• Health care that is safe, effective, timely, efficient and patient-centred relies on the right information reaching the right person (or organisation) at the right time. A digitalised information infrastructure that ensures timely and reliable sharing of clinical and other information can improve health outcomes and efficiency, and also create a repository of valuable data for researchers and system managers (OECD, 2017). Enabling people to access, and interact with, their electronic medical record (EMR) is an important feature that can help people become more involved in their health and their care.

  • Access to the internet among Europeans is rising (85% of EU households had internet access in 2016) and people are increasingly going on line to access information and interact with the provider of different services. Health is no exception. The amount of information regarding health and illness available on line is growing, as are the opportunities of interacting with health care providers electronically, for example to make medical appointments. Digital technologies can improve patient experience and outcomes, and the efficiency of services, but some may generate minimal benefit (at a considerable expense), and protecting individuals’ privacy is a frequent problem and a policy priority (OECD, 2017). While online medical information can be a useful way to help people manage their health, regulation is difficult and many people are not in a position to check the veracity of this type of information.

  • Infectious diseases and resistance to antibiotics are global public health threats. Resilient health systems depend on the ability to detect emerging diseases accurately in time to stop outbreaks and avert major international crises such as the recent Ebola epidemic (Albiger, 2018). Public health preparedness requires adequate capacity of microbiology laboratories to: 1) ensure rapid infection diagnostics to guide treatment, detect and control epidemics; 2) characterise infectious agents for designing effective vaccines and control measures; and 3) monitor the impact of prevention of infections and containment of antimicrobial resistance (AMR).

  • The average length of stay in hospital is often regarded as an indicator of efficiency in health service delivery. All else being equal, a shorter stay will reduce the cost per discharge and shift care from inpatient to less expensive settings. Longer stays can be a sign of poor care coordination, resulting in some patients waiting unnecessarily in hospital until rehabilitation or long-term care can be arranged (see the discussion on delayed discharges in ). At the same time, some patients may be discharged too early, when staying in hospital longer could have improved their health outcomes or reduced chances of re-admission.

  • Day surgery has expanded in EU countries over the past few decades, thanks to progress in surgical techniques and anaesthesia, although the pace of diffusion has varied widely across countries.

  • While the health sector remains highly labour-intensive, capital investment in infrastructure and medical equipment has been an increasingly important factor of production of health services in recent decades, as reflected for example by the growing importance of diagnostic and therapeutic devices or the expansion of information and communications technology (ICT) in health care (see the indicator on the adoption and use of Electronic Medical Records and ePrescribing). However, the level of resources invested in buildings, machinery and technology tends to fluctuate more than current spending on health services, often responding to the economic climate whereby investment decisions may be postponed or brought forward.

  • Despite a dramatic slowdown in spending on health and long-term care in many EU member states following the 2008 economic and financial crisis, more recent estimates show that spending is back on an upward path. Since, on average, around three-quarters of health spending is financed out of public sources, this represents a sizeable share of government spending, meaning that growth in health and long-term care spending can have a considerable impact on a country’s budgetary position. In addition, ageing populations will continue to exert pressures on health and long-term care spending while at the same time reducing the size of the working-age population able to finance such expenditures, thereby raising concerns around the fiscal sustainability of health and long-term care systems (OECD, 2015).