Multinational Comparisons

of Health Systems Data, 2017

Roosa Tikkanen
The Commonwealth Fund
Health Care Spending
HEALTH CARE SPENDING

Health Care Spending per Capita, 2000–2016

Adjusted for Differences in Cost of Living
Dollars ($US) 2016 data:
11,000
US ($9,892)
10,000
SWIZ ($7,919)
9,000
NOR ($6,647)
8,000
GER ($5,551)
7,000
SWE ($5,488)
6,000
NETH ($5,385)
5,000
AUS ($4,708)
4,000
CAN ($4,644)
3,000
FRA ($4,600)
2,000

1,000 UK ($4,192)

0 NZ ($3,590)
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

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). 3
Source: OECD Health Data 2017.
HEALTH CARE SPENDING

Health Care Spending per Capita by Source of

Funding, 2015*
Adjusted for Differences in Cost of Living
Dollars ($US)
10,000 Out-of-pocket spending Private, voluntary spending Public spending^

9,000 1054

8,000

7,000
2136 3761
6,000
883
20 579
5,000 800 671 649
60 161 373
610 308 664
4,000 839 647
430 630 229 688
3,000 267
5286 4821
4406 4521 4275 4692
2,000
3286 3575 3181
2848 3024
1,000

0
NZ AUS UK FRA CAN SWE GER NETH NOR SWIZ US

* 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 4
compulsory schemes, including private insurance schemes.
Source: OECD Health Data 2017.
HEALTH CARE SPENDING

Annual Growth Rate of Real Health Care

Spending per Capita, 2015-2016
Adjusted for Differences in Cost of Living
Percent (%)
3.45
3.50

3.00 2.73
2.70
2.56
2.50 2.32

2.00

OECD 1.47
1.50
MEDIAN
1.00
1.00

0.50 0.34
0.21
0.08 0.09
0.00
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 2017. 5
HEALTH CARE SPENDING

Hospital Spending per Discharge, 2015*

Adjusted for Differences in Cost of Living

Dollars ($US)
25,000

21,186
20,000

16,244
14,905 15,483
15,000 14,375
13,201 13,433
10,874 11,149
OECD
10,000
MEDIAN
6,122
5,000

0
GER AUS FR SWE UK NETH NOR SWIZ CAN US

* 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). ‘OECD median’ reflects the median of 35 OECD countries. 6
Source: OECD Health Data 2017.
HEALTH CARE SPENDING

Total Hospital and Physician Costs, 2015

Adjusted for Differences in Cost of Living
Bypass Surgery Appendectomy
Dollars ($US) Dollars ($US)
$90,000 $20,000

$80,000
$78,318 $18,000
$15,930
$70,000 $16,000

$14,000
$60,000
$12,000
$50,000
$10,000
$34,224
$40,000 $8,009
$32,480 $8,000
$28,888 $6,040$6,199
$30,000
$24,059 $6,000
$20,000 $14,579 $3,814
$4,000
$2,003
$10,000 $2,000

$0 $0
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), 2015 Comparative Price Report. 7
HEALTH CARE SPENDING

Pharmaceutical Spending per Capita, 2015*

Adjusted for Differences in Cost of Living
Dollars ($US)
1,200 1,162
1,100 1,056
1,000
900
766 786
800
700 668
OECD 617
600 MEDIAN
497 519
500 474
417
400
300
200
100
0
NETH NOR UK SWE AUS FR GER CAN SWIZ US

* 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 8
outside provider settings. ‘OECD median’ reflects the median of 35 OECD countries.
Source: OECD Health Data 2017.
HEALTH CARE SPENDING

Spending on Health Insurance Administration

per Capita, 2015*
Adjusted for Differences in Cost of Living
Dollars ($US)
900
787
800

700

600

500

400

272 286
300 255
206
200 OECD
123 141
MEDIAN 89 90
100
34
0
NOR SWE UK AUS CAN NETH GER FR SWIZ US
* 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.
‘OECD median’ reflects the median of 34 OECD countries. 9
Source: OECD Health Data 2017.
HEALTH CARE SPENDING

Health vs Social Care Spending, % GDP

Adjusted for Differences in Cost of Living
Percent (%)

40%
Health care Social care
35%

30%

25%
21% 21%
20% 18% 9%
15%
16%
15% 15% 11% 10%
11%

10%
16%
5% 12% 12% 11% 12% 10%
9% 8% 9% 9%

0%
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, 2013.
10
Health Care Resource
Supply & Workforce
HEALTH CARE RESOURCE SUPPLY & WORKFORCE

Doctors and Nurses, 2000-2015

Physicians Nurses
Per 1,000 population 2015 data: Per 1,000 population 2015 data:
5.0 NOR (4.4) 20 SWIZ (18.0)

4.5 SWIZ (4.3) 18 NOR (17.3)

4.0 GER (4.1) 16 GER (13.3)

3.5 SWE (4.2*) 14 NETH

(12.2**)
3.0 AUS (3.5) 12 AUS (11.5)

2.5 FR (3.3) 10 US (11.3)

2.0 NETH 8 SWE (11.1*)

(3.5**)
1.5 NZ (3.0) 6 NZ (10.3)

1.0 UK (2.8) FR (9.9)

4

0.5 CAN (2.7) CAN (9.9)

2

0.0 US (2.6*) UK (7.9)

0
2000 2005 2010 2015 2000 2005 2010 2015

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. 12
Source: OCED Health Data 2017
HEALTH CARE RESOURCE SUPPLY & WORKFORCE

Hospital Beds, 2000-2015

Per 1,000 population
Beds per 1,000 2015 data:

10 GER (8.1)

FRA (6.1)
9
SWIZ (4.6)
8
NETH (4.2**)
7
NOR (3.8)
6
AUS (3.8*)
5
US (2.8*)
4
NZ (2.7)
3
CAN (2.6)
2
UK (2.6)
1
SWE (2.4)
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Total hospital beds per 1,000 population. *2014 data; **2013 data.
Source: OCED Health Data 2017
13
Health Utilization
HEALTH UTILIZATION

Doctor Consultations per Capita, 2015*

Consultations/capita

12

10.0
10

8.2
8 7.7
7.4
OECD 6.3
6 MEDIAN

4.3
3.9 4.0
4 3.7
2.9

0
SWE NZ SWIZ US NOR FR AUS CAN NETH GER
* 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. ‘OECD median’ reflects the median of 35 OECD countries. 15
Source: OECD Health Data 2017.
HEALTH UTILIZATION

Hip Replacements, 2015*

Inpatient cases
Surgical procedures per 100,000 population

350

299 308
300

250 240 244

228 233
OECD 204
200 182
MEDIAN
161
148
150

100

50

0
CAN NZ UK US NETH SWE FR NOR GER SWIZ
* Or nearest year; data from 2014 for New Zealand; 2012 for Netherlands; and 2010 for the US. No recent data for
Australia (since 1999). ‘OECD median’ reflects the median of 30 OECD countries.
Source: OECD Health Data 2017. 16
 HEALTH UTILIZATION

Hospital length of stay and discharges,

2000-2015*
Average Length of Inpatient Stay Discharges
Days 2015 data: Per 1,000 2015 data:
FRA GER (255)
14 300
(10.1*)
GER (9.0) AUS (174*)
12
SWIZ (8.4) 250 SWIZ (170)

10 CAN (7.4) NOR (168)

200
UK (7.0) FR (163)
8
NZ (6.8*) 150 SWE (153)
6 NOR (6.7) NZ (150*)

NETH 100
4 UK (128)
(6.2)
US (6.1*) US (126***)
50
2
SWE (5.9) NETH (119**)

0 AUS (5.5*) 0 CAN (84)

2000 2005 2010 2015 2000 2005 2010 2015

*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. 17
Source: OECD Health Data 2017.
 Prevention and
Population Health
PREVENTION AND POPULATION HEALTH

Select population health indicators, 2015^

Life expectancy Infant Obesity rate Daily smokers
at birth mortality Percent (%) Percent (%) of
Years Deaths per 1,000 SM, self-reported; population over 15
live births M, measured 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 median 81.3 3.3 18.0 (M/SR) 18.9

^ Or nearest year: * 2014 data; ** 2013 data; *** 2012 data. (M) Measured; (SR) Self-reported. ‘OECD median’ reflects
the median of 35 OECD countries.
Source: OECD Health Data 2017. 19
PREVENTION AND POPULATION HEALTH

Breast Cancer Screening Rates, 2015*

Among women 50-69 years
Percent (%) screened

100

80 79
80 75 75
72

60 OECD MEDIAN ^
55 54 52
49 47

40

20

0
US NETH NOR UK NZ AUS GER FR CAN SWIZ

* Or nearest year; 2014 data for Netherlands, Germany; 2012 data for Switzerland; 2011 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. 20
Source: OECD Health Data 2017.
 PREVENTION AND POPULATION HEALTH

Flu Immunizations, 2005 and 2015*

Among older adults aged 65 or older
Percent (%) immunized

100.0 2005 2015

80.0 75 77
71 69 71
67 67
62 64 63
60 61 61 59
60.0
51 49
46 44
40.0 37
27

20.0

0.0
UK US NZ NETH CAN FR SWE SWIZ GER NOR

Data reflect influenza immunizations. * Or nearest year; 2010 data for Switzerland. No recent data for Australia (since
2009). Different methodologies used between time periods in Germany; German data reflects 60+ population. For
Sweden, data are collected only during the winter season. Change in survey in the Netherlands in 2010. Change in 21
survey instrument for Canada in 2015.
Source: OECD Health Data 2017.
PREVENTION AND POPULATION HEALTH

Mortality as a result of cancer, 1994 and 2014*

Deaths per 100,000 population

300 1994 2014

272 279
264 267
249 250 252 253
250
244 244 238
227
213 212 215
203 205 207
200 192 193 193
182

150

100

50

0
SWIZ AUS SWE US NOR FR GER CAN NZ UK NETH
* 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.
Source: OECD Health Data 2017. 22
PREVENTION AND POPULATION HEALTH

Mortality as a result of ischemic heart disease,

1994 and 2014*
Deaths per 100,000 population

300 1994 2014

261 257
250 241 234
223 229
216
205
200

159
150
150
129
113
99 106
93 98
100 85
79 72 78

48
50 39

0
FR NETH NOR SWI AUS CAN UK SWE GER US NZ
* 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. 23
Source: OECD Health Data 2017.
Quality Indicators
QUALITY INDICATORS

Diabetes Hospital Admissions in Adults, 2013*

Age-sex standardized rates per 100,000

250

216
198
200 187
181

150 141
OECD MEDIAN

111
100
95
76
64 68

50 44

0
SWIZ UK NETH NOR CAN SWE AUS FR NZ US GER
* 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. ‘OECD median’ reflects the median of 32
OECD countries. 25
Source: OECD Health Data 2017.
QUALITY INDICATORS

COPD Hospital Admissions in Adults, 2013*

Age-sex standardized rates per 100,000

350
324 326

300

243 245
250
217 222
213
200
OECD MEDIAN 192
164
150
120
101
100

50

0
SWIZ FRA NETH SWE UK US NOR CAN GER AUS NZ
* 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. ‘OECD median’ reflects the median of 33
OECD countries. 26
Source: OECD Health Data 2017.
QUALITY INDICATORS

Mortality Amenable to Health Care,

2000 and 2014*
Deaths per 100,000
2000 2014
160
145 149

140 131 135

121
117
120 111 110 112
108
100 90 90
85 87
83
78
80 72
69
61 62 64
60 55

40

20

0
SWIZ FRA AUS NOR SWE NETH CAN GER UK NZ US
*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. 27
Source: Marina Karanikolos, European Observatory on Health Systems and Policies (2017).
Aging Populations
AGING POPULATIONS

Share of older adults, 2016

Percent of total population (%)
25
65-79 year-olds 80+ year-olds

20
5.8
5.1
4.4 4.8 5 5.9
15
4.2 4.2
3.6 3.8 3.9

10

15 15
14 13 13 13
11 11 11 12 12
5

0
NZ US AUS NOR CAN NETH UK SWIZ FRA SWE GER
Source: OECD Health Data 2017.

29
AGING POPULATIONS

Trends in the share of older adults

aged 80 years and older, 1980-2015
Percent of total population (%) 2015 data:
7 FR (5.9)

GER (5.8)
6
SWE (5.1)

5 SWIZ (5.0)

UK (4.8)
4
NETH (4.4)

3 CAN (4.2)

NOR (4.2)
2
AUS (3.9)

1 US (3.8)

NZ (3.6)
0
1980 1985 1990 1995 2000 2005 2010 2015

Source: OECD Health Data 2017.

30
AGING POPULATIONS

Mortality from dementia, 2000-2015

Deaths per 100,000 2015 data:
60
NETH (53.9)

UK (53.9**)
50
SWE (43.2)

SWIZ (42.7**)
40

US (41.3*)

30 CAN (36.6***)

NOR (36.5*)
20
AUS (34.9*)

NZ (30.4***)
10
GER (24.7*)

0 FR (17.2**)
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

*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 31
details in Wu, et al. Nat Rev Neurol 2017;13:327-39.
Source: OECD Health Data 2017.