3. RESULTS OF THE EURO HEALTH CONSUMER INDEX 2017
3.1 R ESULTS S UMMARY
Figure 3.2 EHCI 2017 total scores14.
This 11th attempt at creating a comparative index for national healthcare systems has confirmed that there is a group of EU member states, which all have good healthcare systems seen from the customer/consumer’s point of view.
The scoring has intentionally been done in such a way that the likelihood that two states should end up sharing a position in the ranking is almost zero. It must therefore be noted that great efforts should not be spent on in-depth analysis of why one country is in 13th place, and another in 16th. Very subtle changes in single scores can modify the internal order of countries, particularly in the middle of the ranking list, and in the EHCI 2016 also for positions 3 - 8.
The scoring criteria have been tightened on some indicators in the EHCI 2017, in order to keep the Index challenging. Nevertheless, there are 12 Western European countries making it into the “800 Club”, i.e. scoring more than 800 out of the theoretical maximum of 1000 (“All Green on every indicator). The EHCI 2017 rewards real clinical excellence more than previous editions, creating a visible gap between the 800 Club and the other countries.
14 Cyprus is very difficult to score in the EHCI, as Cyprus does not really have a public healthcare system in the general European meaning. “The percentage of public expenditure on health is around 41-42% of the total health expenditure and is indeed the lowest in the EU. That is due to the absence of a National Health Insurance Scheme. The share paid from private insurance companies on health is about 11,4%, whereas the out-of-pocket household expenditure without any insurance coverage come up to 44% of the total health expenditure.”
As the EHCI normally does not reward a country for such services obtained by paying privately, it was decided to have Cyprus run out-of-competition in the EHCI 2017.
The Cyprus parliament did pass a bill in June 2017, providing universal coverage11. The HCP is looking forward to this taking effect, thus enabling the HCP to re-include Cyprus in the EHCI scoring in 2018.
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Euro Health Consumer Index 2017 The EHCI 2017 total ranking of healthcare systems shows The Netherlands again pulling ahead, scoring 924 points out of 1000. Thus, the NL top position survives the onslaught of Switzerland, 898 points.
The changes in rank should not at all be dismissed as an effect of changing indicators, of which there are 46 in the EHCI 2017 – two indicators less than in the previous year. The Netherlands is the only country which has consistently been among the top three in the total ranking of any European Index the Health Consumer Powerhouse has published since 2005. The Netherlands is discipline winner, or joint winner, in three of the six sub-disciplines of the EHCI 2017. The Dutch healthcare system does not seem to have any really weak spots in the other sub-disciplines. Normally, the HCP takes care to state that the EHCI is limited to measuring the “consumer friendliness” of healthcare systems, i.e.
does not claim to measure which European state has the best healthcare system across the board.
However, the fact that it seems very difficult to build an Index of the HCP type without ending up with The Netherlands on the medallists’ podium, creates a strong temptation to actually claim that the winner of the EHCI 2017 could indeed be said to have “the best healthcare system in Europe”. There should be a lot to learn from looking deeply into the Dutch progress!
Switzerland has for a long time had a reputation for having an excellent healthcare system, and it therefore comes as no surprise that the more profound research which eliminated most n.a. scores results in a prominent position in the EHCI.
Bronze medallists are Denmark, which for a number of years held position #2 in the EHCI;
down to 9th place in 2016. Apart from losing a few points by no longer providing hospital treatment results to the public, Denmark scores high on Outcomes, and Danish patients have seemingly learned to cope with the very strict rules for Access to healthcare services.
Norway (also winner or joint winner of three sub-disciplines) is 4th at 850 points, sharing this position with Luxembourg.
In southern Europe, Spain and Italy provide healthcare services where medical excellence can be found in many places. Real excellence in southern European healthcare seems to be a bit too much dependent on the consumers' ability to afford private healthcare as a supplement to public healthcare. Also, both Spain and Italy show large regional variation, which tends to result in a lot of Amber scores for the countries.
Some eastern European EU member systems are doing surprisingly well, particularly Slovakia, Slovenia, the Czech Republic and Estonia, considering their much smaller healthcare spend in Purchasing Power adjusted dollars per capita. However, readjusting from politically planned to consumer-driven economies does take time.
Generally European healthcare continues to improve but medical outcomes statistics is still appallingly poor in many countries. This is not least the case regarding the number one killer condition: cardiovascular diseases, where data for one very vital parameter; 30-day case fatality for hospitalized heart infarct patients, would have to be compiled from several disparate sources. This indicator (3.1) has therefore been modified.
If healthcare officials and politicians took to looking across borders, and to "stealing"
improvement ideas from their European colleagues, there would be a good chance for a national system to come much closer to the theoretical top score of 1000. As a prominent example; if Sweden could achieve a Belgian waiting list situation, that alone would suffice to lift Sweden to compete with The Netherlands at ~920 points!
A further discussion on results of states and the changes observed over time can be found in Chapter 5: Trends over the ten years.
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3.1.1 Country scores
With the possible exception of the Netherlands and Switzerland, there are no countries, which excel across the entire range of EHCI indicators. The national scores seem to reflect more of “national and organisational cultures and attitudes”, rather than mirroring how large resources a country is spending on healthcare. The cultural streaks have in all likelihood deep historical roots. Turning a large corporation around takes a couple of years – turning a country around can take decades!
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3.1.2 Results in “Hexathlon”
The EHCI 2017 is made up of six sub-disciplines. As no country excels across all aspects of measuring a healthcare system, it can therefore be of interest to study how the 35 countries rank in each of the five parts of the “pentathlon”. The scores within each sub-discipline are summarized in the following table:
As the table indicates, the total top position of the Dutch healthcare system is to a great extent a product of an even performance across the sub-disciplines, very good medical quality and improved Accessibility, which used to be a weaker point in previous years.
Runner-up Switzerland is in top position for Accessibility, with Belgium. No country scores All Green on Outcomes. The Swedish healthcare system would be a real top contender, scoring high on Range & Reach of Services along with the NL, were it not for an accessibility situation, which by Belgian or Swiss standards can only be described as abysmal.
Sub-discipline Top country/countries Score Maximum score
1. Patient rights and
information Netherlands, Norway 125! 125
2. Accessibility Switzerland, Slovakia 225! 225
3. Outcomes Finland, Norway 289 300
4. Range and reach of services Netherlands, Sweden 125! 125
5. Prevention Norway 119 125
6. Pharmaceuticals Germany, Netherlands 89 100
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