International Health Care using OECD data

1. Baruch College/Mount Sinai
School of Medicine
Program in Health Care
Administration and Policy
International Health Care
BUS9100
Lecture 12B
Raymond R. Arons, Dr. P.H, M.P.H

2. Lecture 12B 2
Baruch College/Mount Sinai School of Medicine
Program In Health Care Administration and Policy
BUS 9100: The Social and Governmental Environment of the
Business of Health Care
Lecture 12C
International Health Care Systems-OECD 2009
Raymond R. Arons, Dr. P.H, M.P.H
Health at a Glance
2009
OECD Indicators
Released on December 8, 2009
http://www.oecd.org/health/healthataglance
Copyright © 2010 Raymond R. Arons, Teaneck, NJ, USA

3. Lecture 12B 3
1. HEALTH STATUS
• Life expectancy and
mortality
• Chronic diseases
Copyright © 2010 Raymond R. Arons, Teaneck, NJ, USA

4. Lecture 12B 4
Life expectancy at birth has increased by more than 10 years in OECD
countries since 1960, reflecting a sharp decrease in mortality rates at all
ages
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
Infant mortality has decreased sharply in OECD countries,
associated
with improvements in socio-economic status and health care
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
Copyright © 2010 Raymond R. Arons, Teaneck, NJ, USA

5. Lecture 12B 5
Mortality rates from cardiovascular diseases have also
declined, although they still vary considerably
Ischemic heart disease mortality rates, Stroke mortality rates, 1980-2006
1980-2006
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
Life expectancy at age 65 in OECD countries stands, on
average, at over 20 years for women and close to 17 years
for men
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
Copyright © 2010 Raymond R. Arons, Teaneck, NJ, USA

6. Lecture 12B 6
However, the prevalence of chronic diseases such as
diabetes
is rising, due to population ageing but also to changes in
Prevalence estimates of diabetes, adults aged 20-79 years,
2010 lifestyle
Note: The data are age-standardised to the World Standard Population.
Source: International Diabetes Federation (IDF) (2009), “Diabetes Atlas, 4th edition”.
2. RISK FACTORS FOR HEALTH
• Among children
• Among adults
Copyright © 2010 Raymond R. Arons, Teaneck, NJ, USA

7. Lecture 12B 7
About 1/3 of 15-year-olds have already
been drunk at least twice in their life
2005-06
Source: HBSC Survey 2005-2006, Currie et al. (2008).
Only 1 in 8 15-year-olds undertake physical exercise
daily in France and Switzerland
2005-06
Source: HBSC Survey 2005-2006, Currie et al. (2008).
Copyright © 2010 Raymond R. Arons, Teaneck, NJ, USA

8. Lecture 12B 8
The share of children eating fruit on a daily basis has increased,
particularly among girls … but less than half of all children have taken
up this good habit
Source: HBSC Survey 2001-2002 and 2005-2006, Currie et al. (2004, 2008).
Obesity among adults is increasing in all OECD
countries.
More than one in three Americans are obese
1. Australia, Czech Republic (2005), Japan, Luxembourg, New Zealand, Slovak Republic (2007), United
Kingdom and United States figures are based on health examination surveys, rather than health interview
surveys.
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
Copyright © 2010 Raymond R. Arons, Teaneck, NJ, USA

9. Lecture 12B 9
3. HEALTH
WORKFORCE
• Number of physicians, nurses
and other health professionals
• Training and remuneration of
physicians and nurses
Access and quality of care depends on the number
and training of health professionals
Source: The looming crisis of the health workforce: How can OECD countries respond? (OECD, 2008).
Copyright © 2010 Raymond R. Arons, Teaneck, NJ, USA

10. Lecture 12B 10
The number of physicians per capita has increased in all
OECD countries since 1990, except in Italy
2007 (or latest year 1990-2007 (or nearest year)
available)
1. Ireland, the Netherlands, New Zealand and Portugal provide the number of all physicians entitled to practise
rather than only those practising.
2. Data for Spain include dentists and stomatologists.
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
The number of medical graduates has increased in
several OECD countries since 2000, after 15 years of
stability or decline
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
Copyright © 2010 Raymond R. Arons, Teaneck, NJ, USA

11. Lecture 12B 11
The share of physicians trained abroad has increased in
several OECD countries since 2000, but not in Canada
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
The number of nurses per capita has increased in all OECD countries
since 2000, except in Australia, the Netherlands and the Slovak Republic
2007 (or latest year available) 2000-2007
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
Copyright © 2010 Raymond R. Arons, Teaneck, NJ, USA

12. Lecture 12B 12
The number of nursing graduates has increased in some OECD countries
since 2000, including France, Switzerland and the United States
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
The remuneration of nurses in Luxembourg and the United
States is 4 to 6 times higher than in the Slovak Republic and
Hungary
2007 (or latest year available)
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
Copyright © 2010 Raymond R. Arons, Teaneck, NJ, USA

13. Lecture 12B 13
4. Consumption of health
goods and services
• Diagnostics and
treatments
• Pharmaceuticals
The number of MRI units and CT scanners is increasing in all OECD
countries.
Japan has the highest number per capita
2007 (or latest year available)
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
Copyright © 2010 Raymond R. Arons, Teaneck, NJ, USA

14. Lecture 12B 14
The United States has the highest number of MRI and CT exams
per capita, followed by Luxembourg, Belgium and Iceland
2007 (or latest year available)
1. Only include exams for out-patients and private in-patients (excluding exams in public hospitals).
Note: Several countries, including Japan, have not provided any data.
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
The average length of stay for acute care has fallen
in nearly all OECD countries
Average length of stay for acute
care
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
Copyright © 2010 Raymond R. Arons, Teaneck, NJ, USA

15. Lecture 12B 15
The average length of stay for normal delivery has become
shorter
in all OECD countries, even if large variations still exist
2007 (or latest year available)
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
Rates of caesarean delivery have increased in all OECD
countries.
On average, 1 birth out of 4 involved a C-section in 2007,
against 1 out 7 in 1990
1990-2007 (or nearest year)
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
Copyright © 2010 Raymond R. Arons, Teaneck, NJ, USA

16. Lecture 12B 16
The consumption of pharmaceuticals is increasing across
OECD countries, particularly for antidiabetics and
Antidiabetics antidepressants Antidepressants
* DQD : Defined Daily Dose
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
5. QUALITY OF
CARE
• Life threatening conditions
(cancers and
acute myocardial infarctions)
• Chronic diseases
Copyright © 2010 Raymond R. Arons, Teaneck, NJ, USA

17. Lecture 12B 17
Cancer survival rates are increasing in all OECD countries
Five-year relative survival
Cervival cancer rates Breast cancer
Note: Survival rates are age standardised to the International Cancer Survival Standards Population. 95%
confidence intervals are represented by H in the relevant figures.
Source: OECD Health Care Quality Indicators Data 2009 (OECD).
In-hospital mortality rates following heart attack
are decreasing in all OECD countries
Note: Rates are age-sex standardised to 2005 OECD population (45+). 95% confidence intervals are represented
by H.
Source: OECD Health Care Quality Indicators Data 2009 (OECD).
Copyright © 2010 Raymond R. Arons, Teaneck, NJ, USA

18. Lecture 12B 18
Treatment for chronic diseases is not optimal.
Too many persons are admitted to hospitals for asthma …
Asthma admission rates, population aged 15 and over,
2007
1. Does not fully exclude day cases.
2. Includes transfers from other hospital units, which marginally elevates rates.
Source: OECD Health Care Quality Indicators Data 2009 (OECD).
… too many persons are admitted to hospitals for diabetes
complications, highlighting the need to improve primary care
Diabetes acute complications admission rates, population aged 15 and over,
2007
1. Does not fully exclude day cases.
2. Includes transfers from other hospital units, which marginally elevates rates.
Source: OECD Health Care Quality Indicators Data 2009 (OECD).
Copyright © 2010 Raymond R. Arons, Teaneck, NJ, USA

19. Lecture 12B 19
6. ACCESS TO
CARE
• Financial barriers
• Geographic barriers
Low-income populations more often report unmet care needs
due to cost, but there are large variations across countries
Unmet care need* due to costs, by income group,
2007
* Did not get medical care, missed medical test, treatment or follow-up, did not fill prescription or missed
doses.
Source: Commonwealth Fund (2008).
Copyright © 2010 Raymond R. Arons, Teaneck, NJ, USA

20. Lecture 12B 20
All OECD countries have achieved universal or near-universal health
care coverage, except Turkey, Mexico and the United States
2007
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
The distribution of physicians within countries
is often uneven, limiting access to care in rural
areas
Physician density in rural and urban regions
Source: AIHW (2008c); CIHI (2005); DREES (2008); NCHS (2007).
Copyright © 2010 Raymond R. Arons, Teaneck, NJ, USA

21. Lecture 12B 21
Low-income populations more often report
unmet dental care needs due to cost
Unmet need for a dental examination due to costs,
2004
Source: Davis et al. (2007).
7. HEALTH EXPENDITURE
• Expenditure
• Financing
Copyright © 2010 Raymond R. Arons, Teaneck, NJ, USA

22. Lecture 12B 22
Health expenditure per capita varies widely across OECD countries.
The United States spends almost two-and-a-half times the OECD average
2007
1. Health expenditure is for the insured population rather than resident population.
2. Current health expenditure.
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
OECD countries allocate about 9% of their GDP to health.
This share varies from 16% in the United States to less than 6% in Mexico
and Turkey
%
GDP
20
16.0
Public expenditure Private expenditure
15
11.0
10.8
10.4
10.2
10.1
10.1
9.9
9.8
9.8
9.6
9.2
9.3
9.1
8.9
8.9
8.7
8.7
8.5
8.4
8.2
10
8.1
7.7
7.6
7.4
7.3
6.8
6.8
6.4
5.9
5.7
5
0
United…
Slovak…
Czech…
Netherlands1
Canada
Sweden
Luxembourg3
Portugal
New Zealand2
Germany
Hungary
Mexico
Japan
Finland
Greece
Norway
OECD
Spain
Belgium1
Korea
Denmark
Austria
Poland
France
United States
Iceland
Switzerland
Turkey
Australia
Ireland
Italy
1. Public and private expenditures are current expenditures (excluding investments).
2. Current health expenditure..
3. Health expenditure is for the insured population rather than resident population.
42
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
Copyright © 2010 Raymond R. Arons, Teaneck, NJ, USA

23. Lecture 12B 23
The share of GDP allocated to health is increasing in all OECD
countries, mostly due to new medical technologies and population
ageing
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
Across OECD countries, health expenditure has grown by
slightly more than 4% annually over the past ten years
Annual average real growth in per capita health expenditure,
1997-2007
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
Copyright © 2010 Raymond R. Arons, Teaneck, NJ, USA

24. Lecture 12B 24
The public sector is the main source of financing in most OECD
countries. Only in the United States and Mexico do public sources
account for less than 50% of health financing
2007
1. Share of current health expenditure.
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
Higher health spending per capita is generally associated with higher life
expectancy, although this link tends to be less pronounced in countries
with higher spending. Other factors also influence life expectancy …
2007 (or latest year available)
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
Copyright © 2010 Raymond R. Arons, Teaneck, NJ, USA