Final Report Part III ECHIM Pilot Data Collection Analyses and Dissemination

NB: The data from Finland originate from the year 2000 and are regarded as out-dated. However, the Finnish
data are not excluded from data computation. The German data are not as valid as for other ECHI indicators
due to the small sub- sample size.
General remarks on the first EHIS wave and computation of this indicator:
Likewise with other ambulatory health care providers, EHIS asks respondents to report visits that took place
during the past four weeks, as using a relatively short time frame will prevent recall biases. The downside of
using a short recall period, however, is that seasonal influences may bias the estimates. This should be taken
into account in the design of the fieldwork, i.e. spreading the data collection over the entire year and performing
it within the same season, respectively.
Additionally, extrapolating the estimate from 4 weeks to one year will lead to over- or underestimations by
enlarging the statistical error. ECHI uses this 12 months time frame, as well do the WHO and OECD in their
reports.
The national health care systems differ widely so that it may be of utmost importance which dental services are
covered by which insurance scheme. That may range from very basic services like tooth extractions or dental
fillings up to expensive oral rehabilitation measures like teeth crowns or implantations. In some countries, adult
dental care may not be part of the basic service packages which is included in the public care insurance. In
other countries, prevention and treatments are covered, but a varying share of costs is borne by patients, thus
creating access problems for low-income groups.
At the OECD database [3] the "Private household out-of-pocket expenditure" is extractable. Unfortunately, the
OECD does not differentiate strongly enough between the levels of medical service but aggregates "Providers
of ambulatory health care". However, it becomes evident that in many EU countries both the private sector and
out-of-pocket expenditures have increased over time.
In the OECD Health at a Glance Report 2011 [4] (Chapter 7.5 "Financing of Health Care), it reads that the
public sector remains the main source of health financing in all OECD countries, but many of those countries
with a relatively high public share in the early 1990s, such as Poland and Hungary, have decreased their share,
thus reflecting health system reforms and the expansion of public coverage. After public financing, the main
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