Irish people are living longer, healthier lives, though access to healthcare remains an issue: Department of Health publishes Health in Ireland - Key Trends 2019

Life expectancy in Ireland has increased by almost two and a half years since 2007, with male life expectancy consistently higher than the EU average throughout the last decade, and female life expectancy surpassing the EU average in 2017.

Much of this increase in life expectancy is due to significant reductions in major causes of death such as circulatory system diseases and cancer. The overall mortality rate has reduced by 10.5% since 2009. Provisional data for 2018 however shows a slight increase (2.3%) in the mortality rate from 2017.

These trends emerged in the 12th edition of Health in Ireland, Health in Ireland: Key Trends 2019, published by the Department of Health.

The report touches on several areas, including demographics, population health, hospital and primary care, employment and expenditure and highlights the significant achievements that Ireland has made for key health outcomes in the past decade.

However, it also highlights the challenges that persist in terms of the accessibility of timely and efficient healthcare across the population.

In welcoming the report, the Minister for Health Simon Harris said:

The Minister added:

Key Trends 2019 presents evidence from across the health sector of the progress made and the challenges that still exist in providing efficient and high-quality healthcare in Ireland. This publication provides the background and context for the Department of Health’s work in creating legislation, policy and strategies to address these critical issues. This work is ongoing in the form of Sláintecare, which is working to systematically address these significant challenges to the health care system in the coming years. Improving provisions for mental health, reducing pressure on health resources, limiting spending increases in the health system, supporting the uptake of generic medicines, and reducing hospital waiting lists are key targets for the coming years.

Twelve things we have learned from this year’s Key Health Trends, published by the Department of Health

1. We are continuing to live longer

Over the past decade we have added, on average, 3 months per year to our life expectancy (Table 1.6).

2. The life expectancy gap between men and women has narrowed from 5.3 years to 3.6 years

At 80.4 years, life expectancy for women in Ireland is 3.6 years longer than for men in 2017; however, this gap has narrowed from 5.3 in 1997 and is now at its lowest since the 1950s (Table 1.6).

3. We are living longer than our European counterparts

Male life expectancy in Ireland has been above the EU average over the past decade. The life expectancy at birth for men in Ireland has been consistently greater than that of the EU average by over a year (Figure 1.6 and Figure 1.7). Female life expectancy in Ireland has been similar to the EU average over the period 2008-2017 and is now just above it.

4. Increase in life expectancy is due to significant reductions in major causes of death such as circulatory system diseases and cancer

This decrease is particularly strong for mortality rates from suicide (-38%), pneumonia (-37%) and stroke (-36%) (Table 2.4). The overall mortality rate has reduced by 10.5% since 2009, but 2018 provisional data shows a slight increase in this rate of 2.3% from 2017.

5. We think we are healthier than our European neighbours

In 2016, 83% of Irish men and women rated their health as good or very good. This is the highest in the EU and compares with an average of 73% and 67% for males and females respectively across the EU (Figure 2.3).

6. We are seeing a reduction in deaths from suicide

There has been a 38% reduction in the mortality rate from suicide since 2009. After a rise in the male suicide rate from 2008 to 2013, the three-year moving average has decreased, and the latest figures have fallen below the EU average for both sexes (Table 2.4, Figure 2.8).

7. Men are more inclined to be overweight or obese while women are more likely to be physically inactive

Nearly 70% of men are likely to be overweight or obese compared to around 57% of women while just over 62% of women are physically inactive compared to about 46% of men (Figure 2.13).

8. Current smokers or ex-smokers are more likely to live with a chronic condition

Smokers or ex-smokers are more likely to suffer from chronic health conditions such as high blood pressure, high cholesterol, arthritis or anxiety (Figure 2.14).

9. Our public hospitals continue to treat more patients, and patients admitted to our hospitals are older

Acute hospital beds, discharges, Emergency Dept attendances and outpatient appointments have increased. In 2018, 54% of inpatients and 40% of day cases were aged 65 and over. This compared to 48% and 35% respectively in 2009 (Table 3.1a).

10. Half of those attending Emergency Departments can expect to be seen and discharged within 6 hours

50% of attendees spent less than 6 hours in the Emergency Department and 75% of attendees experience waiting time of less than 9 hours with little monthly variation in both of these measures (Figure 3.7).

11. A greater proportion of total (public and private) health expenditure is now paid for by government funds

The proportion of total health expenditure paid for either out-of-pocket or through private health insurance has been reducing in recent years; the government funded 73% of total health expenditure in Ireland in 2017 (Table 6.3).

12. Our new regional health areas have different population characteristics

The new regional health areas’ populations differ in size, age structure, deprivation status, eligibility entitlements and mortality rates (Chapter 7).

ENDS

Health in Ireland - Key Trends 2019.

This is the twelfth edition of this easy-to-use reference guide to significant trends in health and health care over the past decade, including population and health status, as well as trends in service provision. This year includes a number of new additions, including a new chapter with content profiling different aspects of the new regional health areas. Each section has a brief introduction summarising key statistics.

Key trends include:

• the number of live births has been falling year-on-year since 2009 and in 2018 the number of registered births was 61,016. Despite reductions in the numbers of births in recent years, the fertility rate in Ireland is the 3rd highest in the EU, behind France and Sweden
• Ireland is now beginning to catch up with other European countries in terms of population ageing. The population of those aged 65 years and over has increased by 35% since 2009 and has been increasing at a faster rate than that of our EU neighbours. The numbers of people in this age group is expected to almost double in the next 20 years, with the greatest proportional increase in the 85+ age group
• over the past decade, Ireland has achieved an improvement in life expectancy. Life expectancy in Ireland has increased by almost two and a half years since 2007, with male life expectancy consistently higher than the EU average throughout the last decade
• much of this increase in life expectancy is due to significant reductions in major causes of death such as circulatory system diseases and cancer. Since 2009 there has been a reduction in mortality rates for most major causes. The overall mortality rate has reduced by 10.5% since 2008
• in comparison to other EU countries, Ireland continues to have the highest levels of self-perceived health of any EU country. Those in higher income brackets tend to report better health than those in lower income brackets
• while there has been a reduction in the mortality rate from respiratory diseases of almost 10.5% since 2009 the rate in Ireland is 40.2% higher than the EU28 average (this comparison includes cancer of the trachea , bronchus and lung)
• there has been a 38% reduction in the mortality rate from suicide since 2009. After a rise in the male suicide rate from 2008 to 2013, the three-year moving average has decreased and the latest figures (2015) have fallen below the EU average
• total hospital discharges continue to rise with 63% of this activity carried out on a day case basis (including dialysis)
• while there are fewer public inpatient beds than a decade ago, there has been a 26% increase in day beds. The increase in day beds has allowed for a 31.1% increase in the number of day case patients over the last decade
• there are 1,796 inpatient beds in private acute hospitals in Ireland
• in-patient discharges per bed have increased from 52 to 59 discharges per bed between 2009 and 2018, showing increased utilisation of in-patient beds. There was a steady year-on-year increase from 2008 to 2015, peaking at 61.4, but the past two years have seen a slight decrease
• from 2009 to 2017 the average length of stay in public acute hospitals decreased by 2.7%. Between 2017 and 2018 there was a increase of 3.8%
• there has been a decrease of almost 2,000 people in the number of adults waiting 9 months or longer for an elective procedure during the period November 2018 to November 2019. The number of children waiting 8 months or longer has remained stable throughout the year (Note: refers to those classified as active)
• the total number of people on outpatient waiting lists has increased to over 563,000 in November 2019 (Note: refers to those classified as active)
• the 30-day moving average of the number of admitted patients on trolleys at 2pm in emergency departments has been increasing since June 2019. Since July 2019, the average has been above levels since in previous years
• between 2017 and 2018 there was a decrease (0.4%) in the number of medical cards to 1.57 million. Numbers of GP only visit cards in 2017 increased to just under 503,700, though it should be noted that this is largely due to the introduction of GP visit cards to all children under six in 2015
• there were 119,126 wholetime equivalents employed in September 2019; this represents a 1.1% increase since December 2018
• total public health expenditure has risen from €14.2 billion in 2009 to an estimated €18.3billion in 2019. Estimates for 2019 indicate an 8.4% increase in expenditure from 2018
• Chapter 7 profiles some of the differences in population among the new regional health areas. Area A is estimated to have the largest population (23%) followed closely by Area B (21%) and Area C (19%) (Figure 7.1). Area F and Area D make up 15% and 14% of Ireland’s population respectively while Area E has the smallest population (8%)

Further key trends are presented by chapter below:

Section 1 – Population and Life Expectancy

The latest population estimate for Ireland in 2018 has shown that the population has grown by an estimated 3.8% since the 2016 Census.

• the population estimate for 2019 is 4,921,500, an increase of 3.8% on Census 2016 (Table 1.1)
• the population has grown by 8.1% since 2010. The largest change was seen in the over 65 age group which increased by 35% between 2010 and 2019 (Table 1.2)
• the west and north-west of Ireland have the highest old age dependency ratios (Figure 1.1a)
• the total population in Ireland has increased more rapidly than the EU average in the last decade. The population aged 65 and over has increased at a greater rate than the population, and at a greater rate than the EU average for those aged 65 and over (Figure 1.2)
• the numbers of births in 2018 have shown a 4.4% decrease on the previous year, with 61,016 births being registered in the year. The number of live births has fallen year on year since 2010 (Table 1.3)
• the Total Fertility Rate has decreased in recent years and now stands at 1.80. However, Ireland has the 3rd highest rate of fertility amongst EU countries behind France and Sweden. The EU average fertility rate in 2017 was 1.60 (Table 1.3 and Figure 1.4)
• in 2017, counties Dublin, Kilkenny and Cork had the lowest fertility rates (Figure 1.2)
• the number of people in older age groups is beginning to increase significantly. The numbers of people over the age of 65 years is projected to almost double to around 1.2 million by 2038. The greatest proportional increase will be in the 85+ age group (Table 1.4 and Figure 1.5)
• life expectancy at birth for women in Ireland was 3.6 years longer than for men in 2017; this compares to a difference of 5.3 between men and women in 1997
• female life expectancy in Ireland has matched the EU average and male life expectancy in Ireland has been above the EU average over the past decade. The life expectancy at birth for men in Ireland has been consistently greater than that of the EU average by over a year (Figure 1.6 and Figure 1.7)
• in addition to longer life expectancy, women at age 65 are likely to experience a higher proportion of healthy life years than men, indicating that men live shorter lives with more health problems (Figure 1.8)

Chapter 2 – Health of the Population

Please note that any references below to 2018 mortality data should be considered provisional as 2018 data in this report are based on year of registration, and not year of occurrence.

• in 2016, 82.9% of males and females rated their health as being good or very good. This is the highest in the EU and compares with an average of 72.6% and 67.3% for males and females respectively across the EU. With those in higher income brackets tending to report better health than those in lower income brackets (Table 2.1, Figure 2.1 and 2.2)
• 50.8% of males and 49.2% of females aged 65 and over reported suffering from a chronic illness or health problem in 2016. In people over the age of 75, 40.7% and 45.6% of males and females respectively reported some or severe limitation in usual activities due to health problems (Table 2.2 and Table 2.3)
• over the 10 year period 2009-2018, age-standardised death rates for all causes fell by 10.5% (Table 2.4)
• among those aged 65 years and over diseases of the circulatory system accounted for 30.8% of all deaths registered in 2018. This compares with 19.1% of deaths of those aged less than 65 years (Figure 2.5a and Figure 2.5b)
• deaths from respiratory diseases (including cancer of the trachea, bronchus and lung) accounted for 21.1% of all deaths to those aged 65 and over and 14.7% of all deaths of those aged under 65 (Figure 2.5a and Figure 2.5b)
• there has been an 10.0% decline in the age-standardised death rate for cancer in the last decade. Cancer of the female breast death rate has decreased by 2.9% since 2009 (Table 2.4)
• death rates from suicide are down 38% since 2009 and have decreased by 8.5% between 20167and 2018 (data for 2018 are provisional). Males have consistently had a higher suicide rate than females, in both Ireland and the EU. The latest figures show that Ireland’s three-year moving average for male suicide deaths have fallen below the EU average (Table 2.4, Figure 2.8)
• the 5-year age-standardised death rates for deaths occurring from external causes and poisoning (2014-2018) are highest in counties Cavan , Monaghan and Clare (Figure 2.6)
• Ireland’s age-standardised death rate in 2016 was below the EU average. The death rate from respiratory diseases (including cancer of the trachea, bronchus and lung) was 40.2% above the EU average (Table 2.5)
• the age-standardised death rates for cancer (excl. trachea, bronchus and lung), circulatory system diseases, ischaemic heart disease and respiratory system diseases (incl. cancer of the trachea, bronchus and lung) have all decreased since 2000 (Figure 2.7)
• treatable mortality (causes of death which are considered to be avoidable through optimal quality healthcare) is below the EU28 average for both men and women in Ireland (Figure 2.9)
• Ireland has had a lower infant mortality rate than the EU average over the last decade; however the gap has widened in recent years (Figure 2.10)
• the percentage of children among 11-17 year olds engaging in risky health behaviors in Ireland has declined between 2010 to 2018 (Figure 2.11)
• cigarette consumption has declined over the past decade, while alcohol consumption has increased slightly since 2013. In 2018, Irish people consumed 11 litres of alcohol per capita, based on Revenue figures. The official figures do not include purchases made outside the State or illegal imports into the State which may exaggerate the recent years’ decline. Cigarette consumption excludes ‘roll-your-own’ cigarettes (Figure 2.12)
• nearly 70% of Men are likely to be overweight or obese compared to around 57% of women while just over 60% of Women are physically inactive compared to about 45% of Men. A gender gap is present across a number of different indicators in the publication (Figure 2.13)
• smokers or ex-smokers are more likely to live with chronic conditions such as high blood pressure, high cholesterol , arthritis , depression or anxiety (Figure 2.14)

Chapter 3 – Hospital Care

• inpatient discharges from publicly funded acute hospitals have increased by 10.1% since 2009 (Table 3.1a)
• from 2008 to 2014 the average length of stay decreased by 10.6%. It has since increased by 3.8%, with the average length of stay currently at 5.8 days (Table 3.1a)
• the number of beds for day cases has risen to 2,240 in 2018, an increase of 26.4% since 2009 (Table 3.1a)
• the number of day cases has risen to 1,074,172 in 2017, an increase of 31.1% compared to 2008. The number of day cases per total discharges has increased 7.1% in the period 2009-2018 (Table 3.1a)
• the majority of bed days used in public acute hospitals are used by the over 65 age group. Figure 3.1 shows that the proportion of bed days used increases with age
• private acute discharges increased by 1.7% between 2016 and 2017. Day cases account for 74.6% of total discharges in private acute hospitals, compared to 62.6% in public acutes (Table 3.1a and Table 3.1b)
• there has been a decrease of almost 2,000 people in the number of adults waiting 9 months or longer for an elective procedure during the period November 2018 to November 2019. The number of children waiting 8 months or longer has remained stable throughout the year (Note: refers to those classified as active) (Figure 3.3)
• the total number of people on outpatient waiting lists has increased to over 563,000 in November 2019 (Note: refers to those classified as active) (Figure 3.4)
• the 30-day moving average of the number of admitted patients on trolleys at 2pm in emergency departments has been increasing since June 2019. From July 2019, the average has been above levels since in previous years (Figure 3.4)
• there has been a increase in the number of patients admitted through Emergency departments in public hospitals since 2012. The annual percentage increase is larger for older age groups (Figure 3.6)
• monthly data since 2017 shows that 50% of ED attendees spent less than 6 hours in the Emergency Department and 75% of attendees experience a time less than 9 hours. The figure also shows little monthly variation in both of these measures over the period of interest. However, when examining the time spent in the Emergency Department by 95% of people as measured by the 95th percentile, there is a large degree of monthly variation (Figure 3.7)
• nearly 80% of ECHO Ambulance calls are responded to within 18 minutes and 59 seconds. 57% of DELTA Ambulance calls are responded to within 18 minutes and 59 seconds (Figure 3.8)
• 234 transplants were carried out in Ireland in 2018, with kidney transplants being the most common (Figure 3.9)
• the number of admissions to psychiatric hospitals and units has decreased by 15.8% over the period 2009 to 2018. The admission rate per 100,000 population has fallen by 21.2% over the same period (Table 3.2, Figure 3.11)
• 84% of people felt they were always treated with respect and dignity in Irish hospitals while 83 % of people felt they has confidence and trust in the hospital staff treating them, according to the 2019 National Patient Experience Survey (Figure 3.12)

Chapter 4 – Primary Care and Community Services

• 32.4% of the population had a medical card at the end of 2018. This compares with 33.8% in 2009 (Table 4.1)
• numbers of GP only visit cards in 2016 increased significantly to just under 503,700, though it should be noted that this is largely due to the introduction of GP visit cards to all children under 6 in 2015 (Table 4.1)
• the number of people registered for the Drugs Payments Scheme has decreased by 24.0% between 2009 and 2018 (Table 4.1)
• the numbers of people on the Long-Term Illness Scheme has increased by 107.1%, or over 153,000 people, since 2009 (Table 4.1)
• the average cost per item dispensed under the General Medical Services (GMS) scheme decreased by over 3.2% from 2017 to 2018 (Figure 4.2)
• the average annual attendances to a GP was 3.5 visits per year for men and 4.5 visits per year for women, according to the latest Healthy Ireland survey. In the younger age groups, women attended a GP more often then men in the past year, but this gap narrows for those over the age of 45 (Figure 4.3)
• an ‘Out-of-Hours’ fee is payable for non-routine consultations when a GMS cardholder is seen by their GP or another GP acting on their behalf outside of normal working hours (Mon-Fri, 9am-5pm. The number of out of hours contacts with GPs has increased by over 71,000 between 2013 to 2018, allowing for increased access to primary care (Figure 4.4)
• the percentage of the population covered by private health insurance has risen between 2014 and 2018, from 41.4% to 43.4% (Figure 4.5). This increase can be seen across most age groups and is particularly large among those aged 80 and over (+6% since 2013) (Figure 4.5)
• the number of beds available in long-term care units covered by the nursing homes support scheme has increased by 4.1% over the period 2015 to 2018. The proportion of patients aged 75+ in long term care has decreased slightly over this period, with nearly half of all patients in long term stay units in 2017 aged 85 or over (Table 4.2)
• both the number of blood donations and the percentage of blood donors in the Irish population have declined in the past 5 years. The percentage of blood donors in the population in 2017 was 1.64% (Figure 4.6)
• the immunisation uptake rates of children aged 24 months in 2016 was 94% for most immunisations, with the exception of the MMR, Meningococcal and Pneumococcal Conjugate vaccines (Table 4.3)
• HPV vaccine uptake rates among secondary school girls rose to 64% in 2018 from 51% in 2017, still down from a high of 88% in 2014 (Table 4.3)
• there were 17,093 cases in treatment for problem drug and alcohol use in 2018 , this is an increase of 13.3% since 2009 (Table 4.4, Figure 4.7)

Chapter 5 – Health Service Employment

• over the period 2010 to 2014 total numbers employed in the public health services saw a gradual decline, however in recent years this trend has been reversed. There were 119,126 whole time equivalents employed in September 2019; this represents a 1.1% increase from December 2018 (Table 5.1, Figure 5.1)
• all grade categories have shown an increase since 2018. Nurses make up the largest grade category in the public health service, with 31.7% of total staff employed in September 2019 (Table 5.1, Figure 5.2)
• the number of hospital consultants employed by the public health service increased by 32.3% in the period 2010-2019. They also increased by 3.1% between December 2018 and September 2019 (Table 5.2, Figure 5.3)
• the number of non-consultant hospital doctors increased by 40.6% in the period 2010-2019. They also increased by 3.0% between December 2018 and September 2019 (Table 5.2, Figure 5.3)
• there were 3.07 practicing doctors per 1,000 population in Ireland in 2017. This is below the OECD28 average of 3.40 (Figure 5.5)

Chapter 6 – Health Service Expenditure

• total public expenditure on health has increased by 28.8% since 2010, with an increase of 8.4% between 2018 and 2019 (data for 2019 are estimates) (Table 6.1, Figure 6.1)
• HSE non-capital total allocation has increased by 6.3% in the period 2012-2017, with an increase of 5.9% in the period 2016-2017. Acute hospitals accounted for 34.1% of HSE gross non-capital expenditure in 2017 (Table 6.2, Figure 6.2)
• public capital expenditure on health increased 17.2% between 2018 and 2019 (Table 6.3)
• according to the System of Health accounts (SHA) methodology, Ireland’s total (public and private) health expenditure was estimated to be €21.1 billion in 2017. The largest financing scheme in Ireland is government financing schemes and compulsory contributory health care financing schemes, accounting for 73% of all finance in health care expenditure. Curative and rehabilitative care accounted for 56% of total current health care expenditure, and hospitals accounted for 37% of total current health care expenditure (Table 6.4, Table 6.5 and Table 6.6)
• the proportion of total health expenditure paid for either out-of-pocket or through private health insurance has been reducing in recent years meaning that the government is now funding 73% of total health expenditure in Ireland in 2017 (Table 6.6)
• total health expenditure in Ireland per capita in real terms (adjusted for inflation) has shown an overall increase over the period 2008-2017 (Figure 6.3)
• in terms of health expenditure per capita, Ireland ranks as the 14th highest spend amongst selected OECD countries. Using modified gross national income or (GNI*) for Ireland as a comparator with GDP from other countries (as recommended by the Economic Statistics Review Group), Ireland’s total current health expenditure as a percentage of GDP/GNI* ranks 3rd behind the United States and Switzerland. This position changes to 7th when looking at public expenditure only (Table 6.7, Figure 6.4)

Chapter 7 – New Regional Health Areas

• figure 7.1 shows the distribution of Ireland’s population among the new regional health areas. Area A is estimated to have the largest population (23%) followed closely by Area B (21%) and Area C (19%) (Figure 7.1). Area F and Area D make up 15% and 14% of Ireland’s population respectively while Area E has the smallest population (8%)
• area F has the largest proportion of people aged 65+ (approx. 16%). Area A and Area B have the youngest population among the new regional health areas
• figures 7.3a-f shows the age structure of each regional health area. Each area has a different population age profile
• information from the Census 2016 is shown in Figure7.4. Area E has the highest proportion of the population living with a disability. Area A has the lowest proportion of the population living with a disability
• area F has the largest proportion of the population with medical card (43%). Area A, Area B and Area C has a lower proportion of the population with a medical card (Figure 7.5)
• areas B, E and F have the largest proportion of their population considered to be very/extremely disadvantaged
• area D has the highest age standardised mortality rate for circulatory diseases (322.84 per 100,000) while Area B has the lowest rate (261.05 per 100,000 population)
• area A has the highest age standardised mortality rate for respiratory diseases (including cancer of the trachea, bronchus and lung) (239.02 per 100,000 population)
• area A has the highest age standardised mortality rate for cancer (excluding cancer of the trachea, bronchus and lung) (257.37 per 100,000 population)