Diskussionspapie e des
Eu opäischen Ins i u s ü Sozioökonomie e. V.
Wo king Pape s o he
Eu opean Ins i u e o Socioeconomics
In es men s and capi al s ocks as es ima ions o
heal h in as uc u e in he Eu opean Coun ies
(EU28)
Michael Koch
N . 25
2018
Michael Koch
Fachbe eich: Spo ökonomie und Spo soziologie
Ad esse: Fakul ä ü empi ische Humanwissenscha en
und Wi scha swissenscha
Uni e si ä des Saa landes
66123 Saa b ücken
Tel: 0049 (0)681 302 4912
E-Mail: michael.koch@uni-saa land.de
© 2018
Eu opäisches Ins i u ü Sozioökonomie e. V. / Eu opean Ins i u e o Socioeconomics
c/o Uni e si ä des Saa landes
Spo wissenscha liches Ins i u
A bei sbe eich Spo ökonomie und Spo soziologie
Campus, Gebäude 8.1
66123 Saa b ücken
h p://www.soziooekonomie.o g
In es men s and capi al s ocks as es ima ions o heal h
in as uc u e in he Eu opean Coun ies (EU28)
Michael Koch
Abs ac :
Heal h is, beside o o he se ices and commodi ies, e.g. educa ion o social housing, a me i ,
quasi-public good. Since p i a e p o ision o heal h se ices would p esump i ely no be
su icien in quali y and quan i y, one could a gue he e is a esponsibili y by he s a e o
p o ide a su icien amoun o heal h se ices o i s popula ion. Howe e , i is di icul o
quan i y he su icien amoun wi h public goods, in gene al. One equi ed componen o he
heal hca e p o ision is in as uc u e, such as hospi als, ope a ion hea e s e c. and i s ela ed
equipmen , such as beds, imaging de ices e c. To es ima e he exis ing in as uc u e in he
Eu opean coun ies, wi hou an on- he-g ound e alua ion, we use in es men ime se ies o
angible and in angible asse s (G oss Fixed Capi al Fo ma ion) epo ed o Eu os a and
compu e Capi al S ock o each coun y, using he Pe pe ual In en o y Me hod (PIM)
conside ing coun y speci ic dep ecia ion a es and g ow h a es o each included asse .
Based on he las compu ed capi al s ock in 2016 as benchma k, we e alua e he e ec o he
global inancial c ises in 2008. Fu he mo e, we un wo u u e scena ios o EU28 in o al
and each coun y: (I) how much annual in es men is needed, such ha he capi al s ocks keep
pace wi h annual GDP g ow h a es and (II) how much annual in es men is needed, such ha
he 2016 capi al s ock pe capi a can be main ained in he u u e.
Keywo ds:
Pe pe ual-In en o y-Me hod, Capi al S ock, In es men Time Se ies, Heal h In as uc u e,
Eu opean Union
!
4!
In es men s(and(capi al(s ocks(as(es ima ions( o (heal h(
in as uc u e(in( he(Eu opean(Coun ies((EU28)(
by!Michael!Koch!
P e ace(
This!wo king!pape !is!an!adap ion!o ! he! inal! epo !o ! he!p ojec !“Capi al!s ocks!and!
in es men ! needs! in! he! physical! in as uc u e! o ! he! heal h! sec o ! in! Eu opean!
coun ies”!by!Michael!Koch!on!behal !o ! he!Eu opean!In es men !Bank,!Luxembou g.!This!
esea ch! is! based! on! p e ious! wo k!(unpublished)! on! ‘capi al! s ocks! and! in es men !
needs! in! he! physical! in as uc u e! o ! he! educa ion! sec o ’! by! Hube ! S auss! and!
Michael!Koch.!!
Any!e o s! emain! hose!o ! he!au ho s.! The! indings,!in e p e a ions!and! conclusions!
p esen ed!in! his! esea ch!a e!en i ely! hose!o ! he!au ho s!and!should!no !be!a ibu ed!
in!any!manne ! o! he!Eu opean!In es men !Bank.!Resul s!exposed!a e!p elimina y!and!
may!be!subjec ! o! u u e! e isions.!!
In oduc ion(
Heal h!and!o he !se ices!and!goods,!e.g.!social!housing!and!educa ion!a e!majo !a eas!o !
s a es! esponsibili y.! The! ideal- ypical! o m! o ! so-called!public! goods!show! wo! main!
cha ac e is ics:!Fi s ,! he!use!o ! he!good!o !se ice!by!one!pe son!does!no !p eclude!i s!
simul aneous!use!by!a!di e en !pe son!and!second,!nobody!can!be!excluded! om! he!use!
o ! he!good! o ! se ice! (e.g.! Musg a e,! 1969).!Examples! a e! na ional! de ence,! public!
i ewo ks,!e c.!a e!na u ally!gi en!public!goods!like!e.g.!clean!ai !o !na u e!(moun ains,!
i e s,! o es )!in!gene al.!Depending!on!how!s ic !public!goods!a e!de ined,!also!heal h,!
educa ion! o ! museums! among! o he s,! can! be! included! as! public! goods.! Because!
excludabili y!is! possible! he e,! hey! a e! usually! classi ied! as! quasi-public! goods.! Those!
goods! (e.g.! heal h,! educa ion! and! social! housing)! a e! me i ! goods,! meaning,! ha ! he!
se ice,!o !mo e!gene al!commodi y,!should!be!uni e sally!p o ided! o!indi iduals!o ! he!
socie y!in! o al,!since!wi hou !public!p o ision!dange !inc eases,! ha ! he!p i a e!o e !is!
no !su icien !in!quali y!and!quan i y.!Thus,! he e!is!a!(g ea e !o !lesse )! esponsibili y!by!
he! s a e! o! p o ide! hose! goods! o! i s! popula ion.! Ques ions! abou ! who! should! be!
included!o !excluded!as!legi !use !o ! hose!goods,!how! hey!should!be! inanced!and!by!
!
5!
whom! hey!should!be!p o ided! a e! complex! ques ions! o !each!s a e!and! subjec ! o ! a!
pe manen ! p ocess! o ! coo dina ion.! In! he! ollowing,! me i ! quasi-public! goods,! e.g.!
educa ion,! heal h! o ! social! housing! a e! named! as! ‘social! goods’,! wi h! e e ence! o!
Musg a e!(1969)!and! o !a!clea !di e en ia ion!agains !public!goods!( o !a!discussion!c .!
Desma ais-T emblay,!2014).!!
Va ious!his o ical!de elopmen s!and!di e en !deg ees!o !cen alisa ion!lead! o!di e en !
app oaches!in!coun ies!abou !how! o!p o ide!men ioned!se ices! o! hei !inhabi an s.!
They!a e!impo an !a eas! o ! he!de elopmen !o !a!coun y!o !in! e e se:! he!de elopmen !
o !a!coun y!can!be!indica ed!by! he!quan i y!and!quali y!o !p o ided!se ices.!!
Fu u e!challenges!migh !inc ease! he!need!o !public!se ices:!
• In!educa ion:!The!need!o ! e ia y!educa ion!inc eases!since! he!amoun !o !blue-
colla !jobs!dec ease!and! echnological!and!knowledge! ela ed!jobs!inc ease.!!
• In! heal h:! The! amoun ! o ! elde ly! popula ion! inc eases,! such! ha ! na u ally! he!
amoun !o ! ela ed!heal h!p oblems!inc eases!and!need! ea men .!!
• In!social( housing:!U ban! a eas! expe ience! a! s eady!in lux!which!inc eases! he!
demand! o !housing!and!especially!a o dable!housing.!Because!cons uc ion!cos s!
a e!a!majo !pa !o ! o al!building!cos s,! he!di e ence!in!cons uc ion!cos s! o !low!
and!high!s anda d!housing!a e!mino !while! eal!es a e!de elope !can!gene a e!an!
income!p emium!wi h!high!s anda d!housing.!!
In!addi ion,! he!plu ali y!o !coun ies!has!commi ed! hemsel es! o!pu sue! he!sus ainable!
de elopmen !goals!(SDG,!Uni ed!Na ions,!2018).!Beside!o !‘good!heal h!and!well-being’!
(Goal!3),!‘quali y!educa ion’!(Goal!4)!and!‘sus ainable!ci ies!and!communi ies’!(Goal!11),!
which! ep esen ! he!social!goods!men ioned!abo e,!o he !challenges!like!‘a o dable!and!
clean!ene gy’!(Goal!7)!and!‘indus y,!inno a ion!and!in as uc u e’!(Goal!9)!a e! a ge ed.!
The!p o ision!o !social!goods!and! he!s a e’s!e o s! o! each! he!SDG!does!no !come!by!no!
cos .! Ins ead! i ! is! a! majo ! challenge! o! p o ide! he! op imal! amoun ! o ! se ices! o! he!
coun y!and!i s!inhabi an s.!The! inancing!o !coun ies’!du ies!is!mos ly! ealised!by! ax!
and!loans.!While!some! axes!a e!ea ma ked! o !ce ain! asks,!o he s!en e ! he!gene al!
s a e!budge ! oge he !and!can!be!used! o !di e en !du ies.!The!alloca ion!o ! esou ces! o!
ul il!go e nmen ! asks!and! he!moni o ing! he!compliance!wi h! he!budge a y!objec i es!
a e! amongs ! he! esponsibili ies! o ! he! pa liamen ! (in! democ acies).! Since! he! s a e!

!
6!
budge !is! ini e,! he!alloca ion!o ! esou ces!needs! o!be!nego ia ed!be ween!go e nmen al!
depa men s!and! oge he !wi h! he!membe s!o !pa liamen .!!
While!on! he!“ ee!ma ke ”! he!op imal!amoun !o !a!no mal!good!(and!i s!p ice)!can!be!
de e mined!by! he!in e play!o !supply!and!demand,!i !is!ha d! o! ell,!wha !quan i y!and/o !
quali y!o !a!ce ain!social!good
1
!would!be!op imal.!I !depends! o!a!ce ain!amoun !on! he!
his o ical!de elopmen !and! he! esul ing!‘philosophy’!o !a!coun y,!while!a! eal!ma ke !
p ice!canno !be!de e mined
2
.!The e o e,!nego ia ions!in!go e nmen !and!pa liamen !need!
o! be! based! on! o he ! la en ! a iables.! This!opens! he! poli ical! a ea! o ! disc e iona y!
leeway.! When! he! alloca ion! pa ! is! se ,! mo e! hough s! need! o! go! in o! he! how! he!
p oduc ion!o ! he!(public)!goods!should!be!happen.!Two!majo !op ions!a e!possible!wi h!
hei ! espec i e! ad an ages! and! disad an ages,! e.g.! endency! o ! inc easing!
bu eauc a iza ion!and!budge -maximiza ion!in!public!adminis a ion!(Niskanen,!1971),!
p incipal-agen -p oblem! when! engaging! con ac ing! companies! (Coase,! 1937),!
a ionaliza ion!in!bu eauc acy!(Webe ,!1921)!and!alloca ion!e iciency!(A ow,!1962).!I !
also!depends!on! endencies! o! monopoliza ion! ha ! can! esul ! om! go e nmen !
in e en ions.!!
Typically,! poli icians,! ins i u ions! (NGO),! scien is s! and! o he ! s akeholde s!on!
in e na ional,!na ional!o !e en!local!le el,!a e! ecu en ly!conce ned!in! andom!o de ! ha !
no !enough!a en ion!and! inancing!has!been!di ec ed! o!one!o ! he!o he !public!domain!
and! i s! ela ed! commodi ies
3
.! Since! he! op imal! quali y! and/o ! quan i y! is! ha d! o!
de e mine,!i !is!also!ha d! o!disag ee!on! u he !in es men ,!especially!when!g ie ances!
a e! eal.!The e!is!a!s ong!knowledge!base!howe e ,! ha !in es men !(in!in as uc u e),!
he!amoun !o !in as uc u e
4
!and! he!economic!powe !(GDP!g ow h,!income!dis ibu ion,!
inequali y,! e c)!a e! s ongly! co ela ed,! which! addi ionally! jus i y! high! amoun s! o !
in es men s! (Calde ón! &! Se én,! 2014).! On! EU28! a e age,! he! expendi u e! o ! heal h!
accoun s! o !9.6%! o ! GDP! in! 2014! (WHO,! 2017),! while! middle! and! no h! Eu opean!
coun ies!ha e!mos ly!spen !la ge !pe cen ages.!Coun ies!di e ! ega ding! he!amoun !
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!
1
!No mally! he!p ice! o !social!goods!(as!quasi-public!good)!canno !be!de e mined!and! he e o e!nei he !
ela ed!oppo uni y!cos s.!!
2
!The e!is!a!p i a e!sec o !in!heal h!and!educa ion!and!also!philan h opis !make!e o s! o!p o ide!se ices.!
Thus,! he e!is!an!ac ual!ma ke !p ice! o !heal h!and!educa ion!se ices,!howe e !i !would!be!mos !likely! oo!
expensi e! o ! he!majo i y!o !people.!In! u n,! ha !is!why!go e nmen !make! he!p o ision! hei !du y.!
3
!Ins i u ions,!which!go!public!wi h!speci ic!conce ns!in! hei !scope,! ega dless!i !i !is! ue!o ! alse,!also!signal!
he!necessi y!o ! hei !exis ing!(C aw o d!&!Sobel,!1982).!
4
!In!Na ional!Accoun s!(ESA2010)!in es men s!in!in as uc u e!is!de ined!as!G oss!Fixed!Capi al!Fo ma ion!
and! includes! angible! and! in angible! asse s.! In! his! e ised! edi ion! also! in es men s! in! Resea ch! and!
De elopmen !a e!conside ed.!(Lequille !&!Blades,!2014)!
!
7!
indi iduals!mus !pay!ou $o $pocke ! o !heal h!se ices.!While!in!no he n!coun ies,!social!
goods,!e.g.!heal h!se ice!a e! axed! inanced! o!a!majo !deg ee
5
,!o he !coun ies! ely!mo e!
on!p i a e!( o !p o i !and!non-p o i )!p o ide s!(OECD,!2018).!!
!
Figu e(1:(Heal h(expendi u e(as(%(o (GDP(and(sha e(o (p i a e(ou (o (pocke (expendi u e.(Sou ce:(
WHO((H2020_30,(H2020_29),(own(calcula ions.(
!
In as uc u e(
In as uc u e! oge he !wi h!human! ecou ses!and!ope a ion!a e!c ucial!asse s! o ! he!
p o ision! o ! social!goods.!While! in as uc u e! migh ! be! less! impo an ! in! he! case! o !
educa ion,!while!human! esou ces!play!an!essen ial! ole!(Nicole i!&!Rabe,!2012,!OECD,!
2012)
6
,! he! need! o ! in as uc u e! o ! he! p o ision! o ! heal h! se ices! (hospi als,!
ope a ion! hea es,!MRI,!RT,!e c.)!o !social!housing!(apa men s,!houses,!e c.)!is!ob ious.!
Va ious!e en s!in! ecen ! ime!show! o !di e en !coun ies,! ha !in as uc u e!is!a!main!
conce n!in!socie y!and! hus!in!poli ics!and!media.!!
One! eason! o ! low! in as uc u e! in es men s! in! ecen ! yea s! migh ! be! he! global!
inancial!c ises.!I !ci cums ances!ask! o !expendi u e!cu s,! he! educ ion!o !in es men s!in!
in as uc u e!is!a!common! eac ion,!since!expendi u e! o !human! esou ces!(e.g.!medical!
and!nu sing!s a )!and!ope a ion! esou ces!and!sys ems!(e.g.! ood!supply!in!hospi al! o !
pa ien s!and!s a )!canno !be!spon aneously! educed.!Whe eas!exis ing!in as uc u e!can!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!
5
!E en! hough! he!heal h!sys em!in! he!no he n!Eu opean!coun ies!is!p edominan ly! axed! inanced,!ou !
o !pocke !expendi u e! o !heal h!s ill!accoun ! o !14%!in!Sweden,!13%!in!Denma k!and!18%!in!Finland!
(WHO,!2017).!!!
6
!E en! hough!new! echnologies!ha e!become!mo e!impo an !as!didac ic!me hods!la ely!and!a! echnology!
d i en!mode n!wo king!wo ld!ask! o !a!co esponding!educa ional!p og amme.!!
0%
2%
4%
6%
8%
10%
12%
14%
SE
FR
DE
AT
NL
DK
BE
MT
FI
PT
EU28
IT
SI
UK
ES
EL
SK
HR
IE
CZ
HU
CY
LU
LT
EE
PL
LV
BG
RO
!
8!
be!s ill!used! o ! he!p o ision!o !se ices! o!a!ce ain!ex en ,!e en!i !no!new!in es men s!
a e! made.! Main enance! wo ks! can! be! pos poned! o! a! la e ! da e.! E en! hough! some!
Eu opean!coun ies! issued! in es men ! p og ams! o! s imula e! he! domes ic! economy!
du ing!c isis!yea s! he! o al!in as uc u e!in es men s!in!EU28!a guably!would!ha e!been!
highe ,!since!economy!was!on! he! ise!p e-c isis.!!
Table(1:(Composi ion(o (G oss(Domes ic(P oduc ((e.g.(Lequille (&(Blades,(2014).(
!
A! coun ies’! in as uc u e! in es men s! a e! ep esen ed! in! he! s uc u e! o ! na ional!
accoun s!(ESA2010)!as!G oss$Fixed$Capi al$Fo ma ion!(GFCF)!and!accoun ! o !app ox.!20%!
o ! GDP!(Eu os a ,! 2018).! He e! all! in es men s! o ! he! p oduc ion! and! main enance! o !
angible!and!in angible!asse s!a e!accumula ed.!The!in es men !in!in as uc u e!based!
on!GFCF!da a!(ESA2010)!in! he!heal h!sec o !can!be!es ima ed!wi h!0,74%!o !GDP!in!2017.!
La ge ! sha es! o ! GFCF! a e! going! in o! eal! es a e! ac i i ies! (5,8%),! indus y! (excep !
cons uc ion)!(4,1%)!and!wholesale!and! e ail! ade,! anspo ,!accommoda ion!and! ood!
se ice!ac i i ies!(2,3%)!(Figu e!2-4).!!
Consequen ly,! in es men s! in! adequa e! in as uc u e! in! he! heal h! sec o ! a e! only! a!
mino ! ac ion!o ! o al!heal h!expendi u e,!bu !c ucial! o ! he!p o ision!o !heal h!se ices!
while!ope a ion!and!human! esou ces!a e!mo e!cos -in ensi e.!!
!
G oss(Domes ic(P oduc (=((
Final(consump ion(expendi u e(
(
+!Household!and!non--p o i !ins i u ions!se ing!households! inal!expendi u e!
(
+!Go e nmen al! inal!consump ion!expendi u e!
+(G oss(capi al( o ma ion(
!
+!G oss! ixed!capi al! o ma ion!
!
+!Changes!in!in en o ies!
!
+!Acquisi ion!less!disposal!o ! aluables!
+(Ex e nal(balance(o (goods(and(se ices(
!
+!Expo s!
!
-!Impo s!
!
9!
!
Figu e(2:(Composi ion(o ( he(G oss(Domes ic(P oduc (o ( he(Eu opean(Union((EU28)(2005-2017.(
Sou ce:(Eu os a .(
!
Figu e( 3:( Composi ion( o ( G oss( capi al( o ma ion( o ( he( Eu opean( Union( (EU28)( 2005-2017.((
Sou ce:(Eu os a .(
!
Figu e( 4:( P opo ions( o ( indus ies( on( G oss( Fixed( Capi al( Fo ma ion( in( 2017.(
Sou ce:(Eu os a .(
0
10
20
30
40
50
60
70
80
90
100
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
%
Final!consump ion!expendi u e G oss!capi al! o ma ion Ex e nal!balance!o !goods!and!se ices
-10
0
10
20
30
40
50
60
70
80
90
100
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
%
G oss! ixed!capi al! o ma ion Changes!in!in en o ies!and!acquisi ions!less!disposals!o ! aluables
2,47%
20,32%
3,14%
11,60%
4,90% 2,45%
28,75%
4,13% 4,01% 8,70%
3,53% 3,72% 1,66% 0,62%
Ag icul u e,! o es y!and
ishing
Indus y!(excep
cons uc ion)
Cons uc ion
Wholesale!and! e ail
ade,! anspo ,
accomoda ion!and! ood…
In o ma ion!and
communica ion
Financial!and!insu ance
ac i i ies
Real!es a e!ac i i ies
P o essional,!scien i ic!and
echnical!ac i i ies
Adminis a i e!and
suppo !se ice!ac i i ies
Public!adminis a ion!and
de ence;!compulso y
social!secu i y
Educa ion
Human!heal h!and!social
wo k!ac i i ies
A s,!en e ainmen !and
ec ea ion
O he !se ice!ac i i ies
!
16!
We! u he !assume!geome ic!dep ecia ion
10
!pa e n!wi h!a!cons an !dep ecia ion! a e!δ,!
we!can! ew i e:!
56=
(
1 − B
)
5689 + =6
!
Fo ! %=%1! he!equa ion!is!
59=
(
1 − B
)
5G+ =9
!
wi h
%5G≡ 0
!! ! ! ! !
59= =9
!!
!and!!!!!!
56=
∑
%(1 − B)K
689
KLG ∗ =K89
!
He ewi h! he! Capi al! S ocks! K! a ! ime! ! is! he! sum! o ! in es men ! dep ecia es! wi h! i s!
dep ecia ion! a e!δ!and!wi h! espec ! o!i s! in age.!In! ac ,! he!pe pe ual!in en o y!me hod!
es !on!some!unde lying!assump ions.!!
Fo !ou !pu pose!we!assume:!!
• We! use!a! geome ic! dep ecia ion,! which! is! based! on! wo ks! by! OECD! and!
EUROSTAT.!We!also!conside !a!balance! a e!o !α!=!1.6! o!ge !a!be e !ma ch!o !
dep ecia ion! pa e n! and! eal! li e! (Blades,! 2000;! OECD,! 2009;! E umban,! 2008;!
Be gen!e !al.!2009).!The!in luence!o !a!mo ali y! unc ion!is!al eady!included!he e!
( able!2).!!
• We!s a ! he!calcula ion!o ! he!capi al!s ocks!in!1970!wi h!a!benchma k!capi al!
s ock!K 0.!We!should!ha e!a! ime!se ies! eaching!in o! he!pas !long!enough,!such!
ha ! he! angible!asse s,!which!ha e!been!acqui ed!wi h!pas !in es men ,!a e! ully!
eplaced!when!capi al!s ocks!a e!analysed.!Wi h!expec ed!se ice!li es!o !40!yea s!
o !cons uc ion!wo k,!we! he e o e!seek!in es men ! ime!se ies! ill!a !leas !1975,!
wi h! he!mo e!yea s! he!be e .!We!s a !in!1970.!
• Following! Blades! (2015)! and! he! OECD! manual! (2009),! he! ini ial! benchma k!
capi al! s ock! can! be! app oxima ed! wi h! he! i s ! known! (bu ! in! some! cases!
es ima ed)!in es men !I 0,! he!a e age!dep ecia ion! a e!
M
N
%
o !each!asse ! ype!and!
he! a e age! g ow h! a e!
O
N.! Ins ead! o ! assuming! K0! o! be! 0! we! es ima e! K0!as!
ollows:!
5G=PQR
(S
T
UV
T
)
.!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!
10
!We!a e!going!wi h!geog aphic!dep ecia ion! a es,!meaning! ha !ac ually!no!asse !would!no mally! e i e.!
Howe e ,! ollowing!Eu os a ,!&!OECD!(2015),!asse s!a e!no mally!going!ou !o !se ice!wi h!a!sal age! alue!
o !10%!o !ini ial! alue,!while!new!in es men s! o !main enance!ex end! he!se ice!li e!o !asse s.!

!
17!
Table(2:(Asse ( ype,(expec ed(a e age(se ice(li e(and(dep ecia ion( a e(conside ing(a(balance( a e(
o (α(=(1.6.(
Asse ( ype(
Se ice(Li e(
Dep ecia ion(
a e(
Cons uc ion!(dwellings!and!o he !buildings!and!
s uc u es)!
40!
4,0%!
Machine y!and!Equipmen !
!
!
T anspo !
9!
17,8%!
ICT!
5!
32%!
O he !Machine y!and!Equipmen !
12!
13,3%!
In ellec ual!p ope ies!/!R&D!
10!
16,0%!
So wa e!
3!
53,3%!
EU-28(a e age((2005-2016)(
(
6,81%(
!
Benchma king(and( u u e(scena ios(
The! i s ! pa ! o ! ou ! analysis! is! e ospec i e! and! e alua es! he! amoun ! o ! pas !
in es men s! and! he! de elopmen ! o ! he! dependen ! Capi al! S ocks.! Wi h! gi en!
in o ma ion! on! his o ical! landma ks! (e.g.! he! global! inancial! c ises! o ! poli ical!
in e en ion!in!di e en !coun ies)!we!migh !explain! he!e olu ion!o !in es men s!and! he!
Capi al!S ocks.!Fu he mo e,!we!can!examine!i ! a ge ed!miles ones!ha e!been! eached!
(e.g.!did!in es men s!in! he!heal h!sec o ! ollow! he!na ional!( egional)!g ow h! a es!o !
GDP?!O !could!a!coun y!main ain!o !e en!inc ease! he!capi al!s ock! olumes?).!!
In!a!second!pa !we!model! wo!di e en !scena ios! o!p edic !how! he!in es men s,!as!
a ec ing! a iable,!ha e! o!de elop,!such! ha !p ede ined!benchma ks!can!be! eached.!The!
scena ios!s a !in!2016!and! un! ill!2030.!We!also!conside !popula ion!es ima es! e ie ed!
om! Eu os a ! (2018).! Possible! changes! o ! he! heal h! sys em!in! he! u u e! a e! no !
conside ed!and!kep !cons an .!The!Capi al!S ocks!o !2016!is! aken!as! he!basis! o ! he!
scena ios.!Fu u e!dep ecia ion! a es!( o!compu e! u u e!Capi al!S ocks)!a e!kep !cons an !
wi h! he!a e age!o !pas !dep ecia ion! a es! om!2014-2016.!The!scena ios!a e!de ined!as!
ollows:!!
!
!
18!
- Scena io(1((op imis ic(scena io):(Gi en! he!Capi al!S ocks!o !2016!and! he!es ima es!
o !popula ion!size!in! he! u u e,!we!change!in es men s!wi h! he!g ow h! a es!o !GDP!
p ojec ions!(OECD,!2018).!(
o Idea:(GFCF!and! hus!in es men s!in! he!heal h!sec o !is!a! ac ion!o ! he!
na ional!GDP.!Assuming! ha ! he!po ion!should!be!mo e!o !less!cons an ,!
he!annual!in es men s!should!inc ease,!when!GDP!inc eases.!(
- Scena io(2((conse a i e(scena io):(Gi en! he!es ima es! o ! he!popula ion!size!in!
he! u u e,!and!Capi al!S ocks!a !2016!le el,!we!change! he!Capi als!S ocks!in!a!way,!
such! ha ! he! a io!o !Capi al!S ocks!pe !capi a!s ay!cons an !o e ! ime.(
o Idea:( The! need! o ! heal h! se ice! changes! o e ! ime! due! o! popula ion!
changes!(bi h! a es),!mig a ion,!e c.!Thus,!we!examine!how!Capi al!S ocks!
and! he e o e!in es men s!migh !change!wi hou !indi iduals!expe ience!a!
loss.(
Nei he !scena io!1!o !2!imply,! ha !coun ies’!capi al!s ock! olumes!in!2016!a e!op imal!
olumes,! no ! ha ! es ima ed! in es men s! in! he! u u e! a e! on! op imal! le el! o ! each!
coun y.!E en!no!o he !capi al!s ock!can!be!seen!as! he!only!op imal! olume!and! he e o e!
canno ! unc ion!as!benchma k!pe !se.!Hence!ei he ! he!benchma k!is!se !in!a! ela ionship!
wi h!pe o mance!pa ame e !such! ha !e ec i eness!o !e iciency!coun ,!e.g.! o !a!c oss-
coun y!analysis,!o !in!a!longi udinal!pe spec i e! he!highes !capi al!s ock! olume!in! he!
cou se!o ! ime!is!se !as!benchma k.!Then!any!downwa d!de ia ion!mus !be!conside ed!as!
nega i e!de elopmen .!We!examine!bo h!pe spec i es!la e !on.!In!con as ! o!common!
conce ns!(e.g.!F ansen!e !al.!2017)!howe e ,!we!would! a e!lowe !in es men s!as!a!c ucial!
issue!only!i !in es men !go!down! o !longe !pe iods!and! he e!is!a! isk! o !o !an!ac ual!
dec ease!o !capi al!s ock! olumes.!O he wise! ola ili y!is! iewed!as!“no mal”.!!
Resul s(
As! men ioned! be o e,! in es men s,! e.g.! in! in as uc u e! a e! ola ile! in! longi udinal!
pe spec i e! and! a e! a ec ed! by! mac o-economic! a iables! and! poli ical! decisions.!
In as uc u e!in es men s!happen!cyclical,!meaning!a e ! imes!o !high!in es men s!in!
angible!and!in angible!asse s,!in es men s!migh !be! educed.!Wea !and! ea !only!show!
a e !a!longe !pe iod!depending!on! he!a e age!se ice!li e,!such! ha ! he!asse s!can!be!
u ilized!wi hou !a!no iceable!loss!o ! unc ion! o !some! ime.!
!
19!
In es men s!in!heal h!made!by!EU28!coun ies!in!2016!accumula e! o!EUR!65.8!bn,!which!
is!simila ! o!p e-c ises! olumes! om!2007!(EUR!64.7!bn).!In!p e-c ises!yea s!in es men s!
showed! an! annual! inc ease! o ! 3! o! 4! %,! bu ! when! in! 2008! he! global! inancial! c ises!
eme ged,!in es men s!s agna ed!and/o ! empo a y!dec eased!in! he! ollowing!yea s,!wi h!
he! lowes ! amoun ! in! 2013! (EUR! 60.2! bn).! Be ween! 2007-2016! lowe ed! in es men s!
accumula ed! o!an!“in es men !gap”!o !EUR!13.9!bn,!in!compa ison! o! he!case,!when!2007!
in es men ! le el! would! ha e! been! kep ! cons an ! un il! 2016.! Dec easing! in es men s!
become!e iden !in!GER,!EST,!GRE,!ESP,!ITA,!CYP,!LUX,!SVK!and!UK
11
.!!
!
Figu e( 7:( EU28( in es men s( in( heal h( in as uc u e( 2005-2016.( G oss( ixed( capi al( o ma ion,(
accumula ed(da a( o (EU28.(Real( olumes.(In la ion-adjus ed(wi h(implici (de la o ((2010(=(100).(
EU28( agg ega e( does( no ( include( da a( om( C oa ia,( La ia,( Li huania,( Mal a.( Sou ce:( Eu os a (
(nama_10_n a_ l),(own(calcula ions.((
!
Public! in es men ! in! heal h! in! EU28! is! a ound! hal ! (56%)! o ! o al! in es men ! and!
accumula e! o!EUR!35.2!bn!in!2016,!which!is!a!plus!o !5%!in!compa ison! o!2007!bu !a!
dec ease!o !2,8%!(EUR!1bn)!in!compa ison! o!2010.!In!mean ime!no!in es men !gap!bu !
a!plus!o !EUR!12.0!bn!can!be!obse ed!in!compa ison! o! he!case,!when!2007!in es men !
le el!would!ha e!been!kep !cons an !un il!2016.!Wi h!2010!in es men !as!baseline! he!
in es men !gap!would!accumula e! o!EUR!13.4!bn,.!While! he! o al!in es men !in!EU28!
dec eased!in!c ises!yea s,! he!public!in es men !inc eased!un il!2010!which!migh !be!due!
o!an!an i-cyclical!Keynesian!economic!policy!in!some!coun ies,!bu !has!been! educed!
a e wa ds,!s a ing! o!inc ease!again!in!2013.In!2016!howe e ,! o me !in es men !le els!
ha e!no !been! eached!ye ,!which!indica es!a! endency! o !s a e!budge !consolida ions.!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!
11
!UK!accumula ed!in es men !gap!is!highes !wi h!EUR!28.5!bn,! hus!excluding!UK!because!o !B exi !would!
esul !in!in es men !su plus! o ! hen!EU27!(+!EUR!14.5!bn).!
0
10
20
30
40
50
60
70
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
bn(EUR
!
20!
!
Figu e(8:(EU28(public(in es men (in(heal h(in as uc u e(2005-2016.(G oss( ixed(capi al( o ma ion,(
accumula ed(da a( o (EU28.(Real( olumes.(In la ion-adjus ed(wi h(implici (de la o ((2010(=(100).(
EU28(agg ega e(does(no (include(da a( om(Ge many,(Es onia,(I eland,(Spain,(C oa ia,(Cyp us,(La ia,(
Li huania,(Mal a,(Poland,(Slo enia.(Sou ce:(Eu os a ((go _10a_exp),(own(calcula ions.(
!
Taking! he!popula ion!in o!accoun ,! he!in es men s!pe !capi a!in!heal h!in as uc u e!in!
EU28!accumula e! o! olumes!be ween!EUR!117!(2005)!and!EUR!129!(2007)!pe !capi a!
pe !yea .!Since!popula ion!numbe s!only!inc ease!a!li le!(c .!EUROSTAT!demo_pjan),! he!
change!in!in es men s!pe !capi a!is!mos ly!d i en!by! he! a ia ion!o ! o al!in es men !
numbe s.!Public!in es men s!pe !capi a!accoun ! o ! olumes!be ween!EUR!63!(2013)!and!
EUR!72!(2010)!pe !capi a!pe !yea .!
!
Figu e( 9:( EU28( in es men ( in( heal h( in as uc u e( pe ( capi a( 2005-2016.( G oss( ixed( capi al(
o ma ion,(accumula ed(da a( o (EU28.(Real( olumes.(In la ion-adjus ed(wi h(implici (de la o ((2010(
=(100).(EU28(agg ega e(does(no (include(da a( om(C oa ia,(La ia,(Li huania,(Mal a.(Sou ce:(Eu os a (
(nama_10_n a_ l,(demo_pjan),(own(calcula ions.(
0
10
20
30
40
50
60
70
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
bn(EUR
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
EUR
!
21!
!
Figu e( 10:( EU28( public( in es men ( in( heal h( in as uc u e( 2005-2016.( G oss( ixed( capi al(
o ma ion,(accumula ed(da a( o (EU28.(Real( olumes.(In la ion-adjus ed(wi h(implici (de la o ((2010(
=(100).(EU28(agg ega e(does(no (include(da a( om(Ge many,(Es onia,(I eland,(Spain,(C oa ia,(Cyp us,(
La ia,( Li huania,( Mal a,( Poland,( Slo enia.( Sou ce:( Eu os a ( (go _10a_exp,( demo_pjan),( own(
calcula ions.(
!
The! accumula ed! capi al! s ock! o ! EU28! in! 2005,! based! on! he! pe pe ual! in en o y!
me hod!(PIM)!can!be!es ima ed!wi h!app ox.!EUR!645!bn!in! o al!and!wi h!EUR!1,302!pe !
capi a.!While!in es men s! a y! signi ican ly! o e ! ime,! he!annual! capi al!s ocks!show!
s eady!annual!inc ease!o !1.92%,!which!is!a!plus!o !1.63%!p.a.! o !capi al!s ocks!pe !capi a.!
Thus,!e en! hough!a! educ ion!o !heal h!in as uc u e!in es men s!is!e iden !be ween!
2008! and! 2016,! in es men s! ha e! been! high! enough! no ! only! o! eplace! dep ecia ed!
capi al!s ock!bu !also! o! u he !ex end! he!capi al!s ock! olume.!The!annual!g ow h!o ! he!
capi al!s ock!depends!i.a.!on! he! a io!be ween!in es men !and!cu en !capi al!s ock!which!
is!8.3%! o ! he!na ional!accoun s! ime!se ies.!Ne e heless,! he!lowe !in es men s!lead! o!
a! es ained! inc ease! o ! he! capi al! s ock! om! 2010! o! 2014! bu ! accele a e! again!
he ea e .!In!2016! he!capi al!s ock!inc eased! o!EUR!1,556!pe !capi a.!
!-
!20
!40
!60
!80
!100
!120
!140
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
EUR

!
22!
!
Figu e(11:(Capi al(s ock(es ima ion(using(PIM.(Real( olumes.(EU28(agg ega e(does(no (include(da a(
om(C oa ia,(La ia,(Li huania,(Mal a.(Sou ce:(Eu os a ((nama_10_n a_ l),(own(calcula ions.(
!
Figu e(12:(Capi al(s ock(pe (capi a(es ima ion(using(PIM.(Real( olumes.(EU28(agg ega e(does(no (
include(da a( om(C oa ia,(La ia,(Li huania,(Mal a.(Sou ce:(Eu os a ((nama_10_n a_ l,(demo_pjan),(
own(calcula ions.(
!
The!capi al!s ock!o ! he!public!domain!has!a! olume!o !app ox.!EUR!350!bn!which!is!ca.!
54%!o ! he! o al!capi al!s ock!in!EU28!in!2005.!The!annual!inc ease!is!1,48%,!which!is!a!
plus!o !1.2%!p.a.!on!capi a!le el!and!sligh ly!lowe ! a es! han!in! o al.!Simila ! o! he! o al!
capi al! s ock,! g ow h! is! slowed! a e ! 2010! in! o al! olumes! and! pe ! capi a.! The! a io!
be ween! in es men s! and! capi al! s ock! is! 8.4%.! I ! public! in es men s! s ay! on! cu en !
le els,! u he !ex ension!o !public!capi al!s ock!will!comple ely! ail!o .!!
0
100
200
300
400
500
600
700
800
900
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
bn(EUR
0
200
400
600
800
1000
1200
1400
1600
1800
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
EUR
!
23!
!
Figu e(13(Capi al(s ock(es ima ion(using(PIM.(Real( olumes.(EU28(agg ega e(does(no (include(da a(
om(Ge many,(Es onia,(I eland,(Spain,(C oa ia,(Cyp us,(La ia,(Li huania,(Mal a,(Poland,(Slo enia.(
Sou ce:(Eu os a ((go _10a_exp),(own(calcula ions.((
!
Figu e(14:(Public(capi al(s ock(pe (capi a(es ima ion(using(PIM.(Real( olumes.(EU28(agg ega e(does(
no (include(da a( om(Ge many,(Es onia,(I eland,(Spain,(C oa ia,(Cyp us,(La ia,(Li huania,(Mal a,(
Poland,(Slo enia.(Sou ce:(Eu os a ((go _10a_exp,(demo_pjan),(own(calcula ions.((
(
In!compa ison!wi h! he!e olu ion!o !GDP!( igu e!15),!capi al!s ock!inc eases! as e ! han!
GDP!especially!du ing! he! inancial!c isis,! hus! he!gap!widened.!Public!s ock!de eloped!
slowe !un il!2007,!bu !du ing! he! inancial!c isis!g ow h! a es!ha e!been!highe ! han! o !
GDP.!Since!2012! he!gap!dec eases!be ween!GDP!and!public!capi al!s ock!and!in!2015!GDP!
g ow h!o e ake! he!public!capi al!s ock!again.!I !can!be!assumed! ha !in! he!ea ly!c isis!
yea s,!public!in es men s!p o ec ed! he! o al!capi al!s ock! om!declining.!
0
100
200
300
400
500
600
700
800
900
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
bn(EUR
0
200
400
600
800
1000
1200
1400
1600
1800
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
EUR
!
24!
!
Figu e(15:(De elopmen (o (GDP,(capi al(s ock(and(public(capi al(s ock((2005=100).(Sou ce:(Eu os a (
(nama_10_gdp,(nama_10_n a_ l,(go _10a_exp),(own(calcula ions.(
!
In!conclusion! o al!in es men s!in!EU28!a e!su icien ! o!inc ease! he!capi al!s ock,!e en!
hough! in es men s! ha e! been! lowe ed!du ing! he! global! inancial! c isis.! Taking! he!
highes !in es men !in!c isis!yea s!as! e e ence!poin ,! he!lowe ed!in es men !accumula es!
in o!an!‘in es men !gap’!o !EUR!13.9!bn!and!EUR!13.4!bn! espec i ely! o ! o al!and!public!
in es men s.!I !can!be!assumed,! ha !capi al!s ock!could!ha e!been!highe !wi hou ! he!
c ises,! he!‘in es men !gap’!howe e !did!no !lead! o!a!decline!o ! he!EU28! o al!o !public!
capi al!s ock,!es ima ed!wi h!s a e!budge !da a!and! he!unde lying!assump ions.!!
While! inancing!on!Eu opean!s age!can! he e o e!be! ega ded!as!posi i e,! he!si ua ion!
migh !di e !in! he!EU28!membe !s a es,!mos !ob ious!in! he!so-called!p og am!coun ies,!
which! ha e! been! o ! a e!pa ly!s ill! suppo ed! by! di e en ! ins i u ions! and! he! o he !
Eu opean!coun ies.!!
Resul s( o (coun ies(
Agg ega ed!in es men s!in! he!heal h!sec o !and!de i ed!es ima ions! o !capi al!s ock!as!
an!indica o ! o !exis ing!in as uc u e!on!EU28!le el!imply,! ha !heal h!in as uc u e!
de elops!o e ! he!cou se!o ! ime,!e en! hough!in es men s!ha e!been!lowe ed!du ing! he!
global! inancial!c ises.!Si ua ions!on!coun y!le el!howe e ,!indica e!majo !di e ences.!In!
he! ollowing,!we!p esen !summa ized! esul s! o ! he!EU28!membe !s a es.!!
100,000
105,000
110,000
115,000
120,000
125,000
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
GDP Capi al!s ock Public!capi al!s ock
!
25!
Una ailable(da a(
To al! in es men s! epo ed! in! Na ional! Accoun s! (ESA2010,! Eu os a ,! 2018)! a e! no !
a ailable! a ! all! o ! C oa ia,! La ia,! Li huania,! Mal a
12
.! Public! in es men ,! which! a e!
epo ed!in!COFOG!(Eu os a ,!2018)!a e!no !a ailable! o !Ge many,!Es onia,!I eland,!Spain,!
C oa ia,!Cyp us,!La ia,!Li huania,!Mal a,!Poland,!Slo enia.!!
In es men s(2005-2015(
In! 2005! he! highes ! amoun s! pe !capi a! ha e! been! in es ed! in! LU,! DE!and! AT.! In! he!
ollowing! yea s! un il! 2015,!which! include! he! pe iod! o ! he! global! inancial! c isis,! he!
annual!in es men s! o !heal h!in as uc u e!wen !down!in! i e!coun ies!(G eece,!I aly,!
Cyp us,! Luxembou g,! Uni ed! Kingdom).! In! 18! coun ies! we! can! obse e! a! posi i e!
de elopmen ! o ! in es men s.! While! he! g ow h! a es! a e! below! GDP! g ow h! in! six!
coun ies! (Bulga ia,! Ge many,! Es onia,! F ance,! Poland,! Romania),! in es men s! g ow!
s onge ! han! he!a e age!economy!(GDP)!in!12!coun ies!(Belgium,!Czech!Rep.,!Denma k,!
I eland,! Spain,! Hunga y,! Ne he lands,! Aus ia,! Po ugal,! Slo enia,! Slo akia,! Finland,!
Sweden).!!
!
Figu e(16:(In es men (in(heal h(in as uc u e(pe (capi a(and(by(coun y( o (2005(and(2016.(G oss(
ixed(capi al( o ma ion.(Real( olumes.(In la ion-adjus ed(wi h(implici (de la o ((2010(=(100).(Sou ce:(
Eu os a ((nama_10_n a_ l,(demo_pjan),(own(calcula ions.(
!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!
12
!In!ESA2010!una ailable!da a!a e!an!issue! o !mo e!coun ies.!Wi h!OECD!STAN!Da abase! o !S uc u al!
Analysis!missing!da a!ha e!been! eplaced.!!
0
50
100
150
200
250
300
350
LU
DE
AT
DK
NL
BE
SE
IT
FR
IE
EU28
FI
UK
ES
CZ
SI
CY
EE
SK
PT
HU
PL
BG
EL
RO
EUR
2005 2016
!
32!
!
Figu e'23:'capi al's ock'p.'capi a'(x-axis)' s.'s anda dised'dea h' a e'by' esidence'(y-axis).'Sou ce:'
Eu os a ,'own'calcula ions'
!
Figu e' 24:' capi al' s ock' p.' capi a' (x-axis)' s.' in an ' dea h' a es' (y-axis).' Sou ce:' Eu os a ,' own'
calcula ions.'
'
E en! hough!heal h!se ices!a e!in!gene al!seen!as!pubic!good,!which!should!be!p o ided!
by! he!s a e,!some!expendi u e!need! o!be!made!ou !o !pocke ,! he!amoun !howe e !di e !
be ween!s a es.!Showing! he!p opo ions!o ! o al!heal h!expendi u es!(in!%!o !GDP)!in!
compa ison!wi h!capi al!s ock! olumes!show! ha ! he! ac ion!dec eases!wi h!inc easing!
capi al!s ock!pe !capi a! olumes.!I !can!be!assumed!howe e ,! ha !amoun s!which!ha e!
been!spend!ou !o !pocke ! o !heal h!se ices!migh !be!highe !in! o al!numbe s,!since!high!
le els!o !capi al!s ocks!a e! ela ed!wi h!high!economic!powe !in! he!same!coun ies!and!
he e o e!high!GDP! a es.!
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Figu e' 25:' capi al' s ock' p.' capi a' (x-axis)' s.' P i a e' household' ou -o -pocke ' expendi u e' as' a'
p opo ion'o ' o al'heal h'expendi u e.'Sou ce:'WHO'(HFA_584'6860),'own'calcula ions.'
!
Fu he ! in o ma ion! can! also! be! e ie ed! om! pe o mance! pa ame e s! on!
in as uc u e!le el.!High!numbe s!o !a ailable!(hospi al!and!day!ca e)!beds!(pe !100,000)!
a e! epo ed! o !coun ies!wi h!low!capi al!s ock! olumes!(<!EUR!1,000)!and! o !coun ies!
wi h!mo e! han!EUR!1,500.!In!DE!(828)!and!AT!(765)!excep ional!high!numbe s!o !beds!
a e!p o ided,!bo h!coun ies!wi h!high!capi al!s ock!pe !capi a! olumes!( igu e!23).!This!
U-shape! ega ding! a ailabili y! is! also! gi en! o ! he! numbe ! o ! hospi als! pe ! 100,000!
capi a.!The!supply!is!pa icula ly!high! o !Cyp us!(9,6!hospi als),!F ance!(5,3),!Finland!
(4,8)! and! Bulga ia! (4,7).! The! high! numbe s! o ! hospi als! pe ! 100,000! capi a! in! CY! a e!
mos ly!gi en!because!o ! he!high!numbe s!o !p i a e,! o !p o i !hospi als!( igu e!25)!Thus!
he!p o ision!wi h!hospi als!and!(hospi al!and!day!ca e)!beds!is! a he !low!in!coun ies!
wi h!mode a e!capi al!s ock! olumes.!The!supply!wi h!o he ! echnical!equipmen !(e.g.!CT,!
MRI,! Mammog aphs,! adia ion! he apy! equipmen )! does! no ! seem! o! depend! on! high!
capi al! s ock! olumes! ei he ! ( igu e! 24).! In! gene al,! CTs! coun ! he! highes ! in! mos !
coun ies,!while!mo e!Mammog aphs! han!CTs!a e!a ailable!in!FI,!CY,!SI,!EL,!HR!and!MT.!
Rega ding!human! esou ces! wo!obse a ions!can!be!made.!The!numbe !o !physicians!pe !
100,000! capi a! a ies! ega dless! o ! he! capi al! s ock! pe ! capi a! olumes! be ween! 73!
physicians!(Belgium)!and!279!(Aus ia),!whe eas! he!numbe !o !nu ses!and!midwi es!(in!
hospi al)!pe !100,000!capi a!is! a he !high!i !coun ies’!capi al!s ock! olumes!a e!high!as!
well.!!
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Figu e'26:'Capi al's ock'and'pu chasing'powe 'pa i ies' s.'in as uc u e'and'human' ecou se'pa ame e .'Sou ce:'WHO,'Eu os a ,'own'calcula ions.'
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physicians!in!hospi als!pe !100000 nu ses!and!midwi es!in!hospi al!pe !100000 hospi als!pe !100000
Female!li e!expec ancy!a !bi h Male!li e!expec ancy!a !bi h
!
35!
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Figu e'27:'Capi al's ock'and'pu chasing'powe 'pa i ies' s.' echnical'equipmen .'Sou ce:'WHO,'Eu os a ,'own'calcula ions.
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capi al!s ock Pu chasing!Powe !Pa i ies
CT!pe !100,000!2013!some!2014!i aly!2012 MRI!pe !100,000!2013!some!2014,!i aly!2012
Mammog aphs!pe !100,000!2013!some!2014,!i aly!2012 Radia ion! he apy!equipmen !pe !100,000!2013!some!2014,!i aly!2012
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36!
!
Figu e'28:'Hospi als'in'EU28'coun ies'by'se ice'p o ide .''
!
Benchma king''
In!conclusion,!only!weak! o!mode a e! ela ions!be ween!coun ies’!capi al!s ock! olumes!
and! pe o mance! a iables,! ei he ! subjec i e! (su ey),! ega ding! ou come! (li e!
expec ancy! and! dea h! a es)! o ! se ice! supply! (hospi als,! beds,! echnical! and! human!
esou ces)! can! be! iden i ied.! Fo ! hospi als! and! he! numbe ! o ! beds! a! U-shape! o ! he!
supply!can!be!obse ed,!meaning! ha !high!supply!is!gi en!in!coun ies!wi h!high!and!low!
capi al! s ock! olumes.! I ! can! be! assumed! ha ! he! numbe s! o ! beds! and! hospi als! a e!
in e co ela ed.!Addi ionally,!a!minimum!capaci y!migh !be!conside ed!when!planning!
new!hospi als.!Then!again!popula ion!mo emen s!can!lead! o!a!si ua ion!whe e!hospi als!
(and! beds)! capaci y! a e! a ailable! o ! he! popula ion! si ua ion! o ! passed! imes,! bu !
in as uc u e!ha e!no !been!adap ed,!e.g.!by!dismoun ing!o ! e i emen .!!
I !appea s! om!ou come!pa ame e s,!e.g.!li e!expec ancy!and!dea h! a es,! ha !a!capi al!
s ock! olume!o !EUR!1,000!migh !be!a!minimum! o !good!o !a !leas !su icien !heal h!
se ice!supply.!By! isual!e alua ion!li e!expec ancy!and!dea h! a es!a e!co ela ed!wi h!
he!exis ing!capi al!s ock! olumes!below!EUR!1,000!pe !capi a,!howe e ! he e!migh !be!a!
media ion!e ec !by!li es yle!as!well.!Whe eas!a e !exceeding!a! h eshold!o !EUR!1,000!
pe !capi a,! he! ela ionship!is!less!ob ious.!Va iance!in! he!capi al!s ock!migh !depend!on!
di e en !policies.!
In!a!longi udinal,!in a-coun y!pe spec i e! he! ecen !global! inancial!c isis!was!highly!
challenging! o ! mos ! coun ies! in! EU28! and! globally,! such! ha ! some! coun ies!
!-
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public!hospi als!pe !100.000 o !p o i !p i a e!hospi als!pe !100000
non!p o i !p i a e!hospi als!pe !100000 unkown
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37!
expe ienced! a! educ ion! o ! in as uc u e! in es men s,! e.g.! in! he! heal h! sec o .! Some!
coun ies! esponded!wi h!a!Keynesian! inancial!policy,!inc easing!public!in es men s! o!
s imula e!na ional!economy.!Beside! he! ac ,! ha !an!in es men !gap!can!be!obse ed! o !
almos !all!EU28!coun ies!and! he e o e!also!on!agg ega ed!le el,! he!capi al!s ocks!ha e!
been! main ained! o ! e en! imp o ed! in! mos ! coun ies.! Only! in! G eece! and! Cyp us! a!
educ ion!o !capi al!s ock! olumes!occu ed.!In es men s!in!Hunga y!and!I aly!ha e!been!
educed! as! well,! howe e ! capi al! s ocks! a e! s able.! Gi en! he! numbe s! o ! exis ing!
in as uc u e!(hospi als,!beds!and! echnical! esou ces),! he!quan i y!is!compa able!wi h!
he! o he ! EU28! coun ies,! while! no! asse ions! can! be! made! ega ding! he! quali y! o !
exis ing!in as uc u e.!!
The!same!applies!gene ally! o!all! esul s!in! his!pape :!E en!i !in es men s!and!capi al!
s ock! olumes! appea ! su icien ! om! a! mac o! pe spec i e,! i ! migh ! be! he! case! ha !
in es men s!and!an!inc ease!o !capi al!s ock! olumes!de i e! om!e.g.!addi ional!hospi al!
buildings,! while! exis ing! in as uc u e! deg ade,! such! ha !a! gap! in! supplies! occu !
none heless.! Thus,! poli ical! choices! (po k! ba el! spending,! p es ige)! and/o ! business!
equi emen s!o !in es o s!(loca ion! ac o s,! e u n!expec a ions)!need! o!be!conside ed!
as!well.!!
EU28' u u e'scena ios'
In! he! ollowing!we! un! wo! u u e!scena ios,!based!on!2016!capi al!s ock! olumes! o !
EU28.!The! i s ! (ambi ious)!scena io!claims,! ha ! in es men !g ow!wi h!expec ed! GDP!
g ow h! a es!un il!2030!(OECD,!2017),!which!implies! ha !coun ies!a e!de e mined! o!
in es !a!ce ain!pe cen age!o !annual!GDP.!The!second!(conse a i e)!scena io!in ends,!
ha ! he! EU28! capi al! s ock! pe ! capi a! olume! o ! 2016! should! be! main ained! wi h!
su icien ! u u e! in es men s.! Gi en! he,! EU28! capi al! s ock! in! 2016,! inc easing!
in es men s!(wi h!GDP!g ow h! a es,!which!is!app ox.!2%!p.a.)!accumula e! o!an!absolu e!
imp o emen ! o ! 28%! in! 2030.! Fo ! he! main aining! o ! 2016! capi al! s ock! olumes,! an!
immedia e! educ ion! o ! in es men s! by! 12,4%! could! be! ealized,! while! he! es ima ed!
popula ion! decline! lead! o! u he ! educ ion! in! he! cou se! o ! ime.! F om! a! pe ! capi a!
pe spec i e! he! i s !scena io!implies!an!inc ease!o !24.2%!o ! he!capi al!s ock!pe !capi a!
olumes!by!2030,!while! he!second!scena io!lead! o!main ained!capi al!s ock!le els!by!i s!
assump ions.!!

!
38!
!Because!o ! u u e!challenges!and/o ! he! ul ilmen !o ! he!SDG,!i !migh !be!necessa y! o!
in es !e en!mo e! han!jus ! he!gi en!cons an !p opo ion!o !GDP.!On! he!o he !hand,!new!
echnologies,!e en! hough! hey!do!no !come!by!no!cos ,!could!gene a e!al e na i es! o !
cos -in ensi e! in as uc u e! (specially! equipped! ambulance! ehicles! s.! hospi al!
buildings!in! u al!a eas),!such! ha !in as uc u e!in es men s!in! o al!could!be! educed!
in! he!long! e m.!!
!
Figu e'29:'EU28'in es men 'and'capi al's ock'(bn'€)'wi h' u u e'in es men 'scena io'I'&'II.'Real'
olumes'EU28'agg ega e'does'no 'include'in es men 'da a' om'C oa ia,'La ia,'Li huania,'Mal a.'
A e age' GDP' g ow h' a e' 2015-2030:' 2.23%.' Sou ce:' Eu os a '(nama_10_n a_ l,' demo_pjan,'
p oj_15npms),'own'calcula ions.'
!
Figu e'30:'EU28'in es men 'and'capi al's ock'pe 'capi a'(€)'wi h' u u e'in es men 'scena io'I'&'II.'
Real' olumes' EU28' agg ega e' does' no ' include' in es men ' da a' om' C oa ia,' La ia,' Li huania,'
Mal a.'A e age'GDP'g ow h' a e'2015-2030:'2.23%.'Sou ce:'Eu os a '(nama_10_n a_ l,'demo_pjan,'
p oj_15npms),'own'calcula ions.'
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capi al!s ock u u e!capi al!s ock!I u u e!capi al!s ock!II pas !in es men u u e!in es men !I u u e!in es men !II
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As!men ioned!be o e,! he!public!capi al!s ock!in!EU28!is!app ox.!56%!o ! o al!capi al!s ock.!
Since! public! in es men s! a e! ela i ely! highe ! compa ed! o! o al! in es men s,! public!
capi al!s ock!accumula ed! o!addi ional! 28.8%! o !capi al!s ock! olume!in! 2030,!which!
would!imply,! ha !ce e is!pa ibus! he!sha e!o !public!capi al!s ock! olumes!in! o al!capi al!
s ocks!inc ease!a!li le.!The!capi al!s ock!pe !capi a! olume!imp o es!wi h!25%.!Fo ! he!
conse a i e!second!scena io,!11.4%!less!in es men !would!be!needed!immedia ely! o!
main ain!2016!capi al!s ock!pe !capi a!le el.!!
!
Figu e'31:'EU28'public'in es men 'and'public'capi al's ock'(bn'€)'wi h' u u e'in es men 'scena io'
I' &' II.' Real' olumes' EU28' agg ega e' does' no ' include' in es men ' da a' om' Ge many,' Es onia,'
I eland,'Spain,'C oa ia,'Cyp us,'La ia,'Li huania,'Mal a,'Poland,'Slo enia.'A e age'GDP'g ow h' a e'
2015-2030:'2.23%.'Sou ce:'Eu os a '(go _10a_exp,'demo_pjan,'p oj_15npms),'own'calcula ions.''
!
Figu e'32:'EU28'public'in es men 'and'public'capi al's ock'pe 'capi a'(€)'wi h' u u e'in es men '
scena io' I' &' II.' Real' olumes' EU28' agg ega e' does' no ' include' in es men ' da a' om' Ge many,'
Es onia,' I eland,' Spain,' C oa ia,' Cyp us,' La ia,' Li huania,' Mal a,' Poland,' Slo enia.' A e age' GDP'
g ow h' a e' 2015-2030:' 2.23%.' Sou ce:' Eu os a ' (go _10a_exp,' demo_pjan,' p oj_15npms),' own'
calcula ions'
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Discussion'and'Ou look:'
Based! on! he! p esen ed! analysis,! we! can! conclude! ha ! he! p oclaimed! need! o ! e e !
inc easing!in es men s!in!in as uc u e!is!pa ly!sound,!pa ly!cheap! alk.!Since!heal h,!
educa ion!and!social!housing!among!o he s!a e!social!goods,! he!ac ual!demand!and!p ice!
canno !be!speci ied! he!same!way!as! o !a!no mal!good.!Each!s a e!claims!i s! esponsibili y!
o ! he! p o ision! o ! social!goods! up! o! a! ce ain! amoun ,! because! he! good!should! be!
gene ally!a ailable!and!a! ee!ma ke !supply!would!no !be!su icien !o ! oo!expensi e! o !
he!majo i y!o !people!(c .!Me i !goods,!Musg a e,!199).!Con e sely,!since! he!demand!
canno !be!de e mined,!also! he!op imal!supply!is!inde e mina e.!Since!social!goods!and!
high!supply!o !i !a e!gene ally!conside ed! o!be!desi able,! he!call! o ! u he !in es men s!
canno ! be! con adic ed.! I ! would! be! inoppo une! o ! any! poli ics! o ! any! o he ! pa y,!
dealing!wi h!social!goods! o!a gue! he!case! o !less!in es men .!!
The! e alua ion! o ! pas ! in es men s! and! capi al! s ocks,! using! he! pe pe ual! in en o y!
me hod!(OECD,!2009)!indica e!howe e ,! ha ! he!in es men !gap,!as!i !is!claimed!by!e.g.!
he!High!le el! ask! o ce!(F ansen,!del!Bu alo!&!Re iglio,!2017)!and!which!can!be!indeed!
iden i ied! o ! he!global! inancial!c isis! om!2008!onwa ds,!has!no !lead! o!a!decline!o !
capi al!s ock! olumes!in!EU28.!Since!some!coun ies!ha e!been!mo e!a ec ed!(p og am!
coun ies)! han! o he s,! he! in e -coun y! pe spec i e! lead! o! di e en ia ed!
conside a ions.!In!gene al,! he!si ua ion!is!no !as!bad!as!o en!p oclaimed,!a !leas ! om!a!
mac o!pe spec i e.!!
I !is!undeniably! ue!and!ha e!been! epo ed!mul iple! imes,! ha !exis ing!in as uc u es!
decompose,! because! i ! has! no ! been! su icien ly! main ained.! A ! he! same! ime! new!
in as uc u e! has! been! build,! such! ha ! in es men ! and! capi al! s ock! olumes! as! an!
ope a ionaliza ion! o !exis ing!in as uc u e!imp o e! a ou ably!on! he!mac o!le el,!e en!
hough!on! he!g ound!poo !condi ions!o !in as uc u e!migh !be! epo ed!by!poli icians,!
media!and! he!inhabi an s.!In! he!nex ! ound,!howe e ,!beside!o ! he!olde !in as uc u e!
also! he! new! in as uc u e! is! in! need! o ! p ese a ion! wo ks! and! co esponding!
in es men s.!!
The! analysis! also! shows,! ha ! pe o mance! a iables! a e! only! weakly! ela ed! o! he!
exis ing!capi al!s ock! olumes.!Tha !indica es,! ha !‘ he!mo e! he!be e ’!claim!does!no !
hold!and!ins ead!a!good!o !a !leas !su icien !heal h!se ice!can!be!also!p o ided!wi h!
lowe !le els!o !in as uc u e.!We!iden i ied!a!capi al!s ock!pe !capi a! olume!o !EUR!1,000!
as! he!poin ,!abo e!which!li e!expec ancy!and!(s anda dised!and!in an )!dea h! a es!do!no !
!
41!
di e !signi ican ly.! Also,! highe ! olumes! o ! capi al! s ock! do!no ! educe! p i a e! ou ! o !
pocke !expendi u es! o !heal h!se ices,!which!is!somewha !su p ising,!especially!since!
heal h!se ices!as!a!social!good!a e!al eady! axed! inanced! o!a!ce ain!amoun .!
I !can!be!assumed,! ha !abo e!a!ce ain!le el!o !basic!endowmen ! u he !spending!a e!
mos ly! in es ed! o ! an! inc ease! o ! quali y! o ! heal h! se ices,! e.g.! ad anced! echnical!
equipmen ! o ! specialized! ca e,! which! o mally! imp o e! he! coun y’s! o e all! heal h!
se ice.!Depending!on! he!unde lying!s a egy!i !migh !happen!in! he!nex ! ound,! ha !by!
all!appea ances,! he!heal h!sys em!pe o mance!is!high,!bu ! he!pe cei ed!o !e ec i e!
quali y,!e.g.! o !s anda d! ea men s!is!low.!In! his!si ua ion,!s akeholde s,!e.g.!poli icians!
o !ins i u ions!would!speak!up! o ! u he !in es men s! o! emedy! he!p oblem!wi h!bad!
heal h!se ices.!This!si ua ion!would!be!p edes ined! o !a! u he !inc ease!o !dispa i y!
be ween! alking!and!ac ion,!which!is!a!common!beha iou !in!ins i u ions!and!poli ics,!
since! he!“hypoc isy”!(con inual!unde in es men )!helps! o!s abilize! he!ins i u ion!and!
jus i y!i s!exis ing!(B unsson,!1989).!
In!summa y!i !is!possible! o!iden i y!coun ies,! egions!and!segmen s!o !se ice,!which!a e!
in!need! o ! u he !in es men s! o!imp o e! he!p o ision!o !heal h!se ices!in!gene al,!o !
whe e!less!could!be!in es ed.!A! i s !s ep!could!be! o!inc ease!capi al!s ock! olumes!up! o!
EUR! 1,000! pe ! capi a! o ! e e y! Eu opean! coun y.! A ! he! same! ime! he! alloca ion! o !
in es men s!is!c ucial!as!well.!I !is!likely! ha !poli icians!and!o he !s akeholde s!would!like!
o!alloca e!in es men s!in!p es igious!p ojec s,!while! he!gene al!public!migh !be!in!need!
o !su icien !heal h!se ices.