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Archive:Enlargement countries - health statistics

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Data extracted in May 2021.

Planned article update: April 2022.

Highlights

Public expenditure on health relative to GDP was lower in all the candidate countries and potential candidates than it was in the EU in 2019 (or latest available data).

Hospital discharges of in-patients relative to population size were lower in all candidate countries and potential candidates than the EU in 2019, although Turkey came within 5 % of the EU figure (although coverage definition differs) and Serbia 15 % (2018 data).

[[File:CPC21_Expenditure on health 2009 and 2019.xlsx]]

Public expenditure on health, 2009 and 2019 (% of GDP)

  • Country codes: RS = Serbia; TR = Turkey; AL = Albania; BA = Bosnia and Herzegovina; XK = Kosovo*
  • * This designation is without prejudice to positions on status, and is in line with UNSCR 1244/1999 and the ICJ Opinion on the Kosovo Declaration of Independence.
  • Note: data supplied by and under the responsibility of the national statistical authority. Montenegro and North Macedonia, not available. Countries are ranked based on public expenditure in 2019.
  • EU and Kosovo: 2009: not available
  • EU, Serbia and Bosnia and Herzegovina: 2018 instead of 2019.
  • Albania: Total expenditure not available.
  • Source: Eurostat (online data codes: hlth_sha11_hf and nama_10_gdp) and Eurostat data collection.


This article is part of an online publication and provides information on a range of population statistics for the European Union (EU) and candidate countries and potential candidates, otherwise known as the enlargement countries. Montenegro, North Macedonia, Albania, Serbia and Turkey currently have candidate status, while Bosnia and Herzegovina and Kosovo* are potential candidates.

Health statistics measure both objective and subjective aspects of people's health. They cover key indicators on the functioning of the health care systems and health and safety at work. Statistics on healthcare expenditure and financing may be used to evaluate how a healthcare system responds to the challenge of universal access to quality healthcare. Financial resources within the healthcare sector are measured, as are the allocation of these resources between healthcare activities, such as preventive and curative care, or groups of healthcare providers, for example, hospitals and ambulatory centres.

This article gives an overview of health developments in the candidate countries and potential candidates and in the EU, presenting an analysis of health expenditure, health resources, hospital discharges, healthcare personnel and health status.

Full article

Public expenditure on health

Public and total health expenditure as a percentage of gross domestic product (GDP) is shown for each of the candidate countries and potential candidates in Figure 1. Data is compared for 2019 and 2009, where available. In Serbia, public health expenditure was 5.1 % of GDP in 2018, having been 6.1 % in 2009. In Turkey, the figures were 3.6 % in 2019 and 4.7 % in 2009. Albania’s public expenditure on health in 2019 was 3.1 % of GDP, up from 2.7 % in 2009. Public expenditure on health in Bosnia and Herzegovina was 6.1 % in 2018, about the same as in 2009, when it was 6.2 %. Kosovo public expenditure on health was 3.5 % of GDP in 2019; there is not data available for 2009.

In 2019, public expenditure on health in the EU was 7.9 % of GDP.

Note that these developments reflect changes in both health expenditure and GDP and that falling health expenditure relative to GDP does not necessarily imply a lower absolute level of health expenditure.
Figure 1: Expenditure on health, 2009 and 2019
(% of GDP)
Source: Eurostat (hlth_sha11_hf) and (nama_10_gdp) and Eurostat data collection

Healthcare resources

Figure 2 illustrates data on hospital discharges of in-patients, an indicator of the level of healthcare activity in hospitals. A hospital discharge occurs when a patient is formally released after an episode of care: discharge may result from the end of their treatment; a decision by the patient to sign out against medical advice; the patient’s transfer to another healthcare institution; or because of death. Trends in hospital discharges per 100 000 population over time can be affected by the level of hospital activity; longevity; the advent of new hospital based medical treatments; and their replacement by out-patient treatments, which are normally cheaper. 2019 is the latest year for which data are available; it is also the last year before the data begin to be affected by the COVID-19 pandemic.

Turkey had 16 603 hospital discharges per 100 000 inhabitants in 2019, the highest among candidate countries and potential candidates. Between 2009 and 2019, this measure increased by 22 %; note that there is a break in series. Serbia had the next highest level of hospital discharges per 100 000 inhabitants in 2019, at 14 814. This was a decrease of 4 % from the 2009 figure; there is a break in the data series. Montenegro hospital discharges were 13 854 per 100 000 inhabitants in 2019, up by 29 % from 2009. There were 9 864 hospital discharges per 100 000 inhabitants in Albania in 2019. Kosovo had the lowest ratio of in-patient discharges relative to population size in the region at 8 123 hospital discharges per 100 000 inhabitants in 2019. Data was not available for Kosovo or for Albania in 2009. Data was not available for either year for North Macedonia nor for Bosnia and Herzegovina.

In 2019, there were approximately 17 400 hospital discharges per 100 000 inhabitants across the EU. This number had decreased by 2 % from 2009. Figure 2 shows the highest and lowest EU Member States concerning in hospital discharges per 100 000 population. The highest was Bulgaria, which showed an increase of more than 31 % from 2009 to 2019 and, at 34 464 in 2019, was much higher than any candidate country or potential candidate. The lowest was Portugal, which had 8 431 hospital discharges per 100 000 in 2019, a decline of 5 % from 2009.
Figure 2: Hospital discharges of in-patients, 2009 and 2019
(number per 100 000 inhabitants)
Source: Eurostat (hlth_co_disch1) and (demo_pjan) and Eurostat data collection

Figure 3 provides information on healthcare personnel. Physicians need to possess a degree in medicine and are licensed to provide treatment to patients, including: giving advice, conducting medical examinations and making diagnoses; applying preventive medical methods; prescribing medication and treating diagnosed illnesses; giving specialised medical or surgical treatment.

Nursing professionals typically provide services to patients in hospitals, ambulatory care and patients’ homes: nurses assume responsibility for the planning and management of patient care, including the supervision of other healthcare workers, working autonomously or in teams with medical doctors and others in the application of preventive and curative care.

Midwives plan, manage, provide and evaluate care services during pregnancy and after childbirth, providing delivery care for reducing health risks to women and new-born children; they may work autonomously or in teams with other healthcare providers.

Among the five candidate countries and potential candidates for which data are available, the number of physicians relative to population size was recorded in 2019 in Serbia at 298.2 physicians per 100 000 inhabitants and in Montenegro, with 274.6 physicians per 100 000 inhabitants. Bosnia and Herzegovina was next highest, with 217.1 physicians working in public institutions per 100 000 inhabitants. However, data for Bosnia and Herzegovina covers only professionals working in public institutions and is therefore not directly comparable with the other candidate countries and potential candidates. Turkey had 193.4 professionally active physicians per 100 000 inhabitants. Kosovo was far behind, with 7.4 physicians per 100 000 inhabitants.

Of the candidate countries and potential candidates for which data are available, Turkey recorded the highest number of dentists per 100 000 inhabitants in 2019, at 39.6 professionally active personnel. Serbia was next highest, with 27.6 dentists per 100 000 inhabitants, followed by Bosnia and Herzegovina, with 23.8 dentists working in public institutions per 100 000 inhabitants. Kosovo had a similar figure of 22.6 dentists per 100 000 inhabitants, while Montenegro had a much lower figure of 5.1 dentists per 100 000 inhabitants.

In 2019, there were 517.9 nursing professionals in public institutions per 100 000 inhabitants in Bosnia and Herzegovina; and in Kosovo 552.6 per 100 000 inhabitants, the highest in the region. Montenegro had 490.5 nursing professionals per 100 000 inhabitants. These three were the highest among the candidate countries and potential candidates. Much lower ratios were recorded in Turkey, with 238.2 professionally active nurses per 100 000 inhabitants; and Serbia, with 86.9 per 100 000 inhabitants.

The ratio of midwives to population was considerably the highest in Turkey in 2019, with 67.3 professionally active personnel per 100 000 inhabitants. Montenegro had 40.4 midwives per 100 000 inhabitants in 2019. In Serbia and Bosnia and Herzegovina (in public institutions) in 2019, there were 36.2 and 30.4 midwives per 100 000 inhabitants respectively. The ratio in Kosovo was 4.9 midwives per 100 000 inhabitants in 2019.

In the EU (estimate based on the closest reference period available for each EU Member State), there were an estimated 381.0 physicians per 100 000 inhabitants; 73.9 dentists per 100 000 inhabitants; 683.8 nursing professionals per 100 000 inhabitants; and 34.9 midwives per 100 000 inhabitants in the EU. The Member State with the highest number of physicians, Greece, had 609.9 per 100 000 inhabitants, while the lowest figure was 237.8, for Poland (both 2018 data).
Figure 3: Healthcare personnel, 2019
(number per 100 000 inhabitants)
Source: Eurostat (hlth_rs_phys), (hlth_rs_prs1), (hlth_rs_prsns) and (demo_pjan) and Eurostat data collection
Figure 4 below illustrates the number of midwives per 1000 live births, which takes into account the birth rate. All the candidate countries and potential candidates for which data is available for both 2009 and 2019 showed an increase in this ratio over the decade. Turkey in 2019 had the highest such ratio, at 46.6 professionally active personnel, up from 38.5 in 2009. Serbia had 39.6 midwives per 1000 live births in 2018, having had a ratio of 37.8 in 2009. In Montenegro, there were 34.8 midwives per 1000 live births in 2019 and 28.5 in 2009. In Kosovo, there were 4.0 midwives per 1000 live births in 2019 but no data for 2009. In Bosnia and Herzegovina in 2009, there were 38.9 midwives working in public institutions per 1000 live births; there was no data for 2019.
Figure 4: Practicing midwives, 2009 and 2019
(number per 1 000 live births)
Source: Eurostat (demo_gind), (demo_pjan) and (hlth_rs_prsns) and Eurostat data collection

Health Status

This section examines the maternal mortality rate and the incidence of two diseases, tuberculosis and hepatitis B. The maternal mortality rate is defined by the United Nations as the annual number of female deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of the termination of pregnancy, irrespective of the duration/place of pregnancy. It is expressed as a ratio per 100 000 live births. Deaths related to pregnancy and childbirth are very rare and so, particularly within smaller populations, even a difference of two or three deaths between years can result in relatively large percentage changes.

Data is available on the maternal mortality ratio for three of the candidate countries and potential candidates and is illustrated in Figure 5 for 2009 and 2019. Serbia recorded a major fall, from 19.9 in 2009 to 6.2 deaths per 100 000 live births in 2019. The rate in Turkey in 2019 was 13.1 deaths per 100 000 live births, a considerable fall from the 2009 figure of 18.4. The maternal mortality ratio increased in Albania from 5.9 deaths per 100 000 live births in 2009 to 7.0 in 2019.
Figure 5: Maternal mortality ratio, 2009 and 2019
(deaths per 100 000 live births)
Source: Eurostat annual data collection cycle – see Data Sources

In 2019, the incidence of tuberculosis – presented in Figure 6 – was highest among candidate countries and potential candidates in Kosovo at 40.7 cases per 100 000 inhabitants. This was far greater than elsewhere, as the next highest incidence rates were recorded in Albania at 14.4, in Turkey at 13.5 and in Montenegro at 13.0 cases per 100 000 inhabitants. In Serbia, incidence of tuberculosis was 9.0 cases per 100 000 inhabitants in 2019. Data for 2009 are available for Turkey, Montenegro and Serbia; in all three countries incidence of tuberculosis declined considerably from then to 2019.

Among the candidate countries and potential candidates, Albania had the highest incidence of hepatitis B in 2019, at 7.1 newly registered cases per 100 000 inhabitants. Kosovo was next highest on the basis of 2018 estimated data, with 3.7 per 100 000 inhabitants. Montenegro had 3.2 newly registered cases per 100 000 inhabitants in 2019. Turkey and Serbia (all registered cases of acute hepatitis B) had similar outcomes, with 1.4 and 1.3 cases per 100 000 inhabitants in 2019. Turkey, Montenegro and Serbia are again the countries for which data are available for 2009; in Turkey and Serbia, incidence of hepatitis B declined considerably from 2009 to 2019. However, in Montenegro the incidence had been 2.4 cases per 100 000 inhabitants in 2009, so that there was a recorded increase in incidence.
Figure 6: Incidence of tuberculosis and hepatitis B, 2009 and 2019
(per 100 000 inhabitants)
Source: Eurostat annual data collection cycle – see Data Sources

Source data for tables and graphs

Data sources

Data for the candidate countries and potential candidates are collected for a wide range of indicators each year through a questionnaire that is sent by Eurostat to candidate countries or potential candidates. A network of contacts has been established for updating these questionnaires, generally within the national statistical offices, but potentially including representatives of other data-producing organisations (for example, central banks or government ministries). The statistics shown in this article are made available free-of-charge on Eurostat’s website, together with a wide range of other socio-economic indicators collected as part of this initiative.

In December 2008, the European Parliament and the Council adopted Regulation 1338/2008 on Community statistics on public health and health and safety at work. It was designed to ensure that health statistics provide adequate information for all EU Member States to monitor Community actions in the field of public health and health and safety at work. It lists five domains for which implementing regulations specifying (in detail) the list of variables and methodological aspects were to be developed, including:

Tables in this article use the following notation:

Value in italics     data value is forecasted, provisional or estimated and is therefore likely to change;
: not available, confidential or unreliable value.

Context

EU policies seek to improve and foster health in the European Union; protect people in the European Union from serious cross-border threats to health; improve medicinal products, medical devices and crisis-relevant products; and strengthen health systems. The COVID-19 pandemic has a major impact on patients, medical and healthcare staff, and health systems in Europe. The 2021-2027 EU4Health programme will go beyond crisis response to address healthcare systems’ resilience. Established by Regulation (EU) 2021/522, it will provide funding to eligible entities, health organisations and NGOs from EU countries and to non-EU countries associated to the programme. Health statistics are used to monitor the EU’s health strategy as well as their contribution to the sustainable development goals (SDGs). These statistics have a key role to support the development of evidence-based policies both nationally and within the EU. They also serve as a basis for calculating indicators to monitor some aspects of social protection and social inclusion and a set of indicators known as the European core health indicators (ECHI).

While basic principles and institutional frameworks for producing statistics are already in place, the candidate countries and potential candidates are expected to increase progressively the volume and quality of their data and to transmit these data to Eurostat in the context of the EU enlargement process. EU standards in the field of statistics require the existence of a statistical infrastructure based on principles such as professional independence, impartiality, relevance, confidentiality of individual data and easy access to official statistics; they cover methodology, classifications and standards for production.

Eurostat has the responsibility to ensure that statistical production of the candidate countries and potential candidates complies with the EU acquis in the field of statistics. To do so, Eurostat supports the national statistical offices and other producers of official statistics through a range of initiatives, such as pilot surveys, training courses, traineeships, study visits, workshops and seminars, and participation in meetings within the European Statistical System (ESS). The ultimate goal is the provision of harmonised, high-quality data that conforms to European and international standards.

Additional information on statistical cooperation with the enlargement countries is provided here.

Notes

* This designation is without prejudice to positions on status, and is in line with UNSCR 1244/1999 and the ICJ Opinion on the Kosovo Declaration of Independence.

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Publications

  • Statistical books/pocketbooks
Key figures on enlargement countries — 2019 edition
Key figures on enlargement countries — 2017 edition
Key figures on the enlargement countries — 2014 edition
  • Leaflets
Basic figures on enlargement countries — 2019 edition
Basic figures on enlargement countries — 2018 edition
Basic figures on enlargement countries — 2016 edition

Database

Health status (hlth_state)
Health determinants (hlth_det)
Health care (hlth_care)
Health care expenditure (SHA 2011) (hlth_sha11)
Health care resources (hlth_res)
Health care activities (hlth_act)
Disability (hlth_dsb)
Causes of death (hlth_cdeath)
Health and safety at work (hsw)

Dedicated section

Methodology

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