Medicalised homecare across Europe: who uses it the most?

We take a look at medicalised homecare user rates across Europe, which reflect the take-up of specialised medical treatment in the home by the whole population and give us interesting insights into how numerous markets operate: France, Iceland and Benelux use it far more than anyone else.

Eurostat (the European Commission’s statistics centre) does not clarify exactly what services are included in these figures, but at HBI we consider medicalised homecare to include everything from specialised nursing and medical services, to drug deliveries and oxygen or sleep apnea equipment in the home. The figures cover the whole population based on surveyed samples.

Below, we see that rates are highest in France, Belgium, the Netherlands and Iceland between 6-10% (with rates in France and Belgium between 9-10%) suggesting more mature markets and higher population coverage. The lowest penetration is seen in Turkey with a user rate of 0.5% where the market is only just developing. Burgeoning opportunities exist in Eastern Europe and Sweden in particular, where user rates are low – between 1-2% in Romania, Slovakia, Estonia, Lithuania, Latvia, but also in Croatia and Portugal.

Favourable regulation and a willingness of the public sector to outsource homecare contracts will determine how the for-profit sector can develop. Currently, in Sweden, long-term intensive care is only outsourced to the for-profit sector in Stockholm and has yet to expand into northern regions.

The graph below shows, within the homecare-using population outlined above, the level of acuity of services used as well as the where in the country they are being used.

By ‘severe dependency’ we understand patients accessing long-term intensive or palliative care services. Patients with ‘moderate dependency’ needs would include patients accessing temporary intensive treatment, rehabilitative services or post-acute homecare. The ‘no dependency’ range would be patients receiving medication deliveries, hourly nursing supervision and the maintenance of artificial stomas, for instance.

If we look at user rates according to degree of dependency, it is interesting to note that countries where usage in the moderate or no dependency ranges are highest (Malta, Iceland and Belgium in particular) see some of the lowest take-up in users with severe dependency needs. Countries with the most patients with severe dependency such as Lithuania at 89%, Slovakia at 88% and Estonia at 85%, have the lowest take-up in patients with no dependency needs, at 0-3.3%. Does this show how higher rates of use within lower categories of need can delay the slide into severe dependency?

As healthcare systems struggle under the weight of ageing societies and limited public healthcare budgets, medicalised homecare for patients with low to moderate dependency is becoming a way to reduce hospitalisation costs, increase patient engagement – especially with the advent of digital monitoring and feedback technology – and thus boost prevention. Homecare for those with severe needs is only going to increase as the elderly live longer lives and diseases such as COPD (Chronic Obstructive Pulmonary Disease) remain on the rise.

We would welcome your thoughts on this story. Email your views to Anaïs Charles or call 0207 183 3779.