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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Health at a Glance: Europe 2016

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Health at a Glance: Europe 2016

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23 Nov 2016
9789264265592 (PDF) ; 9789264265646 (EPUB) ;9789264265585(print)

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This fourth edition of Health at a Glance: Europe presents key indicators of health and health systems in the 28 EU countries, 5 candidate countries to the EU and 3 EFTA countries. This 2016 edition contains two main new features: two thematic chapters analyse the links between population health and labour market outcomes, and the important challenge of strengthening primary care systems in European countries; and a new chapter on the resilience, efficiency and sustainability of health systems in Europe, in order to align the content of this publication more closely with the 2014 European Commission Communication on effective, accessible and resilient health systems. This publication is the result of a renewed collaboration between the OECD and the European Commission under the broader "State of Health in the EU" initiative, designed to support EU member states in their evidence-based policy making.


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  • Foreword

    Ensuring universal access to quality care demands greater efforts to improve the effectiveness, accessibility and resilience of health systems in all EU countries. This new edition of Health at a Glance: Europe stresses that more should be done to improve the health of populations in EU countries and, in particular, to reduce inequalities in access and quality of services. This is necessary to achieve more inclusive economic growth and to deliver on the Sustainable Development Goals (SDGs), in particular SDG 3 to ensure healthy lives and promote well-being for all at all ages.

  • Executive summary

    Life expectancy across EU member states has increased by more than six years since 1990, rising from 74.2 years in 1990 to 80.9 years in 2014, yet inequalities persist both across and within countries. People in Western European countries with the highest life expectancy continue to live over eight years longer, on average, than people in Central and Eastern European countries with the lowest life expectancy. Within countries, large inequalities in health and life expectancy also persist between people with higher levels of education and income and the more disadvantaged. This is largely due to different exposure to health risks, but also to disparities in access to high-quality care.

  • Readers' guide

    Health at a Glance: Europe 2016 presents key indicators of health and health systems in 36 European countries, including the 28 European Union member states, five candidate countries and three European Free Trade Association countries.

  • The labour market impacts of ill-health

    This chapter looks at the labour market impacts of chronic diseases and related behavioural risk factors, including obesity, smoking, and harmful alcohol consumption. Chronic diseases lead to the premature death of more than 550 000 people aged 25 to 64 each year across EU countries, resulting in the loss of some 3.4 million potential productive life years. Chronic diseases such as cardiovascular diseases, respiratory problems, diabetes, and serious mental health problems also have important labour market impacts for people living with these conditions: reduced employment, earlier retirement, and lower income. Using the latest data from the SHARE survey (Survey of Health, Ageing and Retirement in Europe), this chapter shows that the employment rate of people aged 50-59 who have one or more chronic diseases is lower than that of people who do not suffer from any disease. The same is true for people who are obese, smokers, or heavy alcohol drinkers. The labour market impacts of mental health problems such as depression are also large: across European countries, people aged 50-59 suffering from severe depression are more than two times more likely to leave the labour market early. The burden of ill‑health on social benefit expenditures is huge: 1.7% of GDP is spent on disability and paid sick leave each year on average in EU countries, more than what is spent on unemployment benefits. Greater efforts are needed to prevent chronic diseases among the working-age population, and better integration is needed between health and labour market policies to reduce the detrimental labour market impacts of ill‑health, and thus contribute to better lives and more inclusive economies.

  • Strengthening primary care systems

    The demand for health care is evolving rapidly in EU countries in a context of population ageing and the growing number of people living with one or more chronic conditions. To meet the challenge of these demographic and epidemiological shifts, EU health systems need to strengthen primary care systems to provide continuous, comprehensive, and co-ordinated care for their populations.This chapter looks at the organisation and provision of primary care across EU countries. It uses a number of indicators to measure access to primary care and its effectiveness and quality, either directly through indicators such as pharmaceutical prescribing quality or indirectly through potentially avoidable hospital admissions. The chapter identifies possible policy options that countries could consider to strengthen their primary care systems, drawing lessons from the recent series of OECD Reviews of Health Care Quality and other relevant OECD work. This chapter shows that some countries, such as Denmark and the Netherlands, generally perform relatively well on several indicators related to access to and quality of primary care. All EU countries, particularly those in Central and Eastern Europe, need to pursue comprehensive reforms to strengthen their primary care system to better address the needs of ageing populations and reduce the unnecessary use of hospital care.

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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 EU countries, rising on average by 3 months each year. These gains in longevity can be attributed to a number of factors, including improved education, socio-economic conditions and lifestyle, as well as progress in health care.

    • 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 combined with 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 this registration process 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 across EU countries in 2013. They cover a range of diseases related to the circulatory system, including ischemic heart diseases (which includes heart attacks) and cerebrovascular diseases (or strokes). Together, ischemic heart diseases and strokes comprise around 60% of all cardiovascular deaths, and caused more than one-fifth of all deaths in EU member states in 2013.

    • Mortality from cancer

      Cancer is the second leading cause of mortality in EU member states after cardiovascular diseases, accounting for 26% of all deaths in 2013. More than 1 300 000 people died of cancer in 2013 across the 28 EU countries. Cancer mortality rates were lowest in Cyprus, Finland, Sweden and Spain, with rates at least 10% lower than the EU average. They were highest in Hungary, Croatia, the Slovak Republic, Slovenia and Denmark, with rates at least 10% higher than the EU average ().

    • Mortality from respiratory diseases

      Mortality from respiratory diseases is the third main cause of death in EU countries, accounting for 8% of all deaths in 2013. More than 400 000 people died from respiratory diseases in 2013, mainly from chronic obstructive pulmonary disease and pneumonia, but also from asthma, influenza and other diseases.

    • Suicide

      Suicide is a significant cause of death in many EU member states. Approximately 60 000 people committed suicides in 2013 across all EU countries. Suicide rates vary widely across countries, with the lowest rates in Southern European countries – Greece, Malta, Cyprus and Italy – as well as in the United Kingdom, and the highest rates in Lithuania, followed by Slovenia, Hungary and Latvia (). There is an eight-fold difference between Lithuania and Cyprus, the countries with the highest and lowest death rates from suicides. The high suicide rates in Lithuania are driven by exceptionally high rates among men, which are six times higher than among women. These very high rates of suicide are associated with a range of factors, including high levels of psychological and social insecurity, and high rates of addictions to alcohol and illegal drugs.

    • Infant and child 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, particularly in addressing any life-threatening problem during the neonatal period (i.e. during the first four weeks).

    • 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).

    • Notified cases of vaccine-preventable diseases

      Communicable diseases such as measles, pertussis, hepatitis B and many others still pose major threats to the health of European citizens (ECDC, 2016a). 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 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 indicator Childhood vaccination programme in ).

    • New reported cases of HIV, tuberculosis, and sexually-transmitted infections

      HIV remains a major public health issue in Europe, with more than 500 000 people living with HIV infection in the EU countries in 2014 and continued transmission increasing this number. In 2014, nearly 30 000 people were newly-diagnosed with HIV infection in EU countries. Estonia had the highest rate of new cases (22.1 per 100 000 population), followed by Latvia and Luxembourg. Since 2000, the main transmission route in Estonia has been the sharing of contaminated needles among drug users, along with increases in sexual transmission (ECDC and WHO Regional Office for Europe, 2015). The lowest rates were in the Slovak Republic, Croatia, the Czech Republic and Slovenia. In total across EU countries, about six new cases of HIV infection were diagnosed per 100 000 population in 2014 (). More than three-quarters of these cases were among men. The predominant mode of transmission of HIV was through men having sex with men (42%), followed by heterosexual contact (33%). As already noted for Estonia, drug use through injections is also a frequent mode of transmission in some countries.

    • Cancer incidence

      In 2012 (latest year available), 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

      Diabetes is a chronic disease characterised by high levels of glucose in the blood. It occurs either because the pancreas stops producing the insulin hormone (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 higher risks for sight loss, foot and leg amputation due to damage to the nerves and blood vessels, and renal failure requiring dialysis or transplantation.

    • Asthma and COPD prevalence

      Asthma is a disease of the bronchial tubes characterised by wheesing during breathing, shortness of breath or coughing. Asthma is the single most important chronic disease among children, and also affects many adults. It is a significant public health problem for which prevention is partly possible and treatment can be effective. Its causes are not well understood, but effective medicines are available to help in maintaining quality of life.

    • 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. Alzheimer’s disease is the most common form of dementia, representing about 60% to 80% of cases. There is currently no cure or disease-modifying treatment, but better policies can improve the lives of people with dementia by helping them and their families adjust to living with the condition and ensuring that they have access to high quality health and social care.

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

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    • Smoking among children

      Smoking in adolescence has both immediate and long-term health consequences. Children who establish smoking habits early on increase their risk of cardiovascular diseases, respiratory illnesses and cancer (Currie et al., 2012). Daily cigarette smoking in adolescence is associated with an increase in likelihood of diagnoses of anxiety and mood disorders (USDHHS, 2012). Young smokers experience lower physical fitness in terms of performance and endurance, with reduced lung growth and higher resting heart rates. They are also more likely to experiment with alcohol and other drugs. One of the most significant effects of adolescent smoking is nicotine addiction, which keeps young smokers smoking longer, increasing their risk of adverse health effects.

    • Smoking among adults

      Tobacco consumption is the largest avoidable health risk in the European Union and is the most significant cause of premature death, with nearly 700 000 per year (European Commission, 2014a). Around 50% of smokers die prematurely (14 years earlier on average). 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.

    • Alcohol consumption among children

      Adolescent alcohol use is a major health concern in many European countries. Early and frequent drinking or drunkenness is associated with negative psychological, social and physical health issues, such as violence, accidents, injury and use of other substances (Inchley et al., 2016). Alcohol use has been shown to affect learning performance. Binge drinking, as well as high frequency of drinking, reduce achievement scores. Alcohol consumption also reduces attendance and increases probability of having difficulty in school or dropping out without having graduated (Balsa et al., 2011; Chatterji et al., 2005).

    • Alcohol consumption among adults

      Alcohol-related harm is a major public health concern in the European Union, both in terms of morbidity and mortality (WHO Europe, 2012; OECD, 2015). 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.

    • Overweight and obesity among children

      Children who are overweight or obese are at a greater risk of poor health in adolescence as well as in adulthood. Among young people, psychosocial problems such as poor self-esteem, eating disorders and depression can result from being obese. Excess weight problems in childhood are associated with an increased risk of being an obese adult, at which point cardiovascular disease, as well as pulmonary and musculoskeletal complications, become health concerns (Inchley et al., 2016).

    • Overweight and obesity among adults

      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.

    • Fruit and vegetable consumption among children

      Nutrition is important for children’s development and long-term health. Eating fruit and vegetables during childhood, rather than foods high in fat, sugar and salt, can protect against health problems such as obesity, diabetes and cardiovascular diseases. Moreover, eating fruit and vegetables when young can be habit-forming, promoting healthy eating in adult life.

    • 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 and certain cancers. The 2007 EU Strategy on Nutrition, Overweight and Obesity-related Health Issues promotes a balanced diet and active lifestyle among all the population. The WHO recommends adults consume five portions (400g) of fruit and vegetables daily, excluding starches.

    • Physical activity among children

      Undertaking physical activity during childhood is beneficial for health and can set standards for adult physical activity levels, thereby influencing health outcomes later in life. Research suggests that physical activity has a role in child and adolescent development, learning and well-being, and in the prevention and treatment of a range of youth health issues including asthma, mental health and bone health. More direct links to adult health are found between physical activity in childhood and its effect on overweight and obesity and related diseases, breast cancer rates and bone health in later life (Currie et al., 2012).

    • Physical activity among adults

      Physical inactivity is a risk factor for cardiovascular disease, as well as a number of other chronic diseases including diabetes, certain types of cancer, obesity and hypertension (Knight, 2012). Regular physical activity improves chances of living longer, strengthens bones and muscles, helps control body weight and improves mental health and mood. It has also been shown to have positive effects on symptoms of anxiety and clinical depression (Anderson et al., 2013; Richardson et al., 2005).

    • Use of illicit drugs among adults

      The use of illicit drugs remains an important public health issue in Europe. Over a quarter of adults in the European Union aged 15-64, or over 88 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, 2016). 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 an important cause of mortality among young people in Europe, both directly through overdose and indirectly through drug-related diseases, accidents, violence and suicide.

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

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    • Health expenditure per capita

      How much a country spends on health and the rate at which that spending grows can be the result of a wide array of social and economic factors, as well as the financing and organisational structures of a country’s health system. At the same time, there is a strong relationship between the overall income level of a country and how much the population of that country will spend on health.

    • Health expenditure in relation to GDP

      The amount a country spends on health care in relation to all the other goods and services in the economy depends on growth in health spending itself as well as in the economy as a whole.

    • Health expenditure by function

      Spending on inpatient care and outpatient care combined covers the major part of health expenditure across EU member states – almost two-thirds of current health expenditure in the European Union in 2014 (). A further 19% of overall EU health spending was allocated to medical goods (mainly pharmaceuticals), while 15% went towards long-term care and the remaining 7% to collective services, such as public health and prevention services as well as administration.

    • Pharmaceutical expenditure

      Pharmaceuticals play a vital role in the health system and policy makers must balance the access of patients to new effective medicines, while providing the right incentives to manufacturers to go on developing new generations of drugs. At the same time, health care budgets are limited. After inpatient and outpatient care, pharmaceuticals represent the third largest expenditure item of health care spending and accounted for around a sixth of health expenditure in the European Union in 2014, not taking into account spending on pharmaceuticals in hospitals.

    • Financing of health care

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

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  • Expand / Collapse Hide / Show all Abstracts Effectiveness and quality of care

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    • Avoidable mortality (preventable and amenable)

      Improving public health and the performance of health care systems is a key priority across EU countries. One approach to assess the general effectiveness of public health programmes and health care policies, in achieving their objective of improving health outcomes, is through measuring potentially avoidable mortality. This term refers to deaths that might either be avoided through effective preventive strategies or through the provision of high-quality care. Better prevention and health care policies should be reflected in lower numbers of both preventable deaths and deaths amenable to health care.

    • Avoidable hospital admissions

      Most health systems have developed a primary level of care whose functions include health promotion, disease prevention, managing new health issues, managing chronic conditions, and referring patients to hospital-based services when appropriate (see ). This primary level serves as a consistent point of care for patients and provides continuity in health management including chronic disease management. As rates of chronic conditions rise across EU countries, managing these conditions at the primary level becomes increasingly important to improve health outcomes and control costs.

    • Prescribing in primary care

      Beyond consumption and expenditure information (see ), prescribing can be used as an indicator of health care quality. Antibiotics, for example, should be prescribed only where there is an evidence-based need, to reduce the risk of resistant bacteria. Quinolones and cephalosporins are considered second-line antibiotics in most prescribing guidelines and their use should be restricted in order to ensure their availability, should first‑line antibiotics fail. The total volume of antibiotics prescribed and the proportion of second-line antibiotics prescribed have been validated as markers of quality in the primary care setting. In the context of rising antibiotic resistance, the European Commission has requested that the ECDC develop draft EU guidelines on the prudent use of antimicrobials in human medicine.

    • Mortality following acute myocardial infarction (AMI)

      Mortality due to coronary heart disease has declined substantially since the 1970s (see indicator Mortality from heart disease and stroke in ). Smoking reduction (see indicator Smoking among adults in ) and improvements in treatment of cardiovascular diseases have played a large role in this decline (OECD, 2015) along with changes in diet and exercise. Clinical practice guidelines such as those developed by the European Society of Cardiology have also helped optimise treatment. Despite these advances, AMI (or heart attack) remains the leading cause of cardiovascular deaths across EU countries, making further improvements a priority.

    • Mortality following stroke

      Annually, 15 million people worldwide suffer a stroke leading to 5 million deaths and 5 million people permanently disabled (WHO, 2016). Ischemic stroke represents around 85% of all cerebrovascular disease cases. Ischemic stroke occurs when the blood supply to a part of the brain is interrupted, leading to a necrosis (i.e. cell death) of the affected region. 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 (Seenan et al., 2007).

    • 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 is the human papilloma virus (HPV) which accounts for approximately 95% of all cases (IARC, 2005).

    • Screening, survival and mortality for breast cancer

      Breast cancer is the most prevalent form of cancer in women across EU countries. One in nine women will develop breast cancer at some point in their life and one in thirty will die from the disease. Risk factors that increase a person’s chance of getting this disease include age, family history of breast cancer, genetic predisposition, reproductive factors, oestrogen replacement therapy, and lifestyles-related factors including obesity, physical inactivity, diet, and alcohol consumption.

    • Survival and mortality for colorectal cancer

      Colorectal cancer is the third most commonly diagnosed form of cancer among men after prostate and lung cancers and the second most common form among women (after breast cancer) across EU countries. Incidence varies greatly across the EU region from over 40 cases per 100 000 population in the Slovak Republic, Hungary, Denmark and the Netherlands to less than half this rate in Greece. Several risk factors exist including age, ulcerative colitis, a personal or family history of colorectal cancer or polyps, along with lifestyle factors such as a high‑fat, low‑fibre diet, lack of physical activity, obesity, tobacco use and alcohol consumption.

    • Healthcare-associated infections

      Each year in the European Union, over 4 million patients acquire a healthcare-associated infection (HAI). These infections are estimated to contribute to roughly 110 000 deaths across Europe, along with substantial morbidity and cost for health systems (ECDC, 2016a).

    • Childhood vaccination programmes

      All EU countries have established vaccination programmes based on the appraisal of the epidemiology of diseases and the availability of vaccines which have been proven to be safe and effective for prophylactic use. Measles, diphtheria and pertussis are highly infectious diseases spread through human contact while tetanus is often acquired through a wound or skin puncture. Effective vaccination is available for all of these diseases and usually managed by the primary health care system (see ). These vaccines are part of larger childhood vaccinations efforts across the European Union.

    • Influenza vaccination for older people

      Influenza is a common infectious disease affecting 5‑10% of adults and 20-30% of children. Seasonal influenza causes 4-50 million symptomatic cases in the UE/EEA each year, and 15 000-70 000 European citizens die every year of causes associated with influenza (ECDC, 2016). Epidemics of influenza can result in high rates of worker absenteeism and place high demands on health systems from increases in medical visits, hospitalisations, and medication usage including antibiotics. Vaccination has proven to be an effective tool in reducing the burden of seasonal influenza and is usually managed at the primary level of health care (see ). Older people are at high risk for serious illness from influenza and WHO recommends vaccination in this group. A review of vaccination drivers and barriers found that among elderly populations, personalised postcards or phone calls were effective in increasing vaccination coverage while barriers included social disadvantage, smoking, and lack of social support (ECDC, 2013). In addition to older people, the European Council recommends influenza vaccination for persons with chronic medical conditions and health care workers. Along with these groups, WHO recommends influenza vaccination also for pregnant women and children.

    • Late-diagnosed HIV and tuberculosis treatment outcomes

      Along with a growing prevalence of chronic diseases, management of infectious diseases such as Human Immunodeficiency Virus (HIV) and Tuberculosis remains a priority in many EU countries.

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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. 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.

    • 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 often reflect significant barriers to care.

    • Out-of-pocket medical expenditure

      Financial protection through public or private health insurance substantially reduces the amount that people pay directly for medical care, yet in some countries the burden of out-of-pocket spending can still create barriers to health care access and use: households that face difficulties paying medical bills may delay or even forgo needed health care. In the European Union, 15% of health spending is paid directly by patients, but large differences exist between member states (see indicator Financing of health care in ).

    • Doctors

      Access to medical care requires an adequate number of doctors, with a proper mix between generalists and specialists and a proper distribution in all parts of the country.

    • Nurses

      In all countries, nurses are the most numerous health professional group. Nurses play a critical role in providing access to 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. There are concerns in many countries about current or future shortages of nurses, particularly as the demand for nurses is expected to continue to increase with ageing populations while the ageing of the baby boom generation of nurses itself is expected to lead to the retirement of many nurses in the coming years. However, many countries have already anticipated this wave of retirement by increasing the training of new nurses, combined with efforts to increase retention rates in the profession (OECD, 2016).

    • 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 EU countries (e.g. Denmark, Italy, the Netherlands, Portugal, the Slovak Republic and Spain), 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, patients may approach specialists directly.

    • Medical technologies: CT scanners and MRI units

      Recent advances in medical imaging technologies are improving diagnosis of a wide range of diseases, but also involve substantial costs in purchasing the equipment and using it. 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, rehabilitative 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 payment and reimbursement systems, 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.

    • Cardiac procedures

      Heart diseases are a leading cause of hospitalisation and death in European countries (see indicator on mortality from heart diseases and stroke in ). 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.

    • Hip and knee replacement

      Significant advances in surgical treatments 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.

    • Waiting times for elective surgery

      Long waiting times for elective (non-emergency) surgery are an important policy issue in many European countries as they generate dissatisfaction for patients because the expected benefits of treatments are postponed, and the pain and disability remain while waiting. Whereas long waiting times are considered an important policy issue in many countries, this is not the case in others (e.g. Belgium, France, Germany, Luxembourg).

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  • Expand / Collapse Hide / Show all Abstracts Resilience, efficiency and sustainability of health systems

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    • eHealth adoption in general practice and in hospitals

      Demographic change, rising chronic disease and multi-morbidity, along with fiscal pressures, are challenging the medium- and long-term sustainability of European health systems. In order to meet these challenges, health services must become more effective and efficient. Health care is an information-intensive endeavour, and adoption of digital technology and eHealth (see definition in the box below) can enable such improvement. While health system digitalisation is complex, and can be costly, the potential longer-term benefits in promoting efficiency gains must also be considered. These include improved quality of care, better planning and resource allocation, and enhancing the evidence base for health service delivery and policy making.

    • Capital expenditure in the health sector

      Although health systems remain a highly labour-intensive sector, capital has been an increasingly important factor of production of health services over recent decades, as reflected for example by the growing importance of diagnostic and therapeutic equipment or the expansion of information and communications technology (ICT) in health care (see previous indicator on eHealth adoption in general practice and hospitals). However, the level of resources invested in infrastructure, equipment and ICT tends to fluctuate more with economic cycles than current spending on health services, as investment decisions are often more discrete and can more easily be postponed or brought forward depending on economic circumstances.

    • Share of generic market for pharmaceuticals

      All EU countries see the development of generic markets as a good opportunity to increase efficiency in pharmaceutical spending, but many do not fully exploit the potential of generics (). In 2014, generics accounted for more than 70% of the volume of pharmaceuticals sold in the United Kingdom, Germany, the Netherlands and the Slovak Republic, while they represented less than 20% of the market in Luxembourg, Italy and Greece.

    • Ambulatory surgery

      The number of surgical procedures carried out on a same-day basis has increased markedly in EU countries over the past few decades. Advances in medical technologies, particularly the diffusion of less invasive surgical interventions and better anaesthetics, have made this development possible. These innovations have improved patient safety and health outcomes, and have also 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 these interventions.

    • Average length of stay in hospital

      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 may 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.

    • Medical and nursing graduates

      One of the main policy levers that countries can use to adjust the supply of health workers to projected demand is to change the number of students admitted to medical, nursing and other health-related education programmes. However, the effect of these policies are not felt immediately, as it takes several years to train new doctors (about 8‑10 years) and nurses (about three years for general nurses going to university).

    • Projections of public expenditure on health and long-term care

      Health and long-term care expenditure in EU member states has increased rapidly up until the 2008 economic and financial crisis. At the same time, three-quarters of health spending on average is financed from public sources. Given that health and long-term care expenditure represents a sizeable share of government spending, it is often difficult to exempt it from any comprehensive budgetary consolidation efforts. In many countries, there are concerns that ageing populations may lead to growing health and long-term care spending while at the same time reducing the share of the working-age population to finance these public spending, creating pressures around the fiscal sustainability of health and long-term care systems (OECD, 2015).

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