Health at a Glance: Europe 2016

- State of Health in the EU Cycle

Joint publication of the OECD and the European

Commission

Released on November 23, 2016 http://www.oecd.org/health/health-at-a-glance-europe-23056088.htm http://ec.europa.eu/health/state

Table of Contents 1. Labour market impacts of ill-health 2. Strengthening primary care systems 3. Health status 4. Determinants of health 5. Health expenditure 6. Effectiveness and quality of care 7. Access to care 8. Resilience, efficiency and sustainability of health systems

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.

Source: OECD Health Statistics 2016; Eurostat Database; WHO Global Health Expenditure Database

Health spending accounts for nearly 10% of GDP in EU; 11% or more in Germany, Sweden and France

Health expenditure as a share of GDP, 2015 (or nearest year)

1. Includes investments. 2. OECD estimate.

11,1 11,1 11,0 10,8 10,6 10,4 10,4 9,9 9,8 9,6 9,6 9,4

9,1 9,0 8,9 8,4 8,3 8,2

7,5 7,2 7,0 7,0 6,8 6,6 6,5 6,3 6,3

5,6 5,0

11,5

10,3 9,9

8,8

6,5 6,2

5,9

5,2

0

2

4

6

8

10

12

14

% GDP Government/compulsory Private/voluntary

Growth in health spending has started to pick up after the collapse following the crisis

Per capita health spending growth rates in real terms, EU and OECD average, 2008 to 2015

Source: OECD Health Statistics 2016; Eurostat Database

Source: OECD Health Statistics 2016; Eurostat Database; WHO Global Health Expenditure Database

Several EU countries hard hit by the economic crisis have cut their health spending since 2009

Annual average growth rate in per capita health expenditure, real terms, 2005 to 2015 (or nearest year) 4,5

1,3

4,3

4,1

0,5

3,4

6,9

3,8

3,2

3,3

3,1

4,1

1,7

3,2

2,2

3,1

-2,7

2,4

1,7

12,2

8,4

2,8

2,8

5,4

7,4

9,4

-0,3

1,0

2,8

0,4

-0,2

5,6

2,2

3,6

1,3

-6,6

-2,0

-1,6

-1,5

-1,1

-0,4

-0,2

-0,1

0,1

0,5

0,7

0,7

0,8

0,9

1,1

1,2

1,2

1,5

1,5

1,8

2,0

2,0

2,0

2,1

2,5

3,1

3,2

3,6

5,8

-1,1

0,4

1,4

1,6

2,0

2,1

2,4

-10

-5

0

5

10

15

2005-09 2009-15

Pharmaceutical and prevention spending have been cut in many EU countries

Source: OECD Health Statistics 2016; Eurostat Database

EU average

3,3

3,8

5,2

1,4

5,1

1,9

0,9

1,2

2,3

-1,1

-1,9

0,8

-3

-2

-1

0

1

2

3

4

5

6

Inpatient care Outpatient care Long-term care Pharmaceuticals Prevention Administration

2005-09 2009-14Annual growth rate in real terms (%)

LABOUR MARKET IMPACTS OF ILL-HEALTH

(new chapter)

• Mortality from non-communicable diseases among working-age population

• Employment and productivity impacts of chronic diseases and related risk factors

NCDs led to a loss of 3.4 million potential productive life years in EU countries in 2013 -> EUR 115 billion (0.8% of GDP)

Source: OECD estimates based on Eurostat data

Potential productive life years lost related to NCDs among people aged 25–64, EU countries, 2013

The employment rate of people with chronic diseases is much lower than for those who do not have any

Source: OECD estimates based on SHARE data (wave 5)

Number (median) of sick days in the last 12 months among employed people aged 50-59, by chronic diseases, 14 European countries, 2013

When they work, people with chronic diseases have a greater number of sick days

Source: OECD estimates based on SHARE data (wave 5)

Number (median) of sick days in the last 12 months among employed people aged 50-59, by chronic diseases, 14 European countries, 2013

Public and mandatory private spending on disability benefits and paid sick leave accounted for 2% of GDP in 2013

Source: OECD Social Expenditure Database (2016)

This is more than spending on unemployment benefits (1.2% of GDP in 2013)

STRENGTHENING PREVENTION AND PRIMARY CARE TO TACKLE CHANGING DEMOGRAPHICS AND

RISK FACTORS

Spending on prevention represents only 3% of current health spending on average, and has been

cut down in several countries after the crisis

4,1 4,1

3,7

3,3 3,2 3,2

3,1 3,0 3,0 3,0 2,9

2,7 2,6 2,6 2,6

2,4

2,1 2,1 2,1 2,0 2,0 1,9 1,9 1,8 1,8

1,4

0,8

0,6

2,9

2,3 2,2

0,0

0,5

1,0

1,5

2,0

2,5

3,0

3,5

4,0

4,5

Prevention spending as share of current health expenditure, 2014

Source: OECD Health Statistics 2016

%

Source: OECD Health Statistics 2016; 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 2014 (or nearest year)

1. Data refer to all doctors licensed to practice, resulting in a large over-estimation of the number of practising doctors (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).

But the share of GPs is declining in most countries, threatening access to primary care

15 Source: OECD Health Statistics 2016

25

30

35

40

45

50

55

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

France

Netherlands

Germany

Belgium

United Kingdom

Share of generalists as % of all physicians

Source: OECD Health Statistics 2016; Eurostat Database

Greater efforts needed to prevent both communicable and non-communicable diseases

Vaccination coverage against influenza among people aged 65+ has come down in many countries, increasing the risk of complications, hospitalisations and even deaths

Source: OECD analysis of data from Prince et al. (2013) and the United Nations

Estimated number of people with dementia in EU countries, by age, 1995, 2015 and 2035

Strengthening primary care is key to managing growing number of people with chronic diseases

1995

2015

2035

1 million

2 million

3 million

4 million

60-64 65-69 70-74 75-79 80-84 85-89 90+

Consequence of limited access to primary care: Too many avoidable and costly hospital admissions

Source: OECD Health Statistics 2016

2013 (or nearest year)

Conclusions

• More prevention to reduce or postpone chronic diseases

• Strengthen primary care and patient-centred care to better manage chronic diseases and avoid unnecessary hospital admissions

• Maintain or achieve universal health coverage by reducing financial and geographic barriers to needed care and ensuring effective and timely access to services

• Achieve further efficiency in health spending to meet growing demands with limited resources

More information

http://www.oecd.org/health/health-at-a-glance-europe-23056088.htm

http://ec.europa.eu/health/state