Archive:Healthcare statistics
- Data from October 2010, most recent data: Further Eurostat information, Main tables and Database.
,_1997-2007.PNG)
Several factors of different nature can influence health of individuals and of population. In addition to genetic and environmental factors, and cultural and socio-economical conditionings, health care itself can play a crucial role. The way health care provision is organised and financed within the health care system differs among European Union member States (MS), but most Europeans would agree that there is a basic need for universal access to good quality health care services to be available at an affordable cost to both individuals and the society at large.
To trace how a country's health care system responds to these needs, high quality statistical information that encompasses both monetary and non-monetary data is required on a national level. Such data may includes the amount of financial, human and technical resources dedicated to health care sector, its allocation between different type of health care activities (preventive or curative services), different groups of health care providers (hospitals or ambulatory centres) or different types of health professionals (medical or paramedical professionals). This, in conjunction with additional information concerning technical and managerial solutions in health care provision (in-patient vs. outpatient mode of provision, the length of stay in hospital) can help in the evaluation of health care system performance. Health care decision makers often tend also to pose the question how the health care system performs from an international perspective.
This article presents some key statistics on health care across the EU countries. It comprises both monetary and non–monetary indicators build on the results of Joint (OECD, Eurostat, and WHO) data collections on 1) health care expenditure following the methodology of System of Health Accounts and 2) health care human and physical resources. The latter is completed by Eurostat additional data collection related to hospital activities (discharges and
procedures).
Main statistical findings
Healthcare expenditure
The indicator 'total current health care expenditure' quantifies the economic resources of both the public and private sectors dedicated to health care, with the exception of those related to capital investment. It reflects current expenditure of resident units on final consumption of health care goods and services directed at improving the health status of individuals and of the population. The level of total current health care expenditure being measured both in relative and in absolute terms varies significantly among these EU countries that reported the SHA data. As shown in figure 1 the share of current health expenditure in 2008 exceed 10% of GDP in Germany and France and represented almost twice of that in Romania, Cyprus or Estonia, where this share was below 6 % of GDP. This disparity is even bigger when comparing the level of health care spending per inhabitant, which varied from 635 Euro (PPS) in Romania to more than 4 280 Euro (PPS) in Luxembourg. Notwithstanding the effect of organisation and financing of health care system, the use of both measures shows that a society with a higher income per capita spends more on purchasing health care goods and services than those with a lower income.
The use of a mix of public and private funding reflects countries' specific arrangements in health care financing systems. Table 1 provides a complete breakdown of health care expenditure into public and private units incurring expenditure on health. In 2008, public funding dominates in the health care sector in the majority of EU MS reporting data, the exception being Cyprus (42%). Nevertheless, the share of public funding in current health care spending varies, among these countries, ranging from 56% in Bulgaria to more than 80% in Romania, Netherlands, Czech
Republic, Sweden, Luxembourg and Denmark. The major channel of public funding is through social security, which corresponds at the extreme to three quarters or more of overall spending in Czech Republic and the Netherlands (77 %). On the other hand, in Denmark and Sweden, it is government financing that counts for more than four fifths of total current expenditure on health care. Private expenditure on health care is often used as an indicator for accessibility of health care systems. The major source of private funds in 2008 were direct household payments, referred to as ‘out-of-pocket’ expenditure, which in Netherlands and France represented less than 7 % of current health care expenditure, while in Bulgaria this counted for over two fifths of overall spending, and in Cyprus nearly a half. Private insurance generally represented a small share of healthcare financing in EU MS that reporting the data, and only in Slovenia and France did it exceed 10%.
The split between personal health care goods and services that are consumed by individuals and collective services that are acquired by the population at large can be derived from the functional classifications of SHA. It also shows which of various health care activities incur the most expenditure in the health care sector. The functional patterns of health care expenditure presented in table 2 show that in 2008 curative and rehabilitative services incurred more that 50% of current health expenditure in the majority of EU MS reporting data, the exceptions being Slovakia, Romania and Hungary. Medical goods delivered to outpatients was the second largest function, with average spending around one quarter of current expenditure, although with a significant degree of variation, ranging from 13% in Luxembourg up to almost 40% in Slovenia. The third group, comprising services related to long-term nursing care, accounted for less than 10 % of current expenditure in more than half of EU MS that reported these data, but reached almost 20% in Luxembourg and 22 % in Denmark. It has to be noted that for many countries reporting a low share, this is due to the fact that the main burden of long term nursing care lay on family members with no payment being made for providing these services. Other reason is related to data limitation. For many countries it is not possible to separate the medical and social components of expenditure on long-term nursing care, which at the end has an inevitable impact on cross country comparison. The proportion of current health expenditure incurred by ancillary services such as laboratory testing or patient transport varies significantly from country to country, ranging from 2.4% in Belgium to 10% in Estonia. Similarly expenditure related to prevention and public health programme exhibits large discrepancies between EU reporting countries. In both cases the figures do not reflect the total amount of expenditure under these headings as often they are partly attributed to medical treatment and as such recorded under curative care. Expenditure on health administration and health insurance are lower in countries with centralised social security system or with narrow role of private insurance and ranged from less than 1.5% in such countries as Bulgaria, Denmark, Portugal, Hungary and Sweden up to 7% and more in France and Belgium.
Information concerned main actors that are involved in provision of health care goods and services and their role in incurring financial recourse can be identified using the provider classification of SHA. The breakdown of current health care expenditure by type of provider, as shown in table 3, identifies the three main groups of health care providers which account for the majority of financing recourses dedicated to health care. The greatest expenditure is on the hospital industry, with its share ranked from 27% in Slovakia to above 46 % in Denmark, Estonia, and Sweden. This is followed by expenditure on ambulatory care, accounting from between 16-17% in Romania and Bulgaria to more than 30% in Germany, Finland, Cyprus and Portugal. The third group of providers includes various establishments of retail sale and other providers of medical goods. The share of this group varied around threefold, from between 11% to 20% in such countries as Luxembourg, Sweden or Cyprus, through 20% to 30% in Czech Republic, Germany, Estonia or Lithuania, up to more than 30% of health care provision in Hungary, Bulgaria and Slovakia. However, it has to be mentioned here that health care providers classified under the same group do not necessary perform the same set of activities. Hospitals for example may, in addition to inpatient services, offer outpatient, ancillary or other type of services. Therefore, data reported under provider dimension, due to a variety of countries specific arrangements in health care provision are less comparable than these presented under functional dimension.
Non-expenditure data on healthcare
Information on the non-expenditure component of healthcare can be divided into two broad groups of data:
- resource-related healthcare data on human, physical and technical resources, including staff (such as physicians, dentists, nurses, pharmacists and physiotherapists) and hospital beds, and
- output-related data that focuses on hospital patients and their treatment(s), in particular in-patient discharges.
Non-expenditure healthcare data are mainly based on administrative national sources reflecting countries' specific ways of organisation. However, a few countries extract the information from surveys. As a consequence the information collected is not always corresponding.
The key indicator for healthcare staff is the total number of physicians (head counts) by country, expressed per 100 000 inhabitants. Three different concepts for health professionals are used: practising, professionally active and licensed. ‘Practising’ physicians are providing services directly to the patients; ‘professionally active’ physicians are those who are ‘practising’ plus those working in administration and research with their medical education being a pre-requisite for the job, and ‘licensed to practice’ are all those entitled to work as physicians plus e.g. those who are retired.
In the context of comparing healthcare services across Member States Eurostat gives preference to the concept of ’practising professionals’. In six Member States, the number of practising physicians is not available and is replaced by the number of professionally active (Greece, France, Italy) or by the number of licensed physicians (Ireland, Netherlands and Portugal).
The year of actual collection may also slightly differ depending on the national capacity for providing data.
As table 4 shows, in 2008 the highest number of practising physicians per 100 000 inhabitants was recorded in Austria (458) followed by Norway (398.1). Between 1998 and 2008 the number of physicians per 100 000 inhabitants increased in the majority of Member States, although some reductions were recorded in Lithuania and Poland. Nevertheless, the reduction of practising physicians in Poland may be explained by several breaks in data series, as from 2004 data on practising physicians in Poland does not include private practices (private medical offices, about 2000 physicians).
Hospital beds provide information on the maximum number of patients that can be treated by hospitals. They cover curative, psychiatric, long-term care and other beds. The data include establishments of the public as well as the private sector. However, some countries provide data for the public sector only. That is the case for Denmark (psychiatric beds), Ireland (total and curative beds), Cyprus (curative and psychiatric beds) and United Kingdom. The number of hospital beds per 100 000 inhabitants in 2008 ranged from 243 in Turkey to 820 in Germany. During the ten years between 1998 and 2008, the number of hospital beds per 100 000 inhabitants fell in every MS for which data is available, except in Malta. This exception in Malta may be explained by the restructuration of the main General Hospital. The largest reductions in the availability of hospital beds were recorded in the three Baltic countries (Estonia, Lithuania, and Latvia) and Bulgaria.
A closer look to curative and psychiatric beds (table 5) shows a reduction from 1998 to 2008 for those categories for all countries except for the curative beds in Greece, with an average of 379 curative care beds and 64 psychiatric care beds per 100 000 inhabitants in the EU-27 in 2008.
The general reduction in hospital bed numbers may reflect economic constraints, but also a rise of efficiency in technical resources such as image based equipments. In view of the operational sector it may also be due to a shift from in-patient to outpatient operations and shorter periods spent in the hospital following an operation.
In term of healthcare activity, circulatory system diseases accounted for the highest number of hospital discharges in 2008 in the vast majority of countries for which data are available: data for one third of the Member States show more than 3 000 discharges per 100 000 inhabitants for that group of diseases (table 6). For the other selected groups of diseases presented on the same table, the EU-27 aggregates for discharges per 100 000 inhabitants range in a close interval between 1 315 and 1 550.The average length of hospital stay was generally longest for those patients suffering from cancer or from circulatory system problems (table 7).
Data sources and availability
Healthcare expenditure
The System of Health Accounts (SHA) provides a framework for a family of interrelated classifications and tables for standard international reporting for expenditure on health care and its financing. The set of core tables in the SHA addresses three basic questions: i) who finances health care goods and services, ii) which health care providers deliver them and iii) what kinds of health care goods and services are consumed; Consequently, the SHA is organised around a tri-dimensional system for the recording of health expenditure, by means of International Classification for Health Accounts (ICHA), defining:
- health care expenditure by function (ICHA-HC); The functional classification of health care delineates the boundaries of activities of health care to be captured from an international perspective. It refers to the purpose of health care such as disease prevention, health promotion, treatment, rehabilitation and long-term care by grouping various health care activities performed either by institutions or individuals through the application of medical, paramedical and nursing knowledge and technology into homogenous categories of classification categories.
- health care expenditure by provider industries (ICHA-HP); The classification of health care providers encompasses all units which contribute to the provision of health care goods and services such as hospitals, various outpatients settings, diagnosis centre or retail sellers of medical goods and by this serve the purpose of arranging country-specific provider units into common, internationally applicable categories.
- health care expenditure by financing agents (ICHA-HF); Classification of financing agents offers breakdown of health expenditure into public and private institutions that directly pay to providers for their supply of health care goods and services. It refers to institutional sectors, following the central SNA Framework. Respectively, public funding comprises government (both central and local) spending and social security funds while private encompasses household out-of-pocket payments, expenditure of private health insurance (including private social insurance), of corporation (employers outlay on occupational medicine) and of non profit organisations.
In 2005 Eurostat, OECD and WHO established a framework for a joint health accounts data collection. EU MS submit data to Eurostat on the basis of a gentlemen's agreement established in the framework of the Eurostat Working Group on "Public Health Statistics". Health care data on expenditure are based on various surveys and administrative (register) data sources as well as on experts' estimation in the countries, reflecting the country-specific way of organising health care sectors thus may not always be completely comparable. Data coverage is close to 100 % on the 1st digit level for all three core classifications, but range between 75-85% on the 2nd digit level what makes expenditure data less comparable on the second and the lower digits of ICHA classification.
Non-expenditure data on healthcare
Hospitals are defined according to the classification of healthcare providers of the System of health accounts (SHA); all public and private hospitals should be covered.
Data on healthcare staff, in the form of human resources available for providing healthcare services, are provided irrespective of the sector of employment (i.e. whether the personnel are independent, employed by a hospital, or any other healthcare provider). These statistics cover healthcare professionals such as physicians, dentists, nurses, pharmacists and physiotherapists.
Hospital bed numbers provide information on healthcare capacities, i.e. on the maximum number of patients who can be treated by hospitals. Hospital beds are those which are regularly maintained and staffed and immediately available for the care of admitted patients. These include: beds in all hospitals, including general hospitals, mental health and substance abuse hospitals, and other specialty hospitals: occupied and unoccupied beds. The statistics exclude surgical tables, recovery trolleys, emergency stretchers, beds for same-day care, cots for healthy infants, beds in wards which were closed for any reason, provisional and temporary beds, or beds in nursing and residential care facilities. They cover beds accommodating patients who are formally admitted (or hospitalised) to an institution for treatment and/or care and who stay for a minimum of one night. Curative care (or acute care) beds are those that are available for curative care; these form a subgroup of total hospital beds.
Output-related indicators focus on hospital patients and covers the interaction between patients and healthcare systems, namely in the form of the treatment received. Data in this domain are available for a range of indicators including hospital discharges of in-patients and day cases by age, sex, and selected (groups of) diseases; the average length of stay of in-patients; or the medical procedures performed in hospitals; the number of hospital discharges is the most commonly used measure of the utilisation of hospital services. Discharges, rather than admissions, are used because hospital abstracts for in-patient care are based on information gathered at the time of discharge. A hospital discharge is defined as the formal release of a patient from a hospital after a procedure or course of treatment. A discharge occurs whenever a patient leaves because of finalisation of treatment, signs out against medical advice, transfers to another healthcare institution or on death. Healthy newborn babies should be included, while patient transfers to another department within the same institution are excluded.
Further Eurostat information
Publications
- Health in Europe – Data 1998-2003, Eurostat pocketbook 2006
- Health statistics – Key data on health 2002 – Data 1970 – 2001
Main tables
- Health, see:
- Public health
- Main tables
- Public health (t_hlth)
- Health care: resources and patients (non-expenditure data) (t_hlth_care)
- Public health (t_hlth)
- Main tables
Database
- Health, see:
- Public health
- Database
- Public health (hlth)
- Health care expenditure (hlth_sha)
- Health care: resources and patients (non-expenditure data) (hlth_care)
- Health care: indicators from surveys (SILC, HIS round 2004) (hlth_care1)
- Public health (hlth)
- Database
