10.5. Quality of healthcare
Health is at the heart of citizens’ well-being. Improving human health and providing access to affordable, high-quality healthcare is a key concern of all countries. The healthcare system is responsible for preventing health problems as well as protecting citizens from threats related to health. Quality of healthcare can be measured through outcome measures, such as estimated life expectancy at birth and number of healthy years. It is important to note that these measures can also be affected by other factors, such as lifestyle and behaviour (e.g. smoking, alcohol consumption) and self-care attitudes of the population (e.g. following recommended schedules of medical check-ups) that are beyond the control of the healthcare system.
Health status in the Western Balkan region has improved considerably since the turn of the millennium. Life expectancy has increased from 72 years in 2000 to 76 years in 2017. By comparison, the average life expectancy in OECD-EU countries was 80 years on average in 2017, with an equivalent increase of four years compared to 2000. Overall, the Western Balkans still lag behind OECD-EU countries, but there is a positive convergence trend.
Significant variations can be observed within the Western Balkan region, with Kosovo having the lowest life expectancy (72 years) and Albania having the highest (78 years). Life expectancy has increased the most in Serbia (5 years) and the least in North Macedonia (2 years) when comparing the years 2000 and 2017.
In 2016, the number of healthy years that a citizen of in the Western Balkans could expect was on average 68 years, whereas the number of healthy years on average in OECD countries was 71 years. The number of healthy years does not vary significantly among Western Balkans. Albania ranks the highest with an average of 68.1 healthy years and North Macedonia the lowest with 67.1 years. The number of healthy years has increased by 2.7 years since 2000 in the Western Balkan region. The highest increase is in Albania and Montenegro (both 3.2 years) and the lowest increase in Bosnia and Herzegovina (1.7 years).
Healthcare outcomes such as life expectancy and number of healthy years are linked to the services covered by healthcare. Providing universal coverage and equal access to the healthcare system for all remains a challenge for the Western Balkan region. On average, the coverage of essential health services (e.g. prevention, treatment, rehabilitation) index score was at 65 in 2017 whereas the OECD average stood at 80. For example, in Montenegro the World Bank has recommended implementing reforms related to service delivery, in order to address the dual challenges of a rising burden of non-communicable diseases and an aging population. These reforms aim to increase the quality and coverage of primary and preventive care, and streamline the hospital network. Similar to life expectancy, there is significant variation across the region for the coverage of essential health services. The highest rate of the region belongs to North Macedonia (72) and the lowest to Albania (59), a difference of 13 points. However, the index is relatively stable over time recording the highest increase in North Macedonia (+2) compared to 2015.
Life expectancy at birth measures the average number of years that people born today could expect to live based on currently prevailing age-specific death rates. Life expectancy at birth for the population as a whole is computed as a weighted average of life expectancy for men and women. Data is drawn from the World Bank database.
The World Health Organisation (WHO) collects data on number of healthy years. Healthy life expectancy (HALE) is a form of health expectancy that uses disability weights to health states to compute the equivalent number of years of good health that a newborn can expect.
The Universal Health care (UHC) Index of service coverage is a composite indicator prepared by the WHO. The index allows policymakers to compare the coverage of essential health services across countries. The index is the geometric mean of 14 selected indicators of health service coverage and it is presented as a score from 0 to 100. The indicators are grouped into four components of service coverage: reproductive, maternal, newborn and child health; infectious diseases; non-communicable diseases; and service capacity and access. For more information see: https://apps.who.int/gho/data/node.imr.UHC_AVAILABILITY_SCORE?lang=en.
Further reading
World Bank (2019), Montenegro Public Finance Synthesis Report: Restoring Sustainability and Strengthening Efficiency of Public Finance, World Bank, Washington.
Figure notes
10.12., 10.13.: Data for Kosovo are not available.
Source: The World Bank (2017) World Development Indicators.
Source: World Health Organisation (2017) Global Health Observatory (GHO) data.
Source: World Health Organisation (2017) UHC Service Coverage Index (SCI).
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