THE COMMONWEALTH FUND

Multinational Comparisons of Health Systems Data, 2012

David Squires The Commonwealth Fund November 2012

Health Care Spending and Coverage

THE COMMONWEALTH FUND

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Average Health Care Spending per Capita, 1980 –2010 Adjusted for Differences in Cost of Living Dollars ($US) 9000 8000 7000 6000 5000 4000 3000 2000 US ($8,233) NOR ($5,388) SWIZ ($5,270) NETH ($5,056) DEN ($4,464) CAN ($4,445) GER ($4,338) FR ($3,974) SWE ($3,758) AUS ($3,670)* UK ($3,433) JPN ($3,035)* NZ ($3,022)

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1000 0 1980 1984

* 2009 Source: OECD Health Data 2012.

1988 1992 1996 2000 2004 2008 THE COMMONWEALTH FUND

Health Care Spending as a Percentage of GDP, 1980 –2010 Percent 18 16 14 12 10 8 6 4 2 0 1980 1984 1988

* 2009 GDP refers to gross domestic product.

Source: OECD Health Data 2012.

1992 1996 2000 2004 2008 US (17.6%) NETH (12.0%) FR (11.6%) GER (11.6%) CAN (11.4%) SWIZ (11.4%) DEN (11.1%) NZ (10.1%) SWE (9.6%) UK (9.6%) JPN (9.5%)* NOR (9.4%) AUS (9.1%)* THE COMMONWEALTH FUND

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Health Care Spending per Capita by Source of Funding, 2010 Adjusted for Differences in Cost of Living Dollars ($US) 9 000 8,233 8 000 970 7 000 Out-of-pocket spending Private spending Public spending 6 000 5 000 4 000 3 000 3 296 5,269 1 325 508 75 4,463 589 4,445 631 656 4,338 571 436 3,974 290 623 80 3,758 632 3,670 682 474 3,433 306 270 106 3,035 485 190 3,022 317 2 000 3 967 3 437 3 800 3 158 3 331 3 061 3 046 2 515 2 857 2 443 2 515 1 000

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0 US SWIZ DEN CAN GER FR SWE AUS* UK JPN* NZ THE COMMONWEALTH FUND

* 2009.

Source: OECD Health Data 2012.

Pharmaceutical Spending per Capita, 2010 Adjusted for Differences in Cost of Living Dollars ($US) 1 000 983 900 800 700 600 500 400 300 200 100 0 741 US 640 CAN GER 634 FR 630 541 510 508 481 474 395 369 331 JPN* AUS* SWIZ OECD Median NETH SWE NOR UK** DEN 285 NZ

6 * 2009.

** 2008.

Source: OECD Health Data 2012.

THE COMMONWEALTH FUND

Health Care Supply and Utilization

THE COMMONWEALTH FUND

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Hospital Discharges per 1,000 Population, 2010 300 250 240 200 150 175 172 169 169 163 155 155 147 136 131 116 107 83 100 50 0 GER NOR DEN SWIZ FR SWE AUS* OECD Median NZ UK US* NETH* JPN** CAN*

* 2009.

** 2008.

Source: OECD Health Data 2012.

THE COMMONWEALTH FUND

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Average Length of Hospital Stay for Acute Myocardial Infarction, 2010

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Days 12 10,6 10 8,2 7,9 7,8 8 7,0 6,5 6,2 6,0 6 5,6 5,0 4,7 4,0 3,9 4 2 0 GER NZ SWIZ UK OECD Median NETH* FR CAN* AUS* US* SWE NOR DEN

* 2009.

Source: OECD Health Data 2012.

THE COMMONWEALTH FUND

Inpatient Coronary Bypass Procedures per 100,000 Population, 2010

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125 116 100 75 79 74 62 61 58 56 50 43 43 42 37 30 28 25 0 GER US* DEN NOR* CAN* NETH* AUS* OECD Median SWE NZ UK SWIZ FR

* 2009.

Source: OECD Health Data 2012.

THE COMMONWEALTH FUND

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Average Annual Number of Physician Visits per Capita, 2010 14 13,1 12 10 8,9 8 6 6,7 6,6 6,5 6,3 5,5 5,2 5,0 4,6 3,9 4 2 2,9 2,9 0 JPN* GER FR NETH AUS OECD Median CAN* NOR* UK* DEN US** NZ SWE

* 2009.

** 2008.

Source: OECD Health Data 2012.

THE COMMONWEALTH FUND

Number of Practicing Physicians per 1,000 Population, 2010

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5 4 4,1 3,8 3,8 3,7 3,5 3 3,1 3,1 2,7 2,6 2,4 2 2,2 1 0 NOR SWIZ SWE* GER DEN* AUS* OECD Median UK NZ US JPN

* 2009.

Source: OECD Health Data 2012.

THE COMMONWEALTH FUND

Number of Acute Care Hospital Beds per 1,000 Population, 2010

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10 8 8,1 6 5,7 4 3,5 3,4 3,1 3,1 3,0 2,9 2,6 2,4 2,4 2,0 1,7 2 0 JPN GER FR AUS** SWIZ OECD Median NETH DEN

* 2009.

** 2008.

Source: OECD Health Data 2012.

US* NOR UK SWE CAN* THE COMMONWEALTH FUND

50 Magnetic Resonance Imaging (MRI) Units per Million Population, 2010

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43,1 40 31,6 30 20 10 15,4 12,2 10,5 9,5 8,2 7,0 5,9 5,6 0 JPN** US

* 2009.

** 2008.

Source: OECD Health Data 2012.

DEN* NETH NZ OECD Median CAN FR UK AUS THE COMMONWEALTH FUND

Computed Tomography (CT) Scanners per Million Population, 2010

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100 97,3 80 60 42,8 40 34,3 32,6 27,6 20 15,6 15,6 14,2 12,3 11,8 8,2 0 JPN** AUS US*** SWIZ DEN OECD Median NZ

** 2008.

*** 2007.

Source: OECD Health Data 2012.

CAN NETH FR UK THE COMMONWEALTH FUND

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Positron Emission Tomography (PET) Scanners per Million Population, 2010 6 5,6 5 4 4,8 4,2 3,7 3,2 3 2 1 1,4 1,2 1,2 1,2 0,9 0 DEN* NETH US** JPN** SWIZ AUS CAN OECD Median NZ

* 2009.

** 2008.

Source: OECD Health Data 2012.

FR THE COMMONWEALTH FUND

Health Promotion and Disease Prevention

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THE COMMONWEALTH FUND

Cervical Cancer Screening Rates, 2010 Percent of women screened 100 85,0 78,7 78,5 78,5 80 75,3 75,2 71,1 66,3 65,7 60 58,2 40 37,7

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20 0 US GER* NOR* UK CAN** NZ FR DEN* NETH AUS*

Note: Norway, UK, NZ, Denmark, and Australia based on program data; all other countries based on survey data.

* 2009.

** 2008.

Source: OECD Health Data 2012.

JPN THE COMMONWEALTH FUND

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Percent 100 Flu Immunization Among Adults Ages 65 or Older, 2010 80 60 74,6 74,0 70,3 66,0 65,8 64,0 63,9 61,1 59,4 57,5 53,0 46,0 45,6 40 20 0 AUS* NETH* UK

* 2009.

** 2008.

Source: OECD Health Data 2012.

FR NZ SWE** US GER** CAN OECD Median JPN SWIZ DEN THE COMMONWEALTH FUND

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Adults Who Report Being Daily Smokers, 2010 Percent 40 30 20 23,3 21,9 21,5 20,9 20,9 20,0 19,5 19,0 16,3 15,1 15,1 14,0 10 0 FR GER* UK* NETH OECD Median DEN JPN NOR CAN AUS US SWE

* 2009.

Source: OECD Health Data 2012.

THE COMMONWEALTH FUND

15 10 5 0 30 25 20 Obesity (BMI>30) Prevalence Among Adult Population, 2010 Percent 40 35,9 35 Measured Self-reported 27,8 26,1 24,2 14,7 13,4 12,9 12,9 11,4 10,0 3,5 US NZ* UK CAN** GER* DEN FR SWE NETH NOR** JPN

21 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. * 2009.

** 2008.

Source: OECD Health Data 2012.

THE COMMONWEALTH FUND

Quality and Patient Safety

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THE COMMONWEALTH FUND

Mortality Amenable to Health Care

Deaths per 100,000 population* 150 100 76 88 89 81 88 1997–98 2006–07 99 97 109 116 106 97 134 115 113 127 120

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50 55 57 60 61 61 64 66 67 74 76 77 78 79 80 83 96 0 FR AUS ITA JPN SWE NOR NETH AUT FIN GER GRE IRL NZ DEN UK US

* 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.

THE COMMONWEALTH FUND

Percent Breast Cancer Five-Year Relative Survival Rate, 2004 –2009 (or nearest period) 100 89,3 87,3 86,6 86,5 86,0 84,5 84,4 83,3 82,0 81,3 80

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60 40 20 0 US JPN CAN NOR SWE NZ NETH GER DEN UK THE COMMONWEALTH FUND

Source: OECD Health Data 2011.

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Diabetes Lower Extremity Amputation Rates per 100,000 Population, 2009 40 30 32,9 33,7 20 10 4,8 5,7 7,0 7,4 9,5 9,9 9,9 11,0 12,0 12,6 18,1 0 UK SWE NZ SWIZ* CAN NOR OECD Median AUS NETH** FR** DEN US* GER

* 2008.

** 2007.

Source: OECD Health Data 2011.

THE COMMONWEALTH FUND

10 In-Hospital Mortality After Admission for Acute Myocardial Infarction † per 100 Patients, 2009

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9,7 8 6 4 2,3 2,5 2,9 3,2 3,2 2 3,9 4,3 4,5 4,6 5,2 5,3 6,8 0 DEN NOR SWE** NZ AUS CAN US* SWIZ* OECD Median UK NETH** GER JPN*

† In-hospital case-fatality rates within 30 days of admission. Age-sex standardized rates.

* 2008.

** 2007.

Source: OECD Health Care Data 2012.

THE COMMONWEALTH FUND

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Foreign Object Left in Body During Procedure per 100,000 Hospital Discharges, 2009 15 13,8 12 9,7 9,8 9 6 4,9 3,4 3 1,8 2,6 0 DEN** SWE GER

Note: Age-sex-SDX standardized rates.

* 2008.

** 2010.

Source: OECD Health Care Data 2012.

US* 5,5 5,7 FR UK 8,7 NZ CAN AUS SWIZ* THE COMMONWEALTH FUND

Postoperative Sepsis per 100,000 Hospital Discharges, 2009

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1 500 1 200 900 600 300 354 541 754 769 858 926 1 077 1 452 1 455 0 SWIZ* GER

Note: Age-sex-SDX standardized rates.

* 2008.

** 2007.

*** 2010.

Source: OECD Health Care Data 2012.

DEN*** CAN FR SWE US* NZ AUS THE COMMONWEALTH FUND

Prices

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THE COMMONWEALTH FUND

Drug Prices for 30 Most Commonly Prescribed Drugs, 2006 –2007 US is set at 1.0

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1,0 1,00 0,8 0,77 0,76 0,63 0,6 0,51 0,49 0,45 0,44 0,4 0,34 0,2 0,0 US CAN GER SWIZ UK AUS NETH FR NZ THE COMMONWEALTH FUND

Source: IMS Health; analysis by Gerard Anderson, Johns Hopkins University.

$272

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Diagnostic Imaging Prices, 2011 MRI scanning and imaging fees $1 200 $1 080 $1 000 $903 $800 $599 $600 $600 $500 $400 $300 CT scanning and imaging fees (head) $510 $319 $400 $200 $281 $141 $200 $100 $0 US Commercial Average SWIZ GER FR $0 US Commercial Average

Note: MRI refers to magnetic resonance imaging; CT refers to computed tomography.

Source: International Federation of Health Plans, 2011 Comparative Price Report.

SWIZ GER FR THE COMMONWEALTH FUND

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Hospital Spending per Discharge, 2010 Adjusted for Differences in Cost of Living Dollars 20 000 19 319 18 000 16 000 14 896 14 000 12 000 10 000 13 134 12 650 11 295 11 219 11 021 9 990 9 531 8 000 6 000 4 000 2 000 8 049 7 856 7 180 5 192 0 US* CAN* NETH* JPN** DEN SWIZ NOR* SWE AUS* FR

* 2009.

** 2008.

Source: OECD Health Data 2012.

NZ OECD Median GER THE COMMONWEALTH FUND

Physician Fee for Hip Replacement, 2008 Adjusted for Differences in Cost of Living Dollars Public payers $1 800 $1 600 $1 634 $1 400 $1 200 $1 251 $1 181 $1 046 $1 000 $4 200 $3 996 Private payers $3 600 $3 000 $2 400 $2 160 $1 943 $800 $674 $652 $1 800 $1 340 $600 $1 200 $400 $600 $200

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$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 THE COMMONWEALTH FUND

Physician Incomes, 2008 Adjusted for Differences in Cost of Living Dollars Orthopedic surgeons Primary care doctors 500 000 450 000 442 450 400 000 350 000 300 000 250 000 200 000 150 000 100 000 50 000 324 138 208 634 202 771 187 609 154 380 186 582 159 532 131 809 125 104 95 585 92 844

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0 US UK CAN GER AUS FR US UK GER CAN FR AUS

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.

THE COMMONWEALTH FUND