Healthcare activities statistics - consultations Statistics Explained Data extracted in September 2017. Figures 5-10 and Tables 3, 4 and 5 c EHIS data: updated in May 2018. This article presents an overview of European Union (EU) statistics related to consultations of medical professionals, in particular the consultation of doctors, dentists, psychologists and physiotherapists. This article is one of a set of statistical articles concerning healthcare activities in the EU which forms part of an online publication on health statistics. Consultations of doctors The average number of consultations with a physician includes consultations at the physician s office, in the patient s home, or in out-patient departments of hospitals or ambulatory health care centres. These figures exclude consultations/visits during a treatment as part of in-patient or day care patient care in a hospital or similar institution. Among the EU Member States, there is a wide range in the frequency with which medical doctors are consulted. In Cyprus and Sweden, on average people consulted physicians less than 3.0 times during 2014, with this average generally ranging between 4.1 and 9.9 consultations in most other EU Member States (no data for Greece or Malta). The highest frequencies for consulting physicians were recorded in the Czech Republic (2013 data), Slovakia and Hungary, where the average during 2014 was 11.1-11.8 consultations per person. Between 2009 and 2014, the average number of consultations increased in 8 of the 23 EU Member States for which data are available (see Figure 1 for data availability); the largest increases were recorded for the Netherlands, Ireland (2010-2015), Lithuania and Germany (note however that there was a break in series for both the Netherlands and Ireland). Falls were registered in 11 Member States, most notably in France (note there is also a break in series) and Slovakia, while Estonia, Slovenia, Finland (break in series) and Sweden reported no change in their average number of consultations per inhabitant. Source : Statistics Explained (http://ec.europa.eu/eurostat/statisticsexplained/) - 11/07/2018 1
Figure 1: Consultation of a medical doctor, 2009 and 2014(average number of consultations per inhabitant)source: Eurostat (hlthhcphys) The proportion of the population who had consulted general practitioners was generally higher than for specialist medical practitioners Figures 2 and 3 present self-reported data on consultations from the second wave of the European health interview survey (EHIS) ; this was conducted between 2013 and 2015. Both Figures 2 and 3 show the percentage of the population aged 15 and over having consulted medical professionals during a four-week period prior to the date when the survey was conducted. In general, the proportion of adults having consulted a general practitioner (as shown in Figure 2) was higher than the proportion having consulted a specialist medical practitioner (as shown in Figure 3); the only exceptions where a higher proportion of adults visited a specialist medical practitioner were Cyprus among the EU Member States and Turkey among the non-member countries. Healthcare activities statistics - consultations 2
Figure 2: Self-reported consultations proportion of people having consulted a generalist medical practitioner during the four weeks prior to the survey, by sex, 2014(%)Source: Eurostat (hlthehisam2u) Figure 3: Self-reported consultations proportion of people having consulted a specialist medical practitioner during the four weeks prior to the survey, by sex, 2014(%)Source: Eurostat (hlthehisam2u) Across the EU-28, just less than one third (31.3 %) of all men and just over two fifths (40.2 %) of all women consulted a general practitioner in 2014 (during the four-week period leading up to the survey). The highest proportion of people having consulted a general practitioner was recorded in Italy (48.3 %), while more than two fifths of all adults consulted a general practitioner in France (44.3 %) and Germany (43.9 %). A breakdown by sex reveals that more than half (53.8 %) of all Italian women aged 15 and over consulted a general practitioner in 2014 (during the four-week period leading up to the survey), while the highest share of men consulting a general practitioner was also recorded in Italy (42.1 %). Healthcare activities statistics - consultations 3
The situation for specialist medical practitioners was quite different, as less than one fifth (17.0 %) of all men across the EU-28 and close to one quarter (23.5 %) of all women consulted a specialist medical practitioner in 2014 (during the four-week period leading up to the survey). The highest proportion of people having consulted a specialist medical practitioner was recorded in Germany (34.5 %), while more than one quarter of the adult populations in Cyprus, Hungary, Luxembourg and the Czech Republic also consulted a specialist medical practitioner. Among the EU Member States, Germany recorded the highest share of men (29.1 %) and women (39.7 %) consulting a specialist medical practitioner. Women more likely than men to have consulted a general practitioner or a specialist practitioner In all but one of the EU Member States for which data are available (no data for Belgium), women were more likely than men to have consulted a general practitioner or a specialist medical practitioner. For general practitioners, the difference between the sexes was more than 10.0 percentage points in Poland, Sweden, Ireland, Italy, Denmark, Latvia, Lithuania and Bulgaria (where the largest difference was recorded among the Member States; 12.6 percentage points); there was also a double-digit gap between the sexes in Turkey. By contrast, the gender gap was close to 4.0 percentage points in Finland, Austria and the Czech Republic, while a slightly higher share of Cypriot men (5.4 %, compared with 5.3 % for Cypriot women) consulted a general practitioner. Table 1: Self-reported consultations proportion of people having consulted a generalist medical practitioner during the four weeks prior to the survey, by age, 2014(%)Source: Eurostat (hlthehisam2u) For consultations of specialist medical practitioners, the difference between the sexes ranged from 16.9 percentage points in Croatia and 10.0 or more percentage points in Estonia and Germany down to less than 3.0 points difference in Malta, Ireland, Romania and the United Kingdom (where the lowest difference was recorded; 1.4 points). There was also a double-digit gap between the sexes in Turkey, while the difference in Norway was less than 3.0 points. Healthcare activities statistics - consultations 4
Table 2: Self-reported consultations proportion of people having consulted a specialist medical practitioner during the four weeks prior to the survey, by age, 2014(%)Source: Eurostat (hlthehisam2u) The data presented in Tables 1 and 2 also come from the second wave of the EHIS and these present an analysis by age group. In most of the EU Member States for which data are available, the proportion of the population having consulted a general practitioner was lowest among persons aged 15-24 or those aged 25-34, after which the share of the population having consulted a general practitioner tended to rise steadily to peak among those aged 65-74 years or 75 years or over. An identical pattern was observed for the proportion of the population having consulted a specialist medical practitioner (see Table 2), as the lowest proportions were recorded for one of the two youngest age groups and the highest shares for either those aged 65-74 or those aged 75 years or over; Malta was the only exception with its highest share recorded among those aged 55-64 years. Consultations of dentists In 2015, the highest average number of consultations of dentists was in the Netherlands The average number of consultations of dentists was, unsurprisingly, far lower than the average number of consultations of medical doctors, as can be seen by comparing the scales of Figures 1 and 4. In Romania, Cyprus and Portugal (2010 data) each person made, on average, less than one trip every two years to consult a dentist. Seven EU Member States reported averages between 0.5 and 1.0 consultations (note the most recent period for Ireland was also 2010). Most of the remaining Member States reported averages between 1.0 and 2.0 consultations per annum, with the Netherlands and Belgium (2010 data) recording significantly higher averages (both 2.5 consultations). Between 2010 and 2015, the average number of dental consultations increased in 5 of the 18 EU Member States for which data are available (see Figure 4 for data availability); the largest increases were recorded for Lithuania and the Netherlands (note there is a break in series), where the averages rose by 0.3 and 0.2 consultations respectively. Seven Member States reported changes of less than 0.1 in their average number of consultations of dentists between 2010 and 2015, while decreases of 0.1 or more were reported by the remaining six Member States, most notably in Denmark and France (2010-2014). Healthcare activities statistics - consultations 5
Figure 4: Consultation of a dentist, 2010 and 2015(average number of consultations per inhabitant)source: Eurostat (hlthhcdent) Women were more likely than men to have consulted a dentist Figure 5, Figure 6 and Table 3 also provide information concerning self-reported consultations of dentists or orthodontists; note however that these data are from the EHIS and relate to the proportion of people aged 15 and over according to the last visit to a dentist or orthodontist. In 2014, about 4 in 10 Europeans reported that they have visited a dentist or orthodontist less than six months prior to the survey. The range in this share was from 22 % in Bulgaria to almost 58 % in Denmark, with Romania (8.8 %) below this range and Germany (61 %) above it. In general, it is observed that in the majority of the EU Member States, persons declared more frequently that they have not consulted a dentist or an orthodontist within the last year. This rate was highest in Romania, where more than three fourths of the population declared that the last time they visited a dentist or orthodontist was one year ago or more. In Ireland, Germany, Denmark, Luxembourg, the Netherlands, the Czech Republic, Slovakia, the United Kingdom and Sweden the opposite situation was observed, recording the lowest rates of persons who have visited a dentist or orthodontist one year ago or more - at a range of 7.4 % to 27.2 %. Healthcare activities statistics - consultations 6
Figure 5: Self-reported consultations proportion of people according to the last visit to a dentist or orthodontist, 2014 (%)Source: Eurostat (hlthehisam1e) Similar to Figures 2 and 3 (which concerned consultations of general practitioners and specialists), Figure 6 shows that women were generally more likely to have consulted a dentist or orthodontist within the last year than men, but the difference was less pronounced than for the consultation of medical doctors. On average, the proportion of persons having visited a dentist or orthodontist within the last year (prior to the survey) accounted for 62.8 % for women and 57.2 % for men (a difference of 5.6 percentage points between the two sexes). A large gender gap was recorded in Estonia and Poland (both 9 percentage points difference), peaking in Lithuania with a difference of 12.4 percentage points. Figure 6: Self-reported consultations proportion of people having consulted a dentist or orthodontist one year ago or less, by sex, 2014 (%)Source: Eurostat (hlthehisam1e) Older people were less likely to have consulted a dentist or orthodontist within the last year An age group analysis of the proportion of people having consulted a dentist or orthodontist over the last year or less is quite different from that described for persons consulting medical doctors. Whereas the elderly were among those most likely to visit a medical doctor (general practitioner or specialist physician), they tended to visit dentists less often than younger people. The proportion of people making consultations with a dentist or orthodontist was relatively uniform in most of the EU Member States across the different age groups through until the age of 55-64 years. With reference to the elder age groups, some countries recorded relatively lower rates. For example, in Bulgaria, Hungary, Poland, and Romania as well as Turkey, one third of the population aged 65-74 or less reported Healthcare activities statistics - consultations 7
having visited a dentist or orthodontist within the last year, while for the same group of countries, the relevant proportion did not exceed 20 % among those aged 75 years and over. Table 3: Self-reported consultations proportion of people having consulted a dentist or orthodontist one year ago or less, by age, 2014 (%)Source: Eurostat (hlthehisam1e) Consultations of psychologists, psychotherapists or psychiatrists Psychologists study the mind and its functions, in particular in relation to individual and social behaviour. Psychiatrists, however, are medical doctors who specialise in the prevention, diagnosis and treatment of mental illness. They have post-graduate training in psychiatry and may also have additional training in a psychiatric specialty, such as neuropsychiatry or child psychiatry. The EHIS included questions asking respondents about their medical consultations with psychologists, psychotherapists or psychiatrists. In 2014, about 5 % of the EU population consulted a psychologist or psychiatrist in the previous 12 months. In almost all of the EU Member States (see Figure 7) the proportion of people (aged 15 or over) having consulted a psychologist or psychiatrist was higher for women than men. The only exceptions were Croatia and Malta, where the proportions for males were higher than for females, as well as Romania, where the share for males and females was equal. In particular, the share of women who consulted a psychologist or psychiatrist was more pronounced in Finland, the Netherlands, Germany, Sweden and Denmark as well as Iceland at a share that exceeded 10 % of the reference population. The rate for men did not reach as high levels as for women; it did not exceed 8 % in any of the EU countries. The largest gender differences were observed in Sweden (a difference of 6.7 percentage points) and Denmark (a difference of 6.6 percentage points). Similarly, the gender difference in Iceland was high (a difference of 6.5 percentage points). Overall (men and women combined), the proportion of the population who had consulted a psychologist or psychiatrist within the previous 12 months was generally between 2 % and 8 % in most of the Member States, with this share rising above this range in Sweden, the Netherlands, Germany and Denmark and falling to 1.1 % in Cyprus and 0.3 % in Romania. Healthcare activities statistics - consultations 8
Figure 7: Self-reported consultations proportion of people having consulted a psychologist, psychotherapist or psychiatrist during the 12 months prior to the survey, by sex, 2014(%)Source: Eurostat (hlthehisam6e) Middle aged people were most likely to have consulted a psychologist or psychiatrist An analysis by age (see Table 4) shows there was a general tendency for the proportion of people having consulted a psychologist or psychiatrist within the past 12 months (prior to the survey) to peak in one of the groups covering middle age (35-64 years), and then to fall again for older age groups. The lowest proportions were recorded among the older age groups (65 years or over). However, this general tendency does not apply in a number of countries: in Estonia, Ireland, Malta, Portugal, Finland, Sweden, the United Kingdom as well as Iceland and Norway the prevalence of those who reported having consulted a psychologist of psychiatrist was higher among the younger age groups (aged 15-24 or 25-34), while in the Czech Republic, Italy and Lithuania, elder persons (aged 65 and over or 75 and over) consulted a psychologist or psychiatrist more frequently than the younger and middle-aged persons. Table 4: Self-reported consultations proportion of people having consulted a psychologist, psychotherapist or psychiatrist during the 12 months prior to the survey, by age, 2014(%)Source: Eurostat (hlthehisam6e) Healthcare activities statistics - consultations 9
Persons living in cities reported more frequently having consulted a psychologist or psychiatrist In 2014, almost 6 % of the Europeans living in cities consulted a psychologist or psychiatrist in the previous 12 months (Figure 8). The corresponding shares were smaller among those living in towns and suburbs (5.3 %) or rural areas (4.4 %). This pattern was not universal across countries: in 14 EU Member States as well as Iceland and Norway, the highest proportions of persons having consulted a psychologist or psychiatrist were recorded in cities, followed by towns and suburbs and then by rural areas. The reverse pattern is observed in Hungary, Latvia and Sweden, where the respective shares were higher among persons living in rural areas and lower for those living in cities. While Bulgaria, Spain, Ireland, Lithuania and Slovakia recorded their highest shares for the population living in towns or suburbs, the Czech Republic, Estonia, Cyprus and the Netherlands reported their lowest shares for towns or suburbs. Figure 8: Self-reported consultations proportion of people having consulted a psychologist, psychotherapist or psychiatrist during the 12 months prior to the survey, by degree of urbanisation, 2014(%)Source: Eurostat (hlthehisam6u) Consultations of physiotherapists Physiotherapists assess, plan and implement rehabilitative programmes that improve or restore human motor functions, maximise movement ability, relieve pain syndromes, and treat or prevent physical challenges associated with injuries, diseases and other impairments. They apply a broad range of physical therapies and techniques such as movement, ultrasound, heating, laser and other techniques. Across the EU Member States (see Figure 9), the proportion of people having consulted a physiotherapist in the past 12 months prior to the survey ranged from 22 % in Denmark to 7 % in Cyprus, with Bulgaria (3.8 %) and Romania (2.7 %) below this range, and Finland (23.1 %), the Netherlands (25.9 %) and Luxembourg (27.9 %) above it. On average, a higher proportion of women than men consulted physiotherapists (17 % and 13.1 %, respectively). This was evident across all EU Member States, with the exception of Cyprus and Malta, where the opposite pattern holds: men consulted a physiotherapist more frequently than women (although the differences between the sexes were relatively small). By contrast, the largest differences between women and men were recorded in Germany and Denmark, where the proportion of women consulting a physiotherapist was about 8 percentage points higher than that for men. Healthcare activities statistics - consultations 10
Figure 9: Self-reported consultations proportion of people having consulted a physiotherapist during the 12 months prior to the survey, by sex, 2014(%)Source: Eurostat (hlthehisam6e) Recourse to physiotherapists higher among middle aged people A further analysis shows that the proportion of people having consulted a physiotherapist increased up to the age group 55-64 and then slightly decreased for the elder persons (aged 65-74 and 75 and over): the lowest proportions were generally recorded among the youngest age groups (either those aged 15-24 or 25-34). In several EU Member States the Czech Republic, Denmark, Germany, Croatia, Cyprus, Lithuania, Luxembourg, Austria, Slovenia, Slovakia, Finland and the United Kingdom the highest proportions were recorded in the age groups 45-54 or 55-64, while in four countries (Ireland, Spain, Latvia and Sweden) the highest proportions were recorded for those aged 35-44. In the remainder of the EU countries (see Table 5) the percentage of persons who consulted a physiotherapist was most pronounced in one of the two oldest age groups. Healthcare activities statistics - consultations 11
Table 5: Self-reported consultations proportion of people having consulted a physiotherapist during the 12 months prior to the survey, by age, 2014(%)Source: Eurostat (hlthehisam6e) About 16 % of the Europeans in towns and suburbs consulted a physiotherapist Figure 10 presents the proportion of people having consulted a physiotherapist in the previous 12 months across the EU. In 2014, this peaked at 16.1 % among the EU-28 population living in towns and suburbs, while it accounted for 15.3 % for those living in cities and 13.9 % among those living in rural areas. Figure 10: Self-reported consultations proportion of people having consulted a physiotherapist during the 12 months prior to the survey, by degree of urbanisation, 2014(%)Source: Eurostat (hlthehisam6u) A closer analysis reveals variations in the shares of persons who reported having consulted a physiotherapist within the last 12 months. Those shares were lower for rural areas (compared with cities and towns and sub- Healthcare activities statistics - consultations 12
urbs) in the majority of the EU countries. Of the remaining countries which deviate from this pattern, Greece, Malta, Finland and the United Kingdom recorded the highest shares for persons living in rural areas. On the contrary, in Belgium, Germany, Sweden and Luxembourg as well as Norway, people living in towns and suburbs reported more frequently to have visited a physiotherapist as compared with those living in cities or rural areas. Additionally, in Croatia the shares for those living in towns and suburbs and rural areas were the same. The only exception was Cyprus, where the respective share was higher among persons living in cities and lower for persons living in towns and suburbs. Source data for tables and graphs Consultations: tables and figures Data sources This article presents data on consultations of medical professionals from two types of sources, the first of which mainly relies on administrative data whereas the other is based on self-reported consultations from population or household surveys. Healthcare resources and activities Statistics on healthcare resources and healthcare activities (such as information on consultations of doctors and dentists) are documented in this background article which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions. Consultations of doctors exclude telephone contacts, visits for prescribed laboratory tests, or visits to perform prescribed and scheduled treatment procedures (such as injections and physiotherapy). Consultations of dentists include consultations of dental specialists, such as orthodontists. For country specific notes on this data collection, please refer to this background information document. Health status Self-reported statistics on consultations of doctors, dentists, psychologists and physiotherapists are provided by the European health interview survey (EHIS). This source is documented in more detail in this background article which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions. Note on tables: the symbol : is used to show where data are not available. Context Medical consultations are usually held in a doctor s surgery/dentist s practice or another place for the provision of ambulatory care, including out-patient care in hospitals, although medical professionals may also travel to patients, for example, in the case of an accident or emergency or as a home visit. The frequency of consulting a particular type of medical professional may be influenced by the way doctors and other professionals are paid (either a fixed rate or as a function of the number and type of consultations and services provided), the range of services offered by other professionals (for example, some services may be provided by both nurses and doctors), and the division of work between generalists and specialists. From the patient s perspective, the time and monetary cost of a consultation may be factors which influence their decision to seek a consultation, alongside their perception as to their own needs for professional assistance; the frequency of consultations is also related to socio-demographic factors, such as age and gender. Healthcare activities statistics - consultations 13
Other articles Online publications Health in the European Union facts and figures Disability statistics Healthcare resources Physicians Dentists, pharmacists and physiotherapists Healthcare activities Hospital discharges and length of stay Surgical operations and procedures Preventive services Medicine use Unmet needs for medical care Methodology Healthcare non-expenditure European health interview survey General health statistics articles Health statistics introduced Health statistics at regional level The EU in the world health Database Health care (hlthcare) Consultations (hlthconsult) Self-reported consultation of a medical professional by sex, age and educational attainment level (%) (hlthehisam2e) Self-reported consultations of a medical professional by sex, age and degree of urbanisation (hlthehisam2u) Self-reported consultations of a dentist by sex, age and educational attainment level (hlthehisam1e) Self-reported consultation of a mental healthcare or rehabilitative care professionals by sex, age and educational attainment level (%) (hlthehisam6e) Consultation of a medical doctor (in private practice or as outpatient) per inhabitant (hlthhcphys) Consultation of a dentist per inhabitant (hlthhcdent) Dedicated section Health Health care Healthcare activities statistics - consultations 14
Methodology Consultation of a medical doctor (in private practice or as outpatient) (ESMS metadata file hlthhcphys esms) European health interview survey (ESMS metadata file hlthdetesms) European Health Interview Survey (EHIS wave 2) Methodological manual 2013 edition External links European Commission Directorate-General for Health and Food Safety European core health indicators (ECHI) European Commission Directorate-General for Health and Food Safety Oral health European Commission Directorate-General for Health and Food Safety Public health Joint OECD / European Commission report Health at a Glance: Europe OECD Health policies and data WHO Global Health Observatory (GHO) World Health Organisation (WHO) Health systems View this article online at http: // ec. europa. eu/ eurostat/ statistics-explained/ index. php/ Healthcare_ activities_ statistics_ -_ consultations Healthcare activities statistics - consultations 15