preface_schema: ‘1.0’ title: ‘OECD or of the European Union.’ source_type: ‘Academic’ publisher: ‘World Health Organization’ publishing_date: ‘November 2024’ authors: [‘OECD Publishing’, ‘Together Initiative’] available_at: ‘https://doi.org/10.1787/b3704e14-en’ availability_status: ‘available’ availability_http_code: ‘206’ availability_checked_at: ‘2026-02-12’ availability_note: ‘Available as at 2026-02-12.’ source_integrity_flag: ‘ok’ credibility_tier_value: ‘5’ credibility_tier_key: ‘peer-reviewed’ credibility_tier_label: ‘Peer-Reviewed’ credibility: ‘Draft Peer-Reviewed Report’ journal_ranking_source: ‘scimagojr_2024’ journal_sourceid: ” journal_title: ” journal_issn: ” journal_sjr: ” journal_quartile: ” journal_rank_global: ” journal_categories: ” journal_areas: ” journal_high_ranked: ” journal_match_method: ‘none’ journal_match_confidence: ” keywords: [‘health’, ‘oecd’, ‘work’, ‘european’, ‘systems’, ‘original’, ‘isbn’, ‘across’] abstract: ‘This work is published under the responsibility of the Secretary-General of the OECD and the President of the European Commission. The opinions expressed and arguments employed herein do not necessarily reflect the official views of the Member countries of the This document, as well as any data and map included herein, are without prejudice to the status of or sovereignty over any territory, to the delimitation of international frontiers and boundaries and to the name of any territory, city or area.‘
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reignty over any territory, to the delimitation of international frontiers and boundaries and to the name of any territory, city or area.‘
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This work is published under the responsibility of the Secretary-General of the OECD and the President of the European Commission. The opinions expressed and arguments employed herein do not necessarily reflect the official views of the Member countries of the OECD or of the European Union. This document, as well as any data and map included herein, are without prejudice to the status of or sovereignty over any territory, to the delimitation of international frontiers and boundaries and to the name of any territory, city or area. The names of countries and territories and maps used in this joint publication follow the practice of the OECD. Specific territorial disclaimers applicable to the OECD: Note by the Republic of Türkiye The information in this document with reference to “Cyprus” relates to the southern part of the Island. There is no single authority representing both Turkish and Greek Cypriot people on the Island. Türkiye recognises the Turkish Republic of Northern Cyprus (TRNC). Until a lasting and equitable solution is found within the context of the United Nations, Türkiye shall preserve its position concerning the “Cyprus issue”. Note by all the European Union Member States of the OECD and the European Union The Republic of Cyprus is recognised by all members of the United Nations with the exception of Türkiye. The information in this document relates to the area under the effective control of the Government of the Republic of Cyprus. Please cite this publication as: OECD/European Commission (2024), Health at a Glance: Europe 2024: State of Health in the EU Cycle, OECD Publishing, Paris, https://doi.org/10.1787/b3704e14-en. ISBN 978-92-64-80445-6 (print) ISBN 978-92-64-58300-9 (PDF) ISBN 978-92-64-82463-8 (HTML) ISBN 978-92-64-55040-7 (epub) He
in the EU Cycle, OECD Publishing, Paris, https://doi.org/10.1787/b3704e14-en. ISBN 978-92-64-80445-6 (print) ISBN 978-92-64-58300-9 (PDF) ISBN 978-92-64-82463-8 (HTML) ISBN 978-92-64-55040-7 (epub) Health at a Glance: Europe ISSN 2305-607X (print) ISSN 2305-6088 (online) European Union ISBN 978-92-68-21383-4 (print) ISBN 978-92-68-21382-7 (PDF) Catalogue number: EW-01-24-003-EN-C (print) Catalogue number: EW-01-24-003-EN-N (PDF) Revised version, November 2024 Details of revisions available at: https://www.oecd.org/en/publications/support/corrigenda.html Photo credits: Cover © fizkes/Shutterstock.com. Corrigenda to OECD publications may be found at: https://www.oecd.org/en/publications/support/corrigenda.html. © OECD/European Union 2024. In the event of any discrepancy between the original work and any translated versions of this work, only the text of original work should be considered valid. Attribution 4.0 International (CC BY 4.0) This work is made available under the Creative Commons Attribution 4.0 International licence. By using this work, you accept to be bound by the terms of this licence (https://creativecommons.org/licenses/by/4.0/). Attribution – you must cite the work. Translations – you must cite the original work, identify changes to the original and add the following text: In the event of any discrepancy between the original work and the translation, only the text of original work should be considered valid. Adaptations – you must cite the original work and add the following text: This is an adaptation of an original work by the OECD. The opinions expressed and arguments employed in this adaptation should not be reported as representing the official views of the OECD or of its Member countries. Third-party material – the licence does not apply to third-party material in the work. If using such material, you are responsible for obtaining permission from the third party and for any claims of infringement. You must not use the OECD and/or Europ
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3 Europe finds itself at a pivotal moment in the evolution of health systems across the continent. The health landscape is changing rapidly, requiring governments, healthcare providers and society at large to address new and complex health challenges while building on the successes of the past. Several megatrends are bound to profoundly influence the future of healthcare. Demographic shifts, driven by increasing life expectancy and declining birth rates, are placing growing demands on health and long-term care services, while reducing the working-age population needed to both finance – through taxation or social security contributions – and deliver these services. At the same time, rapid advances in medical technology – from enhanced diagnostics to the digital transformation of health systems and the integration of artificial intelligence tools – offer potential to improve efficiency and expand access to care, but also raise questions about equity and necessary safeguards against misuse. Moreover, the growing health impacts of climate change, such as the increasing frequency and severity of heatwaves resulting in more heat-related illnesses and fatalities, underscore the need for both more resilient health systems and a sustainable, green transition also within health systems. We need forward-looking policy solutions that fully harness the potentia
ies, underscore the need for both more resilient health systems and a sustainable, green transition also within health systems. We need forward-looking policy solutions that fully harness the potential of new technologies while upholding the core principles of universal access to high- quality care – a hallmark of healthcare in the EU. This 2024 edition of Health at a Glance: Europe comes at a critical juncture, providing valuable analysis and insights to support decision-making across European countries. This year’s thematic section examines two interconnected priorities: (a) promoting healthy longevity, and (b) addressing health workforce shortages. These challenges are fundamental to managing the shifting balance between demand and supply capacity in European health systems. Promoting healthy longevity Healthy longevity can be defined as living a long life in good physical and mental health, without overlooking the social aspects of well-being. Demographic shifts across the EU are profound, with the proportion of the population aged 65 and above having increased from 16% in 2000 to over 21% in 2023, with projections indicating a further rise to nearly 30% by 2050. Despite overall citizens aged 65 and above living with at least two chronic conditions. Promoting healthy longevity requires a change in the health systems paradigm, moving from reactive to proactive, comprehensive prevention actions implemented across the life course. Strengthening the health workforce to build more resilient health systems The EU faces a health workforce deficit, with an estimated shortage of 1.2 million doctors, nurses and midwives as of 2022. This shortage stems from multiple factors: demographic ageing affecting both patients and the health workforce itself, combined with difficult working conditions that contribute to staff burnout and retention difficulties – challenges that were further intensified by the COVID-19 pandemic. Bold policy interventions are required across thr
working conditions that contribute to staff burnout and retention difficulties – challenges that were further intensified by the COVID-19 pandemic. Bold policy interventions are required across three key areas: expanding professional training capacity, improving workplace conditions to attract and retain talent, and leveraging innovations to increase productivity. OECD estimates indicate that strengthening the health workforce to build more resilient health systems would require additional investment equivalent to about 0.6% of GDP on average across EU countries compared to pre-pandemic levels. While this investment is substantial, it is dwarfed by the economic and social costs of fragile and understaffed health systems. Addressing skills shortages, as underscored by the European Commission’s Skills Agenda, and optimising the use of skills within new models of care will be crucial for meeting rising demands with limited resources, while also supporting the digital and green transitions.
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, and optimising the use of skills within new models of care will be crucial for meeting rising demands with limited resources, while also supporting the digital and green transitions.
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4 Health system transformation at the heart of the European Health Union Digital transformation offers significant potential for health system efficiency, with evidence indicating that digital tools can reduce administrative workload for health professionals by up to 30%. The European Health Data Space provides a crucial framework for facilitating health data exchange and accessibility while upholding robust data protection standards. Success in this digital transition requires strengthening health data infrastructure, incorporating comprehensive cybersecurity measures and targeted training for both health workers and patients. Against this backdrop, the OECD continues to support countries’ progress in implementing the 2017 OECD Council Recommendation on Health Data Governance, including activities focused on digital security in health and the responsible use of AI in healthcare. Non-communicable diseases (NCDs) – such as cardiovascular diseases, cancer, diabetes, neurodegenerative disorders and autism – pose a significant burden on health systems in the EU. Implementing Europe’s Beating Cancer Plan and the Healthier Together Initiative, promoting preventive care, reducing lifestyle risk factors and transitioning towards more integrated models of care will be essential. The OECD provides indispensable support for these efforts through rigorous cost-benefit analyses of policy interventions and identification of best practices in health promotion, disease prevention and chronic care management. Furthermore, the forthcoming OECD Patient-Reported Indicator Surveys (PaRIS) results, scheduled for release in early 2025, will integrate patient perspectives into health system performance assessment, marking a significant advancement in measuring what matters to pat
(PaRIS) results, scheduled for release in early 2025, will integrate patient perspectives into health system performance assessment, marking a significant advancement in measuring what matters to patients. Mental health is a public health priority, especially due to the COVID-19 pandemic’s significant and persistent impact on young people. Expanding access to timely and quality mental health services, using digital solutions where appropriate, and promoting mental health literacy throughout the life course, including in the education system, will be vital. The European Commission’s Comprehensive Approach to Mental Health provides a robust framework for action. In partnership with the European Commission, the OECD is working to identify best practices in mental health, including school-based programmes that foster social and emotional skills, measures to improve timely access to mental health services for those with mild to moderate issues and suicide prevention initiatives. Combatting antimicrobial resistance (AMR) and the achievement of the 2030 targets outlined in the Council Recommendation on stepping up EU actions to combat AMR in a One Health approach is paramount. OECD economic analysis quantifies the annual cost of AMR to the EU/EEA economies at EUR 11.7 billion a year, with slightly more than half of this amount related to extra health expenditure incurred from treating resistant infections and the remainder consisting in economic losses due to reduced workforce participation and productivity. The EU’s strategic response to this pivotal challenge encompasses multiple integrated initiatives: the Serious Cross-border Threats to Health Regulation and the Pharmaceutical Strategy for Europe provide support to bolster crisis preparedness and response, strengthen supply chains for critical materials and drive innovation. Building on this foundation, the OECD is advancing its support for member countries in addressing medical supply chain vulnerabilities. As
n supply chains for critical materials and drive innovation. Building on this foundation, the OECD is advancing its support for member countries in addressing medical supply chain vulnerabilities. As a crucial first step, the OECD will update its landscape analysis of recent initiatives aimed at securing medical supply chains, with a particular focus on international efforts. A collaborative path forward The structural challenges facing European health systems demand exceptional levels of collaboration – not only between health and finance ministries, but also across sectors and among countries – to build sustainable, high-performing and people-centred health systems. It will be essential to foster competitiveness and innovation within the health sector, positioning it as a driver of economic growth and societal resilience. However, this pursuit of innovation must be balanced by a strong commitment to ensuring that all citizens can benefit from these advancements. The Commission’s priorities for an Economy that Works for People and the European Pillar of Social Rights offer a valuable framework to guide efforts at both the national and EU levels, aligning with the OECD’s 2025-26 programme of work promoting strong, sustainable, inclusive and resilient economic growth. This report offers a comprehensive review of population health status and the performance of health systems across Europe, encompassing successes and setbacks and delivering valuable insights for shaping forward-looking health policies tailored to diverse national contexts. The European Commission and the OECD remain committed to supporting EU countries in this crucial endeavour, underscoring a shared dedication to health equity and the recognition that robust, accessible health systems are vital for societal well-being and economic prosperity. Through a continued focus on evidence-based policy making, European countries can develop resilient health systems that deliver the high-quality, accessi
r societal well-being and economic prosperity. Through a continued focus on evidence-based policy making, European countries can develop resilient health systems that deliver the high-quality, accessible care that all European citizens – regardless of socio-economic status or geographic location – expect and deserve. This report marks an important step in that journey, providing a reflection and a solid evidence base for the crucial work that lies ahead.
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5 Finally, as we look at the potential enlargement of the EU, it is crucial to support candidate countries in aligning with EU health priorities and closing gaps in health outcomes. Ensuring these nations are fully prepared will foster greater health equity across Europe and strengthen our collective ability to respond to shared challenges. This report serves as both a roadmap of progress made and a compass for future action. By addressing the pressing health challenges of today, we can shape a healthier, more resilient Europe for tomorrow. Stefano Scarpetta, Director for Employment, Labour and Social Affairs, OECD Sandra Gallina, Director-General for Health and Food Safety, European Commission
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ilient Europe for tomorrow. Stefano Scarpetta, Director for Employment, Labour and Social Affairs, OECD Sandra Gallina, Director-General for Health and Food Safety, European Commission
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6 Acknowledgements Health at a Glance: Europe 2024 marks the start of the fifth State of Health in the EU cycle – an initiative launched by the European Commission, in co-operation with the OECD and the European Observatory on Health Systems and Policies, to assist EU Member States in improving the health of their citizens and the performance of their health systems. While the preparation of this publication was led by the OECD, the European Commission provided guidance and substantive inputs throughout the process, as well as financial support via the EU4Health Programme. This publication would not have been possible without the efforts of national data correspondents from the 40 countries covered in this report who have provided most of the data and metadata. We are also grateful to all the national officials who have provided helpful comments on a draft of this report. This report was prepared by a team from the OECD Health Division under the overall co-ordination of Gaétan Lafortune. Chapter 1 on health workforce challenges was prepared by Federico Pratellesi, Jose Ramalho and Gaétan Lafortune. Chapter 2 on ageing and health was prepared by Eileen Rocard and Gaétan Lafortune. Chapter 3 on the health status of populations was prepared by Gaétan Lafortune, Liora Bowers, Abbey Horner, Emily Hewlett and Anna Perez-Lopez. Chapter 4 on risk factors was prepared by Federico Pratellesi, Eileen Rocard and Elina Suzuki, with input from Joao Matias and Maria Ana Santos from the European Union Drugs Agency (EUDA) for the indicator on illicit drug consumption among adults. Caroline Penn, Michael Mueller and Jose Manuel Jerez Pombo prepared Chapter 5 on health expenditure and financing. Chapter 6 on effectiveness and quality of care was prepared by Rie Fujisawa, Kadri
s. Caroline Penn, Michael Mueller and Jose Manuel Jerez Pombo prepared Chapter 5 on health expenditure and financing. Chapter 6 on effectiveness and quality of care was prepared by Rie Fujisawa, Kadri-Ann Kallas, Kate de Bienassis, Candan Kendir, Riho Isaji, Eliana Barrenho, Nicolas Larrain and Ricarda Milstein. Chapter 7 on accessibility was prepared by Lucie Bryndova, Gaétan Lafortune, Michael Mueller, Ekin Dagistan, Abbey Horner, Pauline Fron, Christine Le Thi and Marie-Clémence Canaud, with input from Sarah Thomson and Marcos Gallardo Martínez on behalf of the WHO Barcelona Office for Health Systems Strengthening for the indicator on the financial hardship of out-of-pocket spending. Chapter 8 on resilience was prepared by Federico Pratellesi, David Morgan, Jose Manuel Jerez Pombo and Katarina Vujovic. This publication benefited from useful comments from Francesca Colombo, Head of the OECD Health Division. Many useful comments were also received from Maya Matthews, Dirk Van den Steen, Katarzyna Ptak-Bufkens and Corina Vasilescu from the European Commission’s Health and Food Safety Directorate General, from Ebba Barany, Estefanía Alaminos- Aguilera and Lucian Agafitei from Eurostat, and from many other colleagues who commented on parts of the publication. Editorial assistance was provided by Lucy Hulett and Alastair Wood from the OECD ELS Communications Team.
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tat, and from many other colleagues who commented on parts of the publication. Editorial assistance was provided by Lucy Hulett and Alastair Wood from the OECD ELS Communications Team.
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7 Table of contents Acknowledgements Readers’ guide Executive summary Part I Thematic chapters 1 Addressing health workforce challenges in the EU: Training, retaining, innovating 1.1. Introduction 1.2. Unpacking the key drivers of health worker supply and demand 1.3. Past trends and current challenges in health workforce in the EU 1.4. Improving health workforce planning to guide policy decision-making 1.5. Increasing the education and training of new doctors and nurses 1.6. Improving job quality to increase retention 1.7. Innovating to optimise the use of skills and new technologies 1.8. Conclusions References Notes 2 Living longer, living healthier? Promoting healthy longevity in Europe 2.1. Introduction 2.2. People are living longer in the EU 2.3. Are people living healthier in the EU? 2.4. The burden of diseases and injuries among older people in the EU 2.5. Risk factors to health among older people in the EU 2.6. Promoting healthy longevity 2.7. Conclusions References
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The burden of diseases and injuries among older people in the EU 2.5. Risk factors to health among older people in the EU 2.6. Promoting healthy longevity 2.7. Conclusions References
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8 Part II Overview of health indicators 3 Health status Main causes of mortality Mortality from circulatory diseases Cancer mortality Cancer incidence and prevalence Self-rated health among adults Chronic conditions and disabilities among adults Adolescent health Adult mental health 4 Risk factors Tobacco and cannabis smoking among adolescents Smoking and vaping among adults Alcohol consumption among adolescents Alcohol consumption among adults Use of illicit drugs among adults Nutrition among adolescents Nutrition among adults Physical activity among children and adolescents Physical activity among adults Overweight and obesity among children and adolescents Overweight and obesity among adults Impact of environmental factors on health 5 Health expenditure and financing Health expenditure per capita Health expenditure in relation to GDP Financing of health expenditure Health expenditure by type of service Expenditure on primary healthcare Health expenditure by provider Pharmaceutical expenditure 6 Effectiveness: Quality of care and patient experience Avoidable mortality (preventable and treatable) Routine vaccinations Cancer screening Avoidable hospital admissions Integrated care Mortality following acute myocardial infarction (AMI) Mortality following stroke Hip and knee surgery: Outcomes and emergency responsiveness
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idable hospital admissions Integrated care Mortality following acute myocardial infarction (AMI) Mortality following stroke Hip and knee surgery: Outcomes and emergency responsiveness
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9 7 Accessibility: Affordability, availability and use of services Unmet healthcare needs Population coverage for healthcare Extent of healthcare coverage Financial hardship and out-of-pocket expenditure Availability of doctors Remuneration of doctors (general practitioners and specialists) Availability of dentists and consultations with dentists Availability of nurses Remuneration of nurses Use of diagnostic technologies Hospital beds and discharges Volumes of hip and knee replacements Waiting times for elective surgery 8 Resilience: Crisis preparedness, response capacity and fiscal sustainability Crisis preparedness and public trust in institutions Public health laboratory and critical care capacities Antimicrobial resistance and safe antibiotic prescribing Public health measures: Vaccination to protect older people Use of teleconsultations Digital health readiness Medical and nursing graduates Capital expenditure in the health sector
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measures: Vaccination to protect older people Use of teleconsultations Digital health readiness Medical and nursing graduates Capital expenditure in the health sector
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11 Readers’ guide Health at a Glance: Europe is the first step in the State of Health in the EU cycle of knowledge brokering. It is designed to provide a cross-country assessment of national health systems’ performance in the European Union. It also provides more in-depth analysis on two important topics in the thematic chapters upfront. The publication is divided in two parts. Part I contains the two thematic chapters. In this edition, Chapter 1 reviews recent developments in health workforce supply and demand across EU countries, the available evidence about current shortages, and policy actions to increase the supply of health workers and alleviate the expected increase in demand for certain categories of workers due to population ageing, notably through innovative task-sharing approaches and the growing use of new technologies. over 65 in EU countries to assess to what extent people live not only longer lives but also healthier lives, and reviews policies to promote healthy longevity and reduce the burden of diseases and disabilities among older people in the EU. Part II includes six chapters that provide an overview of key indicators of health and health systems across EU Member States, candidate countries, European Free Trade Association countries and the United Kingdom. Chapters 3 and 4 describe the health status of the population and some of the main risk factors to health. Chapter 5 reviews the most recent trends in health spending, including the temporary impact of the pandemic on health expenditure per capita and as a share of GDP, as well as the mix in public and private financing. The last three chapters are structured around the three objectives set out in the 2014 European Commission Communication on effective, accessible and resilient health sy
public and private financing. The last three chapters are structured around the three objectives set out in the 2014 European Commission Communication on effective, accessible and resilient health systems (https://eur-lex.europa.eu/legal- content/EN/TXT/PDF/?uri=CELEX:52014DC0215). The data presented in this publication come mainly from official national statistics and have been collected in many cases through the administration of joint questionnaires by the OECD and Eurostat. The data have been validated by the two organisations to ensure that they meet high standards of data quality and comparability. Some data also come from European surveys co-ordinated by Eurostat, notably the European Union Statistics on Income and Living Conditions (EU-SILC) survey, as well as from the European Centre for Disease Prevention and Control (ECDC), the World Health Organization (WHO), the Health Behaviour in School-Aged Children (HBSC) study and other sources. Presentation of indicators and calculation of EU averages With the exception of the first two thematic chapters, all indicators in the rest of the publication are presented in the following way. The text provides a brief commentary highlighting the key findings conveyed by the data, defines the indicator and signals any significant data comparability limitation. This is accompanied by a set of figures that typically show current levels of the indicator and, where possible, trends over time. The EU averages include only EU Member States and are calculated either as population-weighted averages (to be consistent with the averages that are calculated by Eurostat) or as unweighted averages (when these averages are calculated by the OECD [Infographic/Figure content omitted in strict text-only mode.]
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the averages that are calculated by Eurostat) or as unweighted averages (when these averages are calculated by the OECD [Infographic/Figure content omitted in strict text-only mode.]
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12 Data limitations Limitations in data comparability are indicated both in the text (in the box related to “Definition and comparability”) as well as in footnotes underneath the figures. Data sources Readers interested in using the data presented in this publication for further analysis and research are encouraged to consult the full documentation of definitions, sources and methods contained in OECD Health Statistics for all OECD member and accession countries, including 25 EU Member States and five additional countries (Iceland, Norway, Switzerland, Türkiye and the United Kingdom). This information is available on OECD Data Explorer (https://data-explorer.oecd.org/). For the other countries, readers are invited to consult the Eurostat database for more information on sources and methods (http://ec.europa.eu/eurostat/data/database) or the data sources mentioned underneath the figures. European country ISO codes Albania AL Lithuania LT Austria AT Luxembourg LU Belgium BE Malta MT Bosnia and Herzegovina BA Moldova MD Bulgaria BG Montenegro ME Croatia HR Netherlands NL Cyprus CY North Macedonia MK Czechia CZ Norway NO Denmark DK Poland PL Estonia EE Portugal PT Finland FI Romania RO France FR Serbia RS Georgia GE Slovak Republic SK Germany DE Slovenia SI Greece EL Spain ES Hungary HU Sweden SE Iceland IS Switzerland CH Ireland IE Türkiye TR Italy IT Ukraine UA Latvia LV UK
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erbia RS Georgia GE Slovak Republic SK Germany DE Slovenia SI Greece EL Spain ES Hungary HU Sweden SE Iceland IS Switzerland CH Ireland IE Türkiye TR Italy IT Ukraine UA Latvia LV UK
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13 Executive summary The 2024 edition of Health at a Glance: Europe presents the state of European health systems as they continue their recovery from the COVID-19 pandemic and respond to the challenges and opportunities brought about by digitalisation, climate change and demographic changes. This year’s report focuses on two linked pivotal themes: addressing health workforce shortages and promoting healthy longevity. Urgent action is needed to address health workforce shortages in Europe • The European health workforce faces a severe crisis. Twenty EU countries reported a shortage of doctors in 2022 and 2023, while 15 countries reported a shortage of nurses. Based on minimum staffing thresholds for universal health coverage (UHC), EU countries had an estimated shortage of approximately 1.2 million doctors, nurses and midwives in 2022. The dual demographic challenges of an ageing population, which augments the demand for health services, and an ageing health workforce, which increases the need to replace current health workers as they retire, are key drivers of this shortfall. Over one-third of doctors and a quarter of nurses in the EU are aged over 55 and expected to retire in the coming years. Concurrently, interest in health careers among young people is declining, with interest in nursing falling in over half of EU countries between 2018 and 2022. Health workforce planning is essential to guide policy making and ensure that the health workforce is sufficiently staffed and skilled. • To address acute domestic workforce shortages, European countries have increasingly relied on recruiting foreign-trained health professionals. Following a temporary reduction during the first two years of the pandemic, the inflow of foreign- trained doctors in European countr
asingly relied on recruiting foreign-trained health professionals. Following a temporary reduction during the first two years of the pandemic, the inflow of foreign- trained doctors in European countries increased by 17% in 2022 compared to 2019, while the inflow of foreign-trained nurses surged by 72%. In 2023, over 40% of doctors in Norway, Ireland and Switzerland, and over 50% of nurses in Ireland were foreign-trained. While providing a quick solution to pressing needs, an overreliance on foreign-trained health workers risks exacerbating workforce shortages and overall fragility in source countries, often lower-income nations already grappling with acute health workforce constraints. • Addressing the health workforce crisis requires a multi-pronged approach. In the short-term, improving working conditions and remuneration are critical to increasing the attractiveness of the profession and retaining current health workers. Increasing education and training opportunities for new doctors and nurses is also vital to boost supply, although its impact will only be felt in the medium to longer-term. Given the slow average growth rate of only 0.5% per year in the number of new nursing graduates in the EU between 2012 and 2022, attracting enough young people to meet the rising demand presents a significant challenge. Optimising the skill-mix through for example greater use of advanced practice nurses, as well as harnessing digital technologies and AI, will be essential to augment health worker productivity and enable them to focus more on patient care. Promoting healthy longevity can reduce the burden on health and long-term care systems • Europe is facing a profound demographic shift, with the proportion of people over age 65 in the EU projected to rise from impaired by chronic illnesses and disabilities. This is particularly the case for women who live several years longer than substantial portion of the disease burden in old age among both women and men can be prev
chronic illnesses and disabilities. This is particularly the case for women who live several years longer than substantial portion of the disease burden in old age among both women and men can be prevented by addressing key risk factors throughout the life course. For example, up to 45% of dementia cases could be avoided by addressing 14 modifiable risk factors, according to the 2024 Lancet Commission on dementia prevention. Insufficient physical activity contributes greatly to the development of cardiovascular diseases, depression and many other diseases in old age. Only 22% of people aged over 65 engage in sufficient physical activity. Obesity rates – a risk factor for numerous chronic conditions – also tend to rise with age, peaking at around 20% among those aged 65 to 74 years across the EU in 2022.
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14 • Effective policy action is imperative to promote healthy longevity by prioritising disease prevention, including by means of vaccination, supporting mental health at all ages and empowering individuals to manage their own health. The costs of inaction – both in terms of reduced healthy life years and economic burden – are too high to bear. Projection models indicate that a concerted “healthy ageing” scenario could slow the growth of health spending as a share of GDP in the coming decades and help contain long-term care costs, while reducing the demand for health and long-term care workers. enduring concern • significant disparities persist between EU Member States, with an eight-year gap between countries with the highest and lowest life expectancies. Spain, Italy and Malta recorded life expectancies more than two years above the EU average, while Latvia and Bulgaria were more than five and a half years below it. Cardiovascular diseases and cancers remained the leading causes of mortality in 2021, accounting for 54% of all deaths, followed by COVID-19 at 11%. Notably, mortality rates from cardiovascular diseases were up to s
diseases and cancers remained the leading causes of mortality in 2021, accounting for 54% of all deaths, followed by COVID-19 at 11%. Notably, mortality rates from cardiovascular diseases were up to seven times higher in some Central and Eastern European countries compared to Western Europe. • Physical and mental health is a critical determinant of people’s well-being, significantly influencing educational outcomes in children and adolescents as well as employment outcomes in adults. Recent evidence points to a deterioration in the physical and mental health of adolescents. The proportion of 15-year-olds reporting multiple health complaints – related to both physical issues and psychological distress – rose from 42% in 2017-18 to 52% in 2021-22 on average across EU countries. Various factors explain the rising trend in psychological distress among adolescents during that period, including the impact of the COVID-19 lockdowns, higher rates of problematic internet and social media use and increased exposure to cyberbullying. The impact of social media and excessive screen time on the mental health of individuals, particularly among youth, warrants close monitoring. Progress in addressing lifestyle risk factors has stalled, with persistent socio-economic disparities • Lifestyle risk factors such as the use of tobacco and related products, harmful alcohol consumption, poor nutrition, lack of physical activity and obesity account for a substantial share of the total burden of morbidity and mortality in EU countries. In 2021, approximately 1.1 million deaths in the EU, equivalent to nearly 21% of all deaths, were attributable to the combined impact of smoking, excessive alcohol use and high body-mass index. • Despite ongoing efforts to curb unhealthy behaviours, risk factors remain prevalent across the EU. In 2022, 18% of adults were daily smokers. One in five adults reported heavy alcohol consumption on a monthly basis. Moreover, over half of adolescents cons
isk factors remain prevalent across the EU. In 2022, 18% of adults were daily smokers. One in five adults reported heavy alcohol consumption on a monthly basis. Moreover, over half of adolescents consumed inadequate quantities of fruit and vegetables, while only 15% met the WHO-recommended levels of physical activity. • Poor nutrition and physical inactivity have contributed to the rising prevalence of overweight and obesity among adolescents and adults in the EU. In 2022, over 20% of 15-year-olds were overweight or obese, with rates exceeding 25% in Malta, Greece and Romania. Socio-economic inequalities play a significant role, with adolescent obesity rates over 60% higher among those from low-affluence families compared to their high-affluence peers. Among adults, over half were overweight or obese in 2022, with a 14 percentage point difference between those with low and high levels of education. • Environmental risk factors, such as air pollution and climate change, pose growing threats to public health in the EU. In 2021, fine particulate matter (PM2.5) exposure alone caused over 253 000 deaths, with the highest mortality in Central and Eastern Europe. The EU has set ambitious targets to reduce air pollution and greenhouse gas emissions, aiming for a 55% reduction in premature deaths due to PM2.5 by 2030 compared to 2005. Based on current progress, the EU is on track to achieve this goal. EU countries have made gradual improvements in health crisis preparedness, but significant challenges remain in building public trust and combatting AMR • Health crisis preparedness levels appear to have improved slightly since the pandemic began, with average self-reported adherence rates to WHO International Health Regulations among EU countries increasing from 75% in 2020 to 78% in 2023. Disease surveillance, laboratory capacity and human resources showed the highest scores, while gaps remain in risk communication and preparedness to radiation emergencies and chemical
to 78% in 2023. Disease surveillance, laboratory capacity and human resources showed the highest scores, while gaps remain in risk communication and preparedness to radiation emergencies and chemical events.
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15 • Public trust in government institutions plays a pivotal role in ensuring effective crisis response. In 2023, more than half of the population in 19 EU countries expressed confidence in their government’s emergency preparedness capabilities. However, trust levels varied significantly. Finland, the Netherlands and Denmark recorded the highest score, with two-thirds or more of their citizens expressing confidence in their government’s ability to handle crises. In contrast, only about one-third of the population reported confidence in Latvia, Portugal and Greece. • Antimicrobial resistance (AMR) remains a major public threat, with antibiotic-resistant infections occurring in the EU resulting in approximately 35 000 deaths every year and direct costs estimated at EUR 6.6 billion. In 2022-23, 32% of tested bacterial isolates were resistant to key antibiotics, a rate which exceeded 50% in Romania, Greece, Cyprus and Bulgaria. Antibiotic consumption in the community – a key driver of AMR – varies almost fourfold across EU countries, highlighting the need for improvements in antimicrobial stewardship to optimise antibiotic use. • Vaccination remains crucial for protecting populations, particularly older people, against infectious diseases. By late 2021, nearly 90% of people aged 60+ in the EU completed their COVID-19 primary vaccination course, with most countries exceeding 75% coverage. However, subsequent uptake of the first booster dose in early 2022 varied sevenfold across countries, and the second booster dose saw even greater disparity, ranging from over 75% in Ireland and Denmark to less than 5% in Bulgaria, Romania, the Slovak Republic and Lithuania. Influenza vaccination rates initially rose during the pandemic’s first
sparity, ranging from over 75% in Ireland and Denmark to less than 5% in Bulgaria, Romania, the Slovak Republic and Lithuania. Influenza vaccination rates initially rose during the pandemic’s first year, but fell in 2021-22, albeit remaining above pre-pandemic levels. Vaccine hesitancy and access issues remain major barriers, with public perceptions of vaccine safety varying from 94% to 60% across EU countries. The European Commission initiated the State of Health in the EU cycle in 2016 to support EU Member States in enhancing citizen health and health system performance. The biennial Health at a Glance: Europe report, the cycle’s first output, provides comprehensive data and comparative analyses to identify health and health system strengths and improvement opportunities. The Country Health Profiles, developed in collaboration with the European Observatory on Health Systems and Policies, form the cycle’s second step. The next edition, due in 2025, will highlight each EU country’s unique health system characteristics and challenges. For further information, please consult: https://health.ec.europa.eu/state-health-eu_en.
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sult: https://health.ec.europa.eu/state-health-eu_en.
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19 Addressing health workforce issues is one of the main challenges that EU health systems will have to face over the next decade. The COVID-19 pandemic highlighted that the most important factor of a good-functioning health system is a robust, well-trained, and dedicated health workforce, but shortages and rigidities hampered responses to the pandemic. During the pandemic and in its aftermath, most EU countries have reported shortages of different categories of health workers. Based on proposed minimum thresholds of health worker densities to achieve universal health coverage, in 2022 EU countries faced a shortage of 1.2 million doctors, nurses and midwives. Looking forward, population ageing will continue to exert pressure on the demand for healthcare, while the ageing of the health workforce itself will increase the need to replace them with newly-trained workers. Several countries are looking at recruiting health workers from abroad to respond to current shortages, but this risks exacerbating shortages in countries of origin and may not be sustainable in the long run, as these countries strengthen their health systems and require more health workers domestically. EU countries can use three broad strategies to address health workforce shortages in the short and longer-term: 1) train more health workers (although this will take several years to yield results); 2) retain more health workers longer in the profession by improving working conditions; 3) support innovations in health service delivery to make a more effective use of the health workforce and new technologies. 1 Addressing health workforce challenges in the EU: Training, retaining, innovating
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health service delivery to make a more effective use of the health workforce and new technologies. 1 Addressing health workforce challenges in the EU: Training, retaining, innovating
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20 1.1. Introduction The COVID-19 pandemic has exposed the vulnerabilities of health systems across the European Union (EU), with one of the most pressing issues being the shortage of health workers. The stark reality witnessed during the first two years of the pandemic, where countries with more health and social care workers experienced fewer excess deaths (defined as deaths in excess of the historical baseline) compared to those with fewer workers, has underscored the critical importance of investing in securing an adequate, properly skilled workforce to nurture the resilience capacity of our health systems. The pandemic has not only exacerbated existing labour shortages, but also highlighted the growing challenges in attracting and retaining workers in the health sector, making it arguably the biggest challenge facing EU health systems today. Concerns about the shortage of health workers in Europe are not new. This challenge has been primarily driven by the “double demographic” phenomenon of an ageing population coupled with an ageing health workforce. As noted in Chapter 2, the proportion of people aged 65 and over in the EU has risen from 16% in 2000 to 21% in 2023, and is projected to reach nearly demand for health and long-term care. At the same time, the health workforce itself is ageing, with large numbers of doctors and nurses retiring or due to retire in the coming years and needing to be replaced by younger professionals. While promoting healthy ageing through effective public health and prevention policies can help mitigate some of the increased demand stemming from population ageing, addressing health workforce shortages remains paramount. The urgency of the challenge is compounded by the potential vicious circle observed in several EU countries
nd stemming from population ageing, addressing health workforce shortages remains paramount. The urgency of the challenge is compounded by the potential vicious circle observed in several EU countries in the aftermath of the acute phase of the pandemic: understaffing creates stressful working conditions, leading to increased resignations and declining interest in health professions. This risks creating a downward spiral where shortages beget further shortages over time. Decisive action is therefore needed to avoid this cycle and ensure the long-term sustainability of Europe’s health systems. Against this background, this thematic chapter examines the complex issue of the shortage of health workers in the EU, offering a comprehensive overview of recent developments, current challenges and potential solutions. The chapter begins by examining the main drivers of supply and demand for health workers, followed by a detailed examination of past trends and current health workforce challenges across EU countries. It then investigates the root causes of these shortages and presents key policy components that should be incorporated into effective remedial strategies. These include enhancing health workforce planning to inform policy decisions, increasing the education and training of new doctors and nurses, improving working conditions to boost retention rates, and leveraging innovations to augment the productivity of health workers and optimise the use of their skills. While many countries are currently aiming to address their health workforce shortages by drawing at least partly on recruitment from other countries, this raises ethical issues when such recruitment occurs in lower-income countries that face even more acute shortages. It is also not a sustainable approach in the long run as the countries of origin develop their economies and health systems and will have greater demand and ability to retain more health workers. 1.2. Unpacking the key drivers of health worker
long run as the countries of origin develop their economies and health systems and will have greater demand and ability to retain more health workers. 1.2. Unpacking the key drivers of health worker supply and demand Health workforce shortages have been a longstanding concern in most European countries, and in the aftermath of the COVID-19 pandemic they have emerged as a mounting challenge that risks threatening the accessibility, quality and resilience of health services in several European health systems (OECD, 2023[1]). By definition, a shortage of health workers means that there is some imbalance between the demand and supply of workers. Many factors shape the demand and supply of different categories [Infographic/Figure content omitted in strict text-only mode.]
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21 also depends on the skill-mix and task sharing modalities in the delivery of health services – for example, the demand for physicians is partly determined by the availability of nurses and other professionals who can complement physician activity. Advances in medical technology are also a key determinant of the demand for health workers: for example, the development of new diagnostic tools, such as AI-powered imaging analysis, may reduce the demand for radiologists. Similarly, the growing adoption of telemedicine and remote monitoring technologies may alter the skill mix required in primary care, with a greater emphasis on digital literacy and communication skills among health professionals. Addressing shortages of different categories of health workers requires a multi-pronged strategy targeting both supply-side policies (e.g. expanding education, increasing retention) and demand-side policies (e.g. making more effective use of the health workforce by changing skill-mix and supporting an effective use of technologies). The optimal policy mix will depend on each country’s specific circumstances. However, in all cases, a long-term, comprehensive workforce strategy is needed
orting an effective use of technologies). The optimal policy mix will depend on each country’s specific circumstances. However, in all cases, a long-term, comprehensive workforce strategy is needed to ensure an adequate supply of health workers to meet the growing demand for health services across Europe. These strategies have to be regularly reassessed and updated to take into account changing circumstances affecting demand-side and supply-side factors. [Infographic/Figure content omitted in strict text-only mode.]
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23 The number of doctors and nurses per capita has increased substantially over the past two decades in most EU countries. However, this does not mean that shortages have decreased if the demand for doctors and nurses has increased even more during the same period. On average across EU countries, there were 4.2 doctors per 1 000 population in 2022, up from 3.1 in 2002 and 3.6 in 2012 [Infographic/Figure content omitted in strict text-only mode.]
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On average across EU countries, there were 4.2 doctors per 1 000 population in 2022, up from 3.1 in 2002 and 3.6 in 2012 [Infographic/Figure content omitted in strict text-only mode.]
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24 Box 1.2. Definition of nurses for the purpose of international data collection Defining who is a nurse (and who is not a nurse) for the purpose of international data collection is not as easy as it might seem at first sight. The main issue is that in several countries the distinction between different categories and levels of nurses is not clear-cut, and there are also blurring lines in qualifications, job titles and tasks between some categories of nurses and personal care workers /healthcare assistants. The OECD/Eurostat/WHO-Europe Joint Questionnaire on Non-Monetary Healthcare Statistics collects data on the two broad categories of nurses that are identified in the International Standard Classification of Occupations (ISCO-08): “professional nurses” and “associate professional nurses”. Data on personal care workers/healthcare assistants are collected separately (based also on the ISCO classification). In the EU, the first category of “professional nurses” has been defined as those who have a level of qualifications meeting the EU Directive on the recognition of professional qualifications for general nurses (i.e. at least three years of study or 4 600 hours of theoretical and clinical training according to Directive 2013/55/EU). The second category of “associate professional nurses” includes all other categories of nurses that are recognised as such in each country. Only about one-third of EU countries report data for this second category. However, a few countries are not able to make a clear distinction between these two broad categories of nurses and only report the total of nurses without any distinction. It is also important to bear in mind that a comprehensive assessment of the nursing-related workforce would also take into account the s
es and only report the total of nurses without any distinction. It is also important to bear in mind that a comprehensive assessment of the nursing-related workforce would also take into account the support provided by personal care workers/healthcare assistants. For example, in some countries that have below average numbers of nurses such as Italy and Spain, a large number of personal care workers/healthcare assistants provide assistance to nurses and patients. The number of nurses has increased over the past decade in most EU countries. On average across EU countries, there were [Infographic/Figure content omitted in strict text-only mode.]
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26 1.3.3. The average working hours of doctors has decreased over the past decade, while it has remained stable for nurses While the number of doctors in headcounts has increased over the past decade in nearly all countries, the average working hours of doctors has decreased in most countries, so the increase in the number of full-time equivalents (FTEs) has been more modest. Part of this reduction is due to the feminisation of the medical workforce, but the working time of male doctors also fell over the past decade as many aim to achieve a better work-life balance. On average in the EU, male doctors worked 43.2 hours per week in 2022 (down from 44.3 hours in 2012), while female doctors worked on average 39.5 hours per week (down from 40.0 hours), often reflecting changes in work-life balance preferences and uneven family responsibilities. Nurses generally work fewer hours [Infographic/Figure content omitted in strict text-only mode.]
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28 1.3.6. The uneven geographical distribution of doctors is a major barrier to access to care in peripheral regions There also continues to be wide variations in the geographic distribution of doctors, resulting in medical deserts. In many countries, there is a particularly high density of doctors in national capital regions, reflecting the concentration of specialised services and physicians’ preferences to practice in national capitals. This is the case for example in Austria, Croatia, Czechia, Denmark, [Infographic/Figure content omitted in strict text-only mode.]
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29 Box 1.3. Recent European projects addressing medical desertification “Medical desertification” refers to the emergence of severely underserved areas where residents face major barriers to accessing needed health services. While various definitions of “medical deserts” exist reflecting different types of access issues, the concept typically encompasses geographical distance to healthcare facilities and providers, shortage of health professionals, and areas with ageing and declining or disadvantaged populations that make it difficult to attract and retain medical staff in such areas. Three EU-funded projects, which ran between 2021 and the first quarter of 2024, aimed to better understand, measure and address this medical desertification: ROUTE-HWF (Roadmap OUT of mEdical deserts into supportive Health WorkForce initiatives and policies) aimed to help EU countries reduce inequalities in healthcare access by supporting them in designing and implementing policies related to medical deserts. It developed a taxonomy of five distinctive types of medical deserts, guidelines on monitoring and measuring them, analysis of factors driving desertification, and a roadmap with a p
medical deserts. It developed a taxonomy of five distinctive types of medical deserts, guidelines on monitoring and measuring them, analysis of factors driving desertification, and a roadmap with a policy mix to address different types of medical deserts. OASES (prOmoting evidence-bASed rEformS) aimed at strengthening the capacity of health authorities in Cyprus, Finland, France, Hungary, Italy, Moldova and Romania to address medical deserts. It developed a methodology to measure spatial access and conducted pilot studies in participating countries to assess medical deserts and built consensus on mitigation strategies among stakeholders. AHEAD (Action for Health and Equity: Addressing medical Deserts) aimed to reduce health inequalities by addressing the challenge of medical desertification in Italy, Moldova, the Netherlands, Romania and Serbia. Its goals were to achieve better access to health services in underserved areas and more equitable access to health workers by building knowledge, encouraging innovation in health service delivery, and applying a participatory approach to health policy making. Sources: https://route-hwf.eu/; https://oasesproject.eu/, https://ahead.health. Countries have sought to address such medical deserts through policies based on financial incentives, health service redesign and digital solutions: • In France, where the term “medical deserts” was first popularised almost two decades ago, successive governments have implemented various initiatives to address the growing shortage or complete absence of GPs in certain regions. The main policy response has been the creation of multidisciplinary health homes, allowing GPs and other primary care providers to work in the same location, thereby mitigating the challenges associated with solo practice. By the end of 2023, a total of 2 500 such homes were in operation, with a target of reaching 4 000 by the end of 2027 (Ministère de la Santé et de la Prévention, 2024[4]). However, despite
ractice. By the end of 2023, a total of 2 500 such homes were in operation, with a target of reaching 4 000 by the end of 2027 (Ministère de la Santé et de la Prévention, 2024[4]). However, despite these efforts and the provision of various financial incentives for doctors to set up their practices in underserved areas, the measures do not seem to have been sufficient to resolve the issue (OECD/European Observatory on Health Systems and Policies, 2023[5]). • In Czechia, the Ministry of Health offers special subsidies to GPs to open offices in underserved areas, and health insurers provide higher payments to doctors serving less densely populated regions to attract and retain them in underserved areas (OECD/European Observatory on Health Systems and Policies, 2023[6]). • Spain has also taken steps to address medical deserts by promoting the adoption of digital health solutions, such as telemonitoring programmes, in combination with the introduction of advanced nursing practices without physicians (Dubas-Jakóbczyk et al., 2024[7]). Furthermore, the Spanish Government has launched initiatives to encourage medical staff to work in rural and sparsely populated areas, including investing in health centre infrastructure and deploying training programmes for medical students in rural settings – a practice which has however received some criticisms from Spain’s General Council of Physicians on the grounds that it risks hampering the professional development of young doctors (Consejo General Médicos, 2024[8]). 1.3.7. What do we know about current shortages of health workers in EU countries? Despite the widespread concern about workforce shortages in most EU countries, there is a scarcity of robust data to accurately quantify the shortages of various categories of health workers at both national and subnational levels. This lack of data makes it difficult to determine to what extent these shortages might have worsened over time. Conventional economic theory sugges
lth workers at both national and subnational levels. This lack of data makes it difficult to determine to what extent these shortages might have worsened over time. Conventional economic theory suggests that unfilled or hard-to-fill job vacancies are a key indicator of shortages, but very few countries routinely collect and report data on this indicator.2 Another indicator that could potentially fill this gap is population-reported unmet healthcare needs due to a lack of available health workers or waiting times. However, the questions on unmet healthcare needs in population-based surveys are often limited to a few professional categories only (e.g. doctors and dentists), and do not provide a precise measure of the shortages of these health professionals.
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30 During the COVID-19 pandemic, the OECD collected data from its member countries on the shortage of various categories of health workers as part of a questionnaire to identify the main challenges countries faced in responding to the crisis. A total of [Infographic/Figure content omitted in strict text-only mode.]
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onding to the crisis. A total of [Infographic/Figure content omitted in strict text-only mode.]
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32 The European Commission has supported over the past 10 years a number of projects and Joint Actions on health workforce planning and forecasting to provide opportunities for countries to effectively learn from each other and identify good practices. The current Joint Action HEROES (HEalth woRkfOrce to meet health challEngeS), which started in early 2023 and is expected to end in 2026, involves 21 countries. It has four main objectives: 1) develop databases, data collection, analysis, linkages and sources on health workforce supply and demand; 2) develop forecasting tools and planning methodologies to address health workforce future challenges; 3) develop and enhance skills and capacities for effective management of health workforce planning systems at national and regional levels; and 4) engage stakeholders for successful and sustainable health workforce governance (HEROES Joint Action, 2023[12]). The European Commission (through its Joint Research Centre) will also release in December 2024 a series of projections about the possible future supply and demand for doctors and nurses across all EU countries over the coming decades based on different scenarios (Box 1.4). Box 1.4. The development of a JRC projection model on the supply and demand for health workers at the EU level The Joint Research Centre (JRC) of the European Commission has developed a Supply ANd DEMand model for the healthcare workforce (SANDEM) to project the evolution of the supply and demand for health workers across the 27 EU countries up to 2071, focussing in particular on doctors and nurses. The goal of the SANDEM model is to complement national health workforce planning with a series of “what if” scenarios with a long-term EU perspective, rather than projecting any specific number of do
goal of the SANDEM model is to complement national health workforce planning with a series of “what if” scenarios with a long-term EU perspective, rather than projecting any specific number of doctors and nurses in each country. While reflecting national differences in the structure of the health workforce and general population trends, the model does not aim to provide any “gold standard” in terms of provider-to-population ratio. The model also remains at a relatively high level of aggregation and does not consider regional variations in the supply and demand for doctors and nurses, nor does it include a breakdown by medical specialty. On the supply side, SANDEM uses a standard stock-and-flow model to characterise the medical and nursing workforce in terms of size and age structure. The model assumes that current trends in dropouts, retirements and migration will remain the same in the future, while allowing changes in the number of new graduates to respond to changes in demand. On the demand side, the model includes several scenarios that combine demographic projections with individuals’ healthcare needs. The “population” scenario is based on a provider-to-population ratio that assumes that the only driver of health workforce demand is population size. The “utilisation” scenario goes a step further and estimates changes in demand using data on past trends in healthcare utilisation by age group based on two different epidemiological scenarios. In the “disease burden” scenario, age-specific healthcare needs are assumed to remain the same in the future, while in the “healthy ageing” scenario they are assumed to decrease over time. The model relies mainly on data from Eurostat, WHO and OECD. Data gaps are addressed by using some approximations. The main challenges relate to the lack of data on outflows from the health workforce (e.g. emigration, dropout and effective retirement age). One of the recommendations is to improve the collection of
The main challenges relate to the lack of data on outflows from the health workforce (e.g. emigration, dropout and effective retirement age). One of the recommendations is to improve the collection of data on migration patterns of health professionals by distinguishing more clearly the emigration of health workers who are both foreign born and foreign trained from the internationalisation of medical education, reflecting the fact that a significant number of international students move temporarily to other countries to obtain a first medical degree before returning to their home country to complete their training and work. More basic data issues also relate to the lack of data on the current stock of practising doctors and nurses in some countries, and the inclusion of different categories of nurses at the national level and in international data collections. The results from the SANDEM projection model are expected to be released by the end of 2024. Source: Bernini, A., Icardi, R., Natale, F. and Nédée, A. (2024[13]), Supply and demand model for the healthcare workforce in the EU27 – Data sources and model structure, https://data.europa.eu/doi/10.2760/957386. It is important to bear in mind that health workforce planning is inherently subject to uncertainty, precluding definitive long-term predictions. Health workforce planning models need to be continuously developed and regularly updated to take into account the availability of more recent and better data, changes in demographic and non-demographic factors that may affect the supply and demand for different categories of health workers, and the effects of any new policies that may affect the skill mix in health service [Infographic/Figure content omitted in strict text-only mode.]
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ferent categories of health workers, and the effects of any new policies that may affect the skill mix in health service [Infographic/Figure content omitted in strict text-only mode.]
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33 1.5. Increasing the education and training of new doctors and nurses One of the main policy levers to increase the supply of doctors and nurses is to increase the number of students in medical and nursing education programmes, although there is a time lag of several years between any decisions to increase student intakes and the completion of their studies (about 8-12 years for doctors depending on the specialisation and at least 3 years for “professional” nurses). Determining what may be the “right” number of student intakes and graduates in medicine and nursing is complex and should be guided by robust health workforce planning. 1.5.1. Most EU countries have already recognised the need to train more doctors and nurses Most EU countries had already taken steps to increase the number of students in medical and nursing education programmes before the pandemic as reflected by the growing number of medical and nursing graduates over the decade from 2012 to 2022. This is one of the main reasons why the number of doctors and nurses has increased in most countries during that period. The increase in the number of medical graduates was stronger than in nursing graduates. Across the EU, the number of new medical graduates increased at an average annual rate of over 3.5% between 2012 and 2022, while the number of nursing graduates increased at a more modest rate of about 0.5% per year. Part of the explanation for this slower growth rate is that the dropout rate from nursing education programmes is, in most countries, higher than from medical education programmes. In 2022, there were 15.5 medical graduates and 37.5 nursing graduates per 100 000 population in the EU as a whole, up from 11.1 medical graduates and 36.0 nursing graduates per 100 000 population in 201
2022, there were 15.5 medical graduates and 37.5 nursing graduates per 100 000 population in the EU as a whole, up from 11.1 medical graduates and 36.0 nursing graduates per 100 000 population in 2012. The number of new medical graduates varied significantly across EU countries in 2022, ranging from about 12 per 100 000 population in Slovenia, Estonia and Germany to over 24 per 100 000 population in Ireland, Romania, Latvia, Malta and [Infographic/Figure content omitted in strict text-only mode.]
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38 Box 1.5. Initiatives to tackle skills gaps in the European health sector The COVID-19 pandemic not only highlighted the critical importance of a skilled and resilient health workforce but also accelerated the adoption of digital health solutions and emphasised the need for sustainable, environmentally-friendly practices in the health sector. In response to these challenges, the European Commission launched two key initiatives in recent years. The first initiative, launched in 2021, is the Skills Partnership for the Health Ecosystem (https://pact-for- skills.ec.europa.eu/about/industrial-ecosystems-and-partnerships/health_en). This initiative includes three large-scale partnerships: a skills partnership focused on health workers, a skills partnership in the long-term care sector, and a skills partnership for the health industry. These partnerships aim to foster collaboration among stakeholders to address skills gaps and build a future-ready health workforce. Their objectives encompass mapping current and future skills needs in the health sector, aligning education, training and employer needs at regional
lls gaps and build a future-ready health workforce. Their objectives encompass mapping current and future skills needs in the health sector, aligning education, training and employer needs at regional/EU level, facilitating cross-border mobility and recognition of qualifications, and promoting continuous professional development. The second initiative, the Be Well Blueprint (https://bewell-project.eu/), launched in December 2022, focuses on upskilling and reskilling the European health workforce for the digital and green transition. Key activities include collecting in an easily accessible monitor existing upskilling/reskilling initiatives, developing and piloting comprehensive curricula and training programmes, and developing and launching a skills strategy for health workers focused on digital and green skills. 1.6. Improving job quality to increase retention The return on investment in education and training will be lost if newly-trained doctors, nurses and other health workers don’t end up working in their profession for most of their working lives. Increasing the retention rates of current doctors, nurses and other health workers is key also to avoid a vicious circle whereby more workers leaving the sector would result in growing shortages and increased workloads and pressures on remaining staff, followed by more resignations and even greater shortages. The quality of jobs plays a central role in the decision of people to stay in their current job or to leave. The OECD Job Quality Framework distinguishes three complementary dimensions of what makes a “good job”: 1) earnings (or remunerations) (discussed in Section 1.6.3), 2) labour market/job security, and 3) the quality of the work environment. This latter dimension includes several non-monetary aspects of job quality (OECD, 2024[16]). 1.6.1. The pandemic led to a deterioration of the working conditions for many health workers, but evidence of a “great resignation” is limited The Eurofound’s 2021 E
ob quality (OECD, 2024[16]). 1.6.1. The pandemic led to a deterioration of the working conditions for many health workers, but evidence of a “great resignation” is limited The Eurofound’s 2021 European Working Conditions Telephone Survey (EWCTS) has gathered data on several aspects of the quality of jobs as it relates to the quality of the work environment of workers in all sectors of the economy, including the health and long-term care sector. Using a methodology developed by the OECD, the data from the EWCTS survey can be used to compare job demands or strains (which affect workers negatively) and job resources (which affect workers positively). When workers have more demands/strains than resources, they experience poorer job quality. In 2021, therefore in the context of the pandemic, almost half of workers in the health sector (48%) and long-term care residential sector (47%) reported high levels of job strain on average in EU countries, a much higher proportion than workers across all sectors (30%). Looking at specific occupations, job strain was about two times higher among nurses (61%) and personal carer [Infographic/Figure content omitted in strict text-only mode.]
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40 Box 1.6. The use of interim staff in hospital can be a short-term fix for acute workforce shortages, but can cause long-term issues Like other industries, the health sector uses temporary staff to overcome momentary workforce shortages and to deal with unexpected increases in demand, as seen during the COVID-19 pandemic. However, recent evidence suggests that these working arrangements have become more systematic and that a growing number of health workers actually prefer to be hired by interim agencies that “rent out” health workers to hospitals and other healthcare providers for short time periods. The normalisation of these employment situations has serious consequences from an organisational perspective as well as cost implications. It increases costs for hospitals and other health facilities and can generate tensions in the workplace, as doctors and nurses doing the same jobs are often paid more when employed by an interim agency than being regular hospital staff and may also have more desirable working schedules. In recent years, this trend has caught on in many European countries and beyond. In France, hospitals have increasingly relied on interim doctors and nurses to fill vacant posts in emergency departments and other hospital units over the past few years. Reports suggest that interim doctors can earn 2-3 times more than their counterparts with a regular contract with the hospital, while interim nurses are able to earn about 30% more. Interim staff also have much more flexibility to choose their working hours than regular staff. The government has adopted some regulations regarding the maximum amount that hospitals should pay interim doctors, although doctors are often in a position to negotiate a higher pay. A recent report by the French Auditin
opted some regulations regarding the maximum amount that hospitals should pay interim doctors, although doctors are often in a position to negotiate a higher pay. A recent report by the French Auditing Court pointed out that between 2017 and 2022 the total costs of interim doctors for public hospitals increased by 25% to reach EUR 147.5 million, while the number of interim doctors increased by 23% over the same period. In Germany, the costs associated with interim staff in hospitals (doctors and other health workers) reached nearly EUR 2.9 billion in 2022, double the costs seen in 2015. In 2022, around 33 000 staff working in hospitals had no employment relationship with hospitals, roughly double the number of 2010. Interestingly, this trend is nearly entirely driven by non-doctors. The use of temporary contracts in the health sector in Spain also remains an issue, having increased to nearly 42% of all health workers in 2020 during the peak of the pandemic, up from 28% in 2012. A new regulation adopted in 2022 aims to reduce the use of temporary contracts by restricting their use to specific circumstances, imposing time limits on their duration and promoting the conversion of long-term temporary staff into permanent positions. Sources: France : Cour des Comptes (2024[19]), Observations définitives Intérim médical et permanence des soins dans les hôpitaux publics - exercices 2017- 2022 [Final observations medical interim and permanent care in public hospitals - financial years 2017-2022]; Germany: Statistisches Bundesamt (2024[20]), Hospitals in Germany - Federal Statistical Office, https://www.destatis.de/; Spain: OECD/European Observatory on Health Systems and Policies, (2023[21]), Spain: Country Health Profile 2023, https://www.doi.org/10.1787/71d029b2-en. Results from health staff surveys conducted during the COVID-19 pandemic in some EU countries showed a perceived degradation of working conditions, growing job dissatisfaction and intention to leave jobs. Fo
from health staff surveys conducted during the COVID-19 pandemic in some EU countries showed a perceived degradation of working conditions, growing job dissatisfaction and intention to leave jobs. For example, in Belgium, the proportion of health workers expressing an intention to leave the profession increased markedly in 2021 to reach 28% by September 2021, up from less than 10% before the pandemic (Sciensano, 2021[22]). During the second year of the pandemic in 2021, the term “great resignation” was coined in the United States to refer to the growing number of frontline workers in the health sector as well as in other sectors who were resigning at that time because of job dissatisfaction and possibly reflecting also some changes in people’s work-life balance preferences. It is hard to get reliable data from most EU countries to measure to what extent there might have been any “great resignation” of health workers in the aftermath of the pandemic because most European countries do not have the equivalent of the American Job Openings and Labour Turnover Survey that can be used to measure resignation (quit) rates. Sweden is an exception.4 The available survey data from the United States and Sweden show fairly similar trends in resignation rates from the health and [Infographic/Figure content omitted in strict text-only mode.]
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nation rates from the health and [Infographic/Figure content omitted in strict text-only mode.]
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41 [Infographic/Figure content omitted in strict text-only mode.]
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42 Box 1.7. The METEOR project called for multipronged policy actions to improve the working conditions of health workers and increase retention rates The METEOR (Mental Health: Focus on Retention of Healthcare Workers) project, funded by the EU Health Programme between 2021 and the first quarter of 2024, aimed to assess the mental health of health workers and to improve job retention. The project conducted surveys in hospitals in four EU countries (Belgium, Italy, the Netherlands and Poland) and organised stakeholder workshops to develop policy recommendations to improve the working conditions of hospital workers and retention rates. In 2022, on average across participating countries and hospitals, only 13% of doctors and 16% of nurses were satisfied with their job, while about a quarter of both categories of workers reported emotional exhaustion and depersonalisation. Nonetheless, the intention to leave the profession remained low (9% among doctors and 13% among nurses). One set of recommendations from the project relates to providing greater professional and personal support. This includes fostering interprofessional collaborations, supporting flexible work schedules, facilitating task sharing and the deployment of healthcare assistants to allow nurses to focus on their core patient-related duties, ensuring a stable and supportive environment and establishing psychological support services. Another set of recommendations related to training and coaching, including recommendations such as putting in place onboarding and mentorship programmes, developing leadership programmes, implementing employee evaluations, encouraging peer supervision groups focused on stress and mental health in the workplace, and promoting lifelong learning and digital literacy among staff
rogrammes, implementing employee evaluations, encouraging peer supervision groups focused on stress and mental health in the workplace, and promoting lifelong learning and digital literacy among staff. The third key area of recommendations was about regulation, including promoting adequate staffing levels and manageable workloads that support high-quality care at all times, enhancing job security, minimising bureaucratic burdens, addressing discrimination and bullying, and protecting workers against verbal abuse and aggression. The fourth area focused on investment and providing flexible financial support. Recommendations included investing in new technologies that can help automate or simplify administrative tasks, allowing greater flexibility in funding allocation for hospital managers, and investing in more up-to-date equipment to improve quality of care and workers’ job satisfaction. Source: https://meteorproject.eu/. Post COVID-19 condition – commonly referred to as long COVID – also presents a significant challenge to health workforce capacity. Health workers face elevated risk of developing this debilitating condition due to increased occupational exposure and the sector’s predominantly female workforce, as women appear to be more susceptible to long COVID (Expert Panel on effective ways of investing in health (EXPH), 2022[28]). The UK Office for National Statistics (ONS, 2023[29]) identified health workers as having the second-highest prevalence of long COVID, surpassed only by long-term care workers. Multiple studies have documented how long COVID reduces health workers’ ability to perform their duties (Cruickshank et al., 2024[30]). The European Commission has announced in September 2024 a new contribution agreement with the WHO Regional Office for Europe to support EU Member States in retaining nurses in health systems and making the profession more attractive. The agreement, funded with EUR 1.3 million from the EU4Health programme, will involve
urope to support EU Member States in retaining nurses in health systems and making the profession more attractive. The agreement, funded with EUR 1.3 million from the EU4Health programme, will involve activities across all EU Member States over a three-year period. Particular focus will be given to those countries with significant shortages in health workers, and specifically shortages in nurses. Through co-operation with Member States, nurses’ organisations and social partners, the initiative will be tailored to specific needs at national and sub-national level. The funding will include creating recruitment action plans, mentoring programmes to attract a new generation of nurses, strategies to improve the health and well-being of nurses, and implementing training opportunities and actions to ensure the health workforce can reap benefits of the digital transformation (European Commission, 2024[31]). As part of another project funded by the European Commission, WHO-Europe has launched in October 2024 a survey to assess the mental health and well-being of health professionals across the 27 EU countries, Iceland and Norway. The survey aims to gather data to better understand the challenges doctors and nurses face in their work environments, including questions related to job satisfaction and intention to leave job (WHO-Europe, 2024[32]). 1.6.2. Retaining experienced doctors for longer in the workforce [Infographic/Figure content omitted in strict text-only mode.]
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43 Over the past decade, the decision of many doctors to continue working beyond the standard retirement age has helped to avoid an exacerbation of shortages in many EU countries. This trend is evident in the increasing proportion of doctors aged over 65 between 2012 and 2022, which has been particularly significant in countries such as Italy, the Slovak Republic, Germany, France [Infographic/Figure content omitted in strict text-only mode.]
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2012 and 2022, which has been particularly significant in countries such as Italy, the Slovak Republic, Germany, France [Infographic/Figure content omitted in strict text-only mode.]
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44 1.6.3. Improving the remuneration of some categories of health workers can increase attractiveness and retention An important aspect of job quality relates to earnings, as explicitly recognised under the OECD Job Quality Framework. Based on standard economic theory, wage adjustments should address any imbalance in the supply and demand for different categories of health workers: if there are shortages of some categories of workers, wages should go up to increase supply (either in terms of the number of health workers and/or their working hours) while the demand should decrease, thereby reducing the shortage. However, this supposes that wages are free to adjust to labour market conditions and that the supply of health workers is fairly responsive (or “elastic”) to wage changes. In practice, both of these conditions often do not apply in the health sector.5 The remuneration of health workers varies widely by categories of workers depending on qualification levels, years of experience (seniority), working time (or activity rates) and negotiating power. In general across EU countries, the remuneration of doctors is several times higher than the average wage of workers in all occupations reflecting their higher qualifications and longer working hours. GPs earn two to four times more than the average wage, while specialists earn two to five times more (see indicator on “Remuneration of doctors” in Chapter 7). The remuneration of nurses is substantially lower than that of doctors. On average across EU countries, it is about 20% higher than the average wage of workers in all occupations, although in some countries nurses do not earn more than the average wage (see indicator on “Remuneration of nurses” in Chapter 7). The remuneration of personal care workers
ers in all occupations, although in some countries nurses do not earn more than the average wage (see indicator on “Remuneration of nurses” in Chapter 7). The remuneration of personal care workers is about 30% lower than the economy-wide average wage on average across EU countries (OECD, 2023[36]). Based on data collected through the Eurofound’s EWCTS survey in 2021, over 40% of personal care workers on average across EU countries reported having financial difficulties (almost the same proportion as cleaners and cooks and waiters). Over 20% of nurses also reported having difficulties in making ends meet, slightly lower than the average across all occupations considered to be in shortage, but nonetheless a significant proportion. Only about 5% of doctors reported facing such financial difficulties on [Infographic/Figure content omitted in strict text-only mode.]
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45 Following the pandemic, nurses have obtained substantial pay rises in several EU countries, including Hungary, Poland, Slovenia, Estonia and France. However, the high inflation rates in the years that followed the pandemic eroded the (nominal) wage gains of nurses as well as other categories of workers in the health and other sectors. In several countries, the growth in the remuneration of nurses in real terms (adjusted for inflation) in the years up to 2022 was almost nil or even negative (see indicator on the “Remuneration of nurses” in Chapter 7). 1.6.4. Several countries are recruiting foreign doctors and nurses to respond to domestic needs, but this strategy raises equity and sustainability issues Health workers can leave the health system in a country to seize better job opportunities in other countries. The mobility of several regulated health professions (including doctors and nurses) has been facilitated by the EU Directive on the recognition of professional qualifications. Many OECD countries in Europe and outside Europe are aiming to address current shortages of h
rs and nurses) has been facilitated by the EU Directive on the recognition of professional qualifications. Many OECD countries in Europe and outside Europe are aiming to address current shortages of health workers at least partly by recruiting them from other countries. While this can be a quick solution to address short-term domestic needs, this may only exacerbate shortages of doctors and nurses when they are recruited from countries that have a lower supply and more acute shortages of skilled health workers. The WHO Global Code of Practice on International Recruitment of Health Personnel establishes ethical principles for the international recruitment of health personnel and discourages active recruitment from countries facing critical health workforce shortages (WHO, 2010[37]). The recruitment of foreign doctors and nurses increased greatly in many European countries in 2022 and 2023 following a temporary reduction during the first two years of the pandemic. Based on data available from 27 European countries (excluding some EU countries for which data is not available but including some of the main destination countries such as Switzerland and the United Kingdom), the recruitment of foreign-trained doctors was 17% higher in 2022 than before the pandemic in 2019, rising from about 28 000 in 2019 to 33 000 in 2022 in terms of annual inflow. The annual inflow of foreign-trained doctors continued to increase in 2023 in 11 of the 12 European countries for which data are available (Lithuania being the only exception), with a further increase of 40% compared to 2022 on average. The increase in the recruitment of foreign-trained nurses between 2019 and 2022 was even stronger, averaging about 72% across the 22 European countries for which data are available (which includes the United Kingdom and Switzerland), rising from about 26 000 in 2019 to 45 000 in 2022. In 2023, the overall (cumulative) stock of foreign-trained doctors as a share of all doctors in the main destina
he United Kingdom and Switzerland), rising from about 26 000 in 2019 to 45 000 in 2022. In 2023, the overall (cumulative) stock of foreign-trained doctors as a share of all doctors in the main destination countries in Europe reached over 40% in Norway, Ireland and Switzerland, although in Norway about half of these foreign-trained doctors are Norwegian students who went abroad to get their first medical degree. When it comes to nurses, the share of foreign-trained nurses among all nurses was highest in Ireland, reaching over 50% in 2023, followed by Switzerland and the United Kingdom [Infographic/Figure content omitted in strict text-only mode.]
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46 [Infographic/Figure content omitted in strict text-only mode.]
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47 It is important to bear in mind that the inflows of foreign doctors and nurses in Ireland, the United Kingdom and Germany are partly offset by the migration of a significant number of doctors and nurses trained in these countries to other European and non- European countries. For example, a significant number of doctors from Ireland and the United Kingdom move to other English- speaking countries such as Australia, the United States, Canada and New Zealand. As noted above, a large number of doctors and nurses trained in Germany are moving to work in Switzerland. [Infographic/Figure content omitted in strict text-only mode.]
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48 For example, following its accession to the EU in 2007, a large number of nurses trained in Romania have moved to work in other EU/EEA countries. The movement to Italy was particularly large in 2007 and the following years, but started to decrease around 2012. Looking at trends over the decade from 2012 to 2022, the annual number of nurses trained in Romania moving to work in some of the main destination countries in Europe (Italy, Germany and the United Kingdom) has decreased. There has been a [Infographic/Figure content omitted in strict text-only mode.]
to work in some of the main destination countries in Europe (Italy, Germany and the United Kingdom) has decreased. There has been a [Infographic/Figure content omitted in strict text-only mode.]
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49 Box 1.8 How is “advanced practice nursing” defined? It is not easy to define precisely what is meant by “advanced practice nursing” and who is an “advanced practice nurse” as this term encompasses a large variety of educational requirements, roles, practices, and titles. A recent review by the European Federation of Nurses pointed out that the definition, recognition, regulation, and education of advanced practice nursing vary significantly across Europe (De Raeve et al., 2023[38]). The International Council of Nurses (ICN) has proposed a few years ago the following definition of advanced practice nurses and nurse practitioners: • “An Advanced Practice Nurse (APN) is a generalist or specialised nurse who has acquired, through additional graduate education (minimum of a master’s degree), the expert knowledge base, complex decision-making skills and clinical competencies for Advanced Nursing Practice… The two most commonly identified APN roles are clinical nurse specialists (CNS) and nurse practitioners (NPs). • A Nurse Practitioner (NP) is an Advanced Practice Nurse who integrates clinical skills associated with nursing and medicine in order to assess, diagnose and manage patients in primary healthcare settings and acute care populations as well as ongoing care for populations with chronic illness.” (Schober et al., 2020[39]). Not surprisingly, the number of NPs is highest in those countries that recognised this role earlier. In the United States and Canada, the number of NPs has increased rapidly over the past decade to respond to growing demands for primary care and hospital care in a context of persisting shortages of certain categories of doctors (e.g. GPs). In Europe, the United Kingdom and the Netherlands have the highes
o growing demands for primary care and hospital care in a context of persisting shortages of certain categories of doctors (e.g. GPs). In Europe, the United Kingdom and the Netherlands have the highest number of NPs (who may have a different title such as “advanced nurse practitioner” in the United Kingdom or “nurse specialist” in the Netherlands). In the Netherlands, the number of NPs has increased steadily since 2010, although their role and scope of practice is more limited than in several other countries, with some functions only permitted under the supervision of doctors (Brownwood and Lafortune, 2024[40]). The Netherlands has also increasingly relied on physician assistants to support [Infographic/Figure content omitted in strict text-only mode.]
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50 Estonia also has a long experience of over 15 years with advanced practice nursing in primary care. In 2009, GPs were incentivised to hire a nurse in their practice by the threat of reduced reimbursement for those who did not. In 2013, GPs were further incentivised to employ a second nurse this time through an extra bonus. Nowadays, most GP practices employ at least two family nurses. Practice assistants are also part of primary care teams. Since the introduction of Family Primary Healthcare Centres in 2018, family nurses have become the usual first point of contact for patients. The nurse competences are relatively broad and include health promotion, disease prevention, and chronic disease monitoring, as well as prescriptions, procedures and health check-ups. When the nurse competences are not sufficient to address the health issues of some patients, these patients get an appointment with a GP. The EU-funded project TaSHI (TAsk SHIfting) gathered evidence on the potential benefits of innovative ways in using the skills of different categories of health workers in delivering health services and developed tools to support implementation (Box 1.9). Box 1.9 TaSHI project: Empowering EU po
vative ways in using the skills of different categories of health workers in delivering health services and developed tools to support implementation (Box 1.9). Box 1.9 TaSHI project: Empowering EU policies on Task SHIfting Between April 2021 to March 2024, the EU-funded TaSHI project, co-ordinated by Semmelweis University in Hungary, collected evidence and tools on task shifting practices in the health sector and provided an overview of the potential benefits of task shifting based on concrete experiences in five European countries (Estonia, Italy, Lithuania, the Netherlands and Norway).This three-year project produced tangible outcomes to support the implementation of new task shifting initiatives, including: • A new curriculum to support task shifting in healthcare accompanied by training materials. • A guidebook on task shifting. • A set of recommendations to strengthen the resilience of the health workforce for different stakeholder groups. Source: https://tashiproject.eu/. 1.7.2. Changing roles and opportunities for health workers in the digital and AI era As European health systems grapple with workforce shortages and rising demand for health services, the integration of digital technologies and artificial intelligence (AI) holds promise in supporting health workers in their workflow and enhancing their productivity. Digital health tools are already enhancing health professionals’ clinical practice. A recent umbrella review indicated that novel tools currently being deployed in high-income countries have been found to generally improve healthcare providers’ performance (Borges do Nascimento et al., 2023[42]). Within the next decade, this technological transformation is poised to significantly transform the roles and responsibilities of health workers across Europe. Early signs of this transformation are already visible with novel roles emerging in recent years, such as telehealth co-ordinators and telemedicine physicians who provide remote care enab
ross Europe. Early signs of this transformation are already visible with novel roles emerging in recent years, such as telehealth co-ordinators and telemedicine physicians who provide remote care enabled by the ability to track patients’ conditions at home. Because of the specific nature and mix of tasks involved in providing health services, for most health occupations the implementation of digital technologies and AI presents opportunities for augmentation rather than outright replacement, as few roles are entirely automatable (Moulds and Horton, 2023[43]; OECD (forthcoming)[44]). Their integration is anticipated to have a multifaceted impact across all stages of the patient journey within the health system (Table 1.1). For instance, digital and AI- powered tools can streamline triage and referral management processes, reducing waiting times and improving the appropriateness of referrals (NHS England, 2018[45]). Administrative tasks carried out by clinical staff, particularly repetitive back- office processes, are prime candidates for automation, with recent estimates suggesting that up to 30% could be at least partially automated through digital solutions that can execute these tasks with greater accuracy and speed than humans (EIT Health; McKinsey & Company, 2020[46]). The Netherlands provides a compelling example of how governments have started leveraging this potential to address healthcare challenges. Faced with a projected shortage of nearly 200 000 health and social care workers by 2033, the Dutch Government plans to harness AI in healthcare to reduce doctors’ administrative burden from 40% to just 20% of their working hours. To achieve this, the government will prioritise legislation and regulations to enable generative AI in hospital care and accelerate efforts to improve data availability and exchange in the healthcare and welfare sectors (Government of the Netherlands, 2024[47]). AI-powered tools can also analyse patients’ data in real-time to sup
fforts to improve data availability and exchange in the healthcare and welfare sectors (Government of the Netherlands, 2024[47]). AI-powered tools can also analyse patients’ data in real-time to support clinical decision-making, allowing clinical staff to focus more on patients and improve the quality and efficiency of care delivery. In diagnostic roles like radiology and pathology, AI can assist in analysing medical images and identifying patterns that may be difficult to discern through manual analysis (Barragán- Montero et al., 2021[48]).
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51 Table 1.1. Emerging digital technologies can augment health professionals’ productivity throughout the care continuum Care point Impact on frontline health workforce Triage Healthcare staff gain access to synthesised health-related information enabling them to precisely understand the unique needs of each patient to deliver the ‘right care, at the right time’ (Churruca et al., 2023[49]). Encounter Frontline health providers have timely access to comprehensive patients’ data thanks to the possibility of linking pre-recorded symptoms summary and data stored in electronic health records (EHRs). Health providers’ administrative workload is alleviated through the integration of voice recognition and AI-powered administrative functions such as multilingual clinical notetaking (Li et al., 2021[50]) Testing Testing professionals (laboratory technicians, radiologists, pathologists, bioinformatics testers etc.) interpret tests with greater precision by using AI applications in laboratory testing, image processing and analysis of genomic data for early symptoms detection (Liu et al., 2021[51]). Diagnosis Innovations such as large language models (LLMS) enhance diagnostic accuracy and timeliness by enabling probabilistic diagnoses based on comprehensive patient health data including lifestyle and environmental metrics, thereby minimising the risk of misdiagnosis (Tian et al., 2023[52]). Treatment AI-app
probabilistic diagnoses based on comprehensive patient health data including lifestyle and environmental metrics, thereby minimising the risk of misdiagnosis (Tian et al., 2023[52]). Treatment AI-applications enables patients’ data analysis for personalised treatment plans (Johnson et al., 2021[53]); Mobile apps extend mental health interventions remotely supplementing psychiatrists’ work (Graham et al., 2019[54]). Predictive AI can be leveraged to reduce the frequency of adverse drug events (Syrowatka et al., 2022[55]). The integration of digital technologies and AI in healthcare holds great potential for augmenting staff capabilities and productivity, but also poses challenges While digital technology and AI tools offer significant potential for enhancing health professionals’ capabilities, their integration also presents challenges and risks that require careful management. A primary concern is the risk of sub-optimal implementation, where the deployment of these advanced technologies fails to align with the practical demands and operational difficulties of day- to-day clinical practice – a potential misalignment which can further burden an already stretched clinical workforce. To mitigate these risks, it is crucial to invest in comprehensive reskilling and upskilling programmes enabling health workers to gradually transition into their evolved roles. This may involve training in data analysis and systems management, as well as in soft skills such as communication, as these novel technologies are bound to transform the nature of physician-patient interactions in ways that remain uncertain (Mittelstadt, 2021[56]). In addition to these adaptations, health workers will need to develop a comprehensive set of digital and data literacy skills. Equally crucial is a thorough understanding of data privacy and security practices to ensure the responsible and ethical use of sensitive patient data. These competencies are not just technical requirements but are funda
thorough understanding of data privacy and security practices to ensure the responsible and ethical use of sensitive patient data. These competencies are not just technical requirements but are fundamental to maintaining patient trust and ensuring high-quality care in an increasingly digitised healthcare environment. To address these evolving skill requirements, collaboration between healthcare organisations, universities and industry is essential in developing comprehensive training programmes. Such initiatives might include, among other elements, integrating AI-specific content into medical and nursing curricula; ensuring that new graduates enter the workforce with a solid foundation in digital health technologies and health data management; offering continuing education opportunities for practising professionals to stay up-to-date with rapidly evolving AI applications in healthcare; and creating interdisciplinary career paths at the intersection of healthcare, data science and AI, with a view to nurturing talent capable of driving best practices and ensuring the seamless integration of novel technologies into frontline clinician workflows. Another related challenge is the potential for emerging digital technologies and AI to alter the nature of healthcare work in unexpected ways, potentially leading to reduced job satisfaction. For instance, while automation of routine administrative tasks enables health professionals to maximise time spent on specialised care work, continuous engagement at peak cognitive capacity may paradoxically increase stress levels and burnout risk (Moulds and Horton, 2023[43]). These complex dynamics highlight the need for careful consideration when implementing AI solutions in healthcare settings. To address these concerns, fostering a culture of collaboration between health professionals and technology experts is essential. Crucially, health workers should be involved in the design and implementation of these capacity-augmenting technol
re of collaboration between health professionals and technology experts is essential. Crucially, health workers should be involved in the design and implementation of these capacity-augmenting technological tools to make sure that their insights are leveraged to create efficient solutions that enhance rather than inadvertently undermine their professional roles. Similarly, health informatics experts should be recognised as key contributors, given their expertise in building and maintaining integrated digital health infrastructures, designed to complement and enhance front-line clinician workflows.
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52 Digital health technologies hold promise to enhance patient involvement in their own health management The increasing availability of heath data through digital health tools, such as mobile apps, wearables and patient portals is empowering patients to take a more active role in managing their own health. By providing patients with secure access to their health records and personalised health metrics, these tools effectively activate millions of additional “health workers” able to track routine health conditions with co-ordinated intervention and engage the health system more efficiently. For example, AI-powered chatbots and virtual health coaches can provide patients with 24/7 access to health information, triage symptoms, and guide them to the appropriate level of care (Iqbal, Celi and Li, 2020[57]). Remote monitoring devices can help patients with chronic conditions track their vital signs and symptoms at home, alerting healthcare providers when intervention is needed (Shaik et al., 2023[58]), and digital therapeutics, such as mental health apps, can extend the reach of care beyond traditional clinical settings, supplementing the work of mental health professionals (Graham et al., 2019[54]). The increasing adoption of patient-facing digital health tools has the potential to alleviate some of the burden on the health workforce and mitigate the
ealth professionals (Graham et al., 2019[54]). The increasing adoption of patient-facing digital health tools has the potential to alleviate some of the burden on the health workforce and mitigate the impact of staff shortages. However, realising these benefits will require careful planning, targeted investments in a fully data-enabled health environment, and a focus on ensuring equitable access and digital literacy for all patients. 1.8. Conclusions Despite a steady increase in the number of doctors, nurses and other health workers over the past few decades, the European health workforce is facing a severe crisis with most countries grappling with significant shortages of several categories of health workers due to growing demand for healthcare as well as a reduction in the working hours of some categories of health workers aiming to achieve a better work-life balance. These workforce shortages may be exacerbated in the coming years, driven by the double demographic challenge of an ageing population and an ageing health workforce, posing a serious threat to the sustainability and resilience of European health systems. As the proportion of the population aged 65 and over in the EU is projected to increase from 23% in 2023 to nearly 30% by 2050, the demand for health services is expected to increase as well. However, this rising demand may be contained by individual and policy actions to promote healthy ageing, and health workforce productivity improvements can also mitigate the impact on the demand for health professionals. On the supply side, large numbers of health professionals are approaching retirement age in a significant number of EU countries, requiring a substantial inflow of new health professionals to replace them, as well as more flexible work-to-retirement options to retain those who are able to work longer. This chapter has examined the complex interplay of factors shaping the supply and demand for health workers in the EU. The analysis has revealed wo
options to retain those who are able to work longer. This chapter has examined the complex interplay of factors shaping the supply and demand for health workers in the EU. The analysis has revealed worrying trends, such as high levels of job dissatisfaction and burnout among current health workers, exacerbated by the COVID-19 pandemic, and declining interest in health careers among young people. Addressing health workforce challenges will require a multi-faceted approach, with some policies having impact in the short term, while the impact of other policies may be felt more in the medium to longer term. Increasing the training and education of new doctors and nurses is crucial, and most EU countries have already recognised this need. However, the declining number of applicants to nursing programmes in some countries underscores the urgency of making nursing and other health careers more attractive. Improving the working conditions and remuneration of health workers – in other words improving the quality of work – is an essential first step to boost both attractiveness and retention rates of current workers and prevent a vicious cycle of shortages leading to increased workloads, stress, and further attrition. The chapter has shed light on the growing role of international migration of health workers in Europe as part of the strategies that many countries are using to address health workforce shortages. While the recruitment of foreign-trained health professionals can provide a quick fix to domestic needs, overreliance on this approach is inefficient and will exacerbate shortages in countries of origin while creating vulnerabilities in the health systems of destination countries. As the demand for healthcare continues to grow, it is crucial for EU countries to strike a balance between leveraging the benefits of intra-EU worker mobility and ensuring the sustainability of their domestic health workforces. To achieve this, better data on health worker movement within
a balance between leveraging the benefits of intra-EU worker mobility and ensuring the sustainability of their domestic health workforces. To achieve this, better data on health worker movement within Europe is essential for monitoring cross-border flows and informing the development of co-operative policies. Increasing the training and improving the working conditions of health workers will be key in addressing the growing domestic need and demand for healthcare, but it will come with a significant financial burden. Prior OECD estimates indicate that bolstering the health workforce to make health systems more resilient would require significant additional resources relative to the pre-pandemic level, amounting to an average of 0.6% of GDP across the EU (OECD, 2023[1]). While this cost is undoubtedly substantial, it pales in comparison to the economic and societal repercussions of having fragile health systems that fail to deliver adequate care, as the pandemic has vividly illustrated. Investing in a robust, well-trained, and motivated health workforce is therefore a prudent economic strategy to ensure the long-term sustainability and effectiveness of health systems.
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nvesting in a robust, well-trained, and motivated health workforce is therefore a prudent economic strategy to ensure the long-term sustainability and effectiveness of health systems.
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53 However, relying solely on an indefinite increase in the number of doctors, nurses and other health workers is unlikely to be feasible or sufficient in meeting the future demand for health services, especially in countries that already have some of the highest densities of health professionals. In conjunction with workforce expansion, it is thus essential to explore innovative solutions that can enhance the productivity and efficiency of healthcare delivery. This includes scaling up research and investment in digital health technologies and artificial intelligence that can augment the capacity of health workers and streamline administrative tasks. Experimenting with new models of care provision enabled by digital technology and task sharing can also help alleviate the burden on doctors and nurses and increase productivity while improving access to care. Modernising the curricula of medical and nursing education programmes to incorporate digital literacy and interprofessional collaboration skills is another essential step to prepare the health workforce for the challenges and opportunities of the digital health era. The health workforce challenge in the EU is a complex and pressing issue that requires urgent and comprehensive action. The decisions and investments made now will have far-reaching consequences for the resilience and sustainability of European health systems in the coming decades. Against this background, the EU has a crucial role to play in supporting Member States in their efforts to attract, train, and retain a sufficient number of skilled and motivated health workers. By fostering collaboration and leveraging its funding instruments, the EU can help create a more resilient and equitable European Health Union that ensures timely access to high-qu
ted health workers. By fostering collaboration and leveraging its funding instruments, the EU can help create a more resilient and equitable European Health Union that ensures timely access to high-quality healthcare for all its citizens. The grit and dedication displayed by health workers during the pandemic and beyond must be matched by policies to address the root causes of the workforce shortages and build a health system that can withstand the demographic challenges ahead. References Advisory Committee on Medical Manpower Planning, (ACMMP) (2022), Capaciteitsplan 2024-2027 [Capacity plan 2024-2027], https://capaciteitsorgaan.nl/capaciteitsplan-2024-2027-integraal-overzicht/. [41] Barragán-Montero, A. et al. (2021), “Artificial intelligence and machine learning for medical imaging: A technology review”, Physica Medica, Vol. 83, pp. 242-256, https://doi.org/10.1016/J.EJMP.2021.04.016. [48] Bernini, A. et al. (2024), Supply and demand model for the healthcare workforce in the EU27 – Data sources and model structure, Publications Office of the European Union, https://data.europa.eu/doi/10.2760/957386. [13] Borges do Nascimento, I. et al. (2023), “The global effect of digital health technologies on health workers’ competencies and health workplace: an umbrella review of systematic reviews and lexical-based and sentence-based meta-analysis”, The Lancet Digital Health, Vol. 5/8, pp. e534-e544, https://doi.org/10.1016/s2589-7500(23)00092-4. [42] Brownwood, I. and G. Lafortune (2024), “Advanced practice nursing in primary care in OECD countries: Recent developments and persisting implementation challenges”, OECD Health Working Papers, No. 165, OECD Publishing, Paris, https://doi.org/10.1787/8e10af16-en. [40] Churruca, K. et al. (2023), “The place of digital triage in a complex healthcare system: An interview study with key stakeholders in Australia’s national provider”, Digital Health, Vol. 9, https://doi.org/10.1177/20552076231181201. [49] Consej
al triage in a complex healthcare system: An interview study with key stakeholders in Australia’s national provider”, Digital Health, Vol. 9, https://doi.org/10.1177/20552076231181201. [49] Consejo General Médicos (2024), Los médicos jóvenes alertan del impacto de la desertificación médica para la cohesión territorial y acceso a servicios de salud en España [Young doctors warn of impact of medical desertification on territorial cohesion and access to health services], https://www.cgcom.es/media/4639/download. [8] Consiglio dei ministri (2023), Decreto Legge n. 215/Art 4. Proroga di termini in materia di salute [Decree-Law No. 215/Art 4. Extension of health-related deadlines], Gazzetta, https://www.gazzettaufficiale.it/. [34] Cour des comptes (2024), Observations définitives Intérim médical et permanence des soins dans les hôpitaux publics
- exercices 2017-2022 [Final observations medical interim and permanent care in public hospitals - financial years 2017-2022]. [19] De Raeve, P. et al. (2023), “Advanced practice nursing in Europe-Results from a pan-European survey of 35 countries”, J Adv Nurs, Vol. 00, pp. 1-10, https://doi.org/10.1111/jan.15775. [59] De Raeve, P. et al. (2023), “Advanced practice nursing in Europe—Results from a pan‐European survey of 35 countries”, Journal of Advanced Nursing, Vol. 80/1, pp. 377-386, https://doi.org/10.1111/jan.15775. [38] Dubas-Jakóbczyk, K. et al. (2024), “Medical deserts in Spain—Insights from an international project”, International Journal of Health Planning and Management, Vol. 39/3, pp. 708-721, https://doi.org/10.1002/HPM.3782. [7] EIT Health; McKinsey & Company (2020), Transforming healthcare with AI: The impact on the workforce and organizations, https://eithealth.eu/. [46] Eurofound (2021), Working conditions in the time of COVID-19: Implications for the future, European Working Conditions Telephone Survey 2021 series,, https://doi.org/10.2806/357794. [17]
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ofound (2021), Working conditions in the time of COVID-19: Implications for the future, European Working Conditions Telephone Survey 2021 series,, https://doi.org/10.2806/357794. [17]
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54 European Commission (2024), Commission supports action across Europe to attract and retain nurses, https://health.ec.europa.eu/. [31] European Commission (2023), Employment and social developments in Europe 2023, Directorate-General for Employment, Social Affairs and Inclusion, https://data.europa.eu/doi/10.2767/089698. [18] European Labour Authority (2024), Report on labour shortages and surpluses 2023, Publications Office of the European Union, Belgium. [61] European Labour Authority (2024), Report on labour shortages and surpluses 2023, Publications Office of the European Union, Belgium, https://data.europa.eu/doi/10.2883/973861. [9] Expert Panel on effective ways of investing in health (EXPH) (2022), Facing the impact of post-COVID-19 condition (long COVID) on health systems C, European Commission, Brussels. [28] Government of the Netherlands (2024), Hoofdstuk 6a. Zorg - Afwenden van een onbeheersbaar arbeidsmarkttekort [Chapter 6a. Care: Averting an unmanageable labour market deficit], https://www.rijksoverheid.nl/regering/regeerprogramma/6a-zorg. [47] Graham, S. et al. (2019), “Artificial Intelligence for Mental Health and Mental Illnesses: an Overview”, Current Psychiatry Reports, Vol. 21/11, pp. 1-18, https://doi.org/10.1007/S11920-019-1094-0. [54] Haakenstad, A. et al. (2022), “Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019”, Lancet (London, England), Vol. 399/10341, pp. 2129-2154, https://doi.org/10.1016/S0140- 6736(22)00532-3. [60] Haakenstad, A. et al. (2022), “Measuring the availability of human resources for health and its relationship to universal health covera
129-2154, https://doi.org/10.1016/S0140- 6736(22)00532-3. [60] Haakenstad, A. et al. (2022), “Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019”, The Lancet, Vol. 399/10341, pp. 2129-2154, https://doi.org/10.1016/s0140-6736(22)00532-3. [11] Health Service Executive (2023), Health Sector Workforce Report: 2023 Annual Turnover Rates, https://www.hse.ie/eng/staff/resources/our-workforce/workforce-reporting/. [25] Healthcare Personnel Commmission (2023), Time for action: personnel in a sustainable health and care service, Departementenes sikkerhets-og serviceorganisasjon Oslo, https://www.regjeringen.no/. [3] HEROES Joint Action (2023), HEROES Joint Action (HEalth woRkfOrce to meet health challEngeS), https://healthworkforce.eu/. [12] Iqbal, U., L. Celi and Y. Li (2020), “How Can Artificial Intelligence Make Medicine More Preemptive?”, Journal of medical Internet research, Vol. 22/8, https://doi.org/10.2196/17211. [57] Johnson, K. et al. (2021), “Precision Medicine, AI, and the Future of Personalized Health Care”, Clinical and Translational Science, Vol. 14/1, p. 86, https://doi.org/10.1111/CTS.12884. [53] Li, B. et al. (2021), “Automating clinical documentation with digital scribes: Understanding the impact on physicians”, Conference on Human Factors in Computing Systems - Proceedings, https://doi.org/10.1145/3411764.3445172. [50] Liu, X. et al. (2021), “Advances in Deep Learning-Based Medical Image Analysis”, Health Data Science, Vol. 2021, https://doi.org/10.34133/2021/8786793. [51] Ministère de la Santé et de la Prévention (2024), Les maisons de santé [Health homes], https://sante.gouv.fr/systeme- de-sante. [4] Mittelstadt, B. (2021), The impact of artificial intelligence on the doctor-patient relationship, Council of Europe. [56] Morgan, D. and C. James (2022), “Inve
//sante.gouv.fr/systeme- de-sante. [4] Mittelstadt, B. (2021), The impact of artificial intelligence on the doctor-patient relationship, Council of Europe. [56] Morgan, D. and C. James (2022), “Investing in health systems to protect society and boost the economy: Priority investments and order-of-magnitude cost estimates”, OECD Health Working Papers, No. 144, OECD Publishing, Paris, https://doi.org/10.1787/d0aa9188-en. [10] Moulds, A. and T. Horton (2023), What do technology and AI mean for the future of work in health care?, The Health Foundation, https://www.health.org.uk/. [43] NHS England (2024), NHS workforce statistics, https://digital.nhs.uk/data-and-information/publications/statistical/. [26] NHS England (2018), Using intelligent automation to improve the triage and referral management pathway, https://transform.england.nhs.uk/. [45] OECD (2024), Fewer young people want to become nurses in half of OECD countries, https://www.oecd.org/en/publications/fewer-young-people-want-to-become-nurses-in-half-of-oecd- countries_e6612040-en.html. [15]
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people want to become nurses in half of OECD countries, https://www.oecd.org/en/publications/fewer-young-people-want-to-become-nurses-in-half-of-oecd- countries_e6612040-en.html. [15]
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55 OECD (2024), OECD Employment Outlook 2024: The Net-Zero Transition and the Labour Market, OECD Publishing, Paris, https://doi.org/10.1787/ac8b3538-en. [16] OECD (2023), Beyond Applause? Improving Working Conditions in Long-Term Care, OECD Publishing, Paris, https://doi.org/10.1787/27d33ab3-en. [36] OECD (2023), Pensions at a Glance 2023: OECD and G20 Indicators, OECD Publishing, Paris, https://doi.org/10.1787/678055dd-en. [35] OECD (2023), Ready for the Next Crisis? Investing in Health System Resilience, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/1e53cf80-en. [1] OECD (2019), Recent Trends in International Migration of Doctors, Nurses and Medical Students, OECD Publishing, Paris, https://doi.org/10.1787/5571ef48-en. [14] OECD (2016), Health Workforce Policies in OECD Countries: Right Jobs, Right Skills, Right Places, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/9789264239517-en. [2] OECD (forthcoming) (n.d.), Digital, AI and Soft Skills in major health occupations: What do we know about new demand?. [44] OECD/European Observatory on Health Systems and Policies (2023), Czechia: Country Health Profile 2023, State of Health in the EU, OECD Publishing, Paris, https://doi.org/10.1787/24a9401e-en. [6] OECD/European Observatory on Health Systems and Policies (2023), France: Country Health Profile 2023, State of Health in the EU, OECD Publishing, Paris, https://doi.org/10.1787/07c48f9f-en. [5] OECD/European Observatory on Health Systems and Policies (2023), Spain: Country Health Profile 2023, State of Health in the EU, OECD Publishing, Paris, https://doi.org/10.1787/71d029b2-en. [21] ONS (2023), Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK, Office for National Statist
n the EU, OECD Publishing, Paris, https://doi.org/10.1787/71d029b2-en. [21] ONS (2023), Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK, Office for National Statistics, https://www.ons.gov.uk/. [29] Ordre National des Infirmiers (2022), L’Ordre National des Infirmiers alerte de nouveau sur la situation de la profession [The Ordre National des Infirmiers is once again alerting the public to the state of the nursing profession], https://www.ordre-infirmiers.fr/. [27] Schober, M. et al. (2020), Guidelines on Advanced Practice Nursing 2020, ICN - International Council of Nurses. [39] Sciensano (2021), Power to care - L’enquête sur le bien-être des personnes et professionnels d’aide et de soin [Power to care - The survey on the well-being of care and support workers and professionals], Epidémiologie et santé publique, Bruxelles, https://www.sciensano.be/. [22] Shaik, T. et al. (2023), “Remote patient monitoring using artificial intelligence: Current state, applications, and challenges”, Wiley Interdisciplinary Reviews: Data Mining and Knowledge Discovery, Vol. 13/2, p. e1485, https://doi.org/10.1002/WIDM.1485. [58] Statistikmyndigheten (2024), Kortperiodisk sysselsättningsstatistik [Short-term employment statistics], SCB, https://www.scb.se/. [24] Statistisches Bundesamt (2024), Hospitals in Germany - Federal Statistical Office, https://www.destatis.de/. [20] Sumai-ASSOPROF (2023), Medici 2023 - 2030 - quale futuro: pubblico o privato? I numeri [Doctors 2023-2030 - what future: public or private? The numbers], Sindacato Unico Medicina Ambulatoriale Italiana, https://www.sumaiassoprof.org/. [33] Syrowatka, A. et al. (2022), “Key use cases for artificial intelligence to reduce the frequency of adverse drug events: a scoping review”, The Lancet Digital Health, Vol. 4/2, pp. e137-e148, https://doi.org/10.1016/s2589-7500(21)00229-6. [55] Tian, S. et al. (2023), “Opportunities and Challenges for ChatGPT and Large Languag
review”, The Lancet Digital Health, Vol. 4/2, pp. e137-e148, https://doi.org/10.1016/s2589-7500(21)00229-6. [55] Tian, S. et al. (2023), “Opportunities and Challenges for ChatGPT and Large Language Models in Biomedicine and Health”, https://arxiv.org/pdf/2306.10070. [52] U.S. Bureau of Labor Statistics (2024), Job Openings and Labor Turnover Survey, https://www.bls.gov/jlt/. [23] Ubom, A. (ed.) (2024), “What is the impact of long-term COVID-19 on workers in healthcare settings? A rapid systematic review of current evidence”, PLOS ONE, Vol. 19/3, https://doi.org/10.1371/journal.pone.0299743. [30] WHO (2010), WHO Global Code of Practice on the International Recruitment of Health Personnel, World Health Organization (WHO), https://www.who.int/publications/i/item/wha68.32. [37] WHO-Europe (2024), WHO Europe launches first-of-its-kind survey on mental health of health-care professionals. [32]
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56 1 The trend analysis for nurses is limited to the last decade only because there are breaks in the time series for several countries in the preceding years. 2 It is important to bear in mind that data on all job vacancies do not provide a precise indicator of shortages. Instead, they serve as an indicator of employers’ interest in recruiting new staff, but not whether they encounter difficulties in doing so. 3 The internationalisation of medical education also complicates the analysis of the “brain drain” in those countries that are attracting a significant number of international students, when the “brain drain” is measured based on the place where doctors have obtained their initial medical degree. 4 Data from professional registrations might be used as an alternative to measure the number of health professionals who decide to leave the profession, but an important limitation is that these professionals will often wish to keep their professional registrations as long as possible in case they might want to rejoin the workforce or because
fession, but an important limitation is that these professionals will often wish to keep their professional registrations as long as possible in case they might want to rejoin the workforce or because they perceive some other potential benefits in keeping their registration. 5 A key characteristic of health labour markets in many countries is the “monopsony” power exercised by the dominant public purchaser on the wages/fees paid to doctors, nurses and other health workers. In NHS systems, governments often play a central role in wage setting as the pre-eminent funder of jobs in the health sector, and pay rates are often based on nationally agreed pay structures (or sub-nationally in federal countries and other countries where responsibility for healthcare delivery rests with sub- national governments/authorities). The wages/fees may be fairly rigid and not responsive to local labour market conditions. In addition, the supply of doctors, nurses and other health workers may not be very elastic to changes in wages for at least two reasons. First, it takes several years to train new doctors, nurses and other skilled health workers, so in the short-term any change in supply can only come either from inactive workers (e.g. nurses) deciding to return to work, current workers choosing to work more hours (in return for higher hourly wages/fees) or increased recruitment of foreign-trained workers (attracted by higher pay). Second, the impact of pay increases on the supply of labour among current health workers is not clear and may not be linear: it is possible that a “substitution” effect (i.e. a preference for more leisure over work) might reduce the elasticity of supply above a certain wage/income threshold. 6 The number of doctors and nurses moving to the United Kingdom from other EU countries fell in the mid-2010s, coinciding with both the Brexit vote and the introduction of language tests by UK professional regulators.
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moving to the United Kingdom from other EU countries fell in the mid-2010s, coinciding with both the Brexit vote and the introduction of language tests by UK professional regulators.
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57 Promoting good physical and mental health across the life course is key to allow people to live active and fulfilling lives for as long as possible and to reduce the demand on health and long-term care systems in the context of population ageing. The available evidence past 20 years in the EU have been years lived in good health, while the other one-third have been years lived with some health issues and disabilities. Despite these gains in healthy life expected to be lived free of disability. The proportion of life lived without disability is significantly lower among women, as they live longer but with more health issues than men. There are also large inequalities in health status according to socio-economic status, highlighting the need to step up health promotion and disease prevention policies to promote healthy longevity for all. One of the main priorities to support further gains in life expectancy in good health is to prevent the main burden of diseases and disabilities among older people in the EU, including dementia, falls, diabetes, arthritis, mental health issues and cardiovascular diseases. Not all diseases and injuries can be prevented, and health systems also need to be prepared to provide more people-centred and integrated care for the growing number of older people who will require chronic care. 2 Living longer, living healthier? Promoting healthy longevity in Europe
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more people-centred and integrated care for the growing number of older people who will require chronic care. 2 Living longer, living healthier? Promoting healthy longevity in Europe
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58 2.1. Introduction Healthy longevity can be defined as living a long life in good physical and mental health and social well-being. It allows people to live active and fulfilling lives across the life course, remaining engaged in work, leisure and social activities well beyond traditional retirement age. The benefits of healthy longevity are clear. If people live longer and healthier lives, this may enable them to work longer and to reduce the demands on health and long-term care systems. Conversely, if people live longer but spend a greater part of their lives with health issues and disabilities, this will reduce their ability to remain active on the labour market and will put additional pressures on health and long-term care systems and the related demand for health and long-term care workers. in particular on the growing number of people aged over 65. It uses data from Eurostat and WHO to assess to what extent people monitor gains in health status, as they combine both the quantity and the health-related quality of life. However, as noted in this (e.g. physical, mental, functioning) that can be measured in many different ways. The available data used to measure trends over breaks in the time series in the Eurostat’s indicator of healthy life years, which hamper robust analysis of trends over time, and Bearing these limitations in mind, one of the main findings of this chapter is that the data available from both Eurostat and WHO suggest that about two-thirds of the additional years of life at age 60 or 65 gained over the past 20 years in the EU are lived in good health, while the other one-third is lived with some health issues and disabilities. Looking at more specific indicators of morbidity, data from the EU statistics on income and living conditions (EU
d health, while the other one-third is lived with some health issues and disabilities. Looking at more specific indicators of morbidity, data from the EU statistics on income and living conditions (EU-SILC) show that in most EU countries, fewer people aged over 65 reported to be in poor health in 2023 than in 2010, while the proportion reporting some chronic diseases and activity the EU can be expected to be lived free of disability, calling for further health promotion and disease prevention efforts. This chapter also reviews the overall burden of diseases and injuries among older people in the EU to assess the relative importance of some of the main health issues in old age and help identify priorities for action. The most recent results from the 2021 Global Burden of Disease (GBD) study show that chronic diseases such as Alzheimer’s disease and other dementias, arthritis, diabetes, cardiovascular diseases, as well as mental health issues such as depression and anxiety, represent the bulk of the burden of diseases in old age in the EU. Falls and fall-related injuries also account for a large burden of health issues and disabilities in old age. Policies to promote healthy longevity must address important risk factors to ill-health among people at all ages, including physical inactivity, malnutrition, overweight and obesity, preventing falls and other injuries among older people, and social isolation. However, not all health issues can be prevented, and health systems must also be prepared to meet the healthcare needs of a growing number of older people. While this chapter reviews mainly a range of prevention policies to support healthy longevity, it also identifies some of the main challenges and emerging best practices in the management of chronic conditions through more integrated and people-centred care. 2.2. People are living longer in the EU 2.2.1. The share of people aged over 65 in the EU is expected to reach 29% by 2050, driven by gains in fertility rates
more integrated and people-centred care. 2.2. People are living longer in the EU 2.2.1. The share of people aged over 65 in the EU is expected to reach 29% by 2050, driven by gains in fertility rates.1 The post-World War II baby boom observed in many European countries has also contributed to an increasing proportion of people over age 65 during the past decade and will continue to increase the proportion in the coming years as this cohort reaches that age group. The proportion of people aged over 65 in the EU has risen from 16% in 2000 to 21% in 2023 and [Infographic/Figure content omitted in strict text-only mode.]
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59 By 2050, the share of people aged over 65 is expected to be the highest in Italy and Portugal but also in Greece and Spain with at least one-third of the population in that age group. It is expected to be the lowest in Luxembourg, Malta and Sweden, but nonetheless rising to reach at least 23% by 2050 in these three countries. [Infographic/Figure content omitted in strict text-only mode.]
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62 arguably among the most important indicators to monitor population health. However, it is challenging to get reliable and comparable data because of the complexity in measuring health (or ill-health). The measurement of health often relies on population-based surveys that may not be harmonised across countries and are based on self-reported information that may be affected by cultural biases and different expectations. to questions from the EU-SILC survey for each indicator. The first and main indicator is referred to as “healthy life years” (HLY) and relies on the two-question item on activity limitations due to health problems. The recommended survey questions are as follows: “Are you limited because of a health problem in activities people usually do?” with response categories including “severely limited”, “limited but not severely” or “not limited at all”; and “Have you been limited for at least the past six months? with “yes” and “no” answer categories. People who report having been limited for at least six months are considered to be based on the question on self-reported health in EU-SILC, with the recommended formulation being: “How is your health in general?” with response categories including “very good, good, fair, bad, very bad”. People responding to be in very good, good or fair health are considered to be healthy, while those responding to be in bad or very bad health are considered unhealthy. The main advantages of the approach used by Eurostat are its simplicity and the availability of annual data from EU-SILC to update these two indicators annually. However, the main downside is that these indicators depend entirely on the reliability of responses to a few questions from EU-SILC and the comparability of the
o update these two indicators annually. However, the main downside is that these indicators depend entirely on the reliability of responses to a few questions from EU-SILC and the comparability of the survey instrument used across countries. Another downside is that these indicators are based on a simple binary valuation of the reported health status. For the main indicator of HLY, a value of zero is assigned to people reporting severe or at least some limitations, or one if they report no activity limitation (for the secondary indicator, a value of zero is assigned for people reporting to be in bad or very bad health and one for those reporting to be in fair, good or very good health). Any changes in the formulation and translation of the survey item in EU-SILC can result in large variations in the reported number of HLY. For example, when Germany revised the EU-SILC question on activity limitations in 2015, it included a first “screening” question that forced people with some but not severe limitations to choose between “Yes” or “No”. This resulted in an immediate increase of 10 healthy life years because of the large reduction in the percentage of people reporting some activity limitations. In 2022, Germany revised again this EU-SILC question and dropped this first “screening” question. This resulted in a loss of 4.5 healthy life years due to the large increase in the percentage of people reporting some or severe activity limitations. is based on a much more complex approach that requires a large volume of data to describe the health status of the population, taking into account the overall burden of diseases and injuries, as well as some valuation (weighting) of the severity of disability related to all these diseases and injuries. The indicator draws on morbidity data, namely years lived with disability (YLD), based on statistical modelling from the Global Burden of Disease (GBD) study, given that the wide range of required data are not readily
s on morbidity data, namely years lived with disability (YLD), based on statistical modelling from the Global Burden of Disease (GBD) study, given that the wide range of required data are not readily available across countries. These estimates may not be consistent with national data. different data sources and methodologies explain why the two indicators of HLY and HALE vary widely in terms of national [Infographic/Figure content omitted in strict text-only mode.]
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66 Eurostat data, in 2022 there was almost no gender gap in the number of healthy life years at age 65 (9.2 years of healthy life years for women compared to 8.9 years for men). Women not only spend more time with diseases and disabilities in old age, but they are also less likely to have the financial resources to meet their health and long-term care needs (Box 2.3). Box 2.3. Older women are more likely to have health issues and less resources to meet their health and long-term care needs Older women can expect to live many more years than men, yet they report more chronic diseases and disabilities than men, thereby reducing the gender gap in the number of healthy life years. Older women are more likely than men to have chronic conditions such as arthritis, osteoporosis, depression and dementia, and they are also more likely to have multiple health problems. One of the consequences of these health issues is that older women are also more likely to have difficulties carrying out activities of daily living such as dressing, walking or bathing according to data from the Survey of Health, Ageing and Retirement in Europe (SHARE) survey, which may require long-term care support. At the same time, older women have fewer financial
ng or bathing according to data from the Survey of Health, Ageing and Retirement in Europe (SHARE) survey, which may require long-term care support. At the same time, older women have fewer financial resources to pay for health or long-term care. In the EU, women received on average 26% less in retirement benefits than men in 2022, reflecting persistent disparities in employment rate and unequal pay during their working years (European Commission, 2024[4]). Over one in five women over age 75 in the EU was living below the poverty line in 2023, according to EU-SILC data. The combination of higher health and long-term care needs with lower incomes impacts the ability of older women to afford health and long-term care services. According to the EU-SILC survey, unmet medical care needs were higher among women aged over 65 than men in 2023 (4.1% compared to 3.0% in the EU), and it was particularly high among older women in the lowest income group (6.0% among women in the lowest income quintile compared to 1.9% among women in the highest income group), mainly because the care was unaffordable. Going without such medical care may aggravate the health problems of older women. 2.3.2. Since 2010, fewer older people report being in bad health, while chronic conditions and activity limitations have remained stable on average in the EU [Infographic/Figure content omitted in strict text-only mode.]
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68 The share of people aged over 65 reporting some or severe activity limitations due to health problems has decreased slightly in the EU from 55% in 2010 to 52% in 2023, although breaks in time series in most countries during that period limit the interpretation [Infographic/Figure content omitted in strict text-only mode.]
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71 Box 2.4. Multimorbidity affects over 40% of people aged over 65 in the EU As people age, they are also more likely to have multiple chronic conditions (multimorbidity), often requiring careful management and care co-ordination because of possible interactions between different treatments and prescriptions. Based on the Survey of Health, Ageing and Retirement (SHARE), 44% of people aged 65 and over reported having at least two chronic diseases on average across EU countries in 2021-22. Older women reported having multiple chronic diseases more often than men (46% versus 40% on average), partly because they live longer. This gender gap is more pronounced in many Central and Eastern European countries such as Romania, the Slovak Republic, Latvia and Croatia. [Infographic/Figure content omitted in strict text-only mode.]
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74 2.4.4. Socio-economic inequalities in health status are large among older people Large inequalities in health status exist among older people not only by gender, but also by socio-economic status, be it measured by education level, income or occupational group. These inequalities stem from many different factors, including greater exposure to various risk factors during the whole life course, more difficult living and working conditions during the working life, and lesser access to and use of health services. 30-year-old men with less than secondary education was about 7 years less than those with a tertiary education (a university degree or the equivalent) on average across 15 EU countries. The education gap in longevity among women was smaller, about 3 years (OECD/European Union, 2020[11]). Previous OECD analysis has shown that the significant gap in mortality rates by education level among both older men and women is driven mainly by higher death rates from the two leading causes of death, circulatory diseases and cancer (Murtin et al., 2017[12]). of education (less than secondary education) compared to the most educated (with a tertiary education). The gap among the least educated and most educated women was slightly narrower at about 8 years. The risk factor contributing most to these educational smoking (Valverde et al., 2021[13]). All indicators of health status show that older people with a lower level of education are on average in poorer health compared to those with the highest level of education (Table 2.1). Table 2.1. Health inequalities among older people by education level are large in the EU Low education All people over age 65 High education Indicators from EU-SILC (2023) Self-reported health (% in poor health) Long-standing illness or health p
ople by education level are large in the EU Low education All people over age 65 High education Indicators from EU-SILC (2023) Self-reported health (% in poor health) Long-standing illness or health problem Activity limitations due to health problem Indicators from SHARE (2021-22) Depression symptoms People with at least two chronic diseases People bothered by falls (aged 75+) Note: Low education is defined as people who have not completed secondary education, while high education refers to people who have completed tertiary education (a university degree or the equivalent). Source: Eurostat based on EU-SILC (hlth_silc_02, hlth_silc_05, hlth_silc_07) and SHARE wave 9 (2021-22 data, weighted observations). 2.5. Risk factors to health among older people in the EU 2.5.1. Some behavioural and environmental risk factors are more important among older people A wide range of behavioural and environmental risk factors can increase the likelihood of illness or injury amongst people in old age. Some behavioural risk factors increase with age, while others decrease. Physical inactivity is a particularly important issue among older adults. Over three-quarters (78%) of people aged over 65 in the EU do not meet the WHO recommendation regarding the minimum level of physical activity per week, compared to 65% among younger adults. Obesity rates are also higher among people aged over 65 (18%) than among younger adults (15% among people aged 25-64). On the other hand, nutritional habits, as measured by the consumption of fruit and vegetables, are generally better among older people. While other risk factors such as tobacco smoking and heavy alcohol consumption also tend to be less frequent among older people than younger adults, this is mostly due to both behavioural changes and a selection effect. As people age, they are more likely to stop smoking and reduce alcohol consumption, especially if they have chronic diseases that require healthier lifestyles. However, the lower smoking a
ion effect. As people age, they are more likely to stop smoking and reduce alcohol consumption, especially if they have chronic diseases that require healthier lifestyles. However, the lower smoking and drinking rates among older people is also partially due to survivorship. Adults who smoke more and consume more alcohol at younger ages are more likely to be ill and die before reaching age 65. When it comes to environmental factors, exposure to air pollution and extreme temperatures have a more pronounced impact on older people than younger adults (Table 2.2).
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75 Table 2.2. Overview of behavioural and environmental risk factors among older people compared to younger people People aged 18-64 People aged 65 or over Behavioural risk factors Physical inactivity (% reporting to spend less than 150 minutes per week) Physical inactivity (% reporting to do physical activity less than once a week) Obesity rate Nutrition (% not eating any vegetable or fruit a day) Smoking rate (% smoking daily) Alcohol consumption (% reporting heavy drinking at least once a month) Environmental risk factors (mortality) Air pollution (% of deaths attributable to air pollution) 3% (people aged < 70) 4% (people aged 70+) Extreme temperature (% deaths attributable to heat or cold wave) 2% (people aged < 70) 4% (people aged 70+) Note: Data refer to 2019 for physical activity (duration), nutrition, smoking, alcohol consumption; 2021 for air pollution and extreme temperature;2022 for obesity and physical inactivity (frequency). Source: Eurostat (hlth_ehis_pe2e, ilc_hch07b, ilc_hch10, hlth_ehis_al3e, hlth_ehis_sk3e, hlth_ehis_fv3e) and IHME GBD for environmental risks. 2.5.2. Physical activity decreases sharply with age, despite being crucial for mitigating the negative effects of ageing Physical activity is one of the most important activities that people can do to avoid or slowdown the negative consequences of ageing. It reduces the risks of many chronic conditions and falls,
geing Physical activity is one of the most important activities that people can do to avoid or slowdown the negative consequences of ageing. It reduces the risks of many chronic conditions and falls, promotes mental health, and reduces cognitive functioning decline. WHO released in 2020 new guidelines on physical activity and sedentary behaviour for different age groups, including people aged over 65. These guidelines recommend at least 150-300 minutes of moderate intensity physical activity or 75-150 minutes of vigorous intensity physical activity per week for older adults. As part of their weekly physical activity, it is also recommended that older adults do varied physical activity that emphasises functional balance at least three days per week. Older adults should also limit the amount of time spent being sedentary (WHO, 2020[14]). [Infographic/Figure content omitted in strict text-only mode.]
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76 Physical activity decreases with age equally among both men and women, and less women report physical activity than men in all age groups. About 27% of men aged over 65 reported doing physical activity that met the WHO guidelines in 2019 compared to 19% of women only. Not only does the time spent doing physical activity reduce with age, but its frequency also decreases. Based on the EU-SILC survey, over half (52%) of people aged over 65 reported doing physical activity less often than once a week or never in 2022. This proportion was highest in Central and Eastern European countries, and lowest in Nordic countries and the Netherlands. [Infographic/Figure content omitted in strict text-only mode.]
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78 About 165 000 deaths of people aged over 65 in the EU in 2021 could be attributed to extreme temperature (too cold or too hot), according also to GBD estimates. The percentage of deaths due to extreme temperature rises from 2% among those aged 65-69 to 4% among those aged over 80. A combination of physiological and behavioural factors makes older adults particularly vulnerable to hypothermia and heat. Certain chronic illnesses affecting physiological responses, such as diabetes, and the use of various medications can impair heat regulation. Older people are also more vulnerable to heat because they don’t sweat or cool down as efficiently as younger people, making them more susceptible to heat stress, which can worsen underlying conditions like heart, lung and kidney diseases. Poor air quality can also make it harder for older people to breathe, especially among those with existing respiratory issues. [Infographic/Figure content omitted in strict text-only mode.]
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ir quality can also make it harder for older people to breathe, especially among those with existing respiratory issues. [Infographic/Figure content omitted in strict text-only mode.]
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79 Achieving healthy longevity requires fostering environments and promoting lifestyles that help people to avoid becoming ill in the first place, and that provide access to people-centred and integrated care to people when they do get sick to restore their health and reduce the risk of complications. Another important element of healthy longevity strategies is to mitigate the inequalities that develop and often widen over the life course by addressing the social determinants of health and ensuring universal access to care when people get sick. This section identifies a range of policy actions and good practices in health promotion and disease prevention, as well as in providing more integrated care for people with chronic conditions with a particular focus on older people, drawing on recent OECD evaluations of best practices (OECD, 2022[20]; 2023[21]). 2.6.1. Preventing diseases and injuries as people age A significant proportion of health issues in old age can be prevented or delayed by supporting healthier lifestyles and health- promoting environments to reduce exposure to risk factors to various diseases and injuries. Making physical activity a daily habit Being physically active is one of the most important activities people at all ages can do to maintain and improve their physical and mental health. Physical activity helps prevent a range of non-communicable diseases, such as cardiovascular diseases and [Infographic/Figure content omitted in strict text-only mode.]
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80 Reducing falls through prevention campaigns [Infographic/Figure content omitted in strict text-only mode.]
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81 Policy efforts are underway across EU countries to tackle dementia more effectively. For instance, the EU4Health programme includes a Joint Action with funding of EUR 4.5 million to support collaborative work between EU countries to address challenges related to neurological disorders and dementia. This Joint Action is expected to focus on early detection and improved access to care and management, and on awareness raising and fighting stigma. Protecting older people against infectious diseases While it is crucial to step up efforts to prevent chronic diseases among older people, it is also important to protect them against infectious diseases, notably by boosting vaccination rates. Vaccination is a cornerstone of public health and disease prevention programmes. It is particularly critical for older adults who are more vulnerable to severe complications from infections. Ensuring high vaccination coverage among older populations can minimise illness and death rates, as well as alleviate pressure on healthcare systems. The COVID-19 pandemic served as a stark demonstration of the life-saving efficacy of vaccines, with countries that achieved higher vaccination rates experiencing markedly lower excess mortality (OECD, 2023[25]). COVID-19 vaccination was especially crucial for people aged over 60 who accounted for 93% of all COVID-19 deaths in the EU in 2020 and 2021. By the end of 2021, nearly 90% of people aged over 60 in the EU had completed their primary vaccination course, with all countries except three reaching at least 75% coverage (see indicator “Public health measures: Vaccination to protect older people” in Chapter 8). Similar to COVID-19, all EU countries have national recommendations to promote influenza vaccination among older people. Before the pa
h measures: Vaccination to protect older people” in Chapter 8). Similar to COVID-19, all EU countries have national recommendations to promote influenza vaccination among older people. Before the pandemic, 44% of people aged over 65 on average across EU countries received the flu vaccine during the 2019/20 influenza season. The start of the pandemic prompted efforts to prevent a simultaneous outbreak of influenza and COVID-19, which led to a marked increase in flu vaccination rates in the EU to 51% during the 2020/21 season. In 2021/22, average vaccination uptake decreased to 48% despite the fact that influenza virus activity resumed following the relaxation of measures to reduce COVID-19 transmission. The vaccine take-up nevertheless remained 4 percentage points above the pre-pandemic level [Infographic/Figure content omitted in strict text-only mode.]
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82 2.6.2. Promoting more people-centred and integrated care for older people with chronic conditions Even with enhanced prevention efforts, not all health issues in old age can be prevented, and it is essential to ensure that all older people receive the necessary care when they are ill. As the first point of contact, general practitioners (GPs) and other primary care providers are key to boost prevention, early diagnosis and to provide treatments for older people with multiple diseases. During the pandemic, only about 2% of people aged over 65 reported having had to forgo some GP visits due to cost or accessibility issues, according to the SHARE survey in 2021/22 [Infographic/Figure content omitted in strict text-only mode.]
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eported having had to forgo some GP visits due to cost or accessibility issues, according to the SHARE survey in 2021/22 [Infographic/Figure content omitted in strict text-only mode.]
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83 Box 2.7. What works in providing more integrated care to older people with multimorbidity? The Basque model focussing on patient-centred care and a robust health information system In 2010, the Spanish Basque country started to implement an integrated care model for patients with multiple chronic conditions to improve chronic care for this population group. This model incorporates several key components to enhance care quality for these patients: • A comprehensive baseline assessment conducted by a multidisciplinary care team. • An individualised therapeutic plan tailored to each patient’s needs. • The support from multidisciplinary care teams, including a general practitioner, specialists, social workers, a care manager (usually a primary care nurse), and a hospital liaison nurse. • Co-ordinated hospital discharge, with a collaboration between the hospital liaison nurse and the primary care nurse to ensure smooth transitions from hospital to home, with follow-up calls to detect any early signs of deterioration. • Patient empowerment programmes to provide education sessions to help patients understand and manage their conditions. The Basque Country model also leverages technology to enhance patient accessibility and ensure continuous care. The health information system provides unified electronic health records, ePrescriptions and a Personal Health Folder. A Health Service Centre offers a 24x7 eHealth Call Centre, patient tele-monitoring, online consultations, and a mobile app. This integrated care model increases patient contacts with primary care providers and reduces hospitalisations. The evaluation of the model showed that the average healthcare costs were 5% lower for patients who received the integrated care model compared to the control group
iders and reduces hospitalisations. The evaluation of the model showed that the average healthcare costs were 5% lower for patients who received the integrated care model compared to the control group. Source: OECD (2023[21]), Integrating Care to Prevent and Manage Chronic Diseases: Best Practices in Public Health, https://doi.org/10.1787/9acc1b1d-en. 2.6.3. Supporting older people in the management of chronic conditions While health professionals will remain important actors in regularly monitoring older people with chronic conditions and providing required care, much of the day-to-day management of chronic conditions can be undertaken by people themselves. Successful self-management hinges on a range of factors, including people’s health status, the complexity of their healthcare needs, their personal capabilities, and the effectiveness of the information and support that they receive from healthcare providers. As people get older, their level of health literacy (defined as the ability to obtain, understand, and use health information) generally diminishes while their healthcare needs often become more complex. Across EU countries, the shares of people needing help to read medical instructions are larger for older age groups. At age 65-74, 16% of people need help to read medical instructions and this share nearly doubles to 29% among people aged over 75. The share of women needing help to read medical instructions is [Infographic/Figure content omitted in strict text-only mode.]
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85 Alongside tackling risk factors for mental health issues, older adults should also have access to effective mental health care services when they need it. Despite having a higher prevalence of common mental health issues such as depression, older people tend to access mental health services less often than younger adults. Out of five EU countries, only in Slovenia did people aged over 65 have as many mental health consultations with specialists as younger adults aged 18 to 64, although the number of [Infographic/Figure content omitted in strict text-only mode.]
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86 data. While women continue to live many years longer than men in all EU countries, they also tend to spend a greater proportion of their lives with some health issues and disabilities, so the gender gap in healthy life years is almost nil. As people age, the prevalence of various chronic diseases and disabilities tends to increase, although a substantial share of these chronic diseases can be prevented or delayed through effective health promotion and disease prevention. Over 60% of people aged over 65 in the EU reported having at least one chronic disease in 2023, and this share has remained stable since 2010. Data from the SHARE survey show that over 40% of people aged over 65 had at least two chronic conditions (multimorbidity) in 2021/22, often requiring strong care co-ordination from multiple providers. Dementia (including Alzheimer’s disease) is the most important cause of healthy life years lost due to disability among older people in the EU, but other chronic diseases such as diabetes, arthritis, depression and cardiovascular diseases, are also important causes of ill-health and disabilities. In addition, accidental falls account for a large number of years of life lost
as diabetes, arthritis, depression and cardiovascular diseases, are also important causes of ill-health and disabilities. In addition, accidental falls account for a large number of years of life lost due to disability among older people. Many of the risk factors contributing to the burden of these diseases and injuries are preventable through individual actions and health promotion and prevention policies. Promoting physical activity, healthy eating and healthy weight, and better management of conditions such as hypertension and hearing loss can substantially prevent or delay many chronic diseases and injuries. However, not all health issues can be prevented in old age and health systems must be prepared to meet the healthcare needs of a growing number of older people. Early diagnosis of health conditions, along with equal access to people-centred and integrated care, will be instrumental to help older people manage their health conditions and avoid or delay any further deterioration in their health and functional status. References Ballester, J. et al. (2023), “Heat-related mortality in Europe during the summer of 2022”, Nature Medicine, Vol. 29/7, pp. 1857-1866, https://doi.org/10.1038/s41591-023-02419-z. [3] Clemson, L. et al. (2023), “Environmental interventions for preventing falls in older people living in the community”, Cochrane Database of Systematic Reviews, Vol. 2023/3, https://doi.org/10.1002/14651858.cd013258.pub2. [24] Crichton, M. et al. (2018), “A systematic review, meta-analysis and meta-regression of the prevalence of protein- energy malnutrition: associations with geographical region and sex”, Age and Ageing, https://doi.org/10.1093/ageing/afy144. [16] DREES (2022), Suicide : mesurer l’impact de la crise sanitaire liée au Covid-19 [Suicide: measuring the impact of the health crisis linked to COVID-19], https://drees.solidarites-sante.gouv.fr/publications-communique-de- presse/rapports/suicide-mesurer-limpact-de-la-crise-sanitaire-l
cide: measuring the impact of the health crisis linked to COVID-19], https://drees.solidarites-sante.gouv.fr/publications-communique-de- presse/rapports/suicide-mesurer-limpact-de-la-crise-sanitaire-liee-au-0. [10] European Commission (2024), 2024 Ageing Report - Economic & Budgetary Projections for the EU Member States (2022-2070), https://economy-finance.ec.europa.eu/document/download/971dd209-41c2-425d-94f8-e3c3c3459af9_en. [19] European Commission (2024), The 2024 pension adequacy report – Current and future income adequacy in old age in the EU, Publications Office of the European Union, https://data.europa.eu/doi/10.2767/909323. [4] European Commission (2023), European Health Union: a new comprehensive approach to mental health, https://ec.europa.eu/commission/presscorner/detail/en/IP_23_3050. [27] Eurostat (2024), Causes of death statistics, https://ec.europa.eu/eurostat/statistics- explained/index.php?title=Causes_of_death_statistics#Major_causes_of_death_in_the_EU_in_2021. [1] Hopewell, S. et al. (2019), “Multifactorial interventions for preventing falls in older people living in the community: a systematic review and meta-analysis of 41 trials and almost 20 000 participants”, British Journal of Sports Medicine, Vol. 54/22, https://doi.org/10.1136/bjsports-2019-100732. [23] IHME (2024), GBD Results, Institute for Health Metrics and Evaluation, https://vizhub.healthdata.org/gbd-results/. [5] Leij-Halfwerk, S. et al. (2019), “Prevalence of protein-energy malnutrition risk in European older adults in community, residential and hospital settings, according to 22 malnutrition screening tools validated for use in adults ≥65 years”, Maturitas, Vol. 126, pp. 80-89, https://doi.org/10.1016/j.maturitas.2019.05.006. [17] Livingston, G. et al. (2024), “Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission”, The Lancet, Vol. 404/10452, https://doi.org/10.1016/s0140-6736(24)01296-0. [6] Morgan, D. et al. (2023), “Exam
a prevention, intervention, and care: 2024 report of the Lancet standing Commission”, The Lancet, Vol. 404/10452, https://doi.org/10.1016/s0140-6736(24)01296-0. [6] Morgan, D. et al. (2023), “Examining recent mortality trends: The impact of demographic change”, OECD Health Working Papers, No. 163, OECD Publishing, Paris, https://doi.org/10.1787/78f69783-en. [2]
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87 Murtin, F. et al. (2017), “Inequalities in longevity by education in OECD countries: Insights from new OECD estimates”, OECD Statistics Working Papers, No. 2017/2, OECD Publishing, Paris, https://doi.org/10.1787/6b64d9cf-en. [12] Nurminen, M. (2023), Mapping of loneliness interventions in the EU, JRC Publications Repository, https://publications.jrc.ec.europa.eu/repository/handle/JRC134255. [28] OECD (2024), Fiscal Sustainability of Health Systems: How to Finance More Resilient Health Systems When Money Is Tight?, OECD Publishing, Paris, https://doi.org/10.1787/880f3195-en. [18] OECD (2024), Healthcare through patients’ eyes: The next generation of healthcare performance indicators, https://splsportugal.com/wp-content/uploads/2023/07/1719311695353.pdf. [26] OECD (2024), Society at a Glance 2024: OECD Social Indicators, OECD Publishing, Paris, https://doi.org/10.1787/918d8db3-en. [29] OECD (2023), Health at a Glance 2023: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/7a7afb35- en. [8] OECD (2023), Integrating Care to Prevent and Manage Chronic Diseases: Best Practices in Public Health, OECD Publishing, Paris, https://doi.org/10.1787/9acc1b1d-en. [21] OECD (2023), Ready for the Next Crisis? Investing in Health System Resilience, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/1e53cf80-en. [25] OECD (2022), Healthy Eating and Active Lifestyles: Best Practices in Public Health, OECD Publishing, Paris, https://doi.org/10.1787/40f65568-en. [20] OECD/European Union (2020), Health at a Glance: Europe 2020: State of Health in the EU Cy
Lifestyles: Best Practices in Public Health, OECD Publishing, Paris, https://doi.org/10.1787/40f65568-en. [20] OECD/European Union (2020), Health at a Glance: Europe 2020: State of Health in the EU Cycle, OECD Publishing, Paris, https://doi.org/10.1787/82129230-en. [11] OECD/WHO (2023), Step Up! Tackling the Burden of Insufficient Physical Activity in Europe, OECD Publishing, Paris, https://doi.org/10.1787/500a9601-en. [15] Sherrington, C. et al. (2019), “Exercise for preventing falls in older people living in the community”, Cochrane Database of Systematic Reviews, Vol. 2019/1, https://doi.org/10.1002/14651858.cd012424.pub2. [22] and 80 in Europe”, SSM - Population Health, Vol. 13, https://doi.org/10.1016/j.ssmph.2021.100740. [13] Vasile, M. et al. (2023), “Association Between Social Isolation and Mental Well-Being in Later Life. What is the Role of Loneliness?”, Applied Research in Quality of Life, Vol. 19/1, pp. 245-267, https://doi.org/10.1007/s11482-023-10239-z. [9] WHO (2020), WHO guidelines on physical activity and sedentary behaviour, https://www.who.int/publications/i/item/9789240015128. [14] Wolters, F. et al. (2020), “Twenty-seven-year time trends in dementia incidence in Europe and the United States”, Neurology, Vol. 95/5, https://doi.org/10.1212/wnl.0000000000010022. [7]
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urology, Vol. 95/5, https://doi.org/10.1212/wnl.0000000000010022. [7]
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88 age 60, based on WHO data [Infographic/Figure content omitted in strict text-only mode.]
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89 1 The 2024 edition of Society at a Glance provided a detailed analysis of the long-term decline in fertility rates in OECD and EU countries, as well as policy options to halt this decline (OECD, 2024[29]). The fertility rates have fallen over the past few decades to reach just 1.5 children per woman in 2022 on average across the OECD and EU, well below the “replacement level” of 2.1 children per woman. Among EU countries in 2022, the fertility rate was highest in France with 1.8 children per woman, and lowest in Malta, Italy and Spain with 1.2 children per woman. 3 The main reason why 2010 was selected as the baseline year rather than 2005 is that Eurostat does not report any EU average before 2010. 4 The data from the IHME GBD study are model-based estimates that may not always be consistent with national data. 5 People at risk of malnutrition are identified based on one of the 22 validated malnutrition screening tools for older adults. These tools assess various parameters such as nutritional intake, weight loss, body mass index and physical health. 6 See indicator on public expenditure projections for health and long-term care in Chapter 8 for more specific information. 7 Unmet medical care needs among older people are also low based on the EU-SILC survey: 3.6% of people aged 65 and over reported unmet medical care needs in 2023 in the EU. However, there is also large inequality across income groups: while only 1.6% of older people in the highest income quintile reported going without medical care, this proportion reached 5.5% in the lowest quintile.
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ple in the highest income quintile reported going without medical care, this proportion reached 5.5% in the lowest quintile.
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93 recovered from the unprecedented reductions during the COVID-19 pandemic, but there longer than men, the gender gap in healthy life years is much smaller as women live a greater proportion of their lives with some health issues and disabilities. The main causes of death are cardiovascular diseases and cancer, which together accounted for over half of all deaths (54%) in the EU in 2021. COVID-19 was the third leading cause in 2021, accounting for one in nine deaths. Over one-third of adults (35%) in the EU report living with a chronic condition, and this proportion increases to 60% among people aged over 65. There is some evidence that the health of young people deteriorated during the pandemic. Over half (52%) of 15-year-olds on average across the EU reported multiple health complaints in 2022, an increase from 42% in 2018. The most common health complaints are related to psychological distress. The gender difference in multiple health complaints is large: 68% of 15-year-old girls reporting multiple health complaints in 2022 compared to 37% of boys. 3 Health status
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94 EU countries at 84.0 years in 2023, followed by Italy, Malta, Luxembourg, Sweden and France, with all these countries having a expectancy in the EU in 2023 was the lowest in Bulgaria and Latvia at less than 76 years. The gap between the lowest and highest [Infographic/Figure content omitted in strict text-only mode.]
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96 healthier workforce, fewer early retirements due to health problems, and reduced or postponed health and long-term care needs. [Infographic/Figure content omitted in strict text-only mode.]
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100 Mortality from circulatory diseases Circulatory (or cardiovascular) diseases remain the leading cause of mortality in most EU countries, accounting for over 1.7 million deaths (or 32% of all deaths) in the EU in 2021. Age-standardised mortality rates from circulatory diseases are four to seven times higher in Bulgaria, Romania and Latvia than in [Infographic/Figure content omitted in strict text-only mode.]
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a, Romania and Latvia than in [Infographic/Figure content omitted in strict text-only mode.]
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102 Cancer mortality In 2021, 1.15 million people died from cancer in EU countries, accounting for more than one in five (22%) deaths. Cancer is the second leading cause of mortality in the EU on average after cardiovascular diseases, although it is already the leading cause of death in five EU countries (Belgium, Denmark, France, the Netherlands and Spain). Globally, preventable risk factors are estimated to cause about half of cancer deaths in men and over a third in women. Early diagnosis via population-based screening programmes and high-quality care delivered through comprehensive cancer networks, multidisciplinary teams and timely care pathways can reduce cancer mortality (OECD, 2024[1]). In 2021, there were 227 000 lung cancer deaths in the EU, 132 000 colorectal cancer deaths, 85 000 breast cancer deaths and 68 000 prostate cancer deaths. Lung cancer is by far the leading cause of cancer death among men, responsible for almost a quarter of deaths (23%), followed by colorectal cancer (12%) and prostate cancer (11%). Among women, breast cancer is the leading cause of death, accounting for about one in six cancer deaths (16%), followed closely by lung cancer (15%) and colorectal cancer (11%). While incidence of breast cancer has been on the rise in the decade before COVID-19, efforts at earlier diagnosis and better treatment have led to improvements in survival rates. For example, in the Netherlands, five-year relative breast cancer survival increased from 82% for those diagnosed between 1995-2004 to 89% for those diagnosed between 2015-22. In Belgium, five-year relative breast cancer survival increased from 88% for patients diagnosed in 2004 to 92% for those diagnosed in 2017 (OECD, forthcoming[2]). In 2021, mortality rates from cancer were more than 10% low
relative breast cancer survival increased from 88% for patients diagnosed in 2004 to 92% for those diagnosed in 2017 (OECD, forthcoming[2]). In 2021, mortality rates from cancer were more than 10% lower than the EU average in Malta, Luxembourg and Sweden, while [Infographic/Figure content omitted in strict text-only mode.]
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104 Cancer incidence and prevalence In 2022, about 1.3 million women and 1.5 million men in EU countries were expected to be diagnosed with cancer (ECIS, 2024[1]). This represents an age-standardised incidence rate of 684 per 100 000 men and 488 per 100 000 women. Except for breast and thyroid cancer, men have higher age-standardised incidence rates among all main cancer sites that affect both sexes. Among men, prostate is the most frequent cancer diagnosis, accounting for 23% of all cancer diagnoses, followed by lung and colorectal cancer (both 14%). For women, breast cancer dominates in terms of incidence, accounting for an estimated 30% of cases, followed by colorectal (12%) and lung cancer (9%). While breast cancer is a leading cancer site across women of all ages, prostate, lung and colorectal cancers are diagnosed mainly in people over age 50. Within the EU, Denmark was expected to have the highest cancer incidence rate in 2022, with age-standardised rates around [Infographic/Figure content omitted in strict text-only mode.]
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106 Self-rated health among adults How individuals assess their own health provides an overview of both physical and mental health. Despite its subjective nature, self-rated health is strongly related to morbidity and multi-morbidity and a good predictor of future healthcare needs and mortality (Palladino et al., 2016[1]). Over two-thirds of adults (68%) in the EU reported to be in good or very good health in 2023, while 23% reported their health to [Infographic/Figure content omitted in strict text-only mode.]
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108 Chronic conditions and disabilities among adults Chronic conditions (referred also as longstanding illnesses) are not only the leading causes of death across EU countries, but also reduce the quality of life of people living with such chronic conditions and represent a major disability burden, especially if the conditions are not properly managed. Many chronic conditions are preventable through modifiable risk factors such as smoking, alcohol use, physical inactivity, malnutrition and obesity. [Infographic/Figure content omitted in strict text-only mode.]
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110 Adolescent health Childhood and adolescence are important times for building health habits. Early life is when many mental health issues first appear, making it a priority period for promoting good mental health and preventing mental-ill health. In 2022, over 40% of 11-year-old girls and 30% of 11-year-old boys experienced multiple health complaints such as feeling low [Infographic/Figure content omitted in strict text-only mode.]
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2, over 40% of 11-year-old girls and 30% of 11-year-old boys experienced multiple health complaints such as feeling low [Infographic/Figure content omitted in strict text-only mode.]
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112 Adult mental health Good mental health is essential for maintaining overall well-being and productivity (European Commission, 2023[1]). Living with mental health issues can have a significant impact on people’s daily lives, contribute to poorer educational outcomes, higher rates of unemployment and poorer physical health (OECD, 2021[2]; OECD, 2021[3]). Without effective treatment and support, mental health problems can have a devastating effect on people’s lives, and significantly increase the risk of dying from suicide. Suicide is a significant cause of death in many European countries. In 2021, about 47 300 people died by suicide across EU countries, [Infographic/Figure content omitted in strict text-only mode.]
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115 This chapter examines modifiable risk factors affecting the health of adolescents and adults in the European Union (EU), including tobacco use, alcohol consumption, illicit drug use, poor nutrition, physical inactivity, overweight and obesity, and environmental hazards such as extreme temperatures and air pollution. Although adolescent smoking rates have decreased in most EU countries over the past decade, the increasing use of e-cigarettes among youth has become a growing concern. Adult smoking rates have also decreased in nearly all EU countries over the past decade, but still averaged over 18% in 2022. Binge drinking remains a significant problem among adolescents, with nearly 25% of 15-year-olds having been drunk more than once in their life in 2022. Adult alcohol consumption averaged 10 litres per person in 2022, a small reduction of 3% since 2010. One in five adults reported heavy episodic drinking at least monthly in 2019. Cannabis use among people aged 15-34 in the past year reached 15% on average in 2022, with rates of 20% or higher in Czechia, Italy and Croatia. When it comes to nutrition habits, in 2022, more than 50% of 15-year-olds did not consume fruit or vegetables daily, while one in seven consumed sugary soft drinks each day. Among adults, only about 60% consumed fresh vegetables and fruit daily, with significant socio-economic disparities. Insufficient physical activity is a widespread issue, with only 15% of 15-year-olds and about one-third of adults meeting WHO recommendations on minimum physical activity per day or week. As a consequence of poor nutrition habits and physical inactivity, over 20% of 15-year-olds and more than 50% of adults were overweight or obese in 2022, with notable inequalities by socio-economic status. Environmental ri
or nutrition habits and physical inactivity, over 20% of 15-year-olds and more than 50% of adults were overweight or obese in 2022, with notable inequalities by socio-economic status. Environmental risks, such as air pollution and extreme temperatures, pose increasing health threats. In 2021, exposure to fine particulate matter (PM2.5) alone caused over 253 000 deaths in the EU, with the highest mortality rates in Central and Eastern Europe. The EU has set ambitious targets to reduce air pollution and greenhouse gas emissions, aiming for a 55% reduction in premature deaths due to PM2.5 by 2030 compared to 2005 levels. 4 Risk factors
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116 Tobacco and cannabis smoking among adolescents Adolescence is a period of experimentation, sometimes linked to participation in behaviours detrimental to health, including tobacco consumption and the use of illicit drugs. Tobacco smoking in childhood and adolescence has both immediate and long- term health consequences, increasing the risks of respiratory diseases like asthma in the short term and the long-term risks of cardiovascular diseases, respiratory illnesses, and cancer. While tobacco smoking among adolescents has continued to decline in most EU countries in the last decade, too many adolescents still smoke. On average in EU countries, more than one in six (17%) 15-year-olds reported smoking cigarettes at [Infographic/Figure content omitted in strict text-only mode.]
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118 Smoking and vaping among adults Tobacco consumption remains the leading cause of preventable mortality in the EU, resulting in nearly 500 000 deaths in 2021 (IHME, 2024[1]). As a key risk factor for several cardiovascular and respiratory diseases, it also contributes significantly to various types of cancer, most notably lung cancer that accounted for nearly 20% of all cancer deaths in the EU in 2021. The harmful effects of tobacco use extend beyond the individual, placing a significant burden on healthcare systems and society, with the cost of smoking-attributable diseases estimated at 2.5% of Europe’s annual GDP (Goodchild, Nargis and D’Espaignet, 2018[2]). In 2022, an average of 18.4% of adults smoked daily across EU countries. The proportion of daily smokers varied more than two-fold, ranging from 25% or more in Bulgaria, Greece, Hungary and France to below 12% in Denmark, Finland and Sweden [Infographic/Figure content omitted in strict text-only mode.]
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120 Alcohol consumption among adolescents Repeated drunkenness, defined as being drunk on at least two occasions during their lifetime, continues to be common among adolescents in Europe. Nearly one in four 15-year-olds have experienced repeated drunkenness, although this proportion has decreased over the last decade. Early drinking initiation and getting drunk repeatedly among adolescents are of concern since these behaviours can have serious negative health, education and social consequences. By age 15, 23% of adolescents report having been drunk more than once in their life on average across EU countries, and 17% of 15-year-olds report having been drunk at least once in the past month (Charrier et al., 2024[1]). This is despite the fact that the legal drinking age is 18 in most countries (WHO, 2019[2]). Adolescents who report early initiation to alcohol and having been drunk on several occasions are more likely to develop alcohol dependence later in life. More than 30% of 15-year-olds in Denmark, Hungary, Bulgaria, Austria, Italy and Germany reported having been drunk more than once in their life in 2022. In contrast, this proportion is much lower in countries such as Portugal, Luxembourg, Ireland and France, [Infographic/Figure content omitted in strict text-only mode.]
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122 Alcohol consumption among adults Excessive alcohol consumption is a major public health concern in the EU, contributing significantly to premature mortality and disability, being a causal factor for various chronic diseases including cardiovascular diseases, liver cirrhosis and several types of cancer (WHO, 2024[1]). OECD modelling estimates that between 2020 and 2050, alcohol consumption exceeding one drink per day for women and 1.5 drinks per day for men will lead to over 125 000 premature deaths annually in the EU. Between 2020 and to what it would have been without such consumption. The economic burden of alcohol consumption is also large, with estimates for EU countries for which data are available ranging between 0.4% and 1.5% of GDP (OECD, 2021[2]) Alcohol consumption levels vary considerably across EU countries, with significant differences in drinking patterns. Measured through sales data, overall alcohol consumption averaged 10.0 litres per adult across EU countries in 2022. Latvia and Spain reported the highest consumption at nearly 12 litres per person, followed by Romania, Austria and Czechia. Greece boasted the [Infographic/Figure content omitted in strict text-only mode.]
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124 Use of illicit drugs among adults Drug availability and use remain at high levels across the European Union, although considerable differences exist across countries. Almost a third of adults in the EU aged 15 to 64, or around 89 million people, have used illicit drugs at some points in their lives, with the experience of drug use being still more frequently reported by males than females. The use of illicit drugs, particularly among people who use them regularly and in bigger quantities, is associated with higher risks of cardiovascular diseases, mental health problems, accidents, as well as infectious diseases such as HIV when the drug is injected. The mortality rate due to overdoses in the EU in 2022 is estimated at 22.5 deaths per million in adults. Illicit drug use is a major cause of preventable mortality among young people in Europe, both directly through overdose and indirectly through drug-related diseases, accidents, violence and suicide (EMCDDA, 2024[1]). Cannabis remains the most commonly used illicit drug among young adults in Europe, with approximately 15% (15.1 million) of individuals aged 15 to 34 in EU countries reporting cannabis use in the last year. The highest rates of cannabis consumption are found in Czechia, Italy and Croatia, where 20% or more of people in this age group have used cannabis in the past year. It is estimated that around 1.3% of European adults – primarily males under 35 years old – are daily or almost daily cannabis users. Recent trends in cannabis use at the national level have been mixed, with three countries reporting higher estimates, eight remaining stable, and two showing a decrease compared to their previous comparable surveys. In 2023, out of 51 EU cities with comparable data, 20 reported an increase in canna
higher estimates, eight remaining stable, and two showing a decrease compared to their previous comparable surveys. In 2023, out of 51 EU cities with comparable data, 20 reported an increase in cannabis residues found in wastewater compared to 2021. Cocaine is the most commonly used illicit stimulant in Europe: around 2.5% of young adults reported having used cocaine in the [Infographic/Figure content omitted in strict text-only mode.]
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126 Nutrition among adolescents Nutrition plays a crucial role in child and adolescent development. Establishing good nutritional habits early in life, particularly regular consumption of fruit and vegetables, can help prevent serious health problems such as obesity, diabetes and heart diseases. Various factors influence fruit and vegetable consumption among adolescents, including family income, parental dietary habits, and the availability of fresh products that can be affected by national or local climate conditions. Despite the current recommendation to eat five portions of fruit and vegetables every day, over half (56%) of 15-year-old [Infographic/Figure content omitted in strict text-only mode.]
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128 Nutrition among adults Fruit and vegetables are essential components of a healthy diet, providing essential vitamins, minerals and antioxidants. Regular consumption of these foods is associated with a reduced risk of chronic diseases, including cardiovascular diseases, metabolic conditions and certain types of cancer. Moreover, fruit and vegetables play a crucial role in weight management due to their relatively low-calorie density, high water content and fibre, which promote satiety and help control overall calorie intake. However, many EU citizens face barriers to accessing quality meals, including fruit and vegetables, due to financial constraints. The number of people in the EU who cannot afford a proper meal every other day has risen from 33 million in 2018 to nearly 43 million in 2023, meaning that almost 1 out of 10 individuals in the EU are unable to access nutritious meals regularly (Eurostat, 2024[1]). This lack of affordability contributes to the significant health consequences associated with inadequate fruit and vegetable intake, which was linked to an estimated 275 000 deaths in the EU in 2021 (IHME, 2024[2]). On average across the EU, 60% of the adult population consumed fresh vegetables and 61% consumed fresh fruit at least daily in 2022. Belgium and Italy led in fresh vegetable consumption, with over three-quarters of their adult populations consuming them at least daily. For fresh fruit consumption, Italy and Portugal topped the list, with over 80% of adults consuming them at least once a day. In contrast, daily fresh vegetable consumption was below 40% in Hungary and Romania, while the prevalence of daily fresh [Infographic/Figure content omitted in strict text-only mode.]
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130 Physical activity among children and adolescents Adolescence is a critical period for establishing lifelong healthy habits, including regular physical activity. Engaging in sufficient physical activity during childhood and adolescence has numerous health benefits, such as improved cardiovascular health, better cognitive function and reduced risk of obesity and chronic diseases later in life (OECD/WHO, 2023[1]). Despite the well-known benefits of physical activity, many adolescents in EU countries do not meet the WHO recommended levels of at least 60 minutes of moderate-to-vigorous physical activity per day. On average, only 22% of 11-year-olds and 15% of 15-year-olds reported meeting these guidelines in 2022. This proportion was highest in Finland, Ireland and Hungary, while it was lowest in Italy, Lithuania and France, where fewer than one sixth of all 11- and 15-year-olds met the recommendation. There is a notable gender gap in physical activity levels among adolescents, with boys consistently more active than girls across all EU countries. The difference was especially pronounced among 15-year-olds, with 20% of boys meeting the WHO guidelines in [Infographic/Figure content omitted in strict text-only mode.]
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132 Physical activity among adults Physical activity is a cornerstone of human health, offering profound benefits that extend far beyond mere fitness. Scientific evidence demonstrates that regular moderate- and vigorous-intensity exercise significantly reduces mortality rates from cardiovascular diseases, the leading causes of death in the EU. This protective effect extends to a range of non-communicable diseases, including type 2 diabetes as well as certain types of cancer. Additionally, exercise acts as a natural mood enhancer, releasing endorphins that combat stress, anxiety and depression. In an era of increasing mental health concerns, the role of physical activity in promoting psychological well-being is more crucial than ever. Moreover, regular exercise has been shown to improve cognitive function, reducing the risk of age-related cognitive decline and dementia (OECD/WHO, 2023[1]). The urgency of promoting active lifestyles is underscored by estimates of the overall health burden associated with sedentary behaviour. In 2021, insufficient physical activity accounted for an estimated 1.2 million disability-adjusted life years (DALYs) and 64 000 deaths in the EU, highlighting the ample potential to improve public health and reduce the strain on European healthcare systems by addressing this modifiable risk factor (IHME, 2024[2]). Recognising the critical importance of physical activity for health and well-being, the WHO recommends that adults engage in at least 150 minutes of moderate-intensity physical activity. As of 2019, about one-third of adults across the EU were meeting this recommendation. However, rates varied more than eight-fold across European countries: the Netherlands, Sweden and Denmark, along with Norway and Iceland had over half of their adult
were meeting this recommendation. However, rates varied more than eight-fold across European countries: the Netherlands, Sweden and Denmark, along with Norway and Iceland had over half of their adult populations meeting the recommendation, while Malta, Bulgaria and [Infographic/Figure content omitted in strict text-only mode.]
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134 Overweight and obesity among children and adolescents Childhood obesity is a serious public health concern with far-reaching consequences. Overweight or obese children face a higher risk of poor health, an effect that persists into adulthood. Furthermore, obesity in children is often associated with psychosocial issues such as low self-esteem, bullying, and academic underachievement, potentially exacerbating health and economic outcomes in later life (OECD, 2019[1]). In 2022, over one in five (21%) 15-years-olds on average across EU countries was classified as either overweight or obese [Infographic/Figure content omitted in strict text-only mode.]
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136 Overweight and obesity among adults Overweight and obesity are major risk factors for numerous non-communicable diseases, including cardiovascular diseases, diabetes, and certain types of cancer. The excessive accumulation of body fat is a significant public health concern across the EU, contributing to increased morbidity and mortality rates. In 2021, an estimated 420 000 deaths in the EU were associated with an excessive body mass index (BMI), highlighting the large impact of overweight and obesity on population health (IHME, 2024[1]). Based on self-reported data, in 2022 over half of the EU population was either overweight or obese. The prevalence of overweight and obesity was consistently higher among men compared to women across all EU countries. On average, 44% of men in the EU [Infographic/Figure content omitted in strict text-only mode.]
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average, 44% of men in the EU [Infographic/Figure content omitted in strict text-only mode.]
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138 Impact of environmental factors on health The impacts of air pollution and climate change-related events pose a serious threat to people’s physical and mental health today and to future generations. Air pollution increases the risk of various health problems, including respiratory diseases, lung cancer and cardiovascular diseases, with children and older adults particularly vulnerable to its effects. In EU countries, exposure to fine particulate matter (PM2.5) alone – a key air pollutant – is estimated to have caused the death of more than 253 000 people in 2021 (European Environment Agency, 2023[1]). Mortality rates from PM2.5 were highest in Central and Eastern Europe, where premature death rates were more than twice as high as the EU average. Conversely, mortality rates from exposure to fine particulate matter [Infographic/Figure content omitted in strict text-only mode.]
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141 This chapter looks at recent trends in health spending, overall and disaggregated by type of health service and provider. There is a particular focus on the impact of COVID-19 and the cost-of-living crisis on health spending. The chapter also analyses how healthcare is financed across Europe and takes a closer look at how much is spent on primary healthcare and pharmaceuticals. After exceptionally high health spending growth in 2020 and 2021, due to additional financial resources mobilised to fight the pandemic and address its consequences, health spending declined in 2022 as EU countries were transitioning out of the acute phase of the health emergency. Additionally, emerging geo-political and economic conditions meant that other emergencies – such as the energy and cost-of-living crisis – weakened the position of health within government priorities. As a result, spending on health as a share of GDP dropped to 10.4% in the EU in 2022, down from 10.9% in 2021. Regarding the financing of healthcare, government and compulsory schemes accounted for around four-fifths of overall health spending across EU countries. However, out-of-pocket expenditure – which can impact individuals’ access to care – remains an important source of health financing in several Southern as well as Central and Eastern European countries. 5 Health expenditure and financing
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iduals’ access to care – remains an important source of health financing in several Southern as well as Central and Eastern European countries. 5 Health expenditure and financing
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142 Health expenditure per capita The level of per capita health spending in a country and its changes over time are determined by a wide range of demographic, social, and economic factors, as well as the financing and organisational arrangements of the country’s health system. Given these factors, there are large variations in the level and growth of health spending across Europe. In 2022, with spending at EUR 5 630 per person, Switzerland was the biggest spender on health in Europe, followed by Norway (EUR 5 376). Among EU countries, health spending in Germany (EUR 5 317) was 50% above the population-weighed EU average of EUR 3 533. Health spending in Austria and the Netherlands was also at least 25% higher than the EU average. Per capita health spending in the EU was lowest in Hungary, Croatia, Bulgaria and Romania, at less than EUR 1 900 per person [Infographic/Figure content omitted in strict text-only mode.]
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144 Health expenditure in relation to GDP The resources that a country allocates to healthcare compared to the size of the overall economy vary over time due to differences in both the growth of health spending and overall economic growth. During the 1990s and early 2000s, EU countries generally saw health spending outpace the rest of the economy, leading to a nearly continual rise in the ratio of health expenditure to gross domestic product (GDP). However, this trend was disrupted by the financial and economic crisis of 2008/09. The COVID-19 pandemic also led to fundamentally diverging growth patterns of health spending and economic output, resulting in a major adjustment of this indicator. [Infographic/Figure content omitted in strict text-only mode.]
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adjustment of this indicator. [Infographic/Figure content omitted in strict text-only mode.]
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146 Financing of health expenditure There is a variety of financing arrangements through which individuals or groups of the population obtain healthcare -in some of these arrangements participation is automatic or compulsory, in others it is at people’s discretion. Government financing schemes, on a national or sub-national basis or for specific population groups, entitle individuals to healthcare based on residency. The other main method of financing is some form of compulsory health insurance (managed through public or private entities). Spending by households (out-of-pocket spending), both on a fully discretionary basis and part of some co-payment arrangement, can constitute a significant part of overall health spending. Finally, voluntary health insurance, in its various forms, can also play an important funding role in some countries. Coverage through government schemes or compulsory health insurance forms the bulk of healthcare financing across the EU. [Infographic/Figure content omitted in strict text-only mode.]
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148 Health expenditure by type of service A variety of factors, including disease burden, system priorities, organisational aspects, and costs, determine the allocation of resources across different types of healthcare services. In EU countries, curative and rehabilitative care services constitute the bulk of health spending, primarily delivered through inpatient and outpatient services, which accounted for nearly 60% of all health expenditures in 2022. About one-fifth of health spending is directed toward medical goods (mostly pharmaceuticals), followed by 15% on health-related long-term care. The remaining 9% is spent on collective services such as prevention and public health, as [Infographic/Figure content omitted in strict text-only mode.]
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150 Expenditure on primary healthcare Effective primary healthcare is the cornerstone of an efficient, people-centred, and equitable health system. While the COVID-19 pandemic has highlighted the importance of resilient primary healthcare systems, in many EU countries, the potential of primary healthcare has not yet been fully realised (OECD, 2020[5]). In 2022, EU countries allocated an average of 13% of their health budgets to primary healthcare, with this proportion ranging [Infographic/Figure content omitted in strict text-only mode.]
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152 Health expenditure by provider Healthcare is delivered by a wide variety of providers ranging from hospitals and medical practices to ambulatory facilities and retailers, which impacts expenditure patterns for various healthcare goods and services. Analysing health spending by provider can be particularly useful when considered alongside the functional breakdown of health expenditure, giving a fuller picture of the organisation of health systems. The way healthcare delivery is organised differs substantially across EU countries, resulting in a wide variation in the distribution of health spending across providers. Hospitals are the healthcare provider that consumes the largest part of the total health budget in the EU. In 2022, they accounted for around 37% of all health spending. This proportion was much higher in Cyprus, Croatia, Czechia and Spain, which allocated over 45% of all health expenditure to hospitals. On the other hand, this share was less than [Infographic/Figure content omitted in strict text-only mode.]
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154 Pharmaceutical expenditure Pharmaceutical care is highly complex and evolves over time as a result of novel medicines entering the market. While new medicines may offer alternatives to existing treatments, and in some cases, the prospect of treating conditions previously considered incurable, costly innovations can have major implications for overall healthcare budgets. Across the EU, spending on retail pharmaceutical spending is generally the third largest cost component – after the inpatient and outpatient sector – accounting for around one-seventh of all health spending. In 2022, EU countries spent on average EUR 500 per capita on retail pharmaceuticals (including other medical non-durables) but [Infographic/Figure content omitted in strict text-only mode.]
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157 This chapter starts with a broad indicator of avoidable mortality, providing a general assessment of the effectiveness of public health and healthcare systems in reducing premature deaths. Four causes of preventable mortality – COVID-19, lung cancer, ischaemic heart diseases and alcohol-related deaths – accounted for more than half of all preventable deaths in the EU in 2021. Despite renewed emphasis on vaccination, most EU countries have not met targets on childhood immunisation, though HPV vaccine coverage among boys has increased in a number of countries. Cancer mortality can be reduced through better prevention and earlier diagnosis, but cancer screening rates still fall below the EU’s ambitious targets, and population-based screening rates vary widely. Avoidable hospital admissions for chronic conditions have declined steeply following the pandemic, while case fatality rates following hospitalisation for stroke and heart attack have risen in many countries. These two indicators suggest that EU residents may have been less likely to seek care during the pandemic, resulting in fewer, but more severe, cases upon hospital arrival. Quality and safety metrics for acute care, such as the timeliness of hip-fracture surgery and the prevalence of hospital acquired infections, show that there is room for countries to further invest in high-quality and safe care. Surveys of hospital workers identify staffing levels, work pace, and error reporting as areas for improvement. 6 Effectiveness: Quality of care and patient experience
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and safe care. Surveys of hospital workers identify staffing levels, work pace, and error reporting as areas for improvement. 6 Effectiveness: Quality of care and patient experience
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158 Avoidable mortality (preventable and treatable) Indicators of avoidable mortality provide a starting point for assessing the effectiveness of public health and healthcare systems in reducing premature deaths from causes considered to be avoidable. In 2021, nearly a quarter of deaths (24% or 1.26 million deaths) across the EU were considered avoidable. Of these, more than 860 000 deaths could have been prevented through effective primary prevention or other public health measures (i.e. measures taken before the onset of disease or injury to reduce its occurrence), while nearly 400 000 could have been avoided through more effective and timely healthcare treatment (i.e. measures taken after the onset of diseases, to reduce case-fatality). In 2021, COVID-19 was the largest cause of preventable mortality, accounting for 24% of preventable deaths in people under age 75. The four leading causes of preventable mortality – COVID-19, lung cancer, ischaemic heart diseases and alcohol-related [Infographic/Figure content omitted in strict text-only mode.]
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160 Routine vaccinations All EU countries have established childhood vaccination programmes to reduce the spread of many infectious diseases and related deaths, although the number and type of recommended vaccines vary across countries. The WHO recommends 95% coverage with two doses of measles-containing vaccine and three doses of the hepatitis B vaccine with the first dose at birth (<24 hours). It also recommends reaching 90% coverage of girls aged 9-14 with vaccination against human papillomavirus (HPV) to prevent cervical and other cancers. Global measles incidence increased in 2023, largely attributed to decreased vaccination coverage during the COVID-19 pandemic. Among the 18 449 measles cases reported between September 2023 and August 2024, 87% were among unvaccinated people. In this period, measles outbreaks were reported by several countries in Europe, including Romania (accounting for 77.8% of all cases in Europe), Italy (4.9%), Belgium (3.3%), Austria (2.9%) and Germany (2.8%) (ECDC, 2024[1]). The high burden of measles in Romania, associated with low vaccination levels, led the Ministry of Health to declare a national measles epidemic. Vaccination coverage against measles reflects care continuity and access to primary care. In 2023, 88% of children in the EU [Infographic/Figure content omitted in strict text-only mode.]
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162 Cancer screening Officially adopted in 2021, Europe’s Beating Cancer Plan aims to address challenges in prevention, treatment and care for all cancers (European Commission, 2021[1]). In support of these goals, the EU Council Recommendation on Cancer Screening includes the objective that 90% of the EU population who qualify for breast, cervical and colorectal cancer screening are offered services by 2025 (European Commission, 2022[2]). Breast cancer is the most commonly occurring cancer among women, accounting for almost 30% of new cancer cases in EU countries in 2022 (European Union, 2024[3]). Risk factors for breast cancer include age, genetic predisposition, oestrogen replacement therapy, and lifestyle factors such as obesity, physical inactivity, nutrition habits and alcohol consumption. Beginning in the 1980s, most European countries have adopted population-based breast cancer screening programmes to improve early detection rates (OECD, 2024[4]). In 2022, the proportion of women of screening age (usually 50-69 years of age) [Infographic/Figure content omitted in strict text-only mode.]
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164 Avoidable hospital admissions Asthma, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and diabetes are four of the most common chronic health conditions. Common to these four conditions is the existence of a solid evidence base for effective patient management in primary care. A well-performing primary care system can reduce acute deterioration of people living with asthma, COPD, CHF or diabetes, thereby preventing unwanted and costly avoidable hospital admissions (OECD, 2020[8]). [Infographic/Figure content omitted in strict text-only mode.]
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166 Integrated care People living with chronic conditions often face poor-quality, fragmented care due to the need for multiple interactions with different providers and levels of care. Addressing this requires a shift to people-centred health systems that deliver seamless, integrated care across settings (OECD, 2021[1]). Countries are testing various levels of integration in organisational structures and services to better manage complex health needs, aiming to improve population health, patient experiences, reduce costs, enhance working conditions of health professionals, and promote health equity. However, inconsistent data and varying definitions of “integrated care” make it difficult to inform policy and benchmark progress, despite taxonomies developed by organisations such as the WHO and the EU (OECD, 2023[2]). Policies promoting integrated care can improve patient outcomes and experiences. They also hold the potential to increase value-for- money by reducing duplicative and unnecessary care. Key actions to advance integrated care include strengthening the governance of ca
d experiences. They also hold the potential to increase value-for- money by reducing duplicative and unnecessary care. Key actions to advance integrated care include strengthening the governance of care delivery, developing interoperable information systems and aligning financial incentives across providers. Stressing the need to link electronic health records, the OECD is collecting data to compare post-hospital care performance across countries. Indicators such as mortality rates, readmission rates and medication prescriptions post-hospitalisation offer insight into the effectiveness of care co-ordination between hospital and community settings, particularly when assessed over longer periods following the initial event (Barrenho et al., 2022[3]). Readmissions are a key metric for evaluating integrated care, with higher rates indicating poorer outcomes. [Infographic/Figure content omitted in strict text-only mode.]
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168 Mortality following acute myocardial infarction (AMI) Mortality due to coronary heart disease has declined substantially over the past decade (see indicator “Mortality from circulatory diseases” in Chapter 3). Nonetheless, acute myocardial infarction (AMI) remains the leading cause of cardiovascular death in many EU countries, highlighting the need for further reductions in risk factors and care quality improvements (OECD/The King’s Fund, 2020[1]). The COVID-19 crisis has also revealed the need to maintain access to high-quality acute care for AMI during public health emergencies. Metrics of 30‐day mortality after AMI hospital admission reflect processes of care, such as timely transport of patients and effective medical interventions. However, the indicator is influenced not only by the quality of care provided in hospitals but also by [Infographic/Figure content omitted in strict text-only mode.]
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l interventions. However, the indicator is influenced not only by the quality of care provided in hospitals but also by [Infographic/Figure content omitted in strict text-only mode.]
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170 Mortality following stroke Stroke is a leading cause of death, accounting for 7% of all deaths across the EU in 2021 (see indicator “Main causes of mortality” in Chapter 3). Stroke is a serious life-threatening event that occurs when the blood supply to a part of the brain is interrupted. Of the two types of stroke, about 85% are ischaemic and 15% are haemorrhagic. [Infographic/Figure content omitted in strict text-only mode.]
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172 Hip and knee surgery: Outcomes and emergency responsiveness Hip fractures are a common cause of hospitalisation, typically caused by falls particularly among older people who have lost skeletal strength due to osteoporosis. In nearly all instances following a hip fracture, surgical intervention is required to repair or replace the hip joint. There is general agreement that early surgical intervention improves patient outcomes and minimises the risk of complications. For this reason, surgery should occur within two days (48 hours) of hospitalisation. Some national guidelines stipulate an even more rapid intervention. Time to surgery is influenced by many factors, including hospitals’ surgical and staffing capacity and inter-hospital flow and access. According to the most recent data, nearly three out of four patients aged 65 and over on average across EU countries underwent [Infographic/Figure content omitted in strict text-only mode.]
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across EU countries underwent [Infographic/Figure content omitted in strict text-only mode.]
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174 Approximately 4.3 million people acquire a healthcare-associated infection (HAI) each year in acute care hospitals in EU countries, Iceland and Norway (ECDC, 2024[1]). HAIs lead to increases in patient morbidity, long-term health complications, extended hospital stays and mortality (WHO, 2022[2]). They also contribute to the unnecessary use of healthcare resources and represent a preventable financial burden on healthcare systems, with related costs representing up to 6% of public hospital budgets (Slawomirski, Auraaen and Klazinga, 2017[3]). [Infographic/Figure content omitted in strict text-only mode.]
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176 Patient safety, relating to prevention of harm during healthcare activities, remains a pressing issue with substantial health and economic costs in countries in Europe. It is estimated that up to 13% of health spending goes towards treatment of patients harmed during care, the majority of which could be avoided if appropriate safety protocols and clinical guidelines were adhered to (Slawomirski, Auraaen and Klazinga, 2017[1]). Promoting patient safety culture in healthcare workplaces and capturing the patient voice on patient safety is vital for driving sustainable progress in providing safe care and to meet the goals of WHO’s Global Patient Safety Action Plan 2021-30. Measures of patient safety culture from the perspective of health workers capture aspects of the work environment that facilitate the provision of safe and high-quality care. These measures, along with patient-reported experiences of safety, traditional patient safety indicators and health outcome indicators, provide insights on the safety of health systems from various perspect
measures, along with patient-reported experiences of safety, traditional patient safety indicators and health outcome indicators, provide insights on the safety of health systems from various perspectives. A positive patient safety culture for health workers means there is agreement on the importance of patient safety, transparency and trust, shared responsibility, and confidence in organisational and national safety initiatives. It is associated with better patient outcomes and experiences, as well as improved productivity and staff satisfaction. [Infographic/Figure content omitted in strict text-only mode.]
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179 Most EU countries have achieved universal coverage for a core set of health services, although the range of services covered and the degree of cost-sharing vary, potentially raising affordability issues for some population groups. Effective access to different types of care can also be restricted due to health workforce shortages, long waiting times or long distance to reach the closest healthcare provider. While unmet medical care needs due to financial, waiting time or geographic barriers remained relatively low in most EU countries in 2023, they have increased since 2019. These unmet needs are over three times higher among people in the lowest income group compared to those in the highest income on average in the EU. The pandemic highlighted serious health workforce shortages in most EU countries. Achieving and sustaining universal access to care requires having a sufficient number and proper mix of health workers, with a proper geographic distribution, to respond to the needs of all the population regardless of where they live. 7 Accessibility: Affordability, availability and use of services
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, with a proper geographic distribution, to respond to the needs of all the population regardless of where they live. 7 Accessibility: Affordability, availability and use of services
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180 Unmet healthcare needs Accessibility to healthcare can be limited for a number of reasons, including cost, distance to the closest health facility and waiting times. The disruption of health services during the pandemic also resulted in unmet healthcare needs as resources were mobilised to address the crisis, and people were encouraged to stay home to reduce virus transmission. Information about unmet healthcare needs can be sought by using different survey instruments that provide different results. The data presented here rely on the annual Eurostat’s EU Statistics on Income and Living Conditions (EU-SILC) survey. Based on EU-SILC, most of the population in EU countries reported that they had no unmet medical care needs for financial reasons, distance or waiting times in 2023. Such unmet medical care needs were reported by 2.4% of the population in the EU, [Infographic/Figure content omitted in strict text-only mode.]
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of the population in the EU, [Infographic/Figure content omitted in strict text-only mode.]
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182 Population coverage for healthcare The share of the population covered by a public or private scheme provides an important measure of access to care and the financial protection against the costs associated with healthcare. The COVID-19 pandemic demonstrated the importance of universal health coverage as a key element for the resilience of health systems, as gaps in insurance coverage and high levels of out-of-pocket payments may deter people from seeking care. Higher population coverage through public and primary private health insurance have been associated with lower COVID-19 death and lower excess mortality in the EU and other OECD countries (OECD, 2023[1]). However, population coverage is only a partial measure of access and coverage: the range of services covered and the degree of cost-sharing for those services also define how comprehensive healthcare coverage is in a country (see indicator “Extent of healthcare coverage”). Most European countries have achieved universal (or near-universal) coverage of the population for a core set of health services, [Infographic/Figure content omitted in strict text-only mode.]
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184 Extent of healthcare coverage In addition to the share of the population entitled to core health services, the extent of healthcare coverage is defined by the range [Infographic/Figure content omitted in strict text-only mode.]
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erage is defined by the range [Infographic/Figure content omitted in strict text-only mode.]
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186 Financial hardship and out-of-pocket expenditure Health systems provide adequate financial protection when payments for healthcare do not expose people to financial hardship. A lack of financial protection can reduce access to healthcare, undermine health status, deepen poverty, and exacerbate health and socio-economic inequalities. Exposure to financial hardship for people using health services can also lead to catastrophic health spending, with poorer households and those who must pay for long-term treatment – such as medicines for chronic illness – particularly vulnerable. Financial protection is weakened by a health system’s reliance on out-of-pocket (OOP) payments for healthcare. On average across EU countries, 15% of all spending on healthcare comes directly from patients through OOP payments (see section on “Health expenditure by type of financing” in Chapter 5). The share of household consumption spent on healthcare provides an aggregate assessment of the financial burden of OOP payments. In 2022, around 3% of total household spending was on health services across the EU. This share ranged from less [Infographic/Figure content omitted in strict text-only mode.]
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. This share ranged from less [Infographic/Figure content omitted in strict text-only mode.]
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188 Availability of doctors Proper access to medical care requires having a sufficient number of doctors, with a proper mix of generalists and specialists, and a proper geographic distribution to serve the population in the whole country. The number of doctors in EU countries increased from about 1.65 million in 2010 to 1.83 million in 2022. In all EU countries, the number of doctors increased more rapidly than the size of the population since 2010, so on average the number of doctors rose from 3.4 per 1 000 population in 2010 to 4.2 in 2022. However, this does not mean that the shortages of doctors have reduced if the demand for medical care increased more rapidly than the supply, if the average working hours of doctors have reduced, if there is not an appropriate mix of doctors or if there is a more uneven geographic distribution. In 2022, Greece had the highest number of doctors per population followed by Portugal, but the number in these two countries is an over-estimation as it includes all doctors licensed to practice, including retired physicians and those who might have emigrated to other countries but have kept their licence in the country. The number of doctors per population was the lowest in Luxembourg (although the latest data dates back to 2017) and France (although the number does not include physicians-in-training, resulting in an under-estimation compared to other countries). The density of doctors was also relatively low in Slovenia and Latvia, although [Infographic/Figure content omitted in strict text-only mode.]
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Slovenia and Latvia, although [Infographic/Figure content omitted in strict text-only mode.]
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190 Remuneration of doctors (general practitioners and specialists) The remuneration of various categories of doctors affects the financial attractiveness of general practice and different specialties. Differences in remuneration levels of doctors across countries can also act as a “push” or “pull” factor when it comes to physician migration. In many countries, governments can determine or influence the level and structure of physician remuneration by regulating their fees or by setting salaries when doctors are employed in the public sector. In all European countries, the remuneration of doctors (both GPs and specialists) is substantially higher than the average wage of all workers. In most countries, GPs earned two to four times more than the average wage in each country in 2022, while [Infographic/Figure content omitted in strict text-only mode.]
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n each country in 2022, while [Infographic/Figure content omitted in strict text-only mode.]
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192 Availability of dentists and consultations with dentists Dental health is an integral part of general health and quality of life. Access to dental care is often more limited for certain parts of the population, either because dental care is less covered under public health insurance system and therefore less affordable for people with lower income or because of a short supply of dentists in certain areas. In 2023, 6% of people who needed dental care reported some unmet needs because of affordability or accessibility issues according to the EU-SILC survey, but this proportion reached over 12% among people at risk of poverty (see indicator “Unmet healthcare needs”). Dentists play a key role in both preventing and treating oral health problems. In 2022, there were between 0.5 and 1.3 dentists [Infographic/Figure content omitted in strict text-only mode.]
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between 0.5 and 1.3 dentists [Infographic/Figure content omitted in strict text-only mode.]
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194 Availability of nurses Nurses make up the most numerous category of health workers in nearly all EU countries. The key role they play in providing care in hospitals, long-term care facilities and the community was highlighted during the COVID-19 pandemic. Pre-existing shortages of nurses were exacerbated during the peaks of the epidemic, particularly in intensive care units and other hospital units as well as in long-term care facilities (OECD, 2023[1]). The demand for nurses is expected to continue to rise in the coming years due to population ageing while about one-fourth of nurses on average across EU countries are aged over 55 and therefore approaching retirement age (see Chapter 1 on health workforce challenges). Increasing the retention rate of nurses in the profession is a growing concern to avoid exacerbating current and future shortages. Concerns about growing shortages have prompted many countries to increase the number of places in nursing education programmes, and the number of new nurse graduates has increased at least slightly over the past decade in most EU countries (see indicator on “medical and nursing graduates in Chapter 8”). However, young people’s interest in pursuing a career in nursing has decreased in many countries following the pandemic (OECD, 2024[2]). [Infographic/Figure content omitted in strict text-only mode.]
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the pandemic (OECD, 2024[2]). [Infographic/Figure content omitted in strict text-only mode.]
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196 Remuneration of nurses The COVID-19 pandemic has brought further attention to the pay rate of nurses and the need to ensure a sufficient remuneration level to attract and retain nurses in the profession. On average across EU countries, the remuneration of hospital nurses in 2022 was about 20% above the average wage of all workers in each country. However, in some countries like Finland, France, Portugal, Sweden and Italy, nurses do not earn more [Infographic/Figure content omitted in strict text-only mode.]
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198 Use of diagnostic technologies Modern diagnostic technologies play an important role in health systems, allowing physicians to better diagnose health issues. However, they are also a major cost driver in health systems, particularly if they are overused. This section focuses on the use of three diagnostic imaging technologies that can help diagnose different health issues: computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) exams. CT and MRI exams both show images of internal organs and tissues, while PET scans show other information and problems at the cellular level. Unlike more traditional radiography and CT scanning, MRI and PET exams do not expose patients to ionising radiation, which can increase the risk of cancer if the exposition of radiation is not properly managed. CT exams were first introduced in the 1970s, MRI exams in the 1970s and the 1980s, while PET exams were introduced around the year 2000. Government authorities and medical societies in some countries are working together to promote a more effective use of MRI, CT, PET and other medical imaging exams. For instance, in Belgium,
ear 2000. Government authorities and medical societies in some countries are working together to promote a more effective use of MRI, CT, PET and other medical imaging exams. For instance, in Belgium, the Federal Public Service Health is launching several actions to support doctors and the general public in making more informed decisions. The National Health Insurance, the Federal Public Service and the Belgian Medical Imaging Platform are working together to integrate evidence-based decision rules in physicians’ electronic prescribing so that they are supported when choosing whether a radiological exam is necessary and, if so, which one would be most appropriate for the patient. Citizens will also be informed about situations in which a scan is not necessary, for example for back pain (Sciensano, 2024[1]). Before the pandemic, the use of the CT, MRI and PET diagnostic exams taken together was increasing in all EU countries. Between 2012 and 2019, the number of these exams increased on average across EU countries by over 40%, from 162 exams per 1 000 population in 2012 to 229 exams in 2019. In 2020, diagnostic activities as many other health services were disrupted and sometime temporarily suspended to divert efforts towards COVID-19 patients and avoid people getting infected while seeking diagnostics or care. On average, diagnostic exams decreased by 12% across EU countries in 2020 compared to 2019. Most EU countries then quickly restored diagnostic activities during the second year of the pandemic in 2021, with most countries reaching higher numbers of diagnostic exams in 2021 than in 2019 partly to catch up the reduction in 2020. This surge was supported in several countries by creating diagnostic dedicated hubs and performance monitoring (OECD, 2023[2]). In 2022, the use of the CT, MRI and PET exams further increased in most countries. On average, 247 exams per 1 000 population [Infographic/Figure content omitted in strict text-only mode.]
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2, the use of the CT, MRI and PET exams further increased in most countries. On average, 247 exams per 1 000 population [Infographic/Figure content omitted in strict text-only mode.]
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200 Hospital beds and discharges The COVID-19 pandemic highlighted the need to have a sufficient number of hospital beds and flexibility in their use to address any unexpected surge in demand. Still, adequate staffing was more of a pressing constraint than bed numbers (OECD, 2023[1]). [Infographic/Figure content omitted in strict text-only mode.]
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202 Volumes of hip and knee replacements Hip and knee replacements are amongst the most frequent elective (non-urgent) surgical procedures in the EU. In 2022, nearly 1 million hip replacements were performed across EU countries (up by about 20% since 2012), and 680 000 knee replacements (up by 30% since 2012). The main indication for hip and knee replacement is osteoarthritis, which leads to reduced function and quality of life and is one of the main contributors to years lived with disability among musculoskeletal conditions (WHO, 2024[1]). Before the pandemic, hip and knee replacement rates were steadily growing, driven by increases in osteoarthritis and other types of arthritis caused by ageing populations and growing obesity rates. In 2022, 202 hip replacements per 100 000 population and 134 knee replacements per 100 000 population were performed across [Infographic/Figure content omitted in strict text-only mode.]
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ulation were performed across [Infographic/Figure content omitted in strict text-only mode.]
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204 Waiting times for elective surgery Long waiting times for elective (non-urgent) surgery have been a longstanding issue in many European countries dating back well before the pandemic, but the disruption of elective care during the pandemic exacerbated waiting times as many non-urgent interventions were suspended, generating more backlogs of patients on waiting lists. Long waiting times generate dissatisfaction for patients because the health benefits from treatment are postponed, patients can experience pain and discomfort while waiting, and the wait may worsen health outcomes for patients before and after the intervention. The data presented in this section focus on waiting times for three high-volume surgical procedures: cataract surgery, hip replacement and knee replacement. They review the experience of patients who have been treated after waiting for a certain period of time and those who were still on the waiting lists. In several countries, the waiting times for patients still on waiting lists have increased more than for those who were treated. Compared with the situation before the pandemic, the mean waiting times for people who had a cataract surgery in 2023 was close to 2019 in several countries (e.g. Hungary, Italy and Sweden) while it remained slightly higher than before the pandemic in [Infographic/Figure content omitted in strict text-only mode.]
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207 This chapter presents indicators related to health system resilience – the ability to prepare for, absorb, recover from and adapt to shocks. While the COVID-19 pandemic is the largest recent shock European health systems have faced, other challenges, such as antimicrobial resistance and climate change, also require resilience capacity. The pandemic highlighted the life-saving efficacy of vaccines, with countries with high vaccination coverage experiencing lower excess mortality. Vaccination against COVID-19 was particularly crucial for older people; by the end of 2021, nearly 90% of people aged 60 and above in the EU had completed their primary vaccination course. However, uptake of the booster dose in 2022 was more variable, with countries with higher coverage of the primary course experiencing smaller declines in uptake. Influenza vaccination coverage rates among older people also increased in many countries during the first year of the pandemic, but declined thereafter and remained well below the 75% target in most countries. Teleconsultations were pivotal for safe care delivery during pandemic peaks, but their volumes have since decreased in many countries. Going forward, countries will need to integrate teleconsultations and other telemedicine options efficiently and equitably. Population ageing will drive growing healthcare and long-term care needs in the coming years. Recent projections from the European Commission indicate that public spending on long-term care is projected to grow faster than public spending on healthcare in the coming decades, highlighting the importance of finding innovative ways to meet these needs efficiently within the constraints of human resources and budgets. 8 Resilience: Crisis preparedness, response capacity and fiscal su
ting the importance of finding innovative ways to meet these needs efficiently within the constraints of human resources and budgets. 8 Resilience: Crisis preparedness, response capacity and fiscal sustainability
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208 Crisis preparedness and public trust in institutions The COVID-19 pandemic has exposed vulnerabilities in European public health systems, highlighting the importance of strengthening crisis preparedness capacities to protect public health and minimise disruption. When asked about which risks they feel personally mostly exposed to in 2024, 27% of EU citizens reported feeling exposed to human health emergencies – the second-most frequently reported risk after extreme weather events (38%) (European Commission, 2021[1]). The pandemic has also raised awareness of the growing risks posed by global environmental changes, such as climate change, which in turn increase the likelihood of zoonotic infections spilling over from animals to humans. Strengthening crisis preparedness capacities is thus essential to bolster European countries’ response capacity to future pandemics and mitigate the impact of other looming threats. In this context, the WHO International Health Regulations (IHR) serve as the cornerstone of global efforts to enhance public health emergency preparedness and response worldwide. Amended in 2022 in response to the pandemic, the IHR provide a legal framework for countries to build and maintain minimum capacities to detect, assess and respond to public health threats. Countries must annually assess their capacities using the IHR States Parties Self-Assessment Annual Reporting Tool (SPAR), which covers 15 core capacities for effective public health emergency management (WHO, 2021[2]). In 2023, EU countries had on average a self-assessed IHR score of 75 out of 100, consistent with the average score reported in 2020. Capacity-specific scores showed that surveillance, laboratory capacity and human resources were the highest
elf-assessed IHR score of 75 out of 100, consistent with the average score reported in 2020. Capacity-specific scores showed that surveillance, laboratory capacity and human resources were the highest-ranked capacities on average across EU countries. Conversely, the lowest scores were recorded in risk communication and community engagement, radiation emergencies and chemical events. Compared to 2020, the average EU IHR score for human resource capacities improved significantly (+18%), while chemical events (-23%), radiation emergencies (-21%) and zoonotic diseases (-16%) saw the largest average declines. Scandinavian countries reported the highest total IHR scores, indicating near full compliance with IHR standards. France, Lithuania and Germany followed closely, with average IHR scores of 85 out of 100 or higher. Conversely, Romania (61), Greece (60) and the Slovak Republic (50) self-reported the lowest IHR scores in the EU. Between 2020 and 2023, Poland reported the largest overall IHR score increase (+46%) followed by Czechia and Malta (+13%), [Infographic/Figure content omitted in strict text-only mode.]
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by Czechia and Malta (+13%), [Infographic/Figure content omitted in strict text-only mode.]
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210 Public health laboratory and critical care capacities Infectious diseases, including novel pathogens and resistance to antimicrobials, are major and growing global public health threats. Resilient health systems depend on the timely and accurate detection of emerging and re-emerging diseases to control outbreaks at national and international level and to reduce the impact of public health emergencies on healthcare systems, as well as having a sufficient capacity to provide critical care when needed. Public health preparedness requires adequate capacity of microbiology laboratories to: 1) ensure rapid infection diagnostics to guide treatment, detect and control epidemics; 2) characterise infectious agents for designing effective vaccines and control measures; and 3) monitor the impact of prevention of infections and containment of antimicrobial resistance (AMR). Since 2013, the ECDC is operating the EULabCap (European Laboratory Capability Monitoring System) to assess whether laboratory systems in EU/EEA countries possess key public health microbiology service capacities for EU surveillance and epidemic preparedness for communicable diseases and antimicrobial resistance (ECDC, 2023[1]). In 2021, the EULabCap Index average for EU countries was 7.9 on a maximum scale of 10, a 5% improvement from the 2018 score (7.5). Of the 29 EU/EEA countries surveyed, 17 demonstrated high performance in public health laboratory capacity (score
8.0), while 11 demonstrated intermediate performance (score 6.0-7.9) and one country (Malta) had a low performance [Infographic/Figure content omitted in strict text-only mode.]
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(Malta) had a low performance [Infographic/Figure content omitted in strict text-only mode.]
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212 Antimicrobial resistance and safe antibiotic prescribing Antimicrobial resistance (AMR) occurs when bacteria develop the ability to survive the effects of antimicrobial drugs, rendering them ineffective. Although AMR is a natural process, human activities – such as the misuse of antibiotics and inadequate infection control in healthcare settings, especially hospitals – significantly accelerate its development. AMR constitutes a major public health threat in Europe and at a global level (OECD, 2023[1]). Estimates indicate that over 800 000 antibiotic-resistant infections occur annually in the EU, Iceland and Norway, with more than 70% being healthcare-associated, resulting in approximately 35 000 deaths every year. AMR’s economic impact is equally significant, with direct costs of treating resistant infections estimated at EUR 6.6 billion annually (ECDC, 2023[2]). Measuring AMR is complex due to the diversity of micro-organisms and antibiotics involved and the difficulty of establishing comprehensive surveillance. An effective approach measures the prevalence of resistance for specific pathogen-antibiotic combinations selected on the basis of their clinical importance and public health impact. The ECDC’s Composite AMR Index, combining data on five key bacteria-antibiotic pairs, provides a comprehensive overview of AMR in European hospitals. Data from 2022-23 indicate that, overall, 32% of reported bacterial isolates were resistant to first-level AMR markers, a proportion consistent with levels observed in 2016-17. However, this EU/EEA average masks significant cross-country variations and trends, with Northwestern European countries generally reporting significantly lower AMR rates than southeastern ones. Malta, Sweden and Finland demonstrated the lowes
ant cross-country variations and trends, with Northwestern European countries generally reporting significantly lower AMR rates than southeastern ones. Malta, Sweden and Finland demonstrated the lowest AMR index scores (<12%), while in Romania, Greece, Cyprus and Bulgaria over 50% of isolates exhibited resistance. Between 2016-17 and 2022-23, Cyprus, Lithuania and Estonia experienced the largest increases in their [Infographic/Figure content omitted in strict text-only mode.]
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214 Public health measures: Vaccination to protect older people Vaccination is a cornerstone of primary prevention, aiming to prevent disease and reduce severity when illness occurs. It is especially critical for older adults, who are more vulnerable to severe complications from vaccine-preventable illnesses. Ensuring high vaccination coverage among older populations is thus vital for reducing illness and alleviating pressure on healthcare systems. The COVID-19 pandemic has served as a stark real-world, large-scale demonstration of the life-saving efficacy of vaccines, with countries that achieved higher vaccination rates experiencing markedly lower excess mortality (OECD, 2023[1]). Vaccination was especially crucial for people over 60, who accounted for 93% of all COVID-19 deaths in the EU in 2020-21. By the end of 2021, nearly 90% of people aged 60 and above in the EU had completed their primary vaccination course, with all countries except three reaching at least 75% coverage. Denmark, Belgium and Ireland achieved 100% coverage in this age group. As evidence emerged on the waning effectiveness of vaccines (Menni et al., 2022[2]), European countries began administering booster doses in October 2021. By mid-2022, 83% of individuals aged 60 and above in the EU had received a booster shot. Booster uptake showed greater variation across countries compared to the primary vaccination cou
October 2021. By mid-2022, 83% of individuals aged 60 and above in the EU had received a booster shot. Booster uptake showed greater variation across countries compared to the primary vaccination course. All countries except Italy experienced lower booster uptake rates levels, with countries that had higher primary course coverage generally experiencing smaller declines in booster uptake. Declines were particularly significant in Croatia, Bulgaria, Latvia and Romania, where fewer than 50% of people aged 60 and over received a COVID-19 booster dose. With the emergence of new COVID-19 variants, all EU countries began administering a second set of bivalent booster vaccines in September 2022. However, uptake dropped significantly compared to the first booster, with less than 30% of people aged 60 and over receiving it by the end of 2022. Denmark, Ireland, Portugal, Sweden, Belgium and the Netherlands achieved the highest coverage rates of over 70%, while in Central and Eastern European countries less than [Infographic/Figure content omitted in strict text-only mode.]
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216 Use of teleconsultations Consultations with doctors are the most frequent contact most people have with health services and provide an entry point for subsequent medical treatment. Consultations can take place in different settings and during the COVID-19 pandemic the use of teleconsultations was crucial to continue to deliver care safely. On average across EU countries, in-person consultations fell by almost 20% in 2020, but the declines were almost completely offset by increasing numbers of teleconsultations in some countries such as Belgium, Croatia, Czechia, Estonia, Portugal and Spain. At the beginning of the pandemic, governments acted rapidly to promote the use of teleconsultations by introducing enabling legislation and revising laws. After the pandemic started, at least four EU countries that previously allowed only in-person consultations (Estonia, Hungary, Ireland and Luxembourg) dropped this restriction. France and Lithuania relaxed their prerequisite that patients were only allowed to have teleconsultations with doctors they had already consulted in person. Additionally, volume restrictions on physicians providing remote consultations were lifted in Germany and Sweden. Governments also promoted the use of telemedicine through changes in providers’ payment systems. At least six EU countries began covering teleconsultations through government/compulsory schemes (Belgium, Czechia, Estonia, Hungary, Latvia and Luxembourg) (OECD, 2023[1]). Even before the start of the COVID-19 pandemic, teleconsultations between doctors and patients were used extensively in countries such as Denmark. These teleconsultations were made possible through different options such as the national “My Doctor” mobile application that was set-up as part of Denmark’s Digit
in countries such as Denmark. These teleconsultations were made possible through different options such as the national “My Doctor” mobile application that was set-up as part of Denmark’s Digital Health Strategy 2018-22. Since 1 January 2022, video consultations have become a permanent consultation option (OECD/European Observatory on Health Systems and Policies, 2023[2]). In 2022, teleconsultations accounted for an average of 16% of all doctor consultations across 16 EU countries with available data [Infographic/Figure content omitted in strict text-only mode.]
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218 Digital health readiness Electronic health records (EHRs) are a key component of health systems’ digital transformation, but their successful implementation requires comprehensive technical, legal, and operational preparedness. This includes ensuring patient-provider accessibility, establishing standardized data sharing protocols and implementing secure information management systems. In 2023, EU countries have made significant investments to ensure reliable nationwide access to EHRs, with the average availability of online digital health services (expressed by the Digital Economy and Society Index) rising by 8 percentage points [Infographic/Figure content omitted in strict text-only mode.]
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220 Medical and nursing graduates Ensuring a sufficient supply of doctors and nurses is essential for high-quality healthcare delivery, particularly for ageing populations. In this context, the number of new medical and nursing graduates is a key indicator of the potential influx of new health professionals into health systems. While most EU countries have expanded medical and nursing education programs post- COVID-19, the effect of these changes on the influx of new doctors and nurses will only become apparent after several years due to the length of medical and nursing degree programmes. The number of medical graduates across the EU increased over the last decade at an average annual rate of over 3.5%, rising from about 48 900 in 2012 to 69 300 in 2022. In contrast, the number of nursing graduates increased at a slower rate of about 0.5% per year, from approximately 159 000 in 2012 to 167 300 in 2022. In 2022, there were 15.5 medical graduates and 37.5 nursing graduates per 100 000 population in the EU as a whole, up from 11.1 medical graduates and 36.0 nursing graduates per 100 000 population in 2012. Defining an optimal target for new medical or nursing graduates is complex; the need for new doctors and nurses is influenced by retention rates within the profession (with higher early departure rates increasing replacement needs) as well as evolving demand for health services due to factors such as population ageing and changing disease burden. In 2022, the number of new medical graduates per 100 000 population varied significantly across EU countries, ranging from [Infographic/Figure content omitted in strict text-only mode.]
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ss EU countries, ranging from [Infographic/Figure content omitted in strict text-only mode.]
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222 Capital expenditure in the health sector Adequate infrastructure, encompassing both physical facilities and equipment such as diagnostic and therapeutic equipment as well as digital and information technology (IT) tools, is vital for the resilience and long-term productivity of any health system. In this regard, the COVID-19 pandemic highlighted how sufficient equipment in intensive care units and other healthcare facilities can mitigate crucial delays in diagnosis and treatment (OECD, 2023[1]). While an optimal level of capital investment in the health sector is challenging to define and is subject to many country-specific factors, it is of critical importance for countries to maintain their ability to address future crises, as insufficient investment can overextend service provision and may even lead to system failure. In the long-term, persistent underinvestment combined with deteriorating equipment and facilities can impact day-to-day service delivery and lead to higher overall costs. Capital investment levels in healthcare tend to fluctuate more from year to year compared to current health expenditure, as they are often subject to complex, long-term plans that are influenced by political priorities and aligned with prevailing economic conditions. Capital expenditure can also be affected by the needs to respond to acute and unforeseen events, such as a pandemic. In 2022, EU countries allocated an average of 0.6% of their GDP to capital expenditure in health, equivalent to about 6% of current [Infographic/Figure content omitted in strict text-only mode.]
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223 [Infographic/Figure content omitted in strict text-only mode.]
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valent to about 6% of current [Infographic/Figure content omitted in strict text-only mode.]
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224 With over 80% of health spending in the EU being publicly financed, the ability to forecast future budgetary pressures, such as the magnitude and growth of health expenditure, is essential for fiscal sustainability. In this context, the ageing EU population is a primary concern, as this demographic shift leads to increased health and long-term care needs, a rise in chronic conditions and comorbidities and a smaller proportion of working-age individuals contributing to the tax base that funds health and long-term care services. Additionally, the high cost of innovative medications, particularly in areas like oncology, further strains healthcare budgets. While investing in more resilient health systems and embracing technological advancements can improve the cost- effectiveness of healthcare services, these pursuits can also lead to additional fiscal pressures. Tracking long-term budgetary constraints through long-term projections enables decision-makers to plan ahead and accommodate potential financial needs arising from the health and long-term care sector. The Ageing Working Group of the Economic Policy Committee (AWG), using the European Commission services’ models, regularly conducts projections of public expenditure on both health and long-term care (European Commission, 2024[1]). By varying demographic and economic determinants, their 2024 projections produce a number of scenarios assessing their impact on the evolution of public healthcare and long-term care spending over the 2022-70 period. The data presented is based on the 2024 baseline scenario (formerly known as “AWG reference scenario”), which models the spent without disability, and ii) the income elasticity of healthcare spending converges linearly from 1.1 in 2022 to 1.0 in 2070. According
ly known as “AWG reference scenario”), which models the spent without disability, and ii) the income elasticity of healthcare spending converges linearly from 1.1 in 2022 to 1.0 in 2070. According to this model, the 2024 projections indicate a public spending on healthcare potential average increase of [Infographic/Figure content omitted in strict text-only mode.]
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228 Table A A.1. Total population on 1 January, 1960 to 2023 Austria Belgium Bulgaria Croatia Cyprus Czechia Denmark Estonia Finland France Germany Greece Hungary Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Poland Portugal Romania Slovak Republic Slovenia Spain Sweden EU27 (total) Albania Iceland Moldova Montenegro North Macedonia Norway Serbia Switzerland Türkiye Ukraine United Kingdom Note: Data for 2023 are provisional and subject to revisions. Population figures for Germany prior to 1991 refer to West Germany. Source: Eurostat (demo_pjan). Data extracted in July 2024. StatLink 2 https://stat.link/khdfcl
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229 Table A A.2. Share of the population aged 65 and over, 1 January, 1960 to 2023 Austria Belgium Bulgaria Croatia Cyprus Czechia Denmark Estonia Finland France Germany Greece Hungary Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Poland Portugal Romania Slovak Republic Slovenia Spain Sweden EU27 (total) Albania Iceland Moldova Montenegro North Macedonia Norway Serbia Switzerland Türkiye Ukraine United Kingdom Note: Population figures for Germany prior to 1991 refer to West Germany. The EU average for the year 2000 refers to 2001 data. Source: Eurostat (demo_pjanbroad). Data extracted in October 2024. StatLink 2 https://stat.link/rg1uy0
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91 refer to West Germany. The EU average for the year 2000 refers to 2001 data. Source: Eurostat (demo_pjanbroad). Data extracted in October 2024. StatLink 2 https://stat.link/rg1uy0
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230 Table A A.3 Total fertility rate, number of children per women aged 15-49, 1960 to 2022, or nearest year Austria Belgium Bulgaria Croatia Cyprus Czechia Denmark Estonia Finland France Germany Greece Hungary Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Poland Portugal Romania Slovak Republic Slovenia Spain Sweden EU27 (total) Albania Iceland Moldova Montenegro North Macedonia Norway Serbia Switzerland Türkiye Ukraine United Kingdom Source: Eurostat (demo_find). Data extracted in July 2024; data for the United Kingdom is taken from OECD Statistics. StatLink 2 https://stat.link/n1o3a9
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Health at a Glance: Europe 2024 The 2024 edition of Health at a Glance: Europe examines the major challenges facing European health systems in the aftermath of the COVID‑19 pandemic. The report includes two thematic chapters. The first chapter provides a comprehensive examination of health workforce shortages in Europe, a long‑standing problem exacerbated by the immense strain the pandemic placed on health systems. It explores the factors behind these shortages and proposes policy strategies to attract, train and retain the workforce needed to build resilient health systems. The second chapter reviews the most recent trends in the health of Europe’s ageing the chapter discusses priorities to promote healthy longevity to reduce demands on health and long‑term care systems. The remaining chapters provide a comparative overview of the latest data on health status, risk factors and health system performance across the 27 EU member states, 9 EU candidate countries, 3 European Free Trade Association countries and the United Kingdom. Health at a Glance: Europe 2024 is the first step in the State of Health in the EU cycle. PRINT ISBN 978-92-64-8044
idate countries, 3 European Free Trade Association countries and the United Kingdom. Health at a Glance: Europe 2024 is the first step in the State of Health in the EU cycle. PRINT ISBN 978-92-64-80445-6 PDF ISBN 978-92-64-58300-9 9HSTCQE*iaeefg+
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