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Health at a Glance: Europe 2018 - State of Health in the EU Cycle - CHARTSET

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Key indicators from the latest edition of "Health at a Glance: Europe 2018 - State of Health in the EU Cycle"

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Health at a Glance: Europe 2018 - State of Health in the EU Cycle - CHARTSET

  1. 1. Health at a Glance: Europe 2018 - State of Health in the EU Cycle Joint publication of the OECD and the European Commission Released on November 22, 2018 http://www.oecd.org/health/health-at-a-glance-europe-23056088.htm
  2. 2. Table of Contents 1. Promoting mental health in Europe: Why and how? 2. Strategies to reduce wasteful spending: Turning the lens to hospitals and pharmaceuticals 3. Health status 4. Risk factors 5. Health expenditure and financing 6. Effectiveness: Quality of care and patient experience 7. Accessibility: Affordability, availability and use of services 8. Resilience: Innovation, efficiency and fiscal sustainability Note by Turkey: The information in this document with reference to “Cyprus” relates to the southern part of the Island. There is no single authority representing both Turkish and Greek Cypriot people on the Island. Turkey recognises the Turkish Republic of Northern Cyprus (TRNC). Until a lasting and equitable solution is found within the context of the United Nations, Turkey shall preserve its position concerning the “Cyprus” issue. Note by all the European Union Member States of the OECD and the European Union: The Republic of Cyprus is recognised by all members of the United Nations with the exception of Turkey. The information in this document relates to the area under the effective control of the Government of the Republic of Cyprus.
  3. 3. • Costs of mental health problems • Actions to promote mental health and prevent mental illness 1. PROMOTING MENTAL HEALTH IN EUROPE: WHY AND HOW? Note: The definition of mental health draws on the WHO definition of mental health as a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively, and is able to make a contribution to his or her community. On the other hand, mental health problems are defined as the loss of mental health due to a mental illness or disorder.
  4. 4. The total costs of mental health problems are more than 4% of GDP across EU countries, ranging from 2% to 5% Source: OECD estimates based on Eurostat Database and other data sources. Estimated direct and indirect costs related to mental health problems across EU countries, as a % of GDP, 2015
  5. 5. More than one in six people in EU countries have a mental health problem in any given year Source: IHME, 2018 (these estimates refer to 2016). 18.8% 18.6% 18.5% 18.5% 18.4% 18.3% 18.3% 18.3% 18.0% 17.9% 17.9% 17.7% 17.7% 17.7% 17.6% 17.3% 17.3% 17.0% 17.0% 16.9% 16.9% 15.7% 15.5% 15.4% 15.2% 15.1% 14.9% 14.8% 14.3% 18.5% 17.5% 16.7% 0% 5% 10% 15% 20% 25% Anxiety disorders Depressive disorders Alcohol and drug use disorders Bipolar disorders and schizophrenia Others
  6. 6. People reporting chronic depression are much less likely to work in all EU countries… Note: Due to missing data, the assumption has been made that the situation in Ireland is the same as the EU average. Source: Eurostat Database, based on the European Health Interview Survey (2014). 0 10 20 30 40 50 60 70 80 90 100 % of working age pop. aged 25-64 With depression Without depression % of working age population aged 25-64 Employment rate of people aged 25 to 64 years old …and when they work, people with depression or other mental health problems are often less productive  about 6% less productive
  7. 7. Actions to promote mental health are uneven across the life course: fewer programmes target the unemployed and older people Source: McDaid, Hewlett and Park (2017); EU Compass for Action on Mental Health and Wellbeing (2017); WHO (2018); EU Compass for Action on Mental Health and Wellbeing, 2018 (2018). Number of countries reporting at least one promotion or prevention action, out of the 31 EU and EFTA countries 0 5 10 15 20 25 Pre-natal period to age 2 Children aged 2-10 Young people aged 11-25 Workplace mental health Mental health of the unemployed Older people Number of countries reporting at least one action
  8. 8. • Addressing wasteful spending in hospitals • Addressing wasteful spending on pharmaceuticals 2. STRATEGIES TO REDUCE WASTEFUL SPENDING Note: Wasteful spending includes patients who receive unnecessary or low-value care that makes little or no difference to their health outcomes or for whom the same health benefits could be obtained with fewer resources.
  9. 9. Strategies to reduce hospital costs Increase efficiency and safety to reduce the use of hospital resources Reduce unnecessary hospital admissions Ensure patients leave hospital as early as possible Improve community care for chronic diseases Tackle hospital services overuse Deploy day surgery Curb delayed discharges
  10. 10. Potentially avoidable hospital admissions for chronic conditions consume over 37 million bed days each year Source: OECD Health Statistics and Eurostat Database. Diabetes Hypertension Heart failure COPD & bronchiectasis Asthma Total (five conditions) Admissions/discharges 800 303 665 396 1 749 384 1 109 865 328 976 4 653 924 % of all admissions 1.0% 0.8% 2.1% 1.3% 0.4% 5.6% Average length of stay (days) 8.5 6.9 9.5 8.9 6.6 8.1 (avg.) Total bed days 6 794 572 4 597 886 16 619 148 9 855 601 2 177 821 37 603 706 Proportion of all bed days 1.1% 0.7% 2.7% 1.6% 0.4% 6.5% Hospital admissions and bed days for five chronic conditions, EU countries, 2015
  11. 11. C-section rates are much higher than the EU average in Romania, Bulgaria, Poland and Hungary, and have increased over time Note: The annual growth rate for Luxembourg only covers the period 2011 to 2016 due to a break in the series in 2011. Source: Eurostat, except Netherlands: Perinatal registry (www.perined.nl/). Netherlands Finland Sweden Lithuania Estonia Denmark Slovenia France Belgium Latvia Croatia Spain Czech Republic UK EU Average Austria Slovak Republic Germany Malta Luxembourg Ireland Portugal Italy Hungary Poland Bulgaria Romania -2% -1% 0% 1% 2% 3% 4% 5% 6% 7% 8% 100 150 200 250 300 350 400 450 Number of C-sections per 1 000 live births AverageannualgrowthrateofC-sections,past10years C-section rates in 2016 and their annual growth rate between 2006 and 2016
  12. 12. Several countries are lagging behind in exploiting the potential cost-saving of generic medicines 0 10 20 30 40 50 60 70 80 90 Volume Value % Generic market share by volume and value, 2016 (or latest year) Source: OECD Health Statistics 2018.
  13. 13. Reducing the over-prescription of antibiotics and other medicines can also help reduce waste Note: Cyprus and Romania provide data on overall consumption, including in hospital. Source: European Centre for Disease Prevention and Control (ECDC) (2017). Consumption of antibiotics in the community, EU/EEA countries, 2016 (DDDs per 1 000 population per day)
  14. 14. • Trends and inequalities in life expectancy • Inequalities in self-reported health 3. HEALTH STATUS
  15. 15. Life expectancy exceeds 81 years in a majority of EU countries, but the gap between the highest and lowest countries is still over 8 years 1. Three-year average (2014-16). Source: Eurostat Database. 83.5 83.4 82.7 82.5 82.4 82.3 82.2 81.8 81.8 81.7 81.5 81.5 81.5 81.3 81.2 81.2 81.0 81.0 80.9 79.1 78.2 78.0 78.0 77.3 76.2 75.3 74.9 74.9 74.9 83.7 82.5 82.5 78.5 78.1 76.5 75.7 75.4 60 65 70 75 80 85 90 Years Total Women Men Life expectancy at birth, by gender, 2016
  16. 16. Source: Eurostat Database. Gains in life expectancy have slowed down in many Western European countries since 2011, with reductions registered in 2015 Trends in life expectancy, 2005-16 75 77 79 81 83 85 2005 2007 2009 2011 2013 2015 Years Life expectancy at birth 10 11 12 13 14 15 2005 2007 2009 2011 2013 2015 Years Life expectancy at 75 EU28 Germany France Italy United Kingdom
  17. 17. Note: Data refer to 2012 for France and Austria and to 2011 for Latvia, Belgium and the United Kingdom (England). Source: Eurostat Database; national sources or OECD calculations using national data for Austria, Belgium, France, Latvia, the Netherlands and the United Kingdom (England). There are large gaps in life expectancy by education level: people with low education at age 30 can expect to live six years less than the most educated (eight years for men, four years for women) Slovak Republic Hungary Poland Czech Republic Latvia Romania Estonia EU21 Bulgaria France Slovenia Austria Greece Netherlands Belgium Finland Denmark Portugal Croatia Italy United Kingdom Sweden Norway Women Men 6.9 6.4 5.1 3.0 8.0 3.8 5.4 4.1 4.5 2.6 2.8 3.0 2.4 4.6 4.4 3.5 3.9 2.8 1.6 2.9 4.0 2.9 3.4 05101520 Years 14.4 12.6 12.0 11.1 11.0 9.7 8.5 7.7 6.9 6.5 6.2 6.2 6.0 5.8 5.8 5.6 5.6 5.6 5.2 4.5 4.4 4.1 5.0 0 5 10 15 20 Years Gap in life expectancy at age 30 between people with the lowest and highest level of education, 2016 (or nearest year)
  18. 18. Source: Eurostat Database, based on EU-SILC. There are also large gaps in self-reported health by income level: 60% of people with the lowest income report being in good health compared with 80% for those with the highest income 83 79 76 75 74 74 73 73 71 71 71 70 70 69 69 68 67 66 66 65 65 60 60 59 59 53 48 47 43 78 78 77 76 70 57 0 10 20 30 40 50 60 70 80 90 100 % of population aged 16 years and over Total population Low income High income Health status perceived as good or very good, by income quintile, 2016 (or nearest year)
  19. 19. • Smoking • Alcohol consumption • Overweight and obesity • Air pollution 4. RISK FACTORS
  20. 20. Source: OECD Health Statistics 2018 (based on national health interview surveys), complemented with Eurostat (EHIS 2014) for Bulgaria, Croatia, Cyprus, Malta, and Romania, and with WHO Europe Health for All database for Albania, Serbia and Montenegro. Changes in daily smoking rates among adults, 2006 and 2016 (or latest year) Smoking among adults has declined across EU countries, but still one-fifth of adults smoke daily 28 27 26 26 25 25 24 23 23 23 22 21 21 20 20 20 20 20 20 19 19 18 18 17 17 16 16 15 11 38 31 29 27 18 11 10 0 5 10 15 20 25 30 35 40 45 2006 2016 % reporting to smoke daily
  21. 21. The proportion of adolescents reporting “binge drinking” has come down slightly in recent years, but still nearly 40% report regular “binge drinking” on average across the EU Note: “Binge drinking” is defined as drinking five or more alcoholic drinks in a single occasion. The EU average is not weighted by country population size. Source: ESPAD. 0 10 20 30 40 50 60 1995 1999 2003 2007 2011 2015 % Boys Girls Boys Girls % Changes between 1995 and 2015 in the proportion of 15-16 year old boys and girls reporting heavy episodic drinking in the past 30 days, average across EU countries and Norway
  22. 22. Obesity among adults is rising: one in six adults are obese across EU countries Source: Eurostat (EHIS 2008 and 2014) complemented with OECD Health Statistics 2018 for 2000 data and data for non-EU countries. 25 21 20 20 19 19 19 18 18 18 17 17 17 17 17 16 16 16 16 15 15 15 14 14 14 13 12 10 9 20 19 12 10 0 5 10 15 20 25 30 2000 2008 2014 % Changes in self-reported obesity rates among adults, 2000 to 2014 (or nearest year)
  23. 23. Exposure to serious air pollution is estimated to have caused the death of 238 000 people across EU countries in 2016; mortality rates are highest in Central and Eastern Europe Source: IHME (Global Burden of Disease, 2016). Deaths due to exposure to outdoor PM2.5 and ozone, 2016
  24. 24. • Health expenditure per capita and as a share of GDP • Financing mix (government schemes, out- of-pocket and voluntary health insurance) 5. HEALTH EXPENDITURE AND FINANCING
  25. 25. Source: OECD Health Statistics 2018; Eurostat Database; WHO Global Health Expenditure Database. Health spending per capita is highest in Luxembourg, Germany and Sweden, and lowest in Romania, Bulgaria and Latvia Health expenditure per capita, 2017 (or nearest year) 4713 4160 4019 3945 3930 3885 3831 3572 3493 3045 3013 2773 2568 2551 2446 2066 2023 1873 1722 1678 1625 1551 1473 1463 1409 1367 1252 1234 983 5799 4653 3309 987 824 728 638 583 0 1000 2000 3000 4000 5000 6000 7000 EUR PPP
  26. 26. Health spending accounts for nearly 10% of GDP in the EU; France and Germany allocate more than 11% of their GDP to health spending Health expenditure as a share of GDP, 2017 (or nearest year) Source: OECD Health Statistics 2018; Eurostat Database; WHO Global Health Expenditure Database. 11.5 11.3 10.9 10.3 10.2 10.1 10.0 9.6 9.6 9.2 9.0 8.9 8.9 8.8 8.4 8.4 8.0 7.5 7.2 7.1 7.1 7.1 6.8 6.7 6.7 6.3 6.3 6.1 5.2 12.3 10.4 9.4 8.5 6.8 6.1 5.9 4.2 0 2 4 6 8 10 12 14 % GDP
  27. 27. Health expenditure has grown in line with GDP growth in recent years, so the share of GDP allocated to health has stabilised Source: OECD Health Statistics 2018; Eurostat Database. Source : OECD Health Statistics 2018; Eurostat Database. Source : OECD Health Statistics 2018; Eurostat Database. -5 -4 -3 -2 -1 0 1 2 3 4 5 2005 2007 2009 2011 2013 2015 2017 % 5.4. Annual average growth (real terms) in per capita health expenditure and GDP, EU28, 2005 to 2017 Health expenditure GDP 6 7 8 9 10 11 12 2005 2007 2009 2011 2013 2015 2017 % GDP 5.5. Health expenditure as a share of GDP, EU28 and selected countries, 2005 to 2017 France Germany Italy Spain EU28 Annual average growth (real terms) in per capita health expenditure and GDP, EU28, 2005 to 2017 Health expenditure as a share of GDP, EU28 and selected countries, 2005 to 2017
  28. 28. Note: Countries are ranked by government schemes and compulsory health insurance as a share of health expenditure. Source: OECD Health Statistics 2018; Eurostat Database; WHO Global Health Expenditure Database. Over 75% of health spending is financed through government and compulsory insurance across EU countries. Out-of-pocket payments account for 18%, but represent a much greater share in some countries Health expenditure by type of financing, 2016 (or nearest year) 7 84 84 5 12 6 9 4 79 18 13 2 36 11 62 74 30 4 72 66 10 10 65 8 63 31 55 9 42 74 82 23 1 6 21 4 9 78 78 70 75 72 76 61 65 75 41 65 13 44 69 5 60 57 58 30 41 11 56 66 58 42 55 34 12 14 15 10 15 11 11 18 15 16 21 15 18 23 20 23 19 12 13 24 23 32 28 30 35 34 45 48 45 15 17 16 32 36 30 41 57 7 6 5 3 5 8 4 5 14 12 5 5 5 4 6 76 5 0 10 20 30 40 50 60 70 80 90 100 % Government schemes Compulsory health insurance Out-of-pocket Voluntary health insurance Other
  29. 29. • Avoidable mortality (preventable and amenable) • Vaccination • Patient experience with ambulatory care • Acute care for cancers and heart attacks 6. EFFECTIVENESS: QUALITY OF CARE & PATIENT EXPERIENCE
  30. 30. Note: Preventable mortality is defined as deaths that could be avoided through public health and prevention interventions, whereas amenable (or treatable) mortality is defined as deaths that could be avoided through effective and timely health care. A number of causes of death are included in both preventable and amenable mortality resulting in double-counting; this explains why the total number of avoidable deaths is lower than the sum of the two parts. Source: Eurostat Database. More than 1.2 million deaths could be avoided through better public health and prevention policies and more effective and timely health care Leading causes of preventable and amenable mortality in the European Union, 2015 Amenable mortality (570 791 deaths in 2015) Preventable mortality (1 003 027 deaths in 2015) Hypertension, 5% Colorectal cancer, 12% Breast cancer, 9% Hypertension, 5% Ischaemic heart diseases, 32% Cerebrovascular diseases, 16% Influenza and pneumonia, 5% Others, 22% Colorectal cancer, 7% Lung cancer, 17% Alcohol, 7% Ischaemic heart diseases, 18% Accidents, 16% Suicide, 7% Others, 29%
  31. 31. Source: WHO/UNICEF. Many children are not vaccinated against infectious diseases in several countries Vaccination against measles and hepatitis B, children aged 1, 2017 (or nearest year) Note: Hepatitis B data for Denmark, Finland, Hungary, Iceland and Norway are not available because national infant vaccination programmes do not cover Hepatitis B. Data is not available for the United Kingdom.
  32. 32. Over 85% of patients report positive experiences with doctors in ambulatory care in most countries 1. National sources. 2. Data refer to patient experiences with GP. Note: 95% confidence intervals have been calculated for all countries, represented by grey areas. Source: Commonwealth Fund International Health Policy Survey 2016 and other national sources. Doctor spending enough time with patient in consultation, 2010 and 2016 (or nearest year) Doctor involving patient in decisions about care and treatment, 2010 and 2016 (or nearest year)
  33. 33. In terms of acute care, fewer people are dying following acute myocardial infarction (heart attack) Thirty-day mortality after admission to hospital for AMI (based on unlinked data), 2005 and 2015 (or nearest years) 1. Three-year average. Note: 95% confidence intervals for the latest year are represented by grey areas. The EU average is unweighted and only includes countries with data covering the whole time period. Source: OECD Health Statistics 2018.
  34. 34. • Unmet health care needs • Financial protection • Supply of doctors • Timely access (waiting times) 7. ACCESSIBILITY: AFFORDABILITY, AVAILABILITY AND USE OF SERVICES
  35. 35. Source: Eurostat Database, based on EU-SILC. Poor people are more likely to report unmet needs for medical care, and even more so for dental care Unmet need for medical examination for financial, geographic or waiting times reasons, by income quintile, 2016 (or nearest year) Unmet need for dental examination for financial, geographic or waiting times reasons, by income quintile, 2016 (or nearest year) Estonia Greece Latvia Poland Romania Italy Finland Lithuania Bulgaria Ireland EU28 Belgium Portugal Slovak Republic Croatia Sweden France Hungary Denmark Malta United Kingdom Czech Republic Cyprus Spain Luxembourg Slovenia Germany Netherlands Austria Montenegro Turkey Serbia Iceland FYR of Macedonia Norway Switzerland 0 10 20 30 % High income Low incomeTotal population Portugal Greece Latvia Estonia Italy Romania Finland Spain Lithuania EU28 Belgium Denmark Poland Cyprus Sweden Bulgaria Ireland France Slovak Republic Hungary United Kingdom Croatia Malta Luxembourg Czech Republic Slovenia Germany Austria Netherlands Iceland Serbia Montenegro Turkey Norway Switzerland FYR of Macedonia 0 10 20 30 % High income Low incomeTotal population
  36. 36. Direct out-of-pocket spending by households can restrict access to care 48 45 45 35 34 32 30 28 24 23 23 23 21 20 19 18 18 16 15 15 15 15 14 13 12 12 11 11 10 57 41 36 32 30 17 16 15 0 10 20 30 40 50 60 % Share of total health spending financed by out-of-pocket payments, 2016 (or latest year) Source: OECD Health Statistics 2018.
  37. 37. 1. Data refer to all doctors licensed to practice, resulting in a large over-estimation of the number of practising doctors (e.g. of around 30% in Portugal). 2. Data include not only doctors providing direct care to patients, but also those working in the health sector as managers, educators, researchers, etc. (adding another 5-10% of doctors). Source: OECD Health Statistics 2018; Eurostat Database. The number of doctors per capita has increased in nearly all EU countries since 2000… Practising doctors per 1 000 population, 2000 and 2016 (or nearest year) 6.6 5.1 4.8 4.5 4.3 4.2 4.1 4.0 3.8 3.8 3.8 3.7 3.7 3.6 3.5 3.5 3.5 3.2 3.2 3.2 3.2 3.1 3.1 3.0 2.9 2.9 2.8 2.8 2.4 4.5 4.3 3.9 3.0 3.0 2.6 1.8 0 1 2 3 4 5 6 7 2000 2016 Per 1 000 population
  38. 38. …but general practitioners (family doctors) make up less than 25% of all doctors on average Share of different categories of doctors, 2016 (or nearest year) 1. Other generalists include non-specialist doctors working in hospital and recent medical graduates who have not started yet their post-graduate specialty training. 2. In Portugal, only about 30% of doctors employed by the public sector (NHS) are working as GPs in primary care, with the other 70% working in hospital. Source: OECD Health Statistics 2018; Eurostat Database. 46 38 37 37 30 27 24 24 24 23 22 22 21 21 20 20 19 19 18 17 17 15 15 15 9 5 33 32 27 24 18 17 16 0 20 40 60 80 100 % General practitioners Other generalists¹ Specialists Other doctors (not further defined)
  39. 39. Note: On the right panel, data relate to median waiting times, except for the Netherlands and Spain (average waiting times). Source: OECD Health Statistics 2018. Waiting times for hip replacement vary widely across countries, and has started to rise again in some countries since 2010 Waiting times of patients for hip replacement, 2016 and trends since 2005 n.a. 37 51 75 84 90 64 105 130 211 276 110 45 52 80 82 104 104 120 133 158 326 444 134 0 100 200 300 400 500 Days Median Average 0 50 100 150 200 250 Days Denmark Estonia Netherlands Portugal Spain United Kingdom
  40. 40. • eHealth and ePrescription • Hospital efficiency • Fiscal sustainability of public spending on health and long-term care 8. RESILIENCE: INNOVATION, EFFICIENCY AND FISCAL SUSTAINABILITY
  41. 41. Note: Greece and the Netherlands are implementing ePrescribing but the percentage was not reported. Source: Pharmaceutical Group of the European Union (PGEU). ePresribing is now widely used in Nordic countries and some Southern European countries, but hasn’t been implemented yet in several countries Percentage of ePrescriptions in community pharmacies, 2018
  42. 42. 1. Data refer to average length of stay for curative (acute) care only (resulting in an under-estimation). Source: OECD Health Statistics 2018; Eurostat Database. In hospital, the average length of stay of patients has fallen in nearly all EU countries, reflecting efficiency gains Average length of stay in hospital, 2000 and 2016 (or nearest year) 10.1 9.5 9.3 9.1 9.0 8.9 8.8 8.5 8.3 8.2 7.9 7.9 7.8 7.7 7.7 7.5 7.5 7.4 7.3 7.1 7.1 7.0 6.8 6.0 6.0 5.8 5.4 5.3 5.0 10.2 8.8 8.3 6.9 6.2 5.8 4.0 2 4 6 8 10 12 14 2000 2016 Days
  43. 43. Source: EC and EPC (2018). Public spending on health care as a share of GDP is projected to grow in all countries over the coming decades Public spending on health care as a percentage of GDP, 2016 to 2070, Ageing Working Group reference scenario 0 1 2 3 4 5 6 7 8 9 10 % GDP 2016 Change 2016-70
  44. 44. Public spending on long-term care as a share of GDP is projected to grow even more than health care due to population ageing Public spending on long-term care as a percentage of GDP, 2016 to 2070, Ageing Working Group reference scenario Source: EC and EPC (2018). 0 1 2 3 4 5 6 7 8 % GDP 2016 Change 2016-70
  45. 45. More information http://www.oecd.org/health/health-at-a-glance-europe-23056088.htm https://ec.europa.eu/health/state/glance_en

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