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, 2016http://www.oecd.org/health/health-at-a-glance-europe-23056088.htmhttp://ec.europa.eu/health/state

2

Close links between Health at a Glance and EC Joint Assessment Framework on Health

• Life expectancy and health inequalities• Growing prevalence of chronic diseases

HEALTH STATUS

Life expectancy across EU countries increased by over 6 years since 1990; but the gap between the highest and lowest

countries remains unchanged (more than 8 years)

Source: Eurostat Database completed with data from OECD Health Statistics 2016

Gap in life expectancy at age 65 by gender and educational level, 2013 (or nearest year)

Source: Eurostat Database completed with OECD Health Statistics 2016 for Austria and Latvia

There are also large gaps in life expectancy in each country: in Central and Eastern Europe, 65-year-old men with low

education level live about 4 years less than the most educated

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

The number of people with chronic diseases is growing due to population ageing

1995

2015

2035

1 million

2 million

3 million

4 million

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

GREATER FOCUS ON PREVENTION TO TACKLE RISK FACTORS

AND PROMOTE HEALTHY AGEING

Spending on prevention represents only 3% of current health spending on average

4,1 4,1

3,7

3,33,2 3,2

3,1 3,0 3,0 3,02,9

2,72,6 2,6 2,6

2,4

2,1 2,1 2,12,0 2,0 1,9 1,9 1,8 1,8

1,4

0,8

0,6

2,9

2,32,2

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: EHIS survey for most EU countries for 2014 data; regular national surveys for Czech Republic, Denmark, Estonia, Finland, Germany, Italy, Luxembourg, Sweden, United Kingdom and non-EU countries

Adults smoking daily, 2000 and 2014 (or nearest year)

Smoking among adults has declined across EU countries, but still one-fifth of adults smoke daily

Regular binge drinking in EU countries, 2014

More than one-fifth of adults report regular heavy alcohol drinking (about one in three men and one in seven women)

Source: Eurostat, EHIS 2014

Self-reported obesity among adults in EU countries

Obesity among adults has increased in nearly all countries, rising from 11% in 2000 to over 15% in 2014 on average

Source: Eurostat, EHIS 2008, 2014; OECD Health Statistics 2016 for non-EU countries and 2000 data

Change in self-reported overweight among 15-year-olds, 2001-02 and 2013-14

Overweight and obesity problems among children have also gone up, from 11% in 2001-02 to 17% in 2013-14 on average

Source: HBSC Survey (2001-02 and 2013-14 waves)

Overweight problems in childhood and adolescence increase the risk of obesity in adulthood

TRENDS IN HEALTH SPENDING AND FINANCING (PUBLIC AND

PRIVATE)

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.

11,111,111,010,810,610,410,49,9 9,8 9,6 9,6 9,4

9,1 9,0 8,98,4 8,3 8,2

7,57,2 7,0 7,0 6,8 6,6 6,5 6,3 6,3

5,65,0

11,5

10,39,9

8,8

6,56,2

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 (%)

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

More than 75% of health spending is publicly financed on average across EU countries. Direct out-of-pocket payments account for 15% on average, but represent a much greater share in some countries

Current health expenditure by type of financing, 2014

Note: Countries are ranked by government schemes and compulsory health insurance as a share of current health expenditure.

1. Includes investments.

Source: OECD Health Statistics 2016; Eurostat Database

Since 2009, direct out-of-pocket spending by households has grown more rapidly than public spending on average

Growth of health spending by financing per capita, EU average, 2005-14

• Health coverage• Financial barriers• Supply of doctors and nurses• Timely access (waiting times)

ACCESS TO CARE

Source: OECD Health Statistics 2016; European Observatory Health Systems in Transition (HiT) Series

Most EU countries have universal (or near universal) health coverage, but Cyprus, Romania, Greece and Bulgaria have a large coverage gap

Health insurance coverage for a core set of services, 2014 (or nearest year)

Source: Eurostat Database, based on EU-SILC

Poor people are more likely to report unmet needs for medical care and dental care

Unmet need for medical examination for financial, geographic or waiting times reasons, by income quintile, 2014

Unmet need for dental examination for financial, geographic or waiting times reasons, by income quintile, 2014

Source: Eurostat Database, based on EU-SILC

Unmet medical and dental care needs for financial reasons have increased following the economic crisis

Unmet medical care need for financial reasons, by income quintile, all EU countries, 2005 to 2014

Unmet dental care need for financial reasons, by income quintile, all EU countries, 2005 to 2014

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

25Source: 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: Health at a Glance 2015 (based on Eurostat database)

The number of doctors also varies widely across regions in each country

Note: In Greece and Portugal, data refer to all doctors licensed to practice.

Austria

Belgium

Czech Rep.

Denmark

Estonia

Finland

France

Germany

Greece

Hungary

Italy

Luxembourg

Netherlands

Norway

Poland

Portugal

Slovak Rep.

Slovenia

Spain

Sweden

Switzerland

Turkey

United Kingdom

0 1 2 3 4 5 6 7 8 9

Density per 1 000 population

Vienna

Brussels

Prague

AthensRegion

Lisbon

Bratislava

Helsinki

Copenhagen Region

Source: OECD Health Statistics 2016; Eurostat Database

The number of nurses per capita has increased in nearly all EU countries since 2000

Practising nurses per 1 000 population, 2000 and 2014 (or nearest year)

1. Data include not only nurses providing care for patients, but also those working as managers, educators, researchers, etc.

2. Austria and Greece report only nurses working in hospital.

2828

There are wide variations in number of doctors and nurses across European countries

Note: The number of nurses in Austria is under-estimated as it only includes those working in hospital. Source: OECD Health Statistics 2016; Eurostat Database

AUT

DEU

SWE

ESP

DNK

PRT

LTU

BGR

MLT

ITASLK

CHZ

EU 28

CYP

HUN

FIN

BEL

ROU

GBR

FRA

IRL

SVN

NLD

EST

POL

LVA

HRV

LUX

0

5

10

15

20

1 2 3 4 5 6

Practising nurses per 1 000 population, 2014

EU 28 Avg: 8.4

Practising doctors per 1 000 population, 2014

Physicians HighNurses Low

EU 28 Avg: 3.5

Physicians HighNurses LowPhysicians HighNurses Low

Physicians HighNurses Low

Physicians LowNurses High

Physicians HighNurses High

Physicians LowNurses Low

Source: OECD Health Statistics 2016

Waiting times: Example of hip replacementDecreased in several countries between 2006

and 2010, but have stabilised since then

Hip replacement, waiting times from specialist assessment to treatment, 2006 to 2014/15

Conclusions

• Greater focus on health promotion and prevention both among children and adults to reduce health care needs

• Strengthen primary care and patient-centred care to better manage chronic diseases outside hospital

• Reduce any financial or geographic barriers to care, and ensure timely access to services

• Need to achieve greater 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