What is to be gleaned from the OECD’s Health at a Glance 2013 report? In short: the healthcare services supertankers are starting to alter course, but progress remains slow – and icebergs of diabetes, dementia and longer life expectancy are approaching.

Several main trends stand out. Chief among these is the clear slow-down in the growth of per capita spending in Europe. Having grown annually at 4.1% in real terms from 2000-2009, it slowed to a growth rate of 0.2% in 2009-2011 across the OECD, with a particularly marked slowdown in Europe. The PIIGS have seen real cuts. Greece saw per capita health spending falling by 11% in 2010 and 2011, following an annual growth rate of more than 5% between 2000 and 2009. The report indicates that the OECD doesn’t expect healthcare spending in Europe to bounce back any time soon.

When times are tough, the powerful get the most money. It is not surprising to see that prevention services have been cut since 2009, now accounting for just 3-4% of total spending.

Not that other areas have been untouched, but, while the acute care sector is being reformed, progress has been slow. The average length of stay in hospitals has fallen from 9.2 days in 2000 to 8 in 2011. Germany, at 10, and Russia, at 13, bring up the rear, with Spain, the UK and Poland at around seven. Turkey is at just four. Acute care beds, however, have been barely cut, falling from 5.6 per 1,000 people in 2000 to 5.0 in 2011.

The decline in prevention, and the failure of chronic disease management programmes to take off, is worrying, given the icebergs out there. Take the continued explosion in diabetes. Some 7% of 20-79 year olds have been diagnosed with it. A recent survey in Spain found that, while the incidence rate for under-45s was just 1%, it rose to 20% for over-75-year-old women. This survey found that half of diabetics didn’t even know that they had the condition.

The other icebergs are dementia and increasing life expectancy. In Europe, 14% of men and 16% of women aged 80-84 suffer from dementia, rising to 31% of men and 47% of women older than 90. Dementia costs 6% of the Dutch healthcare budget, and nearly 4% of the healthcare budget in Germany.

Increasing life expectancy exacerbates the problem. Average life expectancy exceeds 80 years across OECD countries in 2011, up 10 years since 1970. There is no sign of the growth of life expectancy starting to diminish.

Long-term care (LTC) expenditure continues to grow. Public expenditure on health and social care components of LTC is now 1.6% of GDP across the OECD, reaching 3.7% in the case of Norway, with Sweden not far behind. Greece, Portugal, Estonia, Hungary, the Czech Republic and Poland spent less than 0.5% of their GDP on long-term care. Projection scenarios suggest that public resources allocated to LTC as a share of GDP may double or more by 2060. Given the icebergs, we think the true figure will end up being far higher.

Privately-funded LTC expenditure is growing, and plays a relatively large role in Switzerland (0.8% of GDP), Germany, the United States, Finland and Spain (about 0.4% of GDP).

Between 2005 and 2011, homecare expenditure rose by 5% per annum, compared to 4% for institutional care.

What of the report card? Yes, countries are making acute care more efficient, and, yes, LTC is increasing, as is homecare. But the rates of change do not match the needs which are now arising.