PERFORMANCE OF THE BELGIUM HEALTH SYSTEM IN INTERNATIONAL COMPARISON

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Bernard Paul
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1 PERFORMANCE OF THE BELGIUM HEALTH SYSTEM IN INTERNATIONAL COMPARISON Academic session: Looking back with an eye on the future 13 January 2017 Mark Pearson - Deputy Director Employment, Labour and Social Affairs

2 BELGIUM HAS A HIGH PERFORMING HEALTH SYSTEM 2

3 Some indicators of health status and quality of care are amongst the best in the OECD Belgium OCDE Life expectancy at birth Ischemic heart disease mortality rates Colorectal cancer five-year relative survival CHD hospital admission in adults 81.4 year 78.4 / hab % / hab 80.6 year 114 / hab % / hab In-hospital case-fatality rates for stroke Health expenditure as a % of GDP 7.3 / 100 admissions 8.0 /100 admissions 10.4 % 9.0 % Source: OECD Health Statistics

4 Most patients are positive about their experience with ambulatory care Doctor spending enough time with patient in consultation, 2013 (or latest year) Doctor providing easy-to-understand explanations, 2013 (or latest year) D Belgium 1 Czech Republic 1 Luxembourg 1 New Zealand 1 Portugal 1, 2 Germany 2 Estonia 1 Australia 1 United Kingdom 2 Netherlands 2 OECD18 Switzerland 2 Israel 1 United States 2 France 2 Norway 2 Canada 2 Sweden 2 Poland 1, A Age-standardised rates per 100 patients 1. National sources. 2. Data refer to patient experiences with regular doctor. Belgium 1 Luxembourg 1 Portugal 1, 2 Japan 1 Czech Republic 1 New Zealand 1 Germany 2 United Kingdom 2 OECD19 Estonia 1, 2 Netherlands 2 United States 2 Australia 2 Canada 2 Norway 2 France 2 Israel 1 Switzerland 2 Sweden 2 Poland 1, 2 1. National sources. 2. Data refer to patient experiences with regular doctor. Note: 95% confidence intervals represented by H. Note: 95% confidence intervals represented by H. Source: Commonwealth Fund International Health Policy Survey 2013 and other national sources Age-standardised rates per 100 patients 4

5 But 3 important challenges do lie ahead for Belgium 1 Inequalities in health and access to care Direct impact on population health 2 Low spending on prevention and rising risk factors Direct or indirect impact on health care costs 3 Waste in clinical care Social and economic consequences 5

6 REDUCING INEQUALITIES IN HEALTH AND ACCESS TO CARE 6

7 Inequality in longevity by education groups is among the highest in Belgium Life expectancy by gender and educational attainment at age 25 (2012 or closest year) Low education High education Men Women EST² HUN LVA CZE POL SVK² CHL OECD³ SVN BEL FIN MEX USA DNK TUR NOR AUT FRA NZL PRT² AUS SWE ISR ITA² GBR 35 LVA EST² HUN POL CHL BEL SVK² MEX CZE DNK USA OECD³ FIN TUR NOR SWE NZL GBR SVN ISR AUT AUS PRT² ITA² FRA Source: Fabrice Murtin (2016), "Annex: Inequalities in Longevity by Education in OECD countries: Insights from New OECD Estimates 7

people with unmet needs for medical examination,

8 The burden of unmet needs for medical examination fell heaviest on low income groups Percentage of people with unmet needs for medical examination, 2014 Belgium EU Source: Eurostat Database, based on EU-SILC. 8

9 STRENGTHENING PREVENTION AND PRIMARY CARE 9

10 Spending on prevention represents only 2.1% of current health spending Source: OECD Health Statistics

11 Risk factors are worsening, having social and economic consequences Alcohol consumption 2 nd highest rate across the EU (increased by 16% from 2000 to 2014) Obesity rates Less than 1 adult in 5 is obese, but on the rise in recent years Physical activity At age 15, less than 1 in 10 girls report daily physical activity High social disparities in risk factors (eg. smoking prevalence is twice among low education groups) Risk factors are associated with numerous chronic diseases, having large employment and productivity impacts Source: OECD Health Statistics

12 The total cost of mental health amounts to 3.4% of GDP in Belgium Suicide mortality rates, 2013 Age-standardised rates of suicides, per population 36% Suicide mortality rates are 1.5 times higher the EU average The indirect costs are larger than direct medical costs of mental illhealth 7% United Kingdom 12% 17% EU 28 Belgium Lithuania People with mental disorders underperform in the labor market : Employment rates are 15 percentage points lower Unemployment rates are 10 percentage points higher Higher risk of living in poverty and social marginalisation Source: Eurostat Database. 12

13 REDUCING WASTE IN CLINICAL CARE 13

14 Prescribing patterns in primary care raise concerns about appropriateness of care Overall volume of antibiotics prescribed, 2014 (or nearest year) Source: European Centre for Disease Prevention and Control 2016; OECD Health Statistics

15 Adverse events are often preventable, while devastating for patients Percentage of hospitalised patients with at least one healthcareassociated infection, Source: ECDC 2013 Point prevalence survey. 15

16 Collecting more patient-reported measures will improve both health system policy and practice Outcome of treatments that people care about levels of pain; Ability to live independently, quality of life, People's experience of care Good communication; Being involved in decisions about care, Convenience, In Sweden, patient-reported outcomes were used to identify brands of hip prosthesis that did little to improve mobility and pain It has improved patient outcomes, and saved the Swedish health care system an estimated SEK 1 billion (EUR 100 million) over seven years. Source: OECD (2013), OECD Reviews of Health Care Quality: Sweden

17 Key policy challenges 1 2 Reduce inequalities More prevention and strengthen primary care Tackle financial and non-financial barriers to improve access to care for socioeconomically disadvantaged Reduce risk factors and postpone chronic diseases Better manage chronic diseases Reduce the detrimental labour market impacts of ill-health 3 Tackle waste Ensure patients get care that is aligned with the outcomes that matter to them PaRIS will standardise international benchmarcking and develop new patient reported indicators 17

18 Thank you Read more about OECD work Follow us on OECD Health Ministerial and Policy Forum on the Future of Health Paris, January 2017 Website: Newsletter: 18

Towards more comparable data to assess the performance of health systems: Past, present and future work at OECD

Towards more comparable data to assess the performance of health systems: Past, present and future work at OECD Gaetan LAFORTUNE, OECD Health Division EUPHA Conference, Helsinki, 12 October 2007 1 1 Overview