Health at a Glance: Europe

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This biennial publication presents a set of key indicators of health status, determinants of health, health care resources and activities, quality of care, health expenditure and financing in 35 European countries, including the 27 European Union member states, 5 candidate countries and 3 EFTA countries. The selection of indicators is based largely on the European Community Health Indicators (ECHI) shortlist, a set of indicators that has been developed to guide the reporting of health statistics in the European Union.  It is complemented by additional indicators on health expenditure and quality of care, building on the OECD expertise in these areas. Each indicator is presented in a user-friendly format, consisting of charts illustrating variations across countries and over time, a brief descriptive analysis highlighting the major findings conveyed by the data, and a methodological box on the definition of the indicator and any limitations in data comparability.

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03 Dec 2014
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This third edition of Health at a Glance: Europe presents a set of key indicators related to health status, determinants of health, health care resources and activities, quality of care, access to care, and health expenditure and financing in 35 European countries, including the 28 European Union member states, four candidate countries and three EFTA countries. The selection of indicators is based largely on the European Core Health Indicators (ECHI) shortlist, a set of indicators that has been developed to guide the reporting of health statistics in the European Union. This is complemented by additional indicators on quality of care, access to care and health expenditure, building on the OECD expertise in these areas.

Compared with the previous edition, this third edition includes a greater number of ECHI indicators, reflecting progress in the availability of comparable data in the areas of non-medical determinants of health and access to care. It also includes a new chapter dedicated to access to care, including selected indicators on financial access, geographic access and timely access.

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  • Foreword

    As we emerge from the economic crisis, the squeeze on health budgets continues in many EU countries, and policy makers face the challenge of maintaining universal access to essential and high-quality care with reduced resources.

  • Executive summary

    European countries have achieved significant gains in population health, but there remain large inequalities in health status both across and within countries. Life expectancy at birth in European Union (EU) member states has increased by more than five years on average since 1990, although the gap between those countries with the highest and lowest life expectancies remains around eight years. There are also persistently large inequalities within countries among people from different socio-economic groups, with individuals with higher levels of education and income enjoying better health and living several years longer than those more disadvantaged. These disparities are linked to many factors, including some outside health care systems, such as the environment in which people live, individual lifestyles and behaviours, and differences in access to and quality of care.

  • Reader's guide

    Health at a Glance: Europe 2014 presents key indicators of health and health systems in 35 European countries, including the 28 European Union member states, four candidate countriesAlbania has become a EU candidate country on 27 June 2014, but is not included in this publication due to limited data availability when this report was prepared. and three European Free Trade Association countries. This third edition builds on the two previous in 2010 and 2012 and presents a greater number of indicators included in the list of European Core Health Indicators (ECHI,, reflecting progress in data availability and comparability. Complemeting the chapter on quality of care which was added in 2012, this 2014 edition includes a new chapter on access to care, based mainly on ECHI indicators, complemented with some additional indicators related to financial access and geographic access.

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  • Expand / Collapse Hide / Show all Abstracts Health status

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    • Life expectancy and healthy life expectancy at birth

      Life expectancy at birth continues to increase in European countries, reflecting reductions in mortality rates at all ages. These gains in longevity can be attributed to a number of factors, including improved lifestyle and better education, as well as greater access to quality health services.

    • Life expectancy and healthy life expectancy at age 65

      Life expectancy at age 65 has increased significantly among both women and men over the past several decades in all EU member states. Some of the factors explaining the gains in life expectancy at age 65 include advances in medical care, greater access to health care, healthier lifestyles and improved living conditions before and after people reach age 65.

    • Mortality from all causes

      Statistics on deaths remain one of the most widely available and comparable sources of information on health. Registering deaths is compulsory in all European countries, and the data collected through the process of registration can be used to monitor diseases and health status, and to plan health services. In order to compare levels of mortality across countries and over time, the data need to be standardised to remove the effect of differences in age structure.

    • Mortality from heart disease and stroke

      Cardiovascular diseases are the main cause of mortality in nearly all EU member states, accounting for almost 40% of all deaths in the region in 2011. They cover a range of diseases related to the circulatory system, including ischemic heart disease (known as IHD, or heart attack) and cerebro-vascular disease (or stroke). Together, IHD and stroke comprise around 60% of all cardiovascular deaths, and caused more than one quarter of all deaths in EU member states in 2011.

    • Mortality from cancer

      Cancer is the second leading cause of mortality in EU member states after diseases of the circulatory system, accounting for 24% of all deaths in 2011. In 2011, cancer mortality rates were lowest in Cyprus, Finland, Bulgaria, Sweden and Switzerland, with rates at least 15% lower than the EU average. They were highest in some central and eastern European countries, including Hungary, Croatia, the Slovak Republic, Slovenia and Denmark, with rates at least 15% higher than the EU average ().

    • Mortality from transport accidents

      Injuries from transport accidents – most of which are due to road traffic – are a major public health problem in the European Union, causing the premature deaths of around 35 000 people in 2011. In addition to these deaths, about 250 000 people were seriously injured in road accidents. The direct and indirect financial costs of transport accidents are substantial: estimations range from 1 to 3% of GDP annually (OECD/ITF, 2014).

    • Suicide

      Suicide is a significant cause of death in many EU member states, with approximately 60 000 such deaths in 2011. Suicide rates vary widely across European countries, with the lowest rates in southern European countries – Cyprus, Greece, Malta, Italy and Spain – as well as in the United Kingdom, and the highest rates in Lithuania, Hungary, Slovenia and Latvia (where suicide rates are more than 50% higher than the EU average). There is an eight-fold difference between Lithuania and Cyprus, the countries with the highest and lowest death rates. The high suicide rates in Lithuania have been associated with a range of factors, including rapid socioeconomic transition, increasing psychological and social insecurity, and the absence of a national suicide prevention strategy.

    • Infant mortality

      Infant mortality, the rate at which babies and children of less than one year of age die, reflects the effect of economic and social conditions on the health of mothers and newborns, as well as the effectiveness of health systems.

    • Infant health: Low birth weight

      Low birth weight – defined as a newborn weighing less than 2 500 grams – is an important indicator of infant health because of the close relationship between birth weight and infant morbidity and mortality. There are two categories of low birth weight babies: those occurring as a result of restricted foetal growth and those resulting from pre-term birth. Low birth weight infants have a greater risk of poor health or death, require a longer period of hospitalisation after birth, and are more likely to develop significant disabilities (UNICEF and WHO, 2004). Babies with a birth weight under 1500 grams are termed very low birth weight babies and are at the highest risk.

    • Self-reported health and disability

      The health module in the EU Statistics on Income and Living Conditions survey (EU-SILC) allows respondents to report on their general health status, whether they have a chronic illness and whether they are limited in usual activities because of a health problem. Despite the subjective nature of these questions, indicators of perceived general health have been found to be a good predictor of people’s future health care use and mortality (DeSalvo et al., 2005; Bond et al., 2006).

    • Incidence of selected communicable diseases

      Communicable diseases such as measles, pertussis and hepatitis B still pose major threats to the health of European citizens. Measles, a highly infectious disease of the respiratory system, is caused by a virus. Symptoms include fever, cough, runny nose, red eyes and skin rash. It can lead to severe health complications, including pneumonia, encephalitis, diarrhoea and blindness. Pertussis (or whooping cough) is highly infectious, and is caused by a bacteria. The disease derives its name from the sound made from the intake of air after a cough. Hepatitis B is an infection of the liver caused by the hepatitis B virus. The virus is transmitted by contact with blood or body fluids of an infected person. A small proportion of infections become chronic, and these people are at high risk of death from cancer or cirrhosis of the liver. Protection against measles, pertussis and hepatitis B is available through vaccination (see , Childhood vaccination programmes).

    • HIV/AIDS

      The onset of AIDS is caused by HIV (human immunodeficiency virus) infection and can manifest itself through many different diseases, such as pneumonia and tuberculosis, as the immune system is no longer able to defend the body, leaving it susceptible to different infections and tumors. There is a time lag between HIV infection, AIDS diagnosis and death, which can be any number of years depending on the treatment administered. Despite worldwide research, there is no cure or vaccine currently available. HIV remains a major public health issue in Europe, with approximately 800 000 people living with HIV infection in the European Union in 2012 and continued transmission increasing this number.

    • Cancer incidence

      In 2012, an estimated 2.7 million new cases of cancer were diagnosed in EU member states, 54% (around 1.5 million) occurring in men and 46% (around 1.2 million) in women. The most common cancer site was breast cancer (13.8% of all new cancer cases), followed by prostate cancer (13.6%), colorectal cancer (13%) and lung cancer (11.8%). These four cancers represented more than half of the estimated overall burden of cancer in the European Union (Ferlay et al., 2013). The risk of getting cancer before the age of 75 years was 27% (31% for men and 24% for women) and the risk of dying from cancer also before the age of 75 was 12% (14% for men and 9% for women).

    • Diabetes prevalence and incidence

      Diabetes is a chronic disease characterised by high levels of glucose in the blood. It occurs either because the pancreas stops producing the hormone insulin (type-1 diabetes), or through a combination of the pancreas having reduced ability to produce insulin alongside the body being resistant to its action (type-2 diabetes). People with diabetes are at greater risk of developing cardiovascular diseases such as heart attack and stroke if the disease is left undiagnosed or poorly controlled. They also have elevated risks for sight loss, foot and leg amputation due to damage to the nerves and blood vessels, and renal failure requiring dialysis or transplantation.

    • Dementia prevalence

      Dementia describes a variety of brain disorders which progressively lead to brain damage, and cause a gradual deterioration of the individual’s functional capacity and social relations. It is one of the most important causes of disability among the elderly, placing a large burden not only on sufferers, but also on carers. Alzheimer’s disease is the most common form of dementia, representing about 60% to 80% of cases. Successive strokes that lead to multi-infarct dementia are another common cause. Currently, there is no treatment that can halt dementia, but pharmaceutical drugs and other interventions can slow the progression of the disease.

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  • Expand / Collapse Hide / Show all Abstracts Determinants of health

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    • Smoking among adults

      Tobacco kills nearly 6 million people each year worldwide, of whom more than 5 million are from direct tobacco use and more than 600 000 are non-smokers exposed to second-hand smoke (WHO, 2014). It is a major risk factor for at least two of the leading causes of premature mortality – circulatory disease and cancer – increasing the risk of heart attack, stroke, lung cancer, cancers of the larynx and mouth, and pancreatic cancer. Smoking is also an important contributory factor for respiratory diseases such as chronic obstructive pulmonary disease (COPD), while smoking among pregnant women can lead to low birth weight and illnesses among infants. It remains the largest avoidable risk to health in European countries.

    • Alcohol consumption among adults

      Alcohol related harm is a major public health concern in the European Union, both in terms of morbidity and mortality (Rehm et al., 2009; WHO Europe, 2012). Alcohol was the third leading risk factor for disease and mortality after tobacco and high blood pressure in Europe in 2012 and accounted for an estimated 7.6% of all men’s deaths and 4.0% of all women’s deaths, though there is evidence that women may be more vulnerable to some alcohol-related health conditions compared to men (WHO, 2014). High alcohol intake is associated with increased risk of heart, stroke and vascular diseases, as well as liver cirrhosis and certain cancers, but even moderate alcohol consumption increases the long term risk of developing such diseases. Foetal exposure to alcohol increases the risk of birth defects and intellectual impairments. Alcohol also contributes to death and disability through accidents and injuries, assault, violence, homicide and suicide, particularly among young people.

    • Use of illicit drugs among adults

      The use of illicit drugs is an important public health issue in Europe. Almost a quarter of adults in the European Union, or over 73 million people, have used illicit drugs at some points in their lives. In most cases, they have used cannabis, but some have also used cocaine, amphetamines, ecstasy and other drugs (EMCDDA, 2014). The use of illicit drugs, particularly among people who use them regularly, is associated with higher risks of cardiovascular diseases, mental health problems, accidents, as well as infectious diseases such as HIV when the drug is injected. Illicit drug use is a major cause of mortality among young people in Europe, both directly through overdose and indirectly through drug-related diseases, accidents, violence and suicide. More than 6 000 overdose deaths and 1 700 HIV/AIDS deaths were attributed to drug use in Europe in 2010 (EMCDDA, 2014).

    • Fruit and vegetable consumption among adults

      Nutrition is an important determinant of health. Inadequate consumption of fruit and vegetables is one factor that can play a role in increased morbidity. Proper nutrition assists in preventing a number of chronic conditions, including hypertension, cardiovascular disease, stroke, diabetes, certain cancers and musculoskeletal disorders. The 2007 EU Strategy on Nutrition, Overweight and Obesity-related Health Issues promotes a balanced diet and active lifestyle among all the population. The European Commission is monitoring progress in the consumption of fruit and vegetables as one of a number of ways to offset a worsening trend of poor diets and low physical activity (European Commission, 2013a).

    • Overweight and obesity among adults

      The growth in overweight and obesity rates among adults is a major public health concern. Obesity is a known risk factor for numerous health problems, including hypertension, high cholesterol, diabetes, cardiovascular diseases, and some forms of cancer. Because obesity is associated with higher risks of chronic illnesses, it is linked to significant additional health care costs.

    • Air pollution

      Air pollution increases the risk of various health problems (including of course respiratory diseases, but also lung cancer and cardiovascular diseases), with children and older people being particularly vulnerable. According to WHO estimates, nearly 500 000 deaths in Europe in 2012 were linked to exposure to outdoor air pollution (WHO, 2014).

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    • Doctors

      The number of doctors per capita varies widely across European countries. In 2012, Greece had, by far, the highest number, with 6.2 doctors per 1 000 population, nearly twice the EU average of 3.4. Following Greece was Austria, with 4.9 doctors per 1 000 population. The number of doctors per capita was also relatively high in Lithuania and Portugal (although the number reported in Portugal is an overestimation as it comprises all doctors licensed to practice, including some who may not be practising). The number of doctors per capita was lowest in Poland, Romania and Slovenia among EU member states ().

    • Consultations with doctors

      Consultations with doctors can take place in doctors’ offices or clinics, in hospital outpatient departments or, in some cases, in patients’ own homes. In many European countries (e.g., Denmark, Italy, the Netherlands, Portugal, the Slovak Republic, Spain and the United Kingdom), patients are required or given incentives to consult a general practitioner (GP) about any new episode of illness. The GP may then refer them to a specialist, if indicated. In other countries (e.g., Austria, the Czech Republic, Iceland and Luxembourg), patients may approach specialists directly.

    • Nurses

      Nurses play a critical role in providing health care not only in traditional settings such as hospitals and long-term care institutions, but increasingly in primary care (especially in offering care to the chronically ill) and in home care settings. However, there are concerns in many countries about shortages of nurses, and these concerns may well intensify in the future as the demand for nurses continues to increase and the ageing of the baby-boom generation precipitates a wave of retirements among nurses. These concerns have prompted many countries to increase the training of new nurses combined with efforts to increase retention rates in the profession, even as the economic crisis has squeezed health budgets.

    • Medical technologies: CT scanners and MRI units

      Recent advances in medical imaging technologies are improving diagnosis and treatment of diseases, but they are also increasing health spending. This section presents data on the availability and use of two diagnostic imaging technologies: computed tomography (CT) scanners and magnetic resonance imaging (MRI) units. CT scanners and MRI units help physicians diagnose a range of conditions by producing images of internal organs and structures of the body. Unlike conventional radiography and CT scanning, MRI exams do not expose patients to ionising radiation.

    • Hospital beds

      The number of hospital beds provides an indication of the resources available for delivering services to inpatients in hospitals. This section presents data on the total number of hospital beds, including those allocated for curative care, psychiatric care, long-term care and other types of care. It does not capture the capacity of hospitals to provide same-day emergency or elective interventions.

    • Hospital discharges

      Hospital discharge rates measure the number of patients who leave a hospital after staying at least one night. Together with the average length of stay, they are important indicators of hospital activities. Hospital activities are affected by a number of factors, including the demand for hospital services, the capacity of hospitals to treat patients, the ability of the primary care sector to prevent avoidable hospital admissions, and the availability of post-acute care settings to provide rehabilitative and long-term care services.

    • Average length of stay in hospitals

      The average length of stay in hospitals is often regarded as an indicator of efficiency. All other things being equal, a shorter stay will reduce the cost per discharge and shift care from inpatient to less expensive post-acute settings. However, shorter stays tend to be more service intensive and more costly per day. Too short a length of stay could also cause adverse effects on health outcomes, or reduce the comfort and recovery of the patient. If this leads to a greater readmission rate, costs per episode of illness may fall only slightly, or even rise.

    • Cardiac procedures

      Heart diseases are a leading cause of hospitalisation and death in European countries (see ). Coronary artery bypass graft and angioplasty have revolutionised the treatment of ischemic heart diseases in the past few decades. A coronary bypass is an open-chest surgery involving the grafting of veins and/or arteries to bypass one or multiple obstructed arteries. A coronary angioplasty is a much less invasive procedure involving the threading of a catheter with a balloon attached to the tip through the arterial system to distend the coronary artery at the point of obstruction; the placement of a stent to keep the artery open accompanies the majority of angioplasties.

    • Cataract surgeries

      In the past two decades, the number of surgical procedures carried out on a same-day basis, without any need for hospitalisation, has grown in European countries. Advances in medical technologies, particularly the diffusion of less invasive surgical interventions, and better anaesthetics have made this development possible. These innovations have also improved patient safety and health outcomes for patients, and have in many cases reduced the unit cost per intervention by shortening the length of stay in hospitals. However, the impact of the rise in same-day surgeries on health spending depends not only on changes in their unit cost, but also on the growth in the volume of procedures performed. There is also a need to take into account any additional cost related to post-acute care and community health services following the interventions.

    • Hip and knee replacement

      Significant advances in surgical treatment have provided effective options to reduce the pain and disability associated with certain musculoskeletal conditions. Joint replacement surgery (hip and knee replacement) is considered the most effective intervention for severe osteoarthritis, reducing pain and disability and restoring some patients to near normal function.

    • Pharmaceutical consumption

      Growth in pharmaceutical spending slowed down or was negative in many European countries in recent years, due mainly to price reductions and a growing share of the generic market (see Pharmaceutical expenditure). However, the overall quantities of pharmaceuticals consumed have often continued to increase, partly driven by growing demand for drugs to treat ageing-related and chronic diseases.

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  • Expand / Collapse Hide / Show all Abstracts Quality of care

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    • Avoidable hospital admissions

      Most health systems have developed a primary level of care whose functions include managing new health complaints that pose no immediate threat to life, managing long term conditions and supporting the patient in deciding when referral to hospital-based services are necessary. A key aim is to keep people well, by providing a consistent point of care over the longer term, tailoring and co-ordinating care for those with multiple health care needs and supporting the patient in self-education and self-management.

    • Prescribing in primary care

      Beyond consumption and expenditure (see Pharmaceutical consumptionPharmaceutical expenditure), information on prescribing can be used as an indicator of health care quality. This section includes an indicator on prescribing in primary care, in order to develop a more comprehensive picture of quality in the sector. Two related indicators are shown: the total volume of antibiotics and the volume of quinolones and cephalosporins as a proportion of all antibiotics, prescribed in primary care.

    • Mortality following acute myocardial infarction

      Mortality due to coronary heart disease has declined substantially since the 1970s (see Mortality from heart disease and stroke). This reduction can, in part, be attributed to better treatments, particularly in the acute phases of myocardial infarction (AMI). Care for AMI has changed dramatically in recent decades, with the introduction of coronary care units and treatments aimed at rapidly restoring coronary blood flow. Clinical practice guidelines, such as those developed by the European Society of Cardiology, provide clinicians with information on how to optimise treatments and studies have shown that greater compliance with guidelines improve health outcomes. However, some AMI patients do not receive recommended care, raising concerns over the quality of care in some countries.

    • Mortality following stroke

      Cerebrovascular disease was the underlying cause for about 11% of all deaths in EU countries in 2011 (Mortality from heart disease and stroke). Ischemic stroke represents around 85% of all cerebrovascular disease cases. It occurs when the blood supply to a part of the brain is interrupted, leading to a necrosis (i.e. the cells that die) of the affected part. Treatment for ischemic stroke has advanced dramatically over the last decade. Clinical trials have demonstrated clear benefits of thrombolytic treatment for ischemic stroke as well as receiving care in dedicated stroke units to facilitate timely and aggressive diagnosis and therapy for stroke victims.

    • Procedural or postoperative complications

      Patient safety remains one of the most prominent issues in health policy and public debate. The European Commission estimates that without any policy changes, there are likely to be 10 million adverse events related to hospitalisations (including infection-related ones) in the European Union per year, of which almost 4.4 million would be preventable (European Commission, 2008). The European Union Network for Patient Safety and Quality of Care, PaSQ Joint Action, was launched in 2012 to create a permanent platform for future co-operation between member states in the area of patient safety and quality of care.

    • Screening, survival and mortality for cervical cancer

      Cervical cancer is highly preventable if precancerous changes are detected and treated before progression occurs. The main cause of cervical cancer, which accounts for approximately 95% of all cases, is sexual exposure to the human papilloma virus (HPV). In 2012, 34 000 new cervical cancers are diagnosed in Europe (IARC, 2012). The 2014-16 Comprehensive Cancer Control Joint Action has the objectives to identify key elements and quality standards for cancer control in Europe in order to reduce incidence by 15% by 2020. Countries follow different policies with regards to the prevention and early diagnosis of cervical cancer. About half of EU countries have cervical cancer screening organised through population-based programmes but the periodicity and target groups vary.

    • Screening, survival and mortality for breast cancer

      Breast cancer is the most prevalent form of cancer among women, with 367 000 new cases diagnosed each year in Europe (IARC, 2012). Risk factors that increase a person’s chance of getting this disease include, but are not limited to, age, family history of breast cancer, oestrogen replacement therapy, lifestyle, nutrition and alcohol. Variation in breast cancer care across European countries is indicated by mammography screening rates in women aged 50-69 years, relative survival, and mortality rates.

    • Screening, survival and mortality for colorectal cancer

      Colorectal cancer is the third most commonly diagnosed form of cancer worldwide, after lung and breast cancers, with 345 000 new cases diagnosed in the European Union in 2012. Incidence rates are significantly higher for males than females (IARC, 2012). There are several factors that place certain individuals at increased risk for the disease, including age, the presence of polyps, ulcerative colitis, a diet high in fat and genetic background. The disease is more common in Europe and the United States, and is rare in Asia. But in countries where people have adopted western diets, such as Japan, the incidence of colorectal cancer is increasing.

    • Childhood vaccination programmes

      Vaccination programmes are among the safest and most effective public health interventions to provide protection against diseases such as diphtheria, tetanus and pertussis, measles and hepatitis B. All EU member countries have established vaccination schedules, recommending the vaccines to be given at various ages during childhood. Although there is strong evidence that childhood vaccines are highly cost-effective health care intervention, too many children in Europe go unvaccinated and remain vulnerable to these potentially life-threatening diseases. Notably, children from disadvantaged socio-economic groups such as Roma migrants have a lower likelihood of receiving vaccination, which calls for actions to design more effective vaccination strategies.

    • Influenza vaccination for older people

      Influenza is a common infectious disease that affects between 5 and 15% of the population each year (WHO, 2014). Most people with the illness recover quickly, but elderly people and those with chronic medical conditions are at higher risk of complications and even death. Influenza can also have a major impact on the health care system. In the United Kingdom, an estimated 779 000 general practice consultations and 19 000 hospital admissions were annually attributable to influenza (Pitman et al., 2006).

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  • Expand / Collapse Hide / Show all Abstracts Access to care

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    • Coverage for health care

      Health care coverage enables access to medical goods and services and provides financial protection against unexpected or serious illness (European Commission, 2014). While the share of the population covered by a public or private health insurance provides some indication of financial protection, this is not a complete indicator of accessibility, since the range of services covered and the degree of cost-sharing applied to those services vary across countries and will impact on direct out-of-pocket expenditure by patients (). Ensuring effective access to health care also requires having a sufficient number of health care providers in different geographic regions in the country () and that patients do not have to wait excessively long times to receive services ().

    • Out-of-pocket medical expenditure

      Financial protection through either public coverage or private health insurance can substantially reduce the amount that people pay directly for medical care. In some countries, the burden of high out-of-pocket spending can create barriers to accessing and using health care services: households that face difficulties paying medical bills may delay or even forgo needed health care. On average across EU member states, a fifth of all health spending is paid directly by patients (see Financing of health care).

    • Geographic distribution of doctors

      Access to medical care requires an adequate number and proper distribution of physicians in all parts of the country. Shortages of physicians in certain regions can increase travel times or waiting times for patients, and result in unmet care needs. The uneven distribution of physicians is an important concern in most European countries, especially in those countries with remote and sparsely populated areas, and those with deprived urban regions which may also be underserved.

    • Unmet health care needs

      All European countries endorse equity of access to health care for all people as an important policy objective. One method of gauging to what extent this objective is achieved is through assessing reports of unmet needs for health care. The problems that people report in obtaining care when they are ill or injured often reflect significant barriers to care.

    • Waiting times for elective surgery

      Long waiting times for health services is an important policy issue in many European countries (Siciliani et al., 2013a). Long waiting times for elective (non-emergency) surgery generates dissatisfaction for patients because the expected benefits of treatments are postponed, and the pain and disability remains.

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  • Expand / Collapse Hide / Show all Abstracts Health expenditure and financing

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    • Health expenditure per capita

      There are large variations in the levels and rates of growth of health spending across Europe. How much a country spends on health and the rate at which this expenditure grows reflect a wide array of economic and social factors, as well the financing and organisational structures of its health system.

    • Health expenditure in relation to GDP

      In 2012, EU member states devoted an (unweighted) average of 8.7% of their GDP to health spending (), up significantly from 7.3% in 2000. A peak of 9.0% was reached in 2009 following the economic crisis which started in many countries in mid-2008. In many countries, public spending on health was maintained in the immediate aftermath of the crisis while GDP fell, but this was followed in 2010 and 2011 by a range of measures to rein in government health spending as part of broader efforts to reduce budgetary deficits.

    • Health expenditure by function

      Spending on inpatient care and outpatient care covers the major part of health expenditure across EU member states – almost two-thirds of current health expenditure on average in 2012 (). A further quarter of overall health spending was allocated to medical goods (mainly pharmaceuticals), while 10% went towards long-term care and the remaining 6% to collective services, including public health and prevention services and administration.

    • Pharmaceutical expenditure

      Spending on pharmaceuticals accounted for almost a fifth of all health expenditure on average across EU member states in 2012, making it the third largest spending component after inpatient and outpatient care.

    • Financing of health care

      Across all European countries, health care is financed by a mix of public and private spending. In some countries, public health spending is generally confined to spending by the government using general revenues. In others, social insurance funds finance the bulk of health expenditure. Private financing of health care consists mainly of payments by households (either as standalone payments or as part of co-payment arrangements) as well as various forms of private health insurance intended to replace, complement or supplement publicly-financed coverage.

    • Trade in health services

      The globalisation of health care has given rise to new patterns of consumption and production of health care services over recent decades. A significant new element of the trade in health care has involved the movement of patients across borders in the pursuit of medical treatment: a phenomenon commonly termed medical tourism. This growth has been fuelled by a number of factors. Technological advances in information systems and communication allow patients or purchasers of health care to seek out quality treatment at lower cost and/or more immediately from health care providers in other countries. The portability of health coverage, as a result of EU-wide measures to facilitate patient flows with regard to public health insurance systems, may also fuel further increases. All this is coupled with a general increase in the temporary movement of populations for business or leisure.

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