Health at a glance 2015

Health at a Glance 2015

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OECD Indicators

Released on November 4, 2015 http://www.oecd.org/health/healthataglance

http://www.oecd.org/health/healthataglance

Table of contents 1.Dashboards of health indicators 2.Pharmaceutical spending trends and future challenges 3.Health status 4.Risk factors for health 5.Health workforce 6.Health care activities 7.Access to care 8.Quality of care 9.Health expenditure and financing 10.Pharmaceutical sector 11.Ageing and long-term care

Information on data for Israel: http://oe.cd/israel-disclaimer

http://oe.cd/israel-disclaimer



• Health status

• Risk factors for health

• Access to care

• Quality of care

• Health care resources

1. DASHBOARDS OF HEALTH INDICATORS

Example of dashboard: Risk factors All countries can achieve progress in certain areas

Top third performers.

Middle third performers.

Bottom third performers.

Note: Countries are listed in alphabetical order. The number in the cell indicates the position of each country among all countries for

which data is available. For all these indicators, the top performers are countries with the lowest rates.

Indicator Smoking in adults Alcohol consumption Obesity in adults *Overweight and obesity

in children **

Australia 4 22 30 * 20

Austria 26 34 8 14

Belgium 15 20 9 5

Canada 6 11 29 * 21

Chile 33 10 28 * 28

Czech Rep. 25 32 20 * 5

Denmark 12 17 10 23

Estonia 31 33 18 7

Finland 10 14 26 17

France 30 30 11 13[…]

United Kingdom 20 19 27 * 32

United States 5 13 34 * 29

* Data on obesity in adults are based on measured height and weight for all the countries marked with an *. These result in more

accurate data and higher obesity rates compared with all other countries that are providing self-reported height and weight.

** Data on overweight or obesity in children are all based on measured data, but refer to different age groups across countries.

Source: Health at a Glance 2015.

Risk factors

Example of dashboard: Quality of care No country is in top performer group for all indicators

Top third performers.

Middle third performers.

Bottom third performers.

Note: Countries are listed in alphabetical order. The number in the cell indicates the position of each country among all countries for which data

is available. For the indicators of avoidable hospital admissions and case-fatality rates, the top performers are countries with the lowest rates.

Indicator

Asthma and

COPD hospital

admission

Diabetes

hospital

admission

Case-fatality for

AMI (admission-

based)

Case-fatality for

ischemic stroke

(admission-based)

Cervical cancer

survival

Breast cancer

survival

Colorectal

cancer survival

Australia 29 17 1 20 11 5 3

Austria 28 29 27 8 19 19 7

Belgium 16 20 19 20 16 12 4

Canada 18 10 11 26 12 8 13

Chile 6 27 31 16 25 23 n.a.

Czech Rep. 12 23 11 22 13 22 21

Denmark 26 14 7 17 5 11 18

Estonia 27 n.a. 28 29 8 25 22

Finland 10 15 9 4 6 4 7

France 7 21 17 13 n.a. n.a. n.a.[…]

United Kingdom 22 5 20 19 22 21 20

United States 25 24 5 3 21 2 9

Source: Health at a Glance 2015.

Quality of care

• Pharmaceutical spending trends • Trend in the generic market

2. PHARMACEUTICAL SPENDING

The United States spends the most on pharmaceuticals, followed by Japan, Greece and Canada

Source: OECD Health Statistics 2015, OECD

2013 (or nearest year)

Pharmaceutical spending has been cut in many countries in recent years


Average annual growth in pharmaceutical and total health expenditure per capita, in real terms, average across OECD countries, 1990 to 2013

Growth in the generic market has contributed to the reduction in pharmaceutical spending…


Trend in share of generics in the reimbursed pharmaceutical market, selected countries, 2000 to 2013

… but the share of the generic market remains low in some countries


Share of generics in the total pharmaceutical market, 2013 (or nearest year)

1. Reimbursed pharmaceutical market. 2. Community pharmacy market.

• Life expectancy • Health inequalities

3. HEALTH STATUS

Life expectancy at birth exceeds 80 years on average in OECD countries – a gain of more than 10 years since 1970


High GDP per capita is associated with high life expectancy, although many other factors play a role

2013 (or latest year)


There remains large gaps in life expectancy between men and women in OECD countries: on average,

men live 5 years less than women



Note: Countries are ranked in descending order of life expectancy for the whole population.

There are also large gaps in life expectancy by education level: on average, people with the lowest level of education

live 6 years less than people with the highest level

Source: Eurostat database complemented with national data for Israel, Mexico and the Netherlands.

Gap in life expectancy at age 30 by sex and education level, 2012 (or latest year)

Note: The figures show the gap in the expected years of life remaining at age 30 between adults with the highest level (“tertiary

education”) and the lowest level (“below upper secondary education”) of education.

People in the highest income group are also much more likely to report being in good health

than those in the lowest income group

Source: OECD Health Statistics 2015, OECD (EU-SILC for European countries).


Note: Countries are ranked in descending order of perceived health status for the whole population.

1. Results for these countries are not directly comparable with those for other countries, due to methodological differences in the

survey questionnaire resulting in an upward bias. In Israel, data by income group relate to the employed population.

4. RISK FACTORS FOR HEALTH

• Smoking • Alcohol consumption • Overweight and obesity among children

and adults

Smoking has declined in nearly all countries, although on average one-fifth of adults still smoke across OECD countries


Change in daily smoking in adults, 2000 and 2013 (or nearest years)

Alcohol consumption has also declined in many countries but not all

Source: OECD Health Statistics 2015, OECD; WHO for non-OECD countries.

Alcohol consumption among adults, 2000 and 2013 (or nearest years)

Overweight and obesity among children have risen in most countries, increasing the risk of obesity in adulthood

Source: Currie et al. (2004); Currie et al. (2008); Currie et al. (2012)

Change in self-reported overweight among 15-year-olds, 2001-02, 2005-06 and 2009-10

Obesity among adults has increased in all OECD countries, one in five adults are now obese in 12 OECD countries

1. Data are based on measurements rather than self-reported height and weight.


• Number of physicians and nurses • Remuneration of physicians and

nurses • International migration of physicians

and nurses

5. HEALTH WORKFORCE

The number of physicians per capita has increased in nearly all OECD countries since 2000

1. Data include not only doctors providing direct care to patients, but also those working in the health sector as managers, educators, researchers,

etc. (adding another 5-10% of doctors).

2. Data refer to all doctors licensed to practice (resulting in a large over-estimation of the number of practising doctors in Portugal, of around 30%).

Practising doctors per 1 000 population, 2000 and 2013 (or nearest year)


Medical specialists greatly outnumber generalists in most countries: there are more than

2 specialists per every generalist on average

1. Generalists include general practitioners/family doctors and other generalist (non-specialist) medical practitioners.

2. Specialists include paediatricians, obstetricians/gynaecologists, psychiatrists, medical, surgical and other specialists.

3. In Ireland and Portugal, most generalists are not GPs (“family doctors”), but rather non-specialist doctors working in hospitals or

other settings. In Portugal, there is some double-counting of doctors with more than one specialty.


Generalists and specialists as a share of all doctors, 2013 (or nearest year)

The remuneration of specialists has grown more rapidly than that of generalists in many countries, but not all


Growth in the remuneration of GPs and specialists, 2005-13 (or nearest year)

1. The growth rate for the Netherlands and for Luxembourg is for self-employed GPs and specialists.

The number and share of foreign-trained doctors is high in some OECD countries

1. In Germany and Spain, the data is based on nationality (or place of birth in Spain), not on the place of training.


Share of foreign-trained doctors in OECD countries, 2013 (or nearest year)

The number of nurses per capita has also increased in nearly all OECD countries

1. Data include not only nurses providing direct care to patients, but also those working in the health sector as managers, educators, researchers, etc.

2. Data in Chile refer to all nurses who are licensed to practice (less than one-third are professional nurses with a university degree).

3. Austria reports only nurses employed in hospital.


Practising nurses per 1 000 population, 2000 and 2013 (or nearest year)

The remuneration of nurses has been frozen or cut down in some countries following the economic crisis, but has

continued to increase in others

Evolution in the remuneration of hospital nurses, selected OECD countries, 2005-13 (or nearest year)


1. Index for France, 2006 = 100.

2. Index for Greece, 2009 = 100.

The share of foreign-trained nurses is lower than that of foreign-trained doctors, but is high in some countries

1. Data for some regions in Spain relate to foreign nationality or country of birth, not the place of training.


Share of foreign-trained nurses in OECD countries, 2013 (or nearest year)

• Diagnostic procedures • Hospital activities and surgical

procedures

6. HEALTH CARE ACTIVITIES

The number of MRI and CT scanners is increasing in all OECD countries. Japan has by far the highest number per capita


1. Equipment outside hospital not included.

2. Only equipment eligible for public reimbursement.

MRI units CT scanners


The United States, France and Luxembourg perform more MRI and CT exams per capita than other countries

CT exams MRI exams 2013 (or nearest year)


1. Exams outside hospital not included (in Ireland, exams in private hospital also not included).

2. Exams on public patients not included.

3. Exams privately-funded not included.

The average length of stay in hospital has fallen in nearly all OECD countries, reflecting efficiency gains

Average length of stay in hospital, 2000 and 2013 (or nearest year)

1. Data refer to average length of stay for curative (acute) care (resulting in an under-estimation).


The average length of stay for normal delivery has become shorter in all OECD countries, but large variations persist



Rates of caesarean delivery have increased in most OECD countries. On average, more than 1 birth out of 4

involved a C-section in 2013, against 1 out of 5 in 2000


Ambulatory surgery has increased in most countries: examples of cataract surgery


Share of cataract surgeries carried out as ambulatory cases, 2000 and 2013 (or nearest years)

• Financial access • Geographic access • Timely access (waiting times)

7. ACCESS TO CARE

All OECD countries have achieved universal (or almost universal) health coverage, except Greece and the USA

Health insurance coverage for a core set of services, 2013


Unmet health care needs are still reported, most commonly among low-income groups

Unmet care needs due to cost, by income level, 2013

Source: 2013 Commonwealth Fund International Health Policy Survey, complemented with data from the national survey for the Czech Republic (2010).

Note: Either did not visit doctor when they had a medical problem, did not get recommended care or did not fill/skipped prescription.

Access to doctors varies widely within countries; more doctors in cities than in rural areas

Source: OECD Regions at a Glance 2015

Physician density, by Territorial Level 2 regions, 2013 (or nearest year)

Waiting times for cataract surgery have decreased or remained stable in several countries, but have started to go up in others

Cataract surgery, waiting times from specialist assessment to treatment, 2007 to 2014 (or 2013)


Waiting times for hip replacement have also decreased or remained stable in several countries, but have started to go up in others

Hip replacement, waiting times from specialist assessment to treatment, 2007 to 2014 (or 2013)


• Management of chronic diseases • Quality of acute care for life-threatening

conditions (cancers and heart attacks) • Prevention of communicable diseases

8. QUALITY OF CARE

Treatment for chronic diseases is not optimal. Too many persons are admitted to hospitals for asthma and

other chronic respiratory diseases…

Asthma and COPD hospital admission in adults, 2013 (or nearest year)


Note: Three-year average for Iceland and Luxembourg.

… and too many persons are admitted to hospitals for diabetes, highlighting the need to improve primary care

Diabetes hospital admission in adults, 2008 and 2013 (or nearest years)


Note: Three-year average for Iceland and Luxembourg.

Survival for cervical cancer has increased in most countries, but remain lower in Chile and Poland

Note: 95% confidence intervals represented by |—|.

1. Period analysis.

2. Cohort analysis.

3. Different analysis methods used for different years.

* Three-period average.


Cervical cancer five-year relative survival, 1998-2003 and 2008-2013 (or nearest periods)

Survival for breast cancer has also increased in most countries, but remain lower in Estonia and Poland


Note: 95% confidence intervals represented by |—|.

1. Period analysis.

2. Cohort analysis.

3. Different analysis methods used for different years.

* Three-period average.

Breast cancer five-year relative survival, 1998-2003 and 2008-2013 (or nearest periods)

Mortality rates following hospital admission for heart attack have decreased in all OECD countries, indicating improvements in acute care

Note: 95% confidence intervals represented by |—|. Three-year average for Luxembourg.

Thirty-day mortality after admission to hospital for AMI based on patient data, 2003 to 2013 (or nearest years)


Mortality rates following hospital admission for stroke have also come down in all OECD countries

Note: 95% confidence intervals represented by |—|. Three-year average for Luxembourg.

Thirty-day mortality after admission to hospital for ischemic stroke based on patient data, 2003 to 2013 (or nearest years)


80% of patients admitted for hip fracture are operated within the recommended two days on average across OECD countries

Hip fracture surgery initiation after admission to hospital, 2013 (or nearest year)


Note: Three-year average for Iceland.

Vaccination rates against influenza among people aged 65 and over have fallen in many countries,

increasing the risks of hospitalisation and death

Influenza vaccination coverage, population aged 65 and over, 2003 and 2013 (or nearest years)


• Expenditure • Financing

9. HEALTH EXPENDITURE

Health expenditure per capita varies widely across OECD countries. The United States spends two-and-a-half times the OECD average

Health expenditure per capita, 2013 (or nearest year)

Note: Expenditure excludes investments, unless otherwise stated.

1. Includes investments.

2. Data refers to 2012.

Source: OECD Health Statistics 2015, OECD; WHO Global Health Expenditure Database.

Several European countries hard hit by the economic crisis have cut their health spending since 2009

Annual average growth rate in per capita health expenditure, real terms, 2005 to 2013 (or nearest years)

1. Mainland Norway GDP price index used as deflator. 2. CPI used as deflator.


55

OECD countries allocated 8.9% of their GDP to health in 2013 (excluding investments), ranging from over 16% in the United States

to 5-6% in Turkey, Estonia and Mexico

Note: Excluding investments unless otherwise stated.

1. Data refers to 2012.

2. Including investments.

Health expenditure as a share of GDP, 2013 (or nearest year)

Source: OECD Health Statistics 2015, OECD; WHO Global Health Expenditure Database.

The share of GDP allocated to health has either stabilised or decreased since 2009 in most OECD countries,

as health spending remained flat or was cut down


Health expenditure as a share of GDP, selected countries, 2005-2013

The public sector is the main source of financing in most OECD countries. Only in Chile and the United States do

public sources account for less than 50% of health financing

1. The Netherlands report compulsory cost-sharing in health care insurance and in Exceptional Medical Expenses Act under social

security rather

than under private out-of-pocket, resulting in an underestimation of the out-of-pocket share.

2. Data refer to total health expenditure (= current health expenditure plus capital formation).

3. Social security reported together with general government.

Expenditure on health by type of financing, 2013 (or nearest year)


• Pharmaceutical expenditure • Financing of pharmaceutical expenditure • Pharmacists and pharmacies • Pharmaceutical consumption • Share of generic market • R&D in the pharmaceutical sector (See Chapter 2 for key charts on some indicators)

10. PHARMACEUTICAL SECTOR

• Rising share of elderly population • Long-term care recipients and caregivers • Long-term care expenditure

11. AGEING AND LONG-TERM CARE

The share of population aged over 65 and 80 in OECD countries will increase sharply in the coming decades

Source: OECD Historical Population Data and Projections Database, 2015

Less than half of the population aged 65 and over report being in good health, on average across OECD countries


1. Results not directly comparable with other countries due to methodological differences (resulting in an upward bias).

Perceived health status in adults aged 65 years and over, 2013 (or nearest year)

Most long-term care continue to be provided by informal caregivers

Source: OECD estimates based on 2013 HILDA survey for Australia, 2012-13 Understanding Society survey for the United Kingdom and 2013 SHARE survey for other European countries

Population aged 50 and over reporting to be informal carers, 2013 (or nearest year)

The number of people receiving formal long-term care varies greatly across countries

Proportion of population receiving long-term care, 2013 (or nearest year)


A growing share of people is receiving long-term care at home, to respond to their preference and reduce cost

Share of long-term care recipients aged 65 years and over receiving care at home, 2000 and 2013 (or nearest year)


Public spending on long-term care varies a lot across countries, reflecting differences

in the development of public programmes

Long-term care public expenditure (health and social components), as share of GDP, 2013 (or nearest year)


Note: The OECD average only includes the eleven countries that report health and social LTC.

1. Figures for the United States refer only to institutional care.

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Health at a glance 2015