OECD Health Data 2012 U.S. health care system from an international perspective

OECD Health Data 2012 U.S. health care system from an international perspective Released on June 28, 2012 http://www.oecd.org/health/healthdata

Why is the US health spending so high?

5 388 5 270 5 056 4 786 4 464 4 445 4 395 4 338 3 974 3 969 3 758 3 718 3 670 3 433 3 309 3 268 3 251 3 076 3 035 3 022 2 964 2 914 2 728 2 428 2 165 2 095 2 035 1 884 1 601 1 389 1 294 1 202 916 913 8 233 US spends two-and-a-half times the OECD average USD PPP Total health expenditure per capita, public and private, 2010 (or nearest year) 8 000 Public expenditure on health Private expenditure on health 6 000 4 000 2 000 0 1. In the Netherlands, it is not possible to clearly distinguish the public and private share related to investments. 2. Total expenditure excluding investments. Information on data for Israel: http://dx.doi.org/10.1787/888932315602.

8.0 7.9 7.9 7.8 7.5 7.1 7.0 6.3 6.2 6.1 12.0 11.6 11.6 11.4 11.4 11.1 11.0 10.7 10.5 10.2 10.1 9.6 9.6 9.6 9.5 9.5 9.4 9.3 9.3 9.2 9.1 9.0 9.0 8.9 17.6 At 17.6% of GDP in 2010, US health spending is one and a half as much as any other country, and nearly twice the OECD average % of GDP 20 18 16 14 12 10 8 6 4 2 0 Total health expenditure as a share of GDP, 2010 (or nearest year) Public Private 1. In the Netherlands, it is not possible to clearly distinguish the public and private share related to investments. 2. Total expenditure excluding investments. Information on data for Israel: http://dx.doi.org/10.1787/888932315602. 4

US spends much more on health than what might be expected by its GDP per capita Health spending per capita (USD PPP) 2010 (or latest year available) 8 000 USA 7 000 6 000 5 000 4 000 3 000 2 000 1 000 R² = 0.6065 CHL MEX TUR NLD CHE CAN DNK DEU AUT BEL FRA SWE IRE GBR AUS NZL ESP ISL FIN GRC ITA JPN PRT SVK SVN ISR KOR CZE POL HUN EST NOR LUX 0 0 10 000 20 000 30 000 40 000 50 000 60 000 70 000 80 000 90 000 GDP per capita (USD PPP) 5

US health spending is much greater for all categories of care, particularly for ambulatory care and administration cost 2010 (or latest year available) Current health spending per capita (USD PPP) 9 000 8 000 7 000 6 000 5 000 4 000 3 000 2 000 1 000 $7,910 (193%) $856 (296%) $1,105 (155%) $2,852 (236%) $5,270 $331 $460 $1,677 $3,097 (168%) $2,802 Other Public health and administration Pharmaceuticals and medical goods Ambulatory health care Hospitals/Nursing homes $4,205 $4,187 $3,835 $416 $281 $300 $853 $904 $2,979 $836 $120 $1,188 $1,278 $1,082 $507 $810 $1,716 $1,574 $1,582 $1,543 0 United States Switzerland Canada Germany France Japan (2009) 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. 6

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

US prices for a set of hospital services are over 60% higher than the average of 12 OECD countries Comparative price levels for total inpatient hospital services, 2007 Source: Koechlin et al. (2010).

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 26 th 3.1 per 1000 population Doctor consultations 3.9 per capita 29 th 6.4 per capita Hospital beds 3.1 per 1000 population 28 th 4.9 per 1000 population Hospital discharges 131.0 per 1000 population 26 th 155.1 per 1000 population Average length of stay in hospitals 4.9 days 29 th 7.1 days

Where the United States health system does MORE than other countries MRI units MRI exams CT scanners CT exams Tonsillectomy Coronary bypass Knee replacements Caesarean sections United States 31.6 per million population 97.7 per 1 000 population 40.7 per million population 265.0 per 1 000 population 254.4 per 100 000 population 79.0 per 100 000 population 226.0 per 100 000 population 32.9 per 100 live births Rank compared with OECD countries 2 nd 2 nd 3 rd 3 rd 1 st 3 rd 1 st 6 th OECD average 12.5 per million population 46.3 per 1 000 population 22.6 per million population 123.8 per 1 000 population 130.1 per 100 000 population 47.3 per 100 000 population 121.6 per 100 000 population 26.1 per 100 live births

Is the quality of care better in the US?

Cancer system is generally performing well Breast cancer, 5-year survival rate Colorectal cancer, 5-year survival rate United States (2003-08) 89.3 Japan (2000-05) 68.0 Japan (2000-05) 87.3 United States (2003-08) 64.5 Canada (2002-07) 86.6 Canada (2002-07) 63.4 OECD (16 countries) 83.5 Germany (2003-08) 60.4 Germany (2003-08) 83.3 OECD (16 countries) 59.9 France (1997-2002) 82.8 France (1997-2002) 57.0 United Kingdom (2004-09) 81.3 United Kingdom (2004-09) 53.3 60 70 80 90 100 Age-standardised rates (%) 40 50 60 70 80 Age-standardised rates (%) Note: 95% confidence intervals are represented by H.

Primary care sector is not performing so well Asthma hospital admission COPD hospital admission Canada (2009) 15.7 France (2007) 79 Italy (2009) 19.2 Italy (2009) 126 Germany (2009) 20.8 Canada (2009) 183 France (2007) 43.4 OECD (28 countries) 198 OECD (28 countries) 51.8 Germany (2009) 201 United Kingdom (2009) 73.7 United Kingdom (2009) 213 United States (2008) 120.6 United States (2008) 230 0 50 100 150 Age-sex standardised rates per 100 000 population 0 100 200 300 Age-sex standardised rates per 100 000 population Note: 95% confidence intervals are represented by H.

What are the trends in key risk factors to health in the US?

Smoking rates have decreased in the US and in most other OECD countries Adult population smoking daily 2010 Change 2000-10 13.3 Mexico n.a. 15.1 United states -20.9 15.1 Australia -23.7 16.3 Canada -27.2 19.5 Japan -27.8 20.9 OECD -19.9 21.5 United Kingdom -20.4 21.9 Germany -11.3 23.1 Italy -5.3 23.3 France -13.7 25 20 15 10 5 % of population aged 15 years and over 0-50 -25 0 25 % change over period

2 3 4 6 9 9 10 10 12 11 13 13 15 14 17 22 21 24 24 23 25 26 30 31 36 Obesity rates have increased substantially over the past 20 years and are highest in the US % 40 1990 2000 2010 30 20 10 0 1. Data are based on measurements rather than self-reported height and weight.

Over one-third of children in the US are overweight or obese Children aged 5-17 years who are overweight (including obese) Girls Boys 37.0 Greece 45.0 35.9 30.9 29.0 26.6 26.1 24.0 21.4 17.6 United States Italy Mexico United Kingdom Canada Australia OECD Germany 35.0 32.4 28.1 22.7 28.9 22.0 22.9 22.6 14.9 14.4 France Japan 13.1 16.2 50 40 30 20 10 0 0 10 20 30 40 50 % of children aged 5-17 years % of children aged 5-17 years Source: International Association for the Study of Obesity (2011).

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