OECD 2018 Report Outlines State of Health in EU

The Organization for Economic Co-operation and Development (OECD) in November 2018 released the 2018 edition of Health at a Glance: Europe.

This report is led by the European Commission and designed to assist member states in improving the health of their citizens and the performance of their health systems.

The report cites “two overarching trends [that] warrant special mention”:

[T]he steady increase in life expectancy has slowed considerably in many EU countries due to a slower rate of reduction of cardiovascular deaths and an increase in the number of deaths among the elderly during winter months in recent years.

Second, large inequality in life expectancy persists. Across the EU, people with a low level of education can expect to live six years less than those with a high level of education.

Health Spending on the Rise

In 2017, health spending accounted for 9.6% of GDP in the EU as a whole, up from 8.8% in 2008. Population ageing means not only that health care needs will increase in the future, but also that there will be increasing demand for long-term care. Indeed, spending on long-term care is expected to grow faster than spending on health care.

While life expectancy increased by at least 2 to 3 years over the decade from 2001 to 2011 in all EU countries, countries particularly in Western Europe, have seen slower gains since 2011 in many countries, and increasing by less than half a year between 2011 and 2016. Large disparities in life expectancy persist not only by gender, but also by socioeconomic status.

On average across the EU, 30-year-old men with a low level of education can expect to live about 8 years less than those with a university degree (or the equivalent), while the “education gap” among women is narrower, at about 4 years. These gaps largely reflect differences in exposure to risk factors, but also indicate disparities in access to care.

Make Mental Health a Priority

The report also makes a strong case for giving greater priority to improving mental health, citing that mental health-related costs are estimated at more than 4% of GDP – or over EUR 600 billion – across the 28 European countries. Statistics show “more than one in six people across EU countries had a mental health issue in 2016, equivalent to about 84 million people” and that in 2015, more than 84,000 deaths were attributed to mental illness or suicide”.

While programmes and policies that address mental illness exist, the report says that much more can be done to manage and promote better mental health.

Another highlight of the report calls for reducing wasteful spending to make health systems more effective and resilient. Wasteful spending on unnecessary tests and treatments, and prescribing high-cost treatments when there are less expensive alternatives, account for one-fifth of health spending in various countries.

Savings can be achieved, the report concludes, by better overall management of chronic conditions, which count for over 37 million bed days devoted to avoidable hospital admissions each year. Finally, the report suggested minimizing waste and optimizing the value derived from pharmaceutical spending.

Prevention

The OECD suggests putting a greater focus on preventing risk factors such as smoking rates in both children and adults, reduction of overall alcohol consumption, which remains an important public health issue, with nearly 40% of adolescents report at least one “binge drinking” event in the preceding month, and more than 40% of young men aged 20-29 also report heavy episodic drinking.

Obesity is another risk factor. The prevalence of obesity continues to increase among adults in most EU countries, with at least one in six defined as obese. Inequality in obesity remains marked: 20% of adults with a lower education level are obese compared with 12% of those with a higher education.

Some of the report’s highlights include the remarkable progress in cancer management through the implementation of population-based screening programmes and the provision of more effective and timely care. Survival rates for various cancers have never been higher, yet there is still considerable room for further improvement in cancer management in many countries.

Accessibility and Inequality

Ensuring universal access to care is critical to reducing health inequalities. Unmet health care needs are generally low in EU countries, but low-income households are five times more likely to report unmet needs than high-income households. Unmet health care needs are an important measure of accessibility.

New digital technologies offer great opportunities to promote healthy ageing and achieve more efficient and people-centred care. The use of Electronic Medical Records and ePrescribing is growing across EU countries, and growing numbers of EU residents use the internet to obtain health information and access health services, although there are disparities by age and socioeconomic groups.

Population ageing requires profound transformations in health systems, from a focus on acute care in hospitals to more integrated and people-centred care in the community. Many EU countries began this transformation over a decade ago – for example by reducing hospital capacity and average length of stay, and strengthening community care – but the process still requires ongoing, long-term effort.