Monday, 20 July 2015

What do the OECD health statistics tell us about Ireland?

Paul Sweeney: The OECD has recently published its “Health at a Glance: Europe 2014”. This is very useful even though I am critical of this organisation for purveying some extreme liberal ideology on economics, taxation and other matters.

For example, OECD rarely uses the word “taxation” without attaching the ideologically-loaded word “burden” to it. Thus tax is always a “burden” to these tax-funded civil servants and they rarely describe it as it is – as a charge or payment.

The OECD’s data is based on national statistics and is very useful for comparisons. So if you ignore many of its economic recommendations, the data is useful in most cases and this international comparative health data/information is helpful. This is a flavour of what is in the report.

The government has established the “Healthy Ireland Council” to create an environment where every individual and sector of society can play their part in achieving a healthy Ireland. Healthy Ireland’s goals are to:

  • Increase the proportion of people who are healthy at all stages of life.
  • Reduce health inequalities in Ireland.
  • Protect the public from threats to health and wellbeing 

I’m interested in this OECD report both as a member of this Council and as a citizen.

Health Spending
It will not surprise that Ireland has had the third deepest cuts in health spending in EU28 since 2009, with an average reduction in spending of 3.7% a year, each year (2009-2012 inclusive) per capita, according to this OECD study. Greece topped the cuts at 9% each year, followed surprisingly by rich Luxembourg (though it imports some of its health services).

Putting the crisis in stark perspective, there were cuts in 14 of the member states in these years in stark contrast to growth which averaged 4.7% a year in the 28 member states in the preceding years 2000 to 2008.

In 2012 health spending per capita in Ireland was €2,921, compared to €2,193 average in EU28, with Romania at bottom at €763 and Netherlands at top at €3,839, or France above us at €3,320 or UK below us at €2,470. However, these are figures for both public and private spending, and we in Ireland spend more on private health than the UK or France per capita.

Another way of examining health spending is to see what proportion of total government spending it consists of. In Ireland in 2013, it stood at the EU average and amounted to a substantial 14% of all public spending. It was the same in Slovenia, Czech, Spain, Luxembourg and Italy. Tops was Netherlands at 20% followed by Germany, Austria and the UK. This is public spending on health.

When it comes to public health spending as a percentage of the total spending on health, Ireland is well down the list of 28 states. Don’t forget when the 10 new Eastern European states joined the EU in 2004, they dragged down the average on many counts. Ireland’s public health spending was 67% of all expenditure on health, (ie 33% was private) compared to 98% for Denmark, or 97% for UK or the average of 73% (these statistics are complex and public include direct expenditure and social security in many states).

In 2012, the 28 EU states spent an unweighted (by size of country) average of 8.7% of GDP on health. This was up considerably on 7.3% in 2000, in spite of the falls in 14 states in the latter years - thanks to the financial and then fiscal crisis. Indeed the spending figure peaked at 9% in 2009.

For Ireland the figure was 8.9% - just above the average of 8.7% for the 28 member states. However, GDP is not a good comparator for Ireland, and adjusting to GNP would push Ireland’s health spending up the rankings from 16th. Netherlands is top followed by France and Germany.

Drugs & Drink
Spending on pharmaceuticals topped €200bn in the EU in 2012 per this OECD report. One fifth of all health spending is on drugs and so its expenditure growth is important. The average spend on drugs was €350 per person in the EU. But Ireland spends much more than this. At €500 spending per head – after the Crash of 2008 - it is spending 43% more that the average. Most of this is public spending.

The grip of the pharma industry in Ireland and power of the American Chamber of Commerce in framing public policy in Ireland is well known. Governments have been slow to confront these mainly Irish-based companies on the cost paid by taxpayers and citizens for drugs. This servile attitude is reflected in this stark figure. However, there has been some progress in recent times on dealing with this issue.

Alcohol consumption here is near the top - per litre per person – we are 4th. Alcohol consumption in the EU is the highest in the world, so this puts us near peak! Alcohol is a key driver of many illnesses, as is well known.

Ireland is tops for eating vegetables and close to the top for eating fruit with Finland at the bottom of this league.

Obesity rates are of great concern as it is the cause of many health problems including hypertension, diabetes, heart disease, cholesterol and forms of cancer. It adds to health costs in the long run. Obesity is evident in most countries.

The OECD says that the majority of adults are overweight in the EU (53%). Adults overweight and obese exceeds a staggering 50% in no less than 17 member states.

Obesity averages 16.2% in EU26 states and is at 7.9% in Romania - the lowest - and 28.5% in Hungary, followed by the UK (24.7%) and then Ireland at a high 23%. There are data difficulties but the overall figure is deeply worrying. More women than men are obese in Ireland per this data.

Doctors, Hospitals and more
There are 3.4 doctors per 1000 population in OECD, but Ireland is near the bottom at 2.7. Why is this when there is such ambition to study medicine here? Topically Greece has the highest at 6.2 doctors per 1000. The number of doctor consultations is very low in Ireland. The number of practising nurses in Ireland is high at 12.8 per 1000 compared to the average of 8 in EU28.

It will come as no surprise in this country which seeks to have the lowest taxes that the number of hospital beds per 1000 population is under 3 in Ireland compared to the average of over 5 in EU28. Ireland near the bottom of Europe at 3 - just above the UK and Sweden at the lowest.  Germany is at the top at 8 followed by Austria. Ireland is near the bottom for average stay in hospital (for acute care) at 6.2 days against the average of 7.8 days in 2012, the base year.

In 2011, Ireland had a high rate of female mortality from breast cancer at 41.8 per 100,000 compared to the EU28 average of 34.8, though we are now high for mammography screening. Ireland is not listed on waiting times for elective surgery in this study.

Future Cuts in Health Spending are Planned
The endless discussions on “Morning Ireland” about deficiencies in Irish public services might (someday?) give equal weight to serious debates on the need to pay more - not less taxation - if we are to fund European levels of such services.  The myth that modern public services can be funded by decreasing levels of taxation should be the big economic/political issue in coming years.

The Government has published and submitted its plan to the EU Commission to cut taxes and thus public services (as a percentage of national income). Without increased funding, the health service is unlikely to improve.

Greater efficiencies will help, but increased funding is needed as needs grow and health inflation continues to exceed other consumer prices.

Paul Sweeney is Chair of TASC's Economists Network 


James Wickham said...

This is really useful.
An important concern for tasc-y people is surely how other areas of public policy impact on public health. Two cases:
1. Alcohol. You mention the power of the pharma industry lobby but another iniquitous lobby is surely the alcohol industry lobby. It's difficult to see how anyone can talk about our worsening alcohol problem without tackling this one.
2. Equally it's astonishing that the discussion of obesity seems to turn this into an issue of lifestyle and individual choice. Of course individual issues are crucial, but so are broader 'societal' questions. The big one here is the nexus of transport and urban planning: the privileging of the private car over public transport, the extent of suburban sprawl, the destruction of 'walkability' in our immediate environment, etc. As far as I can see the Healthy Ireland website doesn't even MENTION these issues. In other words, it focuses on individual level issues, whereas "Ecological models take a broad view of health behaviour causation, with the social and physical environment included as contributors to physical inactivity, particularly those outside the health sector, such as urban planning, transportation systems, and parks and trails" (Bauman et al 2014). There's a very early discussion of these issues in my Gridlock book! (Wickham (2006).

Bauman, A. E., Reis, R. S., Sallis, J. F., Wells, J. C., Loos, R. J., Martin, B. W., & Lancet Physical Activity Series Working Group. (2012). Correlates of physical activity: why are some people physically active and others not?. The lancet, 380(9838), 258-271.
Wickham, J. J. R. (2006). Gridlock: Dublin's transport crisis and the future of the city. New Island.

Happy bus using!



I agree that much of the obesity discussion focuses on individual choice and little on the fact that for many poor people, there is little choice between the multiple offers for junk food in supermarkets over more expensive and more wholesome food. It is worth noting that Healthy Ireland had inequality as a major point and it also has debated it in depth.
I agree with the policy of successive governments is to privilege the car over public transport and this is also unhealthy. They will argue that is what the people want but that is trite.