbidity	Satisfaction with life – share of adults who are satisfied or rather satisfied with life	NIHD	Age, Gender, Region	Mental Health Action Plan 2023‑261	Estonian Health Interview Survey (EHIS)	The survey is conducted every 4 years.
	Emotional well-being and optimism – share of adults who feel hopeful and enthusiastic about the future	NIHD	Age, Gender	Mental Health Action Plan 2023‑261	Survey: EEK	Placeholder indicator Methodology needs to be specified.
	Share of adults who felt stressed in the past 30 days	NIHD	Age, Gender, Region, Education, Cohabiting, Economic activity, Income	Mental Health Action Plan 2023‑261	Survey: Health Behaviour among Estonian Adult Population
	People limited in everyday activities due to health	Statistics Estonia	Age, Gender, Income level, Labour status, Place of Residence	Strategy monitoring Public reporting	Survey: EU-SILC, Statistics Estonia
1.2. Burden of disease and Potential Years of Life Lost	Disability Adjusted Life Years per 1 000 population (DALY)	NIHD	Age, Gender, County, Cause	Strategy monitoring Public reporting	EHIF Database
	Years of Life Lost per 1 000 population due selected type of diseases – cancer, cardiovascular diseases, AMI, injuries, alcohol, diabetes, suicides	NIHD	Age, Gender, County, Cause	Mental Health Action Plan 2023‑261	EHIF Database
1.3. Selected type of morbidity	Cancer incidence rate per 100 000 population	NIHD	Age, Gender, County, Cause/site	Cancer Control Plan 20302	Cancer Register
	Cardiovascular diseases:
	Attacks of acute myocardial infarction per 100 000 population	NIHD	Age, Gender, County, Cause	Strategy monitoring Public reporting	Myocardial Infarction Register	Eurostat collects hospital cases.
	Attacks of stroke per 100 000 population	NIHD	Age, Gender, County, Cause	Strategy monitoring Public reporting	EHIF Database
	Diabetes incidence rate per 100 000 population	NIHD	Age, Gender, County	Strategy monitoring Public reporting	EHIF Database
	External causes of injuries incidence rate per 100 000 population	NIHD	Age, Gender, County, Cause	Strategy monitoring Public reporting	EHIF Database
	Intentional self-harm per 100 000 population	NIHD	Age, Gender, County, Cause	Mental Health Action Plan 2023‑261	EHIF Database
	Mental and behavioural disorders incidence rate per 100 000 population	NIHD	Age, Gender, County	Mental Health Action Plan 2023‑261	EHIF Database
	Mood (affective) and anxiety disorders incidence rate per 100 000 population	NIHD	Age, Gender, County	Mental Health Action Plan 2023‑261	EHIF Database	Placeholder indicator Methodology needs to be specified.
	New HIV cases per 100 000 population	Health Board	Age, Gender, County	Strategy monitoring Public reporting	Communicable Diseases Register
	New chronic and acute cases of hepatitis C per 100 000 population	Health Board	Age, Gender, County	Strategy monitoring Public reporting	Communicable Diseases Register
	Tuberculosis incidence rate (primary, recurrent and re‑treatment cases) per 100 000 population	NIHD	Age, Gender, County	Strategy monitoring Public reporting	Tuberculosis Register
1.4. Multi-morbidity						Placeholder Sub-domain
1.5. Avoidable mortality	Preventable causes of mortality per 100 000 population	NIHD	Age, Gender, County, Cause	NHP 2020‑303	Causes of Death Register, Eurostat
	Treatable causes of mortality per 100 000 population	NIHD	Age, Gender, County, Cause	NHP 2020‑303	Causes of Death Register, Eurostat
1.6. Causes of mortality	Mortality per 100 000 population: Injuries (incl. poisonings, traffic accidents, falls, drowning, fire deaths, freezing), Suicides, Cardiovascular diseases (incl. acute myocardial infarction, cerebrovascular diseases), Cancer/malignant tumours, Diabetes, Alcohol-related illnesses and poisonings, Infant mortality	NIHD	Age, Gender, County, Cause of death	NHP 2020‑303 Mental Health Action Plan 2023‑261 Cancer Control Plan 20302 Green Paper on Alcohol Policy4	Causes of Death Register, Cancer Register
	Standardised premature mortality rate (mortality from chronic non-communicable diseases per 100 000 population aged 30‑69)	NIHD	–	NHP 2020‑303	Causes of Death Register, WHO	Data with a long delay (last available 2016).
2. Healthy Choices
2.1. Nutrition and Physical activity	Self-reported consumption of fruits during last seven days among adults (16‑64, percentage of total population)	NIHD	Age, Gender	Strategy monitoring Public reporting	Survey: Health Behaviour among Estonian Adult Population
	Self-reported consumption of vegetables during last seven days among adults (16‑64, percentage of total population)	NIHD	Age, Gender	Strategy monitoring Public reporting	Survey: Health Behaviour among Estonian Adult Population
	Share of 11‑, 13‑ and 15‑year‑olds reporting at least 60 minutes of moderate‑to-vigorous physical activity daily	NIHD	Age, Gender, Region	NHP 2020‑303 Green Paper of Nutrition and Exercise5	Survey: Health Behaviour in School-aged Children (HBSC)
	Self-reported physical activity/exercises at least 30 minutes four times per week in their leisure time among adults (16‑64, percentage of total population)	NIHD	Age, Gender, County, Education, Income	NHP 2020‑303 Green Paper of Nutrition and Exercise5	Survey: Health Behaviour among Estonian Adult Population
2.2. Overweight and obesity	Overweight and obese rates among children	HWISC	Age, Gender, County	NHP 2020‑303 Green Paper of Nutrition and Exercise5	ENHIS
	Self-reported overweight and obese rates (% of total population) among adults (16‑64 year‑olds)	NIHD	Age, Gender, County, Education, Income	NHP 2020‑303 Green Paper of Nutrition and Exercise5	Survey: Health Behaviour among Estonian Adult Population
2.3. Drug use – alcohol, smoking and illicit drugs	Share of 11‑, 13‑ and 15‑year‑olds who have not been drunk	NIHD	Age, Gender, Region	NHP 2020‑303 Green Paper on Alcohol Policy4	Survey: Health Behaviour in School-aged Children (HBSC)
	Absolute alcohol consumption (litres) among population aged 15 and over	Estonian Institute of Economic Research	–	NHP 2020‑303 Green Paper on Alcohol Policy4	Yearbook report
	Share of 16‑64 year‑olds who have been binge drinking (consuming six or more alcoholic drinks on a single occasion) at least once per week	Estonian Institute of Economic Research	Age, Gender, County	Strategy monitoring Public reporting
	Share of 11‑, 13‑ and 15‑year‑olds who have not used tobacco or nicotine products	NIHD	Age, Gender, Region	NHP 2020‑303 Green Paper on Tobacco Policy	Survey: Health Behaviour in School-aged Children (HBSC)
	Daily smokers among adults (16‑64 year‑olds, percentage of total population)	NIHD	Age, Gender, Region, Education level, Income	NHP 2020‑303 Green Paper on Tobacco Policy	Survey: Health Behaviour among Estonian Adult Population
	Share of adults exposed to tobacco smoke at home (16‑64 year‑olds, percentage of total population)	NIHD	Age, Gender	NHP 2020‑303 Green Paper on Tobacco Policy	Survey: Health Behaviour among Estonian Adult Population
	Share of 15‑ to 16‑year‑olds who have tried drugs	NIHD	Age, Gender, Region	NHP 2020‑303	Survey: Health Behaviour in School-aged Children (HBSC)
	Cannabis and cocaine use in the last 12 months among people aged 16 to 34	NIHD	Age, Gender, Region	Strategy monitoring Public reporting	Survey: Health Behaviour among Estonian Adult Population, EMCDDA
	Mortality from drug overdoses per 1 000 000 population (three‑year average)	NIHD	–	NHP 2020‑303	Causes of Death Register
2.4. Sexual and Reproductive health	Share of 16‑64 year‑olds who always use a condom during sexual intercourse with an episodic partner	NIHD	Age, Gender, County	NHP 2020‑20 303	Survey: Health Behaviour among Estonian Adult Population
	Teenage (10‑19 years of age) mothers per 1 000 girls of the same age	NIHD	Age, County	NHP 2020‑303	Estonian Medical Pregnancy Information System
	Share of mothers who smoked or used nicotine products during pregnancy	NIHD	Age, County	NHP 2020‑303	Estonian Medical Pregnancy Information System	Current data covers only use of cigarettes.
	Number of induced abortions per 100 live births	NIHD	Age, County	NHP 2020‑303	Estonian Medical Pregnancy Information System
3. Health Supportive Environment
3.1. Air quality	Premature deaths attributable to ambient particulate matter pollution (Death rate per 100 000 population)	NIHD	–	Strategy monitoring Public reporting	Causes of Death Register	Placeholder indicator Methodology needs to be specified.
	Number of reported episodes of asthma attributable to air quality	Health Board	–	Strategy monitoring Public reporting		Placeholder indicator Methodology needs to be specified.
	Population satisfaction with outdoor air quality (odour disturbances, air pollution)	Ministry of Finance	County	Strategy monitoring Public reporting	Satisfaction survey (Ministry of Finance), Minuomavalitsus
	Percentage of people living in cities with various PM10 levels in μg/m3	Environment Agency	–	Strategy monitoring Public reporting	WHO	Placeholder indicator Methodology needs to be specified.
	Percentage of people living in cities with various PM2.5 levels in μg/m3	Environment Agency	–	Strategy monitoring Public reporting	WHO	Placeholder indicator Methodology needs to be specified.
3.2. Water quality	Share of consumers supplied with high-quality drinking water from the public water supply	Health Board	–	Strategy monitoring Public reporting	Health Board
	Share of bathing waters with “good” and “very good” quality	Health Board	–	Strategy monitoring Public reporting	Health Board
	Number of reported episodes of water-related (drinking-water and bathing water) illnesses	Health Board	–	Strategy monitoring Public reporting	Health Board
3.3. Climate (changes)	Seasonal mortality (during winter and summer months)	NIHD	–	Strategy monitoring Public reporting	Causes of Death Register	Placeholder indicator Methodology needs to be specified.
3.4. Noise	Population satisfaction with noise levels	Ministry of Finance	County	Strategy monitoring Public reporting	Satisfaction survey (Ministry of Finance), Minuomavalitsus
	Percentage of urban population exposed to noise level Lden > 55 dB	Ministry of Environment	–	Strategy monitoring Public reporting	WHO	Placeholder indicator Methodology needs to be specified.
	Percentage of urban population exposed to noise level Lnight > 50 dB	Ministry of Environment	–	Strategy monitoring Public reporting	WHO	Placeholder indicator Methodology needs to be specified.
3.5. Medicines and AMR	Share of multidrug-resistant tuberculosis cases (MDR-TB) in all new and relapse cases	NIHD	–	NHP 2020‑303 National Medicines Policy 20306	Tuberculosis Register
	Volume of pharmaceutical waste	SaM	–	Strategy monitoring Public reporting		Placeholder indicator Methodology needs to be specified.
3.6. Occupational health	Incidence of occupational diseases	Labour Inspectorate	County, Type of accident	Strategy monitoring Public reporting	Labour Inspectorate
	Deaths from work-related accidents	Labour Inspectorate	County, Type of accident	Strategy monitoring Public reporting	Labour Inspectorate
3.7. Other	Heavy metal intake through food by adults	MoSA	–	Strategy monitoring Public reporting		Placeholder indicator Data is not available.
	Population satisfaction with the availability and accessibility of green areas	Ministry of Finance	–	Strategy monitoring Public reporting	Satisfaction survey (Ministry of Finance), Minuomavalitsus
4. Access
4.1. Waiting times	Self-reported accessibility and unmet need for medical care due to long waiting time (% of population)	Statistics Estonia	Age, Type of service provider, Socio‑economic status, Region	NHP 2020‑303	Survey: EU-SILC, Statistics Estonia
	Waiting time from the creation of the digital referral of the visit that took place	HWISC	Healthcare provider, Type of service, County	Strategy monitoring Public reporting	ENHIS
	Share of expired digital referrals (%) of all digital referrals	HWISC	Healthcare provider, Type of service, County	Strategy monitoring Public reporting	ENHIS
4.2. Timeliness – primary healthcare, cancer, stroke, AMI and musculoskeletal system and eye diseases	Self-reported access to family doctor	EHIF	Age, Gender, year, education, region.	Strategy monitoring Public reporting	Survey: Estonian residents’ assessments of health and healthcare
	Self-reported availability of a family doctor outside of working hours	EHIF	Age, Gender, year, education, region.	Strategy monitoring Public reporting	Survey: Estonian residents’ assessments of health and healthcare
	Time from a primary suspicion cancer to visit to a cancer care centre or cancer specialist: Breast cancer, Cervical cancer, Colorectal cancer, Lung cancer, Prostata cancer	NIHD	Type of Service	Cancer Control Plan 20302	ENHIS	Placeholder indicators Data is not available.
	Share ischemic stroke cases and patients undergoing a revascularisation procedure (thrombolysis or thrombectomy)	EHIF	Age, Diagnose, Type of Service	Strategy monitoring Public reporting	EHIF database
	Share of patients with NSTEMI undergoing coronary angiography within 24 hours of initial hospitalisation	NIHD	Age, Gender, County, Type of hospital	Strategy monitoring Public reporting	Myocardial Infarction Register
	Share of reperfusion therapy in ST-segment elevation myocardial infarction (STEMI) patients with prehospital delay <12 hours (from symptoms to hospitalisation)	NIHD	Age, Gender, County, Type of hospital	Strategy monitoring Public reporting	Myocardial Infarction Register
	Waiting times from specialist assessment to: Hip replacement, Knee replacement, Cataract surgery	EHIF	Mean, Median	Strategy monitoring Public reporting	ENHIS
4.3. Affordability – dental care and medicines	Self-reported unmet needs for healthcare due to financial reason (% of population)	Statistics Estonia	Age, Type of service, Socio‑economic status, Region	Strategy monitoring Public reporting	Survey: EU-SILC, Statistics Estonia
	Self-reported unmet needs for dental care due to financial reason (% of population)	Statistics Estonia	Age, Type of service, Socio‑economic status, Region	Strategy monitoring Public reporting	Survey: EU-SILC, Statistics Estonia
	Proportion of recipes for prescription medicines purchased of the total number prescriptions	EHIF	–	National Medicines Policy 20306	Estonian Medical Prescription Center
5. Patient Safety and Quality
5.1. Patient Safety – self-reported, acute care, healthcare associated infections and morbidity	Patient-reported experiences of safety	MoSA	–	Strategy monitoring Public reporting	–	Placeholder indicator Data is not available.
	Post-operative pulmonary embolism after hip or knee replacement	NIHD	–	NHP 2020‑303	EHIF database
	Post-operative sepsis after abdominal surgery	NIHD	–	NHP 2020‑303	EHIF database
	Share of massive blood loss associated with childbirth	NIHD	–	Strategy monitoring Public reporting	Estonian Medical Birth Register
	Percentage of perineal laceration and rupture uteri during childbirth of all childbirths	NIHD	–	Strategy monitoring Public reporting	Estonian Medical Birth Register
	Number of suicides in hospital	NIHD	–	NHP 2020‑303 Mental Health Action Plan 2023‑261	Causes of Death Register
	Prevalence of hospital acquired infections (% of patients hospitalised/admissions, incl. MRSA, ESBL-producing organisms, CRO, Clostridioides difficile, etc.)	Health Board	–	Strategy monitoring Public reporting	Health Board	Placeholder indicator Methodology needs to be specified.
	Prevalence of hospital-acquired pressure ulcer among hospitalised patients	MoSA	–	Strategy monitoring Public reporting	–	Placeholder indicator Data is not available.
	Prevalence of falls in hospital (% of hospitalised patients)	MoSA	–	Strategy monitoring Public reporting	–	Placeholder indicator Data is not available.
5.2. Clinical effectiveness – primary healthcare, acute care, mental health, diabetes, cancer, medicines	Avoidable admissions due to: Asthma Hypertension Chronic obstructive pulmonary disease Congestive heart failure Diabetes	NIHD	Age, Gender, County, Health care service provider	Strategy monitoring Public reporting	EHIF database
	Postoperative 30 days of emergency rehospitalisation – by selected type of procedures/surgeries (Cholecystectomy, appendectomy, Prostatectomy)	EHIF	County	Strategy monitoring Public reporting	EHIF database
	Screening at-risk patients for chronic kidney disease	EHIF	County, Health care service provider	Strategy monitoring Public reporting	EHIF database
	Thirty-day mortality: Acute Myocardial Infarction, Ischaemic stroke, Haemorrhagic stroke	NIHD	Age, Gender, County, Health care service provider	Strategy monitoring Public reporting	Myocardial Infarction Register, Causes of Death Register, EHIF database
	Postoperative 30‑day mortality – by selected type of procedures/surgeries	NIHD	Age, Gender, County, Health care service provider	Strategy monitoring Public reporting	EHIF database Causes of Death Register	Placeholder indicator Methodology needs to be specified.
	Standardised mortality rate for intensive care	EHIF	Age, Gender, County, Health care service provider	Strategy monitoring Public reporting	EHIF database
	Share of caesarean sections in the case of a single birth in the first child (Robson 1+2)	NIHD	–	NHP 2020‑303	Estonian Medical Pregnancy Information System
	Consumption of Antidepressants (N06A) (Defined Daily Dose/per 1 000 people per day/percentage of adults, at least once in the year)	EHIF	–	Mental Health Action Plan 2023‑261	Estonian Medical Prescription Center	Placeholder indicator Methodology needs to be specified.
	Consumption of Anxiolytics (N05B) (Defined Daily Dose/per 1 000 people per day/percentage of adults, at least once in the year)	EHIF	–	Mental Health Action Plan 2023‑261	Estonian Medical Prescription Center	Placeholder indicator Methodology needs to be specified.
	Diabetes lower extremity amputation per 100 000 population	NIHD	–	Strategy monitoring Public reporting	Estonian Medical Prescription Center
	Share of people with diabetes prescribed the first-line medications according to the treatment guideline, in the past year	EHIF	–	Strategy monitoring Public reporting	Estonian Medical Prescription Center	Placeholder indicator Methodology needs to be specified.
	Cancer sites five‑year relative survival rate: Lung cancer, Colorectal cancer, Cervical cancer, Breast cancer, Prostata cancer	NIHD	Gender	NHP 2020‑303 Cancer Control Plan 20302	Cancer Register, Causes of Death Register
	Patients with cancer discussed at multidisciplinary council (%)	NIHD	County, Health care service provider	Cancer Control Plan 20302		Placeholder indicator Data is not available.
	Use of antibiotics (total DDD/100 pop/day or percentage of population at least once in the year)	EHIF	–	National Medicines Policy 20306	EHIF database
	Polymedication (%) of 75+ who took 5 or more different medicines	EHIF	–	National Medicines Policy 20306	EHIF database	Placeholder indicator Methodology needs to be specified.

1. Mental Health Action Plan 2023‑26: https://sm.ee/tervise-edendamine-ravi-ja-ravimid/vaimne-tervis/vaimse-tervise-abi#valdkondlikud-raamdo

2. Cancer Control Plan 2030: https://www.tai.ee/et/valjaanded/vahitorje-tegevuskava-2021-2030

3. NHP 2020‑30: https://www.sm.ee/rahvastiku-tervise-arengukava-2020-2030

4. Green Paper on Alcohol Policy: https://www.tai.ee/sites/default/files/2021-04/alkoholipoliitika_roheline_raamat.pdf

5. Green Paper of Nutrition and Exercise: https://www.sm.ee/toitumise-ja-liikumise-roheline-raamat

6. National Medicines Policy 2030: https://sm.ee/uudised/ravimivaldkonna-koostoos-valmis-eesti-ravimipoliitika-aastani-2030

Table A E.3. Area: Processes

Domains and sub-domains	Indicator title	Indicator custodian	Disaggregation	Primary use of the indicator	Data source	Comments and/ or known limitations
1. Health Literacy
1.1. Health literacy index						Placeholder sub-domain
1.2. Ambulance and Emergency care	Share of emergency department visits with triage categories Green and Blue	EHIF	Age, Gender, County	Strategy monitoring Public reporting	EHIF database
	Share of ambulance calls with priorities A and B	HWISC	Age, Gender, County	Strategy monitoring Public reporting	ENHIS
1.3. Medicines	Medication adherence	MoSA	Age, Gender, Region, Income level, Education	Strategy monitoring Public reporting	Estonian Medical Prescription Center,	Placeholder indicator Methodology needs to be specified.
1.4. Cancer	Age‑standardised incidence of melanoma in people aged under 55 years	NIHD	Age, Gender, County	Strategy monitoring Public reporting	Cancer register
	Cancer screening coverage:
	Coverage of cervical cancer screening (% of women aged 30‑55 years)	NIHD	Age group, County	NHP 2020‑20301 Cancer Control Plan 20302	Estonian Cancer Screening Register
	Coverage of breast cancer screening (% of women aged 50‑69 years)	NIHD	Age group, County	NHP 2020‑301 Cancer Control Plan 20302	Estonian Cancer Screening Register
	Coverage of colorectal cancer screening (% of 60‑68 years old)	NIHD	Age group, Gender, County	NHP 2020‑301 Cancer Control Plan 20302	Estonian Cancer Screening Register
	Coverage of HPV (human papillomavirus) vaccination among target group girls	Health Board	Age group, County	NHP 2020‑301 Cancer Control Plan 20302	ENHIS
1.5. Oral health and dental care	Contacts with dentists: Children (%) and Adults (%)	NIHD	Age, Gender, County	NHP 2020‑301	NIHD – reports from healthcare providers
	Use of dental care benefits for adults (19 years and older)	EHIF	Age, Gender, County, Benefits classification	NHP 2020‑301	EHIF Database
	Share of 11‑, 13‑ and 15‑year olds reporting washing teeth at least one‑ time per day	NIHD	Age, Gender, Region	Strategy monitoring Public reporting	Survey: Health Behaviour in School-aged Children (HBSC)
	Self-reported share of adults brushing teeth at least twice a day	NIHD	Age, Gender, Region, Income level, Education	Strategy monitoring Public reporting	Survey: Health Behaviour among Estonian Adult Population
1.6. Other	Share of adults (aged 18 and older) who have completed form of consent to donate organs or tissues for transplantation after death	HWISC	Age, Gender	NHP 2020‑301	ENIHS
	Percentage of blood donors in population	NIHD		Strategy monitoring Public reporting	NIHD – reports from healthcare providers
	Share of children who have had a health check-up	EHIF	Age, County, Healthcare provider	Strategy monitoring Public reporting	EHIF Database
2. Person-centeredness
2.1. Patient-reported experiences – PREMs (Patient Reported Experience Measures)	Doctor spending enough time with the patient	EHIF	Age, Gender, Healthcare Service provider	Strategy monitoring Public reporting	Survey: Estonian residents’ assessments of health and healthcare, Hospital feedback questionnaires	Placeholder indicator There is no regularity in data collection.
	Doctor providing easy to understand explanations	EHIF	Age, Gender, Healthcare Service provider	Strategy monitoring Public reporting	Survey: Estonian residents’ assessments of health and healthcare, Hospital feedback questionnaires	Placeholder indicator There is no regularity in data collection.
	Doctor involving patient in decisions about care and treatment	EHIF	Age, Gender, Healthcare Service provider	Strategy monitoring Public reporting	Survey: Estonian residents’ assessments of health and healthcare, Hospital feedback questionnaires	Placeholder indicator There is no regularity in data collection.
	Doctor giving opportunity to ask questions or raise concerns	EHIF	Age, Gender, Healthcare Service provider	Strategy monitoring Public reporting	Survey: Estonian residents’ assessments of health and healthcare, Hospital feedback questionnaires	Placeholder indicator There is no regularity in data collection.
2.2. Patient-reported outcomes – PROMs (Patient Reported Outcomes Measures)						Placeholder sub-domain
2.3. Employment	Employment rate of people – selected chronic diseases	MoSA	Mental health disorder, cancer, musculoskeletal system and connective tissue diseases etc.	Mental Health Action Plan 2023‑263		Placeholder indicator Methodology needs to be specified.
3. Integrated Care
3.1. Primary healthcare	Avoidable specialist visit – selected chronic diseases (hypertension, diabetes)	EHIF	Gender, County, Health care provider	Strategy monitoring Public reporting	EHIF database	Placeholder indicator There is no regularity in data analysis.
	Follow-up visits to a family doctor within 30 days of hospitalisation due to: Acute myocardial infarction, Stroke, Hip fracture	EHIF	County	NHP 2020‑301	EHIF database
	Mortality or disease‑specific readmission within 365 days after discharge: Ischemic stroke, Congestive Heart Failure	NIHD	Age, Gender, Type of hospital	Strategy monitoring Public reporting	EHIF database	Placeholder indicator Not publicly available.
	Mental and behavioural disorders readmissions within 30‑days of discharge	NIHD	Age, Gender, Type of hospital	Mental Health Action Plan 2023‑263	EHIF database	Placeholder indicator Methodology needs to be specified.
	Home visits for infants/newborns	NIHD	County, Health care service provider	Strategy monitoring Public reporting		Placeholder indicator Methodology needs to be specified.
3.2. Medicines	Prescribed statins at acute myocardial infarction (AMI) hospital discharge	EHIF	Age, Gender, Type of hospital	Strategy monitoring Public reporting	Myocardial Infarction Register Estonian Medical Prescription Center
3.3. Rehabilitation services	Share of patients rehabilitated in the first month after – selected diseases and conditions	EHIF	Age, Gender, Type of hospital	Strategy monitoring Public reporting	EHIF database
4. Governance
	Governance and collaboration between health authorities	MoSA	–	Strategy monitoring Public reporting	–	Placeholder indicator Methodology needs to be specified.
	Evidence‑informed and data-driven policy making	MoSA	–	Strategy monitoring Public reporting	–	Placeholder indicator Methodology needs to be specified.
	Public and private money invested in innovation	MoSA	–	Strategy monitoring Public reporting	–	Placeholder indicator Methodology needs to be specified.
	Share of the HSPA indicators with data source ENHIS	MoSA	–	Strategy monitoring Public reporting

1. NHP 2020‑30 (NHP): https://www.sm.ee/rahvastiku-tervise-arengukava-2020-2030

2. Cancer Control Plan 2030: https://www.tai.ee/et/valjaanded/vahitorje-tegevuskava-2021-2030

3. Mental Health Action Plan 2023‑26: https://sm.ee/tervise-edendamine-ravi-ja-ravimid/vaimne-tervis/vaimse-tervise-abi#valdkondlikud-raamdo

Table A E.4. Area: Structures

Domains and sub-domains	Indicator title	Indicator custodian	Disaggregation	Primary use of the indicator	Data source	Comments and/ or known limitations
1. Health Infrastructure
1.1. Primary healthcare infrastructure	Share of family doctors with a patients list working in healthcare centres	EHIF	County	Strategy monitoring Public reporting	EHIF
	Share of healthcare centres offering mandatory primary healthcare services	EHIF	County	Strategy monitoring Public reporting	EHIF
	Ambulance crews	Health Board	County, Type of crew	Strategy monitoring Public reporting	Health Board
1.2. Inpatient care infrastructure – hospital beds	Total number of hospital beds per 100 000 population: Acute care, Day care and Psychiatric care beds	NIHD	County, Public and private sector, Type of hospital	Strategy monitoring Public reporting	NIHD – reports from healthcare providers
	Long-term care (nursing care) beds per 100 000 population	NIHD	Age, 65 and older, County, Public and private sector	Strategy monitoring Public reporting	NIHD – reports from healthcare providers
1.3. Equipment	Magnetic Resonance Imagine (MRI) units per million population	NIHD	–	Strategy monitoring Public reporting	NIHD – reports from healthcare providers
1.4. Medicines	Number of pharmacies per 100 000 population	SaM	County	National Medicines Policy 20301	SaM
2. Workforce
2.1. Volumes and capacity	Practising doctors per 1 000 population: Family physicians, Dentists, Psychiatrist, Occupational health physicians	NIHD	County, Healthcare provider	NHP 2020‑302 Mental Health Action Plan 2023‑263	NIHD – reports from healthcare providers
	Practising midwives per 1 000 fertility age population and nurses per 1 000 population: Family nurses, Mental health nurses/Psychiatric nurses	NIHD	County, Healthcare provider	NHP 2020‑302 Mental Health Action Plan 2023‑263	NIHD – reports from healthcare providers
	Practising other healthcare workers and specialists per 1 000 population: Pharmacists and pharmacists assistants, Clinical psychologists, Physiotherapists, Therapists, Radiologists, Ambulance workers, Dental hygienists	NIHD	County, Healthcare provider	NHP 2020‑302 National Medicines Policy 20301 Mental Health Action Plan 2023‑263	NIHD – reports from healthcare providers
2.2. Training and availability of healthcare workers	Medical graduates per 100 000 population: Doctors graduates and Nurses graduates	Ministry of Education and Research	–	Strategy monitoring Public reporting	Ministry of Education and Research	Placeholder indicator Data is available but not regularly analysed.
	Medical doctor graduates becoming family doctors (% of practicing doctors)	Ministry of Education and Research	Speciality	Strategy monitoring Public reporting	Ministry of Education and Research Health Care Providers’ Information System	Placeholder indicator Data is available but not regularly analysed.
2.3. Workload	Share of healthcare workers (nurses and doctors) working more than one full time contract load	NIHD	County, Speciality	Strategy monitoring Public reporting	NIHD – reports from healthcare providers
	Share of family doctors (with a patient list) with 2 nurses on staff	EHIF	County, Healthcare provider	Strategy monitoring Public reporting	EHIF
	Health worker staff satisfaction on workload	MoSA	–	Strategy monitoring Public reporting	–	Placeholder indicator Data is not available.
2.4. Migration	Share of foreign trained medical workers: Medical doctors and Nurses of all practising doctors or nurses	Health Board	Foreign trained doctors by country of first qualification	Strategy monitoring Public reporting	Health Care Providers’ Information System Working register
3. Financing
3.1. Government spending	Health expenditure by type of financing schemes: Health expenditure as share of GDP Public sector health expenditures in GDP	NIHD	Type of financing schemes (HF)	NHP 2020‑302 Public reporting	NIHD
3.2. Individual spending – medicines, dental care, nursing care, mental health	Out-of-pocket spending as share of (%) current health expenditure	NIHD	–	NHP 2020‑302	NIHD
	Share of out-of-pocket spending on health by type of service:
	Medicines	NIHD	Prescription and non-prescription medicines	NHP 2020‑302. National Medicines Policy 20301	NIHD
	Dental care	NIHD	–	Strategy monitoring Public reporting	NIHD
	Long-term care	NIHD	–	Strategy monitoring Public reporting	NIHD
	Mental health services and medicines	NIHD	–	Mental Health Action Plan 2023‑263		Placeholder indicator Methodology needs to be specified.
3.3. Private funding	Private funding for eHealth and innovation	MoSA	–	UpTIS vision4		Placeholder indicator Methodology needs to be specified.
4. Digitalisation
4.1. Patient Portal Usability for Patients	Use of the national Patient Portal – share of population	HWISC	–	UpTIS vision4	HWISC	Placeholder indicator Methodology needs to be specified.
	Patient Portal users’ satisfaction with the portal	MoSA	–	UpTIS vision4	HWISC	Placeholder indicator Methodology needs to be specified and data is not available.
	Usage of national electronic appointment scheduling – share of appointments booked online	HWISC	–	UpTIS vision4	HWISC	Placeholder indicator Methodology needs to be specified.
	Share of target group persons responding to electronic screening programme invitations	HWISC	–	UpTIS vision4	HWISC	Placeholder indicator Methodology needs to be specified.
	Share of services that a person can initiate in the patient Portal (medication/prescription renewal, sick leaves, etc.)	HWISC	–	UpTIS vision4	HWISC	Placeholder indicator Methodology needs to be specified and data is not available.
	Adding data by patients – patients can add data immediately to their EHRs and supplementary data (complaints, blood pressure, weight, medications list etc).	MoSA	–	UpTIS vision4	HWISC	Placeholder indicator Methodology needs to be specified and data is not available.
	Adding data by caregivers – caregivers can add data immediately to the patients’ EHRs in a respective country	MoSA	–	UpTIS vision4	HWISC	Placeholder indicator Methodology needs to be specified and data is not available.
4.2. Electronic Health Record (EHR) Interoperability	Satisfaction with data availability and data quality for healthcare professionals	HWISC	–	UpTIS vision4	HWISC	Placeholder indicator Methodology needs to be specified and data is not available.
	Use of secure asynchronous electronic communication between patients and healthcare service providers	HWISC	–	UpTIS vision4	HWISC	Placeholder indicator Methodology needs to be specified.
	Share of e‑health services covered by substantive data controls and data quality indicators	HWISC	–	UpTIS vision4	HWISC	Placeholder indicator Methodology needs to be specified.
4.3. Health Information Exchange for Clinicians and Electronic Health Record (EHR) Usability for Clinicians	Number of national clinical decision support tools use in daily practice	MoSA	–	UpTIS vision4	HWISC EHIF	Placeholder indicator Methodology needs to be specified.
	Usage of national tools addressed to professionals (incl. data viewer, etc.)	HWISC	–	UpTIS vision4	HWISC EHIF	Placeholder indicator Methodology needs to be specified.
	Ease of use and satisfaction for the clinician with the different eHealth services, tools and actions (ENHIS-related)	MoSA	–	UpTIS vision4	HWISC EHIF	Placeholder indicator Methodology needs to be specified.
	Self-reported time saved by using e-health solutions and for documentation	MoSA	–	UpTIS vision4	–	Placeholder indicator Methodology needs to be specified and data is not available.
	Integration of health information system – access to patients data by categories of specialists (doctors, nurses, caregivers, social workers, pharmacists etc)	MoSA	–	UpTIS vision4	–	Placeholder indicator Methodology needs to be specified.
4.4. Secondary data use in the Electronic Health Record (EHR)	Number of datasets are published as open data	HWISC	–	UpTIS vision4	HWISC	Placeholder indicator Methodology needs to be specified.
	Satisfaction of data applicant and secondary data users (politicians, scientists, epidemiologists etc.) – with release of the requested data process, time spent, requested data quality	HWISC	–	UpTIS vision4	HWISC	Placeholder indicator Methodology needs to be specified and data is not available.
4.5. Telemedicine	E‑consultations between healthcare providers per 100 000 population	HWISC	County, Health care provider	UpTIS vision4	ENHIS	Placeholder indicator Methodology needs to be specified and data is not publicly available.
	Share of referrals to e‑consultation in all referrals by family physicians	HWISC	County, Health care provider	UpTIS vision4	ENHIS	Placeholder indicator Methodology needs to be specified and data is not publicly available.
	Satisfaction with e‑consultations (different parties)	MoSA	–	UpTIS vision4	–	Placeholder indicator Methodology needs to be specified and data is not available.
	Remote consultations for patients per 1 000 population	NIHD	Doctors and Nurses, County, Health care provider	UpTIS vision4	NIHD	Placeholder indicator Methodology needs to be specified.
	Number of patients enrolled in tele‑homecare/home‑monitoring	MoSA	–	UpTIS vision4	–	Placeholder indicator Methodology needs to be specified and data is not available.
4.6. Security and privacy	Share of employees who have passed an information security training in the last 12 months	MoSA	Healthcare providers, Hospitals and National level	UpTIS vision4	Healthcare providers	Placeholder indicator Methodology needs to be specified and data is not available
5. Innovation
	Passing the stages of innovation projects and reaching implementation	MoSA	–	UpTIS vision4	–	Placeholder indicator Methodology needs to be specified.
	Promoting the development and adoption of mHealth	MoSA	–	UpTIS vision4	–	Placeholder indicator Methodology needs to be specified and data is not available.

1. National Medicines Policy 2030: https://sm.ee/uudised/ravimivaldkonna-koostoos-valmis-eesti-ravimipoliitika-aastani-2030.

2. NHP 2020‑30: https://www.sm.ee/rahvastiku-tervise-arengukava-2020-2030.

3. Mental Health Action Plan 2023‑26: https://sm.ee/tervise-edendamine-ravi-ja-ravimid/vaimne-tervis/vaimse-tervise-abi#valdkondlikud-raamdo.

4. UpTIS vision: https://sm.ee/uudised/ravimivaldkonna-koostoos-valmis-eesti-ravimipoliitika-aastani-2030.

Table A E.5. Area: Cross-cutting

Domains and sub-domains	Indicator title	Indicator custodian	Disaggregation	Primary use of the indicator	Data source	Comments and/ or known limitations
1. Equity
1.1. Income	Share of people covered by health insurance	EHIF	Age, Gender, County	NHP 2020‑301	EHIF Database
	People reporting a longstanding illness of health problem by income quintile	Statistics Estonia	Gender, County, Income quintile	Strategy monitoring Public reporting	Survey: EU-SILC
	People reporting unmet needs for medical care by income quintile	Statistics Estonia	Gender, County, Income quintile	Strategy monitoring Public reporting	Survey: EU-SILC
	Share of households with catastrophic health spending by income quintile	WHO Estonia Country Office	–	Strategy monitoring Public reporting	Survey: Household Budget Survey	Placeholder indicator Not analysed regularly.
	Difference between people who rate their health as good or very good among people with the highest and lowest income	Statistics Estonia	Gender, Income level	NHP 2020‑301	Survey: EU-SILC
1.2. Education	Difference between people who rate their health as good or very good among people with basic and higher education	Statistics Estonia	Gender, Education level	NHP 2020‑301	Survey: EU-SILC
1.3. Medicines	Proportion of the households who have difficulties paying for medicines	Statistics Estonia	–	National Medicines Policy 20302	Survey	Placeholder indicator Methodology needs to be specified.
2. Efficiency
2.1. Use of healthcare services – primary healthcare, ambulance and emergency care, specialist care, equipment	Share of independent appointments of family nurses among family doctor care appointments	NIHD	County	NHP 2020‑301	NIHD – reports from healthcare providers
	New anxiety disorders and depression cases diagnosed in primary healthcare	NIHD	Age, Gender, County	Mental Health Action Plan 2023‑263	NIHD – reports from healthcare providers
	Share of ambulatory and inpatient care cases of all mental and behavioural disorders	NIHD	Age, Gender, County	Mental Health Action Plan 2023‑263	NIHD – reports from healthcare providers
	Ambulance visits per 1 000 population	HWISC	Age, Gender, County	Strategy monitoring Public reporting	ENHIS
	Emergency care department visits per 1 000 population	HWISC	County	Strategy monitoring Public reporting	ENHIS
	Distribution of ambulance calls by priorities – A-B-C-D	HWISC	County	Strategy monitoring Public reporting	ENHIS
	Distribution of emergency department visits by triage categories – Red-Orange‑Yellow-Green-Blue	HWISC	County	Strategy monitoring Public reporting	ENHIS
	Ambulance response time for Delta priority ambulance calls in the emergency care service area in the urban/rural area	HWISC	County, City, Rural area	Strategy monitoring Public reporting	ENHIS	Placeholder indicator The data is available, but not regularly published
	Day treatment surgical hospitalisations (% of surgical stays, selected type of surgeries e.g. inguinal hernia surgery)	NIHD	County, Hospital	Strategy monitoring Public reporting	NIHD – reports from healthcare providers
	Occupancy rate of acute care beds	NIHD	Type of healthcare provider/hospital	NHP 2020‑301	NIHD – reports from healthcare providers
	Occupancy rate of independent inpatient nursing care beds	NIHD	Type of healthcare provider/hospital	NHP 2020‑301	NIHD – reports from healthcare providers
	Average length of stay: hospital acute care, psychiatric hospital	NIHD	Type of healthcare provider/hospital	NHP 2020‑301 Mental Health Action Plan 2023‑263	NIHD – reports from healthcare providers
	Involuntary stay in psychiatric care	NIHD	Type of healthcare provider/hospital	Mental Health Action Plan 2023‑263	–	Placeholder indicator Methodology needs to be specified.
	Extended hospital stays (Stroke, Hip fracture)	EHIF	Type of healthcare provider/hospital	Strategy monitoring Public reporting	EHIF database	Placeholder indicator There is no regularity in data analysis.
	Use of Magnetic resonance tomography per 100 000 population	NIHD	County, Hospital	Strategy monitoring Public reporting	NIHD – reports from healthcare providers
2.2. Medicines	Share of the generic medicinal products in the total volume of pharmaceuticals	SaM	–	National Medicines Policy 20302	SaM
2.3. Financial efficiency	Proportions of healthcare financing – health promotion (incl. mental health) vs other healthcare services	EHIF	–	Mental health strategy, Strategy monitoring, Public reporting	EHIF NIHD	Placeholder indicator Methodology needs to be specified.
	Proportions of healthcare financing – primary care, ambulance and emergency care, specialist care, palliative care, mental health services	EHIF	–	Mental health strategy, Strategy monitoring, Public reporting	EHIF NIHD	Placeholder indicator Methodology needs to be specified.
3. Resilience
3.1. Preparedness	Ratio of doctors to nurses	NIHD	County, Healthcare provider	Strategy monitoring Public reporting	NIHD – reports from healthcare providers
	Share of practising family physicians aged 55 and older	NIHD	County, Healthcare provider	Strategy monitoring Public reporting	NIHD – reports from healthcare providers
	Share of practising nurses aged 55 and older	NIHD	County, Healthcare provider	Strategy monitoring Public reporting	NIHD – reports from healthcare providers
	Availability of electric generators in hospitals (% of hospitals)	Health Board	–	Strategy monitoring Public reporting	Health Board
	Medical ventilators per 100 000 population	NIHD	Type of healthcare provider/hospital	Strategy monitoring Public reporting	NIHD – reports from healthcare providers
	Level 3 ICU beds per 100 000 population	NIHD	Type of healthcare provider/hospital	Strategy monitoring Public reporting	NIHD – reports from healthcare providers
	Isolation beds per 100 000 population	NIHD	Type of healthcare provider/hospital	Strategy monitoring Public reporting	NIHD – reports from healthcare providers
	Availability of crisis preparedness plans and crisis preparedness risk analysis at different levels – state/strategic, hospitals, ambulance care	Health Board	Different levels	Strategy monitoring Public reporting	–	Placeholder indicator Methodology needs to be specified.
3.2. Vaccination	Vaccination coverage rate against infectious diseases listed in the national immunisation schedule	Health Board	Age, Selected communicable diseases, County	NHP 2020‑301	ENHIS	Placeholder indicator Methodology needs to be specified.
	Revaccination coverage rate against infectious diseases listed in the national immunisation schedule	Health Board	Age, Selected communicable diseases, County	NHP 2020‑301	ENHIS	Placeholder indicator Methodology needs to be specified.
	Seasonal vaccination rate against selected type of infectious diseases	Health Board	Age, Risk group, Selected diseases, County	NHP 2020‑301	ENHIS	Placeholder indicator Methodology needs to be specified.
	Vaccine‑preventable diseases incidence rate per 100 000 population	Health Board	Age, Gender, County, Selected diseases	Strategy monitoring Public reporting	ENHIS	Placeholder indicator Methodology needs to be specified.

1. NHP 2020‑30: https://www.sm.ee/rahvastiku-tervise-arengukava-2020-2030.

2. National Medicines Policy 2030: https://sm.ee/uudised/ravimivaldkonna-koostoos-valmis-eesti-ravimipoliitika-aastani-2030.

3. Mental Health Action Plan 2023‑26: https://sm.ee/tervise-edendamine-ravi-ja-ravimid/vaimne-tervis/vaimse-tervise-abi#valdkondlikud-raamdo.