Background
Methods
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systemic factors,
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economic factors,
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political factors, and
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social factors.
Factors | A | B | C | Mean for 1988–2012 | |
---|---|---|---|---|---|
1988–1996 | 1996–2004 | 2005–2012 | |||
p
| Mean | ||||
Economic factors | |||||
GDP per capita (PPP, USD) | <0.05 | 5,789.26 | 8,065.90 | 13,589.57 | 9,680.19 |
GDP change (%) | <0.05 | -1.69 | 4.58 | 3.25 | 2.70 |
Unemployment | <0.05 | 9.36 | 13.75 | 12.37 | 12.28 |
Industry share of GDP | <0.05 | 38.26 | 30.78 | 30.13 | 32.94 |
Services share of GDP | <0.05 | 42.93 | 57.14 | 61.54 | 54.06 |
Agriculture share of GDP | <0.05 | 18.72 | 12. 15 | 8.36 | 13.00 |
Budget deficit (% of GDP) | 0.07 | -6.00 | -2.28 | -3.13 | -2.90 |
Gross public debt (% of GDP) | <0.05 | 33.75 | 43.10 | 32.28 | 36.88 |
Inflation rate | <0.05 | 277.01 | 22.37 | 6.14 | 72.79 |
Total investments (% of GDP) | 0.23 | 25.35 | 23.79 | 26.17 | 25.07 |
Foreign investments (net millions of dollars in current value) | <0.05 | 496.87 | 1,477.40 | 6,230.11 | 3,062.03 |
Foreign investments per capita (dol, current) | <0.05 | 44.19 | 151.42 | 509.49 | 263.05 |
Government spending (% of GDP, excluding military) | 0.13 | 18.33 | 17.97 | 17.82 | 18.03 |
Public expenditure on social policy (% of GDP) | 0.93 | 17.24 | 16.79 | 16.69 | 16.81 |
Social Factors | |||||
Number of people living below poverty line (national threshold) | 0.15 | 38.60 | 23.43 | 19.39 | 21.71 |
Human Development Index | <0.05 | 0.70 | 0.74 | 0.78 | 0.77 |
Public expenditure on education (% of GDP) | 0.07 | 4.86 | 4.36 | 4.79 | 4.64 |
Generalized trust | <0.05 | 24.70 | 20.56 | 17.76 | 21.39 |
Number of people declaring high trust in Parliament | <0.05 | 6.17 | 4.49 | 2.64 | 4.56 |
Active participation in NGOs | <0.05 | n/a | 2.04 | 1.48 | 1.62 |
Number of people living below $1 per day | 0.07 | 2.84 | 3.64 | 1.48 | 2.82 |
Schooling indicator: higher education (gross) | <0.05 | 26.89 | 41.50 | 56.05 | 40.97 |
Schooling indicator: secondary education (net) | <0.05 | 80.05 | 85.12 | 87.16 | 85.98 |
Gini index | <0.05 | 28.77 | 33.28 | 33.37 | 32.36 |
Systemic factors | |||||
Health expenditure (% of GDP) | <0.05 | 6.52 | 6.68 | 7.31 | 6.92 |
Health expenditure per capita (dol, current) | <0.05 | 175.24 | 234.41 | 632.52 | 391.38 |
Public financing on health (% of total expenditures) | 0.13 | 66.62 | 63.93 | 63.22 | 63.96 |
Out-of-pocket payments (% of total private expenditures) | <0.05 | 90.99 | 89.53 | 88.13 | 89.12 |
Spending on hospital care (% of total health expenditures) | <0.05 | 54.13 | 41.53 | 34.80 | 40.83 |
Public spending on hospital care (% of total spending on hospital care) | <0.05 | 95.71 | 88.02 | 82.25 | 85.86 |
Expenditures on pharmaceuticals (% of total health expenditures) | <0.05 | 14.42 | 22.02 | 26.16 | 21.88 |
Public spending on pharmaceuticals (% of total spending on pharmaceuticals) | <0.05 | 59.92 | 49,78 | 44,82 | 49,16 |
Practicing physicians/100,000 population | 0.70 | 282,17. | 286.15 | 288.75 | 285.87 |
General practitioners/100,000 population | <0.05 | 31.48 | 36.94 | 50.39 | 42.76 |
Practicing nurses/100,000 population | <0.05 | 726.01 | 644.05 | 619.74 | 654.88 |
Practicing midwifes/100,000 population | <0.05 | 62.75 | 42.81 | 33.84 | 45.69 |
Practicing pharmacists/100,000 population | 0.08 | 36.72 | 33.63 | 38.62 | 36.26 |
Political factors | |||||
No. of political parties in Parliament | 0.15 | 10.79 | 8.00 | 11.50 | 10.18 |
Seats gained by the political party winning the elections (% of total) | 46 | 43 | 39 | 42 | 42 |
Results
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Period A, covering years 1988–1996;
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Period B, covering years 1997–2004; and
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Period C, covering years 2005–2012.
The determinants of health system outcomes
Measures of health system outcomes
Factors | 1988–1996 | 1996–2004 | 2005–2012 | total | |
---|---|---|---|---|---|
p
| A | B | C | ||
Average number of ambulatory visits per person | 0.26 | 7.67 | 7.09 | 7.90 | 7.54 |
Average number of ambulatory visits per person (change) | <0.05 | -0.04 | 0.01 | 0.01 | -0.01 |
No. of beds in non-public sector (%) | <0.05 | 0.02 | 1.55 | 8.95 | 6.38 |
Bed occupancy | 0.01 | 74.13 | 69.11 | 70.00 | 71.25 |
Bed occupancy (change) | 0.04 | -0.02 | 0.00 | 0.01 | 0.00 |
Average length of stay | <0.05 | 14.48 | 11.16 | 9.05 | 11.63 |
Average length of stay (change) | <0.05 | -0.01 | -0.03 | -0.02 | -0.02 |
Hospital beds/100,000 population | <0.05 | 943.12 | 715.23 | 607.44 | 751.63 |
Hospital beds/100,000 population (change) | <0.05 | 0.06 | -0.03 | -0.01 | 0.00 |
Acute beds/100,000 population | <0.05 | 719.80 | 532.21 | 431.42 | 557.57 |
Acute beds/100,000 population (change) | <0.05 | 0.00 | -0.03 | -0.02 | -0.02 |
Acute beds (% of total hospital beds) | <0.05 | 0.78 | 0.76 | 0.74 | 0.76 |
Acute beds as % of total hospital beds (change) | 0.52 | 0.00 | 0.00 | 0.00 | 0.00 |
Life expectancy | <0.05 | 70.01 | 71.60 | 73.42 | 71.56 |
Life expectancy (change) | <0.05 | 0.00 | 0.00 | 0.00 | 0.00 |
SDR: circulatory system diseases (0–64 population) | <0.05 | 153.17 | 142.15 | 124.57 | 141.75 |
SDR: circulatory system diseases (0–64 population) – change | <0.05 | 0.01 | -0.02 | -0.04 | -0.01 |
SDR: circulatory system diseases – total population | <0.05 | 612.18 | 597.67 | 524.34 | 583.88 |
SDR: circulatory system diseases – total population (change) | <0.05 | 0.00 | -0.01 | -0.03 | -0.01 |
SDR: cancer (change) | <0.05 | 0.01 | 0.00 | -0.01 | 0.00 |
SDR: external causes | <0.05 | 100.92 | 92.55 | 76.42 | 91.49 |
SDR: external causes (change) | <0.05 | 0.02 | -0.02 | -0.04 | -0.01 |
SDR: tuberculosis | <0.05 | 18.36 | 7.09 | 6.67 | 11.26 |
SDR: tuberculosis (change) | <0.05 | 0.04 | -0.03 | -0.06 | -0.01 |
SDR: infectious and parasitic diseases | <0.05 | 21.72 | 10.75 | 10.42 | 14.89 |
SDR: infectious and parasitic diseases (change) | 0.21 | 0.01 | -0.01 | 0.00 | 0.00 |
SDR: diabetes | 0.34 | 24.04 | 14.92 | 13.75 | 18.12 |
SDR: diabetes (change) | <0.05 | 0.05 | 0.02 | -0.01 | 0.02 |
Infant mortality rate | <0.05 | 20.05 | 13.85 | 9.45 | 14.89 |
Infant mortality rate (change) | 0.18 | -0.04 | -0.05 | -0.05 | -0.05 |
Maternal mortality | <0.05 | 36.55 | 26.40 | 19.38 | 27.74 |
Alcohol consumption per capita | <0.05 | 8.98 | 9.11 | 10.68 | 9.422 |
Alcohol consumption per capita (change) | 0.18 | 0.02 | 0.03 | 0.02 | 0.02 |
No. of daily smokers (% of adult population) | <0.05 | 31.18 | 27.90 | 26.18 | 28.00 |
No. of daily smokers (% of adult population) – change | 0.57 | -0.01 | -0.01 | -0.01 | -0.01 |
Non-fatal work accidents | 0.1368 | 73540.81 | 31017.32 | 23416.62 | 41785.05 |
Non-fatal work accidents (change) | 0.21 | -0.07 | -0.03 | -0.03 | -0.04 |
Work accidents per 1,000 employees | <0.05 | 5.23 | 7.45 | 5.45 | 6.42 |
Work accidents per 1,000 employees (change) | 0.61 | -0.07 | -0.02 | -0.04 | -0.03 |
Fatal work accidents (% of all work accidents) | <0.05 | 39.40 | 24.95 | 19.20 | 27.36 |
Fatal work accidents (% of all work accidents) – change | 0.40 | -0.01 | -0.02 | 0.01 | -0.01 |
Aggregated measure of health system outcomes: country rankings
Country | 1988–1996 (A) | Rank (A) | 1997–2004 (B) | Rank (B) | 2005–2012 (C) | Rank (C) | Change A–C | Rank: change A–C |
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Slovenia | 0.79 | 1 | 0.82 | 1 | 0.85 | 1 | 0.07 | 11 |
Albania | 0.77 | 2 | 0.8 | 4 | 0.74 | 15 | -0.02 | 19 |
Czech Rep. | 0.74 | 3 | 0.8 | 2 | 0.85 | 2 | 0.11 | 5 |
Slovakia | 0.75 | 4 | 0.8 | 3 | 0.83 | 5 | 0.08 | 8 |
Macedonia | 0.75 | 5 | 0.79 | 6 | 0.81 | 8 | 0.06 | 14 |
Croatia | 0.75 | 7 | 0.8 | 5 | 0.84 | 4 | 0.09 | 6 |
Belarus | 0.74 | 6 | 0.71 | 15 | 0.75 | 14 | 0.01 | 17 |
Poland | 0.73 | 8 | 0.78 | 7 | 0.84 | 3 | 0.11 | 4 |
Bulgaria | 0.72 | 9 | 0.74 | 12 | 0.79 | 9 | 0.06 | 12 |
Romania | 0.71 | 10 | 0.73 | 13 | 0.78 | 11 | 0.07 | 9 |
Georgia | 0.71 | 11 | 0.75 | 11 | 0.74 | 16 | 0.04 | 16 |
Hungary | 0.7 | 12 | 0.77 | 8 | 0.82 | 7 | 0.11 | 3 |
Lithuania | 0.7 | 13 | 0.76 | 9 | 0.77 | 12 | 0.07 | 10 |
Estonia | 0.68 | 14 | 0.76 | 10 | 0.82 | 6 | 0.14 | 2 |
Armenia | 0.67 | 15 | 0.68 | 16 | 0.75 | 13 | 0.09 | 7 |
Ukraine | 0.66 | 16 | 0.66 | 17 | 0.66 | 19 | 0 | 18 |
Latvia | 0.64 | 17 | 0.71 | 14 | 0.78 | 10 | 0.14 | 1 |
Moldova | 0.63 | 18 | 0.63 | 18 | 0.69 | 17 | 0.06 | 13 |
Russia | 0.62 | 19 | 0.6 | 19 | 0.68 | 18 | 0.05 | 15 |
Factors correlated with the synthetic measure of health system outcomes
Variable | Correlation coefficient |
---|---|
Economic growth | 0.16 |
GDP per capita | 0.64 |
Unemployment | 0.16 |
Industry share of GDP | -0.17 |
Services share of GDP | 0.42 |
Agriculture share of GDP | -0.37 |
Budget deficit | -0.32 |
Public debt | -0.16 |
Inflation rate | -0.17 |
Investments | 0.07 |
Foreign investments | 0.03 |
Foreign investments per capita | 0.27 |
Fiscal burden | -0.17 |
Public spending on social policy | 0.29 |
People living below poverty line (national threshold) | -0.50 |
People living for less than $1/day | -0.28 |
Human Development Index | 0.69 |
Public spending on education | -0.10 |
Generalized trust | -0.33 |
Trust in politicians | 0.17 |
Satisfaction with government | 0.19 |
Civic activity | -0.10 |
Gini index | -0.11 |
Total health expenditure as a percentage of GDP | 0.13 |
Total health expenditure per capita | 0.64 |
The share of public sources in total expenditure on health | 0.32 |
The share of spending on hospital sector in total health expenditure | -0.74 |
The share of spending on pharmaceuticals in total health expenditure | 0.36 |
Public spending on pharmaceuticals as a share of total spending on pharmaceuticals | 0.43 |
Expenditure on public health programmes as a percentage of total health expenditure | -0.08 |
Practicing physicians/100,000 population | -0.37 |
General practitioners/100,000 population | 0.34 |
Practicing nurses/100,000 population | -0.37 |
Practicing midwives/100,000 population | -0.38 |
Practicing pharmacists/100,000 population | 0.46 |
No. of political parties in Parliament | -0.07 |
Electoral turnout (parliamentary elections) | 0.03 |
No. of seats gained by the election’s winning party (%) | -0.04 |
No. of government changes | -0.32 |
No. of beds in non-public sector (%) | 0.06 |
Hospital beds/100,000 population | -0.60 |
Acute beds/100,000 population | -0.74 |