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OECD Health Data 2012


 U.S. health care
  system from
 an international
   perspective


       Released on June 28, 2012
 http://www.oecd.org/health/healthdata
Why is the US health
 spending so high?
US spends two-and-a-half times the OECD average
                         Total health expenditure per capita, public and private, 2010 (or nearest year)
 USD PPP
8 000
         8 233




                                                                                                         Public expenditure on health                                                              Private expenditure on health
                 5 388
                         5 270
                                 5 056




6 000
                                         4 786
                                                 4 464
                                                         4 445
                                                                 4 395
                                                                         4 338
                                                                                 3 974
                                                                                         3 969
                                                                                                 3 758
                                                                                                         3 718
                                                                                                                 3 670
                                                                                                                         3 433


                                                                                                                                         3 268
                                                                                                                                 3 309


                                                                                                                                                 3 251
                                                                                                                                                         3 076
                                                                                                                                                                 3 035
                                                                                                                                                                         3 022
4 000




                                                                                                                                                                                 2 964
                                                                                                                                                                                         2 914
                                                                                                                                                                                                 2 728
                                                                                                                                                                                                         2 428


                                                                                                                                                                                                                         2 095
                                                                                                                                                                                                                 2 165


                                                                                                                                                                                                                                 2 035
                                                                                                                                                                                                                                         1 884
                                                                                                                                                                                                                                                 1 601
                                                                                                                                                                                                                                                         1 389
                                                                                                                                                                                                                                                                 1 294
                                                                                                                                                                                                                                                                         1 202
2 000




                                                                                                                                                                                                                                                                                 916
                                                                                                                                                                                                                                                                                       913
    0




  1. In the Netherlands, it is not possible to clearly distinguish the public and private share related to investments.
  2. Total expenditure excluding investments.
  Information on data for Israel: http://dx.doi.org/10.1787/888932315602.


  Source: OECD Health Data 2012.
At 17.6% of GDP in 2010, US health spending is one and a
half as much as any other country, and nearly twice the OECD
                           average
                                  Total health expenditure as a share of GDP, 2010 (or nearest year)
  % of GDP
20
     17.6




18
16                                                                                                                                                           Public                  Private
14
            12.0
                   11.6
                          11.6
                                 11.4
                                        11.4
                                               11.1
                                                      11.0
                                                             10.7
                                                                    10.5
                                                                           10.2
                                                                                  10.1
12

                                                                                         9.6
                                                                                               9.6
                                                                                                     9.6
                                                                                                           9.5
                                                                                                                 9.5
                                                                                                                       9.4
                                                                                                                             9.3
                                                                                                                                   9.3
                                                                                                                                         9.2
                                                                                                                                               9.1
                                                                                                                                                     9.0
                                                                                                                                                           9.0
                                                                                                                                                                 8.9
10




                                                                                                                                                                       8.0
                                                                                                                                                                             7.9
                                                                                                                                                                                   7.9
                                                                                                                                                                                         7.8
                                                                                                                                                                                               7.5
                                                                                                                                                                                                     7.1
                                                                                                                                                                                                           7.0
 8




                                                                                                                                                                                                                 6.3
                                                                                                                                                                                                                       6.2
                                                                                                                                                                                                                             6.1
 6
 4
 2
 0




1. In the Netherlands, it is not possible to clearly distinguish the public and private share related to investments.
2. Total expenditure excluding investments.
Information on data for Israel: http://dx.doi.org/10.1787/888932315602.
                                                                                                                                                                                                                   4
Source: OECD Health Data 2012.
US spends much more on health than what might
           be expected by its GDP per capita
Health spending per                         2010 (or latest year available)
 capita (USD PPP)
                                                             USA
8 000


7 000


6 000

                                                             CHE            NOR
5 000                                                  NLD
                                                                                                        LUX
                                                     CAN   DNK
                                                   DEU     AUT
                                                     BEL
4 000                                        FRA
                                                    SWE     IRE
                                                GBR      AUS
                                          NZL ESP ISL FIN
3 000                                   GRC       JPN
            R² = 0.6065                        ITA
                                     PRT
                                 SVK        SVN
                                          ISR
2 000                                         KOR
                                         CZE
                             POL    HUN
                         CHL       EST
1 000                   MEX
                        TUR

   0
        0       10 000      20 000       30 000        40 000      50 000         60 000   70 000    80 000       90 000
                                                                                               GDP per capita (USD PPP)
                                                                                                                     5
                                                   Source: OECD Health Data 2012.
US health spending is much greater for all categories of care,
    particularly for ambulatory care and administration cost
                                            2010 (or latest year available)

Current health spending
 per capita (USD PPP)                                                             Other
  9 000
                  $7,910                                                          Public health and administration
                 (193%)
  8 000
                   $856                                                           Pharmaceuticals and medical goods
                 (296%)
  7 000
                 $1,105                                                           Ambulatory health care
  6 000          (155%)
                                   $5,270                                         Hospitals/Nursing homes
  5 000                             $331
                 $2,852             $460             $4,205            $4,187
                 (236%)                                                                   $3,835
  4 000                                               $416             $281
                                   $1,677                                                  $300
                                                      $853             $904                                 $2,979
  3 000                                                                                    $836              $120
                                                                                                             $507
                                                     $1,188            $1,278
  2 000                                                                                   $1,082            $810
                 $3,097
                 (168%)            $2,802
  1 000                                              $1,716            $1,574             $1,582            $1,543

       0
             United States      Switzerland         Canada           Germany              France       Japan (2009)


              Note: Health spending excludes investments. The percentages in the US bar indicate how much
              more the US spends per category compared with the average of the five other OECD countries.            6
              Source: OECD Health Data 2012.
Is US health spending higher
due to higher prices or higher
service provision? (or both?)
US prices for a set of hospital services are over 60%
   higher than the average of 12 OECD countries

Comparative price levels for total inpatient hospital services, 2007




      Source: Koechlin et al. (2010).
US prices for certain procedures are much
        higher than in other OECD countries

                                           (US dollars, 2007)

Procedures                        AUS        CAN     DEU      FIN       FRA      SWE      USA

Appendectomy                       5 044     5 004    2 943     3 739    4 558    4 961    7 962

Normal delivery                    2 984     2 800    1 789     1 521    2 894    2 591    4 451

Caesarean section                  7 092     4 820    3 732     4 808    5 820    6 375    7 449

Coronary angioplasty               7 131     9 277    3 347     5 574    7 027    9 296   14 378

Coronary artery bypass graft      21 698    22 694   14 067   23 468    23 126   21 218   34 358

Hip replacement                   15 918    11 983    8 899   10 834    11 162   11 568   17 406

Knee replacement                  14 608     9 910   10 011     9 931   12 424   10 348   14 946

Source: Koechlin et al. (2010).
Where the United States health system does
          LESS than other countries

                            United States        Rank compared   OECD average
                                                   with OECD
                                                   countries
                                    2.4                                 3.1
Practising physicians                                 26th
                           per 1000 population                   per 1000 population

                                    3.9                                 6.4
Doctor consultations                                  29th
                                 per capita                          per capita

                                    3.1                                 4.9
Hospital beds                                         28th
                           per 1000 population                   per 1000 population

                                  131.0                                155.1
Hospital discharges                                   26th
                           per 1000 population                   per 1000 population

Average length        of            4.9                                 7.1
                                                      29th
stay in hospitals                  days                                 days


Source: OECD Health Data 2012.
Where the United States health system does
          MORE than other countries

                           United States          Rank compared     OECD average
                                                    with OECD
                                                    countries
                                  31.6                                    12.5
MRI units                                              2nd
                         per million population                   per million population
                                  97.7                                    46.3
MRI exams                                              2nd
                         per 1 000 population                      per 1 000 population
                                  40.7                                    22.6
CT scanners                                            3rd
                         per million population                   per million population
                                  265.0                                  123.8
CT exams                                               3rd
                         per 1 000 population                      per 1 000 population
                                  254.4                                  130.1
Tonsillectomy                                          1st
                        per 100 000 population                    per 100 000 population
                                  79.0                                    47.3
Coronary bypass                                        3rd
                        per 100 000 population                    per 100 000 population
                                  226.0                                  121.6
Knee replacements                                      1st
                        per 100 000 population                    per 100 000 population
                                  32.9                                    26.1
Caesarean sections                                     6th
                          per 100 live births                       per 100 live births

 Source: OECD Health Data 2012.
Is the quality of care
  better in the US?
Cancer system is generally performing well


  Breast cancer, 5-year survival rate                              Colorectal cancer, 5-year survival rate


  United States (2003-08)                              89.3                  Japan (2000-05)                                68.0

         Japan (2000-05)                               87.3           United States (2003-08)                            64.5

       Canada (2002-07)                               86.6                 Canada (2002-07)                          63.4

     OECD (16 countries)                        83.5                      Germany (2003-08)                       60.4

      Germany (2003-08)                         83.3                    OECD (16 countries)                       59.9

      France (1997-2002)                       82.8                      France (1997-2002)                   57.0

United Kingdom (2004-09)                      81.3                  United Kingdom (2004-09)               53.3

                            60   70       80        90       100                                40   50       60         70       80
                                  Age-standardised rates (%)                                           Age-standardised rates (%)




           Note: 95% confidence intervals are represented by H.
           Source: OECD Health Data 2012.
Primary care sector is not performing so well


       Asthma hospital admission                                                         COPD hospital admission

       Canada (2009)          15.7                                             France (2007)                  79

           Italy (2009)        19.2                                               Italy (2009)                         126

      Germany (2009)            20.8                                          Canada (2009)                                    183

        France (2007)                  43.4                             OECD (28 countries)                                       198

 OECD (28 countries)                     51.8                                Germany (2009)                                       201

United Kingdom (2009)                           73.7                   United Kingdom (2009)                                         213

  United States (2008)                                      120.6        United States (2008)                                           230

                       0             50            100          150                              0             100             200           300
                   Age-sex standardised rates per 100 000 population                             Age-sex standardised rates per 100 000 population




          Note: 95% confidence intervals are represented by H.
          Source: OECD Health Data 2012.
What are the trends in
key risk factors to health
        in the US?
Smoking rates have decreased in the US and
      in most other OECD countries
                        Adult population smoking daily
                     2010                         Change 2000-10

                               13.3               Mexico                                          n.a.


                             15.1              United states            -20.9


                             15.1                Australia             -23.7


                             16.3                Canada              -27.2


                       19.5                       Japan              -27.8


                      20.9                        OECD                   -19.9


                      21.5                    United Kingdom            -20.4


                      21.9                       Germany                        -11.3


                     23.1                          Italy                               -5.3


                     23.3                         France                       -13.7

25      20      15      10            5   0                    -50           -25              0          25
 % of population aged 15 years and over                          % change over period

     Source: OECD Health Data 2012.
Obesity rates have increased substantially over
 the past 20 years and are highest in the US
  %
40




                                                                                                                       36
          1990   2000     2010




                                                                                                                  31
                                                                                                        30
30




                                                                                              26
                                                                               25
                                                                24




                                                                                                   24


                                                                                                             23
                                                                          22




                                                                                         21
20




                                                           17
                                            15




                                                                                    14
                                  13




                                                      13
                                       12




                                                                     11
                     10




                                                 10
                              9




10
                 9


                          6
        4
       3
      2




0




       1. Data are based on measurements rather than self-reported height and weight.
       Source: OECD Health Data 2012.
Over one-third of children in the US are
          overweight or obese

Children aged 5-17 years who are overweight (including obese)
          Girls                             Boys
     37.0                                         Greece                                               45.0

     35.9                                       United States                                   35.0

            30.9                                    Italy                                   32.4

             29.0                                  Mexico                                28.1

               26.6                            United Kingdom                     22.7

               26.1                                Canada                                28.9

                   24.0                           Australia                       22.0

                        21.4                       OECD                           22.9

                          17.6                    Germany                         22.6

                               14.9                France                13.1

                               14.4                Japan                   16.2

50    40           30          20     10   0                    0   10     20        30          40     50
     % of children aged 5-17 years                         % of children aged 5-17 years
      Source: International Association for the Study of Obesity (2011).
More information




http://www.oecd.org/health/healthdata

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US Health

  • 1. OECD Health Data 2012 U.S. health care system from an international perspective Released on June 28, 2012 http://www.oecd.org/health/healthdata
  • 2. Why is the US health spending so high?
  • 3. US spends two-and-a-half times the OECD average Total health expenditure per capita, public and private, 2010 (or nearest year) USD PPP 8 000 8 233 Public expenditure on health Private expenditure on health 5 388 5 270 5 056 6 000 4 786 4 464 4 445 4 395 4 338 3 974 3 969 3 758 3 718 3 670 3 433 3 268 3 309 3 251 3 076 3 035 3 022 4 000 2 964 2 914 2 728 2 428 2 095 2 165 2 035 1 884 1 601 1 389 1 294 1 202 2 000 916 913 0 1. In the Netherlands, it is not possible to clearly distinguish the public and private share related to investments. 2. Total expenditure excluding investments. Information on data for Israel: http://dx.doi.org/10.1787/888932315602. Source: OECD Health Data 2012.
  • 4. At 17.6% of GDP in 2010, US health spending is one and a half as much as any other country, and nearly twice the OECD average Total health expenditure as a share of GDP, 2010 (or nearest year) % of GDP 20 17.6 18 16 Public Private 14 12.0 11.6 11.6 11.4 11.4 11.1 11.0 10.7 10.5 10.2 10.1 12 9.6 9.6 9.6 9.5 9.5 9.4 9.3 9.3 9.2 9.1 9.0 9.0 8.9 10 8.0 7.9 7.9 7.8 7.5 7.1 7.0 8 6.3 6.2 6.1 6 4 2 0 1. In the Netherlands, it is not possible to clearly distinguish the public and private share related to investments. 2. Total expenditure excluding investments. Information on data for Israel: http://dx.doi.org/10.1787/888932315602. 4 Source: OECD Health Data 2012.
  • 5. US spends much more on health than what might be expected by its GDP per capita Health spending per 2010 (or latest year available) capita (USD PPP) USA 8 000 7 000 6 000 CHE NOR 5 000 NLD LUX CAN DNK DEU AUT BEL 4 000 FRA SWE IRE GBR AUS NZL ESP ISL FIN 3 000 GRC JPN R² = 0.6065 ITA PRT SVK SVN ISR 2 000 KOR CZE POL HUN CHL EST 1 000 MEX TUR 0 0 10 000 20 000 30 000 40 000 50 000 60 000 70 000 80 000 90 000 GDP per capita (USD PPP) 5 Source: OECD Health Data 2012.
  • 6. US health spending is much greater for all categories of care, particularly for ambulatory care and administration cost 2010 (or latest year available) Current health spending per capita (USD PPP) Other 9 000 $7,910 Public health and administration (193%) 8 000 $856 Pharmaceuticals and medical goods (296%) 7 000 $1,105 Ambulatory health care 6 000 (155%) $5,270 Hospitals/Nursing homes 5 000 $331 $2,852 $460 $4,205 $4,187 (236%) $3,835 4 000 $416 $281 $1,677 $300 $853 $904 $2,979 3 000 $836 $120 $507 $1,188 $1,278 2 000 $1,082 $810 $3,097 (168%) $2,802 1 000 $1,716 $1,574 $1,582 $1,543 0 United States Switzerland Canada Germany France Japan (2009) Note: Health spending excludes investments. The percentages in the US bar indicate how much more the US spends per category compared with the average of the five other OECD countries. 6 Source: OECD Health Data 2012.
  • 7. Is US health spending higher due to higher prices or higher service provision? (or both?)
  • 8. US prices for a set of hospital services are over 60% higher than the average of 12 OECD countries Comparative price levels for total inpatient hospital services, 2007 Source: Koechlin et al. (2010).
  • 9. US prices for certain procedures are much higher than in other OECD countries (US dollars, 2007) Procedures AUS CAN DEU FIN FRA SWE USA Appendectomy 5 044 5 004 2 943 3 739 4 558 4 961 7 962 Normal delivery 2 984 2 800 1 789 1 521 2 894 2 591 4 451 Caesarean section 7 092 4 820 3 732 4 808 5 820 6 375 7 449 Coronary angioplasty 7 131 9 277 3 347 5 574 7 027 9 296 14 378 Coronary artery bypass graft 21 698 22 694 14 067 23 468 23 126 21 218 34 358 Hip replacement 15 918 11 983 8 899 10 834 11 162 11 568 17 406 Knee replacement 14 608 9 910 10 011 9 931 12 424 10 348 14 946 Source: Koechlin et al. (2010).
  • 10. Where the United States health system does LESS than other countries United States Rank compared OECD average with OECD countries 2.4 3.1 Practising physicians 26th per 1000 population per 1000 population 3.9 6.4 Doctor consultations 29th per capita per capita 3.1 4.9 Hospital beds 28th per 1000 population per 1000 population 131.0 155.1 Hospital discharges 26th per 1000 population per 1000 population Average length of 4.9 7.1 29th stay in hospitals days days Source: OECD Health Data 2012.
  • 11. Where the United States health system does MORE than other countries United States Rank compared OECD average with OECD countries 31.6 12.5 MRI units 2nd per million population per million population 97.7 46.3 MRI exams 2nd per 1 000 population per 1 000 population 40.7 22.6 CT scanners 3rd per million population per million population 265.0 123.8 CT exams 3rd per 1 000 population per 1 000 population 254.4 130.1 Tonsillectomy 1st per 100 000 population per 100 000 population 79.0 47.3 Coronary bypass 3rd per 100 000 population per 100 000 population 226.0 121.6 Knee replacements 1st per 100 000 population per 100 000 population 32.9 26.1 Caesarean sections 6th per 100 live births per 100 live births Source: OECD Health Data 2012.
  • 12. Is the quality of care better in the US?
  • 13. Cancer system is generally performing well Breast cancer, 5-year survival rate Colorectal cancer, 5-year survival rate United States (2003-08) 89.3 Japan (2000-05) 68.0 Japan (2000-05) 87.3 United States (2003-08) 64.5 Canada (2002-07) 86.6 Canada (2002-07) 63.4 OECD (16 countries) 83.5 Germany (2003-08) 60.4 Germany (2003-08) 83.3 OECD (16 countries) 59.9 France (1997-2002) 82.8 France (1997-2002) 57.0 United Kingdom (2004-09) 81.3 United Kingdom (2004-09) 53.3 60 70 80 90 100 40 50 60 70 80 Age-standardised rates (%) Age-standardised rates (%) Note: 95% confidence intervals are represented by H. Source: OECD Health Data 2012.
  • 14. Primary care sector is not performing so well Asthma hospital admission COPD hospital admission Canada (2009) 15.7 France (2007) 79 Italy (2009) 19.2 Italy (2009) 126 Germany (2009) 20.8 Canada (2009) 183 France (2007) 43.4 OECD (28 countries) 198 OECD (28 countries) 51.8 Germany (2009) 201 United Kingdom (2009) 73.7 United Kingdom (2009) 213 United States (2008) 120.6 United States (2008) 230 0 50 100 150 0 100 200 300 Age-sex standardised rates per 100 000 population Age-sex standardised rates per 100 000 population Note: 95% confidence intervals are represented by H. Source: OECD Health Data 2012.
  • 15. What are the trends in key risk factors to health in the US?
  • 16. Smoking rates have decreased in the US and in most other OECD countries Adult population smoking daily 2010 Change 2000-10 13.3 Mexico n.a. 15.1 United states -20.9 15.1 Australia -23.7 16.3 Canada -27.2 19.5 Japan -27.8 20.9 OECD -19.9 21.5 United Kingdom -20.4 21.9 Germany -11.3 23.1 Italy -5.3 23.3 France -13.7 25 20 15 10 5 0 -50 -25 0 25 % of population aged 15 years and over % change over period Source: OECD Health Data 2012.
  • 17. Obesity rates have increased substantially over the past 20 years and are highest in the US % 40 36 1990 2000 2010 31 30 30 26 25 24 24 23 22 21 20 17 15 14 13 13 12 11 10 10 9 10 9 6 4 3 2 0 1. Data are based on measurements rather than self-reported height and weight. Source: OECD Health Data 2012.
  • 18. Over one-third of children in the US are overweight or obese Children aged 5-17 years who are overweight (including obese) Girls Boys 37.0 Greece 45.0 35.9 United States 35.0 30.9 Italy 32.4 29.0 Mexico 28.1 26.6 United Kingdom 22.7 26.1 Canada 28.9 24.0 Australia 22.0 21.4 OECD 22.9 17.6 Germany 22.6 14.9 France 13.1 14.4 Japan 16.2 50 40 30 20 10 0 0 10 20 30 40 50 % of children aged 5-17 years % of children aged 5-17 years Source: International Association for the Study of Obesity (2011).