| CEE - 10 challenges for the new decade |
| No.4 Healthcare |
Intensified prevention and reduction of risk factors are key pre-requisites for improving avoidable mortality in CEE. Healthcare systems need much better planning and use of resources including healthcare staff and digitalization to address new challenges.
It cannot be denied that the healthcare system in CEE would benefit from higher expenditure. CEE countries spent about 2-4% of GDP less on healthcare compared to the EU average in 2017. There is also little doubt that the level of expenditure is related to the demographic structure of society, the health status of its citizens, and preventable or treatable mortality rates. While a 50-year-old in Germany or France can expect to live another 20 years in health, in CEE the expected number of healthy years at 50 ranges from 17 years in Czechia or Poland to only 12 years in Slovakia. Furthermore, as its population is aging, the region needs to be prepared for the fact that healthcare-related expenditures will rise and place growing burdens on public budgets.
However, expected life in health (be it at birth or later in life) is not only a function of expenditure level. A significant number of lives could be saved in CEE if disease prevention was better (e.g. higher screening intensity). Improved early diagnosis requires, apart from investment in preventive care, an increase in the public awareness that it is better (and cheaper) to prevent than cure. Further, relatively high preventable mortality in CEE is associated with the fact that people are more exposed to risks factors such as smoking, alcohol, air pollution and unhealthy diets.
Reduction of risk factors is most crucial…
The relatively high preventable mortality in CEE is associated with the fact that people in the region are more exposed to risks factors such as smoking, alcohol , air pollution and an unhealthy diet (lack of high-fiber food). Risk factors increase the incidence of ischaemic heart diseases and cancer, the two largest contributors to premature deaths.
Smoking is the key risk factor in CEE countries which needs to be tackled. While the share of adults smoking daily has been on the decline in the last decade in the EU, there has been hardly any progress in CEE countries, with the sole exception of the Czech Republic. The situation is particularly worrying among teenagers, as about 29-33% of 15-16-year-old Croats, Slovaks, Czechs, Romanians and Hungarians smoke regularly or occasionally. CEE countries have not increased tobacco excise taxes as much as Scandinavian countries, Ireland or the Netherlands and keep them close to the minimum level required by the EU Directive. The affordability of cigarettes could be one of the reasons why CEE countries have been less successful in reducing smoking rates.
…together with intensified prevention
Early diagnosis of disease can substantially increase the effectiveness of treatment and chances for survival. Thus many countries have intensified
screenings for risk groups. This is the case for cervical cancer screening, where substantial expansion of screened groups in Poland and Romania led to a visible progress in the reduction of cervical cancer mortality. Romania would still need to at least double the number of cervical screenings to curb its cervical mortality rate, which is the highest in the EU.
Over the last decade, the five-year net survival rate of breast cancer has improved in the EU thanks to early diagnosis and effective treatment. Unfortunately, it remains rather low in Romania and Slovakia, which lag far behind other countries in mammography screening, or in Poland, where the number of screenings only recently increased. Some progress has been made in the reduction of colorectal cancer mortality (mainly in the Czech Republic), but potential for improvement remains very high in all CEE countries, especially in Slovakia, Croatia and Hungary.
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CEE Challenges for the new decade:
No.1 Demography
No.2 Going Green
No.3 Rule of Law
No.5 Euro Adoption
No.6 Labor Market
No.7 Education
No.8 Regional Development
No.9 Capital Markets