WHAT ARE THE KEY HEALTH DISADVANTAGES ACROSS HIGH-INCOME COUNTRIES? Marion Devaux, Health Policy Analyst, OECD 5 April 2016, NHLBI Think Tank

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1 WHAT ARE THE KEY HEALTH DISADVANTAGES ACROSS HIGH-INCOME COUNTRIES? Marion Devaux, Health Policy Analyst, OECD 5 April 2016, NHLBI Think Tank

2 HEALTH OUTCOMES: LIFE EXPECTANCY, MORTALITY, AND DISEASES

3 The US has a shorter life expectancy than other peer OECD countries 90 Years Source: OECD Health at a Glance 2015

4 Mortality from cardiovascular diseases has diminished in the US like in most countries Change Japan France Korea Netherlands Portugal Spain Belgium Luxembourg Chile Israel Denmark Norway Switzerland Greece Italy Slovenia Canada United Kingdom Australia Sweden Poland Germany OECD (34) United States Iceland Ireland New Zealand Austria Mexico Turkey -1 n.a. 154 Finland Estonia Czech Rep Hungary -10 Slovak Rep Age-standardised rates per population Mortality from Ischemic Heart Disease Source: OECD Health at a Glance Change in % 63

5 Mortality from cancer is low in the US reflecting progress in cancer screening and survival 400 Age-standardised rates per population Men Women Total Source: OECD Health at a Glance 2015

6 BEYOND AVERAGES

7 Longevity at age 25 Longevity at age 25 High-educated people live longer than low-educated people in all countries, but the magnitude of the gap differs across countries Men Low education Medium High education Women Source: Murtin et al, 2016 (OECD Statistics Directorate Working Paper, forthcoming)

8 MAIN CONTRIBUTORS TO LIFE EXPECTANCY GAINS

9 Years of life Lifestyles, Education and Health expenditure are the main contributing factors of the gain in life expectancy over Contributions to life expectancy gains et birth between 1990 and OECD countries (Preliminary results) 1.52 Source: OECD Data and Estimates, James et al (2016) (OECD Health working paper, forthcoming) Residual Obesity Drinking Smoking Unemployment Education level Sanitation Air pollution Health expenditure GDP

10 LIFESTYLE RISK FACTORS: OBESITY, SMOKING, AND ALCOHOL USE

11 Age-standardised Rate of obesity The US has the highest obesity rate, while all countries have seen obesity growing 40% 35% USA 30% 25% 20% Mexico Australia Canada 15% England Spain 10% 5% France Italy Korea Switzerland 0% Year Source: OECD Obesity Update 2014, OECD estimates for recent data.

12 Relative index of inequality Women with lower education level are more likely to be overweight in all countries Source: OECD, Health Working Paper 45

13 The US has low smoking rates compared to other peer OECD countries 40 % of population aged 15 years and over Source: OECD Health at a Glance 2015

14 Alcohol consumption has diminished in many countries Liters per capita (15 years +) Source: OECD Health at a Glance 2015

15 Rate of heavy episodic drinking 16% but risky drinking is on the rise in most countries Heavy Episodic Drinking a least once a week, Women % 14% 12% 10% New Zealand Finland* Italy* 35% 30% England Ireland 8% Australia USA 6% Japan* Germany Canada 4% 2% France 0% % 20% 15% 10% HED at least once a month in Japan and once a year in Italy; crude weighted rates in Finland (age-standardised elsewhere) Source: OECD estimates on national survey data. 15

16 ACCESS TO HEALTH CARE: HEALTH CARE UTILISATION AND UNMET CARE NEEDS

17 Inequities in doctor consultations are stronger in the US than in other OECD countries Average probability of doctor visits varies High-income people more likely to visit a doctor compared to low-income people, for the same level of need, in most countries France Germany Belgium Canada Czech Republic Hungary Spain Slovak Republic New Zealand United Kingdom Switzerland Slovenia Poland Lowest income quintile Average Highest income quintile Stronger inequity in the US Estonia Finland United States Denmark* Rates of doctor visits in the past 12 months (*) in past 3 months in Denmark Source: Devaux and de Looper, 2012 (OECD Health Working Paper No 58)

18 Unmet care needs due to financial reasons are greater in the US than in other peer countries % 50 Below average income Above average income Source: 2013 Commonwealth Fund International Health Policy Survey, complemented with Czech data (2010)

19 HEALTH SYSTEM CHARACTERISTICS HEALTH COVERAGE AND FINANCING

20 All OECD countries have universal (or nearly universal) health coverage, except Greece Total public coverage Australia Canada Czech Republic Denmark Finland Iceland Ireland Israel Italy Japan Korea New Zealand Norway Portugal Slovenia Sweden Switzerland United Kingdom Austria France Spain Germany Netherlands Belgium Mexico Chile Turkey Luxembourg Hungary Colombia Slovak Republic Estonia Poland United States (2014) Greece 34.5 Primary private health coverage % of total population covered for a core set of services, 2013

21 % of current health expenditure While most health spending is publicly financed in nearly all OECD countries, the share of private out-of-pocket spending varies widely General government Social security Private out-of-pocket Private insurance Other 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. Source: OECD Health at a Glance 2015

22 Strong association between health expenditure and health outcomes Source: OECD Health at a Glance 2015

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