Archive:Healthcare statistics
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- Data from October 2010, most recent data: Further Eurostat information, Main tables and Database.
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This article presents key statistics on healthcare in the European Union (EU) and its Member States. The state of health of individuals and of population is influenced by numerous genetic and environmental factors as well as cultural and socio-economical conditions, but also by the available healthcare. How healthcare systems are organised and financed differs across EU Member States, but most Europeans would agree that universal access to good healthcare, at an affordable cost to both individuals and society at large, is a basic need.
Monetary and non-monetary statistics may be used to evaluate how a country's healthcare system responds to this basic need, through measuring financial, human and technical resources within the healthcare sector and the allocation of these resources between healthcare activities (preventive and curative), groups of healthcare providers (hospitals and ambulatory centres) or health professionals (medical and paramedical staff). Combining these data with information on the technical and managerial choices made for healthcare provision (inpatient or outpatient mode of provision, the length of stay in hospital), it is possible to assess and measure the performance of healthcare systems.
Main statistical findings
Healthcare expenditure
Total current healthcare expenditure quantifies the economic resources of both the public and private sectors dedicated to healthcare, with the exception of those related to capital investment. Healthcare expenditure (both in relative and absolute terms) varied significantly among the EU Member States in 2008 [1] As shown in Figure 1 the share of current healthcare expenditure exceeded 10 % of gross domestic product (GDP) in Germany and France (2007 data), which represented almost twice the share recorded in Romania, Cyprus and Estonia (below 6 % of GDP). The disparity was even bigger when comparing the level of healthcare spending per inhabitant, which varied from 635 PPS in Romania to more than 4 280 PPS in Luxembourg. Notwithstanding the effect of organisation and financing of healthcare systems, the comparison of both these measures suggests that individuals living in those Member States with a higher average level of income per capita generally spend more on purchasing healthcare goods and services.
Public and private healthcare expenditure
The mix of public and/or private funding reflects specific arrangements in healthcare financing systems across the EU Member States. Table 1 provides a breakdown of healthcare expenditure into public and private units financing health expenditure. In 2008, public funding dominated the healthcare sector in the majority of EU Member States, the main exception being Cyprus, where public funding accounted for a 42 % share of total funding. Across the remaining Member States for which data are available, the share of public funding in current healthcare spending ranged from 56 % in Bulgaria to more than 80 % in Romania, the Netherlands, the Czech Republic, Sweden, Luxembourg and Denmark.
Public financing of healthcare is conducted through a variety of different systems across the Member States. For example, social security accounted for three quarters or more of overall spending on healthcare in the Czech Republic and the Netherlands (77 %) in 2008. In contrast, Denmark and Sweden reported that government financing accounted for more than four fifths of their total current expenditure on healthcare.
Private expenditure on healthcare is often used as an indicator to measure the accessibility of healthcare systems. The major source of private funding in 2008 was direct household payments, referred to as 'out-of-pocket' expenditure, which in the Netherlands and France represented less than 7 % of current healthcare expenditure, a share that rose to over 40 % of overall spending on health in Bulgaria, and to half of all healthcare expenditure in Cyprus. Private insurance generally represented a small share of healthcare financing among the Member States for which data are available; its relative share only exceeded 10 % in Slovenia and France.
Functional breakdown of healthcare expenditure
The functional patterns of healthcare 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 Member States, the exceptions being Slovakia, Romania and Hungary.
Medical goods delivered to outpatients was the second largest function, with average spending accounting for around one quarter of total current expenditure – although with a significant degree of variation, from 13 % in Luxembourg and Denmark up to more than one third of the total in Slovakia, Bulgaria and Hungary.
The third function, comprising services related to long-term nursing care, accounted for less than 10 % of current expenditure in more than half of the Member States, but reached almost 20 % in Luxembourg and just over 21 % in Denmark. It should be noted that the relatively low share reported for many Member States could well be due to the main burden of long-term nursing care resting with family members with no payment being made for providing these services. Otherwise, limitations in the data compilation exercise may also make it difficult to separate the medical and social components of expenditure on long-term nursing care, leading to an inevitable impact on cross-country comparisons.
The proportion of current healthcare expenditure incurred by ancillary services such as laboratory testing or the transportation of patients varies significantly among EU Member States, ranging from 2.4 % in Belgium to 10 % in Estonia. Similarly expenditure related to prevention and public health programmes exhibits large discrepancies between Member States. In both cases the figures are likely to provide an under-estimate of the true values, as it is likely that some of the expenditure is attributed to medical treatment and as such may be recorded under the heading of curative care. Expenditure on healthcare administration and health insurance was generally lower in those Member States with centralised social security systems or those Member States where private insurance plays a relatively restricted role, ranging from less than 1.5 % of total healthcare expenditure in Bulgaria, Portugal, Denmark, Hungary and Sweden, through to 7 % and more of expenditure in France and Belgium. In general, the expenditure associated with collective services reported under preventive programmes and the administration of healthcare systems did not surpass 10 % of overall healthcare expenditure except in the Netherlands and Belgium.
Healthcare expenditure by type of provider
The breakdown of current healthcare expenditure by type of provider is shown in Table 3, which identifies three main groups. The highest share of expenditure was generally accounted for through hospitals, their share ranging from 27 % in Slovakia to more than 46 % in Denmark, Estonia, and Sweden. The second most important category was generally that of ambulatory care, its share ranging from just over 16 % of total healthcare expenditure in Romania and Bulgaria to more than 30 % of the total in Germany, Finland, Cyprus and Portugal. The third group of providers includes various retail establishments and other providers of medical goods. Their share of healthcare expenditure varied considerably more – around threefold – from 11 % in Luxembourg and 13 % in Denmark, through a middle band of Member States where the share was between 16 % and 27 %, to 30 % or more of total healthcare provision in Lithuania, Hungary, Bulgaria and Slovakia. However, it should be borne in mind that healthcare providers classified under the same group do not necessarily perform the same set of activities. Hospitals, for example, may, in addition to inpatient services, offer outpatient, ancillary or other type of services.
Non-expenditure data on healthcare
High demand for healthcare staff in some Member States is draining qualified resources from others, underlining the need for an EU-wide approach. One of the key indicators for measuring healthcare staff is the total number of physicians (head count), expressed per 100 000 inhabitants. In this context, Eurostat gives preference to the concept of practising physicians (although data are not available for six Member States - being replaced by the number of professionally active physicians for Greece, France and Italy, and by the number of licensed physicians for Ireland, the Netherlands and Portugal – see Table 4.
In 2008 the highest number of practising physicians per 100 000 inhabitants was recorded in Austria (458.1) followed by Lithuania (370.6) among the EU Member States, while Norway (398.1) recorded a ratio between these two figures. Between 1998 and 2008 the number of physicians per 100 000 inhabitants increased in the majority of EU Member States, although 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 Polish data does not include private practices (these private medical offices are thought to account for about 2 000 physicians).
The number of hospital beds per 100 000 inhabitants in 2008 ranged among those Member States for which data are available from 325 in Spain to 820 in Germany, with Turkey (244) below the Spanish level. During the ten years between 1998 and 2008, the number of hospital beds per 100 000 inhabitants fell in every Member State, except Malta (where the main general hospital was reconstructed). The largest reductions in the availability of hospital beds were recorded in the three Baltic States and in Bulgaria. The reduction in hospital bed numbers may reflect, among others, economic constraints, increased efficiency through the use of technical resources (for example, imaging equipment), a general shift from inpatient to outpatient operations, and shorter periods spent in hospital following an operation.
A closer look at the availability of hospital beds, broken down for curative care beds and psychiatric beds (Table 5) also shows a reduction in bed numbers between 1998 and 2008 in each of the Member States for which data are available, except for the number of curative care beds in Greece. The EU-27 averaged 379 curative care beds and 64 psychiatric care beds per 100 000 inhabitants in 2008.
In terms of healthcare activity, diseases of the circulatory system often accounted for the highest number of hospital [Glossary:discharge|discharges]] in 2008 (averaging 2 317 discharges per 100 000 inhabitants in the EU-27) – see Table 6. One third of the Member States for which data are available reported in excess of 3 000 discharges per 100 000 inhabitants for diseases of the circulatory system. The other diseases presented in the same table, each reported between 1 315 and 1 550 discharges per 100 000 inhabitants.
The average length of a hospital stay was generally highest among those patients suffering from cancer or problems relating to the circulatory system (see Table 7).
Data sources and availability
Eurostat, the Organisation for Economic Co-operation and Development (OECD) and the World Health Organization (WHO) established a framework for a joint health accounts data collection exercise in 2005. EU Member States submit their data to Eurostat on the basis of a gentlemen's agreement established under the framework of a Eurostat working group on public health statistics. The data collected relates to:
- healthcare expenditure following the methodology of the system of health accounts (SHA);
- statistics on human and physical resources in healthcare – supplemented by additional Eurostat data on hospital activities (discharges and procedures).
Healthcare expenditure
Healthcare data on expenditure are based on various surveys and administrative (register-based) data sources, as well as estimations made within the Member States, reflecting country-specific ways of organising healthcare.
Total current healthcare expenditure quantifies the economic resources of both the public and private sectors dedicated to healthcare, with the exception of those related to capital investment. It reflects current expenditure of resident units on final consumption of goods and services directed at improving the health status of individuals and of the population.
The SHA provides a framework for interrelated classifications and tables relating to the international reporting of healthcare expenditure and its financing. The set of core SHA tables addresses three basic questions: i) who finances healthcare goods and services; ii) which healthcare providers deliver them, and; iii) what kinds of healthcare goods and services are consumed. Consequently, the SHA is organised around a tri-dimensional system for the recording of health expenditure, by means of the international classification for health accounts (ICHA), defining:
- healthcare expenditure by function (ICHA-HC) – refers to the purpose of healthcare such as disease prevention, health promotion, treatment, rehabilitation and long-term care;
- healthcare expenditure by provider (ICHA-HP) – classifies units which contribute to the provision of healthcare goods and services such as hospitals, various outpatients settings, diagnosis centres or retailers of medical goods;
- healthcare expenditure by financing agents (ICHA-HF) – offers a breakdown of public and private institutions that directly pay providers for their supply of healthcare goods and services.
Data coverage is close to 100 % for the first-digit level of each of the three core classifications, but ranges between 75 % and 85 % at the second-digit level. As such, expenditure data may be less comparable at a more disaggregated level of the 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)
- healthcare: resources and patients (non-expenditure data) (t_hlth_care)
- Public health (t_hlth)
- Main tables
Database
- Health, see:
- Public health
- Database
- Public health (hlth)
- healthcare expenditure (hlth_sha)
- healthcare: resources and patients (non-expenditure data) (hlth_care)
- healthcare: indicators from surveys (SILC, HIS round 2004) (hlth_care1)
- Public health (hlth)
- Database
Dedicated section
Source data for tables, figures and maps on this page (MS Excel)
External links
See also
Notes
- ↑ Belgium, Denmark, France, the Netherlands, Austria and Finland, 2007; Latvia, Portugal and Slovakia, 2006.