To what extent does current health policy hinder or facilitate achieving high-quality healthcare?
Health policies are fully aligned with the goal of achieving high-quality healthcare.
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9
Germany
Health insurances in Germany finance various examinations for the early detection of diseases such as cancer and diabetes, starting at different ages (Betanet, n.d.). Statutory insurants receive a reminder about the opportunity to undergo a cancer screening every five years (OECD/European Observatory on Health Systems and Policies, 2023).
To prevent such diseases, various strategies aim to sensitize the population about the importance of balanced nutrition and physical exercise. The national plan of action for this cause, named IN FORM, was founded in 2008. It consolidates health initiatives into a national strategy and seeks to prevent malnutrition, lack of physical exercise, and excess weight by improving the population’s knowledge about healthy lifestyles and motivating adherence to such lifestyles (Bundesministerium für Gesundheit, n.d.). Since 2015, most governmental prevention expenses have been directed to schools, kindergartens, nursing facilities, and firms to enhance health and prevention knowledge among the population, starting from a young age (Stiftung Gesundheitswissen, 2021).
The federal government plans to prohibit advertising for foods high in sugar, fat, or salt directed at children in all relevant media to prevent unbalanced eating and excess weight (Bundesministerium für Ernährung und Landwirtschaft, 2023).
The prevention of alcohol and tobacco consumption in Germany is progressing slowly compared to other European countries. However, an increase in tobacco taxes is taking place from 2022 to 2026, and advertising for tobacco was banned on billboards and in cinemas in 2020. Germany was the last EU country to do so, though. There is no smoking ban in private cars yet (OECD/European Observatory on Health Systems and Policies, 2023).
Between 2011 and 2019, the avoidable mortality rate – deaths that could have been prevented through better public health measures or a more effective healthcare system – declined by approximately 8%. The avoidable mortality rate remains below the EU average (OECD/European Observatory on Health Systems and Policies, 2023).
Germany has one of the lowest percentages of unmet needs for medical care in the European Union, with under 1%. Moreover, there is only a negligible difference in the unmet needs rate among different income groups (OECD/European Observatory on Health System and Policies, 2023).
The German health insurance system has one of the best coverage rates for medical treatments compared to other European OECD countries. This is true for both statutory and private insurance (Finkenstädt, 2017).
In 2004, the principle of integrated care was introduced into German law. The government aimed to prevent multiple examinations of the same patient by different doctors, thereby saving costs and improving coordination among care, inpatient treatment, and rehabilitation efforts, as well as coordination between family doctors and hospitals (Der Paritätische Gesamtverband, 2011).
To prevent such diseases, various strategies aim to sensitize the population about the importance of balanced nutrition and physical exercise. The national plan of action for this cause, named IN FORM, was founded in 2008. It consolidates health initiatives into a national strategy and seeks to prevent malnutrition, lack of physical exercise, and excess weight by improving the population’s knowledge about healthy lifestyles and motivating adherence to such lifestyles (Bundesministerium für Gesundheit, n.d.). Since 2015, most governmental prevention expenses have been directed to schools, kindergartens, nursing facilities, and firms to enhance health and prevention knowledge among the population, starting from a young age (Stiftung Gesundheitswissen, 2021).
The federal government plans to prohibit advertising for foods high in sugar, fat, or salt directed at children in all relevant media to prevent unbalanced eating and excess weight (Bundesministerium für Ernährung und Landwirtschaft, 2023).
The prevention of alcohol and tobacco consumption in Germany is progressing slowly compared to other European countries. However, an increase in tobacco taxes is taking place from 2022 to 2026, and advertising for tobacco was banned on billboards and in cinemas in 2020. Germany was the last EU country to do so, though. There is no smoking ban in private cars yet (OECD/European Observatory on Health Systems and Policies, 2023).
Between 2011 and 2019, the avoidable mortality rate – deaths that could have been prevented through better public health measures or a more effective healthcare system – declined by approximately 8%. The avoidable mortality rate remains below the EU average (OECD/European Observatory on Health Systems and Policies, 2023).
Germany has one of the lowest percentages of unmet needs for medical care in the European Union, with under 1%. Moreover, there is only a negligible difference in the unmet needs rate among different income groups (OECD/European Observatory on Health System and Policies, 2023).
The German health insurance system has one of the best coverage rates for medical treatments compared to other European OECD countries. This is true for both statutory and private insurance (Finkenstädt, 2017).
In 2004, the principle of integrated care was introduced into German law. The government aimed to prevent multiple examinations of the same patient by different doctors, thereby saving costs and improving coordination among care, inpatient treatment, and rehabilitation efforts, as well as coordination between family doctors and hospitals (Der Paritätische Gesamtverband, 2011).
Citations:
Betanet. n.d. “Früherkennung von Krankheiten.” https://www.betanet.de/frueherkennung-von-krankheiten.html
Bundesministerium für Ernährung und Landwirtschaft. 2023. “Mehr Kinderschutz in der Werbung: Pläne für klare Regeln zu an Kindern gerichteter Lebensmittelwerbung.” https://www.bmel.de/DE/themen/ernaehrung/gesunde-ernaehrung/kita-und-schule/lebensmittelwerbung-kinder.html
Bundesministerium für Gesundheit. n.d. “Prävention.” https://www.bundesgesundheitsministerium.de/service/begriffe-von-a-z/p/praevention
Finkenstädt. 2017. “Zugangshürden in der Gesundheitsversorgung – Ein europäischer Überblick.” https://www.wip-pkv.de/fileadmin/DATEN/Dokumente/Studien_in_Buchform/WIP_Zugangshuerden_in_der_Gesundheitsversorgung.pdf
OECD/European Observatory on Health Systems and Policies. 2023. Germany: Country Health Profile 2023, State of Health in the EU. Paris: OECD Publishing. https://doi.org/10.1787/21dd4679-en
Stiftung Gesundheitswesen. 2021. “Prävention: Der Mix macht’s.” https://stiftung-gesundheitswissen.de/gesundes-leben/kompetenz-gesundheit/praevention-der-mix-machts
Betanet. n.d. “Früherkennung von Krankheiten.” https://www.betanet.de/frueherkennung-von-krankheiten.html
Bundesministerium für Ernährung und Landwirtschaft. 2023. “Mehr Kinderschutz in der Werbung: Pläne für klare Regeln zu an Kindern gerichteter Lebensmittelwerbung.” https://www.bmel.de/DE/themen/ernaehrung/gesunde-ernaehrung/kita-und-schule/lebensmittelwerbung-kinder.html
Bundesministerium für Gesundheit. n.d. “Prävention.” https://www.bundesgesundheitsministerium.de/service/begriffe-von-a-z/p/praevention
Finkenstädt. 2017. “Zugangshürden in der Gesundheitsversorgung – Ein europäischer Überblick.” https://www.wip-pkv.de/fileadmin/DATEN/Dokumente/Studien_in_Buchform/WIP_Zugangshuerden_in_der_Gesundheitsversorgung.pdf
OECD/European Observatory on Health Systems and Policies. 2023. Germany: Country Health Profile 2023, State of Health in the EU. Paris: OECD Publishing. https://doi.org/10.1787/21dd4679-en
Stiftung Gesundheitswesen. 2021. “Prävention: Der Mix macht’s.” https://stiftung-gesundheitswissen.de/gesundes-leben/kompetenz-gesundheit/praevention-der-mix-machts
Norway
Prospects of increasing demographic pressures on health services have intensified interest in preventive care and the relationships between behavior, lifestyles, and the demand for healthcare services. Local authorities are responsible for policy measures. No central government initiatives have been taken, except for a national program screening for some forms of cancer. In general, high-quality services are accessible throughout the country. Patients have the right to choose both their GP and hospital for treatment. Most people, however, choose to be treated at their nearby local hospital, even if this means waiting longer.
Switzerland
By international standards, Swiss healthcare is of outstanding quality. The system fosters preventive healthcare, including detection and treatment, as well as the adoption of a healthy lifestyle. This is demonstrated by the country’s top position with regard to avoidable mortality and high life expectancy (see also FSO 2023) – phenomena that are also related to the general wealth and high quality of life in Switzerland. Health specialists note that despite excellent outcomes, the Swiss health system is oriented toward cutting-edge biomedical interventions at the individual level, while showing clear shortcomings with regard to preventive health, structural regulations and action on the social determinants of health (Monod/Grandchamp 2022). This latter perspective is believed to achieve better sustainability and stronger equity in the health field. To act in this direction, a large coalition of the main health advocacy organizations tried to pass a federal law on prevention and health promotion (LPrév), which failed in the Council of States in 2012 (Gesundheitsförderung Schweiz 2013).
Citations:
FSO (Federal Statistical Office, Bundesamt für Statistik). 2023. Gesundheit. Taschenstatistik 2023. Neuchâtel: Bundesamt für Statistik. https://www.bfs.admin.ch/news/de/2023-0175 accessed on 2023 12 29
Mattig, T. 2013. Das gescheiterte Präventionsgesetz: ein Lehrstück. Arbeitspapier 9, Bern und Lausanne.
Gesundheitsförderung Schweiz.
Monod, S., and Grandchamp, C. 2022. “Système de santé suisse: aux origines de la machine.” Rev Med Suisse 8 (793): 1617–1620. https://www.revmed.ch/revue-medicale-suisse/2022/revue-medicale-suisse-793/systeme-de-sante-suisse-aux-origines-de-la-machine
FSO (Federal Statistical Office, Bundesamt für Statistik). 2023. Gesundheit. Taschenstatistik 2023. Neuchâtel: Bundesamt für Statistik. https://www.bfs.admin.ch/news/de/2023-0175 accessed on 2023 12 29
Mattig, T. 2013. Das gescheiterte Präventionsgesetz: ein Lehrstück. Arbeitspapier 9, Bern und Lausanne.
Gesundheitsförderung Schweiz.
Monod, S., and Grandchamp, C. 2022. “Système de santé suisse: aux origines de la machine.” Rev Med Suisse 8 (793): 1617–1620. https://www.revmed.ch/revue-medicale-suisse/2022/revue-medicale-suisse-793/systeme-de-sante-suisse-aux-origines-de-la-machine
Health policies are largely aligned with the goal of achieving high-quality healthcare.
8
Belgium
Trust in Belgium’s healthcare system is very high: “Satisfaction with public services is generally higher than the OECD average. Satisfaction with the healthcare system is particularly high at 90%, significantly higher than the 68% average across OECD countries” (OECD 2023). However, prevention is not Belgium’s strong suit, as highlighted by the GHS evaluation conducted in 2019, just before the COVID crisis. According to OECD data, Belgium spent only 0.3% of its GDP on preventive measures, compared to 0.6% for Sweden, 0.7% for France, and 1% for the Netherlands and Denmark. This low investment reflects in the country’s performance on prevention for several cancer types, with expected “healthy life years at birth” being close to but below the EU average. Belgium performs much better on the most common cancer types. For instance, from age 50, all citizens receive regular invitations for colon cancer tests, and all women receive invitations for breast cancer screenings. These tests are fully covered by social security.
However, such free tests are exceptions. According to the WHO, (2023, February 28) “catastrophic health spending in Belgium is currently among the highest in western Europe, according to a new report launched today by the WHO Regional Office for Europe. However, concrete steps are being taken to address this challenge […]. The numbers from 2020 show that 1 in 20 Belgian households experiences financial hardship due to out-of-pocket payments for healthcare.” To address this, the current federal health minister plans to cap the prices of several medical services and tests starting in 2024, despite facing opposition from hospitals and physicians.
There are campaigns to promote a healthy lifestyle and reduce smoking, but these are not the best in class due to their relatively low intensity.
The health minister has also taken measures to improve prevention through enhanced access to psychological and psychiatric support. Additionally, he is promoting integrated care, with preliminary plans to improve coordination between different health providers around the patient. Recent measures have been introduced for specific population groups, such as at-risk mothers and adolescents with eating disorders.
However, such free tests are exceptions. According to the WHO, (2023, February 28) “catastrophic health spending in Belgium is currently among the highest in western Europe, according to a new report launched today by the WHO Regional Office for Europe. However, concrete steps are being taken to address this challenge […]. The numbers from 2020 show that 1 in 20 Belgian households experiences financial hardship due to out-of-pocket payments for healthcare.” To address this, the current federal health minister plans to cap the prices of several medical services and tests starting in 2024, despite facing opposition from hospitals and physicians.
There are campaigns to promote a healthy lifestyle and reduce smoking, but these are not the best in class due to their relatively low intensity.
The health minister has also taken measures to improve prevention through enhanced access to psychological and psychiatric support. Additionally, he is promoting integrated care, with preliminary plans to improve coordination between different health providers around the patient. Recent measures have been introduced for specific population groups, such as at-risk mothers and adolescents with eating disorders.
Citations:
OECD 2023. “Government at a Glance 2023: Country Notes - Belgium.” https://www.oecd.org/publication/government-at-a-glance/2023/country-notes/belgium-054f6923/
https://www.ghsindex.org/country/belgium/
WHO. 2023. “Can people afford to pay for healthcare? New evidence on financial protection in Belgium.” https://www.who.int/europe/news/item/28-02-2023-can-people-afford-to-pay-for-health-care–new-evidence-on-financial-protection-in-belgium
https://vandenbroucke.belgium.be/fr/114-millions-d-euros-pour-un-trajet-de-soins-sp-cialis-pour-les-jeunes-souffrant-de-troubles
https://vandenbroucke.belgium.be/fr/frank-vandenbroucke-investit-dans-un-meilleur-suivi-des-m-res-vuln-rables-pendant-et-apr-s-la
https://vandenbroucke.belgium.be/fr/s-curit-tarifaire-meilleure-accessibilit-meilleurs-soins-et-r-mun-rations-correctes-gr-ce-des
OECD 2023. “Government at a Glance 2023: Country Notes - Belgium.” https://www.oecd.org/publication/government-at-a-glance/2023/country-notes/belgium-054f6923/
https://www.ghsindex.org/country/belgium/
WHO. 2023. “Can people afford to pay for healthcare? New evidence on financial protection in Belgium.” https://www.who.int/europe/news/item/28-02-2023-can-people-afford-to-pay-for-health-care–new-evidence-on-financial-protection-in-belgium
https://vandenbroucke.belgium.be/fr/114-millions-d-euros-pour-un-trajet-de-soins-sp-cialis-pour-les-jeunes-souffrant-de-troubles
https://vandenbroucke.belgium.be/fr/frank-vandenbroucke-investit-dans-un-meilleur-suivi-des-m-res-vuln-rables-pendant-et-apr-s-la
https://vandenbroucke.belgium.be/fr/s-curit-tarifaire-meilleure-accessibilit-meilleurs-soins-et-r-mun-rations-correctes-gr-ce-des
Czechia
In July 2020, the Czech government adopted a strategic framework for the development of healthcare through 2030, refined after the experience of the COVID-19 pandemic. One of the objectives of this program is the integration of long-term health and social care and the creation of regionally specific models of such care. Individual regions also have integrated healthcare concepts, considering their specific demographic, health, geographical, and economic situations.
The greatest problems, in relative terms, lie outside the direct realm of the health service. Both life expectancy and healthy life expectancy are below the OECD averages, and Czechia scores poorly on deaths attributable to high air pollution, low activity levels, and high alcohol consumption. These factors are reflected in relatively high mortality rates due to heart conditions. The unhealthy lifestyle of the Czech population is also evident in the high proportion of overweight or obese individuals, with 54.8% of the population aged 15 and older falling into these categories.
The picture is more favorable regarding preventive health services. Preventive healthcare is regulated by statutory standards that determine what preventive care citizens in particular age groups are entitled to and how often they receive it. Preventive check-ups are followed by screening programs designed to detect cancer at an early stage. These programs are funded by health insurance and conducted at accredited centers. Participation is voluntary, and the level of involvement varies depending on the type of screening program. For instance, 58% of women were screened for breast cancer, surpassing the OECD average of 55%, marking the highest participation rate among the programs offered. During the period analyzed, there were five screening programs in Czechia. As of January 2024, the number has increased to six. Bids are being invited under the NPO to improve colorectal screening levels, from either the private or public sector. Health insurance companies also support some recommended voluntary vaccinations, with a greater emphasis on children and seniors. On average, 2% of the total state budget expenditure on healthcare is allocated to preventive care.
The greatest problems, in relative terms, lie outside the direct realm of the health service. Both life expectancy and healthy life expectancy are below the OECD averages, and Czechia scores poorly on deaths attributable to high air pollution, low activity levels, and high alcohol consumption. These factors are reflected in relatively high mortality rates due to heart conditions. The unhealthy lifestyle of the Czech population is also evident in the high proportion of overweight or obese individuals, with 54.8% of the population aged 15 and older falling into these categories.
The picture is more favorable regarding preventive health services. Preventive healthcare is regulated by statutory standards that determine what preventive care citizens in particular age groups are entitled to and how often they receive it. Preventive check-ups are followed by screening programs designed to detect cancer at an early stage. These programs are funded by health insurance and conducted at accredited centers. Participation is voluntary, and the level of involvement varies depending on the type of screening program. For instance, 58% of women were screened for breast cancer, surpassing the OECD average of 55%, marking the highest participation rate among the programs offered. During the period analyzed, there were five screening programs in Czechia. As of January 2024, the number has increased to six. Bids are being invited under the NPO to improve colorectal screening levels, from either the private or public sector. Health insurance companies also support some recommended voluntary vaccinations, with a greater emphasis on children and seniors. On average, 2% of the total state budget expenditure on healthcare is allocated to preventive care.
Citations:
https://zdravi2030.mzcr.cz/zdravi-2030-strategicky-ramec.pdf
https://zdravi2030.mzcr.cz/zdravi-2030-strategicky-ramec.pdf
Denmark
The Ministry of the Interior and Health (2023) reports that hospitals face serious challenges in meeting legally required treatment guarantees, which means healthcare may not be provided in a timely fashion. This is partly due to the structure of the healthcare system. Regions are responsible for hospitals and specialized care, while municipalities handle post-hospitalization care. This division leads to budgetary disputes over who should bear the cost of treatment.
To enhance the quality of treatment, the recent government has pursued a strategy of consolidating care into fewer so-called super-hospitals. The main idea behind this consolidation is that some treatments require a high degree of specialization and expertise that cannot be obtained in smaller units. However, creating super-hospitals has significantly increased the distance to a hospital in some parts of the country.
Recently, a scandal at several hospitals regarding the treatment of cancer patients revealed that hospitals are strained and unable to treat patients promptly (Danish Broadcasting System 2023). This scandal has sparked a debate over whether the legally guaranteed treatment times should be abolished. Some medical experts argue that these treatment guarantees make the healthcare system inflexible and shift the focus from treating the patients most in need to treating patients merely to avoid breaching the treatment guarantees.
The current government has passed several so-called prevention packages, ranging from a plan to reduce the overconsumption of alcohol by Danish teenagers and the provision of healthy school meals to better psychiatric treatment in general (Ministry of the Interior and Health 2023).
To enhance the quality of treatment, the recent government has pursued a strategy of consolidating care into fewer so-called super-hospitals. The main idea behind this consolidation is that some treatments require a high degree of specialization and expertise that cannot be obtained in smaller units. However, creating super-hospitals has significantly increased the distance to a hospital in some parts of the country.
Recently, a scandal at several hospitals regarding the treatment of cancer patients revealed that hospitals are strained and unable to treat patients promptly (Danish Broadcasting System 2023). This scandal has sparked a debate over whether the legally guaranteed treatment times should be abolished. Some medical experts argue that these treatment guarantees make the healthcare system inflexible and shift the focus from treating the patients most in need to treating patients merely to avoid breaching the treatment guarantees.
The current government has passed several so-called prevention packages, ranging from a plan to reduce the overconsumption of alcohol by Danish teenagers and the provision of healthy school meals to better psychiatric treatment in general (Ministry of the Interior and Health 2023).
Citations:
Danish Broadcasting System. 2023. “Her er afsløringerne, der fik kræftskandalen på Aarhus Universitetshospital til at rulle.” https://www.dr.dk/nyheder/indland/her-er-afsloeringerne-der-fik-kraeftskandalen-paa-aarhus-universitetshospital-til
Ministry of the Interior and Health. 2023. “Forebyggelsespakker.” https://sum.dk/sundhed/forebyggelse/forebyggelsespakker
Danish Broadcasting System. 2023. “Her er afsløringerne, der fik kræftskandalen på Aarhus Universitetshospital til at rulle.” https://www.dr.dk/nyheder/indland/her-er-afsloeringerne-der-fik-kraeftskandalen-paa-aarhus-universitetshospital-til
Ministry of the Interior and Health. 2023. “Forebyggelsespakker.” https://sum.dk/sundhed/forebyggelse/forebyggelsespakker
Finland
The aim of the social and healthcare reform in 2023 was to introduce policies and regulations to foster preventive healthcare, including detection and treatment, as well as the adoption of a healthy lifestyle. However, this aim did not materialize. There is only a very minor financial incentive for municipalities and regions to invest in health prevention.
Meanwhile, the government has introduced mandated maximum waiting times to guarantee timely access to services. Maximum waiting times are closely monitored, but in the absence of sanctions, there are many regions in which the regulated waiting-time expectations are not met. The quality of services is maintained through medical professionals who are expected to follow published best practices introduced for different conditions.
The issue of healthcare financing is the most contested health policy topic in Finland (YLE News, 2023). Currently, all funding for the regions is provided by the state on a capitation basis, which does not offer incentives to ensure individuals receive the right care at the right place at the right time. The financing system is under analysis, and new solutions are expected to emerge.
Meanwhile, the government has introduced mandated maximum waiting times to guarantee timely access to services. Maximum waiting times are closely monitored, but in the absence of sanctions, there are many regions in which the regulated waiting-time expectations are not met. The quality of services is maintained through medical professionals who are expected to follow published best practices introduced for different conditions.
The issue of healthcare financing is the most contested health policy topic in Finland (YLE News, 2023). Currently, all funding for the regions is provided by the state on a capitation basis, which does not offer incentives to ensure individuals receive the right care at the right place at the right time. The financing system is under analysis, and new solutions are expected to emerge.
Citations:
YLE News. 2023. “Amnesty Report: Parts of Finland’s Healthcare System Have Failed.” https://yle.fi/a/74-20036481
YLE News. 2023. “Amnesty Report: Parts of Finland’s Healthcare System Have Failed.” https://yle.fi/a/74-20036481
France
Created in 2016, the French Public Health Agency (Santé publique France, SPF) is the principal agency in charge of public health policy. Its competencies include health promotion and education, public health surveillance, disease prevention, and health monitoring. It works in part through regional branches offices located within regional health authorities.
The SPF uses national information campaigns to promote healthy eating, physical exercise or smoking cessation. Since 2017, general practitioners have been allowed to prescribe physical exercise to patients with certain types of conditions, such as diabetes or heart problems. The SPF has also overseen the implementation of an official food rating system, called “nutriscore,” which became mandatory in 2021.
The Ministry of Health has implemented three national cancer screening programs (breast, cervical and colon). Since 2004, all women between 50 and 74 have had access to a biannual mammogram and examination free of charge. A new Cancer Plan 2021 – 2030 aims to increase the number of tests and reduce avoidable deaths by 50,000 per year. The program has benefited from increased funding compared to earlier periods. Other forms of screening and follow-ups are provided by GPs and gynecologists, especially during pregnancy, with patients receiving 100% reimbursement.
There have been important efforts to promote “integrated care,” especially for the elderly, based on substantial experimental evidence. Several programs of this kind have been organized at the regional level. There is little available evidence at this stage as to their effectiveness.
Smoking rates remain high in France, with 24% of the adult population smoking compared to an OECD average of 17%. France also has relatively high levels of alcohol consumption with an average of 11 liters per adult per year (2019) compared to nine across the OECD as a whole. Rates of self-reported obesity are slightly lower than in neighboring countries, but have been increasing among adolescents. The food rating system appears to be having positive effects in this area.
The SPF uses national information campaigns to promote healthy eating, physical exercise or smoking cessation. Since 2017, general practitioners have been allowed to prescribe physical exercise to patients with certain types of conditions, such as diabetes or heart problems. The SPF has also overseen the implementation of an official food rating system, called “nutriscore,” which became mandatory in 2021.
The Ministry of Health has implemented three national cancer screening programs (breast, cervical and colon). Since 2004, all women between 50 and 74 have had access to a biannual mammogram and examination free of charge. A new Cancer Plan 2021 – 2030 aims to increase the number of tests and reduce avoidable deaths by 50,000 per year. The program has benefited from increased funding compared to earlier periods. Other forms of screening and follow-ups are provided by GPs and gynecologists, especially during pregnancy, with patients receiving 100% reimbursement.
There have been important efforts to promote “integrated care,” especially for the elderly, based on substantial experimental evidence. Several programs of this kind have been organized at the regional level. There is little available evidence at this stage as to their effectiveness.
Smoking rates remain high in France, with 24% of the adult population smoking compared to an OECD average of 17%. France also has relatively high levels of alcohol consumption with an average of 11 liters per adult per year (2019) compared to nine across the OECD as a whole. Rates of self-reported obesity are slightly lower than in neighboring countries, but have been increasing among adolescents. The food rating system appears to be having positive effects in this area.
Citations:
“Icope à Toulouse.” La Santé en Action no. 459, March 2022.
“Icope à Toulouse.” La Santé en Action no. 459, March 2022.
Israel
Israel’s healthcare system invests in preventive treatment. The “health basket” (i.e., basic services provided to the entire population) includes early check-ups for various types of cancer, a Papilloma vaccine and treatments for tobacco addiction, among other things. In the last couple of years, more preventive treatments have been added to the health basket and medicine basket (i.e., the drugs and technologies provided to all citizens).
Policies for adopting a healthy lifestyle are less developed; however, there are various programs and vouchers available to encourage beneficiaries to be more physically active.
One of the main problems facing Israel’s healthcare system is the waiting period for various healthcare services, such as MRI scans or appointments with specialist physicians. These issues are particularly severe in peripheral regions, where individuals can wait several months for an MRI appointment and over a month to see a specialist. Despite these delays, the services provided are of high quality.
The healthcare system is highly digitalized, which enables integrated treatment, and the flow of information between experts and healthcare facilities.
Policies for adopting a healthy lifestyle are less developed; however, there are various programs and vouchers available to encourage beneficiaries to be more physically active.
One of the main problems facing Israel’s healthcare system is the waiting period for various healthcare services, such as MRI scans or appointments with specialist physicians. These issues are particularly severe in peripheral regions, where individuals can wait several months for an MRI appointment and over a month to see a specialist. Despite these delays, the services provided are of high quality.
The healthcare system is highly digitalized, which enables integrated treatment, and the flow of information between experts and healthcare facilities.
Japan
Japan boasts one of the most efficient healthcare systems in the world. However, at the same time, the system is under increasing pressure due to demographic aging. According to the OECD’s Health at a Glance 2023, Japan performed better than the OECD average on 73% of indicators related to healthcare quality. Japan has one of the longest healthy life expectancies and lowest infant mortalities in the world. Japan’s health budget accounts for 11.5% of GDP, more than the OECD average of 9.2%. There are 12.6 hospital beds in Japan per 1,000 population, compared to 4.3 on average in the OECD, and 2.6 doctors per 1,000 population (OECD: 3.7). The majority of hospitals suffer from doctor shortages but waiting times for medical treatment are relatively short. The care sector is also massively impacted by a lack of workers, with 70% of providers reporting staff shortages. Policies to fill these positions with foreign workers have so far been insufficient.
National health promotion strategies advocate for healthy lifestyles, including dietary habits, physical activity, rest, and discouragement of smoking and drinking alcohol. Prefectural healthcare delivery visions contain detailed plans for treating various diseases and developing different types of healthcare. Prefectures are responsible for annual inspections of hospitals, but public reporting on hospital performance is voluntary. Hospitals are evaluated by the Japan Council for Quality Healthcare, which develops clinical guidelines but cannot penalize medical institutions for poor performance.
Performance has been improved by reducing the number of hospital beds, though the number remains high by international comparison. A 2022 analysis for the World Economic Forum claims there are some deficiencies with primary care and chronic care, but overall the quality of care provided was good. Digitalization of health data is limited to specific localities and a national system is still missing, which means Japan is behind many other countries in this regard.
To cope with the challenge of population aging, after introducing long-term insurance in 2000, Japan established a community-based integrated care system, which combined housing, medical, preventive and long-term care, as well as daily living support for older people at the municipal level.
National health promotion strategies advocate for healthy lifestyles, including dietary habits, physical activity, rest, and discouragement of smoking and drinking alcohol. Prefectural healthcare delivery visions contain detailed plans for treating various diseases and developing different types of healthcare. Prefectures are responsible for annual inspections of hospitals, but public reporting on hospital performance is voluntary. Hospitals are evaluated by the Japan Council for Quality Healthcare, which develops clinical guidelines but cannot penalize medical institutions for poor performance.
Performance has been improved by reducing the number of hospital beds, though the number remains high by international comparison. A 2022 analysis for the World Economic Forum claims there are some deficiencies with primary care and chronic care, but overall the quality of care provided was good. Digitalization of health data is limited to specific localities and a national system is still missing, which means Japan is behind many other countries in this regard.
To cope with the challenge of population aging, after introducing long-term insurance in 2000, Japan established a community-based integrated care system, which combined housing, medical, preventive and long-term care, as well as daily living support for older people at the municipal level.
Citations:
Japan International Cooperation Agency. 2022. “Community-based Integrated Care in Japan – Suggestions for Developing Countries from Cases in Japan.” https://openjicareport.jica.go.jp/pdf/1000048192.pdf
Ministry of Health, Labour and Welfare. 2012. “A Basic Direction for Comprehensive Implementation of National Health Promotion.” https://www.mhlw.go.jp/file/06-Seisakujouhou-10900000-Kenkoukyoku/0000047330.pdf
“Nearly 70% of care service providers in Japan face labor shortage.” The Japan Times, October 7. https://www.japantimes.co.jp/business/2023/10/07/caregiving-labor-shortage/
Nomura, Shuhei, et al. 2022. “Sustainability and Resilience in Japan’s Health System.” London: LSE Consulting. https://www3.weforum.org/docs/WEF_PHSSR_Japan_final_2022.pdf
OECD. 2023. “Health at a Glance 2023.” https://www.oecd.org/japan/health-at-a-glance-Japan-EN.pdf
Japan International Cooperation Agency. 2022. “Community-based Integrated Care in Japan – Suggestions for Developing Countries from Cases in Japan.” https://openjicareport.jica.go.jp/pdf/1000048192.pdf
Ministry of Health, Labour and Welfare. 2012. “A Basic Direction for Comprehensive Implementation of National Health Promotion.” https://www.mhlw.go.jp/file/06-Seisakujouhou-10900000-Kenkoukyoku/0000047330.pdf
“Nearly 70% of care service providers in Japan face labor shortage.” The Japan Times, October 7. https://www.japantimes.co.jp/business/2023/10/07/caregiving-labor-shortage/
Nomura, Shuhei, et al. 2022. “Sustainability and Resilience in Japan’s Health System.” London: LSE Consulting. https://www3.weforum.org/docs/WEF_PHSSR_Japan_final_2022.pdf
OECD. 2023. “Health at a Glance 2023.” https://www.oecd.org/japan/health-at-a-glance-Japan-EN.pdf
Sweden
Preventive healthcare and a healthy lifestyle are included in Sweden’s public health targets (PHA, 2023). However, in practice, preventive healthcare is not always readily available at public primary care centers. A public health policy aims to close any healthcare gaps within a generation through political efforts and the promotion of healthy lifestyles, including smoke-free areas, traffic speed limits, and legal age limits on tobacco and alcohol.
Sweden’s public health is generally good, with several indicators showing improvement, but disparities exist among population groups. Individuals with low socioeconomic status, especially women without upper secondary education, have shorter life expectancies (PHA, 2023). The Swedish population’s perceived health status, with a score of 5.67, is slightly above the OECD average of 5.38 (OECD output indicator P11.6). Additionally, Sweden performs well in terms of healthy life expectancy, scoring 6.63 compared to the OECD average of 5.57 (OECD output indicator P11.4).
Sweden’s spending on preventive healthcare increased from 2021, but as of 2023, it is still lower than the OECD average. In the OECD’s report “Health at a Glance 2023,” Sweden’s public health and preventive measures generally score well compared to other OECD countries. In terms of healthy food consumption, Sweden scores higher than the OECD average for daily vegetable consumption but lower than the average for fruit consumption. Fifty-six percent of both men and women in Sweden engage in at least 150 minutes of physical activity per week. This figure is the sixth highest and well above the 40% OECD average. The self-reported overweight and obesity rate among adults is 15% in Sweden, compared to the OECD average of 18%. Sweden scored high in mammography screenings within the past two years, with 80% of women aged 50 – 69 participating, compared to the OECD average of 55.1%. Between the COVID-19 pandemic years 2020 – 2022, Sweden had 214 deaths per 100,000 inhabitants, which is just below the OECD average of 225 deaths (OECD, 2023).
The quality of Swedish healthcare is good and performs well in international comparisons. Few people abstain from care due to costs or travel times, but long waiting times in Sweden do cause some to forgo care (AHCSA, 2022; Janlöv et al. 2023 119).
In 2021, Sweden spent 11.25% of its GDP on healthcare expenditures, a figure that declined to 10.67% in 2022. These numbers are higher than the OECD average of 10%. While the OECD average remained stable from 2020 – 2022, other countries also exhibited a similar decline in spending as Sweden. In comparison with other OECD countries, Sweden’s healthcare resources are relatively lacking. In both 2021 and 2022, there were 3.18 physicians per 1,000 inhabitants, below the OECD average of 4 physicians. Additionally, Sweden and Greece had the lowest number of consultations with doctors among all OECD countries. Sweden had 2 hospital beds per 1,000 inhabitants in 2021, compared to the OECD average of 5 beds. The number of computed tomography scanners per 100,000 inhabitants decreased from 23.04 in 2021 to 22.96 in 2022, whereas the average for all OECD countries remained at 29 for both years.
Sweden’s healthcare costs are high compared to those of other countries, and improving efficiency is a major health policy goal. There is an ongoing reform to strengthen primary care and enhance integrated care in the pursuit of “a good and close care” (Janlöv et al., 2023, 170). One of the main challenges in Sweden is the coordination of care between different providers. Policies to improve coordination include clinical pathways implemented between 2015 and 2019 aimed at streamlining care and reducing waiting times. However, the implementation is recent, and there is not yet sufficient evidence to assess its impact (Janlöv et al., 2023, 119).
Sweden’s public health is generally good, with several indicators showing improvement, but disparities exist among population groups. Individuals with low socioeconomic status, especially women without upper secondary education, have shorter life expectancies (PHA, 2023). The Swedish population’s perceived health status, with a score of 5.67, is slightly above the OECD average of 5.38 (OECD output indicator P11.6). Additionally, Sweden performs well in terms of healthy life expectancy, scoring 6.63 compared to the OECD average of 5.57 (OECD output indicator P11.4).
Sweden’s spending on preventive healthcare increased from 2021, but as of 2023, it is still lower than the OECD average. In the OECD’s report “Health at a Glance 2023,” Sweden’s public health and preventive measures generally score well compared to other OECD countries. In terms of healthy food consumption, Sweden scores higher than the OECD average for daily vegetable consumption but lower than the average for fruit consumption. Fifty-six percent of both men and women in Sweden engage in at least 150 minutes of physical activity per week. This figure is the sixth highest and well above the 40% OECD average. The self-reported overweight and obesity rate among adults is 15% in Sweden, compared to the OECD average of 18%. Sweden scored high in mammography screenings within the past two years, with 80% of women aged 50 – 69 participating, compared to the OECD average of 55.1%. Between the COVID-19 pandemic years 2020 – 2022, Sweden had 214 deaths per 100,000 inhabitants, which is just below the OECD average of 225 deaths (OECD, 2023).
The quality of Swedish healthcare is good and performs well in international comparisons. Few people abstain from care due to costs or travel times, but long waiting times in Sweden do cause some to forgo care (AHCSA, 2022; Janlöv et al. 2023 119).
In 2021, Sweden spent 11.25% of its GDP on healthcare expenditures, a figure that declined to 10.67% in 2022. These numbers are higher than the OECD average of 10%. While the OECD average remained stable from 2020 – 2022, other countries also exhibited a similar decline in spending as Sweden. In comparison with other OECD countries, Sweden’s healthcare resources are relatively lacking. In both 2021 and 2022, there were 3.18 physicians per 1,000 inhabitants, below the OECD average of 4 physicians. Additionally, Sweden and Greece had the lowest number of consultations with doctors among all OECD countries. Sweden had 2 hospital beds per 1,000 inhabitants in 2021, compared to the OECD average of 5 beds. The number of computed tomography scanners per 100,000 inhabitants decreased from 23.04 in 2021 to 22.96 in 2022, whereas the average for all OECD countries remained at 29 for both years.
Sweden’s healthcare costs are high compared to those of other countries, and improving efficiency is a major health policy goal. There is an ongoing reform to strengthen primary care and enhance integrated care in the pursuit of “a good and close care” (Janlöv et al., 2023, 170). One of the main challenges in Sweden is the coordination of care between different providers. Policies to improve coordination include clinical pathways implemented between 2015 and 2019 aimed at streamlining care and reducing waiting times. However, the implementation is recent, and there is not yet sufficient evidence to assess its impact (Janlöv et al., 2023, 119).
Citations:
AHCSA. 2022. Nationell uppföljning av hälso- och sjukvården 2022 - Indikatorer på kvalitet, jämlikhet och effektivitet. Stockholm: The Agency for Health and Care Services Analysis.
Janlöv, N., Blume, S., Glenngård, A.H., Hanspers, K., Anell, A., and Merkur, S. 2023. “Sweden: Health System Review.” Health Systems in Transition 25 (4).
PHA. 2023. Folkhälsan i Sverige - Årsrapport 2023 (The Public Health in Sweden - Yearly report 2023). The Public Health Agency of Sweden.
OECD. 2023. Health at a Glance 2023 - OECD Indicators. Paris: OECD Publishing. https://doi.org/10.1787/7a7afb35-en
AHCSA. 2022. Nationell uppföljning av hälso- och sjukvården 2022 - Indikatorer på kvalitet, jämlikhet och effektivitet. Stockholm: The Agency for Health and Care Services Analysis.
Janlöv, N., Blume, S., Glenngård, A.H., Hanspers, K., Anell, A., and Merkur, S. 2023. “Sweden: Health System Review.” Health Systems in Transition 25 (4).
PHA. 2023. Folkhälsan i Sverige - Årsrapport 2023 (The Public Health in Sweden - Yearly report 2023). The Public Health Agency of Sweden.
OECD. 2023. Health at a Glance 2023 - OECD Indicators. Paris: OECD Publishing. https://doi.org/10.1787/7a7afb35-en
7
Australia
A well-organized and well-funded healthcare system supports high-quality outcomes. However, challenges remain, particularly in how costs are divided between the state and individual users, with some approaches leading to increased health inequality.
The healthcare system is designed to achieve high-quality care through effective structuring across different government levels and varying degrees of decentralization (Department of Health and Aged Care 2019). The national government is responsible for monitoring the quality, effectiveness, and efficiency of primary healthcare providers. It also collects and publishes health-related information and statistics and funds health and medical research. States, territories, and local governments manage public hospitals. Primary health networks coordinate health services in local areas and oversee health centers, GPs, nurses, specialists, and other health professionals. This division of responsibilities aims to leverage the unique resources and strengths of each entity involved in managing the healthcare system. Overlaying these divisions is a complex distribution of responsibilities between public and private health providers. While the system functions effectively, it faces challenges such as integration issues due to its complexity and rising costs, which are reflected in increasing out-of-pocket expenses for services and rising private health insurance premiums (Butler et al. 2019).
The healthcare system is designed to achieve high-quality care through effective structuring across different government levels and varying degrees of decentralization (Department of Health and Aged Care 2019). The national government is responsible for monitoring the quality, effectiveness, and efficiency of primary healthcare providers. It also collects and publishes health-related information and statistics and funds health and medical research. States, territories, and local governments manage public hospitals. Primary health networks coordinate health services in local areas and oversee health centers, GPs, nurses, specialists, and other health professionals. This division of responsibilities aims to leverage the unique resources and strengths of each entity involved in managing the healthcare system. Overlaying these divisions is a complex distribution of responsibilities between public and private health providers. While the system functions effectively, it faces challenges such as integration issues due to its complexity and rising costs, which are reflected in increasing out-of-pocket expenses for services and rising private health insurance premiums (Butler et al. 2019).
Citations:
Department of Health and Aged Care. 2019. “The Australian Health System.” https://www.health.gov.au/about-us/the-australian-health-system
Butler, S., Daddia, J., and Azizi, T. 2019. “The time to act is now.” https://www.pwc.com.au/health/health-matters/the-future-of-health-in-australia.html
Department of Health and Aged Care. 2019. “The Australian Health System.” https://www.health.gov.au/about-us/the-australian-health-system
Butler, S., Daddia, J., and Azizi, T. 2019. “The time to act is now.” https://www.pwc.com.au/health/health-matters/the-future-of-health-in-australia.html
Canada
There is an ongoing problem involving a trade-off between equity of access and the speed of services in the public system. Since the private system is actively discouraged by the provincial payment system, long wait times for certain procedures can result.
The most glaring problem with the Canadian system is timely access to care. In a 2017 study by the Commonwealth Fund, Canada ranked last for providing timely access to care among 11 high-income countries. As hospitals and healthcare units pivoted to deal with COVID-19 – redirecting resources to emergency and intensive care – these wait times and access issues became even more acute.
The Canadian Institute for Health Information reported that almost 560,000 fewer surgeries were performed between March 2020 and June 2021 compared with 2019. The Canadian Medical Association has championed the need for change, highlighting the immense challenges the Canadian healthcare system is “struggling” with and calling for an infusion of CAD 1.3 billion in funding from the federal government (Vogel 2020).
The most glaring problem with the Canadian system is timely access to care. In a 2017 study by the Commonwealth Fund, Canada ranked last for providing timely access to care among 11 high-income countries. As hospitals and healthcare units pivoted to deal with COVID-19 – redirecting resources to emergency and intensive care – these wait times and access issues became even more acute.
The Canadian Institute for Health Information reported that almost 560,000 fewer surgeries were performed between March 2020 and June 2021 compared with 2019. The Canadian Medical Association has championed the need for change, highlighting the immense challenges the Canadian healthcare system is “struggling” with and calling for an infusion of CAD 1.3 billion in funding from the federal government (Vogel 2020).
Citations:
Vogel, Lauren. 2020. “How Can Canada Improve Worsening Wait Times?” CMAJ: Canadian Medical Association Journal 192 (37): E1079–80. https://doi.org/10.1503/cmaj.1095895
Vogel, Lauren. 2020. “How Can Canada Improve Worsening Wait Times?” CMAJ: Canadian Medical Association Journal 192 (37): E1079–80. https://doi.org/10.1503/cmaj.1095895
Estonia
Health promotion and disease prevention are increasingly important priorities for the Estonian Health Insurance Fund (EHIF), and the share of resources dedicated to preventive healthcare has recently doubled. The National Health Plan 2020 – 2030 continues to emphasize the importance of prevention, and deaths from preventable and treatable causes have steadily decreased. However, smoking prevalence, alcohol consumption and obesity rates are all above the EU average. Additionally, the rate of children’s vaccinations is relatively low and decreasing. At the same time, the number of deaths from air pollution remains low.
To address the mental health issues accelerated by the COVID-19 crisis, Estonia began centrally coordinating mental health policy in 2022. The country has set priorities for action to strengthen the provision of mental health services, and has launched prevention and mental health promotion efforts.
Recent health system reforms have introduced financial incentives for multidisciplinary primary healthcare centers and primary care networks that provide better access to services. A 2023 health system performance assessment encouraged the development of a sustainable governance plan. This plan makes use of abundant available healthcare data for purposes such as service integration, clinical decision-making and outcome measurement (OECD, 2023).
To address the mental health issues accelerated by the COVID-19 crisis, Estonia began centrally coordinating mental health policy in 2022. The country has set priorities for action to strengthen the provision of mental health services, and has launched prevention and mental health promotion efforts.
Recent health system reforms have introduced financial incentives for multidisciplinary primary healthcare centers and primary care networks that provide better access to services. A 2023 health system performance assessment encouraged the development of a sustainable governance plan. This plan makes use of abundant available healthcare data for purposes such as service integration, clinical decision-making and outcome measurement (OECD, 2023).
Citations:
OECD. 2023. “State of Health in the EU Estonia Country Health Profile 2023.” https://www.oecd.org/estonia/estonia-country-health-profile-2023-bc733713-en.htm
OECD. 2023. “State of Health in the EU Estonia Country Health Profile 2023.” https://www.oecd.org/estonia/estonia-country-health-profile-2023-bc733713-en.htm
Ireland
Objective indicators of health outcomes in Ireland are relatively good and continue to improve. However, access to healthcare dominates people’s perceptions and reality. Health insurance facilitates access to high-quality and high-technology medical care in private and public-private settings (Connolly 2023). While preventable and treatable mortality rates remain consistently below the EU average, excessively long waiting lists are the primary cause of unmet medical needs. Coverage for publicly funded healthcare in Ireland, though expanding, is not yet universal (OECD 2023). The OECD also notes that Ireland had an effective vaccination rollout, which reduced COVID-19 mortality.
The Health Service Executive (HSE 2020) has laid out a plan for integrated care and support for people with chronic ill health to live well within the community. This plan focuses on keeping people at home with ready and equitable access to general practitioner reviews, diagnostics, health and social care professional input, and specialist opinions as required. The Integrated Care Programme for the Prevention and Management of Chronic Disease aims to prevent and manage chronic disease and associated complications through education sessions, goal-setting, and action plans. The program supports chronic disease management at home, progressing through levels of care from general practitioners in Community Healthcare Networks to a Chronic Disease Management Programme in general practitioner services, and finally to community specialist ambulatory care for diagnostics, pulmonary and cardiac rehabilitation and diabetes management.
Level 3 involves acute specialist ambulatory care with services such as respiratory outreach, while Level 4 provides specialist hospital care for complex issues. Implementation has been uneven, with the absence of integrated home care packages (both in policy and practice) as a major obstacle, indicating a lack of integration governance. The Health Service Executive’s governance and financial management structures are a constant focus for reform, and labor shortages present significant challenges.
Outcome data for healthy life expectancy at birth show Ireland ranked joint 8th at 71 years, compared to the average of 70.4 years, with non-healthy life expectancy reaching 85 years for Irish women. Irish men are considered less proactive about preventative care.
Policies and regulations have been slow to foster investment in digital infrastructure, resulting in some poor investment outcomes. However, the transition to ehealth has accelerated during the pandemic, with improvements in the utilization of health data to monitor emerging threats and accurately assess public health matters. More effort is needed to disaggregate data across equality grounds. The government is implementing measures to offset rising costs caused by an aging population, advance medical technology, and utilize step-down beds in nursing homes and other convalescent and elder social care settings, but progress is variable.
The Health Service Executive (HSE 2020) has laid out a plan for integrated care and support for people with chronic ill health to live well within the community. This plan focuses on keeping people at home with ready and equitable access to general practitioner reviews, diagnostics, health and social care professional input, and specialist opinions as required. The Integrated Care Programme for the Prevention and Management of Chronic Disease aims to prevent and manage chronic disease and associated complications through education sessions, goal-setting, and action plans. The program supports chronic disease management at home, progressing through levels of care from general practitioners in Community Healthcare Networks to a Chronic Disease Management Programme in general practitioner services, and finally to community specialist ambulatory care for diagnostics, pulmonary and cardiac rehabilitation and diabetes management.
Level 3 involves acute specialist ambulatory care with services such as respiratory outreach, while Level 4 provides specialist hospital care for complex issues. Implementation has been uneven, with the absence of integrated home care packages (both in policy and practice) as a major obstacle, indicating a lack of integration governance. The Health Service Executive’s governance and financial management structures are a constant focus for reform, and labor shortages present significant challenges.
Outcome data for healthy life expectancy at birth show Ireland ranked joint 8th at 71 years, compared to the average of 70.4 years, with non-healthy life expectancy reaching 85 years for Irish women. Irish men are considered less proactive about preventative care.
Policies and regulations have been slow to foster investment in digital infrastructure, resulting in some poor investment outcomes. However, the transition to ehealth has accelerated during the pandemic, with improvements in the utilization of health data to monitor emerging threats and accurately assess public health matters. More effort is needed to disaggregate data across equality grounds. The government is implementing measures to offset rising costs caused by an aging population, advance medical technology, and utilize step-down beds in nursing homes and other convalescent and elder social care settings, but progress is variable.
Citations:
Connolly, S. 2023. “Improving Access to Healthcare in Ireland: An Implementation Failure.” Health Economics, Policy and Law First View: 1-11.
https://doi.org/10.1017/S1744133123000130
Health Service Executive (HSE). 2020. National Framework for the Integrated Prevention and Management of Chronic Disease in Ireland 2020 – 2025. https://www.hse.ie/eng/about/who/cspd/icp/chronic-disease/documents/national-framework-integrated-care.pdf
OECD. 2023. “State of Health in the EU Ireland Country Health Profile 2023.” https://read.oecd.org/10.1787/3abe906b-en?format=pdf
Connolly, S. 2023. “Improving Access to Healthcare in Ireland: An Implementation Failure.” Health Economics, Policy and Law First View: 1-11.
https://doi.org/10.1017/S1744133123000130
Health Service Executive (HSE). 2020. National Framework for the Integrated Prevention and Management of Chronic Disease in Ireland 2020 – 2025. https://www.hse.ie/eng/about/who/cspd/icp/chronic-disease/documents/national-framework-integrated-care.pdf
OECD. 2023. “State of Health in the EU Ireland Country Health Profile 2023.” https://read.oecd.org/10.1787/3abe906b-en?format=pdf
Italy
A 2000 World Health Organization (WHO) report ranked the Italian healthcare system second in the world. A recent Bloomberg analysis also placed the Italian system among the most efficient globally. A 2017 Lancet study ranked the Italian system highly for access and infrastructure, cultural factors, and the political and managerial capacities of local administrations, but noted regional disparities in public healthcare quality.
Despite similar levels of per capita expenditure, services are generally better in northern and central Italy than in southern Italy, where corruption, patronage, and administrative inefficiency have driven up healthcare costs. In these regions, lower quality and longer waiting lists mean wealthier individuals often turn to the private sector for medical care.
Regional disparities lead to significant health tourism to the north. The existing system of national quality standards, correlated with resources and intended to be implemented across regions, has not yet reduced the quality gap between the North and South.
To improve the quality of the healthcare system, the NRPP plans to invest around 16 billion euros. This investment aims to disseminate new healthcare models through various organizational innovations. On one hand, it focuses on developing proximity networks, intermediate structures, and telemedicine for territorial healthcare. On the other hand, it promotes innovation, research, and the digitalization of the National Health Service.
The interventions are specifically targeted at significantly improving territorial services by:
-Strengthening and creating territorial structures and services, such as community homes and hospitals
-Enhancing home care
-Developing telemedicine
-More effectively integrating all social health services
However, the risk remains that the implementation of these innovations will vary widely across the country, and the results are not yet clear. Additionally, the Meloni government has expressed doubts regarding the future financial sustainability of these territorial services.
Despite similar levels of per capita expenditure, services are generally better in northern and central Italy than in southern Italy, where corruption, patronage, and administrative inefficiency have driven up healthcare costs. In these regions, lower quality and longer waiting lists mean wealthier individuals often turn to the private sector for medical care.
Regional disparities lead to significant health tourism to the north. The existing system of national quality standards, correlated with resources and intended to be implemented across regions, has not yet reduced the quality gap between the North and South.
To improve the quality of the healthcare system, the NRPP plans to invest around 16 billion euros. This investment aims to disseminate new healthcare models through various organizational innovations. On one hand, it focuses on developing proximity networks, intermediate structures, and telemedicine for territorial healthcare. On the other hand, it promotes innovation, research, and the digitalization of the National Health Service.
The interventions are specifically targeted at significantly improving territorial services by:
-Strengthening and creating territorial structures and services, such as community homes and hospitals
-Enhancing home care
-Developing telemedicine
-More effectively integrating all social health services
However, the risk remains that the implementation of these innovations will vary widely across the country, and the results are not yet clear. Additionally, the Meloni government has expressed doubts regarding the future financial sustainability of these territorial services.
Citations:
Ministero della Salute. 2023. “Moniotoraggio LEA (2021).” https://www.salute.gov.it/portale/lea/dettaglioPubblicazioniLea.jsp?lingua=italiano&id=3329
Ministero della Salute. 2023. “Moniotoraggio LEA (2021).” https://www.salute.gov.it/portale/lea/dettaglioPubblicazioniLea.jsp?lingua=italiano&id=3329
New Zealand
Health policy aims to facilitate the delivery of high-quality healthcare.
Policies are designed to foster preventive healthcare, encourage healthy lifestyles, and facilitate the early detection and treatment of health conditions. The government has invested in health promotion initiatives and screening programs, and access to primary healthcare providers allows for regular check-ups and preventive care. However, despite these initiatives, New Zealand performs worse than the OECD average on many risk factor indicators, such as alcohol consumption and obesity (OECD 2023). New Zealand had a world-leading law to ban smoking for future generations, but this has been scrapped by the new National government to help pay for tax cuts (Corlett 2023).
New Zealand’s commitment to universal healthcare ensures that all residents have access to essential healthcare services regardless of their ability to pay. Policies and regulations establish standards and guidelines for healthcare delivery, ensuring quality in treatment and care. In fact, New Zealand performs better than the OECD average on 71% of the OECD’s “quality of care” indicators (OECD 2023). However, areas for improvement remain; for example, wait times for certain procedures or specialist consultations can be very long (RNZ 2023), and workforce shortages put a strain on the healthcare system (Hewett 2023).
Efforts are underway to enhance integration and coordination between different levels of care. Coordinated care pathways aim to ensure individuals receive appropriate care and are referred to specialized services when needed. Policies support the integration of telehealth and technology to improve access to care (Palmer 2023).
Policies are designed to foster preventive healthcare, encourage healthy lifestyles, and facilitate the early detection and treatment of health conditions. The government has invested in health promotion initiatives and screening programs, and access to primary healthcare providers allows for regular check-ups and preventive care. However, despite these initiatives, New Zealand performs worse than the OECD average on many risk factor indicators, such as alcohol consumption and obesity (OECD 2023). New Zealand had a world-leading law to ban smoking for future generations, but this has been scrapped by the new National government to help pay for tax cuts (Corlett 2023).
New Zealand’s commitment to universal healthcare ensures that all residents have access to essential healthcare services regardless of their ability to pay. Policies and regulations establish standards and guidelines for healthcare delivery, ensuring quality in treatment and care. In fact, New Zealand performs better than the OECD average on 71% of the OECD’s “quality of care” indicators (OECD 2023). However, areas for improvement remain; for example, wait times for certain procedures or specialist consultations can be very long (RNZ 2023), and workforce shortages put a strain on the healthcare system (Hewett 2023).
Efforts are underway to enhance integration and coordination between different levels of care. Coordinated care pathways aim to ensure individuals receive appropriate care and are referred to specialized services when needed. Policies support the integration of telehealth and technology to improve access to care (Palmer 2023).
Citations:
Corlett, E. 2023. “New Zealand scraps world-first smoking ‘generation ban’ to fund tax cuts.” The Guardian, 27 November. https://theguardian.com/world/2023/nov/27/new-zealand-scraps-world-first-smoking-generation-ban-to-fund-tax-cuts#:~:text=The%20laws%20were%20due%20to,outlets%20and%20the%20generation%20ban%E2%80%9D
Hewett, W. 2023. “Govt Unveils New Sustained Improvement Plan to Tackle Issues Within NZ’s Health Workforce.” Newshub, July 4. https://www.newshub.co.nz/home/politics/2023/07/govt-unveils-new-sustained-improvement-plan-to-tackle-issues-within-nz-s-health-workforce.html
OECD. 2023. Health at a Glance 2023: New Zealand. https://www.oecd.org/newzealand/health-at-a-glance-New-Zealand-EN.pdf
Palmer, R. 2023. “Health NZ Te Whatu Ora Unveils Winter Preparedness Plan.” RNZ, May 4. https://www.rnz.co.nz/news/political/489245/health-nz-te-whatu-ora-unveils-winter-preparedness-plan
RNZ. 2023. “Moves to Cut Surgery Waiting Times: Three Down, 98 Recommendations to Go.” 18 November. https://www.rnz.co.nz/news/national/502738/moves-to-cut-surgery-waiting-times-three-down-98-recommendations-to-go
Corlett, E. 2023. “New Zealand scraps world-first smoking ‘generation ban’ to fund tax cuts.” The Guardian, 27 November. https://theguardian.com/world/2023/nov/27/new-zealand-scraps-world-first-smoking-generation-ban-to-fund-tax-cuts#:~:text=The%20laws%20were%20due%20to,outlets%20and%20the%20generation%20ban%E2%80%9D
Hewett, W. 2023. “Govt Unveils New Sustained Improvement Plan to Tackle Issues Within NZ’s Health Workforce.” Newshub, July 4. https://www.newshub.co.nz/home/politics/2023/07/govt-unveils-new-sustained-improvement-plan-to-tackle-issues-within-nz-s-health-workforce.html
OECD. 2023. Health at a Glance 2023: New Zealand. https://www.oecd.org/newzealand/health-at-a-glance-New-Zealand-EN.pdf
Palmer, R. 2023. “Health NZ Te Whatu Ora Unveils Winter Preparedness Plan.” RNZ, May 4. https://www.rnz.co.nz/news/political/489245/health-nz-te-whatu-ora-unveils-winter-preparedness-plan
RNZ. 2023. “Moves to Cut Surgery Waiting Times: Three Down, 98 Recommendations to Go.” 18 November. https://www.rnz.co.nz/news/national/502738/moves-to-cut-surgery-waiting-times-three-down-98-recommendations-to-go
Portugal
Portugal has achieved notable success in several health policy areas despite facing various challenges. This includes commendable life expectancy and infant mortality rates given the country’s level of public expenditure (OECD, 2023). Additionally, Portugal’s response to the COVID-19 pandemic, particularly its vaccination efforts, was remarkable. The country also established the National Integrated Continuing Care Network, which, although currently at full capacity and in need of expansion, provides essential ongoing and integrated support for individuals who are dependent and require continuous healthcare and social support due to acute illnesses or chronic disease management.
Portugal is shifting toward a more proactive, preventive approach in healthcare. A significant example is the breast cancer screening program, where 80% of women participated, a figure well above the OECD average of 55% (OECD, 2023). However, considerable progress is still needed in preventive healthcare. The number of healthy life years at age 65 in Portugal is below the OECD average, despite a higher overall life expectancy. With an aging population, the need for better diagnostic and preventive measures is increasingly critical. Yet, Portugal ranks as the fourth lowest in per capita spending on health prevention programs in the OECD and lags in the proportion of health spending dedicated to prevention. The Directorate-General for Health has prioritized programs focusing on the prevention and promotion of healthy lifestyles, but these initiatives have not received sufficient medium-term funding.
Enhancing the timely delivery of quality healthcare services necessitates addressing the shortage of family doctors. Currently, more than 1.7 million Portuguese people – 16% of those enrolled in primary healthcare – lack a family doctor, a figure that has been increasing in recent months (CNN, 2023). This shortage underscores the need for concerted efforts to improve the capacity and efficiency of primary healthcare services in Portugal.
Portugal is shifting toward a more proactive, preventive approach in healthcare. A significant example is the breast cancer screening program, where 80% of women participated, a figure well above the OECD average of 55% (OECD, 2023). However, considerable progress is still needed in preventive healthcare. The number of healthy life years at age 65 in Portugal is below the OECD average, despite a higher overall life expectancy. With an aging population, the need for better diagnostic and preventive measures is increasingly critical. Yet, Portugal ranks as the fourth lowest in per capita spending on health prevention programs in the OECD and lags in the proportion of health spending dedicated to prevention. The Directorate-General for Health has prioritized programs focusing on the prevention and promotion of healthy lifestyles, but these initiatives have not received sufficient medium-term funding.
Enhancing the timely delivery of quality healthcare services necessitates addressing the shortage of family doctors. Currently, more than 1.7 million Portuguese people – 16% of those enrolled in primary healthcare – lack a family doctor, a figure that has been increasing in recent months (CNN, 2023). This shortage underscores the need for concerted efforts to improve the capacity and efficiency of primary healthcare services in Portugal.
Citations:
OECD. 2023. “OECD Health at a Glance 2023 Country Note – Portugal.”
https://www.oecd.org/portugal/health-at-a-glance-Portugal-EN.pdf
CNN. 2023. “Há mais de 1,7 milhões de portugueses sem médico de família. E anúncio para contratar quase mil médicos arrisca ser mais um ‘fracasso’.” CNN Portugal, December 26.
https://cnnportugal.iol.pt/medico-de-familia/medicina-geral-e-familiar/ha-mais-de-1-7-milhoes-de-portugueses-sem-medico-de-familia-e-anuncio-para-contratar-quase-mil-medicos-arrisca-ser-mais-um-fracasso/20231226/658311b5d34e65afa2f8e05d
OECD. 2023. “OECD Health at a Glance 2023 Country Note – Portugal.”
https://www.oecd.org/portugal/health-at-a-glance-Portugal-EN.pdf
CNN. 2023. “Há mais de 1,7 milhões de portugueses sem médico de família. E anúncio para contratar quase mil médicos arrisca ser mais um ‘fracasso’.” CNN Portugal, December 26.
https://cnnportugal.iol.pt/medico-de-familia/medicina-geral-e-familiar/ha-mais-de-1-7-milhoes-de-portugueses-sem-medico-de-familia-e-anuncio-para-contratar-quase-mil-medicos-arrisca-ser-mais-um-fracasso/20231226/658311b5d34e65afa2f8e05d
Slovenia
Slovenia has several prevention programs. These programs begin with preventive monitoring of pregnant women and extend to newborn screening, healthcare for infants and children, healthcare for adolescents, and healthcare for students, athletes, and adults. For adults, national programs for the primary prevention of cardiovascular disease, diabetes, depression, risky alcohol consumption, and smoking are conducted by referral clinics. Screening programs for cervical cancer, breast cancer, and colorectal cancer – including the ZORA, DORA, and SVIT programs – are also available.
The primary objectives of these screening programs are to reduce the incidence of disease, lower the incidence of serious complications, decrease mortality rates, and increase the chances of complete curability.
The “This is Me” program is Slovenia’s largest web portal for youth counseling, offering young people anonymous public access to problem-solving support.
The mortality rate avoidable through public health and prevention measures increased in 2020 at a rate similar to the EU average and remained above it. Most preventable deaths are related to the prevalence of unhealthy lifestyles. The decline in the pre-pandemic mortality rate was linked to the strengthening of primary-level prevention measures, addressing smoking, alcoholism, healthy eating, and physical activity, as well as screening programs and counseling.
The mortality rate from curable causes decreased in Slovenia in 2020, indicating effective healthcare regarding treatment. Most deaths are due to heart disease, colon and rectal cancer, followed by stroke and breast cancer.
The primary objectives of these screening programs are to reduce the incidence of disease, lower the incidence of serious complications, decrease mortality rates, and increase the chances of complete curability.
The “This is Me” program is Slovenia’s largest web portal for youth counseling, offering young people anonymous public access to problem-solving support.
The mortality rate avoidable through public health and prevention measures increased in 2020 at a rate similar to the EU average and remained above it. Most preventable deaths are related to the prevalence of unhealthy lifestyles. The decline in the pre-pandemic mortality rate was linked to the strengthening of primary-level prevention measures, addressing smoking, alcoholism, healthy eating, and physical activity, as well as screening programs and counseling.
The mortality rate from curable causes decreased in Slovenia in 2020, indicating effective healthcare regarding treatment. Most deaths are due to heart disease, colon and rectal cancer, followed by stroke and breast cancer.
Citations:
Zdravstevna. 2020. “Preventivni presejalni programi v Sloveniji.” https://www.zdravstvena.info/preventiva/preventivni-presejalni-programi-v-sloveniji-svit-dora-zora.html
OECD. “OECD Better Life Slovenia.” https://www.oecdbetterlifeindex.org/countries/slovenia/
UMAR. 2023. “Poročilo o razvoju 2023.” https://www.umar.gov.si/fileadmin/user_upload/razvoj_slovenije/2023/slovenski/POR2023-splet.pdf
Zdravstevna. 2020. “Preventivni presejalni programi v Sloveniji.” https://www.zdravstvena.info/preventiva/preventivni-presejalni-programi-v-sloveniji-svit-dora-zora.html
OECD. “OECD Better Life Slovenia.” https://www.oecdbetterlifeindex.org/countries/slovenia/
UMAR. 2023. “Poročilo o razvoju 2023.” https://www.umar.gov.si/fileadmin/user_upload/razvoj_slovenije/2023/slovenski/POR2023-splet.pdf
Spain
The law on the cohesion and quality of the national health system dates back to 2003 but has been frequently updated, most recently in March 2021. The system is designed to offer efficient primary care. However, recent years have seen the healthcare system come under pressure from demographic changes, evolving healthcare needs, rising expectations, and innovations (WHO 2023). Experts and professionals have long pointed to a budgetary shortfall that has negatively impacted the system, resulting in a lack of human and material resources and increasing variability in the timeliness and quality of healthcare services across autonomous communities. Long waiting lists for ambulatory care and surgery, as well as overloaded emergency services, are common issues. According to the Health Barometer 2023, only 57.5% of the general population rated the functioning of the health system positively in October 2023, compared to 72.1% in 2019.
In 2023, the Spanish Ministry of Health’s budget expenditure exceeded €2.6 billion, up from approximately €2.4 billion in the previous year. The INVEAT plan, part of the RRP, has dedicated €796 million since 2021 to modernize technology, enhance early disease diagnosis, and enable prompt therapeutic intervention.
The national Ministry of Health has improved its constitutionally determined coordination function, aiming to ensure national standards in healthcare delivery. The anticipated National Public Health Agency is expected to improve system governance and foster cooperation mechanisms between the healthcare and public health services of the autonomous communities.
In late 2023, the central government convened a Sectoral Conference for Health with autonomous communities to address systemic issues. However, effective cooperation and shared decision-making have been challenging, evidenced by the government imposing its coordinating power to enforce the use of facemasks in healthcare facilities during the rising incidence of influenza in January 2024.
The RRP has partially improved access to funding for training and research in the health sector, including venture capital investment in technology-based or innovative companies. Investments from the RRP will contribute to creating a healthcare data lake to facilitate massive data processing projects. Autonomous communities’ health services are working on implementing innovative advanced analytics techniques to optimize waiting lists and assist in cancer screening.
Furthermore, the RRP includes measures to strengthen the resilience and capacity of the health system. These measures aim to boost research on pharmaceutical product sustainability, increase genomic testing capabilities, improve human biomonitoring infrastructure, and upgrade patient-oriented clinical research units.
The Public Health Strategy 2022 included a specific action plan to improve the population’s health and well-being through disease prevention, promoting healthy lifestyles, and fostering safe and sustainable environments. Smoking, alcohol consumption, and obesity remain significant public health issues in Spain, with high consumption rates potentially linked to comparatively low taxes on these substances.
In 2023, the Spanish Ministry of Health’s budget expenditure exceeded €2.6 billion, up from approximately €2.4 billion in the previous year. The INVEAT plan, part of the RRP, has dedicated €796 million since 2021 to modernize technology, enhance early disease diagnosis, and enable prompt therapeutic intervention.
The national Ministry of Health has improved its constitutionally determined coordination function, aiming to ensure national standards in healthcare delivery. The anticipated National Public Health Agency is expected to improve system governance and foster cooperation mechanisms between the healthcare and public health services of the autonomous communities.
In late 2023, the central government convened a Sectoral Conference for Health with autonomous communities to address systemic issues. However, effective cooperation and shared decision-making have been challenging, evidenced by the government imposing its coordinating power to enforce the use of facemasks in healthcare facilities during the rising incidence of influenza in January 2024.
The RRP has partially improved access to funding for training and research in the health sector, including venture capital investment in technology-based or innovative companies. Investments from the RRP will contribute to creating a healthcare data lake to facilitate massive data processing projects. Autonomous communities’ health services are working on implementing innovative advanced analytics techniques to optimize waiting lists and assist in cancer screening.
Furthermore, the RRP includes measures to strengthen the resilience and capacity of the health system. These measures aim to boost research on pharmaceutical product sustainability, increase genomic testing capabilities, improve human biomonitoring infrastructure, and upgrade patient-oriented clinical research units.
The Public Health Strategy 2022 included a specific action plan to improve the population’s health and well-being through disease prevention, promoting healthy lifestyles, and fostering safe and sustainable environments. Smoking, alcohol consumption, and obesity remain significant public health issues in Spain, with high consumption rates potentially linked to comparatively low taxes on these substances.
Citations:
Government of Spain. 2022. “Estrategia de Salud Pública 2022.”
https://www.bertelsmann-stiftung.de/de/unsere-projekte/der-digitale-patient/projektthemen/smarthealthsystems/digital-health-index
Government of Spain. 2021. “Plan INVEAT. Investment in High Technology Equipments.”
https://www.sanidad.gob.es/profesionales/prestacionesSanitarias/PlanINVEAT/pdf/Plan_INVEAT.pdf
Opinión de los ciudadanos. Barómetro Sanitario 2023. octubre de 2023. https://www.sanidad.gob.es/estadEstudios/estadisticas/BarometroSanitario/home_BS.htm
WHO. 2023. “Primary Health Care Transformation in Spain: Current Challenges and Opportunities.” https://iris.who.int/bitstream/handle/10665/373464/WHO-EURO-2023-8071-47839-70649-eng.pdf?sequence=1
Government of Spain. 2022. “Estrategia de Salud Pública 2022.”
https://www.bertelsmann-stiftung.de/de/unsere-projekte/der-digitale-patient/projektthemen/smarthealthsystems/digital-health-index
Government of Spain. 2021. “Plan INVEAT. Investment in High Technology Equipments.”
https://www.sanidad.gob.es/profesionales/prestacionesSanitarias/PlanINVEAT/pdf/Plan_INVEAT.pdf
Opinión de los ciudadanos. Barómetro Sanitario 2023. octubre de 2023. https://www.sanidad.gob.es/estadEstudios/estadisticas/BarometroSanitario/home_BS.htm
WHO. 2023. “Primary Health Care Transformation in Spain: Current Challenges and Opportunities.” https://iris.who.int/bitstream/handle/10665/373464/WHO-EURO-2023-8071-47839-70649-eng.pdf?sequence=1
6
Austria
Austrian health policy generally facilitates high-quality healthcare, though within certain limits. The increasing shortage of doctors across the country who treat patients with public health insurance (see P11.1) certainly limits the quality of healthcare in Austria – not only in terms of choice but also in terms of receiving medical treatment on reasonably short notice.
A survey from 2023 found that nearly one-fifth of medical practices, while obliged to accept new patients with public health insurance, were unwilling to take on these patients (see Kleine Zeitung 2023). Additionally, there have been long waiting times for those who eventually secure an appointment. In Vienna in particular, there have been exceptionally long waiting times for receiving medical treatment in hospitals, as has been publicly criticized by the city’s Court of Audit. According to other sources, the lack of sufficiently trained doctors in hospitals, particularly emergency surgeons, has reached a critical stage, with doctors themselves pointing to the growing risk of losing established quality standards (see Der Standard 2023).
Concerning most established indicators of effective preventive care, such as women receiving mammography screening, Austria has ranked in the middle among OECD countries. One of the major challenges has been the development of “integrated care” for elderly people. Integrating care both within the health system and between health and social care has been a significant issue over the past two decades. This challenge is mainly due to the fragmentation of responsibilities, information flows, and funding sources. With the rising number of people with chronic conditions and new patterns of care needs, such as dementia, problems between hospitals and community care have become evident. Consequently, several initiatives have been launched in Austria to adapt organizational structures and processes, such as information exchange, hospital discharge procedures, and education and training programs. However, to date, these reforms have been assessed as piecemeal, often discontinued, and not systematically evaluated.
A survey from 2023 found that nearly one-fifth of medical practices, while obliged to accept new patients with public health insurance, were unwilling to take on these patients (see Kleine Zeitung 2023). Additionally, there have been long waiting times for those who eventually secure an appointment. In Vienna in particular, there have been exceptionally long waiting times for receiving medical treatment in hospitals, as has been publicly criticized by the city’s Court of Audit. According to other sources, the lack of sufficiently trained doctors in hospitals, particularly emergency surgeons, has reached a critical stage, with doctors themselves pointing to the growing risk of losing established quality standards (see Der Standard 2023).
Concerning most established indicators of effective preventive care, such as women receiving mammography screening, Austria has ranked in the middle among OECD countries. One of the major challenges has been the development of “integrated care” for elderly people. Integrating care both within the health system and between health and social care has been a significant issue over the past two decades. This challenge is mainly due to the fragmentation of responsibilities, information flows, and funding sources. With the rising number of people with chronic conditions and new patterns of care needs, such as dementia, problems between hospitals and community care have become evident. Consequently, several initiatives have been launched in Austria to adapt organizational structures and processes, such as information exchange, hospital discharge procedures, and education and training programs. However, to date, these reforms have been assessed as piecemeal, often discontinued, and not systematically evaluated.
Citations:
https://www.kleinezeitung.at/politik/innenpolitik/aerztemangel/6150208/Aerztemangel_Recherche-in-135-Ordinationen_Wie-lange-man-auf
https://www.derstandard.at/story/2000144918798/wo-oesterreichs-gesundheitssystem-an-seine-grenzen-geraet
https://ehma.org/app/uploads/2022/12/Country-report-Austria_20180801.pdf
https://www.meinbezirk.at/wien/c-politik/stadtrechnungshof-kritisiert-wiener-spitaeler_a5101135
https://www.kleinezeitung.at/politik/innenpolitik/aerztemangel/6150208/Aerztemangel_Recherche-in-135-Ordinationen_Wie-lange-man-auf
https://www.derstandard.at/story/2000144918798/wo-oesterreichs-gesundheitssystem-an-seine-grenzen-geraet
https://ehma.org/app/uploads/2022/12/Country-report-Austria_20180801.pdf
https://www.meinbezirk.at/wien/c-politik/stadtrechnungshof-kritisiert-wiener-spitaeler_a5101135
Latvia
The ombudsman, previously in 2021, again approached the Ministry of Health regarding patients who require 24-hour care and support in stationary healthcare institutions. A solution is needed to ensure adequate care for these patients, prevent health deterioration, and respect human dignity in healthcare. As of November 2022, the National Health Service’s service name “Accompanying Person’s Presence with the Patient in Round-the-Clock Rehabilitation Institution or with a Child in a 24-hour Stationery” was changed to “Accompanying Person’s Presence with the Patient in a 24-hour Stationery,” making it possible for an accompanying person to be present when necessary for the patient’s continuous care.
Citations:
Tiesībsargs. 2023. “2022. gada ziņojums.” https://www.tiesibsargs.lv/wp-content/uploads/2023/03/tiesibsarga_2022_gada_zinojums.pdf
Tiesībsargs. 2023. “2022. gada ziņojums.” https://www.tiesibsargs.lv/wp-content/uploads/2023/03/tiesibsarga_2022_gada_zinojums.pdf
Lithuania
Health policies are largely aligned with the goal of achieving high-quality healthcare, although their implementation often faces obstacles. According to the OECD (2023), Lithuania performed better than the OECD average on 58% of quality-of-care indicators. However, it scored poorly on acute care, with a 30-day mortality rate after stroke of 15.4%, compared to the OECD average of 7.8%. In primary care, Lithuania had 554 avoidable admissions per 100,000 population, in contrast to the OECD average of 463. For preventive care, 46% of women were screened for breast cancer, below the OECD average of 55%. Additionally, the rate of unmet need for medical care is among the highest among OECD countries.
The 2020 coalition government prioritized strengthening public health, emphasizing disease prevention and cultivating a healthy lifestyle through proper nutrition, physical activity, balanced working, studying and leisure regimes, sex education, and the prevention of substances affecting stress and psychology (Seimas 2020). It also committed to further improving the quality of individual healthcare services by enhancing focus on their safety. This would be based on a quality management system that uses data and evidence for the purposes of monitoring and diagnosing, with the support of new technologies, best practices and expert recommendations, and quality assessment based on patient feedback.
The government also stressed the importance of increasing healthcare effectiveness through individually tailored services. These services are based on the application of the most recent prevention, diagnosis, treatment and care techniques. Funding for services would be linked to the quality and effectiveness of their provision, irrespective of the ownership or subordination of particular healthcare institutions.
The program defined several indicators of success. By 2024, goals are to increase average life expectancy to 77 years (from 76), reduce the difference in life expectancy between men and women to eight years (from 9.8), increase average healthy life expectancy to 60.5 years (from 58.1), and have the share of adults who assess their state of health as good or very good reach 64% (up from 58%). More ambitious indicators regarding life expectancy and health self-assessments were set for 2030.
In 2022, the government allocated additional resources for activities aimed at strengthening public healthcare, particularly psychological health, healthy lifestyles, more effective management of infectious diseases, and expansions to the network of schools that practice health-strengthening activities (The Government Annual Report for 2022, 2023). It also began implementing a project to establish a model for providing long-term care services, which aims to deliver all types of care services in a sustainable “single point of contact” manner.
Although the annual report on government activities in 2022 noted a slight decrease in the life expectancy gap between men and women (from 9.6 to 9.3 years), it acknowledged that this gap remained the EU’s largest (The Government Annual Report for 2022, 2023). It also noted that, contrary to plans, average healthy life expectancy had decreased compared to 2019. This negative trend was explained with reference to the restricted accessibility of healthcare services due to the management of the COVID-19 pandemic, as well as to the pandemic itself.
The 2020 coalition government prioritized strengthening public health, emphasizing disease prevention and cultivating a healthy lifestyle through proper nutrition, physical activity, balanced working, studying and leisure regimes, sex education, and the prevention of substances affecting stress and psychology (Seimas 2020). It also committed to further improving the quality of individual healthcare services by enhancing focus on their safety. This would be based on a quality management system that uses data and evidence for the purposes of monitoring and diagnosing, with the support of new technologies, best practices and expert recommendations, and quality assessment based on patient feedback.
The government also stressed the importance of increasing healthcare effectiveness through individually tailored services. These services are based on the application of the most recent prevention, diagnosis, treatment and care techniques. Funding for services would be linked to the quality and effectiveness of their provision, irrespective of the ownership or subordination of particular healthcare institutions.
The program defined several indicators of success. By 2024, goals are to increase average life expectancy to 77 years (from 76), reduce the difference in life expectancy between men and women to eight years (from 9.8), increase average healthy life expectancy to 60.5 years (from 58.1), and have the share of adults who assess their state of health as good or very good reach 64% (up from 58%). More ambitious indicators regarding life expectancy and health self-assessments were set for 2030.
In 2022, the government allocated additional resources for activities aimed at strengthening public healthcare, particularly psychological health, healthy lifestyles, more effective management of infectious diseases, and expansions to the network of schools that practice health-strengthening activities (The Government Annual Report for 2022, 2023). It also began implementing a project to establish a model for providing long-term care services, which aims to deliver all types of care services in a sustainable “single point of contact” manner.
Although the annual report on government activities in 2022 noted a slight decrease in the life expectancy gap between men and women (from 9.6 to 9.3 years), it acknowledged that this gap remained the EU’s largest (The Government Annual Report for 2022, 2023). It also noted that, contrary to plans, average healthy life expectancy had decreased compared to 2019. This negative trend was explained with reference to the restricted accessibility of healthcare services due to the management of the COVID-19 pandemic, as well as to the pandemic itself.
Citations:
OECD. 2023. “Health at a Glance 2023 Country Note: Lithuania.” https://www.oecd.org/health/health-at-a-glance/
The Seimas, the Resolution on The Program of the Eighteenth Government of Lithuania (in Lithuanian), 11 December 2020, No. XIV-72;
The Government Annual Report for 2022, 17 May 2023 (in Lithuanian), https://epilietis.lrv.lt/lt/naujienos/seimui-teikiama-vyriausybes-2022-metu-veik los-ataskaita.
OECD. 2023. “Health at a Glance 2023 Country Note: Lithuania.” https://www.oecd.org/health/health-at-a-glance/
The Seimas, the Resolution on The Program of the Eighteenth Government of Lithuania (in Lithuanian), 11 December 2020, No. XIV-72;
The Government Annual Report for 2022, 17 May 2023 (in Lithuanian), https://epilietis.lrv.lt/lt/naujienos/seimui-teikiama-vyriausybes-2022-metu-veik los-ataskaita.
Netherlands
The Dutch healthcare system is facing critical challenges, with structural issues becoming more apparent after the COVID-19 pandemic. Despite its theoretical robustness, the system urgently requires significant maintenance as an increasing number of citizens are being denied their legally entitled care, potentially creating substantial long-term health risks.
Youth care is under considerable pressure, experiencing a surge in demand that has led to prolonged waiting times for assistance. Additionally, dental care is still not included in basic insurance contacts, further highlighting the system’s shortcomings. Health disparities persist, with the most prosperous 20% of the population enjoying over 23 additional years of good health compared to the least prosperous 20%. There is an imperative to consider health impacts in all government policies and to reorient healthcare procurement toward prevention, given the unequal outcomes of the current reactive approach.
Efforts to broaden the National Prevention Agreement include incorporating mental resilience, taxing sugary drinks and increasing excise duties on tobacco. Plans include agreements with industry on producing healthier foods, exploring a sugar tax, and potentially reducing the VAT rate on fruits and vegetables. However, these proposals remain stuck in the planning stage. Additional investments in research and action against Alzheimer’s, obesity and cancer, for both adults and children, have been proposed. Addressing age-related conditions necessitates a heightened focus on prophylactics. However, health insurers’ reluctance to invest in preventive interventions highlights the need for a systemic shift to a mindset in which health is integral to the healthcare system, not just illness.
To help understand addiction’s social impact, the establishment of a national rapporteur on addictions has been proposed. The National Prevention Agreement had achieved 22 out of its 41 set targets by 2021. The focus on reducing smoking, obesity and excessive alcohol consumption by 2040 has yielded outcomes such as smoke-free school grounds and daycare centers, as well as increased promotion of healthy lifestyles in municipalities.
The Care Agreement emphasizes prevention, quality of life and locally accessible care. It envisions increased job satisfaction and digital support for medical staff, along with a national network for exchanging electronic healthcare data. The Integral Care Agreement (IZA) is seen as the beginning of substantial change, with ongoing discussions and a commitment to realizing the agreed-upon measures.
The implementation of the IZA, concluded in September 2022, is facing challenges. The Ministry of Health, Welfare and Sport provided financial resources for 2023 to municipalities only in September. Despite persistent requests from the Association of Dutch Municipalities, the ministry did not grant its approval to carry these funds forward to 2024. This delay in financial support is exerting pressure on the execution of the Integral Care Agreement.
Youth care is under considerable pressure, experiencing a surge in demand that has led to prolonged waiting times for assistance. Additionally, dental care is still not included in basic insurance contacts, further highlighting the system’s shortcomings. Health disparities persist, with the most prosperous 20% of the population enjoying over 23 additional years of good health compared to the least prosperous 20%. There is an imperative to consider health impacts in all government policies and to reorient healthcare procurement toward prevention, given the unequal outcomes of the current reactive approach.
Efforts to broaden the National Prevention Agreement include incorporating mental resilience, taxing sugary drinks and increasing excise duties on tobacco. Plans include agreements with industry on producing healthier foods, exploring a sugar tax, and potentially reducing the VAT rate on fruits and vegetables. However, these proposals remain stuck in the planning stage. Additional investments in research and action against Alzheimer’s, obesity and cancer, for both adults and children, have been proposed. Addressing age-related conditions necessitates a heightened focus on prophylactics. However, health insurers’ reluctance to invest in preventive interventions highlights the need for a systemic shift to a mindset in which health is integral to the healthcare system, not just illness.
To help understand addiction’s social impact, the establishment of a national rapporteur on addictions has been proposed. The National Prevention Agreement had achieved 22 out of its 41 set targets by 2021. The focus on reducing smoking, obesity and excessive alcohol consumption by 2040 has yielded outcomes such as smoke-free school grounds and daycare centers, as well as increased promotion of healthy lifestyles in municipalities.
The Care Agreement emphasizes prevention, quality of life and locally accessible care. It envisions increased job satisfaction and digital support for medical staff, along with a national network for exchanging electronic healthcare data. The Integral Care Agreement (IZA) is seen as the beginning of substantial change, with ongoing discussions and a commitment to realizing the agreed-upon measures.
The implementation of the IZA, concluded in September 2022, is facing challenges. The Ministry of Health, Welfare and Sport provided financial resources for 2023 to municipalities only in September. Despite persistent requests from the Association of Dutch Municipalities, the ministry did not grant its approval to carry these funds forward to 2024. This delay in financial support is exerting pressure on the execution of the Integral Care Agreement.
Citations:
De staat van de zorg. 2023. Nederlandse zorautoriteit. 12.10.2023. https://www.nza.nl/onderwerpen/stand-van-de-zorg
De E-healthmonitor. 2021-2023. “Plan van aanpak op hoofdlijnen.” RIVM. https://open.overheid.nl/documenten/ronl-d0462ee1-7a94-4b34-b510-c5dbdaa555b6/pdf
EY Barometer Nederlandse Gezondheidszorg. 2023. “Resultaten 2023: Nederlandse zorgsector in zeer zwaar weer beland.” https://www.ey.com/nl_nl/health/ey-barometer-nederlandse-gezondheidszorg
Het Integraal Zorgakkoord - samenwerken aan gezonde zorg, Het Integraal Zorgakkoord - samenwerken aan gezonde zorg
Kiezen voor houdbare zorg. Mensen, middelen en maatschappelijk draagvlak. WRR. 15-09-2021. https://www.wrr.nl/publicaties/rapporten/2021/09/15/kiezen-voor-houdbare-zorg
https://www.rijksoverheid.nl/onderwerpen/prinsjesdag/zorg-en-gezondheid
https: //vng.nl/nieuws/uitvoering-integraal-zorgakkoord-iza-onder-druk
De staat van de zorg. 2023. Nederlandse zorautoriteit. 12.10.2023. https://www.nza.nl/onderwerpen/stand-van-de-zorg
De E-healthmonitor. 2021-2023. “Plan van aanpak op hoofdlijnen.” RIVM. https://open.overheid.nl/documenten/ronl-d0462ee1-7a94-4b34-b510-c5dbdaa555b6/pdf
EY Barometer Nederlandse Gezondheidszorg. 2023. “Resultaten 2023: Nederlandse zorgsector in zeer zwaar weer beland.” https://www.ey.com/nl_nl/health/ey-barometer-nederlandse-gezondheidszorg
Het Integraal Zorgakkoord - samenwerken aan gezonde zorg, Het Integraal Zorgakkoord - samenwerken aan gezonde zorg
Kiezen voor houdbare zorg. Mensen, middelen en maatschappelijk draagvlak. WRR. 15-09-2021. https://www.wrr.nl/publicaties/rapporten/2021/09/15/kiezen-voor-houdbare-zorg
https://www.rijksoverheid.nl/onderwerpen/prinsjesdag/zorg-en-gezondheid
https: //vng.nl/nieuws/uitvoering-integraal-zorgakkoord-iza-onder-druk
UK
The National Health Service (NHS) holds iconic status within the UK and is widely considered politically untouchable. However, criticism of its functioning is growing. Since the pandemic, resources for healthcare have steadily increased, making it less convincing to argue that the service is underfunded. Health is a competence delegated to the devolved administrations, but the model of free care at the point of delivery is common to all. Differences in effectiveness are sometimes highlighted in political debates, with Conservative politicians pointing to shortcomings in Wales, where the Labour Party has long been in power.
In addition to alarming headlines about the large increase in waiting lists for treatment since the pandemic, the UK has a poor record in dealing with cancer and cardiovascular disease.
The Kings Fund, a leading health think tank, summarizes the explanations in a report: “The UK lags behind other countries in its capital investment and has substantially fewer key physical resources than many of its peers, including CT and MRI scanners and hospital beds. The UK has strikingly low levels of key clinical staff, including doctors and nurses, and is heavily reliant on foreign-trained staff.”
In addition to alarming headlines about the large increase in waiting lists for treatment since the pandemic, the UK has a poor record in dealing with cancer and cardiovascular disease.
The Kings Fund, a leading health think tank, summarizes the explanations in a report: “The UK lags behind other countries in its capital investment and has substantially fewer key physical resources than many of its peers, including CT and MRI scanners and hospital beds. The UK has strikingly low levels of key clinical staff, including doctors and nurses, and is heavily reliant on foreign-trained staff.”
Citations:
https://www.kingsfund.org.uk/sites/default/files/2023-06/how_NHS_%20compares_%20summary_2023.pdf
https://www.kingsfund.org.uk/sites/default/files/2023-06/how_NHS_%20compares_%20summary_2023.pdf
Health policies are only somewhat aligned with the goal of achieving high-quality healthcare.
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Greece
The quality of healthcare in Greece is far from assured. Although Greece has 67,000 practicing doctors, the country has fewer doctors and significantly fewer hospital beds per 1,000 inhabitants compared to other OECD countries (OECD 2021). Greece also faces a chronic shortage of nurses – a low-status, low-paid job – and medical personnel in rural or remote areas, as most doctors prefer to work in Athens and Thessaloniki, the two largest cities. In these hospitals, there are long waiting lists for emergency ward admissions and surgeries, leading to delays in receiving timely care.
The quality of treatment in public hospitals varies significantly, depending on available infrastructure and the quality of medical personnel. Additionally, patients’ purchasing power influences the volume of unrecorded and untaxed transactions with doctors (under-the-table out-of-pocket payments).
Furthermore, health policy has not historically prioritized preventive care. Only recently has the government begun reorienting the health system toward prevention, focusing on breast, cervical, and colon cancers, cardiovascular diseases, childhood obesity, and prevention programs for adolescents and older adults (Ministry of Health 2023).
The quality of treatment in public hospitals varies significantly, depending on available infrastructure and the quality of medical personnel. Additionally, patients’ purchasing power influences the volume of unrecorded and untaxed transactions with doctors (under-the-table out-of-pocket payments).
Furthermore, health policy has not historically prioritized preventive care. Only recently has the government begun reorienting the health system toward prevention, focusing on breast, cervical, and colon cancers, cardiovascular diseases, childhood obesity, and prevention programs for adolescents and older adults (Ministry of Health 2023).
Citations:
OECD. 2021. “Health Care Resources.” https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_REAC
Ministry of Health. 2023. “Prevention Programs.” https://www.moh.gov.gr/articles/health/dieythynsh-prwtobathmias-frontidas-ygeias/draseis-kai-programmata-agwghs-ygeias/programmata-prolhpshs
OECD. 2021. “Health Care Resources.” https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_REAC
Ministry of Health. 2023. “Prevention Programs.” https://www.moh.gov.gr/articles/health/dieythynsh-prwtobathmias-frontidas-ygeias/draseis-kai-programmata-agwghs-ygeias/programmata-prolhpshs
Poland
High-quality healthcare is gradually being implemented. Polish specialists achieve excellent results in some areas such as ophthalmology, performing breakthrough procedures and forming teams with international renown in other fields. The Act on Healthcare and Patient Safety came into effect on January 1, 2024, imposing requirements for hospitals to obtain authorization and accreditation.
From the patient’s perspective, an essential focus in this area is prevention. Although only 2% of total health expenditures have been allocated to prevention in recent years, there has been increasing emphasis on this area from the Ministry of Health and the National Health Fund. In 2023, 10 preventive programs were conducted in Poland. In 2021, in response to the COVID-19 pandemic, the 40+ program was introduced, allowing diagnostic tests based on gender for individuals aged 40 and above (extended until June 30, 2024). To address the changing needs of the world and growing concerns about the youngest generation, the “Treatment of e-addictions in children” pilot program was launched. This program applies to children and adolescents up to the completion of secondary school and encompasses psychological and therapeutic counseling as well as participation in group or family sessions.
On June 1, 2023, Poland initiated a program for universal, free vaccinations for teenagers against the human papillomavirus (HPV). Additionally, efforts are being made to coordinate patient care, with a current focus on pregnant women and obese individuals in the cardiology and oncology fields, for example. The National Oncology Network introduced a new model of organization and management of oncological care in 2024.
From the patient’s perspective, an essential focus in this area is prevention. Although only 2% of total health expenditures have been allocated to prevention in recent years, there has been increasing emphasis on this area from the Ministry of Health and the National Health Fund. In 2023, 10 preventive programs were conducted in Poland. In 2021, in response to the COVID-19 pandemic, the 40+ program was introduced, allowing diagnostic tests based on gender for individuals aged 40 and above (extended until June 30, 2024). To address the changing needs of the world and growing concerns about the youngest generation, the “Treatment of e-addictions in children” pilot program was launched. This program applies to children and adolescents up to the completion of secondary school and encompasses psychological and therapeutic counseling as well as participation in group or family sessions.
On June 1, 2023, Poland initiated a program for universal, free vaccinations for teenagers against the human papillomavirus (HPV). Additionally, efforts are being made to coordinate patient care, with a current focus on pregnant women and obese individuals in the cardiology and oncology fields, for example. The National Oncology Network introduced a new model of organization and management of oncological care in 2024.
Citations:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9779126/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9779126/
USA
The United States. boasts some of the best healthcare in the world, characterized by highly trained and experienced doctors, cutting-edge medical technology and facilities, and significant spending and investment in health research and practices. However, access to this system is extremely uneven and largely depends on the personal economic resources of individual Americans and their families.
American health outcomes are not as impressive as they should be given the medical resources available in the country. Much of this stems from inequality in the American healthcare system, with poor Americans struggling to access preventive healthcare, lead a healthy lifestyle, and reach health services in a timely fashion.
In addition, the “fee for service” model of American healthcare rewards the volume of interaction with the health service, not the quality of interaction. It is in the economic interest of medical providers for patients to return frequently rather than be kept healthy and away from their practices.
There are some federal policies designed to increase and protect the quality of care for the unwell. The Affordable Care Act of 2010 (Obamacare) created Accountable Care Organizations (ACOs), entities that promote collaboration among healthcare providers with the intention of improving care coordination, increasing quality, and reducing costs.
American health outcomes are not as impressive as they should be given the medical resources available in the country. Much of this stems from inequality in the American healthcare system, with poor Americans struggling to access preventive healthcare, lead a healthy lifestyle, and reach health services in a timely fashion.
In addition, the “fee for service” model of American healthcare rewards the volume of interaction with the health service, not the quality of interaction. It is in the economic interest of medical providers for patients to return frequently rather than be kept healthy and away from their practices.
There are some federal policies designed to increase and protect the quality of care for the unwell. The Affordable Care Act of 2010 (Obamacare) created Accountable Care Organizations (ACOs), entities that promote collaboration among healthcare providers with the intention of improving care coordination, increasing quality, and reducing costs.
4
Slovakia
Slovakia invests very few resources and little effort in preventive healthcare. It does not encourage changes toward a healthier lifestyle (OECD, 2021: 22): “Nearly half of all deaths in Slovakia are attributable to potentially preventable behavioral and environmental causes.”
Waiting lists are not transparently published, but for some treatments, patients must wait more than a year. The level of unmet demand is above the OECD average (OECD, 2021a).
Fico’s government postponed the health network reform prepared by the 2020 OĽaNO-led government, which was part of the National Recovery and Resilience Plan. This reform aimed to ensure that individuals receive appropriate care at the right place and time, particularly on the tertiary level. The strategy for implementing integrated care was already passed in 2014, but Robert Fico blocked its revised version prepared in 2019.
Limited resources restrict access to high-cost technologies and medications (OECD, 2021)).
Waiting lists are not transparently published, but for some treatments, patients must wait more than a year. The level of unmet demand is above the OECD average (OECD, 2021a).
Fico’s government postponed the health network reform prepared by the 2020 OĽaNO-led government, which was part of the National Recovery and Resilience Plan. This reform aimed to ensure that individuals receive appropriate care at the right place and time, particularly on the tertiary level. The strategy for implementing integrated care was already passed in 2014, but Robert Fico blocked its revised version prepared in 2019.
Limited resources restrict access to high-cost technologies and medications (OECD, 2021)).
Citations:
OECD/European Observatory on Health Systems and Policies. 2021. Slovakia: Country Health Profile 2021. Paris: OECD Publishing and Brussels: European Observatory on Health Systems and Policies.
OECD. 2021a. Health at Glance. Paris: OECD
OECD/European Observatory on Health Systems and Policies. 2021. Slovakia: Country Health Profile 2021. Paris: OECD Publishing and Brussels: European Observatory on Health Systems and Policies.
OECD. 2021a. Health at Glance. Paris: OECD
3
Hungary
Hungarians are on average more obese and smoke more than the European average (OECD 2023). The country performs well in preventing alcohol misuse, maintaining a zero-tolerance policy for intoxicated driving, with noticeable effects. Hungary also shows strong performance in vaccination rates. However, in most of the other prevention indicators, Hungary ranks below the OECD average.
A healthy lifestyle and the Hungarian way of life often exclude each other, and although regular physical activity is increasingly popular among younger urban populations, strong regional differences persist (Welk et al. 2015). Improving high-quality services within the state health system would require more financial resources, but this does not occur. High-quality healthcare in Hungary is often privatized, as strong profits have made healthcare a lucrative business opportunity for Fidesz oligarchs. Consequently, high-quality healthcare in Hungary is available if it is financed privately. The state-directed healthcare system is becoming increasingly complementary.
A healthy lifestyle and the Hungarian way of life often exclude each other, and although regular physical activity is increasingly popular among younger urban populations, strong regional differences persist (Welk et al. 2015). Improving high-quality services within the state health system would require more financial resources, but this does not occur. High-quality healthcare in Hungary is often privatized, as strong profits have made healthcare a lucrative business opportunity for Fidesz oligarchs. Consequently, high-quality healthcare in Hungary is available if it is financed privately. The state-directed healthcare system is becoming increasingly complementary.
Citations:
OECD/European Observatory on Health Systems and Policies. 2023. “Hungary: Country Health Profile 2023, State of Health in the EU.” Paris: OECD Publishing/Brussels: European Observatory on Health Systems and Policies. https://health.ec.europa.eu/system/files/2023-12/2023_chp_hu_english.pdf
Welk, G. J., Saint-Maurice, P. F., and Csányi, T. 2015. “Health-related Physical Fitness in Hungarian Youth: Age, Sex and Regional Profiles.” Research Quarterly for Exercise and Sport 86(sup1): S45-S57.
OECD/European Observatory on Health Systems and Policies. 2023. “Hungary: Country Health Profile 2023, State of Health in the EU.” Paris: OECD Publishing/Brussels: European Observatory on Health Systems and Policies. https://health.ec.europa.eu/system/files/2023-12/2023_chp_hu_english.pdf
Welk, G. J., Saint-Maurice, P. F., and Csányi, T. 2015. “Health-related Physical Fitness in Hungarian Youth: Age, Sex and Regional Profiles.” Research Quarterly for Exercise and Sport 86(sup1): S45-S57.
Health policies are not at all aligned with the goal of achieving high-quality healthcare.
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