Metode de analiza si prognoza pentru sistemul

sanitar

Managementul serviciilor de sanatate

An univ. 2014 – 2015
Prof.dr. Daniela Borisov,
daniela.hincu@man.ase.ro

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Tematica curs si seminar
Introducere

I. Problematica previziunii – metode calitative si cantitative

1.1. Prezentare generala – concepte, clasificari
1.2. Teme de discutie – tipuri particulare de previziuni
1.3. Analiza seriilor dinamice

II. Metode de previziune aplicate

2.1. Metode de ajustare, Ajustarea exponentiala.
Aplicatie nr. 1 – Previziunea pentru cursul de schimb valutar leu - euro ptr. Septembrie-
octombrie 2014 (date reale pentru Romania – www.bnro.ro)
2.2. Extrapolarea analitica si fenomenologica
2.3. Analiza de regresie si corelatie. Regresia liniara
Aplicatiile nr. 2-3-4. Previziunea nr. de medici la 100000 locuitori Romania; Testarea
corelatiei
Aplicatia nr. 5. PIB vs. speranta de viata la nastere

MSS_ MAPSS_2014-2015 2
 Tematica curs si seminar
III. Metode de analiza si de luare a deciziilor
3.1. Procesul cunoaşterii ştiinţifice – etape. Informatii – procese
obtinere/procesare
3.2. Cercetare canti & cali tativa. Metoda cantitativa de analiza
3.3. Teoria deciziilor statistice. Decizii multicriteriale – multiatribut.
Aplicatia nr. 6. Efectuarea unor clasamente. Decizii cu mai multe criterii – comparatii, prioritizari
3.4. Actualitate in analiza deciziilor. Teoria deciziilor – economie cognitiva -
economia comportamentala. Elemente de managementul riscului.
Aplicatia nr. 7, 8. Evaluari calitative/cantitative ale riscului
3.5. Testarea ipotezelor .

IV. Elemente introductive de Managementul proiectului si ACB

4.1. Analiza cost – beneficiu (ACB).
Aplicatia nr. 9. Exemplificare pentru construirea unui model financiar pentru venituri si cheltuieli. Calculul unor
indicatori VNA (NPV) si RIR (IRR)
4.2. Analiza cost – eficacitate si Analiza cost – utilitate.
Aplicatia nr. 10. Calcule de eficienta

MSS_ MAPSS_2014-2015 3
Surse de informatii si date statistice
Anuarul Statistic al Romaniei

European health for all database (HFA-DB) World Health Organization Regional Office for Europe
http://data.euro.who.int/hfadb/

EUROPE IN FIGURES http://ec.europa.eu/eurostat

Key Figures on Europe 2013
Eurostat yearbook 2012 “Europe in figures” - Eurostat yearbook 2012,
http://epp.eurostat.ec.europa.eu/statistics_explained/index.php/Europe_in_figures_-_Eurostat_
yearbook
chapters “Population”, “Health, “Living conditions and welfare”

WORLD HEALTH STATISTICS 2012; http://www.who.int/healthinfo/EN_WHS2012_Full.pdf

World Health Organization

http://www.cnp.ro/ro/prognoze
PROIECŢIA PRINCIPALILOR INDICATORI MACROECONOMICI PENTRU PERIOADA 2010 – 2014
Prognoza în profil teritorial 2012 – 2015
Eurostat regional yearbook 2013

MSS_ MAPSS_2014-2015 4
 Bibliografie
 Cicea Claudiu, Borisov Daniela, Alexandru, Gheorghe Investment in Health, Investment in People:
Modern approaches for efficiency evaluation and modelling, Editura ASE, 2012 Bucureşti,
 Jones, Andrew, Rice Nigel, Bago d’Uva Teresa, Balia Silvia – Applied Health Economics, Routledge
Advanced texts in Economics and Finance, 2007
 Raportul “STRATEGIA NAŢIONALĂ DE RAŢIONALIZARE A SPITALELOR” elaborat 2010 Ministerul
Sanatatii, Banca Mondiala
 Raportul “UN SISTEM SANITAR CENTRAT PE NEVOILE CETĂŢEANULUI”, Raportul Comisiei
Prezidenţiale pentru analiza şi elaborarea politicilor din domeniul sănătăţii publice din România,
Noiembrie 2008, Bucuresti
 Health statistics - Atlas on mortality in the European Union, EU 2009, Product code: KS-30-08-357
ISBN: 978-92-79-08763-9
 Global health risks: mortality and burden of disease attributable to selected major risks, WHO
Library Cataloguing-in-Publication Data, © World Health Organization 2009
 WORLD HEALTH STATISTICS 2012-2010, World Health Organization,
http://www.who.int/whosis/whostat/EN_WHS10_Full.pdf
 Health and safety at work in Europe (1999–2007) A statistical portrait
http://epp.eurostat.ec.europa.eu/cache/ITY_OFFPUB/KS-31-09-290/EN/KS-31-09-290-EN.PDF
 Euro Health Consumer Index 2012, 2009, 2008
 Health at a Glance, OECD indicators 2011.
http://www.oecd.org/health/healthpoliciesanddata/healthataglance2011.htm
 Second European Quality of Life Survey 2009
http://www.eurofound.europa.eu/publications/htmlfiles/ef0902.htm
 Human Development Reports 2013-2009 ; hdr.undp.org
 “Systematic review of the effectiveness and cost-effectiveness of home versus hospital or satellite unit
haemodialysis for people with end stage renal failure”, NHS R&D HTA Programme
 Decision Analysis in healthcare, George Mason University, web site:
http://guston.gmu.edu/healthscience/730/IntroductiontoDecisionAnalysis

MSS_ MAPSS_2014-2015 5 5
Detalii pentru desfasurarea examenului/
notarea finala
Examen scris: sesiunea ianuarie – februarie 2015
Durata: 90 minute (max.)
Structura subiectelor:
(notare prin punctaj 10-90 pct. la examenul scris + 10 pct. ptr. prezenta ( punctaj de 100
pct = nota 10))
 I. Subiect “deschis” (din teorie, de redactat cf. notelor de curs/dezbaterilor) (30 pct.)
 II. Teste grila cu unic raspuns corect – 15-20 intrebari (30 pct.)
 III. Aplicatie numerica (30 pct.)

Prezentarea unui referat poate substitui cele 30 pct. (max.) ale unui subiect (la alegere) din
examenul scris – tematica este discutata la seminar cu profesorul, max. 2 persoane pe
referatul prezentat oral pe parcursul a 15 – 20 min.
Prezentarea la ultimul seminar a portofoliului de aplicatii numerice (rezolvate corect si
complet) echivaleaza subiectul III din examenul scris.

MSS_ MAPSS_2014-2015 6
Surse de informare:
EHCI European Health Consumer Index 2013, 2012
(http://www.healthpowerhouse.com/files/ehci-
2013/ehci-2013-report.pdf)
Indexul sistemului sanitar european
Surse de date:
World Health Organization (WHO)
The ECHI (European Community Health Indicators)
European Health for All database (HFA-DB)
EUROSTAT statistics by themes
ECHI (European Community Health Indicators)

MSS_ MAPSS_2014-2015 7
 WORLD HEALTH STATISTICS
Indicators of life expectancy and mortality rates - include overall life expectancy at
birth as well as infant and under-five mortality (the probability of dying between birth
and 1 and 5 years of age, respectively), and adult mortality (the probability of dying
between 15 and 60 years of age).
Cause-specific mortality and morbidity - indicators on the level and distribution of
specific causes of deaths grouped as follows: communicable, maternal and perinatal
conditions and nutritional deficiencies; noncommunicable conditions; and injuries.
Estimates are provided of the distribution of causes of death among children under 5 years
old. These include: diarrhoea; major communicable diseases such as HIV/AIDS, malaria,
measles and pneumonia; and conditions arising in the neonatal period such as
prematurity, birth asphyxia, neonatal sepsis and congenital anomalies.
The “years of life lost” (YLL) is a measure of premature mortality that takes into account
both the frequency of deaths and the age at which death occurs. The country-specific
indictors presented in this section have been derived from a range of sources of mortality,
incidence and prevalence data. Incidence is the number of new cases each year, while
prevalence is the number of people with a given disease at a specific point in time.

MSS_ MAPSS_2014-2015 8
Selected infectious diseases - the section does give an indication of the current status of
officially reported infectious disease data at the global level, and of the major reporting gaps.
Given the variations in the methods used by countries to obtain these numbers, no attempt has
been made to calculate incidence or prevalence. To interpret these numbers, both
epidemiological patterns and data-collection efforts in specific countries must be considered.
Some diseases (for example, malaria and yellow fever) are endemic to certain geographical
regions, but are extremely rare elsewhere. Diseases such as plague are liable to cause outbreaks
that can cause case numbers to fluctuate widely over time. Because some diseases are best
tackled with preventive measures such as mass drug treatment, reporting the number of cases
is a lower priority than estimating the population at risk. For vaccine-preventable diseases, case
numbers are affected by immunization rates. Diseases such as H5N1 influenza, Japanese
encephalitis and malaria are difficult to identify without specialized laboratory tests that are
often not available in developing countries. In many settings, cases of some diseases (such as
malaria) are identified through clinical signs and symptoms alone.
Health service coverage indicators reflect the extent to which people in need actually receive
important health interventions. Such interventions include: the provision of skilled care to
women during pregnancy and childbirth; reproductive-health services; immunization to
prevent common childhood infections; vitamin A supplementation in children; and the
treatment of disease in children, adolescents and adults. Coverage indicators are typically
calculated by dividing the number of people receiving a defined intervention by the population
eligible for – or in need of – the intervention. For example, immunization coverage among 1-
year-old children can be calculated from the number of children having received a specific
vaccine divided by the total population of 1-year-old children in each country. For indicators on
antenatal care, births attended by skilled health personnel and births by caesarean section, the
denominator is the total number of live births in the defined population.
MSS_ MAPSS_2014-2015 9
Risk factors are associated with increased mortality and morbidity. These preventable risk factors
include: unsafe water and lack of sanitation; use of solid fuels in households; low birth weight;
poor infant-feeding practices; childhood under-nutrition; being overweight or obese; harmful
consumption of alcohol; use of tobacco; and unsafe sex. Low birth weight is an important
predictor of the health and survival of the newborn but in many settings (especially where
deliveries occur outside health-care facilities) many infants are not weighed at birth.
Health workforce, infrastructure and essential medicines - data on the resources available to
the health system, including physicians, nurses and midwives, other health-care workers,
hospital beds and select medical devices. The table also includes the MDG target indicator on
access to essential medicines. Such data are essential in enabling governments to determine
how best to meet the health-related needs of their populations.
Health expenditure - data on government, private, external, social security and out-of-pocket
expenditures on health.
Health inequities health inequities – unfair and avoidable differences in health and health service
provision – that arise for example from socioeconomic factors (such as level of education,
occupation and household wealth or income), from geographical location, and from ethnicity
and gender.
Demographic and socioeconomic statistics This section presents data on demographic and
socioeconomic factors that are major determinants of health. The table includes three MDG-
related indicators – adolescent fertility, primary school enrolment ratios and population living
in poverty. The table also includes data on: demographics (population size, growth, fertility
rates and urbanization); coverage of civil registration of births and underlying causes of death;
adult literacy; and per capita gross national income. In addition to their intrinsic value, such
data are also important in making other statistics comparable across countries. For example,
data on disease incidence, prevalence and mortality rates – and on the availability of health-
system resources – all require reliable population-based denominators.
MSS_ MAPSS_2014-2015 10
Surse de date (1) – World Health Organization
(WHO)

WHO Statistical Information System (WHOSIS) incorporated in Global

Health Observatory (GHO) – the WHO's portal providing access to
data and analyses for monitoring the global health situation; it provides
critical data and analyses for key health themes, as well as direct access
to the full database.

http://www.who.int/gho/en/

MSS_ MAPSS_2014-2015 11
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http://www.who.int/gho/en/

MSS_ MAPSS_2014-2015 12
Romania

MSS_ MAPSS_2014-2015 13
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MSS_ MAPSS_2014-2015 15
Surse de date (2): ECHI (European Community Health
Indicators)
http://ec.europa.eu/health/indicators/echi/

MSS_ MAPSS_2014-2015 16
http://ec.europa.eu/health/indicators/indicators/index_en.htm

MSS_ MAPSS_2014-2015 17
MSS_ MAPSS_2014-2015 18
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MSS_ MAPSS_2014-2015 20
MSS_ MAPSS_2014-2015 21
Euro Health Consumer Index 2013
http://www.healthpowerhouse.com/index.php?Itemid=55

Euro Health Consumer Index 2013 (EHCI) a devenit

etalonul de evaluare a sistemelor medicale
europene.

Editia 7 a din 2013 clasifica 34 de sisteme medicale

nationale din Europa pe criteriul a 42 de indicatori,
acoperind cinci domenii esentiale în materie de
sanatate:
drepturile si informarea pacientilor,
durata de asteptare pentru tratament,
rezultate, prevenirea/sfera de aplicare si
acoperire a serviciilor furnizate, precum si
domeniul farmaceutic.

Indexul este alcatuit dintr-o combinatie de statistici

publice, sondaje asupra pacientilor si cercetari
independente realizate de fondator, think tank-ul
din Suedia, Health ConsumerPowerhouse.

MSS_ MAPSS_2014-2015 22
Euro Health Consumer Index report
there is an abundance of statistics on input of
resources, but a traditional scarcity of data
on quantitative or qualitative output.
Organisations such as the WHO and OECD
are publishing easily accessible and
frequently updated statistics on topics like:
 the number of doctors/nurses per capita
 hospital beds per capita
 share of patients receiving certain treatments
 number of consultations per capita
 number of MR units per million of
population
 health expenditure by sources of funds
 drug sales in doses and monetary value
(endless tables).
In the design and selection of indicators, the
EHCI has been working on the following
three criteria since 2005: relevance, scientific
soundness; feasibility (i.e. can data be
obtained).
MSS_ MAPSS_2014-2015
the Index is a compromise between which indicators were
judged to be most significant for providing
information about the different national healthcare
systems from a user/consumer’s viewpoint, and the
availability of data for these indicators.
It has been deemed important to have a mix of indicators
in different fields; areas of service attitude and
customer orientation as well as indicators of a “hard
facts” nature showing healthcare quality in outcome
terms. It was also decided to search for indicators on
actual results in the form of outcomes rather than
indicators depicting procedures, such as “needle
time” (time between patient arrival to an A&E
department and trombolytic injection), percentage of
heart patients trombolysed or stented, etcetera.
Intentionally de-selected were indicators measuring public
health status, such as life expectancy, lung cancer
mortality, total heart disease mortality, diabetes
incidence, etc. Such indicators tend to be primarily
dependent on lifestyle or environmental factors rather
than healthcare system performance. They generally
offer very little information to the consumer wanting
to choose among therapies or care providers, waiting
in line for planned surgery, or worrying about the risk
of having a post-treatment complication or the
consumer who is dissatisfied with the restricted
information. 23
Euro Health Consumer Index 2013 report

MSS_ MAPSS_2014-2015 24
Euro Health Consumer Index 2013 report

MSS_ MAPSS_2014-2015 25
 Content of indicators in the EHCI 2012
Sub-discipline 1 (Patient rights, information and e-Health) This sub-discipline has regained the
structure from the EHCI 2007, with three indicators brought back from Sub-discipline e-Health.
Sub-discipline 2 (e-Health) This sub-discipline has been discontinued.

Sub-discipline 3 (Outcomes) – new indicators:

3.6 Caesarean sections
3.7 Undiagnosed diabetes
3.8 Depression
Sub-discipline 4
(Range and Reach of services provided)
– new indicators:
4.8 Smoking Prevention
4.9 Long term care for the elderly
4.10 % of dialysis done outside of clinic
Sub-discipline 5 (Pharmaceuticals)
– new indicators:
5.5 Alzheimer drugs
5.6 Schizophrenia drugs
5.8 Awareness of the efficiency of antibiotics against viruses

MSS_ MAPSS_2014-2015 26
MSS_ MAPSS_2014-2015 27
Euro Health Consumer Index 2012 report
Closing the gap between the patient and professionals

MSS_ MAPSS_2014-2015 28
Euro Health Consumer Index 2013 report

MSS_ MAPSS_2014-2015 29
Accessibility of healthcare system

MSS_ MAPSS_2014-2015 30
Accessibility of healthcare system

MSS_ MAPSS_2014-2015 31
Euro Health Consumer Index 2013 report

MSS_ MAPSS_2014-2015 32
Euro Health Consumer Index 2013 report

MSS_ MAPSS_2014-2015 33
The aging challenge (2013)

MSS_ MAPSS_2014-2015 34
Surse de date (3): http://www.euro.who.int/en/data-and-
evidence/databases

MSS_ MAPSS_2014-2015 35
http://www.euro.who.int/en/data-and-evidence/databases/european-
health-for-all-database-hfa-db

MSS_ MAPSS_2014-2015 36
http://data.euro.who.int/hfadb/ Online version

MSS_ MAPSS_2014-2015 37
Surse de date (4): European Health for All database (HFA-DB)
HFA-DB is a central database of independent, comparable and up-to-date
basic health statistics. It has been a key source of information on health in
the European Region since WHO/Europe launched it in the mid-1980s. It
contains time series from 1970. HFA-DB is updated biannually and
contains about 600 indicators for the 53 Member States in the Region.

The indicators cover:

 basic demographics;
 health status (mortality, morbidity, maternal health and child health);
 health determinants (such as lifestyle and environment)
 health care (resources and utilization).

HFA-DB allows country and intercountry analyses to be displayed as charts,

curves or maps, which can be exported free of charge to other software
programs.

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MSS_ MAPSS_2014-2015 38 38
Databases
http://www.euro.who.int/en/what-we-do/data-and-evidence/databases
This is WHO/Europe’s portal to health statistics and to detailed monitoring and assessment tools for key
areas of health policy. These links provide access to a broad range of information systems: from
international comparisons of aggregate indicators to the results of detailed disease surveillance and the
monitoring of specialized areas of health policy. Users can browse the information online and present and
analyse it in different formats (in tables, graphs and/or maps).
European Health for All Database (HFA-DB)This is WHO/Europe’s prime data source for international
comparisons. If offers a comprehensive set of more than 600 items covering 53 Member States for time
series back to 1970.
Mortality indicator database (MDB) This database allows age- and sex-specific analysis of mortality trends by
broad disease-groups, as well as disaggregated to 67 specific causes of death. Data reach back to 1980.
European detailed mortality database (DMDB) For a more detailed analysis, DMDB provides mortality data
by three-digit codes of the International Classification of Diseases, disaggregated by five-year age groups,
and series back to 1990.
European hospital morbidity database (HMDB)
The HMDB is a unique tool for the analysis and international comparison of morbidity and hospital
activity patterns, based on hospital-discharge data by detailed diagnosis, age and sex, since 1999.
Centralized information system for infectious diseases (CISID)
CISID is WHO/Europe’s main surveillance platform with information on communicable diseases,
immunization coverage, and on recent outbreaks in Europe It allows detailed reviews and assessments of
the situation regarding infectious diseases in the WHO European Region. It includes subnational level
data for selected items.
Tobacco control database
This database contains data on smoking prevalence and various aspects of tobacco control policy in
Member States in the WHO European Region. It allows to track and assess the tobacco-related situation
in and across countries and has a special section on tobacco control legislation.
European inventory of national policies for the prevention of violence and injuries Policy initiatives by
different sectors in countries across the Region.
International inventory of documents on physical activity promotion Information and case studies on
policies, strategies and approaches from European countries.
MSS_ MAPSS_2014-2015 39
 European Health for All database (HFA-DB)
01 DEMOGRAPHIC AND SOCIO-
ECONOMIC INDICATORS
02 MORTALITY-BASED INDICATORS
03 MORBIDITY, DISABILITY AND
HOSPITAL DISCHARGES
04 LIFE STYLES
05 ENVIRONMENT
06 HEALTH CARE RESOURCES
07 HEALTH CARE UTILIZATION AND
EXPENDITURE
08 MATERNAL AND CHILD HEALTH

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MSS_ MAPSS_2014-2015 40 40
Exemplificare extragere informatii – http://data.euro.who.int/hfadb/
MORTALITY-BASED INDICATORS - Infant deaths per 1000 live birth

Infant deaths per 1000 live

births
- a measure of the yearly rate of deaths in
children less than one year old. The
denominator is the number of live births in the
same year.

Infant mortality rate = [(Number of deaths in

a year of children less than 1 year of age) /
(Number of live births in the same year)]
*1000 (ICD-10).

Unfortunately, some countries are not able to

ensure complete registration of all death cases
and births. Therefore, infant mortality rates
which are calculated using incomplete
mortality data are lower than they actually are.
In some cases under-registration of deaths may
reach 20% or more and this has to be kept in
mind when making comparisons between
countries. Particularly high levels of mortality
under- registration are observed in countries of
central Asia and Caucasus, Albania and
possibly some other coutries, like those of
former Yugoslavia .

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MSS_ MAPSS_2014-2015 42
MSS_ MAPSS_2014-2015 43
MSS_ MAPSS_2014-2015 44
MSS_ MAPSS_2014-2015 45
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MSS_ MAPSS_2014-2015 48
Sursa de date (4) – raportari EUROSTAT
http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/themes

MSS_ MAPSS_2014-2015 49
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Eurostat Population and social conditions
Health is a high priority for Europeans, who expect to have a long and healthy life, to be protected against illnesses and accidents
and to receive appropriate health care. Accurate and detailed statistics on health have a key role for evidence based decisions by
national and European authorities and are a major tool for monitoring health policies.
Health statistics include:
Public health issues such as health status, health problems and health determinants, health care provision and resources,
health care expenditures and causes of death
Health and safety at work issues such as accidents at work and work related health problems

Strategy for Public Health

The European Commission's current strategy 'Together for Health: A Strategic Approach for the EU 2008-2013 ' aims to improve
citizens' prosperity, solidarity and security by: Improving citizens’ health security, Promoting health to improve prosperity and
solidarity , Producing and distributing health knowledge.
Competence for the organisation and delivery of health services and healthcare is largely held by the Member States, although the
EU has the responsibility to give added value through launching actions such as those in relation to cross-border health threats
and patient mobility, as well as reducing health inequalities and addressing key health determinants.
Strategy for Health and safety at work
The European Commission's current strategy "
Improving quality and productivity at work: the Community strategy 2007-2012 on health and safety at work " aims to achieve a
sustained reduction of occupational accidents and diseases in the EU through various EU and national actions.
Legal basis for the statistics on health
In December 2008 the European Parliament and the Council adopted a
framework Regulation for statistics concerning public health and health and safety at work . That regulation is addressing five
domains: Health care, health status and health determinants, accidents at work, occupational diseases and other work-related
health problems and causes of death.
Both the Community action Programme on Public Health and the Community strategy on health and safety at work 2007-2012 as
well as the Community Statistical Programme 2008-12 foresee the implementation of that Regulation as a key statistical element
of a sustainable health monitoring system.
MSS_ MAPSS_2014-2015 50
MSS_ MAPSS_2014-2015 51
The collection ‘Public health’ has been divided into three domains:
 Health care:
health care expenditure: Health care expenditure data provide information on
expenditure in the functionally defined area of health distinct by provider category (e.g.
hospitals, general practitioners), function category (products and services) and
financing agent (e.g. social security, private insurance company, household). The
definitions and classifications of the System of Health Accounts (SHA) are followed. 
health care non-expenditure: Non-expenditure health care data cover 'health care
human resources' (physicians, dentists, nursing and caring professionals, etc) as
well as hospital statistics (hospital beds, surgical procedures in hospitals, high-
tech equipment and patient related data ,i.e. hospital discharges by disease). 
health care indicators from surveys: tables on perceived unmet needs for medical
or dental care, consultations of health care professionals, hospitalisation, cancer
screening, etc. 
 health status indicators from surveys: tables on self-perceived health, life styles and
restrictions. Data on health conditions also play a role in the calculation of the
"healthy life years expectancy". This collection includes also tables on employment
of disabled persons based on a 2002 ad hoc module of the Labour Force survey.
 causes of death: Eurostat disseminates COD statistics according to a shortlist of 65
causes ('Causes of death – European shortlist', based on the ICD – International
Statistical Classification of Diseases and Related Health Problems, WHO). Data are
available at national and regional level (NUTS 2) for total number, crude death rates
(CDR) and standardised death rates (SDR), broken down by age groups and by sex. 

MSS_ MAPSS_2014-2015 52
http://epp.eurostat.ec.europa.eu/portal/page/portal/health/public_
health/data_public_health/main_tables

MSS_ MAPSS_2014-2015 53
http://epp.eurostat.ec.europa.eu/portal/page/portal/health/public
_health/data_public_health/database

MSS_ MAPSS_2014-2015 54
http://epp.eurostat.ec.europa.eu/portal/page/portal/health/healt
h_safety_work

MSS_ MAPSS_2014-2015 55
Health and safety at work

The collection ‘Health and safety at work’ is divided into four chapters (groups): 

 accidents at work (accidents at the workplace or in the course of an occupational

activity); 
 occupational diseases (recognised cases from national authorities); 
 commuting accidents (on the journey to or from work); 
 work-related health problems and accidental injuries (self-reported cases).

The data presented in the tables for the first three groups of the collection ‘Health and safety
at work’ are based on national administrative sources, from declarations to the insurance
(public insurance, social security scheme, or private insurance scheme) or to another
competent authority (usually the labour inspectorate).
The data for the last group of the collection ‘Health and safety at work’ (work-related health
problems and accidental injuries) were provided by an ad hoc module in the 1999
Community labour force survey.

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56 56
http://epp.eurostat.ec.europa.eu/portal/page/portal/health/he
alth_safety_work/data/main_tables

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MSS - MAPSS- 2010-2011
57 57
http://epp.eurostat.ec.europa.eu/portal/page/portal/health/he
alth_safety_work/data/database

MSS_ MAPSS_2014-2015 58
Sau cautare directa prin optiunea Database by themes 
http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_database

MSS_ MAPSS_2014-2015
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Exemplificare cautare de informatii - Database by themes  … Public health
(hlth)  … Health care expenditure by provider (hlth_sha_hp)

MSS_ MAPSS_2014-2015 60
MSS_ MAPSS_2014-2015 61
Health care expenditure by provider [hlth_sha_hp]

Health care expe nditure by prov ide r [hlth_sha_hp]

12.00

10.00

8.00
% of G D P

6.00

4.00

2.00

0.00
2003 2004 2005 2006 2007 2008 2009

Romania Spain Switzerland

MSS_ MAPSS_2014-2015 62
Health care expenditure by provider [hlth_sha_hp]

MSS_ MAPSS_2014-2015 63
Sau cautare directa prin optiunea TABLES by themes 
http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_database

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MSS_ MAPSS_2014-2015 64 64
Health care staff (hlth_staff) -> Health personnel (excluding nursing and caring
professionals) (hlth_rs_prs): Health personnel (excluding nursing and caring
professionals) - Absolute numbers and rate per 100,000 inhabitants

MSS_ MAPSS_2014-2015 65
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Health personnel (excluding nursing and caring professionals) -
Absolute numbers and rate per 100,000 inhabitants

MSS_ MAPSS_2014-2015 66
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Health personnel (excluding nursing and caring professionals) -
Absolute numbers and rate per 100,000 inhabitants

MSS_ MAPSS_2014-2015 67
 Practising physicians or doctors - Per 100,000 inhabitants
450.0

400.3 402.3 406.8

400.0 f(x) = 11.38 x + 314.16 389.8
R² = 0.95 379.1
361.9
350.0 344.4
327.2 327.5

300.0

250.0 236.9
221.3 225.7
f(x) = 4.43 x + 192.44 217.1 215.6 212.1
207.8
R² = 0.9
195.7 199.3
200.0

150.0

100.0

50.0

0.0
2002 2003 2004 2005 2006 2007 2008 2009 2010

Romania Linear (Romania) Norway Linear (Norway)

MSS_ MAPSS_2014-2015 68
European Community health indicators
(ECHI)
 Health indicators are sets of data (tables, graphs, maps) on health status,
determinants and care in EU member countries. They allow for monitoring and
comparison, and serve as a basis for policymaking.
Types of health indicator
 Out of a complete list of 88 health indicators, there are over 40 core  
European Community health indicators for which data is readily available and reasonably
comparable. They are grouped under the following headings. Where appropriate, figures
are given by gender and age as well as by socio-economic status and regional level.

Heading and Examples

 Demographic and socio-economic situation -- Population, birth rate, total
unemployment
 Health status -- Infant mortality, HIV/AIDS, road traffic injuries
 Health determinants -- Regular smokers, consumption/availability of fruit
 Health interventions: health services -- Vaccination of children, hospital beds, health
expenditure
 Health interventions: health promotion -- Policies on healthy nutrition

MSS_ MAPSS_2014-2015 69
 Determinants of health

ECHI - list of indicators 42. Body mass index (I)

43. Blood pressure (D)
44. Regular smokers (I)
Demography and socio-economic situation 45. Pregnant women smoking (D)
1. Population by sex/age (I) 46. Total alcohol consumption (I)
2. Birth rate, crude (I) 47. Hazardous alcohol consumption (D)
48. Use of illicit drugs (I)
3. Mother's age distribution (I) 49. Consumption of fruit (I)
4. Total fertility rate (I) 50. Consumption of vegetables (I)
5. Population projections (I) 51. Breastfeeding (D)
6. Population by education (I) 52. Physical activity (D)
7. Population by occupation (D) 53. Work-related health risks (D)
8. Total unemployment (I) 54. Social support (D)
9(a). Population below poverty line (I) 55. PM10 (particulate matter) exposure (I)
9(b). Income inequality (I) Health interventions: health services
Health status 56. Vaccination coverage in children (I)
10. Life expectancy (I) 57. Influenza vaccination rate in elderly (I)
11. Infant mortality (I) 58. Breast cancer screening (D) European health indicator on breast cancer screening
12. Perinatal mortality (D) European health indicator on perinatal mortality rate 59. Cervical cancer screening (D) European health indicator on cervical cancer screening
60. Colon cancer screening (D)
13. Disease-specific mortality (I)
61. Timing of first antenatal visits among pregnant women (D)
14. Drug-related deaths (I)
62. Hospital beds (I)
15. Smoking-related deaths (D)
16. Alcohol-related deaths (D) 63. Physicians employed (I)
17. Excess mortality by heat waves (D) 64. Nurses employed (I) European health indicator on other health professionals
18. Selected communicable diseases (I) European health indicator on communicable diseases 65. Mobility of professionals (D)
19. HIV/AIDS (D) European health indicator on HIV/AIDS 66. Medical technologies: MRI units and CT scans (I)
20. Cancer incidence (D) 67. Hospital in-patient discharges, limited diagnosis (I)
21(a). Diabetes: self-reported prevalence (D) 68. Hospital day cases, limited diagnosis (D)
21(b). Diabetes: register-based prevalence (D) 69. Hospital day cases/in-patient discharge ratio, limited diagnoses (D)
22. Dementia (D) European health indicator on dementia 70. Average length of stay (ALOS), limited diagnoses (I)
23(a). Depression: self-reported prevalence (D) 71(a). General practitioner (GP) utilisation; self-reported visits (D)
23(b). Depression: register-based prevalence (D)
24. Acute myocardial infarction (AMI) (D) 71(b). General practitioner (GP) utilisation; registered visits (D)
25. Stroke (D) 72(a). Selected outpatient visits: self-reported visits (D)
26(a). Asthma: self-reported prevalence (D) European health indicator on self-reported visits to a dentist or orthodontist
26(b). Asthma: register-based prevalence (D)
27(a). Chronic obstructive pulmonary disease (COPD): self-reported prevalence (D) 72(b). Selected outpatient visits: registered visits (D)
27(b). Chronic obstructive pulmonary disease (COPD): register-based prevalence (D) 73. Surgeries: PTCA, hip, cataract (I)
28. Low birth weight (I) 74. Medicine use, selected groups (D)
29(a). Injuries: home, leisure, school: self-reported incidence (D) 75. Patient mobility (D)
29(b). Injuries: home, leisure, school: register-based incidence (D) 76. Insurance coverage (I)
30(a). Injuries: road traffic: self-reported incidence (D) 77. Expenditures on health (D)
30(b). Injuries: road traffic: register-based incidence (D)
European health indicator on road accidents 78. Survival rates cancer (D)
79. 30-day in-hospital case-fatality of AMI and stroke (D)
31. Injuries: workplace (I) 80. Equity of access to health care services (I)
32. Suicide attempt (D) European health indicator on equity of access to dental care services
33. Self-perceived health (I)
34. Self-reported chronic morbidity (I) 81. Waiting times for elective surgeries (D)
35. Long-term activity limitations (I) 82. Surgical wound infections (D)
36. Physical and sensory functional limitations (D) 83. Cancer treatment quality (D)
37. General musculoskeletal pain (D) 84. Diabetes control (D)
38. Psychological distress (D)
39. Psychological well-being (D) Health interventions: health promotion
40. Health expectancy: Healthy Life Years (HLY) (I) 85. Policies on environmental tobacco smoke (ETS) exposure (D)
41. Health expectancy, others (D) 86. Policies on healthy nutrition (D)
87. Policies and practices on healthy lifestyles (D)
88. Integrated programmes in setting, including workplace, schools, hospital (D)
MSS_ MAPSS_2014-2015 70
ECHI (European Community Health Indicators)
Demographic and socio-economic factors

 Population by gender/age - Data are provided by Eurostat and the US Bureau of the
Census and are calculated as the number of inhabitants of a given area on 1 January
of the year in question (or, in some cases, on 31 December of the previous year). The
population is based on data from the most recent census adjusted by the
components of population change produced since the last census, or based on
population registers.
 Age dependency ratio - Data are provided by Eurostat and defined as the ratio of the
population defined as dependent (the population age 0-14 and 65 and over) divided
by the population 15-64, multiplied by 100.
The indicator 'Old-age-dependency ratio' is the ratio between the total number of
elderly persons of an age when they are generally economically inactive (aged 65
and over) and the number of persons of working age (from 15 to 64).
• Crude Birth rate - The crude birth rate relates the number of births during the year
to the average population in that year. The value is expressed per 1000 inhabitants.
Data are provided by Eurostat.
 Mother's age distribution (teenage pregnancies, aged mothers) - Data are provided
by Eurostat. Life birth is the complete expulsion or extraction from its mother of a
product of conception, irrespective of the duration of the pregnancy, which, after
such separation, breathes or shows any other evidence of life, such as beating of the
heart, pulsation of the umbilical cord, or definite movement of voluntary muscles,
whether or not the umbilical cord has been cut or the placenta is attached; each
product of such a birth is considered live born. The age of the mother is defined as
the age reached in the year the event took place.
MSS_ MAPSS_2014-2015 71
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 Exemplu: ECHI (European Community Health Indicators)
 Fertility rate Data are provided by Eurostat as the mean number of children that
would be born alive to a woman during her lifetime if she were to pass through her
childbearing years conforming to the fertility rates by age of a given year. It is
therefore the completed fertility of a hypothetical generation, computed by adding
the fertility rates by age for women in a given year (the number of women at each age
is assumed to be the same). The total fertility rate is also used to indicate the
replacement level fertility; in more developed countries, a rate of 2.1 is considered to
be replacement level.

 Population projections - Data are provided by Eurostat. Population is divided into age
groups covering intervals of 1 year and a group of all ages. Forecasts beginning with
1995 2005 and then every fifth years. Forecasts are based on assumptions on total
fertility rate, life expectancy and migration.

 Total unemployment Data are provided by Eurostat as the unemployed persons

comprise persons aged 15 to 74 who were: without work during the reference week;
currently available for work, i.e. were available for paid employment or self-
employment before the end of the two weeks following the reference week; actively
seeking work, i.e. had taken specific steps in the four weeks period ending with the
reference week to seek paid employment or self-employment or who found a job to
start later, i.e. within a period of at most three months.

 Population below poverty line Data are provided by Eurostat as the share of persons
with an equivalised disposable income below the risk-of-poverty threshold in the
current year and in at least two of the preceding three years.

MSS_ MAPSS_2014-2015 72
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Eurostat Extragere informatii: Population and social conditions/Population
projections/EUROPOP2008

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MSS_ MAPSS_2014-2015 73 73
1 January population by sex and single year of age
http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=proj_10c2150p&lang=en

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MSS_ MAPSS_2014-2015 74 74
 Extragere informatii - 1 January population by sex and single year of age
Population[T+1] = Population[T] + Births[T] - Deaths[T] + Net International Migration[T])
GEO/TIME 2015 2020 2025 2030 2035 2040 2045 2050 2055 2060
European Union (27
countries) 508,234,690 514,365,687 519,109,103 522,342,413 524,536,969 525,702,440 525,624,613 524,052,690 521,034,357 516,939,958

Belgium 11,238,909 11,592,534 11,910,628 12,204,065 12,472,862 12,717,855 12,935,651 13,125,523 13,291,706 13,445,216

Bulgaria 7,362,311 7,121,205 6,856,247 6,611,320 6,406,149 6,235,049 6,070,437 5,898,876 5,720,244 5,531,318

Czech Republic 10,691,018 10,816,080 10,863,534 10,839,979 10,782,389 10,740,155 10,715,038 10,667,723 10,589,310 10,467,652

Denmark 5,629,468 5,720,332 5,811,158 5,892,997 5,953,827 5,991,954 6,017,076 6,037,836 6,057,758 6,079,838

Germany 80,953,582 80,098,347 79,077,629 77,871,675 76,478,036 74,814,316 72,913,997 70,807,016 68,571,346 66,360,154

Estonia 1,335,196 1,323,909 1,303,556 1,279,865 1,258,685 1,243,008 1,228,717 1,213,261 1,195,113 1,172,707

Ireland 4,605,490 4,814,602 5,051,866 5,276,163 5,512,497 5,757,624 5,995,205 6,207,343 6,386,664 6,544,749

Greece 11,445,190 11,526,085 11,562,199 11,577,875 11,605,065 11,630,098 11,628,484 11,575,793 11,456,450 11,294,664

Spain 46,923,019 47,961,070 49,027,829 49,961,157 50,867,170 51,713,930 52,377,986 52,687,786 52,615,564 52,279,310

France 66,358,014 67,820,253 69,125,300 70,302,983 71,344,846 72,186,344 72,772,775 73,183,970 73,488,983 73,724,251

Italy 61,787,648 62,876,781 63,737,079 64,491,289 65,165,759 65,694,307 65,968,051 65,915,103 65,560,273 64,989,319

Cyprus 839,440 885,452 933,045 973,354 1,006,771 1,036,127 1,063,618 1,090,050 1,113,985 1,134,460

Latvia 2,194,382 2,141,315 2,083,063 2,021,890 1,962,672 1,908,552 1,854,005 1,796,968 1,736,755 1,671,729

Lithuania 3,246,156 3,179,986 3,114,641 3,043,919 2,977,137 2,921,836 2,868,599 2,811,782 2,747,487 2,676,297

Luxembourg 541,014 573,066 600,357 625,941 649,232 669,947 688,101 703,696 716,891 728,098

Hungary 9,958,255 9,900,511 9,820,142 9,704,415 9,574,730 9,442,636 9,316,076 9,176,536 9,028,283 8,860,284

Malta 412,885 415,271 417,736 416,886 412,917 407,555 402,144 397,089 392,346 387,422

Netherlands 16,951,017 17,218,675 17,423,492 17,577,605 17,650,279 17,619,916 17,504,092 17,357,798 17,208,018 17,070,150

Austria 8,470,319 8,591,180 8,729,820 8,849,533 8,934,001 8,977,982 8,987,194 8,968,861 8,922,999 8,868,529

Poland 38,369,400 38,395,403 38,121,117 37,564,978 36,856,824 36,112,044 35,343,356 34,542,704 33,671,215 32,710,238

Portugal 10,689,102 10,727,813 10,759,904 10,779,647 10,785,771 10,767,057 10,707,278 10,598,409 10,444,888 10,265,958

Romania 21,261,298 21,006,219 20,664,381 20,250,626 19,857,184 19,437,293 18,985,583 18,483,288 17,946,383 17,308,201

Slovenia 2,106,182 2,142,217 2,154,934 2,154,609 2,148,629 2,141,070 2,131,661 2,114,985 2,089,905 2,057,964

Slovakia 5,510,842 5,576,326 5,600,020 5,579,504 5,528,481 5,467,229 5,402,868 5,326,176 5,232,121 5,116,496

Finland 5,474,652 5,577,269 5,654,603 5,704,485 5,725,434 5,727,038 5,724,041 5,726,934 5,733,912 5,744,452

Sweden 9,732,212 10,071,521 10,354,529 10,577,959 10,745,871 10,898,366 11,060,433 11,231,198 11,391,111 11,525,240

United Kingdom 64,147,689 66,292,265 68,350,294 70,207,694 71,873,751 73,443,152 74,962,147 76,405,986 77,724,647 78,925,262
European Free Trade
Association 13,677,504 14,247,542 14,719,020 15,126,476 15,454,539 15,715,637 15,937,476 16,127,969 16,275,259 16,379,708

Iceland 315,317 323,431 339,222 355,091 370,341 384,557 397,633 409,941 422,219 435,030

Liechtenstein 37,417 38,490 39,261 39,823 40,081 40,012 39,730 39,338 38,845 38,328

Norway 5,135,483 5,379,920 5,594,156 5,787,755 5,954,599 6,101,189 6,237,169 6,365,895 6,483,438 6,587,061

Switzerland 8,189,287 8,505,701 8,746,381 8,943,807 9,089,518 9,189,879 9,262,944 9,312,795 9,330,757 9,319,289

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75 75
 1st January population by sex and 5-year age groups [proj_10c2150p] Romania

25,000,000

f(x) = − 437074 x + 21923952.6

20,000,000 R² = 0.99

15,000,000

10,000,000

5,000,000

0
2015 2020 2025 2030 2035 2040 2045 2050 2055 2060

Romania Linear (Romania)

04/21/2020
MSS_ MAPSS_2014-2015 76 76
 1st January population by sex and 5-year age groups [proj_10c2150p]

90,000,000

80,000,000

70,000,000

60,000,000

50,000,000

40,000,000

30,000,000

20,000,000

10,000,000

0
2015 2020 2025 2030 2035 2040 2045 2050 2055 2060
Romania Germany (until 1990 former territory of the FRG)
France United Kingdom
Bulgaria

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MSS_ MAPSS_2014-2015 77 77
Rata de dependenţă (contributori/pensionari)
sursa: RAPORT ANUAL DE PREVENIREA CRIZELOR , 2003

MSS_ MAPSS_2014-2015 78
Projected old-age dependency ratio - [tsdde511]%
This indicator is defined as the projected number of persons aged 65 and over expressed as a
percentage of the projected number of persons aged between 15 and 64.

MSS_ MAPSS_2014-2015 79
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Projected old-age dependency ratio (%) - [tsdde511]
geo\time 2010 2015 2020 2025 2030 2035 2040 2045 2050 2055 2060

EU (27 countries) 25.92 28.48 31.37 34.57 38.33 42.31 45.52 48 50.16 51.82 52.55

Belgium 26.03 27.99 30.25 33.23 36.68 39.3 40.95 41.69 42.48 43.07 43.83

Bulgaria 25.44 28.86 32.46 35.8 38.69 41.63 45.96 51.55 56.06 60.11 60.32

Czech Republic 21.57 26.02 30.37 32.78 34.32 35.91 40.07 46.4 50.14 53.29 55

Denmark 24.87 28.83 31.42 33.85 37 40.13 41.91 42.45 41.79 42.04 43.52

Germany 31.26 32.52 35.78 40.22 47.21 54.2 56.44 56.92 58.11 59.57 59.89

Estonia 25.18 27.21 30.07 33.12 35.83 37.61 40.48 43.59 48.33 54.28 55.54

Ireland 16.82 19.98 22.79 25.09 27.59 30.04 33.07 36.3 39.66 38.62 36.65

Greece 28.41 30.6 32.57 34.91 37.74 42.45 47.83 53.35 57.45 57.65 56.65

Spain 24.69 27.04 28.94 31.57 35.52 40.6 46.7 53.26 56.91 57.25 56.37

France 25.66 29.22 32.71 35.81 39.06 41.95 44.37 44.77 45.48 46.34 46.58

Croatia                      

Italy 30.78 33.13 34.76 37.02 41.14 46.5 51.73 55.13 56.34 56.58 56.65

Cyprus 18.64 21.59 24.88 28.22 30.79 31.99 33.32 35.52 39.82 43.76 47.57

Latvia 25.19 26.63 28.84 32.24 36.17 39.17 43.27 47.56 54.25 63.34 67.99

Lithuania 23.28 24.41 26.58 30.42 35.2 38.76 41.79 43.74 47.25 52.73 56.65

Luxembourg 20.43 21.31 23.12 26.04 29.98 34.07 37.08 39.57 41.94 43.58 45.05

Hungary 24.2 26.15 29.98 32.79 33.57 35.69 39.52 46 50.18 54.16 57.81

Malta 21.26 27.03 31.75 36.28 39.22 39.35 40.2 42.93 46.47 51.05 55.56

Netherlands 22.82 27.11 30.79 35.15 40.25 44.84 47.29 46.91 46.5 46.69 47.47

Austria 26.1 27.82 29.78 33.34 38.83 44.22 46.83 47.39 48.56 49.27 50.73

Poland 18.96 21.75 26.94 32.42 35.24 36.86 39.89 45.25 53 60.01 64.59

Portugal 26.7 28.98 31.32 34.04 37.85 41.79 46.72 52.04 55.62 56.66 57.2

Romania 21.37 22.59 25.68 29.04 30.23 35.28 40.65 47.61 53.81 62.31 64.77

Slovenia 23.8 25.83 30.41 34.82 38.84 42.73 46.14 50.81 55.05 57.81 57.61

Slovakia 16.93 19.14 23.59 27.98 31.36 33.88 37.99 44.63 51.38 57.58 61.8

Finland 25.63 31.41 36.18 39.82 42.74 44.25 43.46 43.79 44.86 45.74 47.43

Sweden 27.72 31.28 33.47 35.3 37.21 39.27 40.45 40.85 41.7 43.71 46.21

United Kingdom 24.86 27.76 29.63 31.74 34.83 37.7 38.86 38.58 39.41 40.9 42.07

Iceland 17.87 21.29 25.07 28.84 32.15 33.93 34.45 34.03 33.54 32.57 33.49

Liechtenstein 19.29 24.19 29.68 36.19 43.61 50.61 54.36 54.57 54.08 53.53 52.87

Norway 22.46 24.96 27.39 30.27 33.02 36.13 38.49 39.36 40.29 41.54 42.97

Switzerland 24.71 26.97 29.48 33.11 38.04 42.77 45.71 47.95 50.53 52.76 54.36

MSS_ MAPSS_2014-2015 80
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 Projected old-age dependency ratio (%) - [tsdde511]
70

64.77
60 62.31

53.81
50

47.61

40
40.65

35.28
30
30.23
29.04
25.68
20 22.59
21.37

10

0
2010 2015 2020 2025 2030 2035 2040 2045 2050 2055 2060

EU (27 countries) Romania Germany France United Kingdom

MSS_ MAPSS_2014-2015 81
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EXTRAGERE DE INFORMATII Eurostat: Population and social
conditions/Population projection (t_proj)/ Population projections (tps00002)

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MSS_ MAPSS_2014-2015 82 82
Population projections - Population projections are what-if scenarios that aim to provide information about the likely future size and
structure of the population. Eurostat's population projections is one of several possible population change scenarios based on assumptions for fertility,
mortality and migration. The method used for population projections is the "cohort-component" method. Population refers to 1st January population
for the respective years.

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MSS_ MAPSS_2014-2015 83 83
Population projections 2010-2060

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MSS_ MAPSS_2014-2015 84 84
 Population projections 2010-2060
POPULATION PROJECTION

90,000,000.00

80,000,000.00

70,000,000.00

60,000,000.00

50,000,000.00

40,000,000.00

30,000,000.00

20,000,000.00

10,000,000.00

0.00

2010 2015 2020 2025 2030 2035 2040 2045 2050 2055 2060

Romania Finland Spain Germany

MSS_ MAPSS_2014-2015 85
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Population projection ROMANIA 2010-2060
POPULATION PROJECTION

22,000,000.00

21,000,000.00 21333838
21102552
20833786
20483994
20,000,000.00
20049059

19619064
19,000,000.00
19160713

18678793
18,000,000.00
18149247

17583927
17,000,000.00

16921425

y = -442627x + 2E+07
16,000,000.00
R2 = 0.9842

15,000,000.00

2010 2015 2020 2025 2030 2035 2040 2045 2050 2055 2060

Romania Linear (Romania)

MSS_ MAPSS_2014-2015 86
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Population projections 2060

04/21/2020
MSS_ MAPSS_2014-2015 87 87
Cine și cum va plăti pensiile decrețeilor. Cum pregătește guvernul
țara pentru anul în care 35 la sută dintre români vor fi pensionari. În
2025 pensionarii vor fi 32% din populație
 Combinată cu migrația externă, scăderea natalității a schimbat iremediabil structura populației românești,
inversând piramida demografică sănătoasă: baza e formată din bătrâni, iar vârful din ce în ce mai firav e dat de
generațiile tinere. Populația României îmbătrânește, urmând trendul european general.
 În 2030-2032 vor ieși la pensie brusc cele două milioane de copii născuți între 1967-1972 la ordinul lui
Ceaușescu. În acel an România va avea, potrivit prognozelor, 19 milioane de locuitori, din care peste 10
milioane vor fi bătrâni. Cine va munci atunci ca să plătească pensiile celor care muncesc acum? E o întrebare
la care niciun politician nu poate răspunde azi. Pentru că toate partidele guvernează de pe un an pe altul,
niciunul nu are o viziune și o strategie de dezvoltare a României pe termen lung.
”Decrețeii” sunt copiii născuți începând din vara lui 1967, când rata fertilității în România a explodat de la 1,9 la 3,7 copii/femeie, în
urma politicii de interzicere a avorturilor. După Decretul 770/1966, în perioada iulie-octombrie 1967, numărul nașterilor a fost de
trei ori mai mare decât în perioada ianuarie-mai 1967. Curba s-a menținut ascendentă cu un maxim în 1967-1968 și a scăzut în
următorii ani, până în 1972, la o rată a fertilității de 2,5 copii/femeie.
În ciuda diverselor metode empirice de avort, practicate ilegal până în 1989, rata natalității în România s-a menținut suficientă cât să
asigure înlocuirea naturală a populației și să ducă poporul român comunist la mândra cotă de 23 de milioane de locuitori.
În 1990, abolirea infamului decret 770 s-a tradus printr-un număr record de avorturi – peste un milion în numai un an – iar următorii 20
de ani au scăzut rata fertilității la1,3-1,1 copii născuți de o femeie.
Sociologic și economic vorbind, această explozie demografică nu a avut efectele promise în discursurile triumfaliste ale lui Ceaușescu.
Generațiile numeroase de decreței au supus – până în 1990 – națiunea la costuri suplimentare pentru creștere, educație, asistentă
medicală și formare profesională, costuri care n-au fost recuperate ulterior de la mare parte dintre beneficiari. Deschiderea
granițelor după 1989 a însemnat și plecarea în Occident a multor vârfuri profesionale, deci pierderea valorii pe care ei ar fi redat-o
societății românești.

MSS_ MAPSS_2014-2015 88
„Decrețeii au fost generații care nu și-au putut valorifica potențialul
economic. Tot ce s-a investit în ei nu s-a putut valorifica. E o pierdere
a societății. Va fi o pierdere și la pensie, pentru că vor fi mulți și vor
trebui întreținuți de cei născuți după 1989. La ora actuală avem 24 de
adulți la 100 de persoane. În 2050 vor fi 54 de adulți. Dacă noi acum
avem probleme atât de mari în colectarea și canalizarea resurselor, ce
va fi în 2030-2050?

Cum va fi în următorii 25 de ani:

Una dintre problemele cu consecinţe grave pe termen lung este
slaba acoperire cu asigurări de pensie a populaţiei de vârstă
activă. În prezent, mai puţin de jumătate din populaţia activă este
asigurată pentru pensii (sub 5 milioane din cele 10,5 milioane cât
numără populaţia activă). Peste 25-35 de ani cei care lucrează
„la negru” sau nu lucrează deloc (semnificativi ca număr) vor
atinge vârsta de pensionare fără să fie asiguraţi şi vor împovăra
După 2032 (când generaţiile născute după 1967 vor atinge 65 de
sistemul de asistenţă socială (solicitând din bani publici venitul
ani) un val suplimentar de pensionari va intra din zona de
minim garantat sau alte forme de ajutor social). contributori în zona de beneficiari afectând grav rata de
Pe termen mediu şi lung raportul dintre pensionari şi salariaţi dependenţă pentru următorii 22 de ani. De-abia spre 2050 sistemul
se va menţine ridicat, structura populaţiei României fiind de pensii se va stabiliza pe componenta demografică, echilibrul lui
una atipică, cu cohorte/generaţii foarte numeroase la vârsta depinzând atunci doar de componenta economică.
de 19-41 de ani (rezultat al politicilor pro-nataliste agresive Ponderea pensionarilor va fi de aproximativ 32% din întreaga populaţie
din perioada Ceauşescu) şi foarte mici la vârstele de 0-18 ani în 2025 şi de peste 45% în 2050 în situaţia păstrării vârstei medii reale
(generaţiile tranziţiei). Ca urmare, pe piaţa muncii vor intra de pensionare din prezent. Pentru a menţine o pondere acceptabilă a
în viitor generaţii puţin numeroase, iar numărul de salariaţi pensionarilor în populaţia totală, de aproximativ 30%, vârsta medie
nu va putea creşte foarte mult, chiar în eventualitatea unei reală de pensionare ar trebui să fie de 65 de ani iar vârsta legală de
creşteri economice. Numărul de pensionari, pe de altă parte, aproximativ 70 de ani.
se va menţine constant un timp.

MSS_ MAPSS_2014-2015 89
Tema de discutie: Populatia Romaniei va scadea pana la
16 milioane in anul 2050
Populatia Romaniei va scadea pana la 16 milioane in anul 2050, din care mai mult de jumatate va
avea peste 60 de ani, iar fiecare persoana activa va plati asigurarile sociale pentru noua
persoane, releva un studiu dat publicitatii de catre Fondul ONU pentru Populatie (UNFPA)[1]
Studiul UNFPA arata ca la finele perioadei vizate, daca fertilitatea se mentine la nivelul actual,
populatia Romaniei va ajunge la 16 milioane. Mai mult de jumatate vor avea peste 60 de ani, vor fi
mai putini adulti si copii, iar raportul de dependenta intre populatia activa si persoanele
vulnerabile (copii si varstnici) va fi de unu la noua.
Populatia Romaniei a scazut cu un milion in perioada 1992-2005 si continua sa scada. Aceasta tendinta este
determinata de fertilitatea scazuta (1,3 copii la o femeie, in loc de 2,1, care ar asigura inlocuirea
populatiei) si de migratia externa mare (aproximativ doua milioane de romani se afla legal in
strainatate, dar numarul celor plecati ilegal este necunoscut). Daca in prezent, din cele 21,6 milioane de
locuitori, 10,5 milioane sunt adulti, cinci milioane sunt copii si sase milioane sunt varstnici, la mijlocul
secolului XXI, pensionarii vor reprezenta mai mult de jumatate din populatie si vor fi putini copii si
adulti.
Pentru a nu se ajunge la aceasta situatie, UNFPA propune politicienilor si factorilor de decizie din Romania
reformarea sistemului de sanatate, de educatie si de asigurari sociale, astfel incat sa se
incurajeze natalitatea, scolarizarea si incadrarea pe piata muncii din Romania.
"Fondul ONU pentru Populatie atrage atentia asupra seriozitatii acestei probleme pentru populatia din
Romania si ofera politicienilor sprijin in identificarea problemelor si gasirea solutiilor", a spus
ambasadorul UNFPA in Romania, Peer Sieben. "Guvernul trebuie sa ia masuri de protectie a
persoanelor varstnice, sa incurajeze femeile sa nasca si sa stopeze migratia externa. Aceasta nu este o
problema cu care se confrunta doar Romania, ci toate tarile din aceasta regiune a Europei", a adaugat
Peer Sieben.
UNFPA propune ca, pentru a face fata procesului de imbatranire a populatiei, Romania trebuie sa
sustina serviciile medicale cu politici sociale si sa promoveze activitatile fizice si implicarea
varstnicilor in activitati sociale, care sa creasca respectul de sine, autonomia si independenta
acestora.
[1] Sursa: Wall-Street, 02 Octombrie 2006
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MSS_ MAPSS_2014-2015 90 90
 Populatia Romaniei va scadea cu peste 20% pana in anul 2050 (studiu al
Biroului de Statistica a Populatiei -PRB)[1]
Potrivit datelor prezentate, populatia Romaniei se va diminua de la 21,6 milioane de persoane, cat
se inregistreaza in prezent, pana la 17,1 milioane in 2050. Numarul locuitorilor din Europa de Est
va scadea si el de la 295 de milioane in acest an pana la 229 de milioane de persoane in 2050. La
nivel mondial, populatia va creste de la 6.62 de miliarde, cat numara in prezent, pana la 9.29 de
miliarde pana la mijlocul acestui secol.
Studiul realizat de PRB indica faptul ca procentul mortalitatii infantile in Romania este cel
mai ridicat dintre tarile Europei de est, respectiv de 14 morti la 1000 de nasteri, in timp
ce in Republica Cehia se inregistreaza cel mai scazut nivel (3,3).
In ceea ce priveste durata medie de viata in Romania, studiul PRB afirma ca aceasta este de 71 de
ani, mai mare la femei (75 de ani) decat la barbati (68 de ani).
La nivel mondial, cea mai mare durata de viata se inregistreaza in Japonia (82 de ani), iar cea mai
scazuta in Swaziland (33 de ani).
Conform datelor statistice, pana in anul 2050, India va depasi China ca si numar de locuitori.
Astfel, daca in prezent India are o populatie de 1.13 miliarde de persoane, pana in 2050 acest
numar va ajunge la 1.47 de miliarde. In China, populatia va creste de la 1.38 de miliarde pana la
1.43 miliarde de persoane.
Studiul PRB confirma si el tendinta de imbatranire a populatiei la nivel mondial. In tarile
industrializate, numarul persoanelor de peste 65 de ani va creste, pana in 2050, de la
16% la 26%, cresteri similare inregistrandu-se si in Europa, Africa sau America de Nord.

[1] PRB este o organizatie non-guvernamentala fondata in SUA in 1929 care ofera informatii demografice. Studiul sau anual “World
Population Data Sheet” este considerat una dintre cele mai importante surse de informare despre populatia mondiala.

04/21/2020
MSS_ MAPSS_2014-2015 91 91
Tema de discutie - Previziune pe termen lung - Romania's population will fall
by 4.5 million inhabitants by the year 2060, reaching 16.9 million
inhabitants; dependency ratio to triple to 65%
At EU level, the demographic projections show that EU's population will increase until 2035 (by natural means until
2015 and immigration-sustained until 2035) and will start to fall until 2060.

Romania will have by the year 2060 the fourth sharpest decline in population among the 27 EU states: 21%, after
Bulgaria (28%), Latvia (26%) and Lithuania (24%).

 the old-age dependency ratio in Romania will triple until 2060, from 21.3% in 2008 to 65.3% in 2060;

Data by EUROSTAT shows that Romania will go from 4.7 working-age adults supporting one pensioneer in 2008
to just 1.5 working adults per pensioneer in 2060.

Population projections are what-if scenarios that aim to provide information about the likely future size and structure
of the population, and should therefore be considered with caution.
The EUROPOP2008 “convergence scenario” is based on the population on 1st January 2008 and on the assumption
that fertility, mortality and net migration will progressively converge between Member States in the long run.
Alternative assumptions in a different conceptual framework would yield different results.
Strongest population growth in Cyprus, Ireland, Luxembourg and the United Kingdom

30% of the EU27 population to be aged 65 or more in 2060

MSS_ MAPSS_2014-2015 92
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Romania's population to fall by 4.5 mln. until 2060 STAT/08/119, 26 August 2008
“Population projections 2008-2060; From 2015, deaths projected to outnumber
births in the EU27; Almost three times as many people aged 80 or more in 2060”

MSS_ MAPSS_2014-2015 93
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the dependency ratio to triple to 65%

MSS_ MAPSS_2014-2015 94
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 Luare de pozitie - Valentin Lazea, noiembrie 2008
Economistul sef al BNR a exemplificat corelatia intre crestere economica si demografie printr-un
studiu al Bancii Mondiale, care arata ca doar sapte state si-au mentinut cresterea economica
peste 5% mai mult de 20 de ani, printre acestea numarandu-se China, Guineea Ecuatoriala si
Irlanda.
 Un sfert dintre romanii activi contribuie la PIB-ul altor tari
 In ultima prognoza publicata de Comisia Nationala de Prognoza (CNP), institutia
estimeaza o crestere aproape lineara a populatiei active - intre 15 si 64 de ani - din
Romania, de la 9,608 milioane persoane in 2008 la 9,754 milioane in 2010, 9,91
milioane in 2015 si 10,007 milioane in 2020.
 proiecţiile oficiului european de statistică vin să arate că viitorul “sună prost”:
mortalitatea si emigraţia vor face ca în 2060 românii să nu fie mai mulţi decât în 1955
(17 milioane de locuitori).

Valentin Lazea admite că bunăstarea unei naţiuni depinde de cresterea populaţiei, dar respinge
catastrofa demografică previzionată de Eurostat, dând exemplul Italiei, care a reusit să
compenseze sporul natural negativ cu ajutorul imigraţiei.
- „după 2030 riscăm să intrăm într-o involuţie exponenţială, numărul asistaţilor sociali/
pensionarilor depăsindu-l cu mult pe cel al populaţiei active“.
- “cifrele avansate de Eurostat trebuie tratate cu circumspecţie, dat fiind că nici alte „catastrofe
demografice“ prezise de această instituţie nu s-au adeverit: cel mai recent caz este cel al Italiei,
unde (datorită imigraţiei) scăderea populaţiei previzionate de Eurostat nu a avut loc”

MSS_ MAPSS_2014-2015 95
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 Care sunt, concret, ipotezele pe care îsi bazează Eurostat prognozele pesimiste?

Cel mai pesimist - grupul de ipoteze referitor la natalitate. Numărul nasterilor anuale din România a
scăzut de la circa 315.000 în 1990 până la 210.000 în 2002, după care a început să crească usor, spre
230.000. Or, ipoteza Eurostat este că, în medie, vor exista circa 158.000 de nasteri pe an în intervalul
2008-2060. Această cifră presupune cohorte tot mai mici de femei capabile si dispuse să nască si o
rată a fertilităţii chiar mai mică de 1,37 copii/femeie, care a fost media ratei fertilităţii în perioada
1990-2005.
Există totusi si un anumit risc care poate face ca această prognoză nedorită să se îndeplinească, si
anume faptul că cea mai mare parte a emigraţiei românesti (peste 65% în anul 2007) o constituie
femeile. Dacă la aceasta adăugăm că aproximativ 63% din totalul emigraţiei românesti e
reprezentată din persoane cu vârsta cuprinsă între 18 si 40 de ani (adică tocmai perioada de
fertilitate), obţinem imaginea unor nasteri care nu mai au loc sau au loc în străinătate, văduvind
România de o sursă importantă de crestere. De aceea, politicile de ocrotire a mamei si copilului
trebuie să capete o mare importanţă, precum si politicile firmelor faţă de salariatele aflate în situaţia
să nască.
Grupul de ipoteze privitor la mortalitate mi se pare foarte realist. Astfel, faţă de o medie anuală de
265.000 de decese în perioada 1990-2005, studiul prognozează o usoară scădere, la 251.000 de decese
pe an pentru intervalul 2008-2060, aceasta si ca urmare a cresterii speranţei de viaţă.
Dar al treilea grup de ipoteze, cel referitor la imigraţie, mi se pare, din nou, excesiv de pesimist -
Grecia, Portugalia si Spania au avut, fiecare, o rată de imigraţie netă nesemnificativă în primii 5-10
ani după aderarea lor la Uniunea Europeană. Odată trecută această perioadă însă, imigraţia netă în
aceste ţări a crescut atât de mult încât a compensat cu vârf si îndesat scăderea naturală a populaţiei
autohtone. Astfel, cele trei ţări au acum populaţii în continuă crestere, în pofida unui spor natural
negativ. Cred că acelasi lucru se va întâmpla si cu România, pe măsură ce îsi va consolida economia
si statutul de membru UE. Or, prognoza Eurostat prevede pentru România, în perioada 2008-2060,
o rată a imigraţiei nete de numai 18,4 la mia de locuitori (sau 1,84 la sută), adică de trei ori mai
puţin, proporţional, decât Slovacia si de sapte ori mai puţin decât Cehia. O triplare a acestei rate ar
aduce României un plus de peste un milion de persoane (imigranţi) faţă de prognoza Eurostat.

MSS_ MAPSS_2014-2015 96
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Teme de discutie – modalitati de analiza pe baza …. Anuarul statistic european – capitolul
Sanatate

Causes of death - standardised death rate per 100 000 inhabitants, males, EU-27, 2000-2009
130

118.5 118.5 120.2

120 116.8 115.0 116.2
112.1 113.3
110 106.9
100.0
100 96.7 97.6
92.3
90 86.8
83.9
80 78.6 77.8
73.8
70
69.1

60

50
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Nervous system Cancer (malignant neoplasms) Lung cancer (malignant neoplasm of larynx, trachea, bronchus and lung)

Ischaemic heart diseases Transport accidents

MSS_ MAPSS_2014-2015 97
Anuarul statistic european – capitolul Sanatate

Causes of death - standardised death rate (per 100 000 inhabitants), 2009
600
548.4

500

400

300

217.3
200 181.4169.0 188.8

100 79.8
42.338.6 50.643.6
19.5 18.9 15.1 7.4 22.6 23.1 17.4 7.2
0
Cancer: Lung cancer: Colorectal Circula-tory Heart Respiratory Transport Females - Females -
Malignant Malignant cancer disease disease: diseases accidents Breast cancer Uterus cancer
neoplasms neoplasm of Ischaemic
larynx, heart
trachea, diseases
bronchus and
lung
Romania EU-27

MSS_ MAPSS_2014-2015 98
Anuarul statistic european – capitolul Sanatate
Causes of death - standardised death rate, EU-27, 2009 0 25 50 75 100 125

Ischaemic heart dis...

Cerebrovascular dis...

Female Male Malignant neoplasms of the larynx, trachea, bronchus and...

0 10 20 30 40
Causes of death - standardised death rate, EU-27, 2009le
Accid...
Chronic lower respiratory dise...
Pneum...
Chronic liver dis...
Malignant neoplasm of c...
Malignant neoplasm of br...
Diabetes mell...
Intentional self-...
Malignant neoplasm of panc...
Malignant neoplasm of sto...
Diseases of kidney and ur...
Alcoholic a...
Female Male AIDS (...
Drug depend...

MSS_ MAPSS_2014-2015 99
Anuarul statistic european – capitolul Sanatate
Current healthcare expenditure (total (public + private) health expenditure in PPS per inhabitant), 2009
6,000 18

5,000 15

4,000 12

3,000 9

5.6
2,000 6

1,000 3

129.5
478.7
0 0
Austria

Spain

Slovenia

Romania
France

Sweden

Finland

Slovakia

Estonia

Poland

Lithuania

Switzerland

Iceland

New Zealand

South Korea
Belgium
Netherlands

Denmark

Germany

Czech Republic

Hungary

United States
Portugal*

Cyprus*

Latvia*

Bulgaria*

Norway*

Canada*

Australia*
Luxembourg*

Japan*
Private expenditure (PPS per inhabitant) (left-hand scale) Public expenditure (PPS per inhabitant) (left-hand scale)
Current health expenditure (% of GDP) (right-hand scale)

MSS_ MAPSS_2014-2015 100

România, în topul statelor UE cu cea mai rapidă
îmbătrânire a populatiei (Vladimir Ionescu | 20.3.2013, Mediafax)
Scăderea PIB-ului potenţial, prin reducerea contribuţiei forţei de muncă şi capitalului, presiunea tot mai mare asupra bugetului de stat,
prin majorarea cheltuielilor cu asistenţa socială, şi afectarea ratei de economisire sunt principalele consecinţe ale îmbătrânirii
populaţiei, potrivit unui studiu întocmit de BCR. În prezent, 1 din 7 români are peste 65 de ani, în 2030 se va ajunge la un raport de
1 la 5 persoane, iar în 2060 la 1 din 3, dacă natalitatea nu va fi îmbunătăţită. România se află în top 5 state membre UE (alături de
Slovacia, Polonia, Letonia şi Slovenia) care vor cunoaşte cel mai rapid ritm de îmbătrânire a populaţiei în următoarele decenii.
Mediana vârstei populaţiei va ajunge la 46 de ani în 2030 şi 52 de ani în 2060, de la 39 de ani în 2011, potrivit raportului
“Implicaţiile economice ale procesului de îmbătrânire a populaţiei în România” realizat de divizia BCR Cercetare (2013).
 O primă consecinţă economică a îmbătrânirii şi reducerii populaţiei totale este scăderea PIB-ului potenţial, prin diminuarea
contribuţiei forţei de muncă, dar şi a capitalului, în condiţiile afectării economisirii interne. PIB-ul potenţial al României a scăzut la
1,3% în 2013, de la 5% în 2004, pe seama contracţiei investiţiilor private. Circa o treime din forţa de muncă din România se
regăseşte în agricultură, faţă de doar 3,4% în zona euro. Sectorul serviciilor reprezintă 42% din forţa de muncă ocupată în România,
comparativ cu 72% în zona euro. Dacă în anul 1990 existau 0,4 pensionari la fiecare salariat, raportul s-a inversat din 1998, iar în
prezent la fiecare salariat sunt 1,2 pensionari, urmând ca la orizontul anului 2060 la fiecare salariat să fie 1,5 pensionari.
 A doua consecinţă este presiunea tot mai mare asupra bugetului de stat, atât pe partea de venituri, prin afectarea creşterii economice,
cât şi pe partea de cheltuieli, prin majorarea cheltuielilor pentru asistenţă socială şi sănătate. Orice creştere a cheltuielilor publice
pentru protecţie socială peste nivelul actual poate avea loc numai în condiţiile în care are loc şi o creştere a ponderii veniturilor
bugetare în PIB, care sunt printre cele mai mici din Uniunea Europeană, de 32,9% din PIB în 2011. Creşterea veniturilor bugetare
în PIB trebuie să se facă prin intensificarea luptei împotriva evaziunii fiscale şi nu prin majorarea fiscalităţii, care ar degrada mediul
de afaceri.
 Cea de-a treia consecinţă a îmbătrânirii şi reducerii populaţiei constă în afectarea ratei interne de economisire şi, implicit, a
investiţiilor. “Stimularea economisirii populaţiei este esenţială pentru reducerea dependenţei României de fluxurile externe de
capital şi finanţarea internă a creşterii economice – depozite bancare clasice, fonduri de pensii private, fonduri de investiţii cu
diverse grade de risc, asigurări de viaţă cu o componentă investiţională, obligaţiuni de stat, piaţă de capital”, a mai spus Sinca.

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