Measuring Performance in the Health Sector What do international comparisons tell us? Mark Pearson Head, OECD Health Division Berlin, March 2010.

Measuring Performance Measuring Performance in the Health Sectorin the Health SectorWhat do international What do international comparisons tell us? comparisons tell us?

Mark PearsonHead, OECD Health Division

Berlin, March 2010

Why do economists need to know Why do economists need to know about health systems?about health systems?

• Money: It is already larger than manufacturing industry in some countries

• Jobs: Health was virtually the only sector that kept on expanding jobs through the economic crisis

• Growth: Country after country identifies health as a sector which will drive growth over the coming years

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What most economists know What most economists know about healthabout health

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What we need to do to measure What we need to do to measure performanceperformance

• Identify Inputs• Identify Outputs (quantities of services and goods

produced/consumed)• Identify Outcomes (changes in health status

attributable to outputs; adjust for ‘other factors’ – income, lifestyle)

• Identify policy features which explain differences in performance

Great in theory, but poor quality Outcome measures are a big problem

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Impact of SHA on national Impact of SHA on national health expenditure estimateshealth expenditure estimates

• Austria: pre-SHA implementation: 7.5% of GDP (2003)post-SHA implementation: 10.2% (2003)

• France: pre-SHA implementation: 10.1% of GDP (2003)post-SHA implementation: 10.9% (2003)

• Portugal:pre-SHA implementation: 8.2% of GDP (1999)post-SHA implementation: 8.8% (2000)

Due mainly to redefining boundaries of health care (e.g. long-term care), identifying other (private) sources of funding, etc.

Health expenditure per capita

2007

1. Health expenditure is for the insured population rather than resident population.2. Current health expenditure.

Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).

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Public expenditure Private expenditure

Health expenditure as a share of GDP (2007)

1. Public and private expenditures are current expenditures (excluding investments).2. Current health expenditure..3. Health expenditure is for the insured population rather than resident population.

Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).

Growth rates in spending in Germany have been low over past 10 years

Annual average real growth in per capita health expenditure, 1997-2007

Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).

The average length of stay for acute care has fallen in nearly all OECD countries

Average length of stay for acute care

Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).

Appendectomy procedures per 100,000 population, Appendectomy procedures per 100,000 population, 2007 or latest available year2007 or latest available year

Knee replacement procedures, per 100,000 Knee replacement procedures, per 100,000 population, 2007 or latest available yearpopulation, 2007 or latest available year

Hip replacement procedures, per 100,000 population, Hip replacement procedures, per 100,000 population, 2007 or latest available year2007 or latest available year

Does more spending deliver longer lives?Does more spending deliver longer lives?

Does more spending deliver longer lives?

2007 (or latest year available)

Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).

Quality of care is improvingQuality of care is improving

Avoidable hospital admission rates, 2007Avoidable hospital admission rates, 2007

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3Austria

Belgium

Canada

Denmark

Finland

Germany

Iceland

Ireland

Italy

KoreaNetherlands3

New Zealand

Norway

Poland2

Spain

Sweden

Switzerland

United Kingdom

United States1

Asthma COPD Diabetic acute complications CHF

Out of pocket and private health insurance as Out of pocket and private health insurance as a share of total health expenditure, 2007a share of total health expenditure, 2007

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Low-income populations report unmet care needs due to cost

* Did not get medical care, missed medical test, treatment or follow-up, did not fill prescription or missed doses.

Unmet care need* due to costs, by income group, 2007

Source: Commonwealth Fund (2008).

Thanks for listeningThanks for listening

mark.pearson@oecd.orgwww.oecd.org/health