Publication of OECD Health at a Glance 2009
Ireland welcomes the publication, OECD Health at a Glance 2009. The OECD is a respected authority in developing indicators for assessing the performance of health systems. The 2009 publication is a valuable and reliable source of internationally comparable data on health and health systems up to and including 2007.
The OECD notes that there are opportunities for all countries to improve the performance of healthcare and Ireland is no different in this regard.
A primary goal of healthcare is improved health status. Factors contributing to better health include lifestyle and the performance of the health system itself.
On key indicators such as life expectancy and infant mortality, Ireland scores well. Life expectancy in Ireland stands at 79.7 years in 2007 which is above the OECD average of 79. A key contributory factor is the significant reduction in major causes of death such as diseases of the circulatory system – down by 26% from 13,380 in 1999 to 9,883 in 2008.
Infant mortality rates in Ireland have fallen dramatically over the last few decades. The rate is 3.1 deaths per 1000 live births in 2007, lower than the OECD average of 4.
The mortality rate from suicide for Ireland is 8.9 per 100,000 which is below the OECD average of 11.1. Latest annual figures for suicide indicate a continued reduction in suicide numbers since 2003. It is too early to say whether this trend will be sustained, but it gives some cause for optimism that actions being taken to prevent suicide at local and national level may be beginning to have an impact.
The decline in the death rate from road traffic accidents in the period 1970 -2006 is of the order of 60% in the case of Ireland, just above the OECD average decline of 58%, but below countries such as the Netherlands, Germany and Switzerland where the decline was 80% and over.
Ireland ranks high in terms of the percentage of adults reporting to be in good health – 84% of Irish people rated their health to be good or very good or excellent compared with the OECD average of 69%, placing Ireland in 6th position.
Quality of Care
The five-year relative survival rates in Ireland for breast, cervical and colorectal cancers for the period 2002-2007 (or nearest period available) show improvement over the period 1997-2002, although they are still below the OECD average.
The report provides data up to 2006 or latest year available. In 2007, the National Cancer Control Programme (NCCP) was established to implement the 2006 Cancer Strategy. It has made considerable progress in addressing the fragmented nature of cancer care in Ireland initially in relation to symptomatic breast services but also in other areas including lung and prostate cancers. BreastCheck, the national breast screening programme, has been rolled out to all areas of the country and more than 100,000 mammograms have been performed by the programme so far this year. In 2008, CervicalCheck, the national cervical screening programme was introduced nationally and since then more than a quarter of a million women have been screened.
All of these initiatives are delivering real progress on the goals of the NCCP – improved cancer prevention, detection, treatment and survival through a national service based on evidence and best practice. However, it will be a number of years before data can show the impact on survival (or indeed incidence and mortality) of the National Cancer Control Programme and of the continued focus on prevention and early detection for all cancers.
The report points to asthma management at primary care level being good, particularly as prevalence of the condition in Ireland is estimated to be among the highest in the OECD. Our hospital admission rate (2007) of 52 per 100,000 adults is just above the OECD average of 51.
In relation to stroke, the report notes that in-hospital case fatality rates for hemorrhagic and ischemic stroke have declined by over 25.6% and 11.6% respectively in the case of Ireland between 2002 and 2007. This compares well with the 15% decline for both hemorrhagic and ischemic stroke across OECD countries in the same period. This particular measure is a very sensitive indicator of quality of hospital care and the trend is suggestive of improvement in that area.
The report notes that total expenditure on health accounted for 7.6% of GDP in Ireland in 2007. The report relies on GDP as the basis for examining total health expenditure. When calculated as a percentage of Gross National Income (GNI), which does not include exported profits, the figure rises to 8.9% which puts Ireland on line with the OECD average.
Ireland’s health spending per capita is 3,424 US$ (adjusted for purchasing power parity) which is above the OECD average of 2,984 US$. In terms of the annual average growth rate in real health expenditure per capita between 1997 and 2007, Ireland had the third fastest average annual growth rate of 6.7% behind Korea and Turkey and higher than the OECD average of 4.1%.
Health Care Activities
The report notes that Ireland has 2.7 acute hospital beds per 1,000 population which is lower than the OECD average of 3.8. However, the relatively young population in Ireland (approx. 11% of the Irish population are 65 years and over) would suggest the need for adjustment to reflect this. Also, the data from Ireland excludes acute beds in private hospitals.
The number of acute beds per 1,000 population should not be considered in isolation from the average length of stay and the capacity for day case treatment. The OECD notes that in 2007 the average length of stay in an acute bed in Ireland was 5.9 days, below the OECD average of 6.5 days. Also, the occupancy rate of acute beds in Ireland in 2007 is shown as 87% which is in excess of the OECD average of 75%.