Health and long-term care data needs: the Ageing Report and the European Semester

Public Health Statistics Working GroupLuxembourg, 16-17 December 2014

Santiago Calvo RamosSustainability of Public Finances

DG Economic and Financial AffairsEuropean Commission

Unit C2, DG ECFIN: Main tasks and data needs

• EPC-EC Ageing Report

• European Semester and analysis of sustainability of EU health systems

• Other publications and analysis

The EPC-EC Ageing Report

• 2006, 2009 and 2012: public expenditure projections • health care

• long-term care

• pensions

• Project expenditure until 2060• Departing point: population projections and ageing.

Impact on expenditure?• Consider other drivers of expenditure

Data needs

• Need data on many things! • Population by age and gender

• Eurostat population data

• Data on overall public expenditure on health care• SHA data; when not available ESSPROS

• Data on overall public expenditure on long-term care• SHA data; when not available ESSPROS data from Eurostat• In-kind and cash benefits – for cash use ESSPROS data from

Eurostat

• Data on overall public expenditure on pensions

Data needs

• Data on health status• Life expectancy from Eurostat

• Dependency rates = severe disability rates as in EU-SILC from Eurostat

• Data on age-gender specific expenditure profiles• Per capita for healthcare – national data

• Per user for long-term care – national data

• Data on users of long-term care – national data• Separated in institutional and home care

Data needs

• Data to run specific scenarios: • Health care:

– Wages, capital, pharmaceutical, appliances, administration

• LTC:– Expenditure on Institutional and home care,

– Number of users of institutional and home care

• Pensions:

– Used for comparison with national data.

Data problems encountered

• Comparability not yet there • Two sources of data: SHA and ESSPROS

• Not fully comparable

• No data for specific categories if do not use SHA: • e.g. pharmaceutical expenditure

• Difficulty in obtaining comparable data on capital and wages • use additional sources like COFOG or EUKLEMS

• National data on age-profiles not fully comparable

Data problems encountered

• Bigger problems with LTC data:• No data on cash-benefits from SHA:

• Use ESSPROS but difficult to agree categories with Member States

• So need to improve comparable data collection

Data problems encountered

• Bigger problems with LTC data (cont.):• Data on social services of LTC not available for all:

• Part of previous HCR6 in SHA but not reported for all and not always possible to disentangle from other benefits

• Use ESSPROS but need for adjustments• So need to improve comparable data collection

Data problems encountered

• Bigger problems with LTC data (cont.):• Number of people receiving long-term care in a)

institutions and b) at home, by sex and single age or five-year cohorts

• From? National data so far…

• number of recipients of long-term care-related cash benefits, by sex and single age or five-year cohorts

• From? National data so far…

European Semester

• Support Country Desks in analysis of public finances in HC and LTC• Set of commonly used indicators on expenditure but also

on areas of provision and health status• Pharmaceuticals• Hospitals: beds, ALOS• Ambulatory: staff and staff mix• Prevention and Promotion• Spending on administration• Health status

European Semester: Health care TAF• Hospital care

• Public hospital expenditure as % of GDP, Public hospital expenditure as % of public CHE, Acute hospital beds per 1 000 pop, Acute care bed occupancy rates, Average acute care length of stay in days**, % of day in total discharges

• Ambulatory care• Public ambulatory care expenditure as % of GDP, Public exp. on ambulatory care as % of public CHE, Number of GPs

per 100 000 inhabitants, Share of GPs in total number of physicians, Ratio of nurses to physicians, Ratio of outpatient to inpatient contacts per capita

• Pharmaceutical spending• Public outpatient pharmaceutical expenditure as % of GDP, Public exp. on outpatient pharmaceuticals as % of public

CHE, Public as % of total expenditure on pharmaceuticals, Expenditure in per capita PPS, Generic market shares in volume

• Administrative spending• Public administrative expenditure as % of GDP, Public exp. On administration and insurance as % of public CHE.

• Health status • Life expectancy at birth for females, Life expectancy at birth for males, Amenable mortality, Infant mortality rate per 1 000

life births

European Semester: Long-Term Care TAF

• Distribution of LTC spending• % of spending on institutional as part of formal in-kind spending, % of formal in-kind spending in total spending

• LTC coverage• % of population (aged 15+) receiving formal in-kind LTC and/or cash benefits, % of dependents (aged 15+)

receiving formal in-kind LTC and/or cash benefits

• Unit costs• Unit costs in institutional care per recipient, as % of GDP per capita, Ratio of unit cost per recipient in institutional

to home care

• System features• Eligibility: means tested criterion, Eligibility: minimum dependency criterion

• Need for LTC care services • Expected years in sickness or disability over life time, Expected years in sickness or disability from age 65

onwards*, People having a long-standing illness or health problem, in % of pop., Self-perceived severe limitations in daily activities, in % of pop.

Other publications by C2 • Medeiros J. and Schwierz C. (2013), "Estimating the drivers of and projecting public

health care expenditure in the European Union: Baumol's "cost-disease" revisited, forthcoming.

• Carone, G., C. Schwierz and A. Xavier (2012), “Cost-containment policies in public pharmaceutical spending in the EU”, European Economy, Economic Paper No. 461, European Commission.Cost-containment policies in public pharmaceutical spending in the EU:http://ec.europa.eu/economy_finance/publications/economic_paper/2012/ecp461_en.htm

• European Commission (DG ECFIN)-EPC (AWG) (2010), 'Joint Report on Health Systems', European Economy. Occasional Papers, Vol. 74: http://ec.europa.eu/economy_finance/publications/occasional_paper/2010/pdf/ocp74_en.pdf

DG ECFIN supports better data collection

• Through implementation of SHA 2011

• Through ESSPROSS improvements

• Through collection of consistent and comparable non-monetary health statistics

Thank you!