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THE COMMONWEALTH
FUND
Multinational Comparisonsof Health Systems Data, 2013
David SquiresThe Commonwealth Fund
November 2013
2
Health Care Spending and Coverage
THECOMMONWEALTH
FUND
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
1000
2000
3000
4000
5000
6000
7000
8000
9000US ($8,508)
NOR ($5,669)
SWIZ ($5,643)
NETH ($5,099)
CAN ($4,522)
DEN ($4,495)*
GER ($4,495)
FR ($4,118)
SWE ($3,925)
AUS ($3,800)*
UK ($3,405)
JPN ($3,213)*
NZ ($3,182)
Source: OECD Health Data 2013.
Average Health Care Spending per Capita, 1980–2011Adjusted for Differences in Cost of Living
3
Dollars ($US)
THECOMMONWEALTH
FUND* 2010
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
2
4
6
8
10
12
14
16
18 US (17.7%)
NETH (11.9%)
FR (11.6%)
GER (11.3%)
CAN (11.2%)
DEN (11.1%)*
SWIZ (11.0%)
NZ (10.3%)
JPN (9.6%)*
SWE (9.5%)
UK (9.4%)
NOR (9.3%)
AUS (8.9%)*
GDP refers to gross domestic product. Source: OECD Health Data 2013.
Health Care Spending as a Percentage of GDP, 1980–2011
Percent
* 2010 THECOMMONWEALTH
FUND
4
5Health Care Spending per Capita by Source of Funding, 2011
Adjusted for Differences in Cost of Living
US SWIZ CAN DEN* GER FR SWE AUS* UK JPN* NZ0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
4,0663,661
3,1833,827
3,436 3,161 3,2042,578 2,821 2,638 2,631
3,454
527672
75465 650
86490 246
111 203
987
1,455
666 593 593 307
635 733 338 464 348
Out-of-pocket spending
Private spending
Public spending
* 2010.
Dollars ($US)
8,508
Source: OECD Health Data 2013.
THECOMMONWEALTH
FUND
5,643
4,522 4,495 4,4954,118
3,925 3,8003,2133,405 3,182
6Pharmaceutical Spending per Capita, 2011
Adjusted for Differences in Cost of Living
US CAN JPN* FR GER AUS* SWIZ OECD Median
NETH SWE NOR DEN NZ0
100
200
300
400
500
600
700
800
900
1,000995
752
652 641 633587
531487 479 474
388
300 298
* 2010.Source: OECD Health Data 2013.
THECOMMONWEALTH
FUND
Dollars ($US)
7
Health Care Supply and Utilization
THECOMMONWEALTH
FUND
Hospital Discharges per 1,000 Population, 2011
GER NOR* DEN* SWIZ FR SWE* AUS* OECD Median
NZ UK US* NETH JPN CAN*0
50
100
150
200
250
300
244
175 172 170 169 163 159 159147
136125 122
111
82
* 2010.Source: OECD Health Data 2013.
8
THECOMMONWEALTH
FUND
Average Length of Hospital Stay for Acute Care, 2011
GER CAN* SWIZ UK OECD Median
NETH NZ US FR SWE AUS* NOR*0
2
4
6
8
10
12
7.9 7.7
6.5 6.5 6.45.8 5.6 5.4 5.1 5.1 5.0
4.5
Days
* 2010.Source: OECD Health Data 2013.
9
THECOMMONWEALTH
FUND
10Average Annual Number of Physician Visits per Capita, 2011
JPN* GER CAN* FR AUS NETH OECD Median
NOR** UK** DEN* US** SWE0
2
4
6
8
10
12
1413.1
9.7
7.46.8 6.7 6.6 6.6
5.2 5.04.6
4.1
3.0
* 2010.** 2009.Source: OECD Health Data 2013.
THECOMMONWEALTH
FUND
Number of Practicing Physicians per 1,000 Population, 2011
SWE* GER SWIZ NOR DEN** AUS OECD Median
FR UK NZ US JPN*0
1
2
3
4
5
3.9 3.8 3.8 3.73.5
3.33.2 3.1
2.82.6
2.52.2
Source: OECD Health Data 2013.
11
THECOMMONWEALTH
FUND* 2010.** 2009.
12Number of Acute Care Hospital Beds per 1,000 Population, 2011
JPN GER FR AUS* NETH SWIZ OECD Median
DEN* NZ US* UK NOR SWE CAN*0
2
4
6
8
10
8.0
5.3
3.4 3.4 3.33.0 3.0 2.9 2.6 2.6 2.4 2.4
2.01.7
THECOMMONWEALTH
FUND* 2010.Source: OECD Health Data 2013.
13Inpatient Coronary Bypass Grafts per 100,000 Population, 2011
US** DEN* GER NOR** CAN* NETH* SWIZ OECD Me-dian
NZ SWE UK FR0
20
40
60
80
100
79.074.0
67.561.6
58.654.4
46.1 45.340.9
37.430.9 28.5
THECOMMONWEALTH
FUND
* 2010.** 2009.Source: OECD Health Data 2013.
14Magnetic Resonance Imaging (MRI) Exams per Million Population, 2011
US GER** FR DEN NETH CAN AUS0
20
40
60
80
100
120
102.795.2
67.561.5
49.9 49.8
24.1
THECOMMONWEALTH
FUND
* 2010.** 2009.Source: OECD Health Data 2013.
15
Health Promotion and Disease Prevention
THECOMMONWEALTH
FUND
THECOMMONWEALTH
FUND
Cervical Cancer Screening Rates, 2011
US* GER** NOR NZ FR* UK DEN** NETH AUS JPN*0
20
40
60
80
100
85.078.7 76.2 75.0
71.168.5 66.3 64.8
56.8
37.7
Percent of women screened
Note: NOR, NZ, UK, DEN, and AUS based on program data; all other countries based on survey data.* 2010.** 2009.Source: OECD Health Data 2013.
16
Flu Immunization Among Adults Age 65 or Older, 2011
AUS** NETH** UK US NZ CAN GER** OECD Median
FR JPN* SWIZ* DEN* NOR0
20
40
60
80
100
74.6 74.0 74.0
66.9 65.5 64.4
56.1 55.7 55.2 53.0
46.0 45.6
14.1
Percent
* 2010.** 2009.Source: OECD Health Data 2013.
THECOMMONWEALTH
FUND
17
18Adults Who Report Being Daily Smokers, 2011
FR* GER** NETH JPN OECD Me-dian
DEN* UK* NOR CAN AUS* US SWE0
10
20
30
40
23.321.9 20.8 20.1 20.1 20.0 19.6
17.015.7 15.1 14.8
13.1
Percent
THECOMMONWEALTH
FUND
Source: OECD Health Data 2013.
* 2010.** 2009.
US* AUS NZ** CAN* UK GER** DEN* FR* NETH SWE JPN0
5
10
15
20
25
30
35
4036.5
28.3 27.825.4 24.8
14.713.4 12.9
11.4 11.0
4.1
19Obesity (BMI>30) Prevalence Among Adult Population, 2011
Note: Body-mass index (BMI) estimates based on national health interview surveys (self-reported data) are usually significantly lower than estimates based on actual measurements.
Percent
Measured Self-reported
THECOMMONWEALTH
FUND* 2010.** 2009.Source: OECD Health Data 2013.
20
Quality and Patient Safety
THECOMMONWEALTH
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Mortality Amenable to Health Care
Deaths per 100,000 population*
* Countries’ age-standardized death rates before age 75; including ischemic heart disease, diabetes, stroke,
and bacterial infections. Analysis of World Health Organization mortality files and CDC mortality data for U.S.Source: Adapted from E. Nolte and M. McKee, “Variations in Amenable Mortality—Trends in 16 High-Income Nations,” Health Policy, published online Sept. 12, 2011.
21
THECOMMONWEALTH
FUND
Breast Cancer Five-Year Relative Survival Rate, 2004–2009(or nearest period)
US JPN CAN NOR SWE NZ NETH GER DEN UK0
20
40
60
80
100
89.3 87.3 87.1 86.5 86.0 84.5 84.4 83.3 82.0 81.3
Source: OECD Health Data 2013.
Percent
THECOMMONWEALTH
FUND
22
* 2008.** 2007.Source: OECD Health Data 2013.
UK SWE NZ SWIZ* CAN NOR OECD Me-dian
AUS NETH**
FR** DEN US* GER0
10
20
30
40
4.8 5.77.0 7.4
9.5 9.8 9.8 11.0 12.0 12.6
18.1
32.9 33.7
Diabetes Lower Extremity Amputation Rates per 100,000 Population, 2009
THECOMMONWEALTH
FUND
23
† In-hospital case-fatality rates within 30 days of admission. Age-sex standardized rates.
In-Hospital Mortality After Admission for Acute Myocardial Infarction† per 100 Patients, 2009
DEN NOR SWE** AUS NZ CAN US* SWIZ* OECD Me-dian
UK NETH**
GER JPN*0
2
4
6
8
10
2.3 2.52.9 3.2 3.2
3.94.3 4.5 4.6
5.2 5.3
6.8
9.7
Source: OECD Health Data 2013.
24
THECOMMONWEALTH
FUND* 2008.** 2007.
Note: Age-sex-SDX standardized rates.
Foreign Object Left in Body During Procedure per 100,000 Hospital Discharges, 2009
DEN** SWE GER US* FR UK NZ CAN AUS SWIZ*0
3
6
9
12
15
1.82.6
3.4
4.95.5 5.7
8.79.7 9.8
13.8
Source: OECD Health Data 2013.
25
THECOMMONWEALTH
FUND* 2008.** 2010.
26
Prices
THECOMMONWEALTH
FUND
Retail Price Indexes for Basket of In-Patent Pharmaceuticals, 2010US is set at 100
US GER SWIZ FR CAN AUS UK0
20
40
60
80
100100
9588
61
50 4946
Source: P. Kanavos, A. Ferrario, S. Vandoros et al., "Higher U.S. Branded Drug Prices and Spending Compared to Other Countries May Stem Partly from Quick Uptake of New Drugs," Health Affairs, April 2013 32(4):753–61.
27
THECOMMONWEALTH
FUND
Note: Calculations weighted relative to U.S. consumption patterns. U.S. retail prices were discounted from manufacturer prices according to the rebates obtained by the Medicaid program.
Price level
Diagnostic Imaging Prices, 2012
NETH UK FR NZ SWIZ US$0
$200
$400
$600
$800
$1,000
$1,200
$319 $335 $363
$554
$928
$1,121
Notes: US refers to the commercial average. MRI refers to magnetic resonance imaging; CT refers to computed tomography.Source: International Federation of Health Plans, 2012 Comparative Price Report.
28
MRI scanning and imaging fees
CAN UK FR NETH NZ SWIZ US$0
$100
$200
$300
$400
$500
$600
$124
$175 $183
$252
$310$328
$566
CT scanning and imaging fees (head)
THECOMMONWEALTH
FUND
Hospital Spending per Discharge, 2011Adjusted for Differences in Cost of Living
US* CAN* NETH SWIZ DEN* NOR* SWE* AUS* NZ FR OECD Me-dian
GER0
4,000
8,000
12,000
16,000
20,000
24,000
21,018
15,433
13,02511,968
11,374 11,3069,894 9,611
8,478 8,363 7,842
5,339
Dollars ($US)
29
* 2010.Source: OECD Health Data 2013.
THECOMMONWEALTH
FUND
30Physician Fee for Hip Replacement, 2008
Adjusted for Differences in Cost of Living
US GER UK AUS FR CAN$0
$200
$400
$600
$800
$1,000
$1,200
$1,400
$1,600
$1,800
$1,634
$1,251$1,181
$1,046
$674 $652
Source: M. J. Laugesen and S. A. Glied, “Higher Fees Paid to U.S. Physicians Drive Higher Spending for Physician Services Compared to Other Countries,” Health Affairs, Sept. 2011 30(9):1647–56.
US UK AUS FR$0
$600
$1,200
$1,800
$2,400
$3,000
$3,600
$4,200 $3,996
$2,160$1,943
$1,340
Public payers Private payers
THECOMMONWEALTH
FUND
Dollars ($US) Dollars ($US)
31Physician Incomes, 2008
Adjusted for Differences in Cost of Living
US UK GER CAN FR AUS
186,582159,532
131,809125,104
95,585 92,844
US UK CAN GER AUS FR0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
442,450
324,138
208,634 202,771187,609
154,380
Primary care doctorsOrthopedic surgeons
Source: M. J. Laugesen and S. A. Glied, “Higher Fees Paid to U.S. Physicians Drive Higher Spending for Physician Services Compared to Other Countries,” Health Affairs, Sept. 2011 30(9):1647–56.
THECOMMONWEALTH
FUND
Dollars ($US)