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1
Multinational Comparisonsof Health Systems Data, 2009
Gerard F. Anderson, Ph.D. and Patricia MarkovichJohns Hopkins University
November 2009
Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund or its directors, officers, or staff.
THECOMMONWEALTH
FUND
2International Comparison of Spending on Health,
1980–2007
0
1000
2000
3000
4000
5000
6000
7000
1980 1984 1988 1992 1996 2000 2004
U.S.NorwaySwitzerlandCanadaNetherlandsFranceGermanySwedenU.K.ItalyNew ZealandAustralia
Average spending on healthper capita ($US PPP)
0
2
4
6
8
10
12
14
16
1980 1984 1988 1992 1996 2000 2004
U.S.FranceSwitzerlandGermanyCanadaNetherlandsNew ZealandSwedenNorwayItalyU.K.Australia
Total expenditures on healthas percent of GDP
Source: OECD Health Data 2009 (June 2009)
THECOMMONWEALTH
FUND
3Average Annual Growth Rate of
Real Health Care Spending per Capita, 1997-2007
1.7%
2.3%2.4%
2.4%2.5%
3.7%3.8%3.8%
4.0%4.1%4.2%
4.5%
4.9%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
UK NZ NETH SWE OECD
Median
CAN AUS* US FR ITA NOR SWITZ GER
*1996-2006
Source: OECD Health Data 2009 (June 2009)
THECOMMONWEALTH
FUND
4Out-of-Pocket Health Care Spending per Capita, 2007 Adjusted for Differences in the Cost of Living
$213$246
$343$351
$470$485$528$542$571$580
$720
$890
$1,350
$0
$200
$400
$600
$800
$1,000
$1,200
$1,400
SWITZ US NOR CAN AUS* ITA SWE OECD
Median
GER NZ UK FR NETH
*2006
Source: OECD Health Data 2009 (June 2009)
THECOMMONWEALTH
FUND
5Health Care Expenditure per Capita
by Source of Funding, 2007Adjusted for Differences in Cost of Living
$3,307
$4,005
$2,618 $2,726 $2,844 $2,758$2,124
$2,446$2,056
$3,092
$449$589 $510
$360
$441
$890
$1,350 $580
$571 $343
$2,716
$38
$88$204
$79
$720
$542
$470$627
$528
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
US NOR SWIT CAN FR GER SWE AUS* UK ITA
Out-of-Pocket Spending
Private Spending
Public Spending
*2006
Source: OECD Health Data 2009 (June 2009)
THECOMMONWEALTH
FUND
6Hospital Spending per Discharge, 2007
Adjusted for Differences in Cost of Living
$17,206
$12,163 $11,988
$9,398 $9,131 $9,026
$7,312 $7,312 $7,295
$4,667 $4,527
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
$16,000
$18,000
US* CAN* NETH SWITZ NOR* SWE NZ OECD
Median
AUS* FR GER
* 2006
Source: OECD Health Data 2009 (June 2009)
THECOMMONWEALTH
FUND
7Hospital Discharges per 1,000 Population, 2007
84
109
126126135139
162163165166172
227
274
0
50
100
150
200
250
300
FR GER NOR SWITZ SWE OECD
Median
AUS* ITA* NZ US* UK NETH CAN*
*2006
Source: OECD Health Data 2009 (June 2009)
THECOMMONWEALTH
FUND
8Average Length of Hospital Stay
for Acute Myocardial Infarction, 2007
4.64.8
5.4
6.26.46.8
7.17.1
7.98.0
8.9
11.0
0
2
4
6
8
10
12
GER UK ITA* SWITZ NETH OECD
Median
CAN* FR AUS* US* SWE NOR
* 2006
Source: OECD Health Data 2009 (June 2009)
THECOMMONWEALTH
FUND
9Average Annual Number of Physician Visits
per Capita, 2007
7.5
7.0
6.3 6.3 6.3
5.8 5.7
5.04.7
4.03.8
2.8
0
1
2
3
4
5
6
7
8
GER ITA** AUS FR OECD
Median
CAN* NETH UK NZ SWITZ US* SWE*
*2006 **2005
Source: OECD Health Data 2009 (June 2009)
THECOMMONWEALTH
FUND
10Number of Practicing Physicians
per 1,000 Population, 2007
2.2
3.9 3.9 3.9
3.73.6
3.53.4
3.2
2.8
2.52.4
2.3
0
1
2
3
4
NETH NOR SWITZ ITA SWE* GER FR OECD
Median
AUS* UK US NZ CAN
*2006
Source: OECD Health Data 2009 (June 2009)
THECOMMONWEALTH
FUND
11Pharmaceutical Spending per Capita, 2007
Adjusted for Differences in Cost of Living
$241
$381$422$431$446$446$454
$518$542
$588
$691
$878
$0
$100
$200
$300
$400
$500
$600
$700
$800
$900
US CAN FR GER ITA SWITZ SWE OECD
Median
AUS* NETH NOR NZ
*2006
Source: OECD Health Data 2009 (June 2009)
THECOMMONWEALTH
FUND
12Drug Prices for 30 Most Commonly Prescribed Drugs, 2006-07
US is set at 1.0
0.34
0.440.450.490.51
0.63
0.760.77
1.00
0
0.2
0.4
0.6
0.8
1
US CAN GER SWITZ UK AUS NETH FR NZ
Source: IMS
THECOMMONWEALTH
FUND
13Drug Prices for 30 Most Commonly Prescribed Drugs, 2006-07 – Brand and Generic
US is set at 1.0
Source: IMS
AUS CAN FR GER NETH NZ SWITZ UK US
Brand Drugs 0.40 0.64 0.32 0.43 0.39 0.33 0.51 0.46 1.00
Generic Drugs 2.57 1.78 2.85 3.99 1.96 0.90 3.11 1.75 1.00
THECOMMONWEALTH
FUND
14Drug Prices: Lipitor (atorvastatin), 2006-07 Price for one dose
$0.71
$1.01
$1.35$1.45$1.45$1.46$1.52
$1.83
$2.82
$0
$1
$2
$3
US CAN SWITZ AUS UK NETH GER FR NZ
Source: IMS
THECOMMONWEALTH
FUND
15Drug Prices: Nexium (esomeprazole), 2006-07 Price for one dose
$0.88$1.02
$1.22$1.28$1.32
$1.97$2.15
$3.91
$0
$1
$2
$3
$4
US SWITZ CAN UK NETH FR AUS GER
Source: IMS
THECOMMONWEALTH
FUND
16Magnetic Resonance Imaging (MRI) Machines
per Million Population, 2007
25.9
18.6
14.4
8.88.5 8.2 8.2
6.7 6.65.7 5.1
0
10
20
30
US ITA SWITZ NZ OECD
Median
GER UK CAN NETH** FR AUS
**2005
Source: OECD Health Data 2009 (June 2009)
THECOMMONWEALTH
FUND
17MRI Scan and Imaging Fees, 2009
$1,200
$839 $824
$567
$436
$179
0
200
400
600
800
1,000
1,200
1,400
US GER CAN NETH FR UK
Source: International Federation of Health Plans, 2009 Comparative Price Report
THECOMMONWEALTH
FUND
18Volume Knee and Hip Implants, 2004
Implants per 100,000
164
137
121
95
65
0
20
40
60
80
100
120
140
160
180
US UK GER FR ITA
Source: McKinsey & Company, Accounting for the Cost of Health Care in the United States, 2007
258
208197
141 139
GER FR UK ITA US
Knee Replacements Hip Replacements
THECOMMONWEALTH
FUND
19Cost of Knee and Hip Prostheses to Providers, 2004
GDP Adjusted, US $
$4,866
$3,035
$2,561$2,390
$2,239
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
US ITA FR UK GER
Source: McKinsey & Company, Accounting for the Cost of Health Care in the United States, 2007
$4,821
$1,537$1,380
$1,168 $1,165
US ITA UK GER FR
Knee Replacements Hip Replacements
THECOMMONWEALTH
FUND
20Coronary Bypass Proceduresper 100,000 Population, 2007
32 31
132
8581
77 7673 73
59 58 56
45
0
25
50
75
100
125
150
GER US* NOR* NZ AUS* ITA* CAN* OECD
Median
NETH SWE UK FR SWITZ
* 2006
Source: OECD Health Data 2009 (June 2009)
THECOMMONWEALTH
FUND
21Percentage of Population over Age 65 with Influenza Immunization, 2007
77.5%77.0%
73.5%
69.0%66.7%
64.9% 64.3% 63.7%58.9%
56.0% 56.0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
AUS* NETH UK FR US ITA CAN NZ OECD
Medi an
GER SWITZ
* 2006
a
Source: OECD Health Data 2009 (June 2009)
THECOMMONWEALTH
FUND
22Percentage of Adults Who Report Being
Daily Smokers, 2007
15%15%
29%
25%
23%22% 22% 22%
21% 20%
18% 18%
17%
0%
5%
10%
15%
20%
25%
30%
NETH FR* GER** ITA OECD
Median
NOR UK SWITZ CAN NZ AUS US SWE*
* 2006** 2005
Source: OECD Health Data 2009 (June 2009)
THECOMMONWEALTH
FUND
23
34.3%
26.5%
24.0%
15.4%13.6%
11.2%10.5% 10.2% 9.9% 9.0%
8.1%
0%
5%
10%
15%
20%
25%
30%
35%
US* NZ UK CAN GER** NETH FR* SWE ITA NOR SWITZ
Obesity (BMI>30) Prevalence Among Adult Population, 2007
* 2006**2005
Note: For most countries, BMI estimates are based on national health interview surveys (self-reported data). However, the estimates for the US, UK, and New Zealand are based on actual measurements of weight and height, and estimates based on actual measurements are usually significantly higher than those based on self-report.
Source: OECD Health Data 2009 (June 2009)
THECOMMONWEALTH
FUND
24
Life Expectancy at Birth, 2007
81.1 80.778.2
82.282.382.382.482.983.083.083.784.084.284.4
77.175.4
77.27877.278.278.978.47978.479.277.5
0
10
20
30
40
50
60
70
80
90
FR SWITZ* ITA* AUS CAN* SWE NOR* GER* NETH OECD
Median
NZ UK ** US*
Female Male
* 2006**2005
Source: OECD Health Data 2009 (June 2009)
THECOMMONWEALTH
FUND
25
Mortality Amenable to Health CareDeaths per 100,000 population*
* Countries’ age-standardized death rates before age 75; includes ischemic heart disease, diabetes, stroke, and bacterial infections.Data: E. E. Nolte and C. M. McKee, Measuring the Health of Nations: Updating an Earlier Analysis, Health Affairs, January/February 2008Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008.
7681
88 8489 89
99 9788
97
109 106116 115 113
130134
128
115
65 71 71 74 77 80 82 82 84 84 90 93 96 101 103 103 104 110
74
0
50
100
150
Fran
ceJa
pan
Austra
liaSpai
n
Italy
Canad
aNorw
ayNet
herla
nds
Swed
enG
reec
eAust
riaG
erm
any
Finl
and
New Z
eala
ndDen
mar
k
United
Kingd
omIre
land
Portuga
l
United
State
s
1997/98 2002/03
THECOMMONWEALTH
FUND
26Potential Years of Life Lost Due to Diabetes
per 100,000 Population, 2007
19
25293133
35363637
64
99
0
20
40
60
80
100
US** NZ** NOR* SWE* OECD
Median
GER* NETH ITA* FR* UK SWITZ*
* 2006**2005
Source: OECD Health Data 2009 (June 2009)