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Health in Ireland Key Trends 2015

Health in Ireland Key Trends gives us insights into trends in demographics, population health, hospital and primary care and health service employment and expenditure.

The presentation of trend data over the last decade in the 2015 report highlights the many significant achievements that Ireland has made in terms of key outcomes relating to the health and wellbeing of the population. However, it also highlights the challenges that persist in terms of the accessibility of timely healthcare and in the context of financial constraints.

In the last decade alone, there has been an increase of two and a half years in life expectancy. These gains are driven largely by reductions in mortality rates from principal causes of deaths such as those from heart disease and cancer.

Another striking feature is the growth in the number of people aged over 65. Each year this cohort increases by 20,000 people. This trend is set to continue into the future and will have implications for future planning and health service delivery. Ireland will see the largest proportional increases in the population aged 85 years and older.

Ageing of the population in conjunction with lifestyle-related health threats continue to present major challenges now and into the future in sustaining and further improving health and health services in Ireland. Although difficult to quantify, the contribution of modern health services to these improvements in health outcomes and in life expectancy have been significant.

Ireland’s fertility rates are still among the highest in Europe but the birth rate has fallen to its lowest rate for the last decade.  However, Ireland currently has the highest proportion of children and young people in our population among EU countries.

The first Healthy Ireland survey was published in October and a selection of results highlighting the main determinants of health are included in this publication. This survey along with results from future waves will provide policy makers and stakeholders with valuable information about the health status of the Irish population.

While there are fewer inpatient hospital beds than a decade ago, there has been a 41% increase in day beds and a shorter length of stay. This shows Ireland is using its capacity more efficiently.

This year, for the first year since 2007, the numbers employed in the public health service have increased with the numbers of employees increasing across all grade categories.

Link to report

http://health.gov.ie/wp-content/uploads/2015/12/Health_in_Ireland_KeyTrends2015.pdf

Further Information

This is the eighth edition of this easy-to-use reference guide to significant trends in health and health care over the past decade, including population and health status, as well as trends in service provision. This year, new tables, maps and graphs have been included on some specific topics or where new data has been made available. Each section has a brief introduction summarising key statistics.

Key trends include:

  • Total hospital discharges continue to rise with 61% of this activity now carried out on a day case basis (including dialysis). There has been a 45% increase in the number of day cases seen in public acute hospitals since 2006. Improved and less invasive medical practice is largely responsible for the rapid growth in day patient activity.
  • Over the past decade, Ireland has achieved a rapid improvement in life expectancy. Life expectancy in Ireland has increased by two and a half years since 2004 and has been consistently higher than the EU average throughout the last decade.
  • Much of this increase in life expectancy is due to significant reductions in major causes of death such as circulatory system diseases. Since 2005, there has been a reduction in mortality rates for most major causes. The overall mortality rate has reduced by 19% since 2005.
  • Ireland is now beginning to catch up with other European countries in terms of population ageing. The population of those aged 65 years and over has been increasing at a faster rate than that of our EU neighbours. The numbers of people in this age group is expected to almost double in the next 20 years, with the greatest proportional increase in the 85+ age group.
  • Despite reductions in the numbers of births in recent years, the fertility rate in Ireland remains the 2nd highest in the EU behind France. From 2007 to 2012, Ireland’s fertility rate was the highest in Europe.
  • In comparison to other EU countries, Ireland continues to have the highest levels of self-perceived health of any EU country. Those with higher education attainment tend to report better health than those with lower education attainment.
  • The number of people waiting longer than 52 weeks for an outpatient appointment was increasing to May 2015 but has dropped since.
  • In terms of elective procedures, for adults (waiting more than 8 months) there has been a reduction in the numbers waiting since August 2015.
  • For children (waiting more than 20 weeks) the number waiting for elective procedures increased throughout the year until October 2015. There has been a slight decrease in the numbers of children waiting in November.
  • 38% of the population was covered by a medical card at the end of 2014. Numbers covered increased by 53% over the decade but have started decreasing since 2012. There has been a 4% decrease in medical card numbers from 2013 to 2014.
  • The percentage of the population covered by private health insurance has also declined in recent years.
  • Those with a medical card visit a GP more frequently than those without a card. Those aged 65 and over tend to visit their GP more often than those in younger age groups.
  • Childhood immunisation rates have been increasing since 2005 and are now at 95% or above for most immunisations.
  • The numbers of people employed in the public health service now stands at just over 102,200 (September 2015). This is a 3% increase from the numbers employed in the public health service at the end of 2014.
  • Total public health expenditure has risen from €12.7 billion in 2006 to €14.2 billion in 2015. Estimates for 2015 indicate a 4% increase in expenditure from 2014.

Further key trends, by section of the booklet, are presented below:

Section 1 – Population and Life Expectancy

  • The population in 2015 was 4,635,400 persons. This is a slight increase of 1.3% on the 2011 Census of Population. There has been a 9% increase in population since 2006, with the largest % change in the over 65 age groups. (Tables 1.1 and 1.2)
  • Counties in the west and north-west of Ireland have a greater proportion of people aged 65 and over. (Figure 1.1)
  • The total population in Ireland has increased more rapidly than the EU average in the last decade, however the increase has been modest since 2010. The population aged 65 and over has increased at a greater rate than the population as a whole. (Figure 1.2)
  • The numbers of registered births in 2014 have shown a 2% decrease on the previous year, 67,462 births being registered in the year. This still represents around 6,000 more births annually than a decade ago. (Table 1.3)
  • The Total Fertility Rate has decreased slightly in recent years and now stands at 1.95. However, Ireland has the 2nd highest rate of fertility amongst EU countries behind France. The EU average is 1.55. (Figure 1.4)
  • In 2014, counties Kerry and Dublin had the lowest fertility rates. (Figure 1.3)
  • The numbers of people in older age groups is beginning to increase significantly. The numbers of people over the age of 65 years is projected to almost double to around 1 million by 2031. The greatest proportional increase will be in the 85+ age group. (Tables 1.4, 1.5 and Figure 1.5)
  • Although women have a higher life expectancy than men, when life expectancy is expressed as years lived in good health (i.e. healthy life years) at age 65, the difference between women and men is less significant, indicating that women live longer but with more health problems. (Figure 1.9)

Chapter 2 – Health of the Population

Please note that any references below to 2013 and 2014 mortality data should be considered provisional, as 2013 and 2014 data in this report are based on year of registration, and not year of occurrence.

Also note that because of a change in statistical methods due to the implementation of the new European standard population, the age standardised mortality rates in Key Trends 2015 are not comparable with those stated in previous years, versions of Key Trends. For information on the change in methods see the Statistics section of the Department of Health website.

  • In 2013, 83% of males and 81% of females rated their health as being good or very good. This is the highest in the EU and compares with an average of 70% and 64% for males and females respectively across the EU. Those with higher educational attainment report being in better health. (Table 2.1, Figures 2.1, 2.2)
  • 52% of males and 56% of females aged 65 and over reported suffering from a chronic illness or health problem. In the 75+ age category, 49% and 51% of males and females respectively reported some or severe limitation in usual activities due to health problems. (Tables 2.2, 2.3)
  • Over the 10 year period 2005-2014, age-standardised death rates for all causes fell by 19%. Most recently, death rates have shown a decrease of 6.3% between 2013 and 2014 (data for 2013 and 2014 are provisional). (Table 2.4)
  • Among those aged 65 years and over diseases of the circulatory system accounted for 34% of all deaths registered in 2014. This compares with 18% of deaths to those aged less than 65 years. An overall decline in the age-standardised death rate of 32% occurred between 2005 and 2014. (Table 2.4 and Figures 2.3a, 2.3b)
  • Deaths from respiratory diseases (including cancer of the trachea, bronchus and lung) accounted for 20% of all deaths to those aged 65 and over and 12% of all deaths to those aged under 65. (Figures 2.3a, 2.3b)
  • 19% of deaths in 2014 to those aged less than 65 years were due to external causes of death such as transport accidents and suicide. This compares with just over 2% of deaths to those aged 65 years and over. (Figures 2.3a, 2.3b)
  • There has been an 8% decline in the age-standardised death rate for cancer in the last decade, more recently there has been a decrease of 2.1% between 2013 and 2014. The female breast cancer death rate declined 15% since 2005. (Table 2.4)
  • Death rates from suicide are down 10% since 2005 and have decreased by 3% between 2013 and 2014 (data for 2013 and 2014 are provisional). (Table 2.4)
  • Ireland’s age-standardised death rate in 2012 was above the EU average, though not significantly. The death rate from respiratory diseases (including cancer of the trachea, bronchus and lung) was 42% above the EU average. (Table 2.5)
  • Ireland has had a lower infant mortality rate than the EU average over the last decade; however the gap has narrowed in recent years. (Figure 2.7)
  • There has been significant improvement in survival rates from breast and colorectal cancer in the last 15 years. However, 5-year relative survival rates from breast and cervical cancers are lower in Ireland than the average for OECD countries where data is available. The survival rate in Ireland for colorectal cancer is slightly lower than the OECD average. (Figure 2.8)
  • The percentage of mothers breastfeeding on discharge from hospital has increased steadily in the last decade with the proportion remaining stable between 2013 and 2014. In 2014, 56% of women breastfed at least partially. (Figure 2.9)
  • Cigarette consumption has declined over the past decade while alcohol consumption has increased slightly in 2014.  The official figures do not include purchases made outside the State or illegal imports into the State which may exaggerate the recent years’ decline. (Figure 2.10)
  • Persons who have attained a tertiary level qualification have lower rates of daily smoking and less likely to be classified as overweight or obese than those in other educational groups. (Figure 2.11)
  • Among those who drink alcohol, a higher percentage of males than females partake in risky single-occasion drinking (defined as consuming 6 or more standard units of alcohol at least once per month in the previous 12 months). Across social class, a higher percentage of persons in lower social classes engage in risky single-occasion drinking. (Figure 2.12)
  • Since 2010, the percentage of children aged 10-17 who are smokers or have ever been really drunk has declined, while there has been no significant change in the percentage of children who have been physically active on 7 days in the past week. (Figure 2.13)
  • The percentage of people meeting the minimum physical activity requirements varies across gender and age group. A higher proportion of males than females are considered to be meeting the minimum physical activity requirements, while more persons in younger age groups are considered to be meeting the minimum physical activity guidelines than those at older ages. (Figure 2.14)
  • A higher proportion of females than males eat at least one serving of fruit or vegetables per day.  (Figure 2.15)

Chapter 3 – Hospital Care

  • Inpatient discharges from publicly funded acute hospitals have increased by 12% since 2005. Day cases have increased by 45% since 2006. (Table 3.1)
  • Hospital discharge rates increase with older age groups. There has been an increase in the discharge rate of adults since 2006, with a small decline in rates for children over the same period. In particular, older age groups saw the largest increases. (Figure 3.1)
  • In terms of elective procedures, for adults (waiting more than 8 months) there has been a reduction in the numbers waiting since August 2015.
  • For children (waiting more than 20 weeks) the number waiting for elective procedures increased throughout the year until October 2015. There has been a slight decrease in the numbers of children waiting in November
  • The 30-day moving average has seen a higher seasonal increase in the numbers of patients waiting on trolleys up to July 2015, when the year-on-year increase measured 42%, but this trend has gradually reversed since July and as of the start of December 2015, the 30-day moving average is 3% below the level recorded at the same point in 2014.
  • 251 transplants were carried out in Ireland in 2014. (Figures 3.5, 3.6)
  • The number of admissions to psychiatric hospitals and units has decreased between 2013 and 2014. There are now more than 16% fewer admissions than in 2005. (Table 3.2, Figure 3.7)

Chapter 4 – Primary Care and Community Services

  • 38% of the population had a medical card at the end of 2014. This compares with 28% in 2005. (Table 4.1)
  • Louth, Mayo and Donegal had the highest percentage of population with medical cards. (Figure 4.2) (NOTE: data in the map are presented by Local Health Office areas)
  • Between 2013 and 2014 there was a decrease (4.4%) in medical cards to 1.77 million representing 38% of the population. Numbers of GP only visit cards increased by 27% to just under 160,000. (Table 4.1)
  • The number of people registered for the Drugs Payments Scheme has declined 5% between 2013 and 2014. (Table 4.1)
  • The numbers of people on the Long-Term Illness Scheme has increased by 98% or over 97,000 people since 2005. (Table 4.1)
  • The number of people treated under the dental and ophthalmic schemes has risen by 80% and 82% respectively between 2005 and 2014. (Table 4.1)
  • The average number of visits by a person with a medical card is higher than for someone with a GP only card. The average number of GP visits is lower for those who do not have a medical or GP visit card. (Figure 4.3)
  • The number of prescription items dispensed under the General Medical Services has decreased by 4.2% between 2013 and 2014, yet the average cost per item has reduced by over 5%. (Figure 4.3)
  • There has been a reduction in the percentage of people covered by private health insurance between 2009 and 2014. This is the case for all age groups, with the exception of those aged 70 and over where there has been an increase in the percentage of people covered. (Figure 4.4)
  • The proportion of those aged 85 and over in long stay care as a percentage of all those in long stay care has increased during the period 2005 to 2014. All other age groups over 70 have shown declines over the same period. (Table 4.3, Figure 4.5)
  • The immunisation uptake rates of children aged 24 months in 2014 was 95% or higher for most immunisations, with the exception of the MMR, Meningococcal and Pneumococcal Conjugate vaccines. (Table 4.4)
  • The number of people registered with the National Physical and Sensory Disability Database was 22,908 in 2014. Over 54% of these had a physical disability only. (Table 4.5)
  • The number of persons with intellectual disability availing of day services has increased by 23% for day attendees over the period 2005-2014. (Table 4.6)
  • The number of cases in treatment for problem drug use has increased by 52% during the period 2005-2014. (Table 4.7)

Chapter 5 – Health Service Employment

  • Since 2008, total numbers employed in the public health services have shown a gradual decline. There were 102,245 wholetime equivalents employed in September 2015. This represents an increase of 2.9% since December 2014. It should be noted that figures for 2015 refer to September, and do not therefore represent the end of year position. (Table 5.1, Figure 5.1)
  • All grade categories have shown an increase between December 2014 and September 2015. (Table 5.1)
  • Nurses make up the largest grade category in the public health service, with 34% of total staff employed. (Figure 5.2)
  • The number of consultants employed by the public health service increased by 23% in the period 2006-2015. They also increased by 3% between December 2014 and September 2015. (Table 5.2, Figure 5.3)
  • The number of non-consultant hospital doctors increased by 21% in the period 2005-2014. They also increased between December 2014 and September 2015. (Table 5.2, Figure 5.3)
  • There were 2.7 practicing doctors per 1,000 population in Ireland in 2013. This is below the OECD29 average of 3.3. (Figure 5.4)

Chapter 6 – Health Service Expenditure

  • Total public non-capital expenditure on health has increased by 12.9% since 2006, however during this period there was an 11.9% decrease from 2009 to 2014. It has increased by 4.2% between 2014 and 2015 (data for 2015 are estimates). (Table 6.1)
  • Public capital expenditure on health increased by 11.1% between 2013 and 2014 and decreased by just over 25% since 2005. (Table 6.3)
  • According to the System of Health accounts (SHA) methodology, Ireland’s current total (public and private) health expenditure was estimated to be €18.4 billion in 2013 (This estimate is preliminary). (Tables 6.4-6.6, Figure 6.3)