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Health at a glance 2015

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Health at a glance 2015: OECD Indicators

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Health at a glance 2015

  1. 1. Health at a Glance 2015 - OECD Indicators Released on November 4, 2015 http://www.oecd.org/health/healthataglance
  2. 2. Table of contents 1.Dashboards of health indicators 2.Pharmaceutical spending trends and future challenges 3.Health status 4.Risk factors for health 5.Health workforce 6.Health care activities 7.Access to care 8.Quality of care 9.Health expenditure and financing 10.Pharmaceutical sector 11.Ageing and long-term care Information on data for Israel: http://oe.cd/israel-disclaimer
  3. 3. • Health status • Risk factors for health • Access to care • Quality of care • Health care resources 1. DASHBOARDS OF HEALTH INDICATORS
  4. 4. Example of dashboard: Risk factors All countries can achieve progress in certain areas Top third performers. Middle third performers. Bottomthird performers. Note: Countries are listed in alphabetical order. The number in the cell indicates the position of each country among all countries for which data is available. For all these indicators, the top performers are countries with the lowest rates. Indicator Smoking in adults Alcohol consumption Obesity in adults * Overweight and obesity in children ** Australia 4 22 30 * 20 Austria 26 34 8 14 Belgium 15 20 9 5 Canada 6 11 29 * 21 Chile 33 10 28 * 28 Czech Rep. 25 32 20 * 5 Denmark 12 17 10 23 Estonia 31 33 18 7 Finland 10 14 26 17 France 30 30 11 13 […] United Kingdom 20 19 27 * 32 United States 5 13 34 * 29 * Data on obesity in adults are based on measured height and weight for all the countries marked with an *. These result in more accurate data and higher obesity rates compared with all other countries that are providing self-reported height and weight. ** Data on overweight or obesity in children are all based on measured data, but refer to different age groups across countries. Source: Health at a Glance 2015. Risk factors
  5. 5. Example of dashboard: Quality of care No country is in top performer group for all indicators Top third performers. Middle third performers. Bottomthird performers. Note: Countries are listed in alphabetical order. The number in the cell indicates the position of each country among all countries for which data is available. For the indicators of avoidable hospital admissions and case-fatality rates, the top performers are countries with the lowest rates. Indicator Asthma and COPD hospital admission Diabetes hospital admission Case-fatality for AMI (admission- based) Case-fatality for ischemic stroke (admission-based) Cervical cancer survival Breast cancer survival Colorectal cancer survival Australia 29 17 1 20 11 5 3 Austria 28 29 27 8 19 19 7 Belgium 16 20 19 20 16 12 4 Canada 18 10 11 26 12 8 13 Chile 6 27 31 16 25 23 n.a. Czech Rep. 12 23 11 22 13 22 21 Denmark 26 14 7 17 5 11 18 Estonia 27 n.a. 28 29 8 25 22 Finland 10 15 9 4 6 4 7 France 7 21 17 13 n.a. n.a. n.a. […] United Kingdom 22 5 20 19 22 21 20 United States 25 24 5 3 21 2 9 Source: Health at a Glance 2015. Quality of care
  6. 6. • Pharmaceutical spending trends • Trend in the generic market 2. PHARMACEUTICAL SPENDING
  7. 7. The United States spends the most on pharmaceuticals, followed by Japan, Greece and Canada Source: OECD Health Statistics 2015, OECD 2013 (or nearest year)
  8. 8. Pharmaceutical spending has been cut in many countries in recent years Source: OECD Health Statistics 2015, OECD Average annual growth in pharmaceutical and total health expenditure per capita, in real terms, average across OECD countries, 1990 to 2013
  9. 9. Growth in the generic market has contributed to the reduction in pharmaceutical spending… Source: OECD Health Statistics 2015, OECD Trend in share of generics in the reimbursed pharmaceutical market, selected countries, 2000 to 2013
  10. 10. … but the share of the generic market remains low in some countries Source: OECD Health Statistics 2015, OECD Share of generics in the total pharmaceutical market, 2013 (or nearest year) 1. Reimbursed pharmaceutical market. 2. Community pharmacy market.
  11. 11. • Life expectancy • Health inequalities 3. HEALTH STATUS
  12. 12. Life expectancy at birth exceeds 80 years on average in OECD countries – a gain of more than 10 years since 1970 Source: OECD Health Statistics 2015, OECD
  13. 13. High GDP per capita is associated with high life expectancy, although many other factors play a role 2013 (or latest year) Source: OECD Health Statistics 2015, OECD
  14. 14. There remains large gaps in life expectancy between men and women in OECD countries: on average, men live 5 years less than women Source: OECD Health Statistics 2015, OECD 2013 (or nearest year) Note: Countries are ranked in descending order of life expectancy for the whole population.
  15. 15. There are also large gaps in life expectancy by education level: on average, people with the lowest level of education live 6 years less than people with the highest level Source: Eurostat database complemented with national data for Israel, Mexico and the Netherlands. Gap in life expectancy at age 30 by sex and education level, 2012 (or latest year) Note: The figures show the gap in the expected years of life remaining at age 30 between adults with the highest level (“tertiary education”) and the lowest level (“below upper secondary education”) of education.
  16. 16. People in the highest income group are also much more likely to report being in good health than those in the lowest income group Source: OECD Health Statistics 2015, OECD (EU-SILC for European countries). 2013 (or nearest year) Note: Countries are ranked in descending order of perceived health status for the whole population. 1. Results for these countries are not directly comparable with those for other countries, due to methodological differences in the survey questionnaire resulting in an upward bias. In Israel, data by income group relate to the employed population.
  17. 17. 4. RISK FACTORS FOR HEALTH • Smoking • Alcohol consumption • Overweight and obesity among children and adults
  18. 18. Smoking has declined in nearly all countries, although on average one-fifth of adults still smoke across OECD countries Source: OECD Health Statistics 2015, OECD Change in daily smoking in adults, 2000 and 2013 (or nearest years)
  19. 19. Alcohol consumption has also declined in many countries but not all Source: OECD Health Statistics 2015, OECD; WHO for non-OECD countries. Alcohol consumption among adults, 2000 and 2013 (or nearest years)
  20. 20. Overweight and obesity among children have risen in most countries, increasing the risk of obesity in adulthood Source: Currie et al. (2004); Currie et al. (2008); Currie et al. (2012) Change in self-reported overweight among 15-year-olds, 2001-02, 2005-06 and 2009-10
  21. 21. Obesity among adults has increased in all OECD countries, one in five adults are now obese in 12 OECD countries 1. Data are based on measurements rather than self-reported height and weight. Source: OECD Health Statistics 2015, OECD
  22. 22. • Number of physicians and nurses • Remuneration of physicians and nurses • International migration of physicians and nurses 5. HEALTH WORKFORCE
  23. 23. The number of physicians per capita has increased in nearly all OECD countries since 2000 1. Data include not only doctors providing direct care to patients, but also those working in the health sector as managers, educators, researchers, etc. (adding another 5-10% of doctors). 2. Data refer to all doctors licensed to practice (resulting in a large over-estimation of the number of practising doctors in Portugal, of around 30%). Practising doctors per 1 000 population, 2000 and 2013 (or nearest year) Source: OECD Health Statistics 2015, OECD
  24. 24. Medical specialists greatly outnumber generalists in most countries: there are more than 2 specialists per every generalist on average 1. Generalists include general practitioners/family doctors and other generalist (non-specialist) medical practitioners. 2. Specialists include paediatricians, obstetricians/gynaecologists, psychiatrists, medical, surgical and other specialists. 3. In Ireland and Portugal, most generalists are not GPs (“family doctors”), but rather non-specialist doctors working in hospitals or other settings. In Portugal, there is some double-counting of doctors with more than one specialty. Source: OECD Health Statistics 2015, OECD Generalists and specialists as a share of all doctors, 2013 (or nearest year)
  25. 25. The remuneration of specialists has grown more rapidly than that of generalists in many countries, but not all Source: OECD Health Statistics 2015, OECD Growth in the remuneration of GPs and specialists, 2005-13 (or nearest year) 1. The growth rate for the Netherlands and for Luxembourg is for self-employed GPs and specialists.
  26. 26. The number and share of foreign-trained doctors is high in some OECD countries 1. In Germany and Spain, the data is based on nationality (or place of birth in Spain), not on the place of training. Source: OECD Health Statistics 2015, OECD Share of foreign-trained doctors in OECD countries, 2013 (or nearest year)
  27. 27. The number of nurses per capita has also increased in nearly all OECD countries 1. Data include not only nurses providing direct care to patients, but also those working in the health sector as managers, educators, researchers, etc. 2. Data in Chile refer to all nurses who are licensed to practice (less than one-third are professional nurses with a university degree). 3. Austria reports only nurses employed in hospital. Source: OECD Health Statistics 2015, OECD Practising nurses per 1 000 population, 2000 and 2013 (or nearest year)
  28. 28. The remuneration of nurses has been frozen or cut down in some countries following the economic crisis, but has continued to increase in others Evolution in the remuneration of hospital nurses, selected OECD countries, 2005-13 (or nearest year) Source: OECD Health Statistics 2015, OECD 1. Index for France, 2006 = 100. 2. Index for Greece, 2009 = 100.
  29. 29. The share of foreign-trained nurses is lower than that of foreign-trained doctors, but is high in some countries 1. Data for some regions in Spain relate to foreign nationality or country of birth, not the place of training. Source: OECD Health Statistics 2015, OECD Share of foreign-trained nurses in OECD countries, 2013 (or nearest year)
  30. 30. • Diagnostic procedures • Hospital activities and surgical procedures 6. HEALTH CARE ACTIVITIES
  31. 31. The number of MRI and CT scanners is increasing in all OECD countries. Japan has by far the highest number per capita 2013 (or nearest year) 1. Equipment outside hospital not included. 2. Only equipment eligible for public reimbursement. MRI units CT scanners Source: OECD Health Statistics 2015, OECD
  32. 32. The United States, France and Luxembourg perform more MRI and CT exams per capita than other countries CT examsMRI exams 2013 (or nearest year) Source: OECD Health Statistics 2015, OECD 1. Exams outside hospital not included (in Ireland, exams in private hospital also not included). 2. Exams on public patients not included. 3. Exams privately-funded not included.
  33. 33. The average length of stay in hospital has fallen in nearly all OECD countries, reflecting efficiency gains Average length of stay in hospital, 2000 and 2013 (or nearest year) 1. Data refer to average length of stay for curative (acute) care (resulting in an under-estimation). Source: OECD Health Statistics 2015, OECD
  34. 34. The average length of stay for normal delivery has become shorter in all OECD countries, but large variations persist 2013 (or nearest year) Source: OECD Health Statistics 2015, OECD
  35. 35. Rates of caesarean delivery have increased in most OECD countries. On average, more than 1 birth out of 4 involved a C-section in 2013, against 1 out of 5 in 2000 Source: OECD Health Statistics 2015, OECD
  36. 36. Ambulatory surgery has increased in most countries: examples of cataract surgery Source: OECD Health Statistics 2015, OECD Share of cataract surgeries carried out as ambulatory cases, 2000 and 2013 (or nearest years)
  37. 37. • Financial access • Geographic access • Timely access (waiting times) 7. ACCESS TO CARE
  38. 38. All OECD countries have achieved universal (or almost universal) health coverage, except Greece and the USA Health insurance coverage for a core set of services, 2013 Source: OECD Health Statistics 2015, OECD
  39. 39. Unmet health care needs are still reported, most commonly among low-income groups Unmet care needs due to cost, by income level, 2013 Source: 2013 Commonwealth Fund International Health Policy Survey, complemented with data from the national survey for the Czech Republic (2010). Note: Either did not visit doctor when they had a medical problem, did not get recommended care or did not fill/skipped prescription.
  40. 40. Access to doctors varies widely within countries; more doctors in cities than in rural areas Source: OECD Regions at a Glance 2015 Physician density, by Territorial Level 2 regions, 2013 (or nearest year)
  41. 41. Waiting times for cataract surgery have decreased or remained stable in several countries, but have started to go up in others Cataract surgery, waiting times from specialist assessment to treatment, 2007 to 2014 (or 2013) Source: OECD Health Statistics 2015, OECD
  42. 42. Waiting times for hip replacement have also decreased or remained stable in several countries, but have started to go up in others Hip replacement, waiting times from specialist assessment to treatment, 2007 to 2014 (or 2013) Source: OECD Health Statistics 2015, OECD
  43. 43. • Management of chronic diseases • Quality of acute care for life-threatening conditions (cancers and heart attacks) • Prevention of communicable diseases 8. QUALITY OF CARE
  44. 44. Treatment for chronic diseases is not optimal. Too many persons are admitted to hospitals for asthma and other chronic respiratory diseases… Asthma and COPD hospital admission in adults, 2013 (or nearest year) Source: OECD Health Statistics 2015, OECD Note: Three-year average for Iceland and Luxembourg.
  45. 45. … and too many persons are admitted to hospitals for diabetes, highlighting the need to improve primary care Diabetes hospital admission in adults, 2008 and 2013 (or nearest years) Source: OECD Health Statistics 2015, OECD Note: Three-year average for Iceland and Luxembourg.
  46. 46. Survival for cervical cancer has increased in most countries, but remain lower in Chile and Poland Note: 95% confidence intervals represented by |—|. 1. Period analysis. 2. Cohort analysis. 3. Different analysis methods used for different years. * Three-period average. Source: OECD Health Statistics 2015, OECD Cervical cancer five-year relative survival, 1998-2003 and 2008-2013 (or nearest periods)
  47. 47. Survival for breast cancer has also increased in most countries, but remain lower in Estonia and Poland Source: OECD Health Statistics 2015, OECD Note: 95% confidence intervals represented by |—|. 1. Period analysis. 2. Cohort analysis. 3. Different analysis methods used for different years. * Three-period average. Breast cancer five-year relative survival, 1998-2003 and 2008-2013 (or nearest periods)
  48. 48. Mortality rates following hospital admission for heart attack have decreased in all OECD countries, indicating improvements in acute care Note: 95% confidence intervals represented by |—|. Three-year average for Luxembourg. Thirty-day mortality after admission to hospital for AMI based on patient data, 2003 to 2013 (or nearest years) Source: OECD Health Statistics 2015, OECD
  49. 49. Mortality rates following hospital admission for stroke have also come down in all OECD countries Note: 95% confidence intervals represented by |—|. Three-year average for Luxembourg. Thirty-day mortality after admission to hospital for ischemic stroke based on patient data, 2003 to 2013 (or nearest years) Source: OECD Health Statistics 2015, OECD
  50. 50. 80% of patients admitted for hip fracture are operated within the recommended two days on average across OECD countries Hip fracture surgery initiation after admission to hospital, 2013 (or nearest year) Source: OECD Health Statistics 2015, OECD Note: Three-year average for Iceland.
  51. 51. Vaccination rates against influenza among people aged 65 and over have fallen in many countries, increasing the risks of hospitalisation and death Influenza vaccination coverage, population aged 65 and over, 2003 and 2013 (or nearest years) Source: OECD Health Statistics 2015, OECD
  52. 52. • Expenditure • Financing 9. HEALTH EXPENDITURE
  53. 53. Health expenditure per capita varies widely across OECD countries. The United States spends two-and-a-half times the OECD average Health expenditure per capita, 2013 (or nearest year) Note: Expenditure excludes investments, unless otherwise stated. 1. Includes investments. 2. Data refers to 2012. Source: OECD Health Statistics 2015, OECD; WHO Global Health Expenditure Database.
  54. 54. Several European countries hard hit by the economic crisis have cut their health spending since 2009 Annual average growth rate in per capita health expenditure, real terms, 2005 to 2013 (or nearest years) 1. Mainland Norway GDP price index used as deflator. 2. CPI used as deflator. Source: OECD Health Statistics 2015, OECD
  55. 55. 55 OECD countries allocated 8.9% of their GDP to health in 2013 (excluding investments), ranging from over 16% in the United States to 5-6% in Turkey, Estonia and Mexico Note: Excluding investments unless otherwise stated. 1. Data refers to 2012. 2. Including investments. Health expenditure as a share of GDP, 2013 (or nearest year) Source: OECD Health Statistics 2015, OECD; WHO Global Health Expenditure Database.
  56. 56. The share of GDP allocated to health has either stabilised or decreased since 2009 in most OECD countries, as health spending remained flat or was cut down Source: OECD Health Statistics 2015, OECD Health expenditure as a share of GDP, selected countries, 2005-2013
  57. 57. The public sector is the main source of financing in most OECD countries. Only in Chile and the United States do public sources account for less than 50% of health financing 1. The Netherlands report compulsory cost-sharing in health care insurance and in Exceptional Medical Expenses Act under social security rather than under private out-of-pocket, resulting in an underestimation of the out-of-pocket share. 2. Data refer to total health expenditure (= current health expenditure plus capital formation). 3. Social security reported together with general government. Expenditure on health by type of financing, 2013 (or nearest year) Source: OECD Health Statistics 2015, OECD
  58. 58. • Pharmaceutical expenditure • Financing of pharmaceutical expenditure • Pharmacists and pharmacies • Pharmaceutical consumption • Share of generic market • R&D in the pharmaceutical sector (See Chapter 2 for key charts on some indicators) 10. PHARMACEUTICAL SECTOR
  59. 59. • Rising share of elderly population • Long-term care recipients and caregivers • Long-term care expenditure 11. AGEING AND LONG-TERM CARE
  60. 60. The share of population aged over 65 and 80 in OECD countries will increase sharply in the coming decades Source: OECD Historical Population Data and Projections Database, 2015
  61. 61. Less than half of the population aged 65 and over report being in good health, on average across OECD countries Source: OECD Health Statistics 2015, OECD 1. Results not directly comparable with other countries due to methodological differences (resulting in an upward bias). Perceived health status in adults aged 65 years and over, 2013 (or nearest year)
  62. 62. Most long-term care continue to be provided by informal caregivers Source: OECD estimates based on 2013 HILDA survey for Australia, 2012-13 Understanding Society survey for the United Kingdom and 2013 SHARE survey for other European countries Population aged 50 and over reporting to be informal carers, 2013 (or nearest year)
  63. 63. The number of people receiving formal long-term care varies greatly across countries Proportion of population receiving long-term care, 2013 (or nearest year) Source: OECD Health Statistics 2015, OECD
  64. 64. A growing share of people is receiving long-term care at home, to respond to their preference and reduce cost Share of long-term care recipients aged 65 years and over receiving care at home, 2000 and 2013 (or nearest year) Source: OECD Health Statistics 2015, OECD
  65. 65. Public spending on long-term care varies a lot across countries, reflecting differences in the development of public programmes Long-term care public expenditure (health and social components), as share of GDP, 2013 (or nearest year) Source: OECD Health Statistics 2015, OECD Note: The OECD average only includes the eleven countries that report health and social LTC. 1. Figures for the United States refer only to institutional care.
  66. 66. More information www.oecd.org/health/healthataglance @OECD_Social

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