GESUNDHEITLICHE VERSORGUNG UND SOZIALE ABSICHERUNG IM INTERNATIONALEN VERGLEICH Maria M. Hofmarcher-Holzhacker 3. Symposium: Migration: epidemiologische und medizinische Aspekte Wien, February 26, 20 http://www.healthsystemintelligence.eu
PUBLIC SOCIAL SPENDING IS WORTH 22% OF GDP ON AVERAGE ACROSS THE OECD Gross public social spending rank: 6 Net total social spending rank: 12 3 Public social expenditure as a percent of GDP, 2007, peak level after 2007, and 2014 2014 ( ) Peak level after 2007 2007 30 2 20 10 0 2 Source: OECD (2014), OECD Social Expenditure database, (www.oecd.org/social/expenditure.htm).
20 PENSIONS AND HEALTH EXPENDITURE ARE THE MAIN ITEMS OF PUBLIC SOCIAL SPENDING Public social expenditure by broad social policy area, as a percent of GDP, in 2012 or latest year available 4,7 8,2,1 3,3 6, 6, 3,0 4,2 4,8 4,9 Pensions (old age and survivors) Income support to the working age population 18 16 14 7,9 3,8 6,2 8,3 3,3 4, 6,4 2,3 12 4,4 3,7 4,2,1,3 4,1 4,3 10,1 2,4 4,8,3 4,6 0,4 8 3,9 6 1, 1,1 0,9 4 2 13,8 6,2 10,2 10,3 13,2,8 7,4 10, 14, 10,6 13,0 11,4, 10,2,6 10,0 7,7,3,4 7,9,1 8,9 10,8 6,6 6,7 3,6 2,1 7,0 4, 6,9 4,7 7, 3,1 2, 1,8 0 France (31) Denmark (30.1) Belgium (29.4) Finland (28.3) Austria (27.7) Italy (27.) Sweden (27.2) Spain (26.8) Greece (2.7) Germany (2.) Portugal (24.8) Slovenia (24) Netherlands (23.) Japan (23.1) United Kingdom (22.7) Hungary (22.6) Luxembourg (22.) Ireland (22.3) Norway (21.8) OECD (21.4) New Zealand (21) Czech Republic (20.1) Poland (20.1) Switzerland (19.3) United States (18.7) Australia (18.3) Iceland (18.1) Slovak Republic (18.1) Canada (17.4) Estonia (16.8) Israel (.1) Turkey (12.2) Chile (10.2) Korea (9.6) Mexico (7.7) 8,6 6,7 8,0,7 6,7 7,0 6,7 6,8 6,6 8,0 6,3 6,4 7,9 7,7 7,7 4,9,8,8,6 6,2 8,4 6,2 4, 6, 8,0 6,1,6,6 7,2 4, 3,9 4,2 3,4 4,1 2,8 1,0 0,9 2,3 0,1 1,9 1,7 2,2 1,9 1,0 1,3 0,6 1,1 2,4 2,2 2,1 4,9 2,4 1,1 2,1 4,8 2,2 1,6 1,4 3,,0 1,0 0,9 Source: OECD (2014), Social Expenditure (SOCX) via www.oecd.org/social/expenditure.htm 2,4 2,6 2,7 2,1 0 2 4 6 8 10 12 14 16 18 20 3,0 3,9 7,0 7, Health All social services except health 3
AUSTRIA IS HIGH-SPENDER IN THE AREA OF HEALTH 12 10 8 6 4 % GDP France Germany Italy United Kingdom EU28 Austria 2000 2002 2004 2006 2008 2010 2012 Health expenditure per capita, 2012 (or nearest year), EUR PPP 000 400 Total Residual 4610 46 4000 300 3000 200 2000 00 1000 3829 3676 3613 328 3437 3318 3220 3083 2921 2672 2470 2409 2243 2193 2003 1921 184 1809 1728 80 60 134 1219 16 1133 1086 934 900 73 26 97 783 739 61 00 0 1. Current health expenditure. Source: OECD Health Statistics 2014; Eurostat Statistics Database; WHO Global Expenditure Database. 4
HIGHER LIFE EXPECTANCY COULD BE ACHIEVED WITH THE MONEY INVESTED Potential gains in life expectancy, years Potential gains in amenable mortality, %
AUSTRIA SEES A GRADUAL EXPANSION OF PUBLIC COVERAGE OF HEALTH CARE SERVICES 12,0 Health care Expenditure in Austria, % GDP 10,0 8,0 private 2,7 8,1 6,0 2,1 6,2 4,0 public 2,0 0,0 1990 1991 1992 1993 1994 199 1996 1997 1998 1999 2000 2001 2002 2003 2004 200 2006 2007 2008 2009 2010 2011 2012 2013 Source: Statistik Austria 2014, own compilation 6
GROWTH IN GOVERNMENT EXPENDITURE WITHOUT SOCIAL SECURITY HAS BEEN THE STRONGEST IN RECENT YEARS 7
THIS UNDERLINES THE IMPORTANCE OF TAX REVENUES FOR THE HEALTH SYSTEM AND MAKES POLICY EVEN MORE COMPLEX THAN IN OTHER COUNTRIES Expenditure on health by type of financing, 2012 (or nearest year) % co-payment 8% out-of-pocket payment % of current expenditure Other Private insurance Private out-of-pocket Social Security General Government 100 90 80 6 2 13 3 9 8 17 12 19 18 13 14 8 1 19 10 12 4 2 4 17 20 20 21 23 13 3 6 1 22 24 29 13 17 1 2 2 32 32 34 32 3 29 43 7 18 11 26 0 36 37 37 70 47 29 60 0 40 30 20 10 0 78 8 8 84 79 74 68 69 81 12 9 11 77 74 3 4 77 70 7 4 33 64 11 60 40 33 6 7 69 3 67 64 6 39 29 67 8 9 66 63 61 4 8 38 17 1 46 74 2 77 46 20 9 7 3 4 7 1. The Netherlands do not account for fixed deductable payable by patients (30 EUR per year) as out-of-pocket spending, resulting in an under-estimation of the share of out-ofpocket payments. 2. Data refer to total health expenditure. 3. Public spending cannot be split Source: OECD Health Statistics 2014; Eurostat Statistics Database; WHO Global Health Expenditure Database. 8
GAPS IN HEALTH-RELATED LIFESTYLES ACROSS GROUPS MAY BECOME WORRYING 1. PSA - testicular cancer screening. 2. In the last 12 months. Source: Statistik Austria, "Österreichische Gesundheitsbefragung 200 7, Gönenc et al 2011.. 9
IS THIS RELATED TO A LACK OF INCLUSIVE PREVENTIVE CARE AND WEAK INTEGRATION POLICY? Performance in Social Policy areas, Austria compared to Eurozone countries -+1 point between 2011-2014 in Austria -0.3 points between 2011-2014 in Eurrozone. 10 Source: Bertelsmann Stiftung: Sustainable Governance Indicators http://www.sgi-network.org/2014/austria/social_policies
SOCIAL JUSTICE OVERALL SEEMS TO DECLINE AND NOT ONLY PEER COUNTRIES DO BETTER Social Sustainability Index and health expenditure per capita, 2012 (or nearest year), EUR PPP 9,0 8,0 7,0 6,0,0 4,0 TUR BUL EST LIT POL HUN CZE R POR GRE FIN UK ISL ESP ITA SWE DK LUX GER NL BEL AUT NOR CHE 3,0 2,0 1,0 y = 1,3643ln(x) - 4,1264 R² = 0,0236 Social Sustainability Index Log. (Social Sustainability Index ) 0,0 0 00 1000 00 2000 200 3000 300 4000 400 000 11 Source: Bertelsmann Stiftung: Sustainable Governance Indicators http://www.sgi-network.org/2014/, OECD Health at a Glance Europe 2014, own compilation
RISING INCOME-RELATED HEALTH INEQUALITIES NEED MORE ATTENTION 12 Quelle: EUROSTAT 2010
FISCAL PRESSURES NEED ALSO ATTENTION Main areas of social spending 2010 and 2030, %GDP 3 4,0 30 3, 3, 2,6 3,0 in % of GDP 2 20 10 0,6 1,0 0,6 0,4 0, 1,3 2, 2,0 1, 1,0 0, percentage points change -0, -0,3-0,1-0,2 0,0-0, 0 AT EU27 AT EU27 AT EU27 AT EU27 AT EU27 AT EU27 Pensions Health Care Long-Term Care Education Unemployment Total dark=2010 light=2030 difference 2030-2010 (right scale) Source: European Commission, Aging Report 2012, own compilation -1,0 13
TO BALANCE THIS CHALLENGE SMART POLICIES ARE REQUIRED FOCUSING THOSE MOST IN NEED WHILE IMPROVING POLICY COORDINATION...dass die Daten- und Studienlage zu Migration und Gesundheit in Österreich verbesserungswürdig ist, GÖG 20.Die für die Umsetzung des Rahmen Gesundheitsziels Gesundheitliche Chancengerechtigkeit gebildete Arbeitsgruppe hatte rund ein Jahr nach Beschluss der Rahmen Gesundheitsziele noch immer keine Indikatoren für die Zielerreichung festgelegt. Rechnungshof, Feb. 20 OECD 2011: Implement more effective public health programmes with respect to nutrition, smoking and alcohol consumption. Continue to develop children health programmes which have positive life-long impacts. Develop special programmes for vulnerable groups which lag behind in lifestyles and prevention, notably low education immigrant and resident groups. Source: Daniel Kahnemann: Don t Blink! The Hazards of Confidence, NYT Magazine, October 19, 2011
THANK YOU FOR YOUR ATTENTION Selected Readings OECD (2014): Health at a Glance Europe, OECD Publishing. http://ec.europa.eu/health/reports/docs/health_glance_2014_en.pdf OECD (2014): Social Expenditure Up-date, November 2014: http://www.oecd.org/social/expenditure.htm Schraad-Tischler, D., Ch.Kroll (2014) Social Justice in the EU A Crossnational Comparison Social Inclusion Monitor Europe (SIM) Index Report: http://www.sgi-network.org/docs/2014/basics/social_justice_in_the_eu_2014.pdf GÖG (20): Migration und Gesundheit: http://www.goeg.at/cxdata/media/download/berichte/ migration_und_gesundheit_20.pdf EC (2012): The 2012 Ageing Report Economic and budgetary projections for the 27 EU Member States (2010-2060): http://ec.europa.eu/economy_finance/publications/european_economy/2012/ pdf/ee-2012-2_en.pdf Hofmarcher M M, (2013) Austria: Health system review. Health Systems in Transition, 2013; (7): 1 291, http://www.euro.who.int/ data/assets/pdf_file/0017/233414/hit-austria.pdf Gönenç, R., M. M. Hofmarcher and A. Wörgötter (2011), Reforming Austria's Highly Regarded but Costly Health System, OECD Economics Department Working Papers, No. 89, OECD Publishing. http://dx.doi.org/10.1787/kg1mbntk7j-en OECD (2010), Health Care Systems: Efficiency and Policy Settings, OECD Publishing. http://dx.doi.org/10.1787/9789264094901-en