The Department of Health today (17th December 2012) published Health in Ireland: Key Trends 2012. This is the fifth 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. The booklet is available from the Department of Health website: www.doh.ie/publications/key_trends_2012.html
Health in Ireland: Key Trends 2012 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.
Continuing improvements in health status and life expectancy are evident in the tables and graphs of this booklet. Death rates from all major causes have declined significantly over the period, and life expectancy remains above the EU average. Increased and improved healthcare provision has contributed significantly to these gains. Recent data on expenditure and staffing reflect the effects of continuing economic constraints. The key challenge will be to ensure that scarcer resources are carefully targeted to deliver more efficient and effective ways of providing services. An example of changing practice which is both more beneficial for the patient and more cost-effective can be seen in the acute hospital sector where a gradual decline in inpatient admissions is being more than offset by a rapid rise in daycase treatments.
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 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:
· Total hospital discharges continue to rise but an increasing proportion (60% in 2011) of this activity is now carried out on a day case basis (including dialysis). When dialysis is excluded, there has been a 102% increase in the number of day cases seen in public acute hospitals since 2002. 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 5.7 days for the first time.
· 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, life expectancy in Ireland has increased from below the EU average life expectancy, to almost 1 year above it. 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 is projected to almost double to over 1 million by 2035. The greatest proportional increase will be in the 85+ age group.
· Census 2011 shows that, while we still have very high proportions of people reporting good and very good health, those in higher social classes and those without a disability report being in better health. In comparison to other EU countries, Ireland continues to have the highest levels of self-perceived health of any EU country. The EU Statistics of Income and Living Conditions shows significant chronic health problems in the older age groups, with over half of those aged 65+ reporting a chronic illness or condition.
· 37% of the population is now covered by a medical card. Numbers covered have increased by almost 45% over the decade and by nearly 5% between 2010 and 2011. This is in contrast to the numbers covered by private health insurance which has declined since 2008.
· The number of prescription items dispensed under the General Medical Services has increased by almost 7% between 2010 and 2011, yet the average cost per item has now decreased two years in a row.
· Immunisation rates have been increasing since 2002 and are now at 95% for most immunisations.
· Total public health expenditure has risen from €9.4 billion in 2003 to €14.1 billion in 2011. Estimates for 2012 indicate a decline to €13.9 billion in expenditure.
· Public capital expenditure on health was €347 million in 2011 representing a 5% decline on the previous year.
Dr. James Reilly, TD, Minister for Health said:
“I welcome this publication. It provides an overview of health status and the health services during the past ten years and shows real improvements. Mortality rates from circulatory system diseases, for example, have declined by 36% since 2002. Better health care continues to contribute significantly to better outcomes and gains in life expectancy.
In addition to measuring our progress, this report also helps to identify the considerable challenges we face in the coming years. The population continues to grow and to age. Each year an additional 18,000 people are added to the total of those aged over 65 years. To meet these demands in an environment of reduced resources, we must change the way we manage and deliver our services.
The data on acute hospitals shows one of the ways in which we are achieving this. 55% of hospital admissions are now for day care treatment, compared with 40% in 2002. This is an example of care which provides both better and less invasive treatment while at the same time increasing volume and efficiency.
I also welcome the progress made in the last year towards the target of having no-one waiting more than 9 months for an elective procedure, and of the reductions in the numbers of admitted patients waiting on trolleys, both of which are highlighted in this report.
The report also serves to emphasise the importance of having good data as the basis on which to plan and deliver our services. Policy decisions must be based on evidence of need, effectiveness and best value.”
Ends//
Notes for Editors
Further key trends, by section of the booklet, are presented below:
Section 1 – Population and Life Expectancy
· The population in 2012 was 4,585,400 persons. This is a slight increase of 0.2% on the 2011 Census of Population. There has been a 15% increase in population since 2003, with the largest % change in the over 65 age groups. (Tables 1.1 and 1.2)
· The numbers of registered births in 2011 have shown almost a 1% decrease on the previous year, 74,650 being born in the year, but this still represents around 14,000 more births annually than a decade ago. (Table 1.3)
· The Total Fertility Rate has decreased slightly in recent years and now stands at 2.04. However, Ireland continues to have the highest rate of fertility amongst EU countries, the EU average being 1.56. (Figure 1.1)
· The numbers of people in older age groups is beginning to increase significantly. The numbers of people over the age of 65 years is projected to almost double to over 1 million by 2035. The greatest proportional increase will be in the 85+ age group. (Table 1.4 and Figure 1.2)
· Although women have a higher life expectancy than men, 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 2010, 84% 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 66% for males and females respectively across the EU. Census 2011 shows that those in higher social classes and those without a disability report being in better health. (Table 2.1, Figures 2.1, 2.2)
· Over 53% of males and 57% of females aged 65 and over reported suffering from a chronic illness or condition. In the 85+ age category, 51% and 65% of males and females respectively reported some or severe limitation in daily activities due to health problems. (Tables 2.2, 2.3)
· Over the 10 year period 2002-2011, age-standardised death rates for all causes fell by 23%. Most recently however, death rates have shown a slight increase of 0.6% between 2010 and 2011. (Table 2.4)
· Diseases of the circulatory system accounted for almost 33% of all deaths registered in 2011. A decline in the age-standardised death rate of 36% occurred between 2002 and 2011. (Figures 2.4, 2.5)
· While there has been an 8% decline in the age-standardised death rate for malignant neoplasms in the last decade, more recently there has been an increase of 3.4% between 2010 and 2011. The female breast cancer death rate declined 11% since 2002. (Table 2.4)
· Death rates from suicide are down 4% since 2002 but have increased by 6% between 2010 and 2011.
(Table 2.4)
· While Ireland’s age-standardised death rate in 2010 was 5.5% below the EU average, the death rate from all cancers was 2.2% above the EU average. (Table 2.5)
· 5-year relative survival rates from selected cancers remain lower in Ireland than the average for EU countries. However, the gap is significantly narrowing particularly for breast and cervical cancers. (Figure 2.7)
· Both alcohol and cigarette consumption have declined over the past decade. The official figures do not include purchases made outside the State or illegal imports into the State which may exaggerate the decline. Alcohol and cigarette consumption has changed little between 2010 and 2011. (Figure 2.8)
· Mothers in professional, skilled and management occupations have higher breastfeeding rates. (Figure 2.9)
· Data on smoking, drinking and physical activity in 15 year olds is presented in Figure 2.10 showing Ireland comparing favourably with the international average across all categories. It is notable that both alcohol use and physical activity are higher in boys while smoking is somewhat higher in girls.
Chapter 3 – Hospital Care
· Inpatient discharges from publicly funded acute hospitals have increased by 10% since 2002, but have remained static between 2010 and 2011. Day cases have increased by 102% since 2002 and have also increased by 2.8% between 2010 and 2011. (Table 3.1)
· Emergency Department attendances have decreased by 0.5% between 2010 and 2011. (Table 3.1)
· Since 2008, the number of day cases (excluding dialysis) per 1,000 population treated in publicly funded acute hospitals has been higher than the number of inpatients. This gap has increased ever year since 2008. (Figure 3.1)
· In 2011, per 1,000 population, older age-groups accounted for a higher number of discharges than younger age groups. The rate of discharges has increased for almost all age groups since 2002. (Figure 3.2)
· In the last year, there have been reductions in the numbers of adults waiting longer than 9 months for an elective procedure. (Figure 3.3)
· The numbers of admitted patients waiting on trolleys in Emergency Departments of public acute hospitals has reduced between 2011 and 2012. (Figure 3.4)
· The percentage of adults using the health services increased with age for all services except Emergency Department services, where a higher percentage of younger age groups used this service. (Figure 3.5)
· Ireland continues to have slightly higher Caesarean Section rates than the EU average. (Figure 3.6)
· The number of admissions to psychiatric hospitals and units has continued to decline with a decrease of 3% between 2010 and 2011. There are now almost 20% fewer admissions than in 2002. (Table 3.2, Figure 3.7)
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 almost 7%. (Figure 4.1)
· Between 2010 and 2011 there was a 5% increase in medical cards to almost 1.7 million representing 37% of the population. Numbers of GP Visit cards increased by 7% to nearly 126,000. (Table 4.1)
· The number of prescription items dispensed under the General Medical Services has increased by almost 7% between 2010 and 2011, while the average cost per item has reduced by 8%. (Figure 4.2)
· The numbers of persons covered by private health insurance has declined to over 2.1 million in 2011. (Figure 4.3)
· The number of children in care increased by 5% between 2001 and 2010. The percentage of these children in foster care also increased to 90% over the same period. (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 20% during the period 2002 to 2011. All other age groups over 65 have shown declines over the same period. (Table 4.3, Figure 4.4)
· Since 2006 there has been an increase in the numbers of carers who provide unpaid help for a friend of family member with a long-term illness, health problem or disability. In 2011, the largest number of carers per 1,000 population was in the 50-54 age group. (Figure 4.5)
· The immunisation uptake rates of children aged 24 months in 2011 was 95% for most immunisations, with the exception of the MMR, Meningococcal and Pnemococcal Conjugate. Hepatitis B and Pnemococcal Conjugate vaccines were introduced in 2008 and show immunisation rates of 95% and 90% respectively. (Table 4.4)
· The number of people registered with the National Physical and Sensory Disability Database was 25,170 in 2011. Over 55% of these had a physical disability only. (Table 4.5)
· The number of persons with intellectual disability availing of day services has increased by 25% for day attendees and by 8% for full-time residents over the period 2002-2011. (Table 4.6)
· The percentage of establishments inspected for food safety where infringements were found has declined steadily over the period 2002-2011. In 2011, 16% of establishments inspected were found to have infringements compared with 45% in 2002. (Table 4.7)
Chapter 5 – Health Service Employment
· Since 2007, total numbers employed in the public health services have shown a gradual decline. There were 101,503 wholetime equivalents employed in 2012. This represents a decline of 2.8% since December 2011. It should be noted that figures for 2012 refer to October, and do not therefore represent the end of year position. (Table 5.1, Figure 5.1)
· Nurses make up the largest grade category in the public health service, with 34% of total staff employed. Medical and Dental were the only grade category to show an increase between December 2011 and October 2012. (Table 5.1, Figure 5.2)
· The number of consultants employed by the public health service increased by 42% in the period 2003-2012. They also increased by almost 2% between December 2011 and October 2012. (Table 5.2, Figure 5.4)
· The number of non-consultant hospital doctors increased by almost 21% in the period 2003-2012. They also increased slightly between December 2011 and October 2012. (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 29% in the period 2002-2011. (Table 5.3)
Chapter 6 – Health Service Expenditure
· Total public non-capital expenditure on health has increased by 52.5% since 2003, however it has decreased by 1.7% between 2011 and 2012 (data for 2012 are estimates). (Table 6.1)
· Public capital expenditure on health decreased by 5% between 2010 and 2011 and by over 31% since 2002. (Table 6.3)
· In 2010, Ireland’s total health expenditure on health was 9.2% of GDP and 10.9% of GNI. This compares with the OECD averages of 9.5% and 10.1% respectively. (Table 6.4, Figure 6.4)
· Ireland’s per capita total health expenditure has increased steadily in real terms between 2001 and 2008, but has decreased since 2008. (Figure 6.3)