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