Epidemiological data on morbidity and mortality

Epidemiological data are perhaps the most important statistics on the assessment of health care systems. They show not only the health status, but give perspectives on how to reduce illness, invalidity and premature death. Often these data include information about the satisfaction of the population with their health services and the quality of health care.

As a field epidemiologist, we collect and assess data from field investigations, surveillance systems, vital statistics, or other sources.1 On such a basis the allocation of resources from a macro, meso and micro point of view is possible. Cost-of-illness studies show us the most expensive diseases (according to expenditures, life years lost etc.) and offer a basis for priority setting. With the help of these data we produce economic facts and figures.

Economic data

We often associate healthcare with high costs and the need to curb them. The topics are related mainly to health expenditures, share of health expenditures as a proportion of GDP or per capita, revenue deficits, life expectancy at birth or misuse of certain services. A shortage of skilled personnel during the pandemic is also high on the political agenda of economic data.

Sometimes disregarded is the fact that the healthcare system is not only a cost factor but is also a growing industry. Its economic importance is impressively seen by the contribution to employment, value-added services and exports. These figures are sometimes higher than those of other industries.2 The German Federal Ministry for Economic Affairs and Energy regularly publishes facts and figures on the core and the extended sectors of the healthcare industry and the associated collectively and individually financed healthcare services.

Data on effectiveness and efficiency

From an overall perspective there are often complaints by patients and providers about a lack of efficiency in healthcare systems. Over and underuse of health care services are attributed to a lack of coordination across and between health care providers and missing competition on the demand side for health services. An answer to this problem is perhaps the establishment of more managed care in the system through GP-centered care, disease management programs and integrated care and medical care centers.

Social data (social cohesion and solidarity)

Often neglected and rarely discussed are social characteristics of health care. One of the reasons is perhaps the difficulty in quantifying them. It is easier to use figures and statistics on the financial and employment situation than to quantify terms as equity and social cohesion (solidarity), access and rights or duties and choice in healthcare. Many people associate equity and equality with a basic level of care for all, an equal distribution of burdens and not a two-tiered system.

On the benefit side, healthcare services should be available according to the needs of the population, to all citizens independent of their income, residence or social status. A basic minimum of benefits that ensures that no citizen falls beneath a particular level of subsistence, i.e. the same level of quality of health care should be equally accessible to all.

On the financing side, the provision of care should be guaranteed according to the ability to pay either out of taxes or on the basis of a social security system. Earmarked payroll tax financed solutions through employer and employee contributions (Bismarckian-System) are typical for France, the Netherlands and Germany, whilst the tax-financed solutions (Beveridge-System) are in place in the UK and Scandinavian countries.

Data on different dimensions of choice in health care

Choice in health care is associated with freedom to choose providers in general, or within integrated care certain disease management programs offered by the insurance funds. The table shows the choices in a Bismarckian health care system. Collective and selective contracting takes place between the insurances and the providers.

From an insured person’s point of view there is a choice between different social and private insurance companies. In addition, there are different benefit packages within one insurance company and often there is a choice between certain types of co-payments for ambulatory and inpatient care.


Data on legal rights and duty to live a healthy lifestyle

As a member of a social security system one is entitled to receive the necessary health services. The citizen has a claim on treatment because he has paid his contributions regularly. This membership is based on a social jurisdiction and systems of arbitration. This right to health is combined, at least from a moral point of view, with a duty to live a healthy lifestyle. Thus the individual lifestyle and preventive health care is a lifelong topic by moral standards.


1 Robert E. Fontaine, Describing Epidemiologic Data, in: The CDC Field Epidemiology manual.
2 Henke, K-D., The Effectiveness of the Health Economy: A case study of the Federal Republic of Germany. SEEJPH 2022, posted: 21 January 2022. DOI:10.11576/seeph-5113.