THE COMMONWEALTH FUND Multinational Comparisons of Health Systems Data, 2013 David Squires The Commonwealth Fund November 2013.

THE COMMONWEALTH

FUND

Multinational Comparisonsof Health Systems Data, 2013

David SquiresThe Commonwealth Fund

November 2013

2

Health Care Spending and Coverage

THECOMMONWEALTH

FUND

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

0

1000

2000

3000

4000

5000

6000

7000

8000

9000US ($8,508)

NOR ($5,669)

SWIZ ($5,643)

NETH ($5,099)

CAN ($4,522)

DEN ($4,495)*

GER ($4,495)

FR ($4,118)

SWE ($3,925)

AUS ($3,800)*

UK ($3,405)

JPN ($3,213)*

NZ ($3,182)

Source: OECD Health Data 2013.

Average Health Care Spending per Capita, 1980–2011Adjusted for Differences in Cost of Living

3

Dollars ($US)

THECOMMONWEALTH

FUND* 2010

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

0

2

4

6

8

10

12

14

16

18 US (17.7%)

NETH (11.9%)

FR (11.6%)

GER (11.3%)

CAN (11.2%)

DEN (11.1%)*

SWIZ (11.0%)

NZ (10.3%)

JPN (9.6%)*

SWE (9.5%)

UK (9.4%)

NOR (9.3%)

AUS (8.9%)*

GDP refers to gross domestic product. Source: OECD Health Data 2013.

Health Care Spending as a Percentage of GDP, 1980–2011

Percent

* 2010 THECOMMONWEALTH

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4

5Health Care Spending per Capita by Source of Funding, 2011

Adjusted for Differences in Cost of Living

US SWIZ CAN DEN* GER FR SWE AUS* UK JPN* NZ0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

4,0663,661

3,1833,827

3,436 3,161 3,2042,578 2,821 2,638 2,631

3,454

527672

75465 650

86490 246

111 203

987

1,455

666 593 593 307

635 733 338 464 348

Out-of-pocket spending

Private spending

Public spending

* 2010.

Dollars ($US)

8,508

Source: OECD Health Data 2013.

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5,643

4,522 4,495 4,4954,118

3,925 3,8003,2133,405 3,182

6Pharmaceutical Spending per Capita, 2011

Adjusted for Differences in Cost of Living

US CAN JPN* FR GER AUS* SWIZ OECD Median

NETH SWE NOR DEN NZ0

100

200

300

400

500

600

700

800

900

1,000995

752

652 641 633587

531487 479 474

388

300 298

* 2010.Source: OECD Health Data 2013.

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Dollars ($US)

7

Health Care Supply and Utilization

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Hospital Discharges per 1,000 Population, 2011

GER NOR* DEN* SWIZ FR SWE* AUS* OECD Median

NZ UK US* NETH JPN CAN*0

50

100

150

200

250

300

244

175 172 170 169 163 159 159147

136125 122

111

82

* 2010.Source: OECD Health Data 2013.

8

THECOMMONWEALTH

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Average Length of Hospital Stay for Acute Care, 2011

GER CAN* SWIZ UK OECD Median

NETH NZ US FR SWE AUS* NOR*0

2

4

6

8

10

12

7.9 7.7

6.5 6.5 6.45.8 5.6 5.4 5.1 5.1 5.0

4.5

Days

* 2010.Source: OECD Health Data 2013.

9

THECOMMONWEALTH

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10Average Annual Number of Physician Visits per Capita, 2011

JPN* GER CAN* FR AUS NETH OECD Median

NOR** UK** DEN* US** SWE0

2

4

6

8

10

12

1413.1

9.7

7.46.8 6.7 6.6 6.6

5.2 5.04.6

4.1

3.0

* 2010.** 2009.Source: OECD Health Data 2013.

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Number of Practicing Physicians per 1,000 Population, 2011

SWE* GER SWIZ NOR DEN** AUS OECD Median

FR UK NZ US JPN*0

1

2

3

4

5

3.9 3.8 3.8 3.73.5

3.33.2 3.1

2.82.6

2.52.2

Source: OECD Health Data 2013.

11

THECOMMONWEALTH

FUND* 2010.** 2009.

12Number of Acute Care Hospital Beds per 1,000 Population, 2011

JPN GER FR AUS* NETH SWIZ OECD Median

DEN* NZ US* UK NOR SWE CAN*0

2

4

6

8

10

8.0

5.3

3.4 3.4 3.33.0 3.0 2.9 2.6 2.6 2.4 2.4

2.01.7

THECOMMONWEALTH

FUND* 2010.Source: OECD Health Data 2013.

13Inpatient Coronary Bypass Grafts per 100,000 Population, 2011

US** DEN* GER NOR** CAN* NETH* SWIZ OECD Me-dian

NZ SWE UK FR0

20

40

60

80

100

79.074.0

67.561.6

58.654.4

46.1 45.340.9

37.430.9 28.5

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* 2010.** 2009.Source: OECD Health Data 2013.

14Magnetic Resonance Imaging (MRI) Exams per Million Population, 2011

US GER** FR DEN NETH CAN AUS0

20

40

60

80

100

120

102.795.2

67.561.5

49.9 49.8

24.1

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* 2010.** 2009.Source: OECD Health Data 2013.

15

Health Promotion and Disease Prevention

THECOMMONWEALTH

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THECOMMONWEALTH

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Cervical Cancer Screening Rates, 2011

US* GER** NOR NZ FR* UK DEN** NETH AUS JPN*0

20

40

60

80

100

85.078.7 76.2 75.0

71.168.5 66.3 64.8

56.8

37.7

Percent of women screened

Note: NOR, NZ, UK, DEN, and AUS based on program data; all other countries based on survey data.* 2010.** 2009.Source: OECD Health Data 2013.

16

Flu Immunization Among Adults Age 65 or Older, 2011

AUS** NETH** UK US NZ CAN GER** OECD Median

FR JPN* SWIZ* DEN* NOR0

20

40

60

80

100

74.6 74.0 74.0

66.9 65.5 64.4

56.1 55.7 55.2 53.0

46.0 45.6

14.1

Percent

* 2010.** 2009.Source: OECD Health Data 2013.

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17

18Adults Who Report Being Daily Smokers, 2011

FR* GER** NETH JPN OECD Me-dian

DEN* UK* NOR CAN AUS* US SWE0

10

20

30

40

23.321.9 20.8 20.1 20.1 20.0 19.6

17.015.7 15.1 14.8

13.1

Percent

THECOMMONWEALTH

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Source: OECD Health Data 2013.

* 2010.** 2009.

US* AUS NZ** CAN* UK GER** DEN* FR* NETH SWE JPN0

5

10

15

20

25

30

35

4036.5

28.3 27.825.4 24.8

14.713.4 12.9

11.4 11.0

4.1

19Obesity (BMI>30) Prevalence Among Adult Population, 2011

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.

Percent

Measured Self-reported

THECOMMONWEALTH

FUND* 2010.** 2009.Source: OECD Health Data 2013.

20

Quality and Patient Safety

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Mortality Amenable to Health Care

Deaths per 100,000 population*

* 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.

21

THECOMMONWEALTH

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Breast Cancer Five-Year Relative Survival Rate, 2004–2009(or nearest period)

US JPN CAN NOR SWE NZ NETH GER DEN UK0

20

40

60

80

100

89.3 87.3 87.1 86.5 86.0 84.5 84.4 83.3 82.0 81.3

Source: OECD Health Data 2013.

Percent

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22

* 2008.** 2007.Source: OECD Health Data 2013.

UK SWE NZ SWIZ* CAN NOR OECD Me-dian

AUS NETH**

FR** DEN US* GER0

10

20

30

40

4.8 5.77.0 7.4

9.5 9.8 9.8 11.0 12.0 12.6

18.1

32.9 33.7

Diabetes Lower Extremity Amputation Rates per 100,000 Population, 2009

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23

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

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

DEN NOR SWE** AUS NZ CAN US* SWIZ* OECD Me-dian

UK NETH**

GER JPN*0

2

4

6

8

10

2.3 2.52.9 3.2 3.2

3.94.3 4.5 4.6

5.2 5.3

6.8

9.7

Source: OECD Health Data 2013.

24

THECOMMONWEALTH

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Note: Age-sex-SDX standardized rates.

Foreign Object Left in Body During Procedure per 100,000 Hospital Discharges, 2009

DEN** SWE GER US* FR UK NZ CAN AUS SWIZ*0

3

6

9

12

15

1.82.6

3.4

4.95.5 5.7

8.79.7 9.8

13.8

Source: OECD Health Data 2013.

25

THECOMMONWEALTH

FUND* 2008.** 2010.

26

Prices

THECOMMONWEALTH

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Retail Price Indexes for Basket of In-Patent Pharmaceuticals, 2010US is set at 100

US GER SWIZ FR CAN AUS UK0

20

40

60

80

100100

9588

61

50 4946

Source: P. Kanavos, A. Ferrario, S. Vandoros et al., "Higher U.S. Branded Drug Prices and Spending Compared to Other Countries May Stem Partly from Quick Uptake of New Drugs," Health Affairs, April 2013 32(4):753–61.

27

THECOMMONWEALTH

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Note: Calculations weighted relative to U.S. consumption patterns. U.S. retail prices were discounted from manufacturer prices according to the rebates obtained by the Medicaid program.

Price level

Diagnostic Imaging Prices, 2012

NETH UK FR NZ SWIZ US$0

$200

$400

$600

$800

$1,000

$1,200

$319 $335 $363

$554

$928

$1,121

Notes: US refers to the commercial average. MRI refers to magnetic resonance imaging; CT refers to computed tomography.Source: International Federation of Health Plans, 2012 Comparative Price Report.

28

MRI scanning and imaging fees

CAN UK FR NETH NZ SWIZ US$0

$100

$200

$300

$400

$500

$600

$124

$175 $183

$252

$310$328

$566

CT scanning and imaging fees (head)

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Hospital Spending per Discharge, 2011Adjusted for Differences in Cost of Living

US* CAN* NETH SWIZ DEN* NOR* SWE* AUS* NZ FR OECD Me-dian

GER0

4,000

8,000

12,000

16,000

20,000

24,000

21,018

15,433

13,02511,968

11,374 11,3069,894 9,611

8,478 8,363 7,842

5,339

Dollars ($US)

29

* 2010.Source: OECD Health Data 2013.

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30Physician Fee for Hip Replacement, 2008

Adjusted for Differences in Cost of Living

US GER UK AUS FR CAN$0

$200

$400

$600

$800

$1,000

$1,200

$1,400

$1,600

$1,800

$1,634

$1,251$1,181

$1,046

$674 $652

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.

US UK AUS FR$0

$600

$1,200

$1,800

$2,400

$3,000

$3,600

$4,200 $3,996

$2,160$1,943

$1,340

Public payers Private payers

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Dollars ($US) Dollars ($US)

31Physician Incomes, 2008

Adjusted for Differences in Cost of Living

US UK GER CAN FR AUS

186,582159,532

131,809125,104

95,585 92,844

US UK CAN GER AUS FR0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

500,000

442,450

324,138

208,634 202,771187,609

154,380

Primary care doctorsOrthopedic surgeons

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.

THECOMMONWEALTH

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Dollars ($US)