HOW DATA CAN DRIVE IMPROVEMENTS IN HEALTH SYSTEMS

Mark PearsonHead, OECD Health Division

Japanese Health Economics Association21 July, 2012

Structure of my talk

1. A cautionary tale: don’t ask me which health system is ‘the best’

2. Getting better international measures of health inputs

3. Getting better international measures of health outputs

4. Prices and volumes of activity

1. WHICH SYSTEM IS BEST?

4

Output

70

72

74

76

78

80

82

84

0 1000 2000 3000 4000 5000 6000

Efficiency frontier

Input

Ou

tpu

t in

eff

icie

ncy

Input inefficiency

Source: OECD, 2010

Efficiency of the health sectorDEA analysis

If we spent better, what would we get?

0

1

2

3

4

5

6

Uni

ted

Stat

esH

unga

rySl

ovak

Rep

ublic

Den

mar

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reec

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nlan

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nite

d …Lu

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publ

icA

ustr

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ethe

rlan

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ew Z

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orw

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nada

Spai

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eden

Pola

ndIta

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rtug

alTu

rkey

Fran

ceM

exic

oJa

pan

Icel

and

Kore

aSw

itzer

land

Aus

tral

ia

Years Potential gains in 2007 (DEA) Increase over 1997-2007

Groups of countries sharing broadly similar institutions

Efficiency varies more within groups of countries than across them

OECD average

AUS

AUTBEL

CAN

CZE

DNK

FIN

FRA

DEU

GRC

HUN

ISL

IRL

ITA

JPNKOR

LUX

MEX

NLDNZLNORPOL

PRT

SVK

ESPSWE

CHE

TUR

GBR

0

1

2

3

4

5

0 1 2 3 4 5 6

Potential gains in life expectancy (years, DEA)

Le Corbusier: villa Savoye

What do we currently spend on health?

２ . BETTER INTERNATIONAL MEASURES OF INPUTS

 

 

 

SHA Accounting Framework

Service Provision

HealthFinancing

Healthcare Consumption

What types of health goods and services are

consumed?

Who pays?

Who provides the

service?

Source: Adapted from IHAT for SHA 2011

Three dimensions of health accounting

SHA 2011: What is new and improved?

• Refined boundary setting• Continuity facilitated:

– Functions, Providers, Financing

• New health care classifications:– Factors of provision– Financing revenues

• Introduction of capital classification– Separate reporting for

current and capital

• Consistent labelling and categories introduced:– Link to intl. standards -

SNA 2008, provider classifications (e.g. ISIC)

– Larger compatibility between functions of care and providers

– Closer correspondence to financing “functions” of revenue raising, pooling and purchasing

A need to clarify the boundaries of LTC

0

0.5

1

1.5

2

2.5

3

3.5

4

Long Term Care, as a share of GDP, 2009 (or nearest year) LTC (Health) General government LTC (Health) Private sector LTC (Social) General government LTC (Social) Private sector

Different division between health and social care

Restricted boundary of LTC in health

Policy use of internationally comparable dataU

SA

GRE

ECE

CAN

IREL

AN

D

FRA

BEL

DEU

JPN

ITA

ESP

PRT

AUT

AUS

CHE

SVK

SWE

ISL

HU

N

FIN

SVN

LUX

NO

R

KOR

GBR

CZE

DN

K

POL

NZL

EST

MEX

200

400

600

800

In 2007, per capita spending on pharmaceuticals in Greece was second only to the US

USD PPP

3. BETTER INTERNATIONAL MEASURES OF OUTPUTS

Increasing life expectancy, but in good health?

Sweden

Denmark

United Kingdom

Ireland

Netherlands

France

Spain

EU-27

Greece

Italy

Germany

Hungary

Portugal

Japan (2004)

Source: Eurostat Statistics Database; Cabinet White Paper, 2007.

Healthy life years (HLY) at age 65, by gender, 2008-10Females Males

05101520Years

0 5 10 15 20Years

What factors account for increases in life expectancy?

Contributions to changes in life expectancy

  Women MenHealth care spending 1.14 1.34Smoking 0.00 0.12Alcohol 0.06 0.07Diet 0.02 0.02Pollution 0.15 0.29Education 0.50 0.49GDP 0.11 0.63

     Observed changes 2.49 3.45

Cancer

Korea

United Kingdom

OECD

Germany

Finland

Canada

Japan

United States

0 10 20 30 40 50 60 70 80 90 100

Breast cancer five-year relative survival

1995-2000 2004-2009 or nearest period

Age-standardised rate (%)

Care for acute exacerbation of chronic conditions

Japan

Korea

Finland

United States

Sweden

OECD

Australia

0 1 2 3 4 5 6 7 8

Ischemic stroke 30 day in-hospital mortality

2000 2009 (or nearest year)

Age-sex standardised rate (%)

Care for acute exacerbation of chronic conditions

Sweden

Australia

United States

Finland

OECD

Korea

Japan

0 2 4 6 8 10

AMI 30 day in-hospital mortality

2000 2009 (or nearest year)

Age-sex standardised rate (%)

Care for chronic conditions

Australia

Canada

United States

United Kingdom

OECD (24)

Germany

Finland

Korea

0 20 40 60 80 100 120 140

Uncontrolled diabetes admissions, 2009 (or nearest year)

Age-sex-standardised rate per 100 000 population

Patient safety

Germany

Finland

United States

France

OECD (17)

United Kingdom

Canada

0 2 4 6 8 10

Foreign body left in during procedure, 2009 (or nearest year)

Crude Rate per 100,000 patients

4. PRICES AND VOLUME

Where the Japanese health system does MORE than other countries

Japan Rank compared with OECD countries

OECD average

Doctor consultations 13. 1per capita

1st 6.8 per capita

Practising nurses 10.1 per 1000 population

11th 8.7 per 1000 population

Hospital beds 8.1 per 1000 population

1st 3.4 per 1000 population

MRI units 43.1 per million population

1st 12.5 per million population

CT scanners 97.3 per million population

1st 22.8 per million population

Source: OECD Health Data 2012.

Widespread availability of medical technology

0

20

40

60

80

100

120

Per million population CT scanners

0

10

20

30

40

50

Per million population MRI machines

Source: OECD Health Data 2012.

Where the Japanese health system does LESS than other countries

Japan Rank compared with OECD countries

OECD average

Practising physicians 2.2 per 1000 population

29th 3.1 per 1000 population

Hospital discharges 107.1 per 1000 population

28th 151.6per 1000 population

Source: OECD Health Data 2012.

Irelan

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United

Sta

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Norway

Spain

Austra

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Austri

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Denm

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Nethe

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Belgium

Sweden

Canad

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Germ

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OECD (mea

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Finlan

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United

King

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Isra

el

Sloven

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Eston

ia

Czech

Rep

ublic

Poland

Slovak

Rep

ublic

Hunga

ry0

50

100

150

200

250

208 205197

185

172

148 147 145 141135

130 126119 116

108 105 104 100 10093

83 79

4438

32 3024

Comparative hospital price level, 2009

Per capita volumes of hospital services, 2009

Den

mar

k

Sw

eden

Uni

ted

Kin

gdom

Nor

way

Net

herla

nds

Uni

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Sta

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Fin

land

Aus

tria

Cze

ch R

epub

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Ger

man

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Fra

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Sw

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Hun

gary

Slo

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Rep

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Bel

gium

OE

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(m

ean)

Aus

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Ital

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Slo

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Luxe

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urg

Can

ada

Est

onia

Pol

and

Irel

and

Isra

el

Por

tuga

l

Spa

in

0

500

1000

1500

2000

2500

3000

3500

4000

3332

2705

2684

2667

2584

2531

2510

2462

2423

2359

2353

2336

2248

2239

2136

2110

2046

1996

1939

1933

1777

1620

1532

1524

1512

1420

1394

USD Hospital PPP

Service levels were maintained in Ireland…

Key Metrics 2006 2007 2008 2009 2010Patients treated as inpatients (% change over previous year)

2.3 3.9 -2.0 -1.2 -0.7

Patients treated as day cases (% change)

9.2 4.8 9.6 4.4 8.2

Attendances as out patients (% change)

7.5 10.7 5.9 2.5 6.0

Health expenditure 2006 2007 2008 2009 2010

Gross current expenditure (% change)

9.1 10 10.7 1.6 -4.1

Gross pay (% change) 8.1 6.7 5.7 2.1 -6.6

…while growth in health prices continued in the United States

Source: Martin et at, Health Affairs (2012)

Factors Accounting For Growth In Personal Health Care Spending, Selected Periods 2000–10.

THANK YOU FOR LISTENING

http://www.oecd.org/health/healthdata