U.S. health care system from an international perspective · Germany (2003-08) Canada (2002-07)...

Health at a Glance 2011

U.S. health care system from

an international perspective

Released on November 23, 2011 http://www.oecd.org/health/healthataglance

Why is the US health spending so high?

US spends two-and-a-half times the OECD average

2009 (or latest year available)

1. In the Netherlands, it is not possible to clearly distinguish the public and private share related to investments. 2. Health expenditure is for the insured population rather than the resident population. 3. Total expenditure excluding investments. Information on data for Israel: http://dx.doi.org/10.1787/888932315602.

Source: OECD Health Data 2011; WHO Global Health Expenditure Database.

5

At 17.4% of GDP in 2009, US health spending is half as much as any other country, and nearly twice the OECD average

Source: OECD Health Data 2011; WHO Global Health Expenditure Database for non-OECD countries.

1. In the Netherlands, it is not possible to clearly distinguish the public and private share related to investments. 2. Total expenditure excluding investments. 3. Health expenditure is for the insured population rather than the resident population. Information on data for Israel: http://dx.doi.org/10.1787/888932315602.

2009 (or latest year available)

6

US spends much more on health than what might be expected by its GDP per capita

Source: OECD Health Data 2011; WHO Global Health Expenditure Database.

2009 (or latest year available)

AUS

AUT

BEL

BRA

CAN

CHL

CHN

CZE

DNK

EST

FIN

FRA

DEU

GRC

HUN

IDNIND

ISL

IRL

ISR

ITA

JPN

KOR

LUX

MEX

NLD

NZL

NOR

POL

PRT

RUS

SVK

SVN

ZAF

ESP

SWE

CHE

TUR

GBR

USAR² = 0.71

0

1000

2000

3000

4000

5000

6000

7000

8000

0 15000 30000 45000 60000 75000 90000

GDP per capita (USD PPP)

Health spending per capita (USD PPP)

7

US health spending is much greater for all categories of care, particularly for ambulatory care and administration cost

Note: Health spending excludes investments. The percentages in the US bar indicate how much more the US spends per category compared with the average of the five other OECD countries. Source: OECD Health Data 2011.

2009 (or latest year available)

$2,922 $2,716

$1,643 $1,518 $1,639 $1,458

$2,803

$1,626

$1,171 $1,254 $1,062

$787

$1,070

$463

$860 $887 $842

$466

$803

$339

$434 $271 $298

$121

$7,598

$5,144

$4,139 $4,072 $3,872

$2,832

$-

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

UNITED STATES Switzerland Canada Germany France Japan (2008)

USD PPPOther

Public health & administration

Pharmaceuticals and medical goods

Ambulatory (Physicians, specialists, dentists, etc.)

Hospitals/Nursing homes

(163%)

(238%)

(152%)

(274%)

(189%)

Is US health spending higher due to higher prices or higher service provision? (or both?)

Comparative price levels for total inpatient hospital services, 2007

Source: Koechlin et al. (2010).

US prices for a set of hospital services is over 60% higher than the average of 12 OECD countries

US prices for certain procedures are much higher than in other OECD countries

(US dollars, 2007)

Procedures AUS CAN DEU FIN FRA SWE USA

Appendectomy 5 044 5 004 2 943 3 739 4 558 4 961 7 962

Normal delivery 2 984 2 800 1 789 1 521 2 894 2 591 4 451

Caesarean section 7 092 4 820 3 732 4 808 5 820 6 375 7 449

Coronary angioplasty 7 131 9 277 3 347 5 574 7 027 9 296 14 378

Coronary artery bypass graft 21 698 22 694 14 067 23 468 23 126 21 218 34 358

Hip replacement 15 918 11 983 8 899 10 834 11 162 11 568 17 406

Knee replacement 14 608 9 910 10 011 9 931 12 424 10 348 14 946

Source: Koechlin et al. (2010).

Where the United States health system does LESS than other countries

United States Rank compared with OECD countries

OECD average

Practising physicians 2.4

per 1000 population 26th

3.1 per 1000 population

Doctor consultations 3.9

per capita 29th

6.5 per capita

Hospital beds 3.1

per 1000 population 29th

4.9 per 1000 population

Hospital discharges 130.9

per 1000 population 26th

158.1 per 1000 population

Average length of stay in hospitals

4.9 days

29th 7.2 days

Source: OECD Health Data 2011.

Where the United States health system does MORE than other countries

Source: OECD Health Data 2011.

United States Rank compared with OECD countries

OECD average

MRI units 25.9

per million population 2nd

12.2 per million population

MRI exams 91.2

per 1 000 population 2nd

46.6 per 1 000 population

CT scanners 34.3

per million population 5th

22.8 per million population

CT exams 227.9

per 1 000 population 2nd

131.8 per 1 000 population

Tonsillectomy 254.4

per 100 000 population 2nd

133.8 per 100 000 population

Coronary angioplasty 377.2

per 100 000 population 3rd

187.6 per 100 000 population

Knee replacements 212.5

per 100 000 population 1st

118.4 per 100 000 population

Caesarean sections 32.3

per 100 live births 8th

25.8 per 100 live births

Is the quality of care better in the US?

Cancer system is generally performing well

81.3

82.8

83.3

83.5

86.6

87.3

89.3

60 70 80 90 100

United Kingdom (2004-09)

France (1997-2002)

Germany (2003-08)

OECD (16 countries)

Canada (2002-07)

Japan (2000-05)

United States (2003-08)

Age-standardised rates (%)

53.3

57.0

59.9

60.4

63.4

64.5

68.0

40 50 60 70 80

United Kingdom (2004-09)

France (1997-2002)

OECD (16 countries)

Germany (2003-08)

Canada (2002-07)

United States (2003-08)

Japan (2000-05)

Age-standardised rates (%)

Breast cancer, 5-year survival rate Colorectal cancer, 5-year survival rate

Note: 95% confidence intervals are represented by H. Source: OECD Health Data 2011.

Primary care sector not performing so well

Asthma hospital admission COPD hospital admission

Note: 95% confidence intervals are represented by H. Source: OECD Health Data 2011.

15.7

19.2

20.8

43.4

51.8

73.7

120.6

0 50 100 150

Canada (2009)

Italy (2009)

Germany (2009)

France (2007)

OECD (28 countries)

United Kingdom (2009)

United States (2008)

Age-sex standardised rates per 100 000 population

79

126

183

198

201

213

230

0 100 200 300

France (2007)

Italy (2009)

Canada (2009)

OECD (28 countries)

Germany (2009)

United Kingdom (2009)

United States (2008)

Age-sex standardised rates per 100 000 population

What are the trends in key risk factors to health

in the US?

Mexico

United States

Canada

Australia

United Kingdom

Germany

OECD

Italy

Japan

France

Greece

13.3

16.1

16.2

16.6

21.5

21.9

22.1

23.3

24.9

26.2

39.7

01020304050

% of population aged 15 years and over

n.a.

-16.1

-31.9

-24.9

-20.4

-11.3

-17.9

-5.7

-25.9

-6.4

5.6

-50 -25 0 25

% change over the period

Smoking rates have decreased in the US and in most other OECD countries

Adult population smoking daily

Source: OECD Health Data 2011.

2009 Change 2000-09

Obesity rates have increased substantially over the past 20 years and is highest in US

1. Data are based on measurements rather than self-reported height and weight. Source: OECD Health Data 2011.

2

n.a.

6

n.a. n.a.

9

14

11

n.a.

23

3

9 9

12

14 13

21 22

24

31

4

1011

1517 17

2325

30

34

0

10

20

30

40

1990 2000 2009

% of adult population

(or nearest years)

Over one-third of children in the US are overweight or obese

Canada

Australia

OECD

Germany

France

Japan

Italy

Mexico

United Kingdom

Greece

United States

37.0

35.9

30.9

29.0

26.6

26.1

24.0

21.4

17.6

14.9

14.4

01020304050

% of children aged 5-17 years

45.0

35.0

32.4

28.1

22.7

28.9

22.0

22.9

22.6

13.1

16.2

0 10 20 30 40 50

% of children aged 5-17 years

Source: International Association for the Study of Obesity (2011).

Girls Boys

Children aged 5-17 years who are overweight (including obese)

More information

www.oecd.org/health/healthataglance