The number of hospital beds per capita shows a quite different trend. Over the period 1980–2000, the number of beds declined sharply in most Member States. For the EU as a whole, there was a 30 % drop, probably due largely to the fact that stays in hospital were cut from 17.4 days in 1980 to under 11 days in 1997. In many countries, the length of time patients spend in hospitals has de- clined substantially over the past 30 years. At the
same time, there is now less difference from one country to another. In 1980, the highest value (23.2 days) was recorded in Luxembourg and Sweden, and was over 2.4 times higher than the lowest value (9.8 days) recorded in Ireland. In 1996, the highest value was 15.3 days (Luxem- bourg) and the lowest 7.2 days (Denmark). A further reason for this tendency lies in the grow- ing financial constraints of the 1990s, which
everywhere led to a rationalisation of healthcare services. The increasing demand for healthcare for elderly people, often suffering from chronic dis- ability or illness, was in most cases met by a trans- fer of beds for acute or psychiatric care to beds for long-term care, with a steady fall in total num- bers. Available resources expressed as the number of hospital beds per capita vary noticeably from one Member State to another. Nevertheless, the
Health personnel Doctors per 1 000 inhabitants
2000 — NUTS 2 > 6 4–6 3–4 2–3 !2
Data not available
DK, EE, SI: 1999 D, IRL, UK: NUTS 1
Statistical data: Eurostat database REGIO © EuroGeographics, for the administrative boundaries Cartography: Eurostat — GISCO, May 2003
supply of hospital services at national and region- al levels correlates closely with total expenditure on healthcare.
In Sweden, the United Kingdom and Spain, the number of beds per 100 000 inhabitants is lower than in any of the other Member States (359, 408 and 409 respectively in 1999/2000), whilst it is highest in France (820). These figures include both public and private hospitals, but differ as re-
gards the inclusion of clinical beds and daycare beds. The difference in bed density is still sub- stantial, even if differences in definition are not taken into account.
The share of gross domestic product (GDP) which the Member States spent on healthcare in 1998/2000 ranged from 6 to 10.4 %. There is a certain north–south (plus Ireland) divide, but the difference is not great. Healthcare expenditure
R e g i o n s : S t a t i s t i c a l y e a r b o o k 2 0 0 3 128
HEAL
TH
9
Hospital beds Rate per 1 000 inhabitants2000 — NUTS 2 > 10.0 8.0–10.0 5.8–8.0 4.5–5.8 !4.5
Data not available
DK, EL, IRL, L: 1999 D, IRL, UK: NUTS 1
Statistical data: Eurostat database REGIO © EuroGeographics, for the administrative boundaries Cartography: Eurostat — GISCO, May 2003
accounted for a higher share of GDP in Germany (10.3 %), France (9.5 %) and Denmark (8.3 %) than in Slovakia (5.9 %) or Poland (6.2 %). Be- tween 1980 and 2000, the healthcare share of GDP rose in most Member States. The level of ex- penditure depends partly on the prices of goods and services and partly on quantities supplied. In this sector, the problem generally arises because the output of ‘health’ cannot be measured direct- ly. Whereas figures for goods and prices are read- ily available in most sectors of the economy, it is impossible to record items such as outpatient or hospital services directly. However, it should be stressed yet again that differences in the way in which healthcare is organised and delimited at na- tional or regional level (e.g. where should the di- viding line be drawn between health services and social services?) make it difficult to interpret com- parisons between countries, whether these are of figures on given dates or of trends.
The north–south divide applies to hospital beds (see Map 9.9), but with certain provisos. The German, French, Austrian and Finnish regions (headed by Mecklenburg-Vorpommern, Wien, Itä-Suomi, Saarland and Limousin) have a high density of beds, in marked contrast to the Span-
ish, Portuguese and Greek regions (Algarve and Sicilia, in particular), the United Kingdom and Ireland. Certain border regions such as Yugoiz- tochen (Bulgaria) or Itä-Suomi (Finland), which border on Turkey and Russia, respectively, also have a density higher than other regions owing, possibly, to inflows of patients from these neigh- bouring countries.
It is in Spain that the density of beds per 1 000 in- habitants is most uniform (between 3 and 5) whilst it varies most in Austria (between 6 and 12). The number of beds per 1 000 inhabitants is highest in relation to the EU average in Austria, France and Germany and lowest in Spain, Portu- gal and some regions of Greece. The tendency is very different as regards the number of hospital beds per inhabitant. Between 1986 and 2000, this figure fell noticeably throughout the EU (from 8.3 beds to 6.3). Here, again, there are no noticeable differences between the EU regions and the re- gions in the candidate countries. All the regions in the latter have a bed density which, in many cas- es, is higher than in the EU regions. Examples are Severozápad and Strˇední Morava (Czech Repub- lic), Bratislavsky´ (Slovakia), Bucures¸ti (Romania) and Zachodniopomorskie (Poland).