Poland's performance in the 2022 Health for Money Index stands out as one of the most intriguing findings. It highlights the importance of analyzing both nominal results and spending efficiency.

In the nominal ranking, Poland finds itself placed third from the bottom, surpassing only Slovakia and Latvia. With a score of 8.3, Poland's performance accounts for just slightly over 50% of the score achieved by Sweden, the country leading in nominal results.

However, in terms of spending efficiency (Health for Money Index), Poland emerges as the third-best performer, surpassed only by Italy in first place and Estonia in second. This ranking is attributed to Poland's relatively low public expenditures on healthcare, accounting for just 6.59% of its GDP, which is the second lowest among the countries analyzed. Consequently, Poland's health expenditure per capita was also notably low, reaching a mere 906.09€, making it the lowest among the 26 countries examined.

Thus, these two contrasting analytical perspectives yield significantly divergent outcomes. On one hand, Poland's below-average health outcomes in absolute terms are attributed to its limited public expenditure. However, although Poland's results may fall toward the lower end of the spectrum, they do not represent an extreme outlier. Consequently, Poland's spending efficiency stands out as one of the most notable among the countries under examination, achieving a well-above-average value for every euro spent.

When we think of France and Germany in terms of living standards, we typically envision prosperous, developed countries with efficient public services. However, the findings from the 2022 Health for Money Index paint a different picture.

Both Germany and France allocate substantial portions of their economy to healthcare. Germany's public expenditure on healthcare accounts for 12.81% of its GDP, while France's represents 12.21% of its GDP. These figures position them as the top two countries among the 26 examined nations. Nevertheless, the question remains: Is this money effectively utilized?

In the nominal results ranking, France and Germany are neighboring countries as well. However, their respective positions are considerably lower, with France in eighteenth place and Germany in nineteenth. Scoring 10.8 and 10.3, they find themselves closer to Latvia, which is in last place with a score of 6.3, than to Sweden, which holds the top spot with a score of 16.1.

When considering the combination of substantial public spending and health outcomes that position both countries in the lower half of the ranking, it inevitably results in a subpar performance in terms of spending efficiency, as measured by the Health for Money Index. Germany finds itself at the bottom of the list, while France takes the 24th spot, surpassing Switzerland, another country with high spending.

The examples of France and Germany serve as an illustration that high spending does not automatically lead to the best health outcomes. Resources must be allocated sensibly and with a clear purpose in mind.

The Nordic countries – Denmark, Norway, Sweden, Finland, and Iceland – showcased outstanding performance in the achieved nominal results of the 2022 Health for Money ranking. All of these countries secured positions within the top 10.

Sweden achieved the highest result, securing the top spot among the 26 examined countries with an impressive score of 16.1. Another Nordic country, Norway, also performed exceptionally well, ranking third with a score of 15.8. Denmark, Finland, and Iceland claimed the sixth, seventh, and eighth positions respectively, with scores ranging from 13.7 to 14.2.

Despite the positive outcomes, the Nordic countries do not enjoy comparable rankings in the Health for Money Index, which assesses the spending efficiency of the 26 countries. Among the Nordic nations, only Finland secures a place in the top 10 as one of the most efficient countries, ranking tenth. Iceland also achieves a respectable position, finishing in the upper half of the ranking at thirteenth place.

Denmark, Sweden, and Norway, on the other hand, exhibited spending efficiency below the average. Denmark occupies the sixteenth spot, showing a slightly better performance than Sweden in the seventeenth place. Meanwhile, Norway ranks twenty-third, surpassing only Germany, Switzerland, and France in terms of efficiency.

The Nordic countries have undoubtedly achieved success in ensuring the good health of their populations. Nevertheless, the relatively lower rankings in the Health for Money Index suggest that there are other countries that excel in extracting maximum value from each euro spent.

The Health 4 Money index will be hosted on a dedicated portal health4money.org with expected launch in spring 2023.

After a successful first run in 2019, the INESS Institute published the 2020 international healthcare ranking Health for Money. The rankings follow 23 various indicators including life expectancy, maternal mortality, the consumption of antibiotics, the number of cancer-related deaths, the number of medical employees, and the average length of hospital stays.

Analysts indexed and weighted the indicators by healthcare per capita expenditures (corrected by comparisons of average wage level in the country).

The leader of the index is Iceland, followed by Italy, Spain, Poland, and Estonia. Slovak health care was ranked 21st among 25 European countries.

INESS also delivered recommendations to improve Slovakia’s ranking. We recommend evaluating the data and proposing measures to lower neonatal and infant mortality, especially in the case of marginalized groups.

Another solution may lie in the prevention of the hospitalization of patients with chronic disease, especially hypertension and diabetes, in a better model of motivation for doctors and in the improvement of the population’s attitude towards active prevention.

Other recommendations include strengthening the role of research at the medical faculties, strictly following the value for money principle including in the drugs policy, weakening mechanisms, which do not tie resources with quality, and allowing health insurers to differentiate payments based on the quality of offered services. They also see value in improving the care of long-term patients.

Which healthcare system in Europe provides the best value for money? Rankings of healthcare systems are rare, and those which would rate value for money for a long time have been non-existent.

Institute of Economic and Social Studies (INESS) created a brand new index called Health for Money, which rates healthcare in 26 countries, taking money into consideration as well.

The index compares 26 European OECD members. It follows 23 indicators, starting with general ones (like life expectancy) and going to more specific aspects (hospital admissions with diabetes, 5-year leukaemia survival rates, etc.).

The index touches also academia, measuring number of quotable medical papers from the country, or international rankings of faculties of medicine.

Most of the data comes from OECD, but other sources are used as well.

The data was indexed on a 0-1 scale, aggregated, weights were applied. More specifically, nominal expenditures on healthcare per capita (partly weighted by average wage level) were counted in.

The highest ranking countries are Greece, Italy, and Spain. Estonia (6th) and Slovenia (7th) are the highest ranking East European countries. The tail is populated by Slovakia, Switzerland, and Lithuania.

The positions of both Greece and Switzerland may seem highly surprising for many readers. Greece was propelled to the top by the unprecedented cut in health expenditures, which the country underwent during the crisis. Health expenditures in Greece fell by one third during the past few years.

However, health indicators in the country remained good. We shall see whether this economic experiment will lead to a dramatic fall in health quality in the upcoming years, or if the development will prove right those who say healthcare is much less important than lifestyle.

Switzerland recorded excellent total results of quality – but when expenditures are taken into account, the country falls almost to the bottom. With around 9,000 per capita spending on healthcare, this country has the most expensive system.

Healthcare is a luxury good and only rich countries can afford to purchase services, with relatively low real return.

An appendectomy surgery can be done for EUR 1,000, or for EUR 10,000 in a high-end hospital using cutting-edge technology. The latter will be probably better in term of outcomes, but not 10-times better.

Rich countries can afford to buy also those services which provide relatively little returns. This is not true for post-communist countries, where health outcomes are mostly below EU average. Latvia, Slovakia, or Lithuania are paying a lot and not getting  much.

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