1

Multinational Comparisonsof Health Systems Data, 2009

Gerard F. Anderson, Ph.D. and Patricia MarkovichJohns Hopkins University

November 2009

Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund or its directors, officers, or staff.

THECOMMONWEALTH

FUND

2International Comparison of Spending on Health,

1980–2007

0

1000

2000

3000

4000

5000

6000

7000

1980 1984 1988 1992 1996 2000 2004

U.S.NorwaySwitzerlandCanadaNetherlandsFranceGermanySwedenU.K.ItalyNew ZealandAustralia

Average spending on healthper capita ($US PPP)

0

2

4

6

8

10

12

14

16

1980 1984 1988 1992 1996 2000 2004

U.S.FranceSwitzerlandGermanyCanadaNetherlandsNew ZealandSwedenNorwayItalyU.K.Australia

Total expenditures on healthas percent of GDP

Source: OECD Health Data 2009 (June 2009)

THECOMMONWEALTH

FUND

3Average Annual Growth Rate of

Real Health Care Spending per Capita, 1997-2007

1.7%

2.3%2.4%

2.4%2.5%

3.7%3.8%3.8%

4.0%4.1%4.2%

4.5%

4.9%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

UK NZ NETH SWE OECD

Median

CAN AUS* US FR ITA NOR SWITZ GER

*1996-2006

Source: OECD Health Data 2009 (June 2009)

THECOMMONWEALTH

FUND

4Out-of-Pocket Health Care Spending per Capita, 2007 Adjusted for Differences in the Cost of Living

$213$246

$343$351

$470$485$528$542$571$580

$720

$890

$1,350

$0

$200

$400

$600

$800

$1,000

$1,200

$1,400

SWITZ US NOR CAN AUS* ITA SWE OECD

Median

GER NZ UK FR NETH

*2006

Source: OECD Health Data 2009 (June 2009)

THECOMMONWEALTH

FUND

5Health Care Expenditure per Capita

by Source of Funding, 2007Adjusted for Differences in Cost of Living

$3,307

$4,005

$2,618 $2,726 $2,844 $2,758$2,124

$2,446$2,056

$3,092

$449$589 $510

$360

$441

$890

$1,350 $580

$571 $343

$2,716

$38

$88$204

$79

$720

$542

$470$627

$528

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

US NOR SWIT CAN FR GER SWE AUS* UK ITA

Out-of-Pocket Spending

Private Spending

Public Spending

*2006

Source: OECD Health Data 2009 (June 2009)

THECOMMONWEALTH

FUND

6Hospital Spending per Discharge, 2007

Adjusted for Differences in Cost of Living

$17,206

$12,163 $11,988

$9,398 $9,131 $9,026

$7,312 $7,312 $7,295

$4,667 $4,527

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

$18,000

US* CAN* NETH SWITZ NOR* SWE NZ OECD

Median

AUS* FR GER

* 2006

Source: OECD Health Data 2009 (June 2009)

THECOMMONWEALTH

FUND

7Hospital Discharges per 1,000 Population, 2007

84

109

126126135139

162163165166172

227

274

0

50

100

150

200

250

300

FR GER NOR SWITZ SWE OECD

Median

AUS* ITA* NZ US* UK NETH CAN*

*2006

Source: OECD Health Data 2009 (June 2009)

THECOMMONWEALTH

FUND

8Average Length of Hospital Stay

for Acute Myocardial Infarction, 2007

4.64.8

5.4

6.26.46.8

7.17.1

7.98.0

8.9

11.0

0

2

4

6

8

10

12

GER UK ITA* SWITZ NETH OECD

Median

CAN* FR AUS* US* SWE NOR

* 2006

Source: OECD Health Data 2009 (June 2009)

THECOMMONWEALTH

FUND

9Average Annual Number of Physician Visits

per Capita, 2007

7.5

7.0

6.3 6.3 6.3

5.8 5.7

5.04.7

4.03.8

2.8

0

1

2

3

4

5

6

7

8

GER ITA** AUS FR OECD

Median

CAN* NETH UK NZ SWITZ US* SWE*

*2006 **2005

Source: OECD Health Data 2009 (June 2009)

THECOMMONWEALTH

FUND

10Number of Practicing Physicians

per 1,000 Population, 2007

2.2

3.9 3.9 3.9

3.73.6

3.53.4

3.2

2.8

2.52.4

2.3

0

1

2

3

4

NETH NOR SWITZ ITA SWE* GER FR OECD

Median

AUS* UK US NZ CAN

*2006

Source: OECD Health Data 2009 (June 2009)

THECOMMONWEALTH

FUND

11Pharmaceutical Spending per Capita, 2007

Adjusted for Differences in Cost of Living

$241

$381$422$431$446$446$454

$518$542

$588

$691

$878

$0

$100

$200

$300

$400

$500

$600

$700

$800

$900

US CAN FR GER ITA SWITZ SWE OECD

Median

AUS* NETH NOR NZ

*2006

Source: OECD Health Data 2009 (June 2009)

THECOMMONWEALTH

FUND

12Drug Prices for 30 Most Commonly Prescribed Drugs, 2006-07

US is set at 1.0

0.34

0.440.450.490.51

0.63

0.760.77

1.00

0

0.2

0.4

0.6

0.8

1

US CAN GER SWITZ UK AUS NETH FR NZ

Source: IMS

THECOMMONWEALTH

FUND

13Drug Prices for 30 Most Commonly Prescribed Drugs, 2006-07 – Brand and Generic

US is set at 1.0

Source: IMS

AUS CAN FR GER NETH NZ SWITZ UK US

Brand Drugs 0.40 0.64 0.32 0.43 0.39 0.33 0.51 0.46 1.00

Generic Drugs 2.57 1.78 2.85 3.99 1.96 0.90 3.11 1.75 1.00

THECOMMONWEALTH

FUND

14Drug Prices: Lipitor (atorvastatin), 2006-07 Price for one dose

$0.71

$1.01

$1.35$1.45$1.45$1.46$1.52

$1.83

$2.82

$0

$1

$2

$3

US CAN SWITZ AUS UK NETH GER FR NZ

Source: IMS

THECOMMONWEALTH

FUND

15Drug Prices: Nexium (esomeprazole), 2006-07 Price for one dose

$0.88$1.02

$1.22$1.28$1.32

$1.97$2.15

$3.91

$0

$1

$2

$3

$4

US SWITZ CAN UK NETH FR AUS GER

Source: IMS

THECOMMONWEALTH

FUND

16Magnetic Resonance Imaging (MRI) Machines

per Million Population, 2007

25.9

18.6

14.4

8.88.5 8.2 8.2

6.7 6.65.7 5.1

0

10

20

30

US ITA SWITZ NZ OECD

Median

GER UK CAN NETH** FR AUS

**2005

Source: OECD Health Data 2009 (June 2009)

THECOMMONWEALTH

FUND

17MRI Scan and Imaging Fees, 2009

$1,200

$839 $824

$567

$436

$179

0

200

400

600

800

1,000

1,200

1,400

US GER CAN NETH FR UK

Source: International Federation of Health Plans, 2009 Comparative Price Report

THECOMMONWEALTH

FUND

18Volume Knee and Hip Implants, 2004

Implants per 100,000

164

137

121

95

65

0

20

40

60

80

100

120

140

160

180

US UK GER FR ITA

Source: McKinsey & Company, Accounting for the Cost of Health Care in the United States, 2007

258

208197

141 139

GER FR UK ITA US

Knee Replacements Hip Replacements

THECOMMONWEALTH

FUND

19Cost of Knee and Hip Prostheses to Providers, 2004

GDP Adjusted, US $

$4,866

$3,035

$2,561$2,390

$2,239

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

US ITA FR UK GER

Source: McKinsey & Company, Accounting for the Cost of Health Care in the United States, 2007

$4,821

$1,537$1,380

$1,168 $1,165

US ITA UK GER FR

Knee Replacements Hip Replacements

THECOMMONWEALTH

FUND

20Coronary Bypass Proceduresper 100,000 Population, 2007

32 31

132

8581

77 7673 73

59 58 56

45

0

25

50

75

100

125

150

GER US* NOR* NZ AUS* ITA* CAN* OECD

Median

NETH SWE UK FR SWITZ

* 2006

Source: OECD Health Data 2009 (June 2009)

THECOMMONWEALTH

FUND

21Percentage of Population over Age 65 with Influenza Immunization, 2007

77.5%77.0%

73.5%

69.0%66.7%

64.9% 64.3% 63.7%58.9%

56.0% 56.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

AUS* NETH UK FR US ITA CAN NZ OECD

Medi an

GER SWITZ

* 2006

a

Source: OECD Health Data 2009 (June 2009)

THECOMMONWEALTH

FUND

22Percentage of Adults Who Report Being

Daily Smokers, 2007

15%15%

29%

25%

23%22% 22% 22%

21% 20%

18% 18%

17%

0%

5%

10%

15%

20%

25%

30%

NETH FR* GER** ITA OECD

Median

NOR UK SWITZ CAN NZ AUS US SWE*

* 2006** 2005

Source: OECD Health Data 2009 (June 2009)

THECOMMONWEALTH

FUND

23

34.3%

26.5%

24.0%

15.4%13.6%

11.2%10.5% 10.2% 9.9% 9.0%

8.1%

0%

5%

10%

15%

20%

25%

30%

35%

US* NZ UK CAN GER** NETH FR* SWE ITA NOR SWITZ

Obesity (BMI>30) Prevalence Among Adult Population, 2007

* 2006**2005

Note: For most countries, BMI estimates are based on national health interview surveys (self-reported data). However, the estimates for the US, UK, and New Zealand are based on actual measurements of weight and height, and estimates based on actual measurements are usually significantly higher than those based on self-report.

Source: OECD Health Data 2009 (June 2009)

THECOMMONWEALTH

FUND

24

Life Expectancy at Birth, 2007

81.1 80.778.2

82.282.382.382.482.983.083.083.784.084.284.4

77.175.4

77.27877.278.278.978.47978.479.277.5

0

10

20

30

40

50

60

70

80

90

FR SWITZ* ITA* AUS CAN* SWE NOR* GER* NETH OECD

Median

NZ UK ** US*

Female Male

* 2006**2005

Source: OECD Health Data 2009 (June 2009)

THECOMMONWEALTH

FUND

25

Mortality Amenable to Health CareDeaths per 100,000 population*

* Countries’ age-standardized death rates before age 75; includes ischemic heart disease, diabetes, stroke, and bacterial infections.Data: E. E. Nolte and C. M. McKee, Measuring the Health of Nations: Updating an Earlier Analysis, Health Affairs, January/February 2008Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008.

7681

88 8489 89

99 9788

97

109 106116 115 113

130134

128

115

65 71 71 74 77 80 82 82 84 84 90 93 96 101 103 103 104 110

74

0

50

100

150

Fran

ceJa

pan

Austra

liaSpai

n

Italy

Canad

aNorw

ayNet

herla

nds

Swed

enG

reec

eAust

riaG

erm

any

Finl

and

New Z

eala

ndDen

mar

k

United

Kingd

omIre

land

Portuga

l

United

State

s

1997/98 2002/03

THECOMMONWEALTH

FUND

26Potential Years of Life Lost Due to Diabetes

per 100,000 Population, 2007

19

25293133

35363637

64

99

0

20

40

60

80

100

US** NZ** NOR* SWE* OECD

Median

GER* NETH ITA* FR* UK SWITZ*

* 2006**2005

Source: OECD Health Data 2009 (June 2009)