Access to high-quality services depends crucially on the size, skill mix, geographic distribution and productivity of the health workforce. Health workers, and in particular doctors and nurses, are the cornerstone of health systems.

Nurses are usually the most numerous health profession, outnumbering physicians in most European countries. Nurses play a critical role in providing health care not only in traditional settings such as hospitals and long-term care institutions but increasingly in primary care (especially in offering care to the chronically ill) and in patients’ homes. However, there are concerns in many countries about shortages of nurses, and these concerns may well intensify in the future as the demand for nurses continues to increase and the ageing of the “baby boom” generation precipitates a wave of retirements among nurses. These concerns have prompted many countries to increase the training of new nurses combined with efforts to increase retention rates in the profession (OECD, 2008b).

Childhood vaccination continues to be one of the most cost-effective public health interventions. All European countries, or in some cases sub-national jurisdictions, have established vaccination programmes based on their interpretation of the risks and benefits of each vaccine.

Influenza is a common infectious disease worldwide and affects persons of all ages. Most people with the illness recover quickly, but elderly people and those with chronic medical conditions are at higher risk for complications and even death. For example, between 2000 and 2008, influenza along with other acute upper respiratory infections accounted for about 44 000 hospitalisations per year in France and 77 000 in Germany. The impact of influenza on the employed population is substantial, even though most influenza morbidity and mortality occurs among the elderly and those with chronic conditions (e.g. 85-90% of people who die from influenza in France and Germany are over 65 years of age).

New medical technologies are improving diagnosis and treatment, but they are also increasing health spending. This section presents data on the availability and use of two diagnostic technologies: computed tomography (CT) scanners and magnetic resonance imaging (MRI) units. CT scanners and MRI units help physicians diagnose a range of conditions by producing images of internal organs and structures of the body. Unlike conventional radiography and CT scanning, newer imaging technology used in MRI units do not expose patients to ionising radiation.

The number of hospital beds provides an indication of the resources available for delivering services to in-patients in hospitals. This section presents data on the total number of hospital beds, including those allocated for curative, psychiatric, long-term and other types of care. It does not capture the capacity of hospitals to furnish same-day emergency or elective interventions.

Hospital discharges measure the number of people who need to stay overnight in a hospital each year. Together with the average length of stay, they are important indicators of hospital activities. Hospital activities are affected by a number of factors, including the demand for hospital services, the capacity of hospitals to treat patients, the ability of the primary care sector to prevent avoidable hospital admissions, and the availability of post-acute care settings to provide rehabilitative and long-term care services.

The average length of stay in hospitals is often regarded as an indicator of efficiency, since a shorter stay may reduce the cost per discharge and shift care from in-patient to less expensive post-acute settings. However, shorter stays tend to be more service intensive and more costly per day. Too short a length of stay could also have adverse effects on health outcomes, or reduce the comfort and recovery of the patient. If this leads to a rising readmission rate, costs per episode of illness may fall little, or even rise.

Heart diseases are a leading cause of hospitalisation and death in OECD countries (see Indicator 1.4). Coronary angioplasty is a revascularisation procedure that has revolutionised the treatment of ischemic heart diseases over the past twenty years. It involves the threading of a catheter with a balloon attached to the tip through the arterial system, usually started in the femoral artery in the leg, into the diseased coronary artery. The balloon is inflated to distend the coronary artery at the point of obstruction. The placement of a stent to keep the artery open accompanies the majority of angioplasties. Drug-eluting stents (a stent that gradually releases drugs) are increasingly being used to stem the growth of scar-like tissue surrounding the stent.

In the past 20 years, the number of surgical procedures carried out on a day care basis has steadily grown in European countries. Advances in medical technologies, particularly the diffusion of less invasive surgical interventions, and better anaesthetics have made this development possible. These innovations have improved effectiveness and patient safety. They also help to reduce the unit cost of interventions by shortening the length of stay. However, the overall impact on cost depends on the extent to which any greater use of these procedures may be offset by a reduction in unit cost, taking into account the cost of post-acute care and community health services.

Significant advancements in surgical treatment have provided effective options to reduce the pain and disability associated with certain musculoskeletal conditions. Joint replacement surgery (hip and knee replacement) is considered the most effective intervention for severe osteoarthritis, reducing pain and disability and restoring some patients to near normal function.

Cervical cancer is largely preventable. Screening by regular pelvic exam and pap smears can identify premalignant lesions, which can be effectively treated before the occurrence of the cancer. Regular screening also increases the probability of diagnosing early stages of the cancer and improving survival. Consequently, the Council of the European Union and the European Commission promote population based cancer screening programmes among member states (European Union, 2003; European Commission, 2008c) and European countries have instituted screening programmes with specific periodicity and target groups. In addition, promising cancer preventing vaccines have been developed based on the discovery that cervical cancer is caused by sexual transmission of certain forms of the Human Papilloma Virus. The efficacy and safety of those vaccines is now well established, but debates about cost-effectiveness and the implications of vaccination programmes for teenagers for a sexually transmitted disease continue in a number of countries (Huang, 2008).

Breast cancer is the most common form of cancer among women in all EU countries, accounting for 31% of cancer incidence, and 17% of cancer deaths among women in 2008 (see Indicator 1.5). Overall spending for breast cancer care typically amounts to about 0.5-0.6% of total health care expenditure (OECD, 2003).