Transcript Slide 1

HOW DATA CAN
DRIVE
IMPROVEMENTS IN
HEALTH SYSTEMS
Mark Pearson
Head, OECD Health Division
Japanese Health Economics Association
21 July, 2012
Structure of my talk
1. A cautionary tale: don’t ask me which
health system is ‘the best’
2. Getting better international measures of
health inputs
3. Getting better international measures of
health outputs
4. Prices and volumes of activity
1.
WHICH SYSTEM IS BEST?
Efficiency of the health sector
DEA analysis
Source: OECD, 2010
4
0
United States
Hungary
Slovak Republic
Denmark
Greece
Finland
United …
Luxembourg
Ireland
Belgium
Germany
Czech Republic
Austria
Netherlands
New Zealand
Norway
Canada
Spain
Sweden
Poland
Italy
Portugal
Turkey
France
Mexico
Japan
Iceland
Korea
Switzerland
Australia
If we spent better, what would we get?
Years
6
Potential gains in 2007 (DEA)
Increase over 1997-2007
5
4
3
2
1
Groups of countries sharing broadly
similar institutions
Efficiency varies more within groups
of countries than across them
Potential gains in life expectancy (years, DEA)
5
SVK
4
HUN
DNK
GRC
LUX
3
CZE
AUT
BEL
DEU
NLD
FIN
GBR
IRL
OECD average
NZL
NOR
POL
ITA
CAN
2
1
CHE
ESP
PRT
MEX
SWE
TUR
FRA
JPN
KOR
AUS
ISL
0
0
1
2
3
4
5
6
Le Corbusier: villa Savoye
What do we currently spend on health?
２. BETTER INTERNATIONAL
MEASURES OF INPUTS
Three dimensions of health accounting
Healthcare
Consumption
What types of health
goods and services are
consumed?
SHA
Accounting
Framework
Who pays?
Health
Financing
Source: Adapted from IHAT for SHA 2011
Who
provides the
service?
Service
Provision
SHA 2011: What is new and improved?
• Refined boundary setting
• Continuity facilitated:
– Functions, Providers, Financing
• New health care
classifications:
– Factors of provision
– Financing revenues
• Introduction of capital
classification
– Separate reporting for current
and capital
• Consistent labelling and
categories introduced:
– Link to intl. standards SNA 2008, provider
classifications (e.g. ISIC)
– Larger compatibility
between functions of care
and providers
– Closer correspondence to
financing “functions” of
revenue raising, pooling
and purchasing
A need to clarify the boundaries of LTC
Long Term Care, as a share of GDP, 2009 (or nearest year)
4
3.5
3
2.5
2
1.5
1
0.5
0
LTC (Health) General government
LTC (Health) Private sector
LTC (Social) General government
LTC (Social) Private sector
Different division between
health and social care
Restricted boundary of LTC
in health
200
MEX
EST
NZL
POL
DNK
CZE
GBR
NOR
LUX
SVN
FIN
HUN
ISL
SWE
SVK
CHE
AUS
AUT
PRT
ESP
ITA
DEU
FRA
IRELAND
In 2007, per capita spending on
pharmaceuticals in Greece was
second only to the US
KOR
400
BEL
600
CAN
GREECE
800
JPN
USD
PPP
USA
Policy use of internationally comparable data
3.
BETTER INTERNATIONAL
MEASURES OF OUTPUTS
Increasing life expectancy, but in good
health?
Healthy life years (HLY) at age 65, by gender, 2008-10
Females
Males
Sweden
Denmark
United Kingdom
Ireland
Netherlands
France
Spain
EU-27
Greece
Italy
Germany
Hungary
Portugal
Japan (2004)
20
Years
15
10
5
0
0
Source: Eurostat Statistics Database; Cabinet White Paper, 2007.
5
10
15
20
Years
What factors account for increases in life
expectancy?
Contributions to changes in life expectancy
Women
Men
Health care spending
1.14
1.34
Smoking
0.00
0.12
Alcohol
0.06
0.07
Diet
0.02
0.02
Pollution
0.15
0.29
Education
0.50
0.49
GDP
0.11
0.63
Observed changes
2.49
3.45
Cancer
Breast cancer five-year relative survival
1995-2000
2004-2009 or nearest period
United States
Japan
Canada
Finland
Germany
OECD
United Kingdom
Korea
0
10
20
30
40
50
60
70
Age-standardised rate (%)
80
90
100
Care for acute exacerbation of chronic
conditions
Ischemic stroke 30 day in-hospital mortality
2000
2009 (or nearest year)
Australia
OECD
Sweden
United States
Finland
Korea
Japan
0
1
2
3
4
5
Age-sex standardised rate (%)
6
7
8
Care for acute exacerbation of chronic
conditions
AMI 30 day in-hospital mortality
2000
2009 (or nearest year)
Japan
Korea
OECD
Finland
United States
Australia
Sweden
0
2
4
6
Age-sex standardised rate (%)
8
10
Care for chronic conditions
Uncontrolled diabetes admissions, 2009
(or nearest year)
Korea
Finland
Germany
OECD (24)
United Kingdom
United States
Canada
Australia
0
20
40
60
80
100
120
Age-sex-standardised rate per 100 000 population
140
Patient safety
Foreign body left in during procedure, 2009
(or nearest year)
Canada
United Kingdom
OECD (17)
France
United States
Finland
Germany
0
2
4
6
Crude Rate per 100,000 patients
8
10
4. PRICES AND VOLUME
Where the Japanese health system does
MORE than other countries
Japan
13. 1
Doctor consultations
Practising nurses
Hospital beds
MRI units
CT scanners
per capita
10.1
per 1000 population
8.1
per 1000 population
43.1
per million population
97.3
per million population
Source: OECD Health Data 2012.
Rank compared
with OECD
countries
1st
11th
1st
1st
1st
OECD average
6.8
per capita
8.7
per 1000 population
3.4
per 1000 population
12.5
per million population
22.8
per million population
Widespread availability of medical technology
Per million
population
120
CT scanners
100
80
Per million
population
50
40
30
60
20
40
10
20
0
Source: OECD Health Data 2012.
0
MRI machines
Where the Japanese health system does
LESS than other countries
Japan
Practising physicians
Hospital discharges
2.2
per 1000 population
107.1
per 1000 population
Source: OECD Health Data 2012.
Rank compared
with OECD
countries
29th
28th
OECD average
3.1
per 1000 population
151.6
per 1000 population
Comparative hospital price level, 2009
250
208 205
200
197
185
172
150
148 147 145
141
135
130
126
119 116
108 105
104
100
100 100
93
83
50
0
79
44
38
32
30
24
500
0
2423
2359
2353
2336
Czech Republic
Germany
France
Switzerland
2046
1996
1939
1933
Australia
Italy
Slovenia
Luxembourg
1394
Spain
1512
Israel
1420
1524
Ireland
Portugal
1532
1620
Poland
Estonia
1777
2110
OECD (mean)
Canada
2136
Belgium
2239
2462
Austria
Slovak Republic
2510
Finland
2248
2531
United States
Hungary
2584
Netherlands
2667
1000
Norway
1500
2684
2000
United Kingdom
2500
2705
3000
Sweden
3332
3500
Denmark
Per capita volumes of hospital services,
2009
USD Hospital PPP
4000
Service levels were maintained in
Ireland…
Key Metrics
Patients treated as
inpatients (% change
over previous year)
Patients treated as day
cases (% change)
Attendances as out
patients (% change)
Health expenditure
2006 2007 2008 2009
2010
2.3
3.9
-2.0
-1.2
-0.7
9.2
4.8
9.6
4.4
8.2
7.5
10.7
5.9
2.5
6.0
2006 2007 2008 2009
2010
Gross current
expenditure (% change)
9.1
10
10.7
1.6
-4.1
Gross pay (% change)
8.1
6.7
5.7
2.1
-6.6
…while growth in health prices
continued in the United States
Factors Accounting For Growth In Personal Health Care Spending, Selected Periods 2000–10.
Source: Martin et at, Health Affairs (2012)
THANK YOU FOR LISTENING
http://www.oecd.org/health/healthdata