multinational comparisons of health systems data, 2017 › sites › default › ...note: growth...

Roosa Tikkanen

The Commonwealth Fund

Multinational Comparisonsof Health Systems Data, 2017

Health Care Spending

3

Current expenditures on health per capita, adjusted for current US$ purchasing power parities (PPPs). Based on

System of Health Accounts methodology, with some differences between country methodologies (Dutch and Swiss data

excludes spending on capital formation of health care providers; Data for Australia uses narrower definition for long-

term care spending than other countries).

Source: OECD Health Data 2017.

HEALTH CARE SPENDING

Health Care Spending per Capita, 2000–2016Adjusted for Differences in Cost of Living

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000

11,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

US ($9,892)

SWIZ ($7,919)

NOR ($6,647)

GER ($5,551)

SWE ($5,488)

NETH ($5,385)

AUS ($4,708)

CAN ($4,644)

FRA ($4,600)

UK ($4,192)

NZ ($3,590)

Dollars ($US)

4

* Data from 2014 in Australia, and 2013 for New Zealand. Current expenditures on health, adjusted for US$ purchasing

power parities (PPPs). Numbers may not sum to total health care spending per capita due to excluding capital

formation of health care providers, and some uncategorized health care spending. ^ Spending by government and

compulsory schemes, including private insurance schemes.



Health Care Spending per Capita by Source of Funding, 2015*Adjusted for Differences in Cost of Living

2848 3024 3286 3575 31814406 4521 4275

5286 4821 4692

267630 229

647688

60 161 373

20 579

3761

430

839610 308 664

800 671 649

883

2136

1054

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000

NZ AUS UK FRA CAN SWE GER NETH NOR SWIZ US

Out-of-pocket spending Private, voluntary spending Public spending^

Dollars ($US)

5

Note: Growth rates for Norway calculated using the GDP Deflator for Mainland Norway.

Source: OECD Health Data 2017,


Annual Growth Rate of Real Health Care Spending per Capita, 2015-2016Adjusted for Differences in Cost of Living

0.08 0.09 0.21

0.34

1.00

1.47

2.32

2.56 2.70 2.73

3.45

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

UK NETH FR NZ CAN NOR GER AUS US SWE SWIZ

Percent (%)

OECD

MEDIAN

6

* Or nearest year; data from 2014 for Australia and Canada, 2012 for the Netherlands, 2010 for the US. No recent data

for New Zealand (since 2007). Data calculated as: (Current expenditures on hospitals in current prices, current PPPs /

Number of discharges).



Hospital Spending per Discharge, 2015*Adjusted for Differences in Cost of Living

6,122

10,874 11,149

13,201 13,43314,375 14,905 15,483

16,244

21,186

0

5,000

10,000

15,000

20,000

25,000

GER AUS FR SWE UK NETH NOR SWIZ CAN US

Dollars ($US)

OECD

MEDIAN

7

Notes: US refers to the commercial average. Data on non-US fees come from both government sources and data files

of IFHP member plans.

Source: International Federation of Health Plans (IFHP), 2015 Comparative Price Report.


Total Hospital and Physician Costs, 2015Adjusted for Differences in Cost of Living

$14,579

$24,059$28,888

$32,480

$34,224

$78,318

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

$90,000

SPA UK AUS NZ SWIZ US

Bypass Surgery

$2,003

$3,814

$6,040$6,199

$8,009

$15,930

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

$18,000

$20,000

SPA AUS SWIZ NZ UK US

Appendectomy

Dollars ($US) Dollars ($US)

8

* Or nearest year; data from 2014 for Canada and Australia. No recent data available for New Zealand (since 2007).

Current expenditures on pharmaceuticals (prescribed and over-the-counter medicines) and other medical non-durables, per capita,

adjusted for current US$ PPPs), representing retail spending of pharmaceuticals delivered outside provider settings.



Pharmaceutical Spending per Capita, 2015*Adjusted for Differences in Cost of Living

417474 497 519

617668

766 786

1,056

1,162

0

100

200

300

400

500

600

700

800

900

1,000

1,100

1,200

NETH NOR UK SWE AUS FR GER CAN SWIZ US

Dollars ($US)

OECD

MEDIAN

9

* Or nearest year; data from 2014 for Australia and Canada. No recent data for New Zealand (since 2007). Data reflect

current spending on governance and health system and financing administration, in current prices, current PPPs.



Spending on Health Insurance Administration per Capita, 2015*Adjusted for Differences in Cost of Living

3489 90

123 141

206255 272 286

787

0

100

200

300

400

500

600

700

800

900

NOR SWE UK AUS CAN NETH GER FR SWIZ US

Dollars ($US)

OECD

MEDIAN

10

Source: E.H. Bradley, L.A. Taylor, H.V. Fineberg, The American Health Care Paradox: Why Spending

More is Getting Us Less, Public Affairs, 2013.


Health vs Social Care Spending, % GDPAdjusted for Differences in Cost of Living

12% 12% 11% 12%16%

9% 8% 9% 10% 9%

21% 21%

18% 15%9%

16%15% 11% 10%

11%

0%

5%

10%

15%

20%

25%

30%

35%

40%

FR SWE GER NETH US NOR UK NZ CAN AUS

Health care Social care

Percent (%)

Health Care Resource Supply & Workforce

12

Data reflect head counts per 1,000 population. Data for physicians represent practicing physicians except for Canada,

France, Netherlands and Switzerland (Professionally Active Physicians). Data for nurses reflect practicing nurses except

for France, Netherlands and US (Professionally Active Nurses). *2014 data; ** 2013 data.

Source: OCED Health Data 2017

HEALTH CARE RESOURCE SUPPLY & WORKFORCE

Doctors and Nurses, 2000-2015

0

2

4

6

8

10

12

14

16

18

20

2000 2005 2010 2015

SWIZ (18.0)

NOR (17.3)

GER (13.3)

NETH(12.2**)

AUS (11.5)

US (11.3)

SWE (11.1*)

NZ (10.3)

FR (9.9)

CAN (9.9)

UK (7.9)0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

2000 2005 2010 2015

NOR (4.4)

SWIZ (4.3)

GER (4.1)

SWE (4.2*)

AUS (3.5)

FR (3.3)

NETH(3.3**)

NZ (3.0)

UK (2.8)

CAN (2.7)

US (2.6*)

Physicians NursesPer 1,000 population Per 1,000 population

13

Total hospital beds per 1,000 population. *2014 data; **2013 data.

Source: OCED Health Data 2017

HEALTH CARE RESOURCE SUPPLY & WORKFORCE

Hospital Beds, 2000-2015Per 1,000 population

0

1

2

3

4

5

6

7

8

9

10

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

GER (8.1)

FRA (6.1)

SWIZ (4.6)

NETH (4.2**)

NOR (3.8)

AUS (3.8*)

US (2.8*)

NZ (2.7)

CAN (2.6)

UK (2.6)

SWE (2.4)

Beds per 1,000

Health Utilization

15

* Or nearest year; 2014 for France; 2012 for Switzerland and New Zealand; 2011 for United States. No recent data for

the UK (since 2009). Data reflect consultations delivered in all settings, including in the patient’s home, but excluding

telephone and email contacts.


HEALTH UTILIZATION

Doctor Consultations per Capita, 2015*

2.9

3.7 3.9 4.04.3

6.3

7.47.7

8.2

10.0

0

2

4

6

8

10

12

SWE NZ SWIZ US NOR FR AUS CAN NETH GER

OECD

MEDIAN

Consultations/capita

16

* Or nearest year; data from 2014 for New Zealand; 2012 for Netherlands; and 2010 for the US. No recent data for

Australia (since 1999).


HEALTH UTILIZATION

Hip Replacements, 2015*Inpatient cases

148161

182

204

228 233 240 244

299 308

0

50

100

150

200

250

300

350

CAN NZ UK US NETH SWE FR NOR GER SWIZ

Surgical procedures per 100,000 population

OECD

MEDIAN

17

*2014 data; **2012 data; ***2010 data. Length of inpatient stays reflect all hospitals, except for Canada and the

Netherlands, data for which reflect curative care average length of stay (excluding rehabilitative care, long-term care

and palliative care). Discharges reflect total number for all causes.


HEALTH UTILIZATION

Hospital length of stay and discharges, 2000-2015*

0

50

100

150

200

250

300

2000 2005 2010 2015

GER (255)

AUS (174*)

SWIZ (170)

NOR (168)

FR (163)

SWE (153)

NZ (150*)

UK (128)

US (126***)

NETH (119**)

CAN (84)

Discharges

0

2

4

6

8

10

12

14

2000 2005 2010 2015

FRA(10.1*)

GER (9.0)

SWIZ (8.4)

CAN (7.4)

UK (7.0)

NZ (6.8*)

NOR (6.7)

NETH(6.2)

US (6.1*)

SWE (5.9)

AUS (5.5*)

Average Length of Inpatient Stay

Days Per 1,000

Prevention and Population Health

19

^ Or nearest year: * 2014 data; ** 2013 data; *** 2012 data. (M) Measured; (SR) Self-reported.


PREVENTION AND POPULATION HEALTH

Select population health indicators, 2015^Life expectancy at birthYears

Infant mortality Deaths per 1,000 live births

Obesity rate Percent (%) SM, self-reported; M, measured

Daily smokers Percent (%) of population over 15 years

Australia 82.5 3.2 27.9 (M)* 13**

Canada 81.7 ** 4.8 *** 25.8 (M) ** 14*

France 82.4 3.7 15.3 (SR) * 22.4*

Germany 80.7 3.3 23.6 (M) *** 20.9**

Netherlands 81.6 3.3 12.8 (SR) 19

New Zealand 81.7 5.0 ** 30.7 (M) 15

Norway 82.4 2.3 12.0 (SR) 13

Sweden 82.3 2.5 12.3 (SR) 11.2

Switzerland 83 3.9 10.3 (SR) *** 20.4***

United Kingdom 81 3.9 26.9 (M) 19*

United States 78.8 5.8 * 38.2 (M) * 11.4*

OECD average 80.6 3.9 19.1 (M/SR) 18.9

20

* Or nearest year; 2014 data for Netherlands, Germany; 2012 data for Switzerland; 2011 data for Canada.

^ OECD median based on program data.

Note: US, Switzerland, based on survey data; all other countries based on program data. No data for Sweden.



Breast Cancer Screening Rates, 2015*Among women 50-69 years

80 7975 75

72

55 54 5249 47

0

20

40

60

80

100

US NETH NOR UK NZ AUS GER FR CAN SWIZ

Percent (%) screened

OECD MEDIAN ^

21

Data reflect influenza immunizations. * Or nearest year; 2010 data for Switzerland. No recent data for Australia (since

2009). Change in methodology for Germany between 2012-2013; data for 60+ for Germany. For Sweden, data are

collected only during the winter season. Change in survey in the Netherlands in 2010. Change in survey instrument for

Canada in 2015.



Flu Immunizations, 2005 and 2015*Among older adults aged 65 or older

59

44

61

77

34

71

79

49

61

51

71 69 67 6762

51 4946

37

27

0

20

40

60

80

100

UK US NZ NETH CAN FR SWE SWIZ GER NOR

2005 2015

Percent (%) immunized

22

* Or nearest year; data from 2013 for Switzerland, France, UK; 2012 for Canada, New Zealand. Data reflect deaths

caused by neoplasms. All countries (except Denmark) use ICD 9 in 1994 and ICD10 for 2014.



Mortality as a result of cancer, 1994 and 2014*

244 249

213

250 244252

264253

267 272 279

182192 193 193

203 205 207 212 215227

238

0

50

100

150

200

250

300

SWIZ AUS SWE US NOR FR GER CAN NZ UK NETH

1994 2014

Deaths per 100,000 population

23

* Or nearest year; data from 2013 for Switzerland, France, UK; 2012 for Canada, New Zealand. Data reflect deaths

caused by all types of ischemic heart diseases including acute myocardial infarction. All countries (except Denmark)

use ICD 9 in 1994 and ICD10 for 2014.



Mortality as a result of ischemic heart disease, 1994 and 2014*

79

159

216

150

241

205

261

234223 229

257

3948

72 7885

93 98 99 106113

129

0

50

100

150

200

250

300

FR NETH NOR SWI SWIZ CAN UK SWE GER US NZ

1994 2014

Deaths per 100,000 population

Quality Indicators

25

* Or nearest year; data from 2012 in Switzerland, US and New Zealand. Data from 2011 in Netherlands. Data are for

individuals aged 15 years and older, reflecting age- and sex-adjusted rates.


QUALITY INDICATORS

Diabetes Hospital Admissions in Adults, 2013*

44

64 6876

95

111

141

181187

198

216

0

50

100

150

200

250

SWIZ UK NETH NOR CAN SWE AUS FR NZ US GER

Age-sex standardized rates per 100,000

OECD MEDIAN

26

* Or nearest year; data from 2012 in Switzerland, US and New Zealand. Data from 2011 in Netherlands. Data are for

individuals aged 15 years and older, reflecting age- and sex-adjusted rates.


QUALITY INDICATORS

COPD Hospital Admissions in Adults, 2013*

101120

164

192213 217 222

243 245

324 326

0

50

100

150

200

250

300

350

SWIZ FRA NETH SWE UK US NOR CAN GER AUS NZ

Age-sex standardized rates per 100,000

OECD MEDIAN

27

QUALITY INDICATORS

Mortality Amenable to Health Care, 2000 and 2014*

*Trends in amenable mortality for selected countries, 2000-2014. Data from 2014 in all countries except Canada (2011),

France (2013), Netherlands (2013), NZ (2012), Switzerland (2013), UK (2013). WHO Mortality files (number of deaths by age

group) and populations (except Human Mortality Database for Canada, UK and the USA). List of amenable causes: Nolte &

McKee 2004 (Australia, Canada, NZ, Nor, US) Calculations by European Observatory on Health Systems and Policies (2016),

Amenable mortality causes based on Nolte & McKee, 2004.Mortality and population data from WHO mortality files,

released September 2016 (population data for Canada and the USA from Human Mortality Database). Age-specific rates

standardised to European Standard Population 2013.

Source: Marina Karanikolos, European Observatory on Health Systems and Policies (2017).

90 90

108117

111

121

110

131

145

135

149

5561 62 64

69 7278

83 85 87

112

0

20

40

60

80

100

120

140

160

SWIZ FRA AUS NOR SWE NETH CAN GER UK NZ US

2000 2014

Deaths per 100,000

Aging Populations

29


AGING POPULATIONS

Share of older adults, 2016

11 11 11 12 1214 13 13 13

15 15

3.6 3.8 3.94.2 4.2

4.4 4.8 5 5.95.1

5.8

0

5

10

15

20

25

NZ US AUS NOR CAN NETH UK SWIZ FRA SWE GER

65-79 year-olds 80+ year-olds

Percent of total population (%)

30


AGING POPULATIONS

Trends in the share of older adults aged 80 years and older, 1980-2015

0

1

2

3

4

5

6

7

1980 1985 1990 1995 2000 2005 2010 2015

FR (5.9)

GER (5.8)

SWE (5.1)

SWIZ (5.0)

UK (4.8)

NETH (4.4)

CAN (4.2)

NOR (4.2)

AUS (3.9)

US (3.8)

NZ (3.6)

Percent of total population (%)

31

*2014 data; **2013 data; ***2012 data. Note: The diagnosis of dementias relies on clinical judgement and as such is subject to interpersonal variation. Further, prevalence data is influenced by changes to diagnostic criteria and advances in diagnostic technology over time, as well as public awareness of dementia. These factors may introduce heterogeneity within and between countries. Time trends must therefore be interpreted with caution. See further details in Wu, et al. Nat Rev Neurol 2017;13:327-39.


AGING POPULATIONS

Mortality from dementia, 2000-2015

0

10

20

30

40

50

60

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

NETH (53.9)

UK (53.9**)

SWE (43.2)

SWIZ (42.7**)

US (41.3*)

CAN (36.6***)

NOR (36.5*)

AUS (34.9*)

NZ (30.4***)

GER (24.7*)

FR (17.2**)

Deaths per 100,000

multinational comparisons of health systems data, 2017 › sites › default › ...note: growth...

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