Multinational Comparisons of Health Systems Data, 2013

Multinational Comparisons of Health Systems Data, 213 David Squires The Commonwealth Fund November 213

2 Health Care Spending and Coverage

Average Health Care Spending per Capita, 198 211 Adjusted for Differences in Cost of Living 3 Dollars ($US) 9 8 7 6 5 4 3 2 1 198 1984 1988 1992 1996 2 24 28 * 21 Source: OECD Health Data 213. US ($8,58) NOR ($5,669) SWIZ ($5,643) NETH ($5,99) CAN ($4,522) DEN ($4,495)* GER ($4,495) FR ($4,118) SWE ($3,925) AUS ($3,8)* UK ($3,45) JPN ($3,213)* NZ ($3,182)

Health Care Spending as a Percentage of GDP, 198 211 4 Percent 18 16 14 12 1 8 6 4 2 198 1983 1986 1989 1992 1995 1998 21 24 27 21 * 21 GDP refers to gross domestic product. Source: OECD Health Data 213. US (17.7%) NETH (11.9%) FR (11.6%) GER (11.3%) CAN (11.2%) DEN (11.1%)* SWIZ (11.%) NZ (1.3%) JPN (9.6%)* SWE (9.5%) UK (9.4%) NOR (9.3%) AUS (8.9%)*

Health Care Spending per Capita by Source of Funding, 211 Adjusted for Differences in Cost of Living 5 Dollars ($US) 9, 8,58 8, 987 Out-of-pocket spending 7, Private spending Public spending 6, 3,454 5,643 5, 1,455 4, 3, 527 4,522 4,495 4,495 4,118 3,925 3,8 666 593 593 75 672 465 37 65 86 635 733 49 3,45 338 246 3,213 3,182 464 348 111 23 2, 1, 4,66 3,661 3,183 3,827 3,436 3,161 3,24 2,578 2,821 2,638 2,631 US SWIZ CAN DEN* GER FR SWE AUS* UK JPN* NZ * 21. Source: OECD Health Data 213.

Pharmaceutical Spending per Capita, 211 Adjusted for Differences in Cost of Living 6 Dollars ($US) 1, 995 9 8 752 7 6 5 4 3 652 641 633 587 531 487 479 474 388 3 298 2 1 US CAN JPN* FR GER AUS* SWIZ OECD Median NETH SWE NOR DEN NZ * 21. Source: OECD Health Data 213.

7 Health Care Supply and Utilization

Hospital Discharges per 1, Population, 211 8 3 25 244 2 15 175 172 17 169 163 159 159 147 136 125 122 111 1 82 5 GER NOR* DEN* SWIZ FR SWE* AUS* OECD Median NZ UK US* NETH JPN CAN* * 21. Source: OECD Health Data 213.

Average Length of Hospital Stay for Acute Care, 211 9 Days 12 1 8 7.9 7.7 6.5 6.5 6.4 6 5.8 5.6 5.4 5.1 5.1 5. 4.5 4 2 GER CAN* SWIZ UK OECD Median NETH NZ US FR SWE AUS* NOR* * 21. Source: OECD Health Data 213.

Average Annual Number of Physician Visits per Capita, 211 1 14 13.1 12 1 9.7 8 7.4 6.8 6.7 6.6 6.6 6 4 5.2 5. 4.6 4.1 3. 2 JPN* GER CAN* FR AUS NETH OECD Median NOR** UK** DEN* US** SWE * 21. ** 29. Source: OECD Health Data 213.

Number of Practicing Physicians per 1, Population, 211 11 5 4 3 3.9 3.8 3.8 3.7 3.5 3.3 3.2 3.1 2.8 2.6 2.5 2.2 2 1 SWE* GER SWIZ NOR DEN** AUS OECD Median FR UK NZ US JPN* * 21. ** 29. Source: OECD Health Data 213.

Number of Acute Care Hospital Beds per 1, Population, 211 12 1 8 8. 6 5.3 4 2 3.4 3.4 3.3 3. 3. 2.9 2.6 2.6 2.4 2.4 2. 1.7 JPN GER FR AUS* NETH SWIZ OECD Median DEN* NZ US* UK NOR SWE CAN* * 21. Source: OECD Health Data 213.

Inpatient Coronary Bypass Grafts per 1, Population, 211 13 1 8 6 79. 74. 67.5 61.6 58.6 54.4 4 46.1 45.3 4.9 37.4 3.9 28.5 2 US** DEN* GER NOR** CAN* NETH* SWIZ OECD Median NZ SWE UK FR * 21. ** 29. Source: OECD Health Data 213.

14 Magnetic Resonance Imaging (MRI) Exams per Million Population, 211 12 1 12.7 95.2 8 6 67.5 61.5 49.9 49.8 4 2 24.1 US GER** FR DEN NETH CAN AUS * 21. ** 29. Source: OECD Health Data 213.

15 Health Promotion and Disease Prevention

Cervical Cancer Screening Rates, 211 16 Percent of women screened 1 8 85. 78.7 76.2 75. 71.1 68.5 66.3 64.8 6 56.8 4 37.7 2 US* GER** NOR NZ FR* UK DEN** NETH AUS JPN* Note: NOR, NZ, UK, DEN, and AUS based on program data; all other countries based on survey data. * 21. ** 29. Source: OECD Health Data 213.

Percent 1 Flu Immunization Among Adults Age 65 or Older, 211 17 8 74.6 74. 74. 66.9 65.5 64.4 6 4 56.1 55.7 55.2 53. 46. 45.6 2 14.1 AUS** NETH** UK US NZ CAN GER** OECD Median FR JPN* SWIZ* DEN* NOR * 21. ** 29. Source: OECD Health Data 213.

Adults Who Report Being Daily Smokers, 211 18 Percent 4 3 2 23.3 21.9 2.8 2.1 2.1 2. 19.6 17. 15.7 15.1 14.8 13.1 1 FR* GER** NETH JPN OECD Median DEN* UK* NOR CAN AUS* US SWE * 21. ** 29. Source: OECD Health Data 213.

Obesity (BMI>3) Prevalence Among Adult Population, 211 19 Percent 4 35 36.5 Measured Self-reported 3 25 28.3 27.8 25.4 24.8 2 15 14.7 13.4 12.9 11.4 11. 1 5 US* AUS NZ** CAN* UK GER** DEN* FR* NETH SWE JPN 4.1 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. * 21. ** 29. Source: OECD Health Data 213.

2 Quality and Patient Safety

Mortality Amenable to Health Care 21 Deaths per 1, population* 15 1 76 88 89 81 88 1997 98 26 7 116 19 16 99 97 97 134 115 113 127 12 5 55 57 6 61 61 64 66 67 74 76 77 78 79 8 83 96 FR AUS ITA JPN SWE NOR NETH AUT FIN GER GRE IRL NZ DEN UK US * 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, 211.

Percent Breast Cancer Five-Year Relative Survival Rate, 24 29 (or nearest period) 22 1 89.3 87.3 87.1 86.5 86. 84.5 84.4 83.3 82. 81.3 8 6 4 2 US JPN CAN NOR SWE NZ NETH GER DEN UK Source: OECD Health Data 213.

Diabetes Lower Extremity Amputation Rates per 1, Population, 29 23 4 32.9 33.7 3 2 18.1 1 4.8 5.7 7. 7.4 9.5 9.8 9.8 11. 12. 12.6 UK SWE NZ SWIZ* CAN NOR OECD Median AUS NETH** FR** DEN US* GER * 28. ** 27. Source: OECD Health Data 213.

In-Hospital Mortality After Admission for Acute Myocardial Infarction per 1 Patients, 29 24 1 9.7 8 6.8 6 4 2.3 2.5 2.9 3.2 3.2 3.9 4.3 4.5 4.6 5.2 5.3 2 DEN NOR SWE** AUS NZ CAN US* SWIZ* OECD Median UK NETH** GER JPN* In-hospital case-fatality rates within 3 days of admission. Age-sex standardized rates. * 28. ** 27. Source: OECD Health Data 213.

Foreign Object Left in Body During Procedure per 1, Hospital Discharges, 29 25 15 13.8 12 9 8.7 9.7 9.8 6 4.9 5.5 5.7 3 1.8 2.6 3.4 DEN** SWE GER US* FR UK NZ CAN AUS SWIZ* Note: Age-sex-SDX standardized rates. * 28. ** 21. Source: OECD Health Data 213.

26 Prices

Retail Price Indexes for Basket of In-Patent Pharmaceuticals, 21 Price level US is set at 1 27 1 1 95 88 8 6 61 5 49 46 4 2 US GER SWIZ FR CAN AUS UK 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. 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 213 32(4):753 61.

Diagnostic Imaging Prices, 212 28 MRI scanning and imaging fees CT scanning and imaging fees (head) $1,2 $1,121 $6 $566 $1, $928 $5 $8 $4 $6 $554 $3 $252 $31 $328 $4 $319 $335 $363 $2 $124 $175 $183 $2 $1 $ NETH UK FR NZ SWIZ US $ CAN UK FR NETH NZ SWIZ US Notes: US refers to the commercial average. MRI refers to magnetic resonance imaging; CT refers to computed tomography. Source: International Federation of Health Plans, 212 Comparative Price Report.

Dollars ($US) 24, 21,18 2, Hospital Spending per Discharge, 211 Adjusted for Differences in Cost of Living 29 16, 15,433 13,25 12, 8, 11,968 11,374 11,36 9,894 9,611 8,478 8,363 7,842 5,339 4, US* CAN* NETH SWIZ DEN* NOR* SWE* AUS* NZ FR OECD Median GER * 21. Source: OECD Health Data 213.

Dollars ($US) $1,8 $1,634 $1,6 $1,4 Physician Fee for Hip Replacement, 28 Adjusted for Differences in Cost of Living Public payers Dollars ($US) $4,2 $3,6 $3,996 Private payers 3 $1,2 $1, $8 $6 $1,251 $1,181 $1,46 $674 $652 $3, $2,4 $1,8 $1,2 $2,16 $1,943 $1,34 $4 $2 $6 $ US GER UK AUS FR CAN $ US UK AUS FR 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. 211 3(9):1647 56.

Physician Incomes, 28 Adjusted for Differences in Cost of Living 31 Dollars ($US) 5, 442,45 45, Orthopedic surgeons Primary care doctors 4, 35, 3, 324,138 25, 2, 15, 1, 28,634 22,771 187,69 154,38 186,582 159,532 131,89 125,14 95,585 92,844 5, US UK CAN GER AUS FR US UK GER CAN FR AUS 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. 211 3(9):1647 56.