Procedia - Social and Behavioral Sciences 62 ( 2012 ) 896 – 900

1877-0428 © 2012 Published by Elsevier Ltd. Selection and/or peer review under responsibility of Prof. Dr. Hüseyin Araslidoi: 10.1016/j.sbspro.2012.09.151

WC-BEM 2012

countries. A comparative analysis Andreea- a *

aUniversiy Health Policy and Ethics, 16th University Street, Iasi, 700115, Romania bAlexandru Ioan Cuza University, Faculty of Economics and Business Administration, 22nd Carol I Bvd., Iasi, 700505, Romania

Abstract

This article aims at providing an assessment of access and quality of healthcare in EU countries from a bottom up perspective and to investigate the relationship between several macroeconomic indicators related to public expenditure on health and institutional

healthcare quality among EU citizens. Citizens of developed countries have a positive opinion about quality of healthcare in their a

Keywords:

1. Introduction

The deepening of health inequities around the world calls for more patient-centred healthcare systems and for getting higher value for invested money. In this context, access and quality of healthcare are a priority on international agenda and central goals of healthcare reforms for any health system. They are considered as key elements for improved health outcomes and efficiency in healthcare service delivery worldwide. Assessing and monitoring access and quality of care in health systems should mostly relevaluation about their experiences in healthcare.

This research aims at providing an overview on access and quality of healthcare in EU countries from a bottom up perspective and to investigate to what extent several macroeconomic indicators related to public expenditure on

The first part of the paper is a comparison

methodological limitations that should be taken into consideration ( ), we believe that the comparison can provide useful insights into the quality of healthcare in different European systems since the

the main target of any health policy.

* Andreea- . Tel.: +4-726-129-580 E-mail address: andreea_iacobuta@yahoo.com

© 2012 Published by Elsevier Ltd. Selection and/or peer review under responsibility of Prof. Dr. Huseyin Arasli

Available online at www.sciencedirect.com

© 2012 Published by Elsevier Ltd. Selection and/or peer review under responsibility of Prof. Dr. Hüseyin Arasli

897 Andreea-Oana Iacobuta / Procedia - Social and Behavioral Sciences 62 ( 2012 ) 896 – 900

The second part provides a more objective image by correlating several macroeconomic and institutional indicators with people perception of healthcare quality.

The results display significant differences in perception of access and healthcare quality among EU citizens. They also confirm the existence of a relationship between several macroeconomic and institutional factors and

2. Data and methods

We used cross-country analysis in order to compare sfaction with quality of healthcare systems in EU countries. The quality of healthcare system is analysed using two indicators, the percent of positive evaluation for the overall quality of healthcare retrieved from Special Eurobarometer 327 - Patient safety and quality of healthcare and Euro Health Consumer Index released by Health Consumer Powerhouse.

The relationship between the variables was analysed using correlation analysis. The identification of the significant correlations was made using Pearson correlation coefficient.

We used three indicators of financial expenditures on health namely, GDP per capita, Total health expenditure as share of GDP and General Government Expenditure on Health as share of General government expenditure and one indicator of institutional context respectively, Corruption Perceptions Index. Health expenditure data were obtained from the WebPages of World Bank (for GDP per capita) and World Health Organization National Health Accounts Database (Total health expenditure as share of GDP and General Government Expenditure on Health as share of General government expenditure). Corruption Perceptions Index is released by Transparency International.

The data are available all EU member states and they are registered for 2009. Statistical data processing was conducted using SPSS software.

3. Results

3.1. Evaluation of healthcare quality and access across EU countries

Euro Health Consumer Index 2009 for all 27 EU member states. Wide variations in both variables can be observed. The percentage of positive evaluation for the overall quality of healthcare rages from 97% in Belgium to 25% in Greece and Romania, the EU average being 70%. Also, Euro Health Consumer Index ranges from a score of 863 in Netherlands to approximately half of it in Bulgaria. Although, by its methodology, the index implies that we should

-depth analysis of why one country is in 13th place and another in 16th

c.)

Romania, Latvia). Table 1. Healthcare quality in EU countries

Country % positive evaluation for the overall quality

of healthcare

Euro Health Consumer Index

2009

Austria 95 795 Belgium 97 732 Bulgaria 28 448 Cyprus 73 637

Czech Republic 78 667 Denmark 87 819 Estonia 70 638 Finland 94 721 France 91 778

Germany 86 787 Greece 25 600

Hungary 28 633 Ireland 53 701

898 Andreea-Oana Iacobuta / Procedia - Social and Behavioral Sciences 62 ( 2012 ) 896 – 900

Italy 54 671 Latvia 37 512

Lithuania 40 546 Luxembourg 88 777

Malta 81 565 Netherlands 91 863

Poland 30 565 Portugal 42 632 Romania 25 489 Slovakia 53 560 Slovenia 69 668

Spain 81 630 Sweden 90 762

United Kingdom 86 682 Data sources: European Commission (2009), Special Eurobarometer-327: Patient safety and quality of healthcare; Euro Health Consumer Index 2009 Report, Health Consumer Powerhouse.

From the presented data there can be noticed that those countries which have more consumer-oriented healthcare

systems (high values for Euro Health Consumer Index) display higher percentage of positive evaluation for the overall quality of healthcare. This relationship is also proven by the strong correlation (Pearson correlation coefficient equals 0.790) between the two variables presented in Figure 1 below.

3.2. Statiscal analysis of the relationships between macroeconomic and institutional indicators and perceived healthcare quality in EU countries in 2009

3.2.1. Correlation between variables For the sample of 27 EU countries, we studied the bivariate correlations between the variables, using Pearson

correlation coefficient. Figure 1 presents, for each analysed correlation, the estimated value of Pearson correlation coefficient and Sig

probability.

Figure 1. Correlations Matrix

Pearson correlation coefficients show a positive strong correlation between Euro Health Consumer Index and the

following health expenditure indicators: GDP per capita, Total health expenditure as share of GDP and General Government Expenditure on Health as share of General government expenditure. Also, there is a strong positive correlation between Euro Health Consumer Index and Corruption Perceptions Index. The results highlight the same

Correlations

1 .771** .460* .521** .730** .640**.000 .016 .005 .000 .000

27 27 27 27 27 27.771** 1 .734** .711** .864** .790**.000 .000 .000 .000 .000

27 27 27 27 27 27.460* .734** 1 .823** .538** .534**.016 .000 .000 .004 .004

27 27 27 27 27 27

.521** .711** .823** 1 .536** .576**

.005 .000 .000 .004 .00227 27 27 27 27 27

.730** .864** .538** .536** 1 .795**

.000 .000 .004 .004 .00027 27 27 27 27 27

.640** .790** .534** .576** .795** 1

.000 .000 .004 .002 .00027 27 27 27 27 27

Pearson CorrelationSig. (2-tailed)NPearson CorrelationSig. (2-tailed)NPearson CorrelationSig. (2-tailed)N

Pearson CorrelationSig. (2-tailed)NPearson CorrelationSig. (2-tailed)NPearson CorrelationSig. (2-tailed)N

GDP per capita (currentUS$)

Euro Health ConsumerIndex 2009

Total health expenditure% GDP

General Gov ernmentExpenditure on Healthas % of Generalgovernment expenditureCorruption PerceptionIndex 2009

% positive ev aluation f orthe ov erall quality ofhealthcare

GDP percapita (current

US$)

Euro HealthConsumerIndex 2009

Total healthexpenditure

% GDP

GeneralGovernmentExpenditureon Health as% of Generalgovernmentexpenditure

CorruptionPerceptionIndex 2009

% positiveevaluation for

the ov erallquality ofhealthcare

Correlation is signif icant at the 0.01 level (2-tailed).**.

Correlation is signif icant at the 0.05 level (2-tailed).*.

899 Andreea-Oana Iacobuta / Procedia - Social and Behavioral Sciences 62 ( 2012 ) 896 – 900

strong relationship between People positive evaluation for the overall quality of healthcare and Corruption Perceptions Index.

3.2.2. Distribution of EU countries by several selected variables

For two of the strongest corelations, namely those between Euro Health Consumer Index and GDP per capita (with Pearson correlation coefficient of 0.771) and Euro Health Consumer Index and Corruption Perceptions Index (with Pearson correlation coefficient of 0.864) scatter diagrams developed in SPSS were used in order to position the EU countries in relation with the analysed variables.

Figure 2 displays the distribution of EU countries according to Euro Health Consumer Index and GDP per capita (current US $). As can be noticed, most of the EU countries can be divided in two main categories: one includes countries with low scores for Euro Health Consumer Index and low GDP per capita, below the average; the other includes countries with both Euro Health Consumer Index and GDP per capita above the average.

Figure 2. The positioning of EU countries in relation with Euro Health Consumer Index and GDP per capita Figure 3 displays the positioning of EU countries according to Euro Health Consumer Index and the indicator of

institutional context, Corruption Perception Index. EU countries with high values for Corruption Perceptions Index (perceived as less corrupt) register high scores for Euro Health Consumer Index. On the contrary, the countries which are perceveid as more corrupt have less consumer-oriented healthcare systems.

Figure 3. The positioning of EU countries in relation with Euro Health Consumer Index and Corruption Perceptions Index

120000100000800006000040000200000

GDP per capita (current US$)

900

800

700

600

500

400

Euro

Hea

lth C

onsu

mer

Inde

x 20

09

United Kingdom

Sweden

Spain

Slovenia

Slovakia

Romania

Portugal

Poland

Netherlands

Malta

Luxembourg

Lithuania

Latvia

Ireland

Greece

Germany

France

Estonia

Denmark

Czech Republic

Cyprus

Bulgaria

Belgium

Austria

10.08.06.04.02.0

Corruption Perception Index 2009

900

800

700

600

500

400

Euro

Hea

lth C

onsu

mer

Inde

x 20

09

United Kingdom

Sweden

Spain

Slovenia

Slovakia

Romania

Portugal

Poland

Netherlands

Malta

Luxembourg

Lithuania

Latvia

Italy

Ireland

Hungary

Greece

GermanyFrance

Finland

Estonia

Denmark

Czech Republic

Cyprus

Bulgaria

Belgium

Austria

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4. Discussions and conclusions

EU member states and at investigating the relationships existing between indicators of public spending on health and institutional context and indicators of healthcare quality.

The results show significant differences in perception of access and healthcare quality among EU citizens. Citizens of developed countries have from developing countries evaluate it rather negatively.

Also, the findings confirm that, in general, GDP per capita and government spending on health have a positive impact on the perceived quality of healthcare system. EU countries positioning in relation with analysed variables prove the fact that countries with low GDP per capita have also less consumer-oriented healthcare systems.

The analysis also shows that institutional factors, assessed in this paper with the Corruption Perceptions Index, are strongly and positively correlated with people evaluations of healthcare quality and the extent to which healthcare systems are consumer-oriented. EU countries positioning in relation with the above mentioned variables shows that the less corrupt EU countries have high consumer-oriented healthcare systems.

The obtained results are in line with the ones in previous published studies in this area, especially the ones dealing with the macroeconomics of health financing. They provide an image of the significant role the level of development and the level of health financing in a country plays for healthcare quality.

Still, issues like quality, access, equity in healthcare are much more complex and subjective to be assessed only with financial data. A substantive analysis should also take into consideration the influence of other possible explanatory variables such as, socio-cultural, political and institutional factors.

Acknowledgements

This work was co-financed from the European Social Fund through Sectoral Operational Programme for Human Resources Development 2007-2013, Priority Axis 1 Education and training in support for growth and development of a knowledge based society, Area of intervention: Doctoral and postdoctoral programmes in support of research, project number University

References

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