Publicado em Estudos e recursos, Europa, Saúde

Tools and methodologies to assess efficiency of health care services in Europe, 2019

“In a context of rising health care costs driven principally by the increasing prevalence of chronic conditions, ageing populations and the high costs associated with technological advances in medicine, health care systems in Europe are nowadays facing the intricate challenge of delivering accessible, equitable and high-quality care while ensuring the sustainability of public finances.
At the same time, there is emerging consensus among policymakers and researchers that a significant share of current health care spending in modern health systems could be reallocated to better use
without undermining access and quality of care. As a result, European governments are increasingly interested in capturing opportunities to extract additional value from available resources, and increase the efficiency of their health care systems to tackle this twofold challenge.
Yet while the idea of efficiency in this context – that is, how well a health care system uses its resources (input) to improve population health (outcome) – is simple to understand, several methodological questions remain on how to correctly identify inefficiencies within health care systems and devise corrective interventions without unintended consequences on access or quality of care.
The relationship between health system inputs and health outcomes is complex and influenced by several factors that are typically outside of the control of the health system, which makes it difficult to measure the effect of specific care interventions on health outcomes and perform fair comparative
assessments across entities. Together with considerable data limitations affecting analysts’ capacity to capture the performance of different segments of the ‘health production process’, assessing health care efficiency becomes a very complex endeavour in practice.
In light of these difficulties, specifying a set of appropriate instruments to analyse, measure
and assess efficiency of care (as well as spelling out their limitations) is a precondition for policymakers to design and implement interventions that can effectively make use of the ample potential to increase
efficiency mentioned above.
In support of this undertaking, among its activities over the course of 2018 the Expert Group on Health Systems Performance Assessment (HSPA) produced this report on tools and methodologies to assess efficiency of care. The report sets out to explore the most recent theory and observed practice of
health care efficiency measurement and assessment across European countries, in view of discovering what opportunities exist for European countries to improve their tools and methods to measure and assess efficiency of care, and to make better use of efficiency information for policy formation.”

executive summary

 

Publicado em Europa, Saúde mental

Health at a Glance 2018, Saúde Mental [II]

Portugal é o quinto país da União Europeia com maior prevalência de problemas de saúde mental. De acordo com o relatório Health at a Glance 2018, divulgado esta quinta-feira pela Organização para a Cooperação e Desenvolvimento Económico (OCDE), 18,4% da população portuguesa sofre de doença mental, onde se inclui ansiedade, depressão ou problemas com o consumo de álcool e drogas.

As estimativas são referentes a 2016, com base no trabalho feito pelo Instituto de Métricas e Avaliação em Saúde (IHME, sigla em inglês). De acordo com o relatório da OCDE, que analisa dados de 36 países europeus — entre os quais os 28 que fazem parte da União Europeia —, “mais de uma em cada seis pessoas nos países europeus sofre de um problema mental”. A média europeia é de 17,3%, ou seja as estimativas apontam para perto de 84 milhões de pessoas afectadas por este problema.

Os problemas mais comuns são ansiedade, com uma estimativa de 25 milhões de pessoas a viver com este problema, seguido de depressão, que afecta 21 milhões de pessoas. Estima-se que 11 milhões de indivíduos na Europa tenham problemas de consumo de álcool e/ou drogas. Doenças mentais graves como a doença bipolar afecta quase cinco milhões de pessoas e a esquizofrenia 1,5 milhões”, diz o relatório.

No topo da lista de países com maior prevalência estão a Finlândia, a Holanda, França e Irlanda, com taxas iguais ou superiores a 18,5% da população afectada por estes problemas. Logo a seguir surge Portugal, na quinta posição, com 18,4% de prevalência estimada. Também em Portugal, os problemas mais comuns são a depressão e a ansiedade (cada um afecta 6% da população). Seguem-se os problemas relacionados com o consumo de álcool e drogas (2%) e a doença bipolar e esquizofrenia (2%).

Os países com menos prevalência são a Roménia, Bulgária e Polónia, com taxas inferiores a 15%. “As diferenças podem estar relacionadas com o facto de em alguns países a população estar mais alerta para a saúde mental e à existência de menos estigma associado às doenças, assim como um acesso mais fácil aos cuidados de saúde e com isso haver um diagnóstico mais cedo. Em muitos países ainda há um grande estigma, associado ao facto de que é melhor não falar de doenças mentais”, lê-se no documento.

Na lista de doenças mentais não estão contabilizados problemas com demência, tema que no ano passado mereceu especial destaque da OCDE. Nesse relatório Portugal também estava entre os países com prevalências mais altas de demência, com 20 em cada mil habitantes a sofrer desta doença.

O Health at a Glance 2018 afirma que o custo associado às doenças mentais é muito elevado também a nível económico. O relatório estima que os custos da doença mental representem mais de 4% do PIB dos 28 países da União Europeia em 2015. Ou seja, mais de 600 mil milhões de euros.

Este valor engloba custos directos com saúde (190 mil milhões de euros), com a segurança social (170 mil milhões de euros) e custos indirectos associados à baixa produtividade laboral e desemprego (240 mil milhões de euros). “Apesar dos valores serem consideráveis, são subestimados pois vários custos adicionais não foram tidos em conta”, ressalva o relatório, dando como exemplo as limitações de horas de trabalho dos cuidados informais.

O peso do custo das doenças mentais varia entre países. Na Roménia, Bulgária e República Checa, este peso está entre os 2% e os 2,5% do PIB. Já na Dinamarca, Finlândia, Holanda e Bélgica representa valores acima dos 5% do PIB. Em Portugal, a estimativa do custo total das doenças mentais é de 6,5 milhões de euros (3,6% do PIB).

[artigo do Público]

Publicado em Europa, Saúde mental

“Health at a Glance: Europe 2018”, Saúde Mental

Capítulo 1 –Promoting mental health in Europe: Why and how?  [p. 19-40]
Mental illness affects tens of millions of Europeans every year
Mental health problems affect about 84 million people across EU countries
Although there are significant gaps in information about the prevalence of mental health problems across EU countries, all available evidence suggests that mental health problems affect tens of millions of Europeans every year. The data currently available from population-based surveys are often limited to a few specific mental health disorders, or specific age groups. However, the Institute for Health Metrics and Evaluation (IHME) provides estimates of the prevalence of a wide range of mental health disorders across all age groups based on a wide variety of data sources and a set of assumptions.
According to the latest IHME estimates, more than one in six people across EU countries (17.3%) had a mental health problem in 2016 (Figure 1.1) – that is, nearly 84 million people.
The most common mental disorder across EU countries is anxiety disorder, with an estimated 25 million people (or 5.4% of the population) living with anxiety disorders, followed by depressive disorders, which affect over 21 million people (or 4.5% of the population). An estimated 11 million people across EU countries (2.4%) have drug and alcohol use disorders. Severe mental illnesses such as bipolar disorders affect almost 5 million people (1.0% of the population), while schizophrenic disorders affect another estimated 1.5 million people (0.3%).
By country, the estimated prevalence of mental health disorders is highest in Finland, the Netherlands, France and Ireland (with rates of 18.5% or more of the population with at least one disorder), and lowest in Romania, Bulgaria and Poland (with rates of less than 15% of the population).
Portugal é o quinto país da União Europeia com maior prevalência de problemas de saúde mental.
Some of these cross-country differences may be due to the fact that people living in countries with greater awareness and less stigma associated with mental illness, as well as easier access to mental health services, may be diagnosed more easily or may be more likely to self-report mental ill-health. In many countries, there is still strong stigma associated with various mental health problems, and in some countries this stigma sits alongside a still-widespread belief that it is better to simply avoid talking about mental illness (Munizza et al., 2013).
Several mental illnesses are more common amongst women, including anxiety disorders, depressive disorders and bipolar disorders. Some of these gender gaps may be due to a greater propensity of women to report these problems. However, one exception is drug and alcohol use disorders, which are more than two times more likely to occur in men than women on average across EU countries (IHME, 2018).
[p. 21-22]
Mortality related to mental health problems and suicides is substantial
Over 84 000 people died of mental health problems and suicides across EU countries in 2015, and this is an under-estimation as many people with mental health problems also die prematurely because of higher rates of physical health problems and chronic diseases that are not properly treated. “Excess mortality” for mental disorders – the gap between the mortality rate of the general population and the mortality rate for people with a mental disorder – is huge. For example, excess mortality amongst women who have been diagnosed with schizophrenia is above 6 in Finland, Norway and Sweden (OECD, 2018). Persons with severe mental illness die 10-20 years earlier than the general population (Liu et al., 2017; OECD, 2014; Coldefy and Gandré, 2018).
Of the 84 000 deaths directly related to mental health problems and suicides, most of these deaths were among men, mainly because of higher suicide rates among men (Figure 1.4). Some 43 000 men in EU countries died from suicide in 2015, compared with 13 000 women. However, the gender gap in suicide attempts is much smaller or even reversed in some countries, because women often use less fatal methods.
The costs of mental health problems exceed 4% of GDP
The total costs of mental health problems on EU economies are huge, highlighting the need for greater efforts to prevent mental ill-health and to provide timely and effective treatments when it occurs. Besides the costs on health care systems, mental health problems also result in substantial costs in terms of social security benefits as well as
negative labour market impacts in terms of reduced employment and productivity.
(…)
In 2015, the overall costs related to mental ill-health are estimated to have exceeded 4% of GDP across the 28 EU countries.
This equates to more than EUR 600 billion. This total breaks down approximately into the equivalent of 1.3% of GDP (or EUR 190 billion) in direct spending on health systems, 1.2% of GDP (or EUR 170 billion) on social security programmes, and a further 1.6% of GDP (or EUR 240 billion) in indirect costs related to labour market impacts (lower employment and lower productivity).
Despite these costs being considerable, they are still a significant under-estimate, as several additional costs have not been taken into account. These include, in particular, social spending related to mental health problems, such as higher social assistance benefits and higher work-injury benefits, and the higher cost of treating a physical illness if the patient also has a mental illness.
In addition, some of the indirect impacts of mental health problems on labour market participation such as reduced employment rates or working hours for informal caregivers taking care of people with mental health problems or the impact on co-workers, have not been taken into account.
Conclusions [p. 40] [bold nosso]
Many European countries are taking action to prevent mental illness and to promote mental well-being. More than one hundred interventions to promote good mental health and protect populations from the negative impacts of mental illness were found across the EU, targeting all age groups.
Measures are being adopted to promote well-being in schools and nurseries, with new parents, or in workplaces. Reducing stigma and increasing understanding of mental well-being are policy priorities. Furthermore, with improved population-level awareness and understanding of mental health, the stigma around seeking mental health care and talking about mental illness falls. Overcoming stigma and improving diagnosis rates can be expected, in turn, to contribute to more robust data on the true prevalence of mental ill-health.
As this chapter shows, mental ill-health is not distributed evenly across the population, and there are important age, gender and socio-economic differences in the burden of disease. Some groups are also less likely to be the target of promotion or prevention interventions. Supporting vulnerable groups, such as older people or unemployed people, is important to build more inclusive and active societies, but at present far fewer policies reach these groups. The dialectic relationship between distance from social structures and deteriorated mental well-being should also not be underestimated. Just as mental ill-health reduces the likelihood of being in employment, unemployment increases the risk of having poor mental health. Programmes that foster good mental health – reducing loneliness, encouraging social participation, building support structures – and interventions that can identify and respond to signs of mental distress, should be priorities for European countries.
The growing evidence base along with the significant burden of mental illness make clear that there is a societal case for introducing many such promotion and prevention programmes, but there is also a clear economic case for further investment in this area. Actions to prevent mental illness and promote good mental health can bring lifelong benefits to children and their families, workplace interventions can reduce absenteeism and presenteeism, and suicide prevention strategies can prevent tragic losses of life and potential.
The costs of mental illness are extremely high, the potential gains from strengthening mental well-being are significant, and the opportunities for promotion and prevention are far from exhausted. This chapter lays the grounds for a clear case: much more can and must still be done to promote mental well-being and prevent mental ill-health.
Publicado em Europa, Saúde

“Health at a Glance: Europe 2018” – Sumário Executivo

Health at a Glance: Europe 2018
STATE OF HEALTH IN THE EU CYCLE
Health at a Glance: Europe 2018,  lançado a 22 de novembro, apresenta dados de saúde da União Europeia [28 países].
Sumário Executivo

Health at a Glance: Europe 2018 presents comparative analyses of the health status of EU citizens and the performance of the health systems of the 28 EU Member States, 5 candidate countries and 3 EFTA countries. It is the first step in the State of Health in the EU cycle of knowledge brokering.

This publication has two parts. Part I comprises two thematic chapters, the first focusing on the need for concerted efforts to promote better mental health, the second outlining possible strategies for reducing wasteful spending in health. In Part II, the most recent trends in key indicators of health status, risk factors and health spending are presented, together with a discussion of progress in improving the effectiveness, accessibility and resilience of European health systems.

Ideias-chave destacadas no sumário executivo

Making the case for greater priority to improving mental health

  • Mental health is critical to individual well-being, as well as for social and economic participation. Yet, according to recent estimates, more than one in six people across EU countries had a mental health issue in 2016, equivalent to about 84 million people. Moreover, in 2015 the deaths of more than 84 000 people in EU countries were attributed to mental illness or suicide.

The total costs of mental ill-health are estimated at more than 4% of GDP – or over EUR 600 billion – across the 28 EU countries

  • The economic and social costs of mental illness are substantial.The total costs of mental ill-health are estimated at more than 4% of GDP – or over EUR 600 billion – across the 28 EU countries. EUR 190 billion (or 1.3% of GDP) reflects direct spending on health care, another EUR 170 billion (1.2% of GDP) is spent on social security programmes, while a further EUR 240 billion (1.6% of GDP) represents indirect costs to the labour market due to lower employment and productivity.
  • The heavy individual, economic and social burdens of mental illness are not inevitable. Many European countries have in place policies and programmes to address mental illness at different ages. However, much more can be done to manage and promote mental health.

Reducing wasteful spending to make health systems more effective and resilient

“Evidence from various countries suggests that up to one-fifth of health spending is wasteful and could be reallocated to better use”

  • Wasteful spending occurs when patients receive unnecessary tests or treatments or when care could have been provided with fewer and less costly resources. Evidence from various countries suggests that as much as one-fifth of health spending is wasteful and could be reduced or eliminated without undermining quality of care. Reducing wasteful spending not only contributes to health system resilience, but helps achieve and maintain universal access to effective care.
  • When it comes to hospitals, many admissions could be avoided with better management of chronic conditions in the community. Potentially avoidable admissions for conditions such as asthma and diabetes consume over 37 million bed days each year across the EU. Unnecessarily delayed discharges are also costly for hospitals, and many discharge-ready patients occupy beds that could be used for patients with greater needs.
  • When it comes to pharmaceuticals, minimising waste and optimising the value derived from medicine spending are also critical to achieving efficient and sustainable health systems. A mix of policy levers can support this goal, including: 1) ensuring value for money in the selection and coverage, procurement and pricing of pharmaceuticals through Health Technology Assessment; 2) exploiting the potential savings from generics and biosimilars; 3) encouraging rational prescribing; and 4) improving patient adherence.

Gains in life expectancy have slowed in many EU countries, and large  inequalities persist

  • While life expectancy increased by at least 2 to 3 years over the decade from 2001 to 2011 in all EU countries, the gains have slowed down markedly since 2011 in many countries particularly in Western Europe, increasing by less than half a year between 2011 and This slowdown appears to have been driven by a slowdown in the rate of reduction of deaths from circulatory diseases and periodical increases in mortality rates among elderly people due partly to bad flu seasons in some years.

“People with a low level of education can expect to live six years less than those with a high level of education”

  • Large disparities in life expectancy persist not only by gender, but also by socioeconomic status. On average across the EU, 30-year-old men with a low level of education can expect to live about 8 years less than those with a university degree (or the equivalent), while the “education gap” among women is narrower, at about 4 years. These gaps largely reflect differences in exposure to risk factors, but also indicate disparities in access to care.

Putting a greater focus on preventing risk factors

  • While smoking rates in both children and adults have declined in most EU countries, about one-fifth of adults still smoke every day, and as many as one in four in countries with less advanced tobacco control policies.
  • Alcohol control policies have reduced overall alcohol consumption in several countries, but heavy alcohol consumption among adolescents and adults remains an important public health issue. In EU countries, nearly 40% of adolescents report at least one “binge drinking” event in the preceding month, and more than 40% of young men aged 20-29 also report heavy episodic drinking.

At least one in six adults are obese across EU countries, with wide disparities by socioeconomic status”

  • The prevalence of obesity continues to increase among adults in most EU countries, with at least one in six defined as obese. Inequality in obesity remains marked: 20% of adults with a lower education level are obese compared with 12% of those with a higher education.

Strengthening the effectiveness of health systems can reduce premature mortality

More than 1.2 million deaths could have been avoided in EU countries in 2015 through better public health policies or more effective and timely health care

  • More than 1.2 million people in EU countries died in 2015 from diseases and injuries that could have been avoided either through stronger public health policies or more effective and timely health care.
  • Vaccine-preventable diseases have resurged in some parts of Europe in recent years, pointing to the importance of promoting effective vaccination coverage for all children across all EU countries.
  • It is estimated that 790 000 people in EU countries died prematurely in 2016 due to tobacco smoking, harmful consumption of alcohol, unhealthy diets and lack of physical activity.
  • The quality of acute care for life-threatening conditions has improved in most countries over the past decade. Fewer people die following a hospital admission for acute myocardial infarction (a 30% reduction on average between 2005 and 2015) or stroke (a reduction of over 20% during this same period). However, wide disparities in the quality of acute care persist not only between countries but also between hospitals within each country.
  • Remarkable progress has also been achieved in cancer management through the implementation of population-based screening programmes and the provision of more effective and timely care. Survival rates for various cancers have never been higher, yet there is still considerable room for further improvement in cancer management in many countries.

Ensuring universal access to care is critical to reducing health inequalities

“Unmet health care needs are generally low in EU countries, but low-income households are five times more likely to report unmet needs than high-income households

  • Unmet health care needs are an important measure of accessibility. Recent survey data show that in most EU countries the share of the population reporting unmet care needs is generally low and has declined over the past ten years. Yet, low-income households are still five times more likely to report unmet care needs than high-income households, mainly for financial reasons.
  • In addition to being affordable, health services must also be accessible when and where people need them. While the numbers of doctors and nurses in nearly all EU countries have increased over the past decade, shortages of general practitioners are common, particularly in rural and remote areas.
  • Long waiting times for elective surgery is an important policy issue in many EU countries as it impedes timely access to care. In many of these countries, waiting times have worsened in recent years as the demand for surgery has increased more rapidly than the supply.

Strengthening the resilience of health systems

  • Health systems need to respond more efficiently to changing health care needs driven by demographic changes and exploit more fully the potential of new digital technologies to strengthen prevention and care.
  • In 2017, health spending accounted for 9.6% of GDP in the EU as a whole, up from 8.8% in Population ageing means not only that health care needs will increase in the future, but also that there will be increasing demand for long-term care. Indeed, spending on long-term care is expected to grow faster than spending on health care. “New digital technologies have the potential to promote more healthy ageing and more people-centred care”
  • New digital technologies offer great opportunities to promote healthy ageing and achieve more efficient and people-centred care. The use of Electronic Medical Records and ePrescribing is growing across EU countries, and growing numbers of EU residents use the internet to obtain health information and access health services, although there are disparities by age and socioeconomic groups.
  • Population ageing requires profound transformations in health systems, from a focus on acute care in hospitals to more integrated and people-centred care in the community. Many EU countries began this transformation over a decade ago – for example by reducing hospital capacity and average length of stay, and strengthening community care – but the process still requires ongoing, long-term effort.

Monitoring and improving the State of Health in the EU

Health at a Glance: Europe 2018 is the result of ongoing and close collaboration between the OECD and the European Commission to improve country-specific and EU-wide knowledge on health issues as part of the Commission’s State of Health in the EU cycle.

—————————————-

The State of Health in the EU is a two-year initiative undertaken by the European Commission that provides policy makers, interest groups, and health practitioners with factual, comparative data and insights into health and health systems in EU countries. The cycle is developed in cooperation with the Organisation for Economic Co-operation and Development (OECD) and the European Observatory on Health Systems and Policies.

The two year State of Health in the EU cycle consists of four main stages:

  • The Health at a Glance: Europe, prepared by the OECD, gives a horizontal starting point.
  • 28 Country Health Profiles, adapted to the individual context and specificities of each EU country, assess the strengths and challenges in their respective health systems.
  • A Companion Report published along with the Country Health Profiles draws cross-cutting conclusions, links common policy priorities across EU countries, and explores the scope for mutual learning.
  • At the close of the two-year cycle, health authorities in EU countries can request voluntary exchanges with the experts behind the State of Health in the EU, to discuss findings and potential policy responses.

The research is undertaken by health experts and is designed to inform and support policy making, not to make recommendations. The cycle is aligned to the policy objectives set out in the 2014 Commission Communication on effective, accessible and resilient health systemsSearch for available translations of the preceding link

Publicado em Ensino superior, Europa

EHEA Ministerial Conference 2018 – Comunicado de Paris

Na sequência dos posts anteriores sobre o assunto, anote-se adoção, a 25 de maio, na Conferência Ministerial do Espaço Europeu de Ensino Superior, do Comunicado de Paris.

Beyond 2020: a more ambitious EHEA
The EHEA has proved its role as a unique framework for higher education co-operation in Europe. To develop the EHEA further, we will intensify cross-disciplinary and cross-border cooperation as well as develop an inclusive and innovative approach to learning and teaching. We call on the BFUG to submit proposals in time for our 2020 meeting in order to enable higher education to fully play its role in meeting the challenges faced by our societies.

E o STATEMENT OF THE FIFTH BOLOGNA POLICY FORUM

We believe that the Bologna Policy Forum, supported by Ministers and international organisations, can bring about a more systematic and sustainable level of international
cooperation. This cooperation needs to take account of the diversity across our regions, including the different domestic social and political contexts of higher education and
its wider geopolitical dimension. It should define realistic ambitions and goals that can be achieved in a spirit of exchange and mutual learning. It is important for those with responsibility for higher education to listen, learn and engage on common issues. These include quality, academic freedom, student participation, social inclusion, the status, the
autonomy and the wider role of higher education institutions. The Fifth Bologna Policy Forum has initiated a global policy dialogue focussing on two of these common concerns – social inclusion and the wider civic role of higher education.
We, the Ministers, commit to supporting this ongoing, successful interregional dialogue on issues of common concern amongst policy makers, stakeholder organisations, students, staff and higher education institutions. We propose the establishment of a Global Working Group in the next 2018-2020 Bologna work programme to take this agenda forward and we invite countries to express their interest to hold high level workshops on a yearly basis to continue the dialogue on social inclusion and the wider role of higher education. We are also committed to continuing to collaborate, to share experience and to identify future goals through joint workshops, conferences and importantly peer learning for innovative answers to our common challenges. In order to further develop international partnerships, we call on higher education institutions to explore all opportunities provided by bilateral actions and multilateral mobility and cooperation programmes, such as the EU-funded Erasmus+ or the Horizon 2020 research programmes, to collaborate on reaching solutions to our common challenges.
Measures adopted:
• Structured peer support approach for the implementation of the three Bologna key commitments
• Belarus strategy for 2018-2020
• Short cycle qualifications as a stand-alone qualification level within the overarching Qualifications Framework of the European Higher Education Area (QF-EHEA)
• Revised Diploma Supplement, with a recommendation for its adoption in identical form in the respective frameworks of the Lisbon Recognition Convention and Europass

Com a vantagem da leitura do Relatório, estes dois documentos sintetizam o «para onde vamos» até 2020.

[The European Higher Education Area in 2018: Bologna Process Implementation Report]

Publicado em Ensino superior, Estudos e recursos, Europa, Portugal

“The European Higher Education Area in 2018” – referências a Portugal [4]

The European Higher Education Area in 2018: Bologna Process Implementation Report

Referências a Portugal [finalizando]

Chapter 6: Relevance of the Outcomes and Employability

“As expected, the smallest differences in unemployment rates can be found between the medium skilled and Bachelor-level educated, but in general, having a Bachelor-level degree protects against unemployment better than upper secondary level education. However, in seven countries (Denmark, the former Yugoslav Republic of Macedonia, Moldova, Portugal, Serbia, Slovenia and Turkey), graduates with Bachelor degrees are more likely (albeit not always by much) to be unemployed than those with upper secondary education, and in Serbia and Denmark even graduates with a Master degree are in a similar situation.” (p. 218)

When looking at the following years (2013 to 2016), the situation has improved considerably. The majority of countries experienced a decrease in unemployment during these years. In fact, Andorra, Bulgaria, Croatia, Estonia, Iceland, Lithuania, Malta, the Netherlands, Romania, Poland and Portugal had a negative growth rate of over 10 % during these years. However, looking at different education levels, there are some exceptions to the overall positive situation.” (p. 219)

“The ratio of the median annual gross income of employees with tertiary qualification to lower levels of education is depicted in Figure 6.7. In 2015, tertiary qualified employees in every country analysed had an income advantage. According to Figure 6.7A, the ratio of tertiary qualification to upper secondary education ranges from 1.9 in Portugal and Turkey – which means that the median annual gross income of tertiary qualified employees is almost twice as high as the income of upper secondary qualified employees.” (p.222)

“The biggest differences between female and male overqualification rates are on the one hand in Belarus, Albania, Kazakhstan, Turkey and Andorra (with higher over-qualification rates for men) and on the other hand in Slovakia, Italy, Cyprus, Finland, the Czech Republic and Portugal (with higher over-qualification rates for women).” (p. 228)

“In some countries, employers have to be involved in curriculum development in professional higher education institutions (for example in France, Latvia and Portugal). In Belgium (Flemish Community), Cyprus, Estonia, Germany, and Slovakia, for example, employers are typically involved in curriculum development in such institutions.” (p. 232)

Chapter 7: Internationalisation and Mobility

“Overall, in the majority of countries the share of mobile students from inside the EHEA is higher compared to the ones coming from outside the EHEA. However, the reverse is true for the United Kingdom, Ireland, France, Portugal, Ukraine and Finland, as well as Belarus, Russia, Kazakhstan and Moldova, where the share of students from outside the EHEA is double or more the share of students coming from another EHEA country.(…) The weighted average share of international students from outside the EHEA increased from 2.27 to 3.59 since 2011/12. The weighted average share of international students from inside the EHEA also increased from 2.1 % to 2.8 %, with increases in most countries, with the exception of Portugal which registers a decrease of around 50 %.” (p.254)

“In comparison with the 2015 Bologna Process Implementation Report, several countries (France, Portugal, the United Kingdom, Italy and Hungary) register a significant decrease of the within EHEA incoming/outgoing ratio. On the other hand, an increase of more than factor 2 is observed in Armenia, Cyprus, Estonia, Lithuania, Latvia, the former Yugoslav Republic of Macedonia and Poland. These countries have a higher imbalance towards incoming students than reported for 2011/12.” (p. 260)

“In addition to the eleven counties already mentioned above (see Figure 7.17), Finland, France, Germany, Italy, Portugal and Sweden are clear net importing countries. Kazakhstan, Ireland and Latvia have a balanced incoming/outgoing ratio.” (p. 261)

“Looking at the outward diversity, Andorra and Liechtenstein show the least diverse mobility patterns. More than 95 % of outgoing students of these countries study in only three countries of destination. For Andorra these countries are Spain, France and Portugal and for  Liechtenstein, these countries are Switzerland, Austria, and Germany.” (p. 264)

“In around one-third of all EHEA systems, portability of grants is limited to credit mobility, i.e. when students move abroad for a short period of time (e.g. a semester or an academic year) in the framework of their home-country programme. Some of these systems apply portability restrictions (Armenia, Greece, Kazakhstan, Latvia, Lithuania, Malta, Portugal, Spain and the United Kingdom – England, Wales and Northern Ireland), limiting, in particular, the portability of grants to programme exchanges within recognised schemes such as Erasmus (e.g. Greece, Latvia, Lithuania, Portugal and Spain).” (p. 268)

“Moreover, as the higher education mobility scoreboard shows (European Commission /EACEA/ Eurydice 2016b, p. 29), some systems register only a negligible proportion of loan beneficiaries among their student population (e.g. less than 1 % in the French Community of Belgium, France, Italy, Portugal and Slovakia), so that loans in these systems cannot be regarded as a major element of national student support (i.e. their portability is not considered in Scorecard indicator n°12 – Figure 7.26).” (p. 269)

“Most systems that offer publicly-subsidised loans allow portability for both credit and degree mobility. While the overall geographical pattern is very similar to the portability of grants, some countries with limited grant portability – for example Hungary, Latvia, Portugal, Slovakia and Switzerland – are more flexible when it comes to portability of publicly-subsidised loans (i.e. loans are portable – with or without restrictions – for credit as well as degree mobility, whereas grants are only portable for credit mobility). Iceland is another noteworthy case, as although there is no standard grant package, publicly-subsidised loans are portable without restrictions.” (p. 269)

Seven countries – Kazakhstan, Latvia, Lithuania, Malta, Portugal, Spain and most parts of the United Kingdom – apply various restrictions to credit mobility (‘orange’). Among them, Latvia and Portugal offer fully portable loans, yet, the portability of grants is limited to credit mobility with restrictions. Kazakhstan provides loans that are portable for credit mobility without restrictions, while grants are portable for credit mobility with restrictions.” (p. 270)

Publicado em Ensino superior, Estudos e recursos, Europa, Portugal

“The European Higher Education Area in 2018” – referências a Portugal [3]

The European Higher Education Area in 2018: Bologna Process Implementation Report

Referências a Portugal [continuando]

Chapter 3: Degrees and Qualifications

“There are significant differences between countries in terms of the participation in master or equivalent programmes. The lowest share – less than 10 % – is observed in Andorra, Azerbaijan, Belarus, Georgia, Greece, Kazakhstan, the former Yugoslav Republic of Macedonia, Montenegro and Turkey. At the other end of the scale are countries where more than 30 % of all higher education students can be found in ISCED 7 programmes, namely Austria, Bulgaria, Croatia, the Czech Republic, Cyprus, France, Germany, Italy, Liechtenstein, Luxembourg, Poland, Portugal, Romania, Slovakia and Sweden.” (p. 94)

“Only a dozen countries were able to supply national statistics (including estimates) on the proportion of short-cycle graduates continuing their studies in the first cycle. The highest proportion – between 50 % and 74.9 % – is reported by Andorra, France and Portugal. In Cyprus, Denmark, Ukraine and the United Kingdom (Scotland), the proportion is situated between 25 % and 49.9 %; while in Hungary, Italy, Norway, Sweden and Turkey, only up to 25 % of short-cycle graduates continue their studies in the first cycle.” (p. 103)

“In contrast, in 12 higher education systems (Albania, Andorra, Belgium–French Community, Bulgaria, Hungary, Kazakhstan, Lithuania, Luxembourg, Montenegro, Poland, Portugal and Ukraine), less than 5 % of second-cycle graduates eventually enter a doctoral-degree programme. In around half of all EHEA countries, the proportion is situated between 5 % and 20 %.” (p. 105)

Finland, Portugal and Switzerland do not define the duration of doctoral studies in their steering documents. However, in Finland, there are ongoing discussions aiming to set the duration of doctoral training at four years. Portugal indicates that while not stipulated in steering documents, the most common duration is aligned with the Salzburg Principles. In Switzerland, each university is responsible to define autonomously the duration of doctoral training, but in general it lasts three to four years.” (p. 107)

“A number of higher education systems use a flexible approach to ECTS in doctoral programmes. For example, in Finland, there are no regulations on the length or workload of third-cycle programmes, but ECTS credits commonly cover taught elements. In Croatia, the Czech Republic, Liechtenstein, Portugal and Romania, regulations do not have a prescriptive character regarding the use of ECTS in doctoral programmes. This means that higher education institutions can decide autonomously whether and to what extent they use ECTS.” (p. 108)

“Croatia, the Czech Republic, Germany, Italy, Lithuania, Norway and Portugal also report a substantial number of fields in which integrated programmes exist (all, or almost all fields depicted by Figure 3.15) and, at the same time, almost all these countries (except Lithuania) register a relatively higher proportion of students in integrated programmes.” (p. 110)

“Completing the self-certification of the NQF to the QF-EHEA (step 10) makes qualifications more visible, comparable and understandable for other countries. Through this process a country proves that its NQF is compatible with the QF-EHEA and that the common European principles – in particular related to the use of learning outcomes, credits, quality assurance, the involvement of stakeholders – are respected. Bulgaria, Cyprus and Romania have completed their self-certification processes since 2015 but their reports and the final NQFs are not available online. By 2018, self-certification reports and NQFs of 30 higher education systems can be consulted on a public website (step 11). Austria, Iceland, Montenegro, Portugal and Turkey have made public their self-certification reports since 2015.” (p. 121)

“The most widespread use by national authorities in 34 of the 44 systems that have established an NQF is coordinating policy developments across different educational levels and sectors. For example, according to a report by Cedefop, most NQFs for higher education are integrated into comprehensive NQFs for lifelong learning that cover all levels and sectors of education (Cedefop, 2016). These comprehensive NQFs provide a common set of learning outcomes for developing
standards and qualifications for schools, higher education, vocational education and training, adult education and, in some cases, non-formal and informal learning. In Estonia, the NQF is also linked to the development of a lifelong learning strategy. In Croatia, Denmark and Portugal, the NQF coordination group provides a forum for regular cross-education discussions; similarly, in the United Kingdom (Scotland), the framework supports so-called learner journey discussions.” (p. 123)

“Twenty-nine systems report that higher education institutions are formally required to use the NQF and its features in qualification and programme design, and a
further eight countries indicate that (although not required) institutions usually use NQFs for these purposes. Some countries (Denmark, Hungary, Latvia, Lithuania, Portugal, Slovenia and the United Kingdom – Scotland) require higher education institutions to specify the NQF level of the qualification in the Diploma Supplement and other documentation related to the diploma (see also 3.2.1).” (p. 123)

Chapter 5: Opening Higher Education to a Diverse Student Population

“In the first group of countries (Group 1), which includes Malta, Portugal and Turkey, the proportion of people with tertiary education in the 45-64 age group is low (around or below 15 %), and the share of the population aged 45-64 with low educational attainment (ISCED 0-2) is high (above 68 %). At the same time, the share of first-cycle new entrants coming from families with low educational background is the highest in these three countries (above 35 % in Portugal and Malta, and more than 55 % in Turkey), though these proportions are still lower than the share of people with low education attainment in their parents’ cohort. On the other hand, new entrants from families with medium educational attainment (ISCED 3-4) are relatively over-represented: while the share of people with medium educational attainment is between 12 % and 21 % in these three countries, the proportion of new entrants with this educational background is between 20 % and 36 %. In other words, the strong and comparatively recent higher education expansion (see also Section 5.2.1) has created opportunities particularly for learners from medium educated families to access higher education in these countries.” (p. 157)

“In six countries (Sweden, Denmark, Portugal, Norway, Austria and Russia), the higher the level, the lower the share of female entrants. In Portugal and Norway, nevertheless, the share of female entrants is above 50 % at all levels. In the other four countries, women are in a minority in the third cycle.” (p. 162)

“According to the latest Eurostudent survey, international students are a more sizeable group than firstgeneration immigrants in almost all countries, with the exception of Croatia, Portugal and Slovakia (see Figure 5.6). First-generation immigrant students have the largest share among all students in Ireland (11 %), Sweden (8 %), Denmark and Switzerland (7 %). The share of international students is above 10 % in Austria, Finland, France, Ireland, Sweden and Switzerland (in Austria and Finland, their proportion is 20 % or higher). ” (p. 164)

“In comparison to 2011/12, more countries registered increases than decreases in the share of mature students. However, the decreases have been more substantial than the increases. Consequently, the EHEA median decreased slightly from 16.1 % to 15.7 %. The largest decrease was registered in Andorra (10.9 percentage points), followed by Cyprus (8.8 percentage points), Turkey (6.3 percentage points) and Bulgaria (5.3 percentage points). In contrast, the education system registering the largest increase in this period is Slovenia (3.8 percentage points), followed by Austria (3.7 percentage points), the United Kingdom (3.5 percentage points), Portugal (3.3 percentage points) and Slovakia (3.2 percentage points).” (p. 166)

“Frameworks for the recognition of prior learning exist primarily in western European countries. In most cases, a recognition procedure is enough for applicants to gain access to (selected) higher education programmes. Nevertheless, such a recognition procedure is not always compulsory for all higher education institutions, but is an option institutions can choose to apply in their admission procedure. Furthermore, as Figure 5.15 shows, in three countries – Austria, Germany and Portugal – the recognition procedure in itself is not enough for applicants to gain access to higher education: they also have to pass an additional entrance examination. (…) these examinations should be open to a wider group of learners (e.g. all applicants or applicants over a certain age). Such special entrance examinations exist in Andorra, Austria (Studienberechtigungsprüfung), the French Community of Belgium, Luxembourg, the Netherlands (colloquium doctum), Portugal and Spain (see Figure 5.15).” (p. 177)

“When looking at students entering higher education with standard qualifications obtained later in life (i.e. through second-chance routes), their proportion is relatively substantial in some countries, especially in the Netherlands (23 %), Iceland (23 %), Portugal (19 %) and Malta (18 %). In most other countries, however, even their participation in higher education is very low.” (p. 179)

More than three-quarters of participating students claimed to pay fees in the Netherlands, Switzerland, Iceland, Albania, Portugal, Norway, Ireland and Slovenia.” (p. 181)

In 14 countries, fee amounts are not influenced by students’ socio-economic background. Data shows that in these countries either all students pay the same amount (Iceland, Liechtenstein and Portugal) or other criteria determine which students pay fees and how much they pay. The most common criteria are the study field, whether a student has a different status from the full-time status (part-time students, distance learning; see Figure 2.18) or academic performance.” (p. 182)

“In some countries, a higher share of first-cycle students receives grants than second-cycle students. In Portugal, Slovakia and the United Kingdom (Scotland), more than 10 % of students are targeted by need-based grants in the first cycle, and less than 10 % in the second cycle. While the current data set does not allow looking at the actual percentage point differences, the different proportions may indicate that governments make a policy choice to provide student support to a broader pool of students in the first cycle. By this measure they may aim to widen access to the first cycle of higher education for under-represented groups.” (p. 188)

In countries like the Netherlands, Switzerland, Iceland and Portugal, where all students pay fees, there is no difference in the share of fee-payers among recipients and non-recipients of support. In France, Ireland and Italy, the higher share of fee-payers among non-recipient of support reflects a policy where disadvantaged students receive a fee-waiver and a need-based grant at the same time. A different policy is followed in Hungary, Latvia, Romania and Serbia, where students who study in non-state funded places are not eligible for any or at least some support (in particular grants).” (p. 191)

Drop-out rates are also systematically calculated in the majority of the countries at the end of each year. Nevertheless, nine countries (Iceland, Ireland, Italy, the
Netherlands, Portugal, Spain, Sweden, Switzerland and the United Kingdom) measure drop-out rates only after the first year.(…) In addition, in Estonia, Portugal and Slovenia, information portals providing data on completion and drop-out have been or are in the process of being set up.” (p. 201)

“Yet, there are large variations among education systems regarding such limitations. Some countries specify the maximum number of credits – for example 10 (in Liechtenstein) or 12 ECTS (in Italy) – that can be awarded on the basis of prior learning within a higher education programme. Others define the maximum amount of credits to be gained as a proportion of all credits necessary to complete a higher education programme. For example, in Portugal, one third of all credits can be gained through recognition procedures within a cycle.” (p.208)

“Twelve education systems are in the light green category. In these cases, two possibilities exist. First, there could be nationally established procedures, guidelines or policy for the recognition of prior learning as a basis for both accessing higher education programmes and the allocation of credits towards a qualification, but these procedures are not monitored regularly. This is the case in Germany, Norway and Portugal (where the procedures for the recognition of prior learning for progression are not monitored), and the French Community of Belgium, Liechtenstein, Luxembourg, Spain, Sweden and the United Kingdom (with no central level monitoring).” (p. 209)