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DELSA/ELSA/WD/HEA(2003)6/ANN2

OECD HEALTH WORKING PAPERS

Tackling Excessive Waiting Times for ElectiveSurgery: A Comparison of Policies in Twelve OECD

Countries

Annex 3: Detailed Country Reviews: Figures

Jeremy Hurst and Luigi Siciliani

6

Unclassified DELSA/ELSA/WD/HEA(2003)6/ANN2 Organisation de Coopération et de Développement Economiques Organisation for Economic Co-operation and Development 04-Jul-2003 ___________________________________________________________________________________________

English text only DIRECTORATE FOR EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS COMMITTEE

Tackling Excessive Waiting Times for Elective Surgery: A Comparison of Policies in Twelve OECD Countries Annex 3: Detailed Country Reviews: Figures

Jeremy Hurst and Luigi Siciliani

JEL classification: I11, I18, H4

JT00147123

Document complet disponible sur OLIS dans son format d'origine Complete document available on OLIS in its original format

DE

LSA

/EL

SA/W

D/H

EA

(2003)6/AN

N2

Unclassified

English text only


2

TABLE OF CONTENTS

1. AUSTRALIA........................................................................................................................................ 5

Figure A3.1.1. Inpatient and day-case surgery procedures...................................................................... 5 Figure A3.1.2a. and A3.1.2b. Number of treatments (per 100 000 population) by surgical procedure (total) .................................................................................................................................................... 6 Figure A3.1.3a. and A3.1.3b. Percentage of publicly funded patients over total number of treatments performed (by surgical procedure) ......................................................................................................... 7 Figure A3.1.4a. and A3.1.4b. Percentage of publicly funded patients treated in privately owned hospitals8 Figure A3.1.5. Expenditure on health, per capita, NCU 95 GDP price.................................................... 9 Figure A3.1.6. Number of practising physicians, per 1000 population.................................................... 9

2. CANADA............................................................................................................................................10

Figure A3.2.1. Inpatient surgical procedures .........................................................................................10 Figure A3.2.2. Number of treatments (per 100 000 population) by surgical procedure...........................10 Figure A3.2.3. Expenditure on health, per capita, NCU 95 GDP price...................................................11 Figure A3.2.4. Number of practising physicians, per 1000 population...................................................11 Figure A3.2.5. Median waiting time by speciality, British Columbia.....................................................12 Figure A3.2.6. Median waiting time by surgical procedure, British Columbia .......................................12 Figure A3.2.7. Number of completed cases by speciality, per 1000 population, British Columbia..........13 Figure A3.2.8. Number of completed cases by surgical procedure, per 1000 population, British Columbia..............................................................................................................................................13

3. DENMARK.........................................................................................................................................14

Figure A3.3.1. Median waiting time from GP referral to treatment........................................................14 Figure A3.3.2. Percentage of the patients admitted for treatment waiting longer than 60 days and 90 days15 Figure A3.3.3a. and A3.3.3b. Median waiting time from GP referral to treatment by surgical procedure16 Figure A3.3.4. Median waiting time from GP referral to treatment by speciality ...................................17 Figure A3.3.5. Median waiting time from GP referral to specialist visit by speciality ............................17 Figure A3.3.6. Inpatient and day-case surgery procedures.....................................................................18 Figure A3.3.7. Percentage of the patients treated as day-cases for selected surgical procedures .............18 Figure A3.3.8a. and A3.3.8b. Number of treatments (per 100 000 population) by surgical procedure ....19 Figure A3.3.9. Expenditure on health, per capita, NCU 95 GDP price...................................................20 Figure A3.3.10. Expenditure on health, as a percentage of GDP............................................................20 Figure A3.3.11. Number of practising physicians, per 1000 population .................................................21 Figure A3.3.12. Waiting times for cardiac surgery ................................................................................21 Figure A3.3.13. Volume of procedures for cardiac surgery....................................................................22

4. ENGLAND..........................................................................................................................................23

Figure A3.4.1. Mean and median inpatient waiting time of patients on the list.......................................23 Figure A3.4.2. Mean and median inpatient waiting time of patients admitted ........................................23 Figure A3.4.3. Median inpatient waiting time of patients admitted by speciality....................................24 Figure A3.4.4. Median outpatient waiting time of patients admitted by speciality..................................24


3

Figure A3.4.5a. and A3.4.5b. Median inpatient waiting time of patients admitted by main surgical procedure .............................................................................................................................................25 Figure A3.4.6a. and A3.4.6b. Number of treatments (per 100 000 population) by main surgical procedure26 Figure A3.4.7. Expenditure on health, per capita, NCU 95 GDP price...................................................27 Figure A3.4.8. Number of practising physicians, per 1000 population...................................................27

5. FINLAND ...........................................................................................................................................28

Figure A3.5.1. Mean waiting time for the patients admitted (total, inpatient, day-surgery).....................28 Figure A3.5.2. Median waiting time for the patients admitted (total, inpatient, day-surgery)..................28 Figure A3.5.3a. and A3.5.3b. Median inpatient waiting time for the patients admitted by surgical procedure .............................................................................................................................................29 Figure A3.5.4. Inpatient and day-case surgery procedures.....................................................................30 Figure A3.5.5a. and A3.5.5b. Number of treatments (per 100 000 population) by surgical procedure ....31 Figure A3.5.6. Expenditure on health, per capita, NCU 95 GDP price...................................................32 Figure A3.5.7. Number of practising physicians, per 1000 population...................................................32

6. IRELAND ...........................................................................................................................................33

Figure A3.6.1. Number of patients on the list waiting longer than three months ....................................33 Figure A3.6.2a and A3.6.2b. Waiting time by main speciality...............................................................34 Figure A3.6.3. Waiting time by main surgical procedure.......................................................................35 Figure A3.6.4. Number of surgical treatments (per 100 000 population)................................................35 Figure A3.6.5a and A3.6.5b. Number of treatments (per 100 000 population) by main surgical procedure36 Figure A3.6.6. Expenditure on health, per capita, NCU 95 GDP price...................................................37 Figure A3.6.7. Number of practising physicians, per 1000 population...................................................37 Figure A3.6.8. Funding for the Waiting List Initiative...........................................................................38

7. ITALY.................................................................................................................................................39

Figure A3.7.1. Inpatient and day-case surgery procedures.....................................................................39 Figure A3.7.2. Expenditure on health, per capita, NCU 95 GDP price...................................................39 Figure A3.7.3. Number of physicians entitled to practice, per 1000 population......................................40

8. THE NETHERLANDS........................................................................................................................41

Figure A3.8.1. Inpatient and day-case surgery procedures.....................................................................41 Figure A3.8.2a.and A3.8.2b. Number of treatments (per 100 000 population) by surgical procedure .....42 Figure A3.8.3. Expenditure on health, per capita, NCU 95 GDP price...................................................43 Figure A3.8.4. Number of practising physicians, per 1000 population...................................................43

9. NEW ZEALAND.................................................................................................................................44

Figure A3.9.1. Number of the patients on the list waiting more than six months and two years..............44 Figure A3.9.2. Number of the patients waiting for specialist assessment more than six months and 18 months .................................................................................................................................................45 Figure A3.9.3. Surgical discharges for elective services ........................................................................46 Figure A3.9.4. Funding for elective services .........................................................................................47 Figure A3.9.5. Expenditure on health, per capita, NCU 95 GDP price...................................................47 Figure A3.9.6. Number of practising physicians, per 1000 population...................................................48 Figure A3.9.7. Status of the patients on the list .....................................................................................48

10. NORWAY .........................................................................................................................................49

Figure A3.10.1. Expenditure on health, per capita, NCU 95 GDP price.................................................49 Figure A3.10.2. Number of practising physicians, per 1000 population .................................................49

11. SPAIN ...............................................................................................................................................50


4

Figure A3.11.1. Targets: mean and maximum waiting time of the patients on the list ............................50 Figure A3.11.2. Mean waiting time of the patients on the list. Insalud. ..................................................51 Figure A3.11.3a. and A3.11.3b. Mean waiting time of the patients on the list by surgical procedure. Insalud. ................................................................................................................................................52 Figure A3.11.4. Mean waiting time of the patients on the list by main speciality (inpatient and day surgery). Vasque country. .....................................................................................................................53 Figure A3.11.5. Mean waiting time of the patients on the list by main speciality (outpatient). Vasque country.................................................................................................................................................54 Figure A3.11.6. Patients on the list waiting longer than 6 months..........................................................55 Figure A3.11.7. Patients on the waiting list ...........................................................................................56 Figure A3.11.8. Surgical treatments......................................................................................................56 Figure A3.11.9. Cost of the initiatives...................................................................................................57 Figure A3.11.10. Expenditure on health, per capita, NCU 95 GDP price ...............................................58 Figure A3.11.11. Number of practising physicians, per 1000 population ...............................................58

12. SWEDEN ..........................................................................................................................................59

Figure A3.12.1. Median waiting time....................................................................................................59 Figure A3.12.2. Percentage of the patients waiting longer than 4, 6 and 9 months .................................59 Figure A3.12.3. Number of surgical procedures performed ...................................................................60 Figure A3.12.4. Expenditure on health, per capita, NCU 95 GDP price.................................................60 Figure A3.12.5. Number of practising physicians, per 1000 population .................................................61


5

1. AUSTRALIA

Figure A3.1.1. Inpatient and day-case surgery procedures

0

20

40

60

80

100

120

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Su

rgic

al p

roce

du

res

/ 100

0 p

op

ula

tio

n

Total

Day-case

Inpatient

Note:

1. Total surgical procedures are calculated by the addition of total surgical day cases and total surgical in-patients where the data are available.

Source: OECD Health Data 2002.


6

Figure A3.1.2a. and A3.1.2b. Number of treatments (per 100 000 population) by surgical procedure (total)

0

100

200

300

400

500

600

700

800

93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-01

Pro

ced

ure

s / 1

0000

0 p

op

ula

tio

n

Cataract surgery CholecystectomyInguinal and fem. hernia ProstatectomyKnee arthroscopy

0

20

40

60

80

100

120

140

160

93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-01

Pro

ced

ure

s / 1

0000

0 p

op

ula

tio

n

PTCA Coronary bypassVaginal hysterectomy Hip replacementKnee replacement Varicose veins

Source: National Hospital Morbidity Database, Australian Institute of Health and Welfare, Australia.


7

Figure A3.1.3a. and A3.1.3b. Percentage of publicly funded patients over total number of treatments performed (by surgical procedure)

0

10

20

30

40

50

60

70

93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-01

Per

cen

t

PTCA Coronary bypassCholecystectomy Inguinal and fem. herniaVaginal hysterectomy Hip replacement

0

10

20

30

40

50

60

93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-01

Per

cen

t

Cataract surgery ProstatectomyKnee arthroscopy Knee replacementVaricose veins



8

Figure A3.1.4a. and A3.1.4b. Percentage of publicly funded patients treated in privately owned hospitals

0

1

2

3

4

5

6

7

8

9

10

93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-01

Per

cen

t

Cataract surgery CholecystectomyVaginal hysterectomy Knee arthroscopyKnee replacement

0

1

2

3

4

5

6

7

8

9

10

93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-01

Per

cen

t

PTCA Coronary bypassInguinal and fem. hernia ProstatectomyHip replacement Varicose veins



9

Figure A3.1.5. Expenditure on health, per capita, NCU 95 GDP price

0

500

1000

1500

2000

2500

3000

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Exp

end

itu

re /

cap

ita,

NC

U 1

995

GD

P p

rice

Total

Public

Private

Note:

1. Expenditure is displayed as expenditure per capita in the national currency units at the 1995 GDP price level.


Figure A3.1.6. Number of practising physicians, per 1000 population

0

1

2

3

4

5

6

7

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Ph

ysic

ian

s / 1

000

po

pu

lati

on



10

2. CANADA

Figure A3.2.1. Inpatient surgical procedures

0

10

20

30

40

50

60

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Su

rgic

al p

roce

du

res

/ 100

0 p

op

ula

tio

n

Inpatient


Figure A3.2.2. Number of treatments (per 100 000 population) by surgical procedure

0

50

100

150

200

250

300

350

400

450

500

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Su

rgic

al p

roce

du

res

/ 100

000

po

pu

lati

on

Coronary bypass Hip replacementProstatectomy Hysterectomy

Note:

1. Prostatectomy refers to surgical procedures per 100 000 males. 2. Hysterectomy refers to surgical procedures per 100 000 females.



11


0

500

1000

1500

2000

2500

3000

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Exp

end

itu

re /

cap

ita,

NC

U 1

995

GD

P p

rice

Total

Public

Private

Note:

1. Expenditure is displayed as expenditure per capita in the national currency units at the 1995 GDP price level. Source: OECD Health Data 2002.


0

1

2

3

4

5

6

7

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Ph

ysic

ian

s / 1

000

po

pu

lati

on



12

Figure A3.2.5. Median waiting time by speciality, British Columbia

0

20

40

60

80

100

120

140

160

Dec 97 June 98 Dec 98 June 99 Dec 99 June 00 Dec 00 June 01 Dec 01 June 02

Med

ian

wai

tin

g t

ime

(day

s)Cardiac surgery Ear, nose and throatGeneral surgery GynaecologyNeurosurgery OpthalmologyOrthopaedic surgery UrologyVascular surgery

Note: 1. Data refers only to British Columbia.

Source: Ministry of Health Services, Government of British Columbia web-site http://www.healthservices.gov.bc.ca/waitlist/provdata.html.

Figure A3.2.6. Median waiting time by surgical procedure, British Columbia

0

50

100

150

200

250


Med

ian

wai

tin

g t

ime

(day

s)

Cataract surgery Hip replacementKnee replacement

Note: 1. Data refers only to British Columbia.



13

Figure A3.2.7. Number of completed cases by speciality, per 1000 population, British Columbia

0

1

2

3

4

5

6


Cas

es /

1000

po

pu

lati

on

in t

he

last

6 m

on

ths

Ear, nose and throat General surgeryGynaecology NeurosurgeryOpthalmology Orthopaedic surgeryUrology Vascular surgery

Notes: 1. Data refers only to British Columbia. 2. Data refers to completed cases in the preceding 6 months.


Figure A3.2.8. Number of completed cases by surgical procedure, per 1000 population, British Columbia

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5


Pro

ced

ure

s / 1

000

po

pu

lati

on

in t

he

last

6 m

on

ths

Cataract surgery Hip replacementKnee replacement

Notes: 1. Data refers only to British Columbia. 2. Data refers to completed cases in the preceding 6 months.



14

3. DENMARK

Figure A3.3.1. Median waiting time from GP referral to treatment

0

10

20

30

40

50

60

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Med

ian

wai

tin

g t

ime

(day

s)

Inpatient

Day-case

Notes:

1. Waiting times is calculated as the delay between the GP referral and the admission for treatment. 2. ‘Inpatient’ refers to patients with overnight stay, as opposed to ‘day-cases’. 3. Data includes passive waiting time but excludes healthy companions, healthy newborn infants, potential donors

and donors. Patients who were admitted as urgent cases but have in fact been waiting for treatment are included as waiting patients.

4. The waiting time data prior to 1999 is corrected to create a continuous time series. 5. Waiting times refers to the patients admitted for treatment (not the patients on the list at a point in time).

Source: Personal correspondence, Department of the Interior and Health, Denmark, 2003.


15

Figure A3.3.2. Percentage of the patients admitted for treatment waiting longer than 60 days and 90 days

0

10

20

30

40

50

60

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Per

cen

t

waiting >60 days

waiting >90 days

Notes:

1. Waiting time refers to the waiting time for elective surgical overnight stay patients. It includes passive waiting time but excludes healthy companions, healthy newborn infants, potential donors and donors. Patients who were admitted as urgent cases but have in fact been waiting for treatment are included as waiting patients.

2. The waiting time data prior to 1999 is corrected to create a continuous time series.

Sources: The Danish Healthcare Sector in Figures 2001/2002, Danish Ministry of the Interior and Health, 2002; The Danish Health Care Sector in Figures 2000/2001, Danish Ministry of Health, 2001.


16

Figure A3.3.3a. and A3.3.3b. Median waiting time from GP referral to treatment by surgical procedure

0

20

40

60

80

100

120

140

160

180

200

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Med

ian

wai

tin

g t

ime

(day

s)

Cataract surgery Hip replacement

Knee replacement Varicose veins

0

20

40

60

80

100

120

140

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Med

ian

wai

tin

g t

ime

(day

s)

Cholecystectomy Inguinal and fem. hernia

Prostatectomy Vaginal hysterectomy

Knee arthroscopy

Notes:

1. Data are for publicly funded patients only. 2. The waiting time data prior to 1999 is corrected to create a continuous time series. 3. Waiting times refer to the patients admitted for treatment (not the patients on the list at a point in time). Source: Response to OECD Waiting Times data questionnaire, Department of the Interior and Health, Denmark.


17

Figure A3.3.4. Median waiting time from GP referral to treatment by speciality

0

20

40

60

80

100

120

140

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Med

ian

wai

tin

g t

ime

(day

s)General surgery Vascular surgeryThoracic surgery UrologyOphthalmology Orthopaedic surgeryOto-rhino-laryingology Gynaecology and Obst.

Notes: 1. Data are for publicly funded patients only. 2. The waiting time data prior to 1999 is corrected to create a continuous time series 3. Waiting times refers to the patients admitted for treatment (not the patients on the list at a point in time). Source: Response to OECD Waiting Times data questionnaire, Department of the Interior and Health, Denmark.

Figure A3.3.5. Median waiting time from GP referral to specialist visit by speciality

0

10

20

30

40

50

60

70

1996 1997 1998 1999 2000 2001

Med

ian

wai

tin

g t

ime

(day

s)

General surgery Vascular surgeryThoracic surgery UrologyOphthalmology Orthopaedic surgeryEar Nose and Throat Gynaecology and Obst.

Notes: 1. Data are for publicly funded patients only. 2. The waiting time data prior to 1999 is corrected to create a continuous time series. 3. Waiting times refer to the patients admitted for treatment (not the patients on the list at a point in time). Source: Response to OECD Waiting Times data questionnaire, Department of the Interior and Health, Denmark.


18


0

10

20

30

40

50

60

70

80

90

100

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Per

100

0 p

op

ula

tio

nInpatient

Day-case

Total

Note: 1. Total surgical procedures are calculated by the addition of total surgical day cases and total surgical inpatients where the data are available. Source: OECD Health Data 2002.

Figure A3.3.7. Percentage of the patients treated as day-cases for selected surgical procedures

0

10

20

30

40

50

60

70

80

90

100

1996 1997 1998 1999 2000

Per

cen

t p

erfo

rmed

as

day

-cas

e su

rger

y

Cataract procedures

Hernia procedures

Varicose veins

Laparoscopic cholecystectomy

Notes: 1. Per cent day-case surgery refers to the number of elective operations performed on a day-case basis divided by the number of elective operations. 2. Inpatients who are discharged the same day as they are admitted and are not transferred to another overnight-stay ward are counted as day-cases. 3. Only elective operations are included. Only operations registered as primary or most important in a contact are examined.

Sources: The Danish Healthcare Sector in Figures 2001/2002, Danish Ministry of the Interior and Health, 2002; The Danish Health Care Sector in Figures 2000/2001, Danish Ministry of Health, 2001. OECD Health Data 2002.


19

Figure A3.3.8a. and A3.3.8b. Number of treatments (per 100 000 population) by surgical procedure

0

50

100

150

200

250

300

350

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Pro

ced

ure

s / 1

0000

0 p

op

ula

tio

n

Cataract surgery Inguinal and fem. herniaKnee arthroscopy Hip replacementVaricose veins

0

20

40

60

80

100

120

140

160

180

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Pro

ced

ure

s / 1

0000

0 p

op

ula

tio

n

Cholecystectomy ProstatectomyVaginal hysterectomy Knee replacement

Note:

1. Data are for publicly funded inpatients only.

Source: Response to OECD Waiting Times data questionnaire, Department of the Interior and Health, Denmark.


20


0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Exp

end

itu

re /

cap

ita,

NC

U 1

995

GD

P p

rice

Total

Public

Private

Note: 1. Expenditure is displayed as expenditure per capita in the national currency units at the 1995 GDP price level.


Figure A3.3.10. Expenditure on health, as a percentage of GDP

0

1

2

3

4

5

6

7

8

9

10

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Exp

end

itu

re, %

GD

P

Total

Public

Private

Note: 1. Expenditure is displayed as a percent of GDP.



21


0

1

2

3

4

5

6

7

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Ph

ysic

ian

s / 1

000

po

pu

lati

on


Figure A3.3.12. Waiting times for cardiac surgery

0

10

20

30

40

50

60

1994 1995 1996 1997 1998 1999 2000 2001

Per

cen

t w

aiti

ng

>=

4 w

eeks

PTCA & Bypass

Notes:

1. The 2001 waiting times data cover the period up to 31.10.2001. 2. PTCA refers to Percutaneous Transluminal Coronary Angioplasty. Sources: The Danish Healthcare Sector in Figures 2001/2002, Danish Ministry of the Interior and Health, 2002; The Danish Health Care Sector in Figures 2000/2001, Danish Ministry of Health, 2001.


22

Figure A3.3.13. Volume of procedures for cardiac surgery

0

20

40

60

80

100

120

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Pro

ced

ure

s / 1

0000

0 p

op

ula

tio

n

PTCA

Coronary Bypass

Notes:

1. PTCA refers to Percutaneous Transluminal Coronary Angioplasty with the ICD-9-CM category 36.0. 2. Coronary bypass refers to the ICD-9-CM category 36.1.



23

4. ENGLAND

Figure A3.4.1. Mean and median inpatient waiting time of patients on the list

0

50

100

150

200

250

300

Mar

-89

Sep

-89

Mar

-90

Sep

-90

Mar

-91

Sep

-91

Mar

-92

Sep

-92

Mar

-93

Sep

-93

Mar

-94

Sep

-94

Mar

-95

Sep

-95

Mar

-96

Sep

-96

Mar

-97

Sep

-97

Mar

-98

Sep

-98

Mar

-99

Sep

-99

Wai

tin

g t

ime

(day

s)

Mean waiting time

Median waiting time

Notes: 1. Waiting time takes into account periods of suspension or self-deferrals. 2. Data for 1998/99 is provisional. Source: Quarterly Körner waiting list returns.

Figure A3.4.2. Mean and median inpatient waiting time of patients admitted

0

20

40

60

80

100

120

140

Mar

-89

Sep

-89

Mar

-90

Sep

-90

Mar

-91

Sep

-91

Mar

-92

Sep

-92

Mar

-93

Sep

-93

Mar

-94

Sep

-94

Mar

-95

Sep

-95

Mar

-96

Sep

-96

Mar

-97

Sep

-97

Mar

-98

Sep

-98

Mar

-99

Sep

-99

Wai

tin

g t

ime

(day

s)

Mean waiting time

Median waiting time

Notes: 1. Waiting time refers to the period between the date of the decision to admit and the date of eventual admission in a NHS hospital. 2. Waiting time does not take into account periods of suspension or self-deferrals. 3. Data for 1998/99 is provisional. Source: Hospital Episode Statistics.


24

Figure A3.4.3. Median inpatient waiting time of patients admitted by speciality

0

20

40

60

80

100

120

140

160

1994 1995 1996 1997 1998 1999 2000 2001 2002

Med

ian

wai

tin

g t

ime

(day

s)

General surgery Vascular surgeryThoracic surgery UrologyOphthalmology Orthopaedic surgeryOto-rhino-laryingology Gynaecology & Obst.

Note: 1. Data are for publicly funded patients only. Source: Response to OECD Waiting Times data questionnaire, Department of Health, England.

Figure A3.4.4. Median outpatient waiting time of patients admitted by speciality

0

50

100

150

200

250

300

350

400

450

1994 1995 1996 1997 1998 1999 2000 2001 2002

Med

ian

wai

tin

g t

ime

(day

s)

General surgery Vascular surgeryThoracic surgery UrologyOphthalmology Orthopaedic surgeryOto-rhino-laryingology Gynaecology & Obst.

Note: 1. Data are for publicly funded patients only. Source: Response to OECD Waiting Times data questionnaire, Department of Health, England.


25

Figure A3.4.5a. and A3.4.5b. Median inpatient waiting time of patients admitted by main surgical procedure

0

50

100

150

200

250

300

90-91 91-92 92-93 93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-01

Med

ian

wai

tin

g t

ime

(day

s)

Cataract surgery Coronary bypass

Hip replacement Knee replacement

Varicose veins

0

20

40

60

80

100

120

140

90-91 91-92 92-93 93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-01

Med

ian

wai

tin

g t

ime

(day

s)

PTCA CholecystectomyInguinal and fem. hernia ProstatectomyVaginal hysterectomy Knee arthroscopy

Note:

1. Data are for publicly funded patients only.

Source: Response to OECD Waiting Times data questionnaire, Department of Health, England.


26

Figure A3.4.6a. and A3.4.6b. Number of treatments (per 100 000 population) by main surgical procedure

0

50

100

150

200

250

300

350

400

450

500

90-91 91-92 92-93 93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-01

Pro

ced

ure

s / 1

0000

0 p

op

ula

tio

n

Cataract surgery Cholecystectomy

Inguinal and fem. hernia Hip replacement

Varicose veins

0

10

20

30

40

50

60

70

80

90

100

90-91 91-92 92-93 93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-01

Pro

ced

ure

s / 1

0000

0 p

op

ula

tio

n

PTCA Coronary bypassProstatectomy Vaginal hysterectomyKnee arthroscopy Knee replacement

Note:


Source: Response to OECD Waiting Times data questionnaire, Department of Health, England.


27


0

200

400

600

800

1000

1200

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Exp

end

itu

re /

cap

ita,

NC

U 1

995

GD

P p

rice

Total

Public

Private

Notes: 1. Expenditure is displayed as expenditure per capita in the national currency units at the 1995 GDP price level. 2. Data refers to the United Kingdom. Source: OECD Health Data 2002.


0

1

2

3

4

5

6

7

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Ph

ysic

ian

s / 1

000

po

pu

lati

on

Note: 1. Data refers to the United Kingdom.



28

5. FINLAND

Figure A3.5.1. Mean waiting time for the patients admitted (total, inpatient, day-surgery).

0

20

40

60

80

100

120

140

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Mea

n w

aiti

ng

tim

e (d

ays)

Total

Day-surgery

Inpatient

Source: Personal correspondence, Stakes, Finland.

Figure A3.5.2. Median waiting time for the patients admitted (total, inpatient, day-surgery).

0

10

20

30

40

50

60

70

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Med

ian

wai

tin

g t

ime

(day

s)

Total

Day-surgery

Inpatient

Source: Personal correspondence, Stakes, Finland.


29

Figure A3.5.3a. and A3.5.3b. Median inpatient waiting time for the patients admitted by surgical procedure

0

50

100

150

200

250

300

1997 1998 1999 2000 2001

Med

ian

wai

tin

g t

ime

(day

s)

Cataract surgery Hip replacementKnee replacement Varicose veinsCholecystectomy Vaginal hysterectomy

0

10

20

30

40

50

60

70

80

90

100

1997 1998 1999 2000 2001

Med

ian

wai

tin

g t

ime

(day

s)

PTCA Coronary bypass

Inguinal and fem. hernia Prostatectomy

Knee arthroscopy

Notes:

1. Data refers only to patients admitted to public hospitals. 2. Patients who have been admitted as 'out-of-hours' (emergency) cases or have been transferred from an outpatient

clinic or another department within the same hospital or from another hospital, have been excluded.

Source: Response to OECD Waiting Times questionnaire, Stakes, Finland.


30


0

10

20

30

40

50

60

70

80

90

100

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Su

rgic

al p

roce

du

res

/ 100

0 p

op

ula

tio

n

Total

Day-surgery

Inpatient

Note:

1. Total surgical procedures are calculated by the addition of total surgical day cases and total surgical in-patients where the data are available.



31

Figure A3.5.5a. and A3.5.5b. Number of treatments (per 100 000 population) by surgical procedure

0

100

200

300

400

500

600

700

1997 1998 1999 2000 2001

Pro

ced

ure

s / 1

0000

0 p

op

ula

tio

n

Cataract surgery CholecystectomyInguinal and fem. hernia Vaginal hysterectomyHip replacement Varicose veins

0

20

40

60

80

100

120

140

160

180

200

1997 1998 1999 2000 2001

Pro

ced

ure

s / 1

0000

0 p

op

ula

tio

n

PTCA Coronary bypassProstatectomy Knee arthroscopyKnee replacement

Note:

1. Data refers to all patients for both public and private providers. 2. All types of admissions including booked admissions, out-of-hours cases (emergency), transfers from other

hospitals are included.

Source: Response to OECD Waiting Times questionnaire, Stakes, Finland.


32


0

200

400

600

800

1000

1200

1400

1600

1800

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Exp

end

itu

re /

cap

ita,

NC

U 1

995

GD

P p

rice

Total

Public

Private

Note: 1. Expenditure is displayed as expenditure per capita in the national currency units at the 1995 GDP price level. Source: OECD Health Data 2002.


0

1

2

3

4

5

6

7

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Ph

ysic

ian

s / 1

000

po

pu

lati

on



33

6. IRELAND

Figure A3.6.1. Number of patients on the list waiting longer than three months

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

Mar

-93

Sep-9

3

Mar

-94

Sep-9

4

Mar

-95

Sep-9

5

Mar

-96

Sep-9

6

Mar

-97

Sep-9

7

Mar

-98

Sep-9

8

Mar

-99

Sep-9

9

Mar

-00

Nu

mb

er

Notes:

1. Number refers to the number of patients on the waiting list who have been waiting longer than three months for treatment.

2. Day surgery is not included.

Sources: A comparative analysis of waiting lists for acute hospital treatment in EU countries, Department of Health and Children, Ireland; Report of the review group on the waiting list initiative Department of Health and Children, Ireland; Department of Health and Children, Ireland (personal correspondence).


34

Figure A3.6.2a and A3.6.2b. Waiting time by main speciality

0

10

20

30

40

50

60

70

80

90

Mar-93 Mar-94 Mar-95 Mar-96 Mar-97 Mar-98 Mar-99 Mar-00 Mar-01

Per

cen

t w

aiti

ng

12

mo

nth

s o

r m

ore

E.N.T. Plastic Surgery UrologyVascular Cardiac Surgery

0

10

20

30

40

50

60

70


Per

cen

t w

aiti

ng

12

mo

nth

s o

r m

ore

Gynaecology Opthalmology

Orthopaedics Surgery (General)

Notes:

1. Per cent refers to the number of patients who are on the list and have been waiting at least 12 months for treatment divided by the number of patients on the list.

2. Day surgery is not included. Source: Response to OECD Waiting Times questionnaire, Department of Health and Children, Ireland.


35

Figure A3.6.3. Waiting time by main surgical procedure

0

10

20

30

40

50

60

70

80

90

100


Per

cen

t w

aiti

ng

12

mo

nth

s o

r m

ore

CABG CataractsHip replacement Knee replacementVaricose veins

Notes: 1. Per cent refers to the number of patients who have been waiting at least 12 months for treatment divided by the total number of patients on the list. 2. Day surgery is not included. 9Source: Response to OECD Waiting Times questionnaire, Department of Health and Children, Ireland.

Figure A3.6.4. Number of surgical treatments (per 100 000 population)

0

20

40

60

80

100

120

140

160

180

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Su

rgic

al p

roce

du

res

/ 100

0 p

op

ula

tio

n

Total

Day cases

In-patients

Notes: 1. Total surgical procedures are calculated by the adding surgical day cases and surgical in-patients. 2. The data for day cases are based on all procedures and not just invasive surgical procedures. Source: OECD Health Data 2002.


36

Figure A3.6.5a and A3.6.5b. Number of treatments (per 100 000 population) by main surgical procedure

0

20

40

60

80

100

120

140

160

180

200

1995 1996 1997 1998 1999 2000 2001

Su

rgic

al p

roce

du

res

/ 100

000

po

pu

lati

on

Cataract surgery CholecystectomyInguinal & fem. hernia Knee arthroscopyHip replacement Varicose veins

0

10

20

30

40

50

60

70

80

90

100

1995 1996 1997 1998 1999 2000 2001

Su

rgic

al p

roce

du

res

/ 100

000

po

pu

lati

on

PTCA Coronary bypassProstatectomy Vaginal hysterectomyKnee replacement

Note:


Source: Response to OECD Waiting Times questionnaire, Department of Health and Children, Ireland.


37


0

200

400

600

800

1000

1200

1400

1600

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Exp

end

itu

re /

cap

ita,

NC

U 1

995

GD

P p

rice

Total

Public

Private

Note:




0

1

2

3

4

5

6

7

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Ph

ysic

ian

s / 1

000

po

pu

lati

on



38

Figure A3.6.8. Funding for the Waiting List Initiative

0

5

10

15

20

25

30

35

40

1993 1994 1995 1996 1997 1998 1999 2000

IR£ (m)

Notes:

1. Expenditure relates to investment in the Waiting List Initiative per calendar year. Sources: A comparative analysis of waiting lists for acute hospital treatment in EU countries, Department of Health and Children, Ireland; Report of the review group on the waiting list initiative Department of Health and Children, Ireland; Department of Health and Children, Ireland (personal correspondence).


39

7. ITALY


0

20

40

60

80

100

120

140

160

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Su

rgic

al p

roce

du

res

/ 100

0 p

op

ula

tio

n

Total

Day cases

In-patients

Note: 1. Total surgical procedures are calculated by the addition of total surgical day cases and total surgical in-patients where the data are available. Source: OECD Health Data 2002.


0

200

400

600

800

1000

1200

1400

1600

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Exp

end

itu

re /

cap

ita,

NC

U 1

995

GD

P p

rice

Total

Public

Private



40

Figure A3.7.3. Number of physicians entitled to practice, per 1000 population

0

1

2

3

4

5

6

7

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Ph

ysic

ian

s / 1

000

po

pu

lati

on



41

8. THE NETHERLANDS


0

10

20

30

40

50

60

70

80

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Su

rgic

al p

roce

du

res

/ 100

0 p

op

ula

tio

n

Total

Day-case

Inpatient

Note: 1. Total surgical procedures are calculated by the addition of total surgical day cases and total surgical in-patients where the data are available. Source: OECD Health Data 2002.


42

Figure A3.8.2a.and A3.8.2b. Number of treatments (per 100 000 population) by surgical procedure

0

100

200

300

400

500

600

1999 2000 2001

Pro

ced

ure

s / 1

0000

0 p

op

ula

tio

n

Cataract surgery CholecystectomyInguinal and fem. hernia Hip replacementVaricose veins

0

20

40

60

80

100

120

1999 2000 2001

Pro

ced

ure

s / 1

0000

0 p

op

ula

tio

n

PTCA Coronary bypassProstatectomy Vaginal hysterectomyKnee replacement Knee arthroscopy

Source: Response to OECD Waiting Times project data questionnaire, Netherlands.


43


0

200

400

600

800

1000

1200

1400

1600

1800

2000

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Exp

end

itu

re /

cap

ita,

NC

U 1

995

GD

P p

rice

Total

Public

Private

Note:




0

1

2

3

4

5

6

7

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Ph

ysic

ian

s / 1

000

po

pu

lati

on



44

9. NEW ZEALAND

Figure A3.9.1. Number of the patients on the list waiting more than six months and two years

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

99/00Q1

99/00Q2

99/00Q3

99/00Q4

00/01 Q1

00/01 Q2

00/01 Q3

00/01 Q4

01/02Q1

01/02Q2

Quarter

Nu

mb

er o

f p

atie

nts

> 6 months

> 2 years

Notes:

1. Number refers to the number of elective services discharges in the relevant quarter who were on the waiting list for the relevant time.

2. Day surgery is included in the elective services discharge numbers.

Sources: Elective Services First Quarterly Report 2001/2002; Elective Services Fourth Quarterly Report 2000/2001; Elective Services Third Quarterly Report 2000/2001; Elective Services Second Quarterly Report 2000/2001; Elective Services First Quarterly Report 2000/2001, New Zealand Ministry of Health.


45

Figure A3.9.2. Number of the patients waiting for specialist assessment more than six months and 18 months

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

50,000

99/00Q1

99/00Q2

99/00Q3

99/00Q4

00/01 Q1

00/01 Q2

00/01 Q3

00/01 Q4

01/02Q1

01/02Q2

Quarter

Nu

mb

er o

f p

atie

nts

> 6 months

> 18 months

Notes:

1. Number refers to the number of patients waiting longer than the relevant time in the relevant quarter for their first specialist assessment after their first referral.

2. Dental data is excluded from Quarter 3 1999/00 onwards and some providers did not report data in 1999/00.

Sources: Elective Services First Quarterly Report 2001/2002; Elective Services Fourth Quarterly Report 2000/2001; Elective Services Third Quarterly Report 2000/2001; Elective Services Second Quarterly Report 2000/2001; Elective Services First Quarterly Report 2000/2001, New Zealand Ministry of Health.


46

Figure A3.9.3. Surgical discharges for elective services

0

20000

40000

60000

80000

100000

120000

140000

160000

180000

200000

220000

1995/96 1996/97 1997/98 1998/99 1999/000 2000/01

Note:

1. Surgical discharges for elective services refers to publicly funded elective surgical discharges.

Source: A Guide to Elective Services.


47

Figure A3.9.4. Funding for elective services

0

100

200

300

400

500

600

95-96 96-97 97-98 98-99 99-00 00-01Year

Fu

nd

ing

fo

r el

ecti

ve s

ervi

ces

($m

)

Notes: 1. Funding for elective services refers to public funding for elective services. 2. GST is included in the public funding for elective services. Source: A Guide to Elective Services.


0

500

1000

1500

2000

2500

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Exp

end

itu

re /

cap

ita,

NC

U 1

995

GD

P p

rice

Total

Public

Private



48


0

1

2

3

4

5

6

7

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Ph

ysic

ian

s / 1

000

po

pu

lati

on


Figure A3.9.7. Status of the patients on the list

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

99/00Q1

99/00Q2

99/00Q3

99/00Q4

00/01 Q1

00/01 Q2

00/01 Q3

00/01 Q4

01/02Q1

01/02Q2

Quarter

Nu

mb

er o

f p

atie

nts

Booked or given certainty

Residual waiting list

Active review

Total

Notes: 1. Number refers to the number of persons on the waiting lists for elective services in the relevant quarter. 2. ‘Booked or given certainty’ refers to those patients who have been advised that they have a firm treatment date within the next six months or that they will receive treatment within the next six months with the date provided later.‘Active review’ refers to patients who are to have their plan of care reviewed at intervals of not more than six months. Residual waiting list refers to those patients who have waited substantial periods of time and often the current status of their condition is unknown. Sources: Elective Services First Quarterly Report 2001/2002; Elective Services Fourth Quarterly Report 2000/2001; Elective Services Third Quarterly Report 2000/2001; Elective Services Second Quarterly Report 2000/2001; Elective Services First Quarterly Report 2000/2001, New Zealand Ministry of Health.


49

10. NORWAY


0

5000

10000

15000

20000

25000

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Exp

end

itu

re /

cap

ita,

NC

U 1

995

GD

P p

rice

Total

Public

Private



0

1

2

3

4

5

6

7

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Ph

ysic

ian

s / 1

000

po

pu

lati

on



50

11. SPAIN

Figure A3.11.1. Targets: mean and maximum waiting time of the patients on the list

0

50

100

150

200

250

300

350

400

Jun-96 Dec-96 Jun-97 Dec-97 Jun-98 Dec-98 Jun-99 Dec-99 Jun-00 Dec-00

Wai

tin

g t

ime

(day

s)

Maximum waiting time

Mean waiting time12 months

9 months

6 months 6 months6 months

Note:

1. The data refers to the INSALUD network.

Source: Surgical waiting list reduction programmes. Management and financing strategies. The Spanish experience. INSALUD, National Institute of Health, Spain.


51

Figure A3.11.2. Mean waiting time of the patients on the list. Insalud.

0

50

100

150

200

250


Wai

tin

g t

ime

(day

s)

Notes:

1. The data refers to the INSALUD network. Source: Surgical waiting list reduction programmes. Management and financing strategies. The Spanish experience. INSALUD, National Institute of Health, Spain.


52

Figure A3.11.3a. and A3.11.3b. Mean waiting time of the patients on the list by surgical procedure. Insalud.

0

50

100

150

200

250

300

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Mea

n w

aiti

ng

tim

e (d

ays)

Prostatectomy Hip replacementCoronary bypass Varicose veinsKnee replacement

0

20

40

60

80

100

120

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Mea

n w

aiti

ng

tim

e (d

ays)

Cataract surgery Inguinal and fem. herniaVaginal hysterectomy Knee arthroscopyCholecystectomy

Notes:

1. Mean waiting time refers to the time elapsed for a patient on the non-emergency (elective) surgery waiting list from the date they were added to the waiting list for the procedure (after specialist assessment) to the date of data collection (31 December of the relevant year).

2. Data refers to the INSALUD network.

Source: Response to OCED Waiting Times project data questionnaire, Spain.


53

Figure A3.11.4. Mean waiting time of the patients on the list by main speciality (inpatient and day surgery). Vasque country.

0

50

100

150

200

250

300

350

400

450

500

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Mea

n w

aiti

ng

tim

e (d

ays)

General surgery Vascular surgeryThoracic surgery UrologyOphthalmology Orthopaedic surgeryOto-rhino-laryingology Gynaecology and Obst.

Notes:


2. Data refers to the Health Service of Vasque Country.



54

Figure A3.11.5. Mean waiting time of the patients on the list by main speciality (outpatient). Vasque country

0

20

40

60

80

100

120

140

160

180

1996 1997 1998 1999 2000 2001

Mea

n w

aiti

ng

tim

e (d

ays)

General surgery Vascular surgeryThoracic surgery UrologyOphthalmology Orthopaedic surgeryOto-rhino-laryingology Gynaecology and Obst.

Notes:


2. Data refers to the Health Service of Vasque Country.



55

Figure A3.11.6. Patients on the list waiting longer than 6 months

0

10000

20000

30000

40000

50000

60000

Jun-96 Dec-96 Dec-97 Dec-98 Dec-99 Dec-00

Nu

mb

er o

f p

atie

nts

Notes:

1. The data refers to the INSALUD network. 2. Data include both day cases and patients with overnight stay.



56

Figure A3.11.7. Patients on the waiting list

0

40000

80000

120000

160000

200000


Nu

mb

er o

f p

atie

nts

Note: 1. The data refers to the INSALUD network. Source: Surgical waiting list reduction programmes. Management and financing strategies. The Spanish experience. INSALUD, National Institute of Health, Spain.

Figure A3.11.8. Surgical treatments

0

50000

100000

150000

200000

250000

300000

350000

400000

450000

500000


Nu

mb

er Total activity

Public activity (normal)

Public activity (extra hours)

Private activity

Note: 1. The data refers to the INSALUD network and publicly funded treatments. Source: Surgical waiting list reduction programmes. Management and financing strategies. The Spanish experience. INSALUD, National Institute of Health, Spain.


57

Figure A3.11.9. Cost of the initiatives

0

10

20

30

40

50

60

70


Co

st o

f p

rog

ram

me

(Eu

ro m

illio

ns)

Total cost

Private

Public extra hours

Note:

1. The data refers to the INSALUD network and publicly funded programmes.



58


0

200

400

600

800

1000

1200

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Exp

end

itu

re /

cap

ita,

NC

U 1

995

GD

P p

rice

Total

Public

Private



0

1

2

3

4

5

6

7

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Ph

ysic

ian

s / 1

000

po

pu

lati

on



59

12. SWEDEN

Figure A3.12.1. Median waiting time

0

10

20

30

40

50

60

70

80

90

Aug-91 Apr-92 92/93 93/94 94/95 95/96

Med

ian

wai

tin

g t

ime

(day

s)

Note:

1. Waiting time refers to prospective waiting time for a non-urgent patient among the waiting lists included in the National Waiting time guarantee.

Source: Reply to Questionnaire on policy initiatives and institutional characteristics, Sweden, 2002.

Figure A3.12.2. Percentage of the patients waiting longer than 4, 6 and 9 months

0

5

10

15

20

25

30

35

40

45

50

Aug-91 Apr-92 92/93 93/94 94/95 95/96

Per

cen

t

3 months

6 months

9 months

Note: 1. Waiting time refers to prospective waiting time for a non-urgent patient among the waiting lists included in the National Waiting time guarantee. Source: Reply to Questionnaire on policy initiatives and institutional characteristics, Sweden, 2002.


60

Figure A3.12.3. Number of surgical procedures performed

0

10

20

30

40

50

60

70

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Su

rgic

al p

roce

du

res

/ 100

0 p

op

ula

tio

nInpatient

Note: 1. Total surgical procedures are calculated by the addition of total surgical day cases and total surgical in-patients where the data are available. As total surgical day cases are not available total surgical procedures are not displayed.



0

2000

4000

6000

8000

10000

12000

14000

16000

18000

1990 1991 1992 1993 1994 1995 1996 1997 1998

Exp

end

itu

re /

cap

ita,

NC

U 1

995

GD

P p

rice

Total

Public

Private



61


0

1

2

3

4

5

6

7

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Ph

ysic

ian

s / 1

000

po

pu

lati

on


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