Health in Ireland Key Trends 2010
The Department of Health and Children today (17th December 2010) published Health in Ireland: Key Trends 2010. This is the third edition of this report which presents, in booklet format, a range of data on significant trends in health and health care over the past decade.
Health in Ireland: Key Trends 2010 covers population and health status as well as trends in service provision. It is designed as an easy-to-use reference guide to significant trends in health and health care over the past decade. A number of new tables and graphs have been included on specific topics of importance and/or where new data has been made available. Each section of the booklet has a brief introduction summarising key statistics.
During the past ten years, major improvements in health status and life expectancy are evident in the tables and graphs of this booklet. Also evident is the very significant investment in the health services which has taken place resulting in increased and improved healthcare provision and which has contributed to the gains in the health of the population. The booklet also illustrates areas where significant improvements are required, where continuing health inequalties exist and where new threats to health are emerging.
Examination of trends over a decade also helps to identify the challenges facing health and the health services in the coming years. Issues such as obesity, smoking and alcohol consumption present serious problems and have the potential to undermine many of the gains achieved in recent years. The ageing of the population is already occurring and will increasingly impose additional demands on service capacity and the management of chronic conditions. Ensuring that health inequalities are reduced and that access to services is maintained and improved are major aims. In an economic climate where resources will be severely constrained, improved efficiency, effectiveness and equity at all levels of the health services will be essential in successfully managing these demands.
Key trends include:
- Over the past decade, Ireland has achieved a rapid and unprecedented improvement in life expectancy. During a period when the average life expectancy in the EU has continued to rise, Ireland has gone from a position of nearly 1 year below the EU average life expectancy, to almost 1 year above. Much of this increase is due to significant reductions in major causes of death such as circulatory system diseases.
- Ireland is now beginning to catch up with other European countries in terms of population ageing. The numbers of people over the age of 65 years will double in the next 20 years to over 1 million. The greatest proportional increase will be in the 85+ age group.
- Ireland continues to have the highest levels of self-perceived health of those countries in Europe participating in the EU Survey on Income and Living Conditions. 86% of men and 83% of women rate their health as being good or very good. This compares with 71% and 65% for males and females respectively across the EU. The survey also shows significant chronic health problems in the older age groups.
- The results of the All Ireland Traveller Health Study indicate that Travellers continue to experience much lower life expectancy than the population as a whole. For Traveller men, life expectancy is 15.1 years lower; for women it is 11.5 years lower.
- Total hospital discharges continue to rise but an increasing proportion of this activity is now carried out on a day case basis. There has been a 139% increase in the number of day cases seen in public acute hospitals since 2000 Improved and less invasive medical practice is largely responsible for the rapid growth in day patient activity. Average length of stay in hospital for inpatients has fallen to just below 6 days for the first time.
- 33% of the population is covered by a medical card. Numbers covered have increased by almost 30% over the decade and by over 9% between 2008 and 2009.
- Number of prescription items dispensed under the General Medical Services has rapidly increased from 22 million to almost 51 million since 1999.
- Immunisation rates have been increasing since 2002 and are now approaching the 95% rate as envisaged by the ‘Immunisation Guidelines for Ireland’, (2008).
- Total public health expenditure has risen from €7.2 billion in 2001 to €15.5 billion in 2009. Estimates for 2010 indicate a decline of 4.3% on the 2009 figure, down to €14.8 billion.
- Public capital expenditure on health was €450 million in 2009 representing a 25% decline on the previous year.
Mary Harney, TD, Minister for Health and Children said: “In welcoming this publication, I would like to draw attention to the major improvements in the health of the population and in the delivery of health services which have been achieved over the past ten years. We have seen remarkable gains in life expectancy resulting from large reductions in mortality rates from major causes of death, particularly in the area of circulatory system diseases, where death rates have decreased by 39%. Sustained investment in the health services and the introduction of new and more effective methods of treatment have played a significant part in this success.
“We are now in a period where resources are severely constrained. Protecting and enhancing our health gains and continuing to improve health services will require working both more efficiently and more effectively. An example of our determination to achieve this is provided by the continuing move to day case treatment in our acute hospitals. At 650,000 per year, day cases now outnumber inpatients and have increased by 139% over the last decade. Our ability to measure our health and health services, with the kinds of data provided in this publication, will be increasingly essential in setting priorities and evaluating progress. “
Further key trends, by section of the booklet, are presented below:
Section 1 – Population and Life Expectancy
- The 2010 population estimates for younger and older age groups (0-14, 65+) have continued to increase, while those of working age (15-64) have decreased. Overall, the population is continuing to grow but at a reduced rate compared with earlier years. (Table 1.2)
- The numbers of births in 2009 have shown a 1% decrease on the previous year, 74,278 being born in the year, but this still represents around 20,000 more births annually than a decade ago. (Table 1.3)
- The Total Fertility Rate has also slightly decreased to 2.07. However, Ireland continues to have the highest rate of fertility amongst EU countries, the EU average being 1.54. (Figure 1.1)
- The numbers of people in older age groups is beginning to increase significantly. Approximately 20,000 more people are being added to the 65+ age group each year. Numbers will double within the next 20 years to over 1 million people, with the largest proportional increase in the 85+ age category. (Figure 1.2)
- Male life expectancy at birth in Ireland is now 76.8 years, female life expectancy at birth is 81.6 years. Ireland now has the 8th highest life expectancy in the EU. This compares with a ranking of 16th in the year 2000. (Figure 1.4)
- When life expectancy is expressed as years lived in good health (i.e. healthy life years), the difference between women and men is much less significant, indicating that women live longer but with more health problems. (Figure 1.5)
Chapter 2 – Health of the Population
- In 2008, 86% of males and 83% of females rated their health as being good or very good. This is the highest in the EU and compares with an average of 71% and 65% for males and females respectively across the EU. Self-perceived health is related to income levels with 20% more people in the highest income group rating their health good or very good compared with the lowest income group. (Table 2.1; Figures 2.1, 2.2)
- Over 52% of males and 55% of females aged 65 and over reported suffering from a chronic illness or condition, while 42.7% and 47.3% of males and females respectively reported some limitation in activity due to health problems in this age group. (Tables 2.1, 2.3)
- Over the 10 year period 2000-2009, age-standardised death rates for all causes fell by 26%. However, the decline has been levelling out in recent years and the rate decreased by just 0.2% between 2008 and 2009. (Table 2.4)
- Diseases of the circulatory system accounted for over 33% of all deaths registered in 2009. A decline in the age-standardised death rate of over 39% occurred between 2000 and 2009. (Figures 2.3, 2.4)
- There has been an 11% decline in the age-standardised death rate for malignant neoplasms during the period 2000-2009. The female breast cancer rate declined 20% during the same period. (Table 2.4)
- Death rates from suicide are down 9% since 2000, but have increased 24% between 2008 and 2009. The interpretation of this single year rise needs to be treated with some caution since figures for 2008 and 2009 are based on deaths which were registered during the year rather than those which occurred in that year. (Table 2.4)
- While Ireland’s age-standardised death rate in 2008 was 6% below the EU average, the death rate from all cancers was 5.5% above the EU average. (Table 2.5)
- 5-year relative survival rates from selected cancers remain lower in Ireland than the average for OECD countries, However, the gap is significantly narrowing particularly for breast and cervical cancers. (Figure 2.6)
- In 2007, 59% of males and 41% of females reported that they were either overweight or obese. This is an increase of 16% and 17% for males and females respectively between 1998 and 2007. (Table 2.6)
- Both alcohol and cigarette consumption have declined in recent years. The official figures do not include purchases made outside the State or illegal imports into the State which may exaggerate the decline. (Figure 2.7)
- Mothers in professional, skilled and management occupations have higher breastfeeding rates. (Figure 2.8)
Chapter 3 – Hospital Care
- Inpatient discharges from publicly funded acute hospitals have increased by 14% since 2000, but have decreased slightly by 1% between 2008 and 2009. Day cases have increased by 139% since 2000 and have also increased by 6.4% between 2008 and 2009. (Table 3.1)
- Since 2008, the number of day cases (excluding dialysis) treated in publicly funded acute hospitals has been higher than the number of inpatients. (Figure 3.1)
- A&E attendances have fallen by 11% between 2007 and 2008. Over the same period, outpatient attendances have increased by 7%. (Table 3.1)
- In 2009, the average length of stay in a publicly funded acute hospital for the first time fell to just under six days (5.96). Average length of stay is strongly associated with age rising from around 3 days for those under the age of 35 to nearly two weeks for those over the age of 85. (Table 3.1; Figure 3.2)
- Ireland continues to have higher Caesarean Section rates than the EU average, with a rate of 27 per 100 live births in 2007. (Figure 3.3)
- The number of admissions to psychiatric hospitals and units has slightly decreased between 2007 and 2008 (0.1%). There are now 17% fewer admissions now than in 1999. Admission rates to psychiatric hospitals and units have decreased for all age groups since 1999, but least for those under the age of 25 reflecting the acute nature of admissions in this age group. (Table 3.3; Figure 3.4)
Chapter 4 – Primary Care and Community Services
- Levels of unmet need for a medical examination at just under 3% are low by EU standards where the average is above 6%. In Ireland, in contrast with the pattern across the EU, people on middle incomes reported slightly higher levels of unmet need for a medical examination than those on lower or higher incomes. (Figure 4.1)
- Between 2008 and 2009 there was an 8% increase in medical cards to nearly 1.5 million representing 33% of the population. Numbers of GP Visit cards increased by 14% to nearly 100,000. (Table 4.1)
- The number of prescription items dispensed under the GMS has increased from just under 22 million in 1999 to just under 51 million in 2009. (Figure 4.2)
- The number of children in care increased by 27% between 1999 and 2008. The percentage of these children in foster care also increased over the same period by 15%. Nearly 90% of children in care are now being fostered. (Table 4.2)
- The proportion of those aged 85 and over in long stay care as a % of all those in long stay care has increased by 25% during the period 1999 to 2008. All other age groups over 65 have shown declines over the same period. (Table 4.3; Figure 4.3)
- The immunisation uptake rates of children aged 24 months in 2009 was 93% for all immunisations, with the exception of the MMR which stood at 90%. (Table 4.4)
- The number of people registered with the National Physical and Sensory Disability Database was 26,168 in 2009. Over 59% of these had a physical disability only. (Table 4.5)
- The number of persons with intellectual disability availing of day services has increased by 9% for day attendees and nearly 4% for full-time residents. (Table 4.6)
- The percentage of establishments inspected for food safety where infringements were found has declined steadily over the period 1999-2008. In 2008, 27.9% of establishments inspected were found to have infringements compared with 52% in 1999. (Table 4.7)
Chapter 5 – Health Service Employment
- Since 2007, total numbers employed in the public health services have shown a gradual decline. The largest fall in numbers has been in the Management/administration category. It should be noted that figures for 2010 refer to August, and do not therefore represent the end of year position. (Table 5.1; Figure 5.1)
- Overall employment in the public health service remains at about 20% higher than a decade ago. (Table 5.1; Figure 5.1)
- Nurses make up the largest grade category in the public health service, with 34% of total staff employed. The Health and Social Care Professionals were the only grade category to show an increase between December 2009 and August 2010. Indeed, this category showed the largest increase between 2001 and 2010, increasing by almost 75%. (Table 5.1; Figures 5.1, 5.2, 5.3)
- The number of consultants employed by the public health service increased by almost 51% in the period 2001-2010. They also increased by almost 5% between December 2009 and August 2010. (Table 5.2; Figure 5.4)
- The number of non-consultant hospital doctors increased by almost 25% in the period 2001-2010. They declined, however, by 3.1% between December 2009 and August 2010. (Table 5.2; Figure 5.4)
- The number of agreements between the HSE and GPs for the provision of services under the Primary Care Reimbursement Service has increased by almost 55% in the period 1999-2008. The number of agreements also increased by almost 11% between 2007 and 2008. (Table 5.3)
Chapter 6 – Health Service Expenditure
- Total public non-capital expenditure on health has increased by 112.5% since 2001, however it has decreased by 4.1% between 2009 and 2010. (Tables 6.1, 6.2)
- Public capital expenditure on health has increased by over 52% over the period 2000-2009, however it has decreased by 25% between 2008 and 2009. (Table 6.3)
- In 2008, Ireland’s total health expenditure on health was 8.7% of GDP and 10.2% of GNI. This compares with the OECD averages of 8.9% and 9.5% respectively. The sharp rise between 2007 and 2008 in health spending as a percent of GNI can be explained by the slowdown in economic growth which had already begun to occur. (Table 6.4; Figure 6.4)
- Ireland’s per capita total health expenditure has increased steadily in real terms between 1999 and 2008. (Figure 6.3)
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