Eesti tervishoiusüsteem rahvusvahelises võrdluses EHK nõukogu

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Shauna Boyd
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1 Eesti tervishoiusüsteem rahvusvahelises võrdluses EHK nõukogu

2 ELANIKE TERVISENÄITAJATEST

3 Eesti on eeldatava keskmise eluea ja tervishoiukulud per capita näitaja osas OECD riikide seas heal tasemel Life expectancy at birth and health spending per capita, 2013 (or latest year) Source: OECD Health Statistics 2015,

4 Eeldatav eluiga on haridustasemeti erinev Gap in life expectancy at age 30 by sex and educational level, 2012 (or latest year) mehed naised 17,8 15,0 20 Gap in years 15 11,6 12,1 3,6 3,7 4,3 4,5 5,1 5,2 5,4 5,5 5,8 6,9 7,7 9, Italy Sweden Portugal Netherlands (2011) Norway Mexico Denmark Finland Israel Slovak Rep. OECD (15) Slovenia Poland Hungary Estonia Czech Rep. 1,8 1,8 3,0 4,2 3,9 4,6 3,8 3,5 4,7 3,5 4,2 4,4 5,0 5,5 5,2 8, Gap in years Note: The figures show the gap in the expected years of life remaining at age 30 between adults with the highest level ("tertiary education") and the lowest level ("below upper secondary education") of education. Source: Eurostat database complemented with national data for Israel, Mexico and Netherlands.

5 Tervena elatud aastad kirjeldavad elukvaliteeti 80,0 Tervena elatud aastad sünnimomendil 70,0 60,0 50,0 40,0 30,0 20,0 10,0 0,0 Allikas: Eurostat 2016.a

6 Kardiovaskulaarsed haigused on OECD riikides peamiseks surmapõhjuseks (32%). Eestis on see suremus vähenenud OECD riikide keskmisest enam Ischemic heart disease mortality, 2013 and change (or nearest years) Age-standardised rates per population 0 Japan France Korea Netherlands Portugal Spain Belgium Luxembourg Chile Israel Denmark Norway Switzerland Greece Italy Slovenia Canada United Kingdom Australia Sweden Poland Germany OECD (34) United States Iceland Ireland New Zealand Austria Mexico Turkey Finland Estonia Czech Rep. Hungary Slovak Rep. Source: OECD Health Statistics 2015, (extracted from WHO) Muutus n.a Change in % 9 63

7 Eestis on ajuveresoonkonna haigustesse suremus viimase 23 aasta jooksul märgatavalt vähenenud Cerebrovascular disease mortality, 2013 and change (or nearest years) 2013 Muutus Age-standardised raes per population 0 Switzerland Canada France Israel United States Spain Luxembourg Austria Norway Belgium Netherlands Australia Germany United Kingdom Japan Denmark Sweden Mexico Iceland Ireland Finland OECD (34) New Zealand Italy Estonia Korea Chile Poland -14 Portugal -73 Slovenia -51 Czech Rep. -69 Turkey n.a. Greece Hungary Slovak Rep Change in % Source: OECD Health Statistics 2015, (extracted from WHO).

OECD riikides on vähk sageduselt teine surmapõhjus (25%) Age-standardised rates per 100 000 population Cancer mortality, 2013 (or latest

8 OECD riikides on vähk sageduselt teine surmapõhjus (25%) Age-standardised rates per population Cancer mortality, 2013 (or latest year) 400 Men Women Total Erinevate vähiliikide osakaal vähki suremusel meeste hulgas, OECD riikides 2013.a.

9 . Erinevate vähiliikide osakaal vähki suremusel meeste hulgas, Eestis 2013, OECD riikides 2013.a. Eesti 2013.a. OECD riigid 2013.a. Muu 33% Magu 8% 6% Jämesool 7% 7% Pankreas Lümfoid ja vereloome Muud 36% Magu 6% 11% Jämesool Maks 6% 6% Pankreas Eesnääre 13% 26% Kops, hingetoru 9% Eesnääre 26% Kops Allikas: TAI Tervisestatistika ja Terviseuuringute andmebaas. Surmad surma põhjuse, soo ja vanuserühma järgi Source: OECD Health Statistics 2015, (extracted from WHO).

10 Imikute suremus on madal oleme jätkuvalt väga heal tasemel Infant mortality, 2013 (or latest year) Deaths per live births 45 41, ,3 1,7 1,7 2,0 2,0 2,3 2,4 2,4 2,5 2,5 2,5 2,6 2,8 2,9 2,9 2,9 3,1 3,3 3,5 3,5 3,5 3,6 3,6 3,7 3,7 3,8 4,0 4,4 4,4 4,5 4,8 5,0 5,0 5,1 7,0 8,2 8,4 10,2 10,9 12,3 13,0 17,5 24,5 32, Three-year average ( ). Note: The data for most countries are based on a minimum threshold of 22 weeks of gestation period (or 500 grams birthweight) to remove the impact of different registration practices of extremely premature babies across countries. Source: OECD Health Statistics 2015,

differences in the survey questionnaire resulting in an upward bias.

11 Eesti inimesed hindavad oma tervist üldiselt heaks Perceived health status among adults, 2013 (or latest year) 1. Results for these countries are not directly comparable with those for other countries, due to methodological differences in the survey questionnaire resulting in an upward bias. In Israel, there is no category related to fair health. Source: OECD Health Statistics 2015, (EU-SILC for European countries).

12 TERVISHOIUSÜSTEEMI PEAMISI NÄITAJAID

13 Eestis on arstide arv OECD keskmisel tasemel Practising doctors per population, 2000 and 2013 (or nearest year) Per population ,0 4,9 4,3 4,3 4,3 4,1 4,0 4,0 3,9 3,8 3,7 3,6 3,6 3,4 3,4 3,4 3,3 3,3 3,3 3,3 3,2 3,2 3,0 3,0 2,8 2,8 2,8 2,7 2,6 2,6 2,6 2,3 2,2 2,2 2,2 1,9 1,8 1,8 1,8 1,7 0,8 0,3 0,7 6, Source: OECD Health Statistics 2015,

14 Arstide vanuseline struktuur on mureks paljudes OECD riikides Share of doctors aged 55 years and over, 2000 and 2013 (or nearest year) % Share of female doctors, 2000 and 2013 (or nearest year) %

Eestis on perearste eriarstide arvu suhtes OECD riikide keskmisel tasemel Generalists and specialists as a share of all doctors, 2013 (or nearest year) 1.

Specialists include paediatricians, obstetricians/gynaecologists, psychiatrists, medical, surgical and other specialists. 3.

15 Eestis on perearste eriarstide arvu suhtes OECD riikide keskmisel tasemel Generalists and specialists as a share of all doctors, 2013 (or nearest year) 1. Generalists include general practitioners/family doctors and other generalist (non-specialist) medical practitioners. 2. Specialists include paediatricians, obstetricians/gynaecologists, psychiatrists, medical, surgical and other specialists. 3. In Ireland and Portugal, most generalists are not GPs ("family doctors"), but rather non-specialist doctors working in hospitals or other settings. In Portugal, there is some double-counting of doctors with more than one specialty. Source: OECD Health Statistics 2015,

16 3,2 3,2 3,1 3,0 3,0 Õdede arv arstide arvu suhtes püsib Eestis stabiilsena Practising nurses per population, 2000 and 2013 (or nearest year) Per population ,4 16,7 16,3 15,5 14,1 13,0 12,4 12,1 11,9 11,5 11,2 11,1 10,5 10,0 9,5 9,5 9,4 9,1 8,3 8,2 8,0 7,9 7,6 7,4 6,4 6,2 6,1 6,1 5,8 5,6 5,3 5,2 5,1 4,9 4,9 3,6 2,6 2,0 1,8 1,5 1,3 1,2 1,2 1, ,7 4,6 4,5 4,3 4,3 4,2 4 4,2 4,1 4,0 3,9 3,7 3,7 3,6 3,4 Ratio of nurses to physicians, 2013 (or nearest year) 3 2,8 2,8 2,8 2,4 2,4 2,2 2,0 2 1,9 1,8 1,7 1,7 1,6 1,6 1,5 1,5 1,5 1,4 1,4 1,3 1,2 1,2 1,0 0,8 1 0,6 0,6 0

17 Eestis on arsti vastuvõttude arv OECD riikide keskmisel tasemel Number of doctor consultations per person, 2013 (or nearest year) Annual consultations per person ,6 12,9 11,7 11,1 11,0 10,5 9,9 8,2 8,1 7,7 7,4 7,4 7,1 7,1 6,8 6,8 6,6 6,5 6,5 6,4 6,4 6,2 6,2 6,2 6,0 5,0 4,7 4,7 4,2 4,1 4,0 3,9 3,8 3,7 3,3 2,9 2,8 2,7 2,6 2,5 2 0 Source: OECD Health Statistics 2015,

18 MRT uuringute osas 1000 isiku kohta on Eesti aastati OECD riikide keskmisel tasemel MRI units, 2013 (or nearest year) MRI exams, 2013 (or nearest year) Japan United States Italy Korea Greece Finland Iceland Switzerland¹ Austria Denmark Spain OECD32 Australia² Ireland Luxembourg Germany¹ Netherlands Estonia New Zealand Belgium¹ Turkey France Canada Slovenia Czech Rep. Slovak Rep. Chile Portugal¹ Poland United Kingdom Isra el Hungary² Mexico 24,6 24,5 24,3 22,1 21,8 19,9 19,2 15,4 15,3 14,1 13,4 13,3 12,9 11,6 11,5 11,4 11,2 10,8 10,5 9,4 8,8 8,7 7,4 6,7 6,6 6,5 6,4 6,1 3,1 3,0 2,1 35,5 46, Per million population Turkey United States France Luxembourg Belgium Iceland Spain Greece Switzerland¹ Denmark Canada OECD28 Estonia Austria¹ Netherlands³ Slovak Rep. Finland Czech Rep. United Kingdom¹ Slovenia Hungary Isra el Portugal¹ Australia² Korea³ Poland Germany¹ Ireland¹ Chile Per population 119 Source: OECD Health Statistics 2015,

19 Eesti tervishoiusüsteemi on hinnatud efektiivseks, samas arenguruumi on voodeid statsionaaris on üle OECD keskmise ja voodihõive alla keskmise Occupancy rate of curative (acute) care beds, 2000 and 2013 (or nearest year) 2013a oli Eesti haiglate voodihõive 10% madalam OECD keskmisest % ,1 93,8 90,9 89, ,3 83,6 80,2 79,3 78,4 78,1 77,5 77,3 75,9 75,8 75,6 75,0 74,9 73,9 70,6 70,4 69,4 69,2 67,9 67,4 64,8 64, Source: OECD Health Statistics 2015,

20 Hooldusravi voodite arvult oleme lähenemas Euroopa Liidu riikide keskmisele tasemele Nursing home and elderly care beds per aged Albania Greece Bulgaria FYR Romania Croatia Serbia Italy Poland Latvia Portugal Lithuania Czech Austria Spain Estonia Denmark Hungary UK Germany Norway Slovenia Luxembourg Ireland Slovakia France Finland Malta Netherlands Iceland Belgium Switzerland Sweden Cypros Montenegros Source: Health Consumer Powerhouse. Euro Health Consumer Index 2015

21 Keskmine haiglas viibimise aeg on üheks tervishoiu efektiivsuse näitajaks Average length of stay in hospital, 2000 and 2013 (or nearest year) Days ,2 16, ,8 10,1 9,5 9,4 9,1 8,9 8,9 8,7 8,1 8,1 7,9 7,9 7,9 7,6 7,6 7,5 7,5 7,1 7,0 6,6 6,5 6,5 6,4 6,1 6,1 6,0 5,9 5,8 5,7 5,6 4,3 4,0 3,9 0 Source: OECD Health Statistics 2015,

22 Uute südameprotseduuride kasutuselevõtul oleme maailma ühed innovatiivseimad Coronary angioplasty as a share of total revascularisation procedures, 2000 to 2013 (or nearest years) % Source: OECD Health Statistics 2015,

23 TEENUSTE KÄTTESAADAVUS

Health insurance coverage for a core set of services, 2013 Health insurance coverage for a core set of services, 2013 Private health insurance coverage, by type, 2013 (or nearest year) Total public

24 Health insurance coverage for a core set of services, 2013 Health insurance coverage for a core set of services, 2013 Private health insurance coverage, by type, 2013 (or nearest year) Total public coverage Australia Canada Czech Republic Denmark Finland Iceland Ireland Israel Italy Japan Korea New Zealand Norway Portugal Slovenia Sweden Switzerland United Kingdom Austria France Spain Germany Netherlands Belgium Mexico Chile Turkey Luxembourg Hungary Colombia Slovak Republic Estonia Poland United States (2014) Greece 34,5 Primary private health coverage 88,8 91,6 79,9 79,0 100,0 100,0 100,0 100,0 100,0 99,8 100,0 100,0 100,0 100,0 100,0 100,0 100,0 100,0 100,0 100,0 100,0 100,0 99,9 99,9 99,0 99,8 99,0 98,1 96,4 96,0 91,7 94,6 93,6 91,6 54,0 18,3 0,2 0,9 11, Percentage of total population Source: OECD Health Statistics 2015, 7,3 4,0

Hinnangud arstiabi ja hambaravi kättesaadavusele varieeruvad väga palju riigiti Unmet care needs for medical examination, by income level, 2013 Unmet care needs for dental examination, by income

25 Hinnangud arstiabi ja hambaravi kättesaadavusele varieeruvad väga palju riigiti Unmet care needs for medical examination, by income level, 2013 Unmet care needs for dental examination, by income level, 2013 Netherlands Austria Spain Luxembourg Czech Rep. Switzerland Denmark Norway Germany United Kingdom Belgium Slovak Rep. Sweden Hungary France Portugal OECD(23) Lithuania Ireland Iceland Finland Italy Estonia Poland Greece Latvia High income Average Low income % Source: OECD Health Statistics 2015,

and goods, 2013 (or nearest year) Source: OECD Health

26 Omaosalus on Eestis OECD riikide keskmisel tasemel Shares of out-of-pocket medical spending by services and goods, 2013 (or nearest year) Source: OECD Health Statistics 2015,

27 KVALITEEDINÄITAJAD

28 Hospitaliseerimine on südamepuudulikkuse, astma ja kroonilise obstruktiivse kopsuhaiguse puhul oluline kvaliteedinäitaja Asthma and COPD hospital admission in adults, 2013 (or nearest year) Age-sex standardised rates per population 600 COPD Asthma Source: OECD Health Statistics 2015,

29 Eestis on insuldijärgne 30 päeva suremus kõrge Thirty-day mortality after admission to hospital for ischemic stroke based on admission data, 2003 to 2013 (or nearest years) 25 Age-sex standardised rate per 100 admissions of adults aged 45 years and over

30 Eesti arstil on ambulatoorsel visiidil patsiendi jaoks piisavalt aega Doctor spending enough time with patient in consultation, 2013 (or latest year) Doctor involving patient in decisions about care and treatment, 2013 (or latest year) Belgium 1 97,5 Czech Republic 1 97,2 Luxembourg 1 95,6 New Zealand 1 92,6 Portugal 1, 2 89,6 Germany 2 88,2 Estonia 1 86,9 Australia 1 86,5 United Kingdom 2 86,3 Netherlands 2 85,1 OECD18 84,9 Switzerland 2 83,6 Israel 1 81,8 United States 2 80,9 France 2 80,0 Norway 2 79,6 Canada 2 79,3 Sweden 2 78,3 Poland 1, 2 59, Age-standardised rates per 100 patients Luxembourg 1 95,5 Belgium 1 95,1 Portugal 1 90,9 New Zealand 1 88,2 United Kingdom 2 88,0 Germany 2 87,7 Australia 2 86,0 United States 2 83,9 Netherlands 2 83,9 Norway 2 83,3 Canada 2 83,0 Czech Republic 1 81,8 Switzerland 2 81,4 OECD19 81,3 Sweden 2 80,5 Israel 1 79,7 France 2 78,8 Estonia 1, 2 67,4 Spain 1, 2 62,1 Poland 1, 2 47, Age-standardised rates per 100 patients Source: OECD Health Statistics 2015,

31 TERVISHOIUSÜSTEEMI RAHASTAMINE

32 Pea kõikides OECD riikides on valitsussektor peamine tervishoiukulude rahastaja Health expenditure as share of total government expenditure, 2013 (or nearest year) New Zealand Switzerland Netherlands United States Japan ¹ Germany Canada Sweden Norway Australia United Kingdom ¹ Iceland Denmark Austria France OECD34 Belgium Chile Spain Czech Rep. Slovak Rep. Italy Ireland Luxembourg Korea Portugal Estonia Mexico Finland Israel Poland Turkey Slovenia Greece Hungary % total government expenditure

function of health care, 2013 (or nearest year) Source: OECD

33 Suurem osa tervishoiukuludest on suunatud statsionaarse ja ambulatoorse ravi rahastamiseks Current health expenditure by function of health care, 2013 (or nearest year) Source: OECD Health Statistics 2015,

34 Kokkuvõte Eesti elanike tervis ja eluiga ning Eesti tervishoiusüsteem on kiiresti arenenud Tervisetulem ja keskmine eluiga ei sõltu ainult tervisesüsteemist Oleme mitmete näitajate osas märkimisväärselt edukad, eriti arvestades Eesti tervishoiukulutusi Arenguruumi on kvaliteedinäitajate mõõtmise arendamisel, et saaksime end teiste riikidega ka siin võrrelda ja seada sihte

UNDER EMBARGO UNTIL 9 APRIL 2018, 15:00 HOURS PARIS TIME

UNDER EMBARGO UNTIL 9 APRIL 2018, 15:00 HOURS PARIS TIME TABLE 1: NET OFFICIAL DEVELOPMENT ASSISTANCE FROM DAC AND OTHER COUNTRIES IN 2017 DAC countries: 2017 2016 2017 ODA ODA/GNI ODA ODA/GNI ODA Percent change USD million % USD million % USD million (1) 2016