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Health Status and Health Care Systems in Central & Eastern European Countries

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Health Status and Health Care Systems in Central & Eastern European Countries European Network of Economic Policy Research Institutes HEALTH STATUS AND HEALTH CARE SYSTEMS IN CENTRAL & EASTERN EUROPEAN COUNTRIES BULGARIA, ESTONIA, POLAND, SLOVAKIA AND HUNGARY STANISŁAWA GOLINOWSKA AGNIESZKA SOWA ROMAN TOPÓR-MĄDRY ENEPRI RESEARCH REPORT NO. 31 AHEAD WP2 DECEMBER 2006 ENEPRI Research Reports consist of papers presenting the findings and conclusions of research undertaken in the context of ENEPRI research projects. This paper was prepared as part of Work Package 2 of the AHEAD project – Ageing, Health Status and the Determinants of Health Expenditure – which has received financing from the European Commission under the 6th Research Framework Programme (contract no. SP21-CT-2003-502641). Its findings and conclusions are attributable only to the authors and not to ENEPRI or any of its member institutions. ISBN 92-9079-639-1 AVAILABLE FOR FREE DOWNLOADING FROM THE ENEPRI WEBSITE (HTTP://WWW.ENEPRI.ORG) OR THE CEPS WEBSITE (WWW.CEPS.BE) © COPYRIGHT 2006, STANISŁAWA GOLINOWSKA, AGNIESZKA SOWA & ROMAN TOPÓR-MĄDRY Contents Introduction................................................................................................................................... 1 1. Demographic Development of CEECs................................................................................... 3 1.1 Population Size and Structure....................................................................................... 3 1.2 Fertility.......................................................................................................................... 6 2. Population Health Status in CEECs........................................................................................ 8 2.1 Life expectancy ............................................................................................................8 2.2 Infant mortality rate .................................................................................................... 10 2.3 Mortality ..................................................................................................................... 12 2.4 Morbidity .................................................................................................................... 19 2.5 Self-assessed health status in selected CEECs............................................................ 21 2.6 Comparison of health status: Conclusions.................................................................. 25 3. Health care system................................................................................................................ 26 3.1 Health insurance and other sources of health care financing...................................... 28 3.2 Decentralisation .......................................................................................................... 30 3.3 Health sector structure ................................................................................................ 32 3.4 Provider payment mechanisms ................................................................................... 35 3.5 Challenges for health care reform............................................................................... 37 4. Use of medical services ........................................................................................................ 38 4.1 Use of out-patient services.......................................................................................... 38 4.2 Primary care................................................................................................................ 41 4.3 Out-patient specialist care........................................................................................... 42 4.4 In-patient care............................................................................................................. 44 4.5 Use of medical services: Conclusions......................................................................... 46 5. Summary and conclusion...................................................................................................... 47 References................................................................................................................................... 50 List of Tables Table 1. The analysis is based on following sample surveys........................................................ 2 Table 2. LE at birth and HALE...................................................................................................10 Table 3. Infant mortality rate, 2002, CEECs 2000...................................................................... 12 Table 4. SDR table for countries under research, 2002-2003 ..................................................... 14 Table 5. Standardised death date due to main causes.................................................................. 18 Table 6. Main causes of deaths by age and sex in accession and candidate countries (13), 1999 ...................................................................................................................................... 18 Table 6. Health status self-assessment ........................................................................................ 22 Table 7. Variables used in econometric models, by country....................................................... 22 Table 8. Health insurance premium – % of gross salary............................................................. 29 Table 9. Health care financing sources and levels in analysed CEECs in 2002.......................... 30 Table 10. Hospital beds and medical personnel, indicator per 100,000 inhabitants, 2002 ......... 31 Table 11. Hospital efficiency indicators, 2002............................................................................ 36 Table 12. Number of outpatient contacts per person, per year.................................................... 39 Table 13. Percent of adult population in Estonia that has used medical services during last 6 months (hospital care – during last 12 months) by age ..................................................... 40 Table 14. In-patient care admissions per 100 population............................................................ 44 List of Figures Figure 1. Population size, 1970-2003............................................................................................4 Figure 2. Share of elderly (65+) in the population, 1970-2002..................................................... 4 Figure 3. Share of elderly (65+) males in the population, 1970-2002 .......................................... 5 Figure 4. Share of elderly (65+) females in the population, 1970-2002 ....................................... 5 Figure 5. Share of young (0-14) in the population, 1970-2003..................................................... 6 Figure 6 Crude birth rate, crude death rate and rate of natural increase in Bulgaria, 1921-2001, per 1,000 people. ................................................................................................. 7 Figure 7. Total fertility rate........................................................................................................... 7 Figure 8. Life expectancy at birth (males and females), 1970-2003............................................. 9 Figure 9. Infant mortality rate, deaths per 1,000 live births, 1970-2003..................................... 11 Figure 10. Standardised death rate, males, 1970-2003................................................................ 12 Figure 11. Standardised death rate, females, 1970-2003 ............................................................ 13 Figure 12. Standardised death rate caused by circulatory system diseases, 1970-2002.............. 15 Figure 13. Standardised death rate caused by cancer, 1970-2002............................................... 16 Figure 14. Standardised death rate caused by external factors (injury and poisoning), 1970-2002............................................................................................................................. 17 Figure 15. Tuberculosis incidence, 1970-2003 ........................................................................... 20 Figure 16. Structure of health status self assessment by elderly (65+, 61+ in Slovakia)............ 23 Figure 17. Average length of stay in hospitals............................................................................ 37 Figure 18. Number of outpatient visits per person per year, 1970-2003..................................... 40 Figure 19. Primary care and hospital care use by age, Poland, 2003.......................................... 41 Figure 20. In-patient care admissions, 1970-2003 ...................................................................... 45 Health Status and Health Care Systems in Central and Eastern European Countries Bulgaria, Estonia, Poland, Slovakia and Hungary ENEPRI Research Report No. 31/December 2006 Stanisława Golinowska, Agnieszka Sowa & Roman Topór-Mądry∗ Introduction The analysis aims to describe processes of demographic and epidemiological change, as well as health status self-assessment in selected Central and Eastern Europe countries (CEECs), including both the new member states and the candidate countries. The analysis is presented in the context of the use of medical services and the structure of services used. Special attention is given to those demographic and epidemiological changes that have direct impact on the frequency of medical services used and, as such, determine increases in health care costs. The ageing
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