Significant contribution by the health services to improving health status and reducing death rates but significant challenges – smoking, alcohol, obesity – must be addressed
The Department of Health today (19th December) published Health in Ireland: Key Trends 2013.Download the document at http://www.dohc.ie/publications/key_trends_2013.html
This is the sixth edition of this easy-to-use reference guide to significant trends in health and health care over the past decade, including population and health status, as well as trends in service provision. This year, new tables, maps and graphs have been included on some specific topics or where new data has been made available. Each section has a brief introduction summarising key statistics.
Overall, the picture which emerges is of continuing progress, but at a reduced rate, set in a context of very significant financial constraints. Rapid ageing of the population in conjunction with lifestyle-related health threats present major challenges now and for the future in sustaining and further improving health and health services in Ireland.
The Minister for Health, James Reilly TD, welcomed the publication. “The 2013 edition of Health in Ireland: Key Trends outlines the progress we have made despite the significant challenges we face”, he said, “It is vital that we continue to collect good data in order to make better policy decisions. This publication illustrates that better health care continues to contribute significantly to better outcomes and gains in life expectancy.”
Continuing improvements in health status and life expectancy are evident – life expectancy in Ireland has gained a full four years since 2000 and is now above the EU average - and death rates from all major causes have declined significantly over the period. The contribution of modern health services to this achievement, while difficult to quantify, has been of unquestionable significance.
While there is currently minimal growth in the overall population, the number of people over the age of 65 is increasing by 20,000 every year and will more than double over the next 30 years. There are clear implications for health service planning and delivery.
Given the continuing economic constraints facing the country, recent data on employment and expenditure in the health services are characterised by considerable reductions. Figures also show increasing numbers and percentages of the population eligible for a medical card and decreasing numbers purchasing private health insurance.
The Minister said, “The key challenge, and opportunity, will be to ensure that scarcer resources are carefully targeted to deliver services in the fairest, most efficient and most effective ways possible. The ageing of our population and the problems that smoking, alcohol and obesity present, are significant challenges. 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.”
“This is already happening through improved models of treatment in areas such as cancer and stroke care leading to better outcomes. Examination of trends over a decade also helps to identify the challenges facing health and the health services in the coming years”, he continued.
Concluding, the Minister said “earlier this year, I launched Healthy Ireland 2013-2025 to provide a national framework for improved health and wellbeing and we have been driving major reform of our health services under Future Health since November 2012. We have made good progress in terms of hospital groups and reform of the HSE as well as a package of measures to address the misuse of alcohol and our strategy to make Ireland tobacco free by 2025. We must continue this work to ensure we maintain the progress outlined in Health in Ireland Key Trends.”
Key trends include:
· Total hospital discharges continue to rise but an increasing proportion (60% in 2012) of this activity is now carried out on a day case basis (including dialysis). When dialysis is excluded, there has been a 93% increase in the number of day cases seen in public acute hospitals since 2003. 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 5.4 days for the first time.
· Over the past decade, Ireland has achieved a rapid and unprecedented improvement in life expectancy. Life expectancy in Ireland has increased by a full four years since the year 2000 and has been consistently higher than the EU average throughout the last decade.
· Much of this increase in life expectancy is due to significant reductions in major causes of death such as circulatory system diseases. Since 2003, there has been a reduction in mortality rates for most of these causes. The overall mortality rate has reduced by 22% since 2003.
· Ireland is now beginning to catch up with other European countries in terms of population ageing. The population of those aged 65 years and over has been increasing at a faster rate than that of our EU neighbours. The numbers of people in this age group is expected to more than double in the coming decades, with the greatest proportional increase in the 85+ age group.
· Despite reductions in the numbers of births in recent years, the fertility rate in Ireland remains the highest in the EU.
· In comparison to other EU countries, Ireland continues to have the highest levels of self-perceived health of any EU country. Those with higher education attainment tend to report better health than those with lower education attainment.
· Recent data on childhood obesity suggests that 20% of children aged 5 years are either overweight or obese.
· The number of people waiting longer than 52 weeks for an outpatient appointment has fallen in the last year. However, the total number of people waiting has started to increase in recent months.
· 40% of the population is now covered by a medical card. Numbers covered have increased by 60% over the decade and by over 9% between 2011 and 2012. This is in contrast to the numbers covered by private health insurance which has declined in recent years.
· Immunisation rates have been increasing since 2003 and are now at 95% for most immunisations.
· The numbers of people employed in the public health service now stands at just over 100,000. This is the lowest level since 2004.
· Total public health expenditure has risen from €10.2 billion in 2004 to €14.1 billion in 2012. Estimates for 2013 indicate a decline to €13.9 billion in expenditure.
Ends//
Notes for Editors
Further key trends, by section of the booklet, are presented below:
Section 1 – Population and Life Expectancy
· The population in 2013 was 4,593,100 persons. This is a slight increase of 0.4% on the 2011 Census of Population. There has been a 14% increase in population since 2004, with the largest % change in the over 65 age groups. (Tables 1.1 and 1.2)
· Counties in the west of Ireland have a greater proportion of people aged 65 and over. (Figure 1.1)
· The total population in Ireland has increased more rapidly than the EU average. The population aged 65 and over has increased at a greater rate than the population as a whole. (Figure 1.2)
· The numbers of registered births in 2012 have shown a 2% decrease on the previous year, 72,225 births being registered in the year. This still represents almost 11,000 more births annually than a decade ago. (Table 1.3)
· The Total Fertility Rate has decreased slightly in recent years and now stands at 2.01. However, Ireland continues to have the highest rate of fertility amongst EU countries, the EU average being 1.57. (Figure 1.4)
· In 2012, counties Dublin, Donegal and Kerry had the lowest fertility rates. (Figure 1.3)
· 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 1.1 million by 2036. The greatest proportional increase will be in the 85+ age group. (Tables 1.4, 1.5 and Figure 1.5)
· 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) at age 65, the difference between women and men is much less significant, indicating that women live longer but with more health problems. (Figure 1.9)
Chapter 2 – Health of the Population
· Please note that any references below to 2012 mortality data should be considered provisional, as 2012 data is currently based on year of registration, and not year of occurrence.
· In 2011, 83% of males and 82% 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 65% for males and females respectively across the EU. Those with higher educational attainment report being in better health. (Table 2.1, Figures 2.1, 2.2)
· Over 56% of males and 57% of females aged 65 and over reported suffering from a chronic illness or condition. In the 75+ age category, 43% and 50% 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 2003-2012, age-standardised death rates for all causes
fell by 22%. Most recently, death rates have shown a decrease of 1.6% between 2011 and 2012 (data for 2012 is provisional). (Table 2.4)
· Among those aged 65 years and over diseases of the circulatory system accounted for 36% of all deaths registered in 2012. This compares with 19% of deaths to those aged under 65 years. A decline in the age-standardised death rate of 35% occurred between 2003 and 2012. (Table 2.4 and Figures 2.3a, 2.3b)
· 19% of deaths in 2012 to those aged under 65 years were due to external causes of death such as transport accidents and suicide. This compares with only 2% of deaths to those aged 65 years and over. (Figures 2.3a, 2.3b)
· There has been an 11% decline in the age-standardised death rate for malignant neoplasms in the last decade, more recently there has been a decrease of 4% between 2011 and 2012. The female breast cancer death rate declined almost 19% since 2003. (Table 2.4)
· Death rates from suicide are down 10% since 2003 and have decreased by almost 9% between 2011 and 2012 (data for 2012 is provisional). (Table 2.4)
· While Ireland’s age-standardised death rate in 2010 was 5.4% below the EU average, the death rate from all cancers was 2.2% above the EU average. (Table 2.5)
· Ireland has had a lower infant mortality rate than the EU average over the last decade; however the gap has narrowed in recent years. (Figure 2.5)
· 5-year relative survival rates from selected cancers remain lower in Ireland than the average for OECD countries where data is available. However, survival rates in Ireland for breast and colorectal cancers have improved in recent years. (Figure 2.8)
· The percentage of mothers breastfeeding on discharge from hospital has increased steadily in the last decade. In 2011, 55% of women breastfed at least partially. (Figure 2.9)
· 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 consumption has remained stable since 2010, while cigarette consumption has declined between 2011 and 2012. (Figure 2.10)
· A higher proportion of adults in younger age groups reported risky single-occasion drinking at least once per month than those in older age groups. (Figure 2.11)
· The prevalence of drug use in the last month was higher among men than women, and higher in younger age groups than older age groups. (Figure 2.12)
· Cigarette and alcohol use in the past 30 days among 15-16 year olds was lower in Ireland than the average of other survey countries. However heavy episodic drinking was slightly higher and cannabis use the same as the average of other survey countries. (Figure 2.13)
· Trends from the Health Behaviour in School-aged Children (10-17 year olds) survey showed a constant decline in those reporting being a current smoker between 1998 and 2010. In 2010, 12% reported being a current smoker. (Figure 2.14)
· Recent data on childhood obesity suggests that 20% of children aged 5 years are either overweight or obese, with those in lower income households more likely to be overweight or obese than those in higher income households. (Figure 2.15)
Chapter 3 – Hospital Care
· Inpatient discharges from publicly funded acute hospitals have increased by 14% since 2003. Excluding dialysis, day cases have increased by 93% since 2003. (Table 3.1)
· Emergency Department attendances have decreased by over 4% between 2011 and 2012. (Table 3.1)
· There has been an 11% reduction in the number of in-patient beds between 2003 and 2012. However, there has been a 125% increase in the number of day beds in the same period. (Table 3.1)
· The average length of stay for in-patients in acute hospitals has declined between 2003 and 2012 for most age groups. (Figure 3.1)
· The number of hospital discharges for Type 2 diabetes has more than doubled between 2005 and 2012. COPD discharges have increased by almost half in the same period. (Figure 3.2)
· In the last year, there has been an increase in the numbers of adults waiting longer than 8 months and children waiting longer than 20 weeks for elective procedures. (Figure 3.3)
· While the number of people waiting longer than 52 weeks for an outpatient appointment has decreased over the past year, the total number of people on the outpatient waiting list has increased in recent months. (Figure 3.4)
· The numbers of admitted patients waiting on trolleys in Emergency Departments of public acute hospitals has reduced between 2012 and 2013. (Figure 3.5)
· The in-hospital mortality rate within 30 days after admission for heart attacks has improved in Ireland since 2001, and in 2011 was on a par with the average rate across EU countries where data is available. (Figure 3.6)
· The number of admissions to psychiatric hospitals and units has continued to decline with a decrease of 4% between 2011 and 2012. There are now more than 21% fewer admissions than in 2003. (Table 3.2, Figure 3.7)
Chapter 4 – Primary Care and Community Services
· Just over 40% of the population had a medical card in 2013. This compares with almost 29% in 2004. (Figure 4.1)
· Louth, Waterford, Mayo and Donegal had the highest percentage of population with medical cards. (Figure 4.2) (NOTE: data in the map are presented by Local Health Office areas)
· Between 2011 and 2012 there was a 9% increase in medical cards to almost 1.9 million representing 40% of the population. Numbers of GP Visit cards increased by 4% to over 131,000. (Table 4.1)
· The number of people treated under the dental and ophthalmic schemes has risen by 13% and 10% respectively between 2011 and 2012. (Table 4.1)
· The number of prescription items dispensed under the General Medical Services has increased by almost 7% between 2011 and 2012, yet there has been no change in the average cost per item. (Figure 4.3)
· There has been a reduction in the percentage of people covered by private health insurance between 2007 and 2012. This is the case for all age groups, with the exception of those aged 70 and over where there has been an increase in the percentage of people covered. (Figure 4.4)
· The number of children in care increased by 3% between 2011 and 2012. The percentage of these children in foster care also increased to almost 92% 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 16% during the period 2003 to 2012. All other age groups over 70 have shown declines over the same period. (Table 4.3, Figure 4.5)
· The immunisation uptake rates of children aged 24 months in 2012 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 91% respectively. (Table 4.4)
· The number of people registered with the National Physical and Sensory Disability Database was 24,988 in 2012. Over 54% of these had a physical disability only. (Table 4.5)
· The number of persons with intellectual disability availing of day services has increased by almost 25% for day attendees and by 5% for full-time residents over the period 2003-2012. (Table 4.6)
· The number of cases in treatment for problem drug use has increased by 45% during the period 2004-2012. (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 100,266 wholetime equivalents employed in September 2013. This represents a decline of 1.2% since December 2012. It should be noted that figures for 2012 refer to September, and do not therefore represent the end of year position. (Table 5.1, Figure 5.1)
· Medical and Dental was the only grade category to show an increase between December 2012 and September 2013. (Table 5.1)
· Nurses make up the largest grade category in the public health service, with 34% of total staff employed. (Figure 5.2)
· The number of consultants employed by the public health service increased by almost 35% in the period 2004-2013. They also increased by 1% between December 2012 and September 2013. (Table 5.2, Figure 5.3)
· The number of non-consultant hospital doctors increased by 18% in the period 2004-2013. They also increased slightly between December 2012 and September 2013. (Table 5.2, Figure 5.3)
· There were 2.7 practising doctors per 1,000 population in Ireland in 2011. This is below the OECD average of 3.1.
Chapter 6 – Health Service Expenditure
· Total public non-capital expenditure on health has increased by 39.8% since 2004, however it has decreased by 2.1% between 2012 and 2013 (data for 2013 are estimates). (Table 6.1)
· Public capital expenditure on health increased by 0.9% between 2011 and 2012 but decreased by almost 32% since 2003. (Table 6.3)
· In 2011, Ireland’s total health expenditure on health was 8.9% of GDP and 11% of GNI. This compares with the OECD averages of 9.3% and 9.8% respectively. (Table 6.4, Figure 6.4)
· Ireland’s per capita total health expenditure has increased steadily in real terms between 2002 and 2008, but has decreased since 2009. (Figure 6.3)