1. THE
COMMONWEALTH
FUND
Multinational Comparisons
of Health Systems Data, 2013
David Squires
The Commonwealth Fund
November 2013

2. 2
Health Care Spending and Coverage
THE
COMMONWEALTH
FUND

3. 0
1000
2000
3000
4000
5000
6000
7000
8000
9000
1980 1984 1988 1992 1996 2000 2004 2008
US ($8,508)
NOR ($5,669)
SWIZ ($5,643)
NETH ($5,099)
CAN ($4,522)
DEN ($4,495)*
GER ($4,495)
FR ($4,118)
SWE ($3,925)
AUS ($3,800)*
UK ($3,405)
JPN ($3,213)*
NZ ($3,182)
Source: OECD Health Data 2013.
Average Health Care Spending per Capita, 1980–2011
Adjusted for Differences in Cost of Living
3
Dollars ($US)
THE
COMMONWEALTH
FUND* 2010

4. 0
2
4
6
8
10
12
14
16
18
1980 1983 1986 1989 1992 1995 1998 2001 2004 2007 2010
US (17.7%)
NETH (11.9%)
FR (11.6%)
GER (11.3%)
CAN (11.2%)
DEN (11.1%)*
SWIZ (11.0%)
NZ (10.3%)
JPN (9.6%)*
SWE (9.5%)
UK (9.4%)
NOR (9.3%)
AUS (8.9%)*
GDP refers to gross domestic product.
Source: OECD Health Data 2013.
Health Care Spending as a Percentage of GDP, 1980–2011
Percent
* 2010 THE
COMMONWEALTH
FUND
4

5. 5
Health Care Spending per Capita by Source of Funding, 2011
Adjusted for Differences in Cost of Living
4,066
3,661
3,183
3,827
3,436 3,161 3,204
2,578 2,821 2,638 2,631
3,454
527
672
75
465
650
86
490
246
111 203
987
1,455
666 593 593
307
635
733 338
464 348
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
US SWIZ CAN DEN* GER FR SWE AUS* UK JPN* NZ
Out-of-pocket spending
Private spending
Public spending
* 2010.
Dollars ($US)
8,508
Source: OECD Health Data 2013.
THE
COMMONWEALTH
FUND
5,643
4,522 4,495 4,495
4,118
3,925 3,800
3,2133,405 3,182

6. 6
Pharmaceutical Spending per Capita, 2011
Adjusted for Differences in Cost of Living
995
752
652 641 633
587
531
487 479 474
388
300 298
0
100
200
300
400
500
600
700
800
900
1,000
US CAN JPN* FR GER AUS* SWIZ OECD
Median
NETH SWE NOR DEN NZ
* 2010.
Source: OECD Health Data 2013.
THE
COMMONWEALTH
FUND
Dollars ($US)

7. 7
Health Care Supply and Utilization
THE
COMMONWEALTH
FUND

8. Hospital Discharges per 1,000 Population, 2011
244
175 172 170 169 163 159 159
147
136
125 122
111
82
0
50
100
150
200
250
300
GER NOR* DEN* SWIZ FR SWE* AUS* OECD
Median
NZ UK US* NETH JPN CAN*
* 2010.
Source: OECD Health Data 2013.
8
THE
COMMONWEALTH
FUND

9. Average Length of Hospital Stay for Acute Care, 2011
7.9 7.7
6.5 6.5 6.4
5.8 5.6 5.4
5.1 5.1 5.0
4.5
0
2
4
6
8
10
12
GER CAN* SWIZ UK OECD
Median
NETH NZ US FR SWE AUS* NOR*
Days
* 2010.
Source: OECD Health Data 2013.
9
THE
COMMONWEALTH
FUND

10. 10
Average Annual Number of Physician Visits per Capita, 2011
13.1
9.7
7.4
6.8 6.7 6.6 6.6
5.2 5.0
4.6
4.1
3.0
0
2
4
6
8
10
12
14
JPN* GER CAN* FR AUS NETH OECD
Median
NOR** UK** DEN* US** SWE
* 2010.
** 2009.
Source: OECD Health Data 2013.
THE
COMMONWEALTH
FUND

11. Number of Practicing Physicians per 1,000 Population, 2011
3.9 3.8 3.8 3.7
3.5
3.3
3.2 3.1
2.8
2.6
2.5
2.2
0
1
2
3
4
5
SWE* GER SWIZ NOR DEN** AUS OECD
Median
FR UK NZ US JPN*
Source: OECD Health Data 2013.
11
THE
COMMONWEALTH
FUND
* 2010.
** 2009.

12. 12
Number of Acute Care Hospital Beds per 1,000 Population, 2011
8.0
5.3
3.4 3.4 3.3
3.0 3.0 2.9
2.6 2.6 2.4 2.4
2.0
1.7
0
2
4
6
8
10
JPN GER FR AUS* NETH SWIZ OECD
Median
DEN* NZ US* UK NOR SWE CAN*
THE
COMMONWEALTH
FUND* 2010.
Source: OECD Health Data 2013.

13. 13
Inpatient Coronary Bypass Grafts per 100,000 Population, 2011
79.0
74.0
67.5
61.6
58.6
54.4
46.1 45.3
40.9
37.4
30.9
28.5
0
20
40
60
80
100
US** DEN* GER NOR** CAN* NETH* SWIZ OECD
Median
NZ SWE UK FR
THE
COMMONWEALTH
FUND
* 2010.
** 2009.
Source: OECD Health Data 2013.

14. 14
Magnetic Resonance Imaging (MRI) Exams per Million Population, 2011
102.7
95.2
67.5
61.5
49.9 49.8
24.1
0
20
40
60
80
100
120
US GER** FR DEN NETH CAN AUS
THE
COMMONWEALTH
FUND
* 2010.
** 2009.
Source: OECD Health Data 2013.

15. 15
Health Promotion and Disease Prevention
THE
COMMONWEALTH
FUND

16. THE
COMMONWEALTH
FUND
Cervical Cancer Screening Rates, 2011
85.0
78.7
76.2 75.0
71.1
68.5 66.3 64.8
56.8
37.7
0
20
40
60
80
100
US* GER** NOR NZ FR* UK DEN** NETH AUS JPN*
Percent of women screened
Note: NOR, NZ, UK, DEN, and AUS based on program data; all other countries based on survey data.
* 2010.
** 2009.
Source: OECD Health Data 2013.
16

17. Flu Immunization Among Adults Age 65 or Older, 2011
74.6 74.0 74.0
66.9 65.5 64.4
56.1 55.7 55.2 53.0
46.0 45.6
14.1
0
20
40
60
80
100
AUS** NETH** UK US NZ CAN GER** OECD
Median
FR JPN* SWIZ* DEN* NOR
Percent
* 2010.
** 2009.
Source: OECD Health Data 2013.
THE
COMMONWEALTH
FUND
17

18. 18
Adults Who Report Being Daily Smokers, 2011
23.3
21.9
20.8 20.1 20.1 20.0 19.6
17.0
15.7 15.1 14.8
13.1
0
10
20
30
40
FR* GER** NETH JPN OECD
Median
DEN* UK* NOR CAN AUS* US SWE
Percent
THE
COMMONWEALTH
FUND
Source: OECD Health Data 2013.
* 2010.
** 2009.

19. 36.5
28.3 27.8
25.4 24.8
14.7
13.4 12.9
11.4 11.0
4.1
0
5
10
15
20
25
30
35
40
US* AUS NZ** CAN* UK GER** DEN* FR* NETH SWE JPN
19
Obesity (BMI>30) Prevalence Among Adult Population, 2011
Note: Body-mass index (BMI) estimates based on national health interview surveys (self-reported data)
are usually significantly lower than estimates based on actual measurements.
Percent
Measured Self-reported
THE
COMMONWEALTH
FUND
* 2010.
** 2009.
Source: OECD Health Data 2013.

20. 20
Quality and Patient Safety
THE
COMMONWEALTH
FUND

21. Mortality Amenable to Health Care
76
88 89
81
88
99 97
109
116
106
97
134
115 113
127
120
55 57 60 61 61 64 66 67 74 76 77 78 79 80 83
96
0
50
100
150
FR AUS ITA JPN SWE NOR NETH AUT FIN GER GRE IRL NZ DEN UK US
1997–98 2006–07
Deaths per 100,000 population*
* Countries’ age-standardized death rates before age 75; including ischemic heart disease, diabetes, stroke,
and bacterial infections. Analysis of World Health Organization mortality files and CDC mortality data for U.S.
Source: Adapted from E. Nolte and M. McKee, “Variations in Amenable Mortality—Trends in 16 High-Income
Nations,” Health Policy, published online Sept. 12, 2011.
21
THE
COMMONWEALTH
FUND

22. Breast Cancer Five-Year Relative Survival Rate, 2004–2009
(or nearest period)
89.3 87.3 87.1 86.5 86.0 84.5 84.4 83.3 82.0 81.3
0
20
40
60
80
100
US JPN CAN NOR SWE NZ NETH GER DEN UK
Source: OECD Health Data 2013.
Percent
THE
COMMONWEALTH
FUND
22

23. * 2008.
** 2007.
Source: OECD Health Data 2013.
4.8 5.7
7.0 7.4
9.5 9.8 9.8
11.0 12.0 12.6
18.1
32.9 33.7
0
10
20
30
40
UK SWE NZ SWIZ* CAN NOR OECD
Median
AUS NETH** FR** DEN US* GER
Diabetes Lower Extremity Amputation Rates
per 100,000 Population, 2009
THE
COMMONWEALTH
FUND
23

24. † In-hospital case-fatality rates within 30 days of admission. Age-sex standardized rates.
In-Hospital Mortality After Admission for Acute Myocardial Infarction†
per 100 Patients, 2009
2.3 2.5
2.9
3.2 3.2
3.9
4.3 4.5 4.6
5.2 5.3
6.8
9.7
0
2
4
6
8
10
DEN NOR SWE** AUS NZ CAN US* SWIZ* OECD
Median
UK NETH** GER JPN*
Source: OECD Health Data 2013.
24
THE
COMMONWEALTH
FUND
* 2008.
** 2007.

25. Note: Age-sex-SDX standardized rates.
Foreign Object Left in Body During Procedure
per 100,000 Hospital Discharges, 2009
1.8
2.6
3.4
4.9
5.5 5.7
8.7
9.7 9.8
13.8
0
3
6
9
12
15
DEN** SWE GER US* FR UK NZ CAN AUS SWIZ*
Source: OECD Health Data 2013.
25
THE
COMMONWEALTH
FUND
* 2008.
** 2010.

26. 26
Prices
THE
COMMONWEALTH
FUND

27. Retail Price Indexes for Basket of In-Patent Pharmaceuticals, 2010
US is set at 100
100
95
88
61
50 49
46
0
20
40
60
80
100
US GER SWIZ FR CAN AUS UK
Source: P. Kanavos, A. Ferrario, S. Vandoros et al., "Higher U.S. Branded Drug Prices and Spending Compared to
Other Countries May Stem Partly from Quick Uptake of New Drugs," Health Affairs, April 2013 32(4):753–61.
27
THE
COMMONWEALTH
FUND
Note: Calculations weighted relative to U.S. consumption patterns. U.S. retail prices were discounted from
manufacturer prices according to the rebates obtained by the Medicaid program.
Price level

28. Diagnostic Imaging Prices, 2012
$319 $335 $363
$554
$928
$1,121
$0
$200
$400
$600
$800
$1,000
$1,200
NETH UK FR NZ SWIZ US
Notes: US refers to the commercial average. MRI refers to magnetic resonance imaging;
CT refers to computed tomography.
Source: International Federation of Health Plans, 2012 Comparative Price Report.
28
MRI scanning and imaging fees
$124
$175 $183
$252
$310
$328
$566
$0
$100
$200
$300
$400
$500
$600
CAN UK FR NETH NZ SWIZ US
CT scanning and imaging fees (head)
THE
COMMONWEALTH
FUND

29. Hospital Spending per Discharge, 2011
Adjusted for Differences in Cost of Living
21,018
15,433
13,025
11,968
11,374 11,306
9,894 9,611
8,478 8,363
7,842
5,339
0
4,000
8,000
12,000
16,000
20,000
24,000
US* CAN* NETH SWIZ DEN* NOR* SWE* AUS* NZ FR OECD
Median
GER
Dollars ($US)
29
* 2010.
Source: OECD Health Data 2013.
THE
COMMONWEALTH
FUND

30. 30
Physician Fee for Hip Replacement, 2008
Adjusted for Differences in Cost of Living
$1,634
$1,251
$1,181
$1,046
$674 $652
$0
$200
$400
$600
$800
$1,000
$1,200
$1,400
$1,600
$1,800
US GER UK AUS FR CAN
Source: M. J. Laugesen and S. A. Glied, “Higher Fees Paid to U.S. Physicians Drive Higher Spending
for Physician Services Compared to Other Countries,” Health Affairs, Sept. 2011 30(9):1647–56.
$3,996
$2,160
$1,943
$1,340
$0
$600
$1,200
$1,800
$2,400
$3,000
$3,600
$4,200
US UK AUS FR
Public payers Private payers
THE
COMMONWEALTH
FUND
Dollars ($US) Dollars ($US)

31. 31
Physician Incomes, 2008
Adjusted for Differences in Cost of Living
186,582
159,532
131,809
125,104
95,585 92,844
US UK GER CAN FR AUS
442,450
324,138
208,634 202,771
187,609
154,380
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
US UK CAN GER AUS FR
Primary care doctorsOrthopedic surgeons
Source: M. J. Laugesen and S. A. Glied, “Higher Fees Paid to U.S. Physicians Drive Higher Spending
for Physician Services Compared to Other Countries,” Health Affairs, Sept. 2011 30(9):1647–56.
THE
COMMONWEALTH
FUND
Dollars ($US)