European Core Health Indicators Research Articles

Challenges in Healthcare Management Models in The Country of Georgia and Proposed Solutions

The article "Problems in Georgia's Health Care Management System and the Proposed Solutions" examines the impact of ongoing health care reforms in Georgia on the overall health status of the population and its influence on changes in such indicators as the country's demography. The article eexplores both the primary health care system and the secondary care and highlights that despite much interventions and funding coming from donor organizations and the state budget, Georgia's health care system is still far from reaching the European Core Health Indicators (ECHI). Specifically: referral rates to a "family doctor" is low; the proportion of "out-of-pocket" payment is still high; there is a substantial shortage of nurses and a surplus of doctors; low hospital bed occupancy rates; funding for primary care on a "residual principle" remains a challenge and more. Concomitantly, all of the above reflected the demographic indicators of the country, and within the last three decades over the period from 1990 to 2021 the birth rates declined, mortality increased, and average life expectancy decreased. Based on the findings, the authors conclude that it is hard to close the existing gaps the country's health care system is facing by means of a single sectoral approach, and propose a strategy for inter-sectoral management model for health care within one cluster. The article examines a model on the example of the Samtskhe-Javakheti region of Georgia. Keywords: health care reforms; management of reforms; "Family Doctor"; Family Medicine; intersectoral management; cluster.

Measuring the efficiency of medical tourism industry in EU member states


 Purpose
 
 Under the Directive 2011/24/EU, medical tourism and cross-border health are interrelated terms regarding the freedom to move to get the most accessible medical treatment into EU Member State within the defined procedures for reimbursement. Little known empirically regarding the efficiency of the cross-border health/medical tourism industry. This study aims to measure its efficiency in Europe for the years 2010-2014, by using Data Envelopment Analysis (DEA).
 
 
 
 Design/methodology/approach
 
 Data obtained from OECD and the European Core Health Indicators (ECHI), which is collecting the data through Eurostat. Eurostat collects data on health-care activities and provides data on hospital discharges, including the hospital discharges of non-residents and these include hospital discharges of in-patients and day care patients. The analysis uses “DEA.P, 2.1 for windows” by Coelli (1996).
 
 
 
 Findings
 
 The results show that the Members States health systems were very efficient in handling non-residents in-patients; however, when managing day cases/outpatients, the efficiency scores dropped.
 
 
 
 Practical implications
 
 The findings would have significant associations affecting intentions to revisit clinics and the destination country. In addition, will be useful to those seeking a better understanding of the cross-border health and medical tourism industry efficiency.
 
 
 
 Originality/value
 
 Extending the findings of the European Commission report (2015c) by examining how well medical tourists are informed about the decision they are making, would be of perceived value. These are important indicators at European level by helping each Member State to measure its medical tourism services.
 

A sustainable ECHI-shortlist

Abstract Background The European Core Health Indicators (ECHI) list provides a 'snapshot' of European public health (including care). It is the result of consecutive EU-wide projects in response to a 1998 European Commission (EC) call to establish an indicator list as the core of the EU public health monitoring system. The current list contains 88 indicators, a large part of which have been implemented and used across the EU. Using ECHI to internationally compare public health aspects adds value to national health information. Currently, EC maintains a tool in which the indicators can be consulted. However, no formal governing entity exists. The aim of this study, under the Joint Action on Health Information (InfAct), is to explore the future of the policy guiding role of the ECHI list, the process of adapting and innovating the list and the role of current member state initiatives in this. Methods Relevant technical information, available via 'doc(umentation) sheets' dating from 2012, was subjected to an update process. Potential improvements in content (additions, deletions, and adjustments), overall balance and policy relevance were suggested by health information experts (via survey and expert meetings). This work will be expanded in the near future of InfAct. Results Peer-reviewed updates of the doc sheets included aligning with meta information from relevant data collecting bodies and reviving web links. A process to guide content changes to the list is in development, balancing sustainability and updates for public health policy. Online background ECHI information is disseminated via ECHI.eu. Conclusions Health information experts still consider the ECHI shortlist important for EU health policy, but it needs to be modernized and promoted. A formal structure is needed to ensure the highest value to EC and MS health policies. The future distributed research Infrastructure on population health (DIPoH) may host the shaping and governing the ECHI, in liaison with EC and MS.

14.I. Workshop: Strengthening the impact of national health information systems in policy and practice

Abstract Health information (HI) includes data on population health, on health determinants, health care systems, and health-relevant policy developments. Duly prioritised HI is essential to inform decision-makers, researchers and the public. However, getting evidence into the hands of key stakeholders is still a challenge in many European countries. Depending on the respective target groups: decision-makers, clinical care providers, allied health professionals, health advocates and patients, various challenges arise for leveraging this data for intervention. While public health agencies aim to improve health for all, building bridges across stakeholder groups for a more efficient implementation of evidence-based recommendations requires concerted efforts and exchange of best practices and innovations in HI. This workshop aims to provide delegates with a clear understanding of the strategies that can strengthen the impact of national health information systems (HIS) in policy and practice. Within InfAct, the EU Joint Action on Health Information (InfAct), EU-Member States have taken significant steps towards building such an integrated infrastructure to advance the use of HI for analysis, decision-making and intervention. Five case examples of this consortium will be presented. The objectives are two-fold: 1) to provide delegates with an overview of the latest developments in public health reporting and monitoring across European countries, and 2) to present solutions that focus on strengthening the impact of national HIS in policy and practice. The workshop will begin with an introduction to national strategies that have been implemented across Europe to identify and prioritise HI needs; good practice recommendations for public health reporting will also be provided. At EU level, the 88 European Core Health Indicators (ECHI) have been widely adopted to provide a 'snapshot' of European public health (including care), and we will explore the future of the ECHI list in guiding decision-makers. There is also increasing interest on how to facilitate the uptake of evidence in the health system but also across sectors; this relies on taking into account the broader socio-political context and envisioning new partnerships with civil society and non-state actors. Therefore, our workshop will explore the latest developments in monitoring knowledge integration into national policies and civil society. Dialogue on what can be done, and what is needed for better knowledge management will be fueled by an interactive voting poll during the session. The Mentimeter poll will prompt the audience to share, in real time, their perspectives and expectations for HI production, dissemination and use across countries. For example, on the role of health literacy in facilitating the implementation of evidence-based recommendations. The delegates will take the perspective of the public, the public health researcher and the health policy maker in this. Key messages Mapping health information (HI) priorities and reporting approaches across countries facilitates the exchange of best practices in the context of building a sustainable EU Health Information system. The future EU distributed research infrastructure on population health (DIPoH) may hold a key role in informing national and EU-level interventions in health policy and practice.

Data Performativity and Health: The Politics of Health Data Practices in Europe

The European Commission produces the European Core Health Indicators (ECHI), a database containing different tools used to compare European Union (EU) countries and recommend policy changes. The ECHI feeds multiple reports and documents and finds its way into health policies. From this arises the main research question addressed in this paper: How is health in Europe influenced by ECHI data practices? Specifically, we look at how some health issues or populations are prioritized or dismissed, which ultimately shapes the meaning of and knowledge about health in Europe. To do so, we first develop the conceptual framework of “data performativity,” underlining how data practices shape their object/subject. We then explore the politics of evidence behind the ECHI health data that materialize into (1) the absence of some health issues and populations and (2) the hypervisibility of neoliberal health. In the end, we argue, the ECHI serves as a site of individual, collective, and political identity enunciation.

Estimating the Prevalence of Alcohol Dependence in Europe Using Routine Hospital Discharge Data: An Ecological Study

This study aims to explore the feasibility of using routine hospital discharge data, at the level of countries within Europe, to estimate the general population prevalence of alcohol dependence (AD). We utilised the European Core Health Indicators data tool to extract the annual rate of hospital discharges due to any wholly attributable alcohol condition as defined by the ICD-10. For those counties with data available, we systematically searched Medline, EMBASE, PsychINFO and Google for studies reporting an estimate of the prevalence of AD from national cross-sectional surveys. We compared these prevalence estimates with those developed from prediction models based on hospital discharge data. The rate of hospital discharges due to any condition from the F10 diagnostic category (mental and behavioural disorders due to alcohol) was moderately correlated with AD prevalence (r=0.56), while the rate due to any condition from the K70 diagnostic category (alcoholic liver disease) was weakly correlated with AD prevalence (r=0.21). Two-thirds of the estimates from cross-sectional surveys were not significantly different to those generated using the F10 discharge rate prediction model. Country-level AD prevalence estimates generated using annual F10 hospital discharge rates are likely to provide information of some utility, particularly when limited other sources of information are available or when examining relative trends over time or between regions. There is, however, currently insufficient evidence to make a definitive recommendation to use hospital discharge data to estimate the absolute prevalence of AD per country in Europe.

Measuring the efficiency of medical tourism industry in EU member states

Purpose Under the Directive 2011/24/EU, medical tourism and cross-border health are interrelated terms regarding the freedom to move to get the most accessible medical treatment into EU Member State within the defined procedures for reimbursement. Little known empirically regarding the efficiency of the cross-border health/medical tourism industry. This study aims to measure its efficiency in Europe for the years 2010-2014, by using Data Envelopment Analysis (DEA). Design/methodology/approach Data obtained from OECD and the European Core Health Indicators (ECHI), which is collecting the data through Eurostat. Eurostat collects data on health-care activities and provides data on hospital discharges, including the hospital discharges of non-residents and these include hospital discharges of in-patients and day care patients. The analysis uses “DEA.P, 2.1 for windows” by Coelli (1996). Findings The results show that the Members States health systems were very efficient in handling non-residents in-patients; however, when managing day cases/outpatients, the efficiency scores dropped. Practical implications The findings would have significant associations affecting intentions to revisit clinics and the destination country. In addition, will be useful to those seeking a better understanding of the cross-border health and medical tourism industry efficiency. Originality/value Extending the findings of the European Commission report (2015c) by examining how well medical tourists are informed about the decision they are making, would be of perceived value. These are important indicators at European level by helping each Member State to measure its medical tourism services.

European Core Health Indicators - status and perspectives

BackgroundThe European Core Health Indicators (ECHI) are a key source of comparable health information for the European Union (EU) and its Member States (MS). The ECHI shortlist contains 88 indicators which were developed by experts from MS and international organisations. Most indicators are derived from data sources at the EU’s statistical office (Eurostat), the World Health Organisation (WHO) and the Organisation for Economic Co-operation and Development (OECD) and are available for most MS. The remaining indicators on the shortlist are at different stages of conceptual and/or methodological development. The indicators have been reviewed in the past against scientific developments, changes in data collections and emerging policy needs, yet not as part of a systematic and sustainable procedure. There is also no regular inventory of problems met by the MS in collecting the necessary data. Work package 4 of the BRIDGE Health project aimed at updating and improving the existing ECHI-indicator knowledge and expertise and at strengthening the scientific base that supports the effective development and use of health indicators for health policy evaluation and prioritization by the EU and its MS. The aim of this paper is to present a first overview of its outcomes and to explore issues concerning the ECHI data availability, content and policy relevance, update process and accessibility to stakeholders, in light of working towards a sustainable future.MethodsTwo surveys were conducted within the framework of the BRIDGE Health project to reassess the status of the ECHI shortlist. The first survey focused on data availability in EU MS, candidate countries and European Free Trade Association (EFTA) countries. The second survey evaluated current needs and criteria with respect to content and policy relevance of the ECHI shortlist. Exploring potential new indicator topics was part of both surveys. All evaluations were supported by an advisory network of national and international experts.ResultsOf the 36 countries (EU MS, candidate and EFTA countries) contacted for the data availability mapping, 23 countries (63%) participated in the survey. Data availability from preferred data sources varied between chapters. Availability was highest for the chapter on demography and socio-economic situation, followed by the chapter on health status, where data were available for most indicators from more than 90% of the participating countries. Problems experienced by MS relating to the incorporation of ECHI into their health systems were also identified through the survey. Findings from the survey on policy relevance point at the need for strengthening the links with policy (priorities) and for exploring a possible format change of the list to accommodate actionability. It also showed support for embedding ECHI in a sustainable health information structure; this may practically be aided by a web-based single point of access to an information repository.ConclusionPolicy relevance is an essential but not systematically developed criterion for the inclusion of indicators into the ECHI shortlist. Data availability is crucial for the actual implementation of indicators and has considerably increased for ECHI in the last decade. The data availability mapping provides a structured overview of the current status of data availability for implemented indicators. The ECHI shortlist can contribute to the collection of comparable policy-relevant health data in Europe, foster evidence-based public health and contribute to Member States learning from each other. Flexible and systematic incorporation of policy relevance in the ECHI shortlist review and revision process may substantiate ECHI as a core component of a future sustainable European health information infrastructure.

Environmental health surveillance in a future European health information system

BackgroundTo date Health information (HI) in the European Union does not comprise indicators or other information related to impacts of hazardous chemicals in consumer products, food, drinking water or air on the health status of the population. Therefore, we inventorised and evaluated the potential of environmental health surveillance and research data sources in the European population to provide HBM-based indicators of internal human exposure and health impact of relevant chemicals.MethodsWe established an up-dated inventory of European cross-sectional Human Biomonitoring (HBM) surveys and of birth cohorts, and compared chemicals and chemical groups addressed by HBM with indicators and health end points collected via European Core Health Indicators (ECHI), in birth registries, as well as in environmental and food data bases and health registries to see on how data collection could be aligned. Finally, we investigated study designs of HBM survey and health examination surveys for potential synergies.ResultsThe inventory covers a total of 11 European cross-sectional national programmes and a large number of birth cohorts and includes information on study population, age groups, covered substances, sampled matrices, and frequency. The comparison of data collections shows that there are many overlaps between environmental chemicals with environmental and health reporting. HBM data could be linked with ECHI indicators for work-related risks, body mass index (BMI), and low birth weight, with perinatal disease, neurologic disorders, and some chronic diseases, or with data bases for e.g. indoor air, food, or consumer products. Existing initiatives to link data collections at European Environment Agency (EEA) and Joint Research Center (JRC) or at World Health Organization (WHO) are good options to further develop linkage of HBM with exposures sources and health end points.ConclusionsThere is potential to use HBM based information in a number of public health policies, and this would help to align reporting to international commitments. Environmental health surveillance based on HBM and HBM-based indicators, is an excellent tool to inform public health policies about risks from environmental chemicals, and the EU health information system would benefit from additional HBM-based indicators for monitoring exposure burden from environmental chemicals. Considerable efforts are needed to align and establish routine data collections and to develop a surveillance system and indicators which may inform public health policies.

Generate knowledge: The European Core Health Indicators

Generate knowledge: The European Core Health Indicators

Health monitoring and health indicators in Europe

Demographic change, new health threats and inequalities in health and healthcare provision in and between European Union (EU) member states pose a great challenge to European health care systems. Not only for these reasons does it make sense to collect comparable European health data. Such information provides insights on the distribution of risk and protection factors, the prevalence of chronic diseases and the levels of care provided in the member states and supports the planning and implementation of (health) policy measures. Since 2013, in the context of the European Health Interview Survey (EHIS), all EU member states are obliged to collect data on the health status, the provision of healthcare, health determinants and socio-economic conditions of their populations. In Germany, the EHIS is integrated into health monitoring at the Robert Koch Institute (RKI). The RKI is thus Germany's interface to the European health monitoring presented here. European health monitoring relies on different indicator systems such as the European Core Health Indicators (ECHI), EU social indicators and the health indicators of the European Sustainable Development Strategy. These are based on administrative and survey data, which stem for example from the EHIS or the European Union Statistics on Income and Living Conditions (EU-SILC) survey. Comparative data analyses must take into account the differences between health care systems, socioeconomic conditions and the age structures of societies. Variances in the prevalence of allergies for example are also due to differences in the available diagnostic tools. Significant differences in the prevalence of hypertension in Europe (with a range of 20% for women and 17% for men) are also related to different levels of awareness of hypertension. Comparative analyses can support the planning of and provide information for policy measures, and enhance the sharing of experiences between EU member states. A forthcoming EU regulation aims to harmonise the content of and intervals between health and social statistical data collection. Moreover, plans exist to establish a European Research Infrastructure Consortium (ERIC), which is set to develop and institutionalise European health monitoring.

Disparities in health and access to healthcare between asylum seekers and residents in Germany: a population-based cross-sectional feasibility study

ObjectivesTo assess disparities in health and healthcare between asylum seekers (AS) and residents in Germany as a proof of concept using European Core Health Indicators (ECHI).DesignPopulation-based cross-sectional feasibility study.ParticipantsAll AS...

Implementing the European Core Health Indicators (ECHI) in the Netherlands: an overview of data availability.

BackgroundThe European Commission, together with the European Union (EU) Member States, developed a core set of indicators for monitoring public health in the EU, the European Core Health Indicators (ECHI) shortlist. From 2009 to 2012 developmental work on the ECHI indicators continued within the framework of the Joint Action for European Community Health Indicators and Monitoring (ECHIM). In this article, we give the current state of affairs on the availability of data for the ECHI indicators in the Netherlands and show what progress has been made over the past 5 years. The information provided serves as an illustration of the challenges encountered in a European country when working on harmonising national data collections with international data delivery requirements.MethodsTo assess data availability, we consulted Dutch data experts and relevant websites and reports on health monitoring activities. We compared the available Dutch data with the definitions, preferred data sources and relevant dimensions as requested by ECHI.ResultsThe Netherlands can provide data for 66 of the 75 ECHI indicators for which availability could be assessed: for all of the 48 ECHI indicators that can be extracted from international databases and for 18 of the 27 indicators not available from international databases. Breakdowns by socio-economic status and region are not possible for 23 (35%) of the total of 66 indicators for which data are available and for 21 (32%) of these 66 indicators the definition is not exactly the same as requested by ECHIM. Since 2009, better estimates have become available for low birth weight, practising physicians and practising nurses.Moreover, several European initiatives to improve harmonised data collection are expected to have a positive effect on data availability for the Netherlands. Such initiatives should become sustainable in order to provide possibilities for monitoring trends. The scattered data ownership in the Netherlands complicates the coordination work for international data deliveries.ConclusionData availability in the Netherlands is good. Since 2009, several Dutch and European developments in harmonising data collection have contributed or will significantly contribute to improvements in the data situation for the ECHI indicators in the Netherlands.Electronic supplementary materialThe online version of this article (doi:10.1186/s13690-014-0058-4) contains supplementary material, which is available to authorized users.