APPENDIX THE EVIDENCE: INTERNATIONAL MEDICAL OUTCOMES AND EXPENDITURE

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1 APPENDIX THE EVIDENCE: INTERNATIONAL MEDICAL OUTCOMES AND EXPENDITURE BENEDICT IRVINE AND DAVID G. GREEN This material was compiled by Civitas, which acknowledges support given by Reform. 1

2 CONTENTS 1. Commissioned Authors. Page 5 2. Subjective Indicators Page Patient satisfaction in European countries 3. Healthcare Funding and Expenditure Page Public expenditure on health care as a percentage of GDP 3.2 Public Expenditure on health care as % of total expenditure on health 3.3 Public expenditure on health care per capita, US$ PPP. 3.4 Public expenditure on health care per capita at US$ exchange rate. 3.5 Private expenditure on health care per capita, as % of total expenditure 3.6 Health expenditures by source of funds, as % of total health expenditures 3.7 Canadian expenditure on health 3.8 Canadian health expenditure by source of funds 3.9 Danish expenditure on health 3.1 Danish health expenditure by source of funds 3.11 French expenditure on health 3.12 French health expenditure by source of funds 3.13 German expenditure on health 3.14 German health expenditure by source of funds 3.15 Dutch expenditure on health 3.16 Dutch health expenditure by source of funds 3.17 Swiss expenditure on health 3.18 Hungarian expenditure on health 3.19 UK expenditure on health 3.2 UK health expenditure by source of funds 3.21 US expenditure on health 3.22 US health expenditure by source of funds 3.23 Breakdown of private expenditure as a percentage of total expenditure on health care in the European Union, Public investment in medical facilities as % of total expenditure on health 3.25 Public investment in medical facilities per capita, US$ PPP. 4. System Resources Page Number of doctors per 1, population, Number of specialists per 1 population, Number of beds in nursing homes and homes for elderly people per 1, population, Number of outpatient contacts per person in selected European countries, Doctor supply and patient choice in reference countries. 2

3 5. Standard Mortality Indicators Page Life expectancy at birth for males and females in the EU 5.2 Infant and maternal mortality rates in the EU 5.3 Standardised death rates in the EU (cancer, cardiovascular diseases, all causes) all ages per 1, population. 6. Cardiovascular Disease Indicators Page Standardised death rates from cardiovascular diseases per 1, population in the European Union, females and males, Diseases of the circulatory system: Mortality rate 6.3 Potential years life lost: Circulatory system disorders 6.4 Rate of cardiovascular surgeries by ICD-CM (table) 6.5 Rate of cardiovascular surgeries by ICD-CM (line graph) 6.6 Standardised death rates from ischaemic heart disease per 1, population in the European Union, females and males, Ischaemic heart disease mortality rate per 1, population 6.8 Potential years life lost: Ischaemic heart disease 6.9 Average length of stay: Ischaemic heart disease 6.1 Average length of stay: Diseases of the circulatory system 6.11 Acute myocardial infarction: Mortality rate 6.12 Potential years life lost: Acute myocardial infarction 6.13 Average length of stay: Acute myocardial infarction 6.14 Rate of coronary bypass surgery by ICD-CM (table) 6.15 Rate of coronary bypass surgery by ICD-CM (line graph) 6.16 Rate of coronary angioplasty by ICD-CM (table) 6.17 Rate of coronary angioplasty by ICD-CM (line graph) 7. Cancer Indicators Page Incidence of cancer in the EU, Standardised death rates from cancer per 1, population in the EU, females and males, EUROCARE II Study cancer survival rates (colon, lung, prostate, breast). 7.4 Colon cancer survival rates 7.5 Colon cancer survival rates females 7.6 Colon cancer survival rates males 7.7 Colon cancer survival rates males: 7.8 Colon cancer survival rates males; England 7.9 Colon cancer survival rates males; 7.1 Colon cancer survival rates males; 7.11 Prostate cancer: Age-standardised relative survival rates ( ) 7.12 Prostate cancer: Age-standardised relative survival rates and European averages ( ) 7.13 Breast cancer: Age-standardised relative survival rates ( ) 7.14 Breast cancer: Age-standardised relative survival rates and European averages ( ) 7.15 Trends in breast cancer mortality and incidence rates per 1, per country 7.16 Lung cancer: Age standardised survival rates in males ( ) 7.17 Lung cancer: Age standardised survival rates in females ( ) 3

4 8. Cerebrovascular Disease Indicators Page Cerebrovascular disease: Mortality rate (table) 8.2 Cerebrovascular disease: Mortality rate (line graph) 8.3 Potential years of life lost: Cerebrovascular Disease. 8.4 Average length of stay: Cerebrovascular Disease. Note: unless otherwise stated, the following material is from OECD Health Data, 21 and 22. Cancer indicators are taken from the published results of the EUROCARE II Study. 4

5 1. Commissioned Authors / Researchers Grace-Marie Arnett (USA) A specialist in tax reform and health care policy, Grace-Marie is Director of the Washington based Galen Institute. She founded the US Health Policy Consensus Group. Craig Bailey () For the past year, Craig has been carrying out research for Civitas on the effect of state funding on the UK hospice movement. He has recently completed his PhD in History at the University of London. Peter Gaal () A qualified medical doctor, Peter is Course Director at the Health Services Management Training centre at the University of Semmelweis. He is working his PhD (Informal Payments in Hungarian Health Services) at the University of London School of Hygiene and Tropical Medicine. Sarah Thomson () Sarah is based at LSE Health and Social Care. Since 2 she has been Research Officer at the European Observatory on Health Care Systems, where she is responsible for editing country reports on European health care systems. She edited the Danish Health Systems in Transition report last year, and also contributed towards the 8 country comparative study that accompanied the final Wanless Report of 22. Stephen Pollard () Stephen left his position as research director at the Fabian Society, to become leader and features writer at the Daily Express. He is Senior Research Fellow at Civitas and holds the same position at the Centre for New Europe, from where he runs the European Health Care Consensus Group. Benedict Irvine (, and and Project Co-ordination) Project manager of the Civitas Health Unit, with responsibility for the Health Policy Consensus Group. Shannon Ferguson (Health outcomes and funding research) Shannon was an intern at Civitas, while she studied for an MSc in Contemporary Health and Social Policy at City University, London. Silvana Reimann. ( and ) A political scientist, Silvana was an intern at Civitas while she was completing her Master s thesis at the University of Berlin. 5

6 2. SUBJECTIVE INDICATORS 2.1 Patient satisfaction in European Countries 1 Very 2 Fairly 3 Neither 4 Fairly 5 Very 6 Don't Very or fairly Very or fairly Country satisfied satisfied dissatisfied dissatisfied know Country satisfied dissatisfied 1 Belgium 11.6% 5.5% 22.2% 1.2% 4.6%.8% 1 Belgium 62.1% 14.78% % 28.7% 3.4% 3.5% 2.%.3% 2 9.8% 5.5% 3 West 1.7% 48.% 16.3% 15.8% 7.8% 1.% 3 West 58.7% 23.58% 4 Greece 2.9% 12.6% 24.8% 31.4% 28.%.3% 4 Greece 15.5% 59.43% 5 Italy 1.3% 19.% 24.3% 29.9% 23.7% 1.8% 5 Italy 2.3% 53.6% 6 Spain 7.9% 36.% 29.6% 19.2% 6.7%.6% 6 Spain 43.9% 25.9% % 53.6% 18.7% 11.3% 4.%.7% % 15.31% 8 Ireland 8.6% 49.7% 13.3% 14.3% 9.8% 4.3% 8 Ireland 58.3% 24.1% 9 N Ireland 13.2% 44.7% 14.8% 16.4% 1.3%.6% 9 N Ireland 57.9% 26.69% 1 Luxembourg 16.% 52.1% 17.5% 9.7% 2.% 2.5% 1 Luxembourg 68.15% 11.72% % 53.6% 8.1% 16.9% 4.7%.7% % 21.53% 12 Portugal.8% 15.7% 16.5% 26.3% 39.7% 1.% 12 Portugal 16.5% 66.% 13 G Britain 15.5% 43.3% 1.9% 2.1% 9.4%.8% 13 G Britain 58.86% 29.48% 14 E 6.4% 45.2% 21.2% 2.% 6.2% 1.2% 14 E 51.54% 26.12% 16 Finland 2.7% 6.9% 7.7% 9.1%.9%.8% 16 Finland 81.61% 9.96% 17 Sweden 12.3% 45.2% 14.6% 19.7% 6.3% 1.9% 17 Sweden 57.46% 26.5% 18 Austria 23.2% 5.9% 17.7% 5.1% 1.1% 2.% 18 Austria 74.11% 6.2% 6

7 3 HEALTHCARE FUNDING AND EXPENDITURE 3.1 Public Expenditure on Health Care as % of GDP Public Expenditure on Health as % of Gross Domestic Product 9 8 Expenditure as percentage of GDP United Kingdom United States Public Expenditure on Health Care as % of Total Expenditure on Health Public Expenditure on Health as a % of Total Expenditure on Health Percentage of Total Expenditure on Health United Kingdom United States

8 3.3 Public Expenditure on Health Care per Capita, US$ PPP. Public Expenditure on Health Per Capita, US$ Purchasing Power Parity 25 2 Expenditure per capita, US$ PPP 15 1 United Kingdom United States

9 3.4 Public Expenditure on Health Care per Capita at US$ Exchange Rate. Public Expenditure on Health Per Capita at US$ Exchange Rate 35 3 Expenditure per capita, US$ Exchange Rate United Kingdom United States

10 3.5 Private Expenditure on Health Care per Capita, as % of Total Expenditure 1

11 3.6 Health Expenditures by Source of Funds, as % of Total Health Expenditures Health Expenditures by Source of Funds, as % of Total Health Expenditures U.S U.K General Taxation Social Security Scheme Out-of-Pocket Payments Private Insurance and Other Priv. Schemes U.S U.K % 2% 4% 6% 8% 1% % of Total Expenditure on Health 11

12 3.7 Canadian Expenditure on Health - Expenditures on Health Million US$ PPP Private expend. on health - Million US$, PPP Public expend. on health - Million US$, PPP 3.8 Canadian Health Expenditure by Source of Funds - Health Expenditure by Source of Funds in 1998 Priv. insur.(except soc.) - % total exp. on health 1% Private social insurance - % total All other private exp. on health funds - % total exp. 1% on health 2% Out-of-pocket payments - % total exp. on health 17% Social security schemes - % total exp. on health 1% Gnrl. gvt., excl. soc.sec. - % total exp. on health 69% 12

13 3.9 Danish Expenditure on Health - Expenditures on Health Million US$ 8 PPP Private expend. on health - Million US$, PPP Public expend. on health - Million US$, PPP 3.1 Danish Health Expenditure by Source of Funds - Health Expenditure by Source of Funds in 1998 Out-of-pocket payments - % total exp. on health 16% Priv. insur.(except soc.) - % total exp. on health 2% Gnrl. gvt., excl. soc.sec. - % total exp. on health 82% 13

14 3.11 French Expenditure on Health - Expenditures on Health Million US$ 8 PPP Private expend. on health - Million US$, PPP Public expend. on health - Million US$, PPP 3.12 French Health Expenditure by Source of Funds - Health Expenditures by Source of Funds in 1999 Priv. insur.(except soc.) - % total exp. on health 5% Private social insurance - % total exp. on health 8% All other private funds - % total exp. on health 1% Gnrl. gvt., excl. soc.sec. - % total exp. on health 3% Out-of-pocket payments - % total exp. on health 1% Social security schemes - % total exp. on health 73% 14

15 3.13 German Expenditure on Health - Expenditures on Health 2 Million US$ PPP Private expend. on health - Million US$, PPP Public expend. on health - Million US$, PPP 3.14 German Health Expenditure by Source of Funds - Health Expenditure by Source of Funds in 1998 Priv. insur.(except soc.) - % total exp. on health 7% Out-of-pocket payments - % total exp. on health 13% All other private funds - % total exp. on health 4% Gnrl. gvt., excl. soc.sec. - % total exp. on health 6% Social security schemes - % total exp. on health 7% 15

16 3.15 Dutch Expenditure on Health - Expenditures on Health Million US$ PPP Private expend. on health - Million US$, PPP Public expend. on health - Million US$, PPP 3.16 Dutch Health Expenditure by Source of Funds - Health Expenditure by Source of Funds in 1998 Private social insurance - % total exp. on health 6% Priv. insur.(except soc.) - % total exp. on health 12% All other private funds - % total exp. on health 6% Gnrl. gvt., excl. soc.sec. - % total exp. on health 4% Out-of-pocket payments - % total exp. on health 8% Social security schemes - % total exp. on health 64% 16

17 3.17 Swiss Expenditure on Health - Expenditures on Health 25 Million US$ PPP Private expend. on health - Million US$, PPP Public expend. on health - Million US$, PPP 3.18 Hungarian Expenditure on Health - Expenditures on Health Million US$ PPP Private expend. on health - Million US$, PPP Public expend. on health - Million US$, PPP 17

18 3.19 UK Expenditure on Health United Kingdom - Expenditures on Health Million US$ PPP Private expend. on health - Million US$, PPP Public expend. on health - Million US$, PPP 3.2 UK Health Expenditure by Source of Funds United Kingdom - Health Expenditures by Source of Funds in 1998 Out-of-pocket payments - % total exp. on health 11% Priv. insur.(except soc.) - % total exp. on health 4% All other private funds - % total exp. on health 2% Social security schemes - % total exp. on health 1% Gnrl. gvt., excl. soc.sec. - % total exp. on health 73% 18

19 3.21 US Expenditure on Health United States - Expenditures on Health 12 1 Million US$ 8 6 PPP Private expend. on health - Million US$, PPP Public expend. on health - Million US$, PPP 3.22 US Health Expenditure by Source of Funds United States - Health Expenditure by Source of Funds in 1999 Private insurance - % total exp. on health 33% All other private funds - % total exp. on health 6% Out-of-pocket payments - % total exp. on health 16% Gnrl. gvt., excl. soc.sec. - % total exp. on health 3% Social security schemes - % total exp. on health 15% 19

20 3.23 Breakdown of private expenditure as a percentage of total expenditure on health care in the European Union, Country Overall growth ( per cent)* Overall growth ( per cent)* Austria VHI OOP* Other** Belgium VHI OOP VHI non-profit OOP Finland VHI non-profit VHI for-profit VHI total OOP Other VHI non-profit VHI for-profit VHI total OOP Other VHI OOP Other Greece VHI OOP Ireland VHI non-profit OOP Italy VHI OOP Luxembourg VHI non-profit OOP VHI non-profit VHI for-profit VHI total OOP Other Portugal VHI OOP Spain VHI OOP UK VHI OOP Source: OECD (Organisation for Economic Co-operation and Development 2) Thomson and Mossialos 21. * OOP refers to out-of-pocket expenditure ** Other refers health expenditure incurred by corporations and private employers providing occupational health services and other non-funded medical benefits to employees plus expenditure by non-profit institutions serving households (excluding social insurance) such as red cross, philanthropic and charitable institutions, religious orders and lay institutions 2

21 3.24 Public Investment in Medical Facilities as % of Total Expenditure on Health Public Investment in Medical Facilities as % of Total Expenditure on Health 6 Expenditure as Percentage of Total Health Expenditure United Kingdom United States Public Investment in Medical Facilities per Capita, US$ PPP. Public Investment in Medical Facilities Per Capita, US$ Purchasing Power Parity Expenditure per capita, US$ PPP United Kingdom United States

22 4. SYSTEM RESOURCES 4.1 Number of doctors per 1, population, (or latest available) Country Austria Belgium Finland Greece Ireland Italy Luxembourg Norway Portugal Spain Sweden *311 United Kingdom **164 - EU average European average Nordic average Source: WHO (World Health Organization 22). * 1997; ** Number of specialists per 1 population, Practising specialists, Density per 1, population United Kingdom United States Source: OECD

23 4.3 Number of beds in nursing homes and homes for elderly people per 1, population, Austria Belgium ,283 1,186 1,74 Norway ,76 1,8 973 Spain Sweden United Kingdom Source: WHO (World Health Organization 22) 4.4 Number of outpatient contacts per person in selected European countries, Country Austria Belgium Finland Greece Ireland Italy Luxembourg Norway Portugal Spain Sweden United Kingdom EU average European average Nordic average Source: WHO (World Health Organization 22) Note: Outpatient here refers to all ambulatory contacts (including hospital outpatient contacts and day case surgery). 23

24 4.5 Doctor supply and patient choice in reference countries. Country UK USA Doctor supply restriction? Medical training places? County based restrictions on specialist and GP numbers. Though there are no explicit manpower restrictions. Yes. Numerous clausus re university access. No restriction post qualification regarding access to sector 1. Restricted access to sector 2 For statutory insurance practices there is geographical restriction by specialism enforced by regional physicians associations. Limits are set at 11% of average numbers in comparable regions. Yes. Numerous clausus re university access. Though students may circumvent limits by paying for their education. State control over the number of hospital doctors. Entry to practice under health insurance is open to all doctors. No numerous clausus. Entrance exams in 4 Canton medical schools. No limit on GPs wishing to practice, however, geographical distribution is controlled. In 1997 it was recommended that medical school places increased by 2%. No numerous clauses. Medical students go into significant debt in the course of training. Free choice of specialism Patient choice? Group 1 patients can change GP every 6 months. Group 2 have free choice. Following referral from a GP there is a degree of free choice of hospital. However, specialist university hospitals cannot be chosen for minor operations. Free choice of GP, family doctor or referring doctor, or office-based doctor. Free choice of public (and private) hospital Effectively, free choice among sickness fund doctors. Sozialamt patients may change once per quarter. Free choice of providers Free choice twice per year among doctors contracted to health insurance fund. Contracted to pharmacy. Free choice Very limited. Can change GP within area of residency (not employment). PCTs / PCGs and hospitals / Health authorities? Some increased choice of hospital is forthcoming. HMOs 24

25 5. STANDARD MORTALITY INDICATORS 5.1 Life expectancy at birth for males (M) and females (F) in the European Union (years), Country Change M F M F M F M F Austria Belgium Finland Greece Ireland Italy Luxembourg Portugal Spain Sweden United Kingdom EU average Source: WHO (World Health Organization 22) 5.2 Infant and maternal mortality rates in the European Union, Country Infant mortality rate (per 1, live births) Maternal mortality rate (per 1, live births) Austria Belgium Finland Greece Ireland Italy Luxembourg Portugal Spain Sweden United Kingdom EU average Source: WHO (World Health Organization 22) 25

26 5.3 Standardised death rates in the European Union, cancer, cardiovascular diseases, all causes, all ages per 1, population, Country Cancer Cardiovascular diseases All causes Austria Belgium Finland Greece Ireland Italy Luxembourg Portugal Spain Sweden United Kingdom EU average Source: OECD (Organisation for Economic Co-operation and Development 21) 6. CARDIOVASCULAR DISEASE INDICATORS 6.1 Standardised death rates from cardiovascular diseases per 1, population in the European Union, females and males, Country Female Male Austria Belgium Finland Greece Ireland Italy Luxembourg Portugal Spain Sweden United Kingdom EU average Source: OECD (Organisation for Economic Co-operation and Development 21) 26

27 6.2 Diseases of the circulatory system: Mortality rate Diseases of the Circulatory System: Mortality Rate Deaths (sdr) / 1, pop United Kingdom United States Potential years life lost: Circulatory system disorders Potential s of Life Lost: Circulatory System Disorders 25 2 s Lost / 1, pop United Kingdom United States

28 6.4 Rate of Cardiovascular Surgeries by ICD-CM Rate of Cardiovascular Surgeries by ICD-CM United Kingdom United States Copyright OECD HEALTH DATA Rate of Cardiovascular Surgeries by ICD-CM Rate of Cardiovascular Surgeries by ICD-CM 25 2 Procedures / 1, pop United Kingdom United States

29 6.6 Standardised death rates from ischaemic heart disease per 1, population in the European Union, females and males, Country Female Male Austria Belgium Finland Greece Ireland Italy Luxembourg Portugal Spain Sweden United Kingdom EU average Source: OECD (21) 6.7 Ischaemic heart disease mortality rate per 1, population Ischaemic Heart Disease: Mortality Rate 3 25 Deaths (sdr) / 1, pop United Kingdom United States

30 6.8 Potential years life lost: Ischaemic heart disease Potential s of Life Lost: Ischaemic Heart Disease 12 1 s Lost / 1, pop United Kingdom United States

31 6.9 Average length of stay: Ischaemic heart disease Average Length of Stay: Ischaemic Heart Disease Days United Kingdom United States

32 6.1 Average length of stay: Diseases of the circulatory system Average Length of Stay: Diseases of the Circulatory System Days United Kingdom United States

33 6.11 Acute myocardial infarction: Mortality rate Acute Myocardial Infarction: Mortality Rate Deaths (sdr) / 1, pop United Kingdom United States Potential years life lost: Acute myocardial infarction Potential s of Life Lost: Acute MI s Lost / 1, pop United Kingdom United States

34 6.13 Average length of stay: Acute myocardial infarction Average Length of Stay: Acute MI 25 2 Days 15 1 United Kingdom United States

35 6.14 Rate of Coronary Bypass Surgery By ICD-CM Rate of Coronary Bypass Surgery By ICD-CM United Kingdom United States Copyright OECD HEALTH DATA Rate of Coronary Bypass Surgery By ICD-CM Rate of Coronary Bypass Surgery by ICD-CM 25 2 Procedures / 1, pop United Kingdom United States

36 6.16 Rate of Coronary Angioplasty by ICD-CM Rate of Coronary Angioplasty by ICD-CM United Kingdom United States Copyright OECD HEALTH DATA Rate of Coronary Angioplasty by ICD-CM Rate of Coronary Angioplasy by ICD-CM Procedures / 1, pop United Kingdom United States

37 7. CANCER INDICATORS Unless otherwise stated, cancer indicators are taken from the results of the EUROCARE II Study. 7.1 Incidence of cancer in the European Union, Country Austria Belgium Finland Greece Ireland Italy Luxembourg Portugal Spain Sweden United Kingdom EU average Source: WHO (World Health Organization 22) 7.2 Standardised death rates from cancer per 1, population in the European Union, females and males, Country Female Male Austria Belgium Finland Greece Ireland Italy Luxembourg Portugal Spain Sweden United Kingdom EU average Source: OECD (Organisation for Economic Co-operation and Development 21) 37

38 7.3 EUROCARE II Study cancer survival rates (colon, lung, prostate, breast). Colon Cancer: Relative 5 year survival rates in males ( ) Survival Rate (%) European Avg. European Average England Scotland Colon Cancer: Relative 5 year survival rates in Females ( ) Survival Rate (%) European Avg. European Average England Scotland Lung Cancer: Age-standardised relative survival rates in males ( ) 1 yr survival (%) 5 yr survival (%) 1 yr Euro. Avg 5 yr Euro. Avg European Average England Scotland Lung Cancer: Age-standardised relative survival rates in females ( ) 1 yr survival (%) 5 yr survival (%) 1 yr Euro. Avg. 5 yr Euro. Avg. European Average England Scotland Prostate Cancer: Age-standardised relative survival rates ( ) 1 yr survival (%) 5 yr survival (%) 1 yr Euro. Avg. 5 yr Euro. Avg. European Average England Scotland Breast Cancer: Age-standardised relative survival rates ( ) 1 yr survival (%) 5 yr survival (%) 1 yr Euro. Avg. 5 yr Euro. Avg. European Average England Scotland

39 7.4 Colon cancer survival rates Colon Cancer: Relative 5 yr Survival Rate ( ) 7 % Survival Rate Males Females European Average England Scotland 7.5 Colon cancer survival rates females Colon Cancer: Relative 5 yr Survival Rate in Females ( ) % Survival Rate Survival Rate (%) European Avg. European Average England Scotland 7.6 Colon cancer survival rates males Colon Cancer: Relative 5 yr Survival Rates in Males ( ) % Survival Rate Survival Rate (%) European Avg. European Average England Scotland 39

40 7.7 Colon cancer survival rates males: Colon Cancer: 5 yr Age Standardised Relative Survival Rates By Period of Diagnosis in Males in % Survival Rate Euro. Avg Colon cancer survival rates males; England Colon Cancer: 5 yr Age Standardised Relative Survival Rates by Period of Diagnosis in Males in England % Survival Rate England Euro. Avg

41 7.9 Colon cancer survival rates males; Colon Cancer: 5 yr Age Standardised Relative Survival Rates by Period of Diagnosis in Males in The 6 5 % Survival Rate The Euro. Avg Colon cancer survival rates males; Colon Cancer: 5 year Age Standardised Relative Survival Rates by Period of Diagnosis in Males in % Age Standardised Relative Survival Rate Euro. Avg. 41

42 7.11 Prostate cancer: Age-standardised relative survival rates ( ) Prostate Cancer: Age-standardised Relative Survival Rates ( ) yr survival (%) 5 yr survival (%) European Average England Scotland 7.12 Prostate cancer: Age-standardised relative survival rates and European averages ( ) Prostate Cancer: Age-standardised Relative Survival Rates ( ) % Survival Rate yr survival (%) 5 yr survival (%) 1 yr Euro. Avg. 5 yr Euro. Avg. European Average England Scotland 42

43 7.13 Breast cancer: Age-standardised relative survival rates ( ) Breast Cancer: Age-standardised relative survival rates ( ) yr survival (%) 5 yr survival (%) 2 European Average England Scotland 7.14 Breast cancer: Age-standardised relative survival rates and European averages ( ) Breast Cancer: Age-standardised Relative Survival Rates ( ) 12 % Survival Rate European Average England Scotland 1 yr survival (%) 5 yr survival (%) 1 yr Euro. Avg. 5 yr Euro. Avg. 43

44 7.15 Trends in breast cancer mortality and incidence rates per 1, per country Trends in breast cancer mortality and incidence rates per 1, by country UK (ENGLAND+Wales) US Rate per 1, Country + Source: Jacobzone and ARD Team, 22. Incidence Mortality 44

45 7.16 Lung cancer: Age standardised survival rates in males ( ) Lung Cancer: Age-standardised Survival Rates in Males ( ) yr survival (%) 5 yr survival (%) European Average England Scotland 7.17 Lung cancer: Age standardised survival rates in females ( ) Lung Cancer: Age-standardised Relative Survival Rates for Females ( ) % Survival Rate yr survival (%) 5 yr survival (%) 1 yr Euro. Avg. 5 yr Euro. Avg. European Average England Scotland 45

46 8. CEREBROVASCULAR DISEASE INDICATORS 8.1 Cerebrovascular Disease: Mortality Rate Cerebrovascular Disease: Mortality Rate Netherland United King United Stat Copyright OECD HEALTH DATA Cerebrovascular Disease: Mortality Rate Cerebrovascular Disease: Mortality Rate Deaths (sdr) / 1, pop United Kingdom United States

47 8.3 Potential years of life lost: Cerebrovascular Disease. Potential s of Life Lost: Cerebrovascular Disease 6 5 s Lost / 1, pop United Kingdom United States Average length of stay: Cerebrovascular Disease. Average Length of Stay: Cerebrovascular Disease Days United Kingdom United States