Health at-a-glance-2015
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HEALTH AT A GLANCE 2015
Berlin, 2. November 2015
Wo steht Deutschland?
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Guter Zugang aber Qualität nicht immer überdurchschnittlich
Themengebiet Merkmale des deutschen Gesundheitssystems
Zugang
Ressourcen
Inanspruchnahme
Qualität
Geringe Wartezeiten, geringe finanzielle Eigenleistung der Patienten, ausgeprägte
Wahlmöglichkeiten für Patienten
Sehr hohe Anzahl von Krankenhäusern und KH-Betten, hohe Verfügbarkeit an Personal
(z.B. Ärzte, Krankenpfleger)
Sehr hohe Anzahl an Operationen, hohe Anzahl von ärztl. Konsultationen, hohes Konsumniveau bei einigen Arzneimitteln
Hohe Überlebensrate nach Schlaganfall, aber hohe Zahl von vermeidbaren KH-Fällen für
COPD und Diabetes
Ausgaben Insgesamt hoch, z.B. auch für Arzneimittel, moderates Wachstum in den letzten Jahren
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INSGESAMT GUTE HEALTH OUTCOMES ABER
ERFOLGE IN GEFAHR
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4
Lebenserwartung über OECD Durchschnitt und steigend
Japa
nSp
ain
Switz
erla
ndIta
lyFr
ance
Aust
ralia
Icel
and
Isra
elSw
eden
Luxe
mbo
urg
Norw
ayKo
rea
Cana
daG
reec
eNe
ther
land
sNe
w Ze
alan
dAu
stria
Unite
d Ki
ngdo
mFi
nlan
dIre
land
Ger
man
yPo
rtuga
lBe
lgiu
mO
ECD
(34)
Slov
enia
Denm
ark
Cost
a Ri
caCh
ileUn
ited
Stat
esCz
ech
Rep.
Esto
nia
Pola
ndTu
rkey
Slov
ak R
ep.
Hung
ary
Chin
aCo
lom
bia
Braz
ilM
exic
oLa
tvia
Lith
uani
aIn
done
sia
Russ
ian
Fed.
Indi
aSo
uth
Afric
a
40
50
60
70
80
90
83.4
83.2
82.9
82.8
82.3
82.2
82.1
82.1
82.0
81.9
81.8
81.8
81.5
81.4
81.4
81.4
81.2
81.1
81.1
81.1
80.9
80.8
80.7
80.5
80.4
80.4
80.0
78.8
78.8
78.3
77.3
77.1
76.6
76.5
75.7
75.4
75.2
75.0
74.6
73.9
73.5
70.9
70.7
66.5
56.8
2013 1970Years
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5
Starker Rückgang bei Herz-Kreislauf-Erkrankungen hat zur Steigerungen der Lebenserwartung beigetragen
Source: Health Statistics 2015
19901992
19941996
19982000
20022004
20062008
20102012
0
100
200
300
400
500
600
700
Mortality from all other causesMortality from cardiovascular diseasesMortality from all causes, GermanyMortality from cardiovascular diseases, Germany
Age-standardised rates per 100 000 population
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6
Aber Anstieg bei Adipositas gefährdet erreichte Erfolge
Source: Health at a Glance 2015
Japa
n ¹
Korea ¹
Norway Ita
ly
Switzerl
and
Netherl
ands
Sweden
Austria
Belgium
Denmark
France
Portug
alIsr
ael
Poland
Spain
OECD (28)
Estonia
Czech
Rep
. ¹
Icelan
d
Luxe
mbourg
¹
German
y ¹
Finlan
d
United
King
dom ¹
Chile ¹
Canad
a ¹
Austra
lia ¹
New Zea
land ¹
Mexico
¹
United
Stat
es ¹
0
10
20
30
40
3 3
8 9
8
9 9 9
12
10 9
13 13
11
13
15 14 14
12
16
20
23
21
25
22
20
25 24
31
4
5
10 10 10 11 12 12
14 14 15
15 16 16 17
18 19
21
22 23
24
25 25 25 26
28
31
32
35
2000 2013% of population aged 15 years and over
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7
Bevölkerungsalterung und Zunahme von Demenz stellen Gesundheits- und Pflegesystem vor Herausforderungen
Source: Health at a Glance 2015
South
Africa
India
Indon
esia
China
Turke
y
Mexico
Brazil
Korea
Slovak
Rep
ublic
Russia
n Fed
.
Israe
l
Poland
Irelan
d
Chile
Czech
Rep
ublic
Icelan
d
United
Stat
es
Hunga
ry
New Ze
aland
Estonia
Sloven
ia
Austra
lia
Luxe
mbour
g
Canad
a
OECD34
Norway
Netherl
ands
Denmark
United
King
dom
Switzerl
and
Austri
a
Portug
al
Belgium
Finlan
d
Sweden
Spain
Greece
Fran
ce
German
y
Japa
n
Italy
0
5
10
15
20
25
30
35
40
2015 2035Per 1 000 population
Estimated prevalence of dementia per 1 000 population, 2015 and 2035
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PRIMÄRER GESUNDHEITSSEKTOR
SOLLTE GESTÄRKT WERDEN
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9
Anteil der Hausärzte geht zurück; dies gefährdet den Zugang zur Primärversorgung
19951996
19971998
19992000
20012002
20032004
20052006
20072008
20092010
20112012
201325
30
35
40
45
50
55
60
%
Source: OECD Health Statistics 2015
France
United Kingdom
Belgium
Germany
Netherlands
Australia
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10
Hohe Anzahl vermeidbarer Krankenhausfälle Verbesserungspotenzial in Primärversorgung
Source: OECD Health Statistics 2015
Diabetes hospital admission in adults, 2013 (or nearest year)
Italy
Switzerl
andSpa
in
Icelan
d
United
King
dom
Netherl
ands
Norway
Portug
alIsr
ael
Canad
a
Hunga
ry
Sweden
Sloven
ia
Denmark
Finlan
dLa
tvia
Irelan
d
Austra
lia
OECD (31)
Japa
n
Luxe
mbourg
Belgium
France
New Zea
land
Czech
Rep
.
United
Stat
es
German
y
Slovak
Rep
.Chil
e
Poland
Austria
Korea
Mexico
0
50
100
150
200
250
300
350
400
4502008 2013Age-sex standardised rates per 100 000 population
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11
Verfügbarkeit von KH-Betten geht zurück, aber noch immer auf hohem Niveau
0
3
6
9
12
15
13.3
11.0
9.1
8.3
7.7
7.3
7.0
6.6
6.5
6.3
6.3
5.8
5.8
5.1
5.0
4.9
4.8
4.8
4.7
4.6
3.9
3.8
3.4
3.4
3.3
3.2
3.1
3.1
3.0
2.9
2.8
2.8
2.8
2.7
2.7
2.6
2.3
2.3
2.2
1.6
1.5
1.0
0.5
2000 2013
Per 1 000 populationPer 1 000 population
Hospital beds per 1 000 population
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12
Sehr hohe Krankenhausaktivität…
0
50
100
150
200
250
300
266
252
235
213
204
202
199
196
182
175
173
173
172
172
171
170
167
166
166
163
162
161
159
155
146
141
140
139
135
129
125
124
119
113
111
99 9583
56 53 4834
Per 1 000 populationPer 1 000 population
Hospital discharges
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13
…vor allem bei elektiven Eingriffen…
…aber erstmaliger Rückgang in 2013
SwitzerlandGermany
AustriaBelgiumNorwayFinland
SwedenFrance
DenmarkNetherlandsLuxembourg
United StatesIceland
United KingdomAustralia
Czech Rep.Italy
OECD33Slovenia
GreeceNew Zealand
HungaryCanadaIreland
EstoniaSpain
Slovak Rep.Portugal
PolandIsrael
TurkeyChile
KoreaMexico
0 50 100 150 200 250 300 350
292283
276246243242238236
227216216
204185183
171170166161161
152150
137136
127112
107105
8885
6344
3320
8
Per 100 000 population
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
100
150
200
250
300
350
France Germany Italy
United States OECD33
Per 100 000 population
Hip replacement surgery, 2013
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HERAUSFORDERUNGEN BEIM GESUNDHEITSPERSONAL
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Deutsche Ärzte sind relativ alt…
Share of doctors aged 55 years and over, 2000 and 2013 (or nearest year)
0
10
20
30
40
50
1315
21
25 25 26 26 26 26 27 27 28
33 33 33 33 34 34 3436
37 3840 41
42 43 44 45
49 492013 2000%
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Ausländische Ärzte sind zunehmend wichtiger, um Personalbedarf zu decken
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 0
2 000
4 000
6 000
8 000
10 000
12 000
Domestic graduates Foreign doctorsDOCTORS
Annual inflow of new doctors
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Anzahl der ausländische Ärzte steigt kontinuierlich…
In 2014, 56% of foreign doctors come from EU countries
High increase from EC countries, Ukraine, Russia and Syria
11%
8%
6%
5%
26%5%5%
35%
Romania
Greece
Austria
Rest EU
Poland
Other
Russia
Syria
2000 2014Total 9,971 31,857Romania 342 3,363Greece 756 2,461Austria 440 1,986Poland 482 1,598Russia 610 1,587Syria 349 1,441Hungary 147 1,321Bulgaria 144 1,188Slovak Republic 18 998Ukraine 145 889
Top 10 countries of origins of foreign doctors working in Germany
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…aber ihr Anteil ist immer noch geringer als in anderen OECD Staaten
Israe
l
New Zea
land
Norway
Irelan
d
Austra
lia
United
King
dom
Switzerl
and
United
Stat
es
Sweden
Canad
a
Finlan
d
OECD26Chil
e
Sloven
ia
Belgium
Spain¹
France
German
y¹
Hunga
ry
Denmark
Austria
Slovak
Rep
.
Czech
Rep
.
Netherl
ands
Estonia
Poland
Turkey
0
10
20
30
40
50
60 58.5
43.5
35.8
34.2
30.5
28.7
27.0
25.0
24.3
23.5
19.9
17.3
15.2
14.4
10.7
9.4
9.2
8.8
7.6
5.6
4.4
3.0
2.7
2.6
2.4
1.8
0.2
%
Share of foreign-trained doctors in OECD countries, 2013
In 2014, share for Germany increased to 9.5%1. In Germany and Spain the data is based on nationality, not the place of training
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HOHES AUSGABENNIVEAU TROTZ GEBREMSTEN
WACHSTUMS , VOR ALLEM BEI ARZNEIMITTELN
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20
Gebremstes Ausgabenwachstum, aber Niveau bleibt über OECD Durchschnitt
Annual average growth rate in per capita health expenditure, real terms, 2005 to 2013 (or nearest year)
Greece
Luxe
mbour
gIre
land
Portug
alSpa
inIta
lyDen
markIce
land
Sloven
iaCze
ch R
ep.
United
King
dom
Canad
aEsto
niaBelg
iumOECD
Slovak
Rep
.
New Ze
aland
Hunga
ryFr
ance
Austri
aSwed
enTu
rkey
Norway
1Fin
land
United
Stat
esNeth
erlan
dsMex
icoAus
tralia
German
yPola
ndSwitz
erlan
dIsr
ael
Japa
nKor
eaChil
e2
-10
-5
0
5
10
15
5.4
-0.4
5.3
1.3
3.5
0.5
3.4
0.4
3.2
5.4
3.6
3.5
6.7
3.2 3.4
11.3
4.1
-2.3
1.5 2.
2
1.7
5.0
1.9
1.7 2.
3 3.3
1.7
2.9
2.8
8.4
1.3 1.
9
3.2
9.0
5.9
-7.2
-4.3 -4.0 -3
.0
-1.7
-1.6 -0
.8 -0.4
-0.3
-0.2
-0.1
0.3
0.3 0.5
0.6
0.6
0.6 0.8
0.9
1.0
1.0
1.2
1.2
1.3 1.5 1.7
1.7 2.0
2.0 2.3 2.5 3.
6 3.9
5.4 6.
4
2005-2009 2009-2013
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21Source: OECD Health Statistics 2015
Spending development of health care functions, OECD average and Germany
Rückgang bei Ausgaben für Prävention und Stagnation bei Arzneimitteln in Deutschland
Germany
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Verstärkter Gebrauch von Generika hat Arzneimittelkosten gebremst…
Share of generics in the total pharmaceutical market, 2013
0
30
60
90
2833
59
3734
41
29
16
37
14
46
2421
24
17 1719
23
1714 16 16
1115
1116
4
84 8380 80 77
72 70 70
55 5450 48 47 46 45
40 40 3935
32 30 29 28
20 19 17
8
Value Volume%
1. Reimbursed pharmaceutical market
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..aber Ausgaben für Arzneimittel bleiben auf hohem Niveau…
United
Stat
esJa
pan
Greece
1Can
ada
German
ySwitz
erlan
dIre
land 1
Belgium
Fran
ceAus
tralia
Italy
1Aus
triaSlov
ak R
ep. 1
Spain
OECD29Hun
gary
Sloven
iaFin
land
Sweden
Korea
Nethe
rland
s 1Ice
land
Portug
al 1
Czech
Rep
.Nor
wayLu
xembo
urgPola
ndIsr
ael 1
Eston
iaDen
mark
0
200
400
600
800
1000
1200
1026
752
721
713
678
666
652
603
596
590
572
536
533
526
515
503
481
459
459
436
397
396
392
381
367
364
326
287
273
240
Prescribed medicines Over-the-counter medicines Total (no breakdown)USD PPP
Expenditure on pharmaceuticals per capita
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…was teilweise durch hohen Konsum erklärt werden kann
ChileAustriaIcelandNorway
DenmarkEstonia
IsraelSwedenTurkey
CanadaOECD27AustraliaPortugal
LuxembourgBelgium
KoreaSlovak Republic
FranceGreece
SpainItaly
SloveniaNetherlands
HungaryCzech RepublicUnited Kingdom
GermanyFinland
0 20 40 60 80 100
94043
4952
5555565658
6262636465656666666767
7375
78808283
86
2013 2000
Defined daily dose, per 1 000 people per day
TurkeyKorea
AustriaGreece
IsraelLuxembourg
AustraliaPortugal
FranceSpain
IcelandNorway
NetherlandsCanada
OECD26EstoniaBelgiumSweden
United KingdomDenmark
ItalySlovak Republic
SloveniaFinland
Czech RepublicHungary
Germany
0 100 200 300 400 500 600
124141
184194
217223239250
266269274279
303311318323328
368380
398399410414427442
543575
2013 2000
Defined daily dose, per 1 000 people per day
Antihypertensive drugs Antidiabetic drugs
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Moderater Konsum von Antidepressiva aber starker Anstieg in letzten Jahren
Antidepressants
ChileKorea
EstoniaHungary
TurkeySlovak Republic
IsraelItaly
NetherlandsGreece
Czech RepublicFrance
GermanySlovenia
LuxembourgNorway
OECD28Austria
SpainFinland
BelgiumNew Zealand
DenmarkUnited Kingdom
SwedenCanada
PortugalAustralia
Iceland
0 20 40 60 80 100
132021
283535
42434344
4950
535354565859
65697273
8082848588
96118
2013 2000
Defined daily dose, per 1 000 people per day
118
2000 2005 2010 20130
10
20
30
40
50
60
70
80
90
Germany Belgium France
Netherlands United Kingdom
DDD
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