health at a glance europe 2018 - chartset · 2018-11-22 · actions to promote mental health are...

Health at a Glance:Europe 2018

-State of Health in the EU Cycle

Joint publication of the OECD and the European Commission

Released on November 22, 2018http://www.oecd.org/health/health-at-a-glance-europe-23056088.htm

http://www.oecd.org/health/health-at-a-glance-europe-23056088.htm

Table of Contents

1. Promoting mental health in Europe: Why and how?2. Strategies to reduce wasteful spending: Turning the lens to hospitals and pharmaceuticals3. Health status4. Risk factors5. Health expenditure and financing6. Effectiveness: Quality of care and patient experience7. Accessibility: Affordability, availability and use of services8. Resilience: Innovation, efficiency and fiscal sustainability

Note by Turkey: The information in this document with reference to “Cyprus” relates to the southern part of the Island. There is no single authority representing bothTurkish and Greek Cypriot people on the Island. Turkey recognises the Turkish Republic of Northern Cyprus (TRNC). Until a lasting and equitable solution is found withinthe context of the United Nations, Turkey shall preserve its position concerning the “Cyprus” issue.Note by all the European Union Member States of the OECD and the European Union: The Republic of Cyprus is recognised by all members of the United Nations with theexception of Turkey. The information in this document relates to the area under the effective control of the Government of the Republic of Cyprus.

• Costs of mental health problems• Actions to promote mental health and

prevent mental illness

1. PROMOTING MENTAL HEALTH IN EUROPE: WHY AND HOW?

Note: The definition of mental health draws on the WHO definition of mental health as a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively, and is able to make a contribution to his or her community. On the other hand, mental health problems are defined as the loss of mental health due to a mental illness or disorder.

The total costs of mental health problems are more than 4% of GDP across EU countries, ranging from 2% to 5%

Source: OECD estimates based on Eurostat Database and other data sources.

Estimated direct and indirect costs related to mental health problems across EU countries, as a % of GDP, 2015

More than one in six people in EU countries have a mental health problem in any given year

Source: IHME, 2018 (these estimates refer to 2016).

18.8

%

18.6

%

18.5

%

18.5

%

18.4

%

18.3

%

18.3

%

18.3

%

18.0

%

17.9

%

17.9

%

17.7

%

17.7

%

17.7

%

17.6

%

17.3

%

17.3

%

17.0

%

17.0

%

16.9

%

16.9

%

15.7

%

15.5

%

15.4

%

15.2

%

15.1

%

14.9

%

14.8

%

14.3

%

18.5

%

17.5

%

16.7

%

0%

5%

10%

15%

20%

25%

Anxiety disorders Depressive disorders Alcohol and drug use disorders

Bipolar disorders and schizophrenia Others

People reporting chronic depression are much less likely to work in all EU countries…

Note: Due to missing data, the assumption has been made that the situation in Ireland is the same as the EU average.

Source: Eurostat Database, based on the European Health Interview Survey (2014).

0

10

20

30

40

50

60

70

80

90

100

% of working age pop. aged 25-64 With depression Without depression

% of working age population aged 25-64

Employment rate of people aged 25 to 64 years old

…and when they work, people with depression or other mental health problems are often less productive

about 6% less productive

Actions to promote mental health are uneven across the life course: fewer programmes target the unemployed and older people

Source: McDaid, Hewlett and Park (2017); EU Compass for Action on Mental Health and Wellbeing (2017); WHO (2018); EU Compass for Action on Mental Health and Wellbeing, 2018 (2018).

Number of countries reporting at least one promotion or prevention action, out of the 31 EU and EFTA countries

0

5

10

15

20

25

Pre-natal period to age 2 Children aged 2-10 Young people aged 11-25 Workplace mental health Mental health of theunemployed

Older people

Number of countries reporting at least one action

• Addressing wasteful spending in hospitals • Addressing wasteful spending on pharmaceuticals

2. STRATEGIES TO REDUCE WASTEFUL SPENDING

Note: Wasteful spending includes patients who receive unnecessary or low-value care that makes little or no difference to their health outcomes or for whom the same health benefits could be obtained with fewer resources.

Strategies to reduce hospital costs

Increase efficiency

and safety to

reduce the use of

hospital resources

Reduce

unnecessary

hospital

admissions

Ensure patients

leave hospital as

early as possible

Improve community care for

chronic diseases

Tackle hospital

services overuse

Deploy

day surgery

Curb delayed

discharges

Potentially avoidable hospital admissions for chronic conditions consume over 37 million bed days each year

Source: OECD Health Statistics and Eurostat Database.

Diabetes Hypertension Heart failure

COPD & bronchiectasis

AsthmaTotal (five conditions)

Admissions/discharges 800 303 665 396 1 749 384 1 109 865 328 976 4 653 924

% of all admissions 1.0% 0.8% 2.1% 1.3% 0.4% 5.6%

Average length of stay (days)

8.5 6.9 9.5 8.9 6.6 8.1 (avg.)

Total bed days 6 794 572 4 597 886 16 619 148 9 855 601 2 177 821 37 603 706

Proportion of all bed days 1.1% 0.7% 2.7% 1.6% 0.4% 6.5%

Hospital admissions and bed days for five chronic conditions, EU countries, 2015

C-section rates are much higher than the EU average in Romania, Bulgaria, Poland and Hungary, and have increased over time

Note: The annual growth rate for Luxembourg only covers the period 2011 to 2016 due to a break in the series in 2011.

Source: Eurostat, except Netherlands: Perinatal registry (www.perined.nl/).

Netherlands

Finland

Sweden

Lithuania

Estonia

Denmark

Slovenia

France

BelgiumLatvia

Croatia

Spain

Czech Republic

UK

EUAverage

Austria

Slovak Republic

Germany

Malta

Luxembourg

Ireland

Portugal

Italy

Hungary

Poland

Bulgaria

Romania

-2%

-1%

0%

1%

2%

3%

4%

5%

6%

7%

8%

100 150 200 250 300 350 400 450Number of C-sections per 1 000 live births

Ave

rage

ann

ual g

row

th r

ate

of C

-sec

tions

, pas

t 10

year

s

C-section rates in 2016 and their annual growth rate between 2006 and 2016

Several countries are lagging behind in exploiting the potential cost-saving of generic medicines

0

10

20

30

40

50

60

70

80

90

Volume Value%

Generic market share by volume and value, 2016 (or latest year)

Source: OECD Health Statistics 2018.

Reducing the over-prescription of antibiotics and other medicines can also help reduce waste

Note: Cyprus and Romania provide data on overall consumption, including in hospital.

Source: European Centre for Disease Prevention and Control (ECDC) (2017).

Consumption of antibiotics in the community, EU/EEA countries, 2016 (DDDs per 1 000 population per day)

• Trends and inequalities in life expectancy • Inequalities in self-reported health

3. HEALTH STATUS

Life expectancy exceeds 81 years in a majority of EU countries, but the gap between the highest and lowest countries is still over 8 years

1. Three-year average (2014-16).

Source: Eurostat Database.

83.5

83.4

82.7

82.5

82.4

82.3

82.2

81.8

81.8

81.7

81.5

81.5

81.5

81.3

81.2

81.2

81.0

81.0

80.9

79.1

78.2

78.0

78.0

77.3

76.2

75.3

74.9

74.9

74.9

83.7

82.5

82.5

78.5

78.1

76.5

75.7

75.4

60

65

70

75

80

85

90Years

Total Women Men

Life expectancy at birth, by gender, 2016


Gains in life expectancy have slowed down in many Western European countries since 2011,

with reductions registered in 2015

Trends in life expectancy, 2005-16

75

77

79

81

83

85

2005 2007 2009 2011 2013 2015

Years

Life expectancy at birth

10

11

12

13

14

15

2005 2007 2009 2011 2013 2015

Years

Life expectancy at 75

EU28 Germany France Italy United Kingdom

Note: Data refer to 2012 for France and Austria and to 2011 for Latvia, Belgium and the United Kingdom (England).

Source: Eurostat Database; national sources or OECD calculations using national data for Austria, Belgium, France, Latvia, the Netherlands and the United Kingdom (England).

There are large gaps in life expectancy by education level: people with low education at age 30 can expect to live six years less than

the most educated (eight years for men, four years for women)

Slovak Republic

Hungary

Poland

Czech Republic

Latvia

Romania

Estonia

EU21

Bulgaria

France

Slovenia

Austria

Greece

Netherlands

Belgium

Finland

Denmark

Portugal

Croatia

Italy

United Kingdom

Sweden

Norway

Women Men

6.9

6.4

5.1

3.0

8.0

3.8

5.4

4.1

4.5

2.6

2.8

3.0

2.4

4.6

4.4

3.5

3.9

2.8

1.6

2.9

4.0

2.9

3.4

05101520Years

14.4

12.6

12.0

11.1

11.0

9.7

8.5

7.7

6.9

6.5

6.2

6.2

6.0

5.8

5.8

5.6

5.6

5.6

5.2

4.5

4.4

4.1

5.0

0 5 10 15 20Years

Gap in life expectancy at age 30 between people with the lowest and highest level of education, 2016 (or nearest year)

Source: Eurostat Database, based on EU-SILC.

There are also large gaps in self-reported health by income level: 60% of people with the lowest income report being in good health

compared with 80% for those with the highest income

83 79 76 75 74 74 73 73 71 71 71 70 70 69 69 68 67 66 66 65 65 60 60 59 59 53 48 47 43 78 78 77 76 70 57

0102030405060708090

100% of population aged 16 years and over

Total population Low income High income

Health status perceived as good or very good, by income quintile, 2016 (or nearest year)

• Smoking• Alcohol consumption• Overweight and obesity• Air pollution

4. RISK FACTORS

Source: OECD Health Statistics 2018 (based on national health interview surveys), complemented with Eurostat (EHIS 2014) for Bulgaria, Croatia, Cyprus, Malta, and Romania, and with WHO Europe Health for All database for Albania, Serbia and Montenegro.

Changes in daily smoking rates among adults, 2006 and 2016 (or latest year)

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

28 2726 26 25 25 24

23 23 23 22 21 21 20 20 20 20 20 20 19 19 18 18 17 17 16 16 15

11

3831

2927

18

11 10

0

5

10

15

20

25

30

35

40

45

2006 2016

% reporting to smoke daily

The proportion of adolescents reporting “binge drinking” has come down slightly in recent years, but still nearly 40% report regular

“binge drinking” on average across the EU

Note: “Binge drinking” is defined as drinking five or more alcoholic drinks in a single occasion. The EU average is not weighted by country population size.

Source: ESPAD.

0

10

20

30

40

50

60

1995 1999 2003 2007 2011 2015

%

Boys

Girls

Boys Girls%

Changes between 1995 and 2015 in the proportion of 15-16 year old boys and girls reporting heavy episodic drinking in the past 30 days, average across EU countries and Norway

Obesity among adults is rising: one in six adults are obese across EU countries

Source: Eurostat (EHIS 2008 and 2014) complemented with OECD Health Statistics 2018 for 2000 data and data for non-EU countries.

25

2120 20 19 19 19 18 18 18

17 17 17 17 17 16 16 16 16 15 15 15 14 14 14 1312

109

2019

1210

0

5

10

15

20

25

30

2000 2008 2014

%

Changes in self-reported obesity rates among adults, 2000 to 2014 (or nearest year)

Exposure to serious air pollution is estimated to have caused the death of 238 000 people across EU countries in 2016; mortality rates

are highest in Central and Eastern Europe

Source: IHME (Global Burden of Disease, 2016).

Deaths due to exposure to outdoor PM2.5 and ozone, 2016

• Health expenditure per capita and as a share of GDP

• Financing mix (government schemes, out-of-pocket and voluntary health insurance)

5. HEALTH EXPENDITURE AND FINANCING

Source: OECD Health Statistics 2018; Eurostat Database; WHO Global Health Expenditure Database.

Health spending per capita is highest in Luxembourg, Germany and Sweden, and lowest in Romania, Bulgaria and Latvia

Health expenditure per capita, 2017 (or nearest year)

4 71

3

4 16

0

4 01

9

3 94

5

3 93

0

3 88

5

3 83

1

3 57

2

3 49

3

3 04

5

3 01

3

2 77

3

2 56

8

2 55

1

2 44

6

2 06

6

2 02

3

1 87

3

1 72

2

1 67

8

1 62

5

1 55

1

1 47

3

1 46

3

1 40

9

1 36

7

1 25

2

1 23

4

983

5 79

9

4 65

3

3 30

9

987

824

728

638

583

0

1000

2000

3000

4000

5000

6000

7000

EUR PPP

Health spending accounts for nearly 10% of GDP in the EU; France and Germany allocate more than 11% of their GDP to health spending

Health expenditure as a share of GDP, 2017 (or nearest year)


11.5

11.3

10.9

10.3

10.2

10.1

10.0

9.6

9.6

9.2

9.0

8.9

8.9

8.8

8.4

8.4

8.0

7.5

7.2

7.1

7.1

7.1

6.8

6.7

6.7

6.3

6.3

6.1

5.2

12.3

10.4

9.4

8.5

6.8

6.1

5.9

4.2

0

2

4

6

8

10

12

14

% GDP

Health expenditure has grown in line with GDP growth in recent years, so the share of GDP allocated to health has stabilised

Source: OECD Health Statistics 2018; Eurostat Database.

Source : OECD Health Statistics 2018; Eurostat Database. Source : OECD Health Statistics 2018; Eurostat Database.

-5

-4

-3

-2

-1

0

1

2

3

4

5

2005 2007 2009 2011 2013 2015 2017

%

5.4. Annual average growth (real terms) in per capita

health expenditure and GDP, EU28, 2005 to 2017

Health expenditure GDP

6

7

8

9

10

11

12

2005 2007 2009 2011 2013 2015 2017

% GDP

5.5. Health expenditure as a share of GDP, EU28 and

selected countries, 2005 to 2017

France Germany Italy

Spain EU28

Annual average growth (real terms) in per capita health expenditure and GDP,

EU28, 2005 to 2017

Health expenditure as a share of GDP,EU28 and selected countries, 2005 to 2017

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


Over 75% of health spending is financed through government and compulsory insurance across EU countries. Out-of-pocket payments

account for 18%, but represent a much greater share in some countries

Health expenditure by type of financing, 2016 (or nearest year)

7

84 84

512

6 94

79

1813

2

36

11

62

74

30

4

7266

10 10

65

8

63

31

55

9

42

7482

23

16

21

49

78 7870

75 7276

6165

75

41

65

13

44

69

5

60 57 58

30

41

11

56

66 58

42

5534

12 14 1510 15

11 1118

15 16 2115 18 23

20 2319

12 1324 23 32

28 30 3534 45

48

45

1517

1632 36

30 41

57

7 6 5 3 5 8 4 514 12

5 5 5 4

676 5

0

10

20

30

40

50

60

70

80

90

100

%

Government schemes Compulsory health insurance Out-of-pocket

Voluntary health insurance Other

• Avoidable mortality (preventable and amenable)

• Vaccination• Patient experience with ambulatory care• Acute care for cancers and heart attacks

6. EFFECTIVENESS: QUALITY OF CARE & PATIENT EXPERIENCE

Note: Preventable mortality is defined as deaths that could be avoided through public health and prevention interventions, whereas amenable (or treatable) mortality is defined as deaths that could be avoided through effective and timely health care. A number of causes of death are included in both preventable and amenable mortality resulting in double-counting; this explains why the total number of avoidable deaths is lower than the sum of the two parts.


More than 1.2 million deaths could be avoided through better public health and prevention policies and more effective and timely health care

Leading causes of preventable and amenable mortality in the European Union, 2015

Amenable mortality

(570 791 deaths in 2015)

Preventable mortality

(1 003 027 deaths in 2015)

Hypertension, 5%

Colorectal cancer, 12%

Breast cancer, 9%

Hypertension, 5%

Ischaemic heart diseases, 32%

Cerebrovascular diseases, 16%

Influenza and pneumonia, 5%

Others, 22%

Colorectal cancer, 7%

Lung cancer, 17%

Alcohol, 7%

Ischaemic heart diseases, 18%

Accidents, 16%

Suicide, 7%

Others, 29%

Source: WHO/UNICEF.

Many children are not vaccinated against infectious diseases in several countries

Vaccination against measles and hepatitis B, children aged 1, 2017 (or nearest year)

Note: Hepatitis B data for Denmark, Finland, Hungary, Iceland and Norway are not available because national infant vaccination programmes do not cover Hepatitis B. Data is not available for the United Kingdom.

Over 85% of patients report positive experiences with doctors in ambulatory care in most countries

1. National sources. 2. Data refer to patient experiences with GP.Note: 95% confidence intervals have been calculated for all countries, represented by grey areas.

Source: Commonwealth Fund International Health Policy Survey 2016 and other national sources.

Doctor spending enough timewith patient in consultation,

2010 and 2016 (or nearest year)

Doctor involving patientin decisions about care and treatment,

2010 and 2016 (or nearest year)

In terms of acute care, fewer people are dying following acute myocardial infarction (heart attack)

Thirty-day mortality after admission to hospital for AMI (based on unlinked data), 2005 and 2015 (or nearest years)

1. Three-year average.Note: 95% confidence intervals for the latest year are represented by grey areas. The EU average is unweighted and only includes countries with data covering the whole time period.


• Unmet health care needs• Financial protection • Supply of doctors• Timely access (waiting times)

7. ACCESSIBILITY: AFFORDABILITY,

AVAILABILITY AND USE OF SERVICES

Source: Eurostat Database, based on EU-SILC.

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

Unmet need for medical examination for financial, geographic or waiting times reasons,

by income quintile, 2016 (or nearest year)

Unmet need for dental examination for financial, geographic or waiting times reasons,

by income quintile, 2016 (or nearest year)

Estonia

Greece

Latvia

Poland

Romania

Italy

Finland

Lithuania

Bulgaria

Ireland

EU28

Belgium

Portugal

Slovak Republic

Croatia

Sweden

France

Hungary

Denmark

Malta

United Kingdom

Czech Republic

Cyprus

Spain

Luxembourg

Slovenia

Germany

Netherlands

Austria

Montenegro

Turkey

Serbia

Iceland

FYR of Macedonia

Norway

Switzerland

0 10 20 30%

High income Low incomeTotal population

Portugal

Greece

Latvia

Estonia

Italy

Romania

Finland

Spain

Lithuania

EU28

Belgium

Denmark

Poland

Cyprus

Sweden

Bulgaria

Ireland

France

Slovak Republic

Hungary

United Kingdom

Croatia

Malta

Luxembourg

Czech Republic

Slovenia

Germany

Austria

Netherlands

Iceland

Serbia

Montenegro

Turkey

Norway

Switzerland

FYR of Macedonia

0 10 20 30%

High income Low incomeTotal population

Direct out-of-pocket spending by households can restrict access to care

48

45 45

35 3432

3028

24 23 23 2321 20

19 18 1816 15 15 15 15

14 13 12 12 11 1110

57

41

36

3230

17 1615

0

10

20

30

40

50

60%

Share of total health spending financed by out-of-pocket payments, 2016 (or latest year)


1. Data refer to all doctors licensed to practice, resulting in a large over-estimation of the number of practising doctors (e.g. of 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).


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

Practising doctors per 1 000 population, 2000 and 2016 (or nearest year)

6.6

5.14.8

4.54.3 4.2 4.1 4.0 3.8 3.8 3.8 3.7 3.7 3.6 3.5 3.5 3.5

3.2 3.2 3.2 3.2 3.1 3.1 3.0 2.9 2.9 2.8 2.82.4

4.54.3

3.9

3.0 3.02.6

1.8

0

1

2

3

4

5

6

7

2000 2016

Per 1 000 population

…but general practitioners (family doctors) make up less than 25% of all doctors on average

Share of different categories of doctors, 2016 (or nearest year)

1. Other generalists include non-specialist doctors working in hospital and recent medical graduates who have not started yet their post-graduate specialty training.2. In Portugal, only about 30% of doctors employed by the public sector (NHS) are working as GPs in primary care, with the other 70% working in hospital.


4638 37 37

30 27 24 24 24 23 22 22 21 21 20 20 19 19 18 17 17 15 15 15 9 5

33 32 27 24 18 17 16

0

20

40

60

80

100

%General practitioners Other generalists¹ Specialists Other doctors (not further defined)

Note: On the right panel, data relate to median waiting times, except for the Netherlands and Spain (average waiting times).


Waiting times for hip replacement vary widely across countries, and has started to rise again in some countries since 2010

Waiting times of patients for hip replacement, 2016 and trends since 2005

n.a.

37 51

75 84 90

64

105 13

0

211

276

110

45 52

80 82

104

104 12

0

133 15

8

326

444

134

0

100

200

300

400

500

Days

Median Average

0

50

100

150

200

250

Days

Denmark Estonia

Netherlands Portugal

Spain United Kingdom

• eHealth and ePrescription• Hospital efficiency • Fiscal sustainability of public spending on

health and long-term care

8. RESILIENCE: INNOVATION, EFFICIENCY AND FISCAL SUSTAINABILITY

Note: Greece and the Netherlands are implementing ePrescribing but the percentage was not reported.

Source: Pharmaceutical Group of the European Union (PGEU).

ePresribing is now widely used in Nordic countries and some Southern European countries, but hasn’t been implemented yet in several countries

Percentage of ePrescriptions in community pharmacies, 2018

1. Data refer to average length of stay for curative (acute) care only (resulting in an under-estimation).


In hospital, the average length of stay of patients has fallen in nearly all EU countries, reflecting efficiency gains

Average length of stay in hospital, 2000 and 2016 (or nearest year)

10.1

9.5

9.3 9.1 9.0 8.9 8.8 8.5 8.3 8.2 7.9 7.9

7.8

7.7 7.7 7.5 7.5 7.4 7.3 7.1 7.1 7.0 6.86.0 6.0 5.8

5.4 5.3 5.0

10.2

8.88.3

6.9

6.2

5.8

4.02

4

6

8

10

12

14

2000 2016

Days

Source: EC and EPC (2018).

Public spending on health care as a share of GDP is projected to grow in all countries over the coming decades

Public spending on health care as a percentage of GDP, 2016 to 2070, Ageing Working Group reference scenario

0

1

2

3

4

5

6

7

8

9

10

% GDP

2016 Change 2016-70

Public spending on long-term care as a share of GDP is projected to grow even more than health care due to population ageing

Public spending on long-term care as a percentage of GDP, 2016 to 2070, Ageing Working Group reference scenario

Source: EC and EPC (2018).

0

1

2

3

4

5

6

7

8

% GDP

2016 Change 2016-70

More information


https://ec.europa.eu/health/state/glance_en


https://ec.europa.eu/health/state/glance_en

health at a glance europe 2018 - chartset · 2018-11-22 · actions to promote mental health are...

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