Multinational Comparisons of Health Systems Data, Roosa Tikkanen The Commonwealth Fund

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1 Multinational Comparisons of Health Systems Data, 217 Roosa Tikkanen The Commonwealth Fund

2 Health Care Spending

3 HEALTH CARE SPENDING Health Care Spending per Capita, Adjusted for Differences in Cost of Living Dollars ($US) 11, 1, 9, 8, 7, 6, 5, 4, 3, 2, 1, 216 data: US ($9,892) SWIZ ($7,919) NOR ($6,647) GER ($5,551) SWE ($5,488) NETH ($5,385) AUS ($4,78) CAN ($4,644) FRA ($4,6) UK ($4,192) NZ ($3,59) Current expenditures on health per capita, adjusted for current US$ purchasing power parities (PPPs). Based on System of Health Accounts methodology, with some differences between country methodologies (Data for Australia uses narrower definition for long-term care spending than other countries). Source: OECD Health Data

4 HEALTH CARE SPENDING Health Care Spending per Capita by Source of Funding, 215* Adjusted for Differences in Cost of Living Dollars ($US) 1, Out-of-pocket spending Private, voluntary spending Public spending^ 9, 154 8, 7, 6, 5, 4, 3, 2, 1, NZ AUS UK FRA CAN SWE GER NETH NOR SWIZ US * Data from 214 in Australia, and 213 for New Zealand. Current expenditures on health, adjusted for US$ 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. Source: OECD Health Data

5 HEALTH CARE SPENDING Annual Growth Rate of Real Health Care Spending per Capita, Adjusted for Differences in Cost of Living Percent (%) OECD MEDIAN UK NETH FR NZ CAN NOR GER AUS US SWE SWIZ Notes: Growth rates for Norway calculated using the GDP Deflator for Mainland Norway. OECD median reflects the median of 35 OECD countries. Source: OECD Health Data

6 HEALTH CARE SPENDING Hospital Spending per Discharge, 215* Adjusted for Differences in Cost of Living Dollars ($US) 25, 21,186 2, 15, 13,21 13,433 14,375 14,95 15,483 16,244 1, OECD MEDIAN 1,874 11,149 6,122 5, GER AUS FR SWE UK NETH NOR SWIZ CAN US * Or nearest year; data from 214 for Australia and Canada, 212 for the Netherlands, 21 for the US. No recent data for New Zealand (since 27). Data calculated as: (Current expenditures on hospitals in current prices, current PPPs / Number of discharges). OECD median reflects the median of 35 OECD countries. Source: OECD Health Data

7 HEALTH CARE SPENDING Total Hospital and Physician Costs, 215 Adjusted for Differences in Cost of Living Bypass Surgery Appendectomy Dollars ($US) Dollars ($US) $9, $2, $8, $7, $78,318 $18, $16, $15,93 $6, $14, $5, $12, $4, $3, $34,224 $28,888 $32,48 $24,59 $1, $8, $6, $8,9 $6,4$6,199 $2, $1, $14,579 $4, $2, $3,814 $2,3 $ $ SPA UK AUS NZ SWIZ US SPA AUS SWIZ NZ UK US 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), 215 Comparative Price Report. 7

8 HEALTH CARE SPENDING Pharmaceutical Spending per Capita, 215* Adjusted for Differences in Cost of Living Dollars ($US) 1,2 1,1 1, 1,56 1, OECD MEDIAN NETH NOR UK SWE AUS FR GER CAN SWIZ US * Or nearest year; data from 214 for Canada and Australia. No recent data available for New Zealand (since 27). Current expenditures on pharmaceuticals (prescribed and over-the-counter medicines) and other medical nondurables, per capita, adjusted for current US$ PPPs), representing retail spending of pharmaceuticals delivered outside provider settings. OECD median reflects the median of 35 OECD countries. Source: OECD Health Data

9 HEALTH CARE SPENDING Spending on Health Insurance Administration per Capita, 215* Adjusted for Differences in Cost of Living Dollars ($US) OECD MEDIAN NOR SWE UK AUS CAN NETH GER FR SWIZ US * Or nearest year; data from 214 for Australia and Canada. No recent data for New Zealand (since 27). Data reflect current spending on governance and health system and financing administration, in current prices, current PPPs. OECD median reflects the median of 34 OECD countries. Source: OECD Health Data

10 HEALTH CARE SPENDING Health vs Social Care Spending, % GDP Adjusted for Differences in Cost of Living Percent (%) 4% 35% Health care Social care 3% 25% 2% 21% 21% 18% 15% 9% 15% 16% 15% 11% 1% 11% 1% 5% 12% 12% 11% 12% 16% 9% 8% 9% 1% 9% % FR SWE GER NETH US NOR UK NZ CAN AUS Source: E.H. Bradley, L.A. Taylor, H.V. Fineberg, The American Health Care Paradox: Why Spending More is Getting Us Less, Public Affairs,

11 Health Care Resource Supply & Workforce

12 HEALTH CARE RESOURCE SUPPLY & WORKFORCE Doctors and Nurses, Physicians NOR (4.4) 2 Nurses Per 1, population 215 data: Per 1, population 215 data: SWIZ (18.) 4.5 SWIZ (4.3) 18 NOR (17.3) 4. GER (4.1) 16 GER (13.3) SWE (4.2*) AUS (3.5) NETH (12.2**) AUS (11.5) 2.5 FR (3.3) 1 US (11.3) 2. NETH (3.5**) 8 SWE (11.1*) 1.5 NZ (3.) 6 NZ (1.3) 1. UK (2.8) 4 FR (9.9).5 CAN (2.7) 2 CAN (9.9) US (2.6*) UK (7.9) Data reflect head counts per 1, 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). *214 data; ** 213 data. Source: OCED Health Data

13 HEALTH CARE RESOURCE SUPPLY & WORKFORCE Hospital Beds, Per 1, population Beds per 1, data: 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) Total hospital beds per 1, population. *214 data; **213 data. Source: OCED Health Data

14 Health Utilization

15 HEALTH UTILIZATION Doctor Consultations per Capita, 215* Consultations/capita OECD MEDIAN SWE NZ SWIZ US NOR FR AUS CAN NETH GER * Or nearest year; 214 for France; 212 for Switzerland and New Zealand; 211 for United States. No recent data for the UK (since 29). Data reflect consultations delivered in all settings, including in the patient s home, but excluding telephone and contacts. OECD median reflects the median of 35 OECD countries. Source: OECD Health Data

16 HEALTH UTILIZATION Hip Replacements, 215* Inpatient cases Surgical procedures per 1, population OECD MEDIAN CAN NZ UK US NETH SWE FR NOR GER SWIZ * Or nearest year; data from 214 for New Zealand; 212 for Netherlands; and 21 for the US. No recent data for Australia (since 1999). OECD median reflects the median of 3 OECD countries. Source: OECD Health Data

17 HEALTH UTILIZATION Hospital length of stay and discharges, 2-215* 12 Average Length of Inpatient Stay SWIZ (8.4) 25 Discharges Days 215 data: Per 1, 215 data: 14 FRA (1.1*) 3 GER (255) GER (9.) AUS (174*) SWIZ (17) 1 8 CAN (7.4) UK (7.) NZ (6.8*) 2 15 NOR (168) FR (163) SWE (153) NOR (6.7) NETH (6.2) US (6.1*) SWE (5.9) 1 5 NZ (15*) UK (128) US (126***) NETH (119**) AUS (5.5*) CAN (84) *214 data; **212 data; ***21 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. Source: OECD Health Data

18 Prevention and Population Health

19 PREVENTION AND POPULATION HEALTH Select population health indicators, 215^ Life expectancy at birth Years Infant mortality Deaths per 1, live births Obesity rate Percent (%) SM, self-reported; M, measured Daily smokers Percent (%) of population over 15 years Australia (M)* 13** Canada 81.7 ** 4.8 *** 25.8 (M) ** 14* France (SR) * 22.4* Germany (M) *** 2.9** Netherlands (SR) 19 New Zealand ** 3.7 (M) 15 Norway (SR) 13 Sweden (SR) 11.2 Switzerland (SR) *** 2.4*** United Kingdom (M) 19* United States * 38.2 (M) * 11.4* OECD median (M/SR) 18.9 ^ Or nearest year: * 214 data; ** 213 data; *** 212 data. (M) Measured; (SR) Self-reported. OECD median reflects the median of 35 OECD countries. Source: OECD Health Data

20 PREVENTION AND POPULATION HEALTH Breast Cancer Screening Rates, 215* Among women 5-69 years Percent (%) screened OECD MEDIAN ^ US NETH NOR UK NZ AUS GER FR CAN SWIZ * Or nearest year; 214 data for Netherlands, Germany; 212 data for Switzerland; 211 data for Canada. ^ OECD median based on data for 28 OECD countries (26 countries based on program data; 2 based on survey data). Note: US, Switzerland, based on survey data; all other countries based on program data. No data for Sweden. Source: OECD Health Data

21 PREVENTION AND POPULATION HEALTH Flu Immunizations, 25 and 215* Among older adults aged 65 or older Percent (%) immunized UK US NZ NETH CAN FR SWE SWIZ GER NOR Data reflect influenza immunizations. * Or nearest year; 21 data for Switzerland. No recent data for Australia (since 29). Different methodologies used between time periods in Germany; German data reflects 6+ population. For Sweden, data are collected only during the winter season. Change in survey in the Netherlands in 21. Change in survey instrument for Canada in 215. Source: OECD Health Data

22 PREVENTION AND POPULATION HEALTH Mortality as a result of cancer, 1994 and 214* Deaths per 1, population SWIZ AUS SWE US NOR FR GER CAN NZ UK NETH * Or nearest year; data from 213 for Switzerland, France, UK; 212 for Canada, New Zealand. Data reflect deaths caused by neoplasms. All countries (except Denmark) use ICD 9 in 1994 and ICD1 for 214. Source: OECD Health Data

23 PREVENTION AND POPULATION HEALTH Mortality as a result of ischemic heart disease, 1994 and 214* Deaths per 1, population FR NETH NOR SWI AUS CAN UK SWE GER US NZ * Or nearest year; data from 213 for Switzerland, France, UK; 212 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 ICD1 for 214. Source: OECD Health Data

24 Quality Indicators

25 QUALITY INDICATORS Diabetes Hospital Admissions in Adults, 213* Age-sex standardized rates per 1, OECD MEDIAN SWIZ UK NETH NOR CAN SWE AUS FR NZ US GER * Or nearest year; data from 212 in Switzerland, US and New Zealand. Data from 211 in Netherlands. Data are for individuals aged 15 years and older, reflecting age- and sex-adjusted rates. OECD median reflects the median of 32 OECD countries. Source: OECD Health Data

26 QUALITY INDICATORS COPD Hospital Admissions in Adults, 213* Age-sex standardized rates per 1, OECD MEDIAN SWIZ FRA NETH SWE UK US NOR CAN GER AUS NZ * Or nearest year; data from 212 in Switzerland, US and New Zealand. Data from 211 in Netherlands. Data are for individuals aged 15 years and older, reflecting age- and sex-adjusted rates. OECD median reflects the median of 33 OECD countries. Source: OECD Health Data

27 QUALITY INDICATORS Mortality Amenable to Health Care, 2 and 214* Deaths per 1, SWIZ FRA AUS NOR SWE NETH CAN GER UK NZ US *Trends in amenable mortality for selected countries, Data from 214 in all countries except Canada (211), France (213), Netherlands (213), NZ (212), Switzerland (213), UK (213). 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 24 (Australia, Canada, NZ, Nor, US) Calculations by European Observatory on Health Systems and Policies (216), Amenable mortality causes based on Nolte & McKee, 24.Mortality and population data from WHO mortality files, released September 216 (population data for Canada and the USA from Human Mortality Database). Age-specific rates standardised to European Standard Population 213. Source: Marina Karanikolos, European Observatory on Health Systems and Policies (217). 27

28 Aging Populations

29 AGING POPULATIONS Share of older adults, 216 Percent of total population (%) year-olds 8+ year-olds NZ US AUS NOR CAN NETH UK SWIZ FRA SWE GER Source: OECD Health Data

30 AGING POPULATIONS Trends in the share of older adults aged 8 years and older, Percent of total population (%) data: FR (5.9) GER (5.8) SWE (5.1) SWIZ (5.) UK (4.8) NETH (4.4) CAN (4.2) NOR (4.2) AUS (3.9) US (3.8) NZ (3.6) Source: OECD Health Data

31 AGING POPULATIONS Mortality from dementia, Deaths per 1, data: 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 (3.4***) GER (24.7*) FR (17.2**) *214 data; **213 data; ***212 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 217;13: Source: OECD Health Data

Multinational Comparisons of Health Systems Data, 2016

Attachment F Multinational Comparisons of Health Systems Data, 216 Dana Sarnak The Commonwealth Fund Health Care Spending per Capita, 198 214 Adjusted for Differences in Cost of Living Dollars ($US) 9,