Transcript THE COMMONWEALTH FUND Multinational Comparisons of Health Systems Data, 2011 David Squires The Commonwealth Fund November 2011

THE
COMMONWEALTH
FUND
Multinational Comparisons
of Health Systems Data, 2011
David Squires
The Commonwealth Fund
November 2011
2
Health Care Spending and Coverage
THE
COMMONWEALTH
FUND
3
Average Health Care Spending per Capita, 1980–2009
Adjusted for differences in cost of living
Dollars
US
8000
NOR
7000
SWIZ
NETH
6000
CAN
DEN
5000
GER
FR
4000
SWE
3000
UK
AUS
2000
NZ
JPN
1000
0
1980
1984
1988
1992
1996
2000
2004
2008
THE
COMMONWEALTH
FUND
Source: OECD Health Data 2011 (June 2011).
4
Health Care Spending as a Percentage of GDP, 1980–2009
Percent
18
US
NETH
16
FR
14
GER
DEN
12
CAN
SWIZ
10
NZ
8
SWE
UK
6
NOR
AUS
4
JPN
2
0
1980
1984
1988
GDP refers to gross domestic product.
Source: OECD Health Data 2011 (June 2011).
1992
1996
2000
2004
2008
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COMMONWEALTH
FUND
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Health Care Spending per Capita by Source of Funding, 2009
Adjusted for Differences in Cost of Living
Dollars
7,960
8,000
976
Out-of-pocket spending
7,000
Private spending
6,000
5,352
3,189
5,000
Public spending
5,144
808
43
4,363
1,568
4,000
504
4,218
636
552
646
424
3,978
3,487
3,445
364
627
620
69
3,000
2,000
3,722
291
587
188
2,983
476 184
4,501
3,795
3,072
3,081
3,242
3,100
3,033
2,935
1,000
2,878
399
99
454
2,342
2,400
2,325
AUS*
NZ
JPN*
0
US
NOR
SWIZ
CAN
* 2008.
Source: OECD Health Data 2011 (June 2011).
GER
FR
SWE
UK
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COMMONWEALTH
FUND
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Pharmaceutical Spending per Capita, 2009
Adjusted for Differences in Cost of Living
Dollars
1,000
956
900
800
744
700
640
628
558
600
500
521
518
503
473
465
391
400
381
319
300
254
200
100
0
US
CAN
FR
GER
JPN* SWIZ OECD AUS* NETH SWE
Median
* 2008.
** 2007.
Source: OECD Health Data 2011 (June 2011).
NOR
UK*
DEN
NZ**
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COMMONWEALTH
FUND
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Health Care Supply and Utilization
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COMMONWEALTH
FUND
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Hospital Discharges per 1,000 Population, 2009
300
263
250
237
200
177
170
168
166
162
160
142
150
138
131
117
100
84
50
0
FR*
GER
NOR
DEN
* 2008.
Source: OECD Health Data 2011 (June 2011).
SWIZ
SWE
AUS* OECD NZ*
Median
UK
US*
NETH CAN*
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COMMONWEALTH
FUND
Average Length of Hospital Stay for Acute Myocardial Infarction, 2009
9
Days
12
10.8
10
8.2
8.1
8
7.6
6.9
6.5
6.3
6.2
6
6.0
5.3
4.5
4.2
4.2
DEN
NOR
4
2
0
GER
NZ*
UK
SWIZ OECD NETH
Median
* 2008.
Source: OECD Health Data 2011 (June 2011).
FR
CAN*
AUS*
US*
SWE
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COMMONWEALTH
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Inpatient Coronary Bypass Procedures per 100,000 Population, 2009
10
150
125
120
100
80
79
77
70
75
70
63
58
48
50
45
40
31
30
SWIZ
FR
25
0
GER
US*
DEN
NZ
* 2008.
Source: OECD Health Data 2011 (June 2011).
NOR* AUS* CAN* NETH* OECD SWE
Median
UK
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COMMONWEALTH
FUND
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Average Annual Number of Physician Visits per Capita, 2009
14
13.2
12
10
8.2
8
6.9
6.5
6.3
6
5.7
5.5
5.0
4.6
4
4.3
4.0
3.9
2.9
2
0
JPN*
GER
FR
AUS
OECD NETH CAN*
Median
* 2008.
** 2007.
Source: OECD Health Data 2011 (June 2011).
UK
DEN
NZ** SWIZ**
US*
SWE
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COMMONWEALTH
FUND
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Number of Practicing Physicians per 1,000 Population, 2009
4
4.0
3.8
3.7
3.6
3.4
3.0
3
3.0
2.7
2.6
2.4
2.2
2
1
0
NOR
SWIZ
SWE*
GER
* 2008.
Source: OECD Health Data 2011 (June 2011).
DEN*
AUS*
OECD
Median
UK
NZ
US
JPN*
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COMMONWEALTH
FUND
Magnetic Resonance Imaging (MRI) Units per Million Population, 2009
13
50
43.1
40
30
25.9
20
15.4
11.0
10
9.7
8.9
8.0
6.4
5.9
5.6
FR
AUS
UK*
0
JPN*
US**
DEN
* 2008.
** 2007.
Source: OECD Health Data 2011 (June 2011).
NETH
NZ
OECD
Median
CAN
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COMMONWEALTH
FUND
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Health Promotion and Disease Prevention
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COMMONWEALTH
FUND
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Cervical Cancer Screening Rates, 2006
Women Ages 20–69
Percent
100
83.5
80
79.4
78.6
75.6
72.8
72.4
70.6
69.6
60.6
60
40
20
0
US
UK
SWE
NOR
CAN*
* Based on survey data; all other countries based on program data.
Source: Health Care Quality Indicators Project, OECD 2009.
FR*
NZ
NETH
AUS
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COMMONWEALTH
FUND
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Adults Who Report Being Daily Smokers, 2009
Percent
40
30
28.0
26.2
24.9
21.9 21.5 21.5 21.0
20.4
20
19.0 18.1
16.6 16.2 16.1
14.3
10
0
NETH FR*
JPN
GER
UK
* 2008.
** 2007.
Source: OECD Health Data 2011 (June 2011).
OECD NOR SWIZ** DEN
Median
NZ** AUS** CAN
US
SWE
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COMMONWEALTH
FUND
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Obesity (BMI>30) Prevalence Among Adult Population, 2009
Percent
40
35
30
Self-reported
Measured
33.8
26.5
25
24.6
24.2
23.0
20
14.7
15
11.8
11.2
11.2
10
10.0
8.1
3.9
5
0
US*
NZ**
AUS**
CAN*
UK
GER
NETH
FR*
SWE
NOR* SWIZ**
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.
* 2008.
** 2007.
Source: OECD Health Data 2011 (June 2011).
JPN
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COMMONWEALTH
FUND
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Quality Outcomes
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COMMONWEALTH
FUND
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Mortality Amenable to Health Care
Deaths per 100,000 population*
1997–98
150
2006–07
134
109
99
100
88
89
76
81
88
116
106
97
127
120
115 113
97
50
55
57
60
61
61
64
66
67
74
76
77
78
79
80
83
96
0
* 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.
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COMMONWEALTH
FUND
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Breast Cancer Five-Year Relative Survival Rate,
2002–2007 (or nearest period)
Percent
100
90.5
87.1
86.1
85.2
82.4
82.1
81.9
DEN
NZ
NOR
80
78.5
60
40
20
0
US
CAN
SWE
NETH
UK
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COMMONWEALTH
FUND
Source: OECD Health Care Quality Indicators Data 2009.
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Diabetes Lower Extremity Amputation Rates
per 100,000 Population Age 15 and Older, 2007
40
36
30
21
20
16
13
12
12
12
11
11
11
9
10
0
US*
DEN
SWIZ*
FR
NZ
* 2006.
** 2005.
*** Among countries shown.
Source: OECD Health Care Quality Indicators Data 2009.
Median*** SWE
CAN
NETH**
NOR
UK
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COMMONWEALTH
FUND
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Mortality After Admission for Acute Myocardial Infarction*
per 100 Patients, 2007
8
6.6
6.3
6
5.1
4.2
4
3.3
3.2
2.9
2.9
DEN
SWE
2
0
NETH**
UK
US*
CAN
* In-hospital case-fatality rates within 30 days of admission.
** 2006.
*** 2005.
Source: OECD Health Care Quality Indicators Data 2009.
NZ
NOR
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COMMONWEALTH
FUND
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Prices
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COMMONWEALTH
FUND
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Drug Prices for 30 Most Commonly Prescribed
Brand-Name and Generic Drugs, 2006–07
US is set at 1.00
AUS
CAN
FR
GER
NETH
NZ
SWITZ
UK
US
Brand-name
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
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COMMONWEALTH
FUND
Source: IMS Health; analysis by Gerard Anderson, Johns Hopkins University.
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MRI Scan and Imaging Fees, 2009
Dollars
1,600
US high-end: 1,500
1,400
1,200
US
average: 1,200
1,000
839
824
800
600
567
500
436
400
179
200
0
US Medicare
US
GER
CAN
NETH
FR
UK
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COMMONWEALTH
FUND
Source: International Federation of Health Plans, 2009 Comparative Price Report.
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Hospital Spending per Discharge, 2009
Adjusted for Differences in Cost of Living
Dollars
20,000
18,142
18,000
16,000
13,483 13,244
14,000
12,650
12,000
11,112 10,875
10,000
10,441
9,870
8,350
8,000
7,160
6,222
6,000
5,204 5,072
4,000
2,000
0
US*
CAN* NETH JPN*
* 2008.
** 2007.
Source: OECD Health Data 2011 (June 2011).
DEN
SWIZ NOR** SWE
AUS*
NZ*
OECD
Median
FR
GER
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COMMONWEALTH
FUND
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Physician Fee for Hip Replacement, 2008
Adjusted for Differences in Cost of Living
Dollars
Private payers
Public payers
$1,800
$4,200
$1,634
$3,996
$1,600
$3,600
$1,400
$1,251
$1,200
$3,000
$1,181
$1,046
$2,400
$1,000
$2,160
$1,943
$800
$674
$652
$1,800
$1,340
$600
$1,200
$400
$600
$200
$0
$0
US
GER
UK
AUS
FR
CAN
US
UK
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.
AUS
FR
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COMMONWEALTH
FUND
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Physician Incomes, 2008
Adjusted for Differences in Cost of Living
Dollars
Orthopedic surgeons
Primary care doctors
500,000
450,000
442,450
400,000
350,000
324,138
300,000
250,000
208,634 202,771
200,000
187,609
186,582
159,532
154,380
150,000
131,809
125,104
95,585 92,844
100,000
50,000
0
US
UK
CAN
GER
AUS
FR
US
UK
GER
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.
CAN
FR
AUS
THE
COMMONWEALTH
FUND