GESUNDHEITLICHE VERSORGUNG UND SOZIALE ABSICHERUNG IM INTERNATIONALEN VERGLEICH

Maria M. Hofmarcher-Holzhacker

3. Symposium: Migration: epidemiologische und medizinische Aspekte

Wien, February 26, 2015

http://www.healthsystemintelligence.eu

PUBLIC SOCIAL SPENDING IS WORTH 22% OF GDP ON AVERAGE ACROSS THE OECD

2

Public social expenditure as a percent of GDP, 2007, peak level after 2007, and 2014

Source: OECD (2014), OECD Social Expenditure database, (www.oecd.org/social/expenditure.htm).

0

5

10

15

20

25

30

35 2014 (↘) Peak level after 2007 2007

Gross public social spending rank: 6 Net total social spending rank: 12

PENSIONS AND HEALTH EXPENDITURE ARE THE MAIN ITEMS OF PUBLIC SOCIAL SPENDING

3

13,8 6,2

10,2 10,3 13,2 15,8

7,4 10,5 14,5 10,6 13,0 11,4 5,5

10,2 5,6

10,0 7,7 5,3 5,4 7,9 5,1 8,9

10,8 6,6 6,7 3,6 2,1 7,0 4,5

6,9 4,7 7,5 3,1 2,5 1,8

4,7 7,9

8,2 6,5

5,1 3,3

4,5 6,5

3,0 3,8

4,2 4,8

6,4 2,3

5,1 4,9

6,2 8,3

5,3 4,4

5,1 3,7

3,3 4,1

2,4 4,8

5,3 4,2

4,6 4,3

3,9 0,4

1,5 1,1 0,9

0 2 4 6 8 10 12 14 16 18 20

Pensions (old age and survivors)

Income support to the working age population

France (31) Denmark (30.1) Belgium (29.4) Finland (28.3) Austria (27.7)

Italy (27.5) Sweden (27.2) Spain (26.8)

Greece (25.7) Germany (25.5) Portugal (24.8) Slovenia (24)

Netherlands (23.5) Japan (23.1)

United Kingdom (22.7) Hungary (22.6)

Luxembourg (22.5) 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 (15.1)

Turkey (12.2) Chile (10.2) Korea (9.6) Mexico (7.7)

8,6 6,7 8,0 5,7 6,7 7,0 6,7 6,8 6,6 8,0 6,3 6,4 7,9 7,7 7,7 4,9 5,8 5,8 5,6 6,2 8,4 6,2 4,5 6,5 8,0 6,1 5,6 5,6 7,2 4,5 3,9 4,2 3,4 4,1 2,8

3,0 7,0

2,1 4,8

1,9 1,0

7,5 2,2

1,3 2,4

0,6 1,1

2,6 2,7

3,9 2,4

2,2 2,1

4,9 2,4

2,1 1,1

1,0 1,6

1,4 3,5 5,0

1,0 0,9

0,9 2,3

0,1 1,9

1,7 2,2

0 2 4 6 8 10 12 14 16 18 20

Health

All social services except health

Source: OECD (2014), Social Expenditure (SOCX) via www.oecd.org/social/expenditure.htm

Public social expenditure by broad social policy area, as a percent of GDP, in 2012 or latest year available

AUSTRIA IS HIGH-SPENDER IN THE AREA OF HEALTH

4

4

6

8

10

12

2000 2002 2004 2006 2008 2010 2012

% GDP

France Germany Italy

United Kingdom EU28 Austria

Health expenditure per capita, 2012 (or nearest year), EUR PPP

3829

3676

3613

3528

3437

3318

3220

3083

2921

2672

2470

2409

2243

2193

2003

1921

1845

1809

1728

1580

1560

1354

1219

1156

1133

1086

934

900

753

4610

4565

2655

957

783

739

651

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

Total Residual

1. Current health expenditure. Source: OECD Health Statistics 2014; Eurostat Statistics Database; WHO Global Expenditure Database.

HIGHER LIFE EXPECTANCY COULD BE ACHIEVED WITH THE MONEY INVESTED

5

Po

ten

tia

l g

ain

s in

lif

e ex

pec

tan

cy, y

ears

P

oten

tial g

ain

s in a

men

ab

le mo

rtality

, %

AUSTRIA SEES A GRADUAL EXPANSION OF PUBLIC COVERAGE OF HEALTH CARE SERVICES

6

6,2

8,1

2,1

2,7

0,0

2,0

4,0

6,0

8,0

10,0

12,0

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

private

Source: Statistik Austria 2014, own compilation

Health care Expenditure in Austria, % GDP

public

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

8

8

85 84

5 9

81

12 11 3 4

77

7

33

11

60

33

7 3

67

6

29

67

9

66 63 61

8 17

46

74

52

20

5 4 7

78 79 74 68 69

77 74 70

45

64

15

40

65 69

5

64

39

58 54 38

1

11

29

77

46

59 57 53

6 13

9 15

12 17 19 18 13

8

19 12

17 20 20 21 23

13

22 24 29

17

32 32 34 32

29 43

47

15 18

15

26 36

37 37

5 2

3 5 8

14 1

10 5 4

2 4 15

6 1

3

13

1 2 2 5

3 5 7

0

0

10

20

30

40

50

60

70

80

90

100

% of current expenditure Other Private insurance Private out-of-pocket Social Security General Government

Expenditure on health by type of financing, 2012 (or nearest year)

1. The Netherlands do not account for fixed deductable payable by patients (350 EUR per year) as out-of-pocket spending, resulting in an under-estimation of the share of out-of-pocket 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.

15% co-payment 85% out-of-pocket payment

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?

10

Source: Bertelsmann Stiftung: Sustainable Governance Indicators http://www.sgi-network.org/2014/Austria/Social_Policies

-0.3 points between 2011-2014 in Eurrozone. -+1 point between

2011-2014 in Austria

Performance in Social Policy areas, Austria compared to Eurozone countries

SOCIAL JUSTICE OVERALL SEEMS TO DECLINE AND NOT ONLY PEER COUNTRIES DO BETTER

11

AUT BEL CZE R

DK

EST

FIN

GER

GRE HUN

ISL

ITA

LUX

NL

NOR

POL

POR ESP

SWE

CHE

TUR

UK

LIT

BUL

y = 1,3643ln(x) - 4,1264 R² = 0,50236

0,0

1,0

2,0

3,0

4,0

5,0

6,0

7,0

8,0

9,0

0 500 1000 1500 2000 2500 3000 3500 4000 4500 5000

Social Sustainability Index

Log. (Social Sustainability Index )

Source: Bertelsmann Stiftung: Sustainable Governance Indicators http://www.sgi-network.org/2014/, OECD Health at a Glance Europe 2014, own compilation

Social Sustainability Index and health expenditure per capita, 2012 (or nearest year), EUR PPP

RISING INCOME-RELATED HEALTH INEQUALITIES NEED MORE ATTENTION

12

Quelle: EUROSTAT 2010

FISCAL PRESSURES NEED ALSO ATTENTION

13

2,6

0,6

1,0

0,6 0,4 0,5

-0,5 -0,3

-0,1 -0,2

3,5

1,3

-1,0

-0,5

0,0

0,5

1,0

1,5

2,0

2,5

3,0

3,5

4,0

0

5

10

15

20

25

30

35

AT EU27 AT EU27 AT EU27 AT EU27 AT EU27 AT EU27

Pensions Health Care Long-Term Care Education Unemployment Total

per

cen

tag

e p

oin

ts c

ha

ng

e

in

% o

f G

DP

dark=2010|light=2030 difference 2030-2010 (right scale)

Main areas of social spending 2010 and 2030, %GDP

Source: European Commission, Aging Report 2012, own compilation

TO BALANCE THIS CHALLENGE SMART POLICIES ARE REQUIRED FOCUSING THOSE MOST IN NEED WHILE IMPROVING POLICY COORDINATION

Source: Daniel Kahnemann: Don’t Blink! The Hazards of Confidence, NYT Magazine, October 19, 2011

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.

“….Die für die Umsetzung des

Rahmen–Gesundheitsziels

„Gesundheitliche Chancen-

gerechtigkeit“ gebildete Arbeitsgruppe

hatte rund ein Jahr nach Beschluss

der Rahmen–Gesundheitsziele noch

immer keine Indikatoren für die

Zielerreichung festgelegt….”

Rechnungshof, Feb. 2015

...dass die Daten- und Studienlage zu Migration

und Gesundheit in Österreich verbesserungswürdig ist”,

GÖG 2015

15

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 Cross-

national Comparison Social Inclusion Monitor Europe (SIM) – Index Report:

http://www.sgi-network.org/docs/2014/basics/Social_Justice_in_the_EU_2014.pdf

¢  GÖG (2015): Migration und Gesundheit:

http://www.goeg.at/cxdata/media/download/berichte/

migration_und_gesundheit_2015.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; 15(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. 895, OECD Publishing.

http://dx.doi.org/10.1787/5kg51mbntk7j-en

¢  OECD (2010), Health Care Systems: Efficiency and Policy Settings, OECD

Publishing. http://dx.doi.org/10.1787/9789264094901-en