Preventive Care practices in Europe according to the health expenditure

Sara Ares Blanco, Juan Antonio López-Rodríguez, Mario Fontán Vela, Elena Polentinos Castro, Isabel Del Cura González

Keywords: primary care, preventive care, early detection of cancer, Health Expenditure

Stronger primary care services are usually related to higher health expenditure in Europe. Investing in health promotion and disease prevention can reduce modifiable risk factors to health and mortality

Research questions:
Is higher health expenditure related to lower comorbidity and higher coverage of preventive care practices?

Cross-sectional questionnaire survey conducted by the European Commission (European Health Interview Survey: EHIS wave 2) based in individuals aged 25 to 74 years from 30 countries, n: 242.212. Questionnaires were collected between 2013- 2015. Variables: sociodemographic factors, comorbidities, cardiometabolic screening (glucose, blood pressure (BP) and cholesterol measurement), influenza vaccination and cancer screening (colon, breast and cervical cancer). Ratio of health spending to gross domestic product (GDP) was categorized in <7%, 7-10%, >10%. Descriptive, bivariate analyses and multilevel logistic regression models were performed.

53.7% of the sample were women. 55.3% of the subjects were aged 40-64 years. 63.6% had a healthy diet and 25.7% smoked. Comorbidities: hypertension (22.4%), obesity (20.7%).

Differences between countries according to health expenditure/GDP between <7% vs >10% were found: BP measurement: 88.1% vs 92.1% (p<0.001); Cholesterol measurement: 78.4% vs 79.5% (p<0.001); Glucose measurement: 46.3% vs 50.8%(p<0.001). Greater ratio of health expenditure/GDP was related to a lower percentage of obesity, coronary heart disease, stroke and renal disease.

Rates of colon cancer screening varied from 8.1% for faecal occult blood test in countries with <7% of expenditure/GDP to 39.4% in countries with >10% of expenditure/GDP (p<0.001). The highest ratios of the cancer screening and influenza vaccination were found in countries with higher expenditure on health.

Individuals living in countries with higher health expenditure received more preventive care practices and had lower comorbities.

Points for discussion:
- If we had to choose just one preventive care practice, what would be more beneficial?

- In countries where the health expenditure is <7%, which preventive policies could improve the health of the population?

- In case the expenditure on health grew, would it improve the expenditure on prevention?