European health sector improves despite crisis: Survey

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This article is part of our special report Future of European Healthcare.

European healthcare systems are defying budget cuts and the bite of continent-wide austerity programmes to deliver improving performances, according to the sixth Euro Health Consumer Index.

The index – which ranks 34 countries on 42 indicators covering patients’ rights, waiting times, medical outcomes, range of services and pharmaceuticals – is compiled using public statistics, patient polls and independent research.

The Netherlands was at the top for the third year, gaining 872 out of potential 1,000 points, followed by Denmark, Iceland, Luxemburg and Belgium.

The index – which ranks 34 countries on 42 indicators covering patients’ rights, waiting times, medical outcomes, range of services and pharmaceuticals – is compiled using public statistics, patient polls and independent research.

The Netherlands was at the top for the third year, gaining 872 out of potential 1,000 points, followed by Denmark, Iceland, Luxemburg and Belgium.

However, more countries scored more than 700 than last year, and the differentials between states have narrowed, according to the report compiler, the Sweden-based think tank Health Consumer Powerhouse.

Czech health system is performing well

Dr Arne Björnberg, head of the index compiling team, told a launch meeting at the European Parliament yesterday (15 May) that the index appeared to show “healthcare quality unaffected by the financial crisis,” and he pointed to unchanged infant mortality figures as a clear sign that this is the case.

“Infant mortality is usually one of the first signs of decreasing healthcare quality,” Björnberg said.

The figures did, however, point to new discrepancies and trends across the continent, with apparent fragmentation into different groups of countries.

The Netherlands, Belgium and the Nordic countries form a bloc of highly developed, consumer-influenced, healthcare systems, but they are being quickly chased by countries such as the Czech Republic, Slovakia, Croatia, Lithuania and Estonia.

Meanwhile, Germany and Austria slipped down the rankings this year – from 6th to 14th and from 4th to 11th places, respectively.

Although Cyprus, Greece and Spain remained under-performers, their scores did not deteriorate on previous years, despite strong pressures on their health budgets, the index showed.

Changing picture

There were few indicators illustrating a possible impact of the economic crisis, despite severe cuts to public health budgets in countries hardest hit by the eurozone's debt challenges. These include a tendency for longer waiting times in hospital and more expensive surgery among countries most affected by the economic downturn, a somewhat increased share of out-of-pocket payment for healthcare services, and a lack of improvement or even deterioration in access to new pharmaceuticals, the report found.

Commentators at the launch event in the Parliament expressed some doubt about how much the results represented a valid reflection of the impact of the crisis on healthcare.

“It’s important to be prudent in assessing the results to consider the real lives of all patients,” said Nicola Bedington, of the European Patient’s Forum, a pubic health advocacy group.

“The notion that that there has been no detectable quality deterioration is highly surprising given some of the stories we are hearing from even some of the highest-scoring countries in the index,” she said.

Positions

“[Dutch] healthcare seems able to deal with new conditions and delivers top results,” said Dr Arne Björnberg, head of the team that compiled the survey. “In spite of rising costs, healthcare in the Netherlands belongs to the top and also measured as value for money. This is an example for European countries to follow, not least by abandoning poorly working single-payer systems.”

What you see in the Netherlands and Denmark is that competition is the driver of qualityin the system. The Netherlands has competing health insurers and the Danish hospital sector is highly competitive on transparency, Nicole Pancetta, the vice president of Abbott Pharmaceuticals, told the Parliament meeting.

“I am surprised that the effects of the crisis have not been more pronounced because we have seen, for example , a marked decrease in the amount of anaesthetics used in Greece, Spain and Portugal, so maybe it is too early to see the impact yet,” Pancetta said.

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