HHE 2018 | Page 17

In 2015, the pharmaceutical expenditure in PPP $ per capita held by the public sector was between 122 in Poland and 643 in Germany.
Chart 5 explores the relationship between the trend of the total and the public pharmaceutical expenditure between 2000 and 2015. In a group of outlier countries( upper right part of the chart) encompassing Estonia, Ireland, Switzerland and Slovakia, both the public and the total spending varies substantially. In Poland, the total pharmaceutical expenditure varies negatively.
In almost all EU member states, the total pharmaceutical expenditure decreased more slowly than the public pharmaceutical expenditure. This suggests that a progressively larger part of the total pharmaceutical expenditure pertains to the private sector. This shift may also indicate that the‘ willingness to pay’ and the consumption of pharmaceuticals by private owners are increasing. chart 6
Number of hospitals in 2015 and number of hospitals closed( opened) since 2000
Ireland
Lithuania
Sweden
Latvia
Estonia
Slovenia
Luxembourg
Number of hospitals in 2015 Number of hospitals closed( opened) since 2000
-2
+ 2
-38
-8
-26
-75
-89
Hospital capacity and delivery of care In the last 15 years health care reforms implemented all over Europe aimed at rationalising the use and provision of hospital care, improving its quality and appropriateness, and reducing its costs. The number of hospital facilities as well as the number of hospital beds dropped off on average( Charts 6 and 7). These reforms also resulted in a broad reduction of acute care admissions and length of stay, as well as in improvements in the occupancy rate of acute care beds.
During this time, almost all European countries made changes in their hospital provision patterns, and major efforts were addressed to delivering better services, increasing quality, improving efficiency and productivity. The streamlining of care delivery started from a sharp reduction in the size of secondary care institutions and moved towards more integrated and efficient patterns of care, which might result in the future in the complete overcoming of the hospital-centric model of care.
This was possible thanks to a package of financial and organisational measures addressed to improve coordination and integration between the different levels of care, increase the use of day-hospital and day-surgery and introduce new and more efficient methodologies of hospital financing in order to incentivise appropriateness( for example, the replacement of daily payments – known to encourage longer hospitalisation – by prospective payment).
In most European countries, these policies led to changes in the management of patients within hospitals and offered a possibility for reducing the number of acute care hospital beds. Only the bed occupancy rates registered more disparate trends across Europe, depending also on the demographic and epidemiological structure of population and the specific organisation of local, social and healthcare systems, that is, the structure of primary care, the presence and the efficiency of a gate-keeping system, the modality of access to secondary care, availability of home care and development of community care.
In 2015 there were, on average, 2.6 hospitals for 100,000 inhabitants, ranging from 0.9 in Sweden to 4.9 in Finland. The only European member state excluded from this range is Cyprus, where the
Luxembourg Hungary Slovakia
Switzerland Greece
Austria
Finland
Czech Republic
Portugal
Germany France
United Kingdom
Italy Poland Spain Netherlands
More than a third of current health expenditure finances hospital care
0 20 40 60 80 100 120 140 160 180 200
0 25 50 75 100 125 150 175 200 225 250
0 50 100 150 200 250 300 350 400
+ 297
-6
+ 264
-206
+ 149
0 500 1000 1500 2000 2500 3000 3500 4000
-6
0
-54
-50
-88
-121
value was approximately 9.9 in 2014. Moreover, there were on average 491 hospital beds every 100,000 inhabitants, ranging from 244 in Sweden to 813 in Germany.
Between 2000 and 2015 few changes in the number of hospitals were registered in Luxembourg(-2), Portugal( 0) and Slovenia(+ 2).
In the same period, the total number of hospital beds per 100,000 inhabitants decreased by 23.2 %, ranging from-57.6 % in Ireland( which means 353 beds cut for every 100,000 inhabitants) and-0.7 % in Poland( 5 beds cut for every 100,000 inhabitants)( Chart 8).
In several countries the decrease in the total
-6
-7
+ 9
-31
-527
17 HHE 2018 | hospitalhealthcare. com