THE
COMMONWEALTH
FUND
Multinational Comparisons
of Health Systems Data, 2012
David Squires
The Commonwealth Fund
November 2012
2
Health Care Spending and Coverage
THE
COMMONWEALTH
FUND
3
Average Health Care Spending per Capita, 1980–2010
Adjusted for Differences in Cost of Living
Dollars ($US)
9000
US ($8,233)
NOR ($5,388)
8000
SWIZ ($5,270)
7000
NETH ($5,056)
DEN ($4,464)
6000
CAN ($4,445)
GER ($4,338)
5000
FR ($3,974)
4000
SWE ($3,758)
AUS ($3,670)*
3000
UK ($3,433)
JPN ($3,035)*
2000
NZ ($3,022)
1000
0
1980
1984
* 2009
Source: OECD Health Data 2012.
1988
1992
1996
2000
2004
2008
THE
COMMONWEALTH
FUND
4
Health Care Spending as a Percentage of GDP, 1980–2010
Percent
18
US (17.6%)
NETH (12.0%)
16
FR (11.6%)
14
GER (11.6%)
CAN (11.4%)
12
SWIZ (11.4%)
DEN (11.1%)
10
NZ (10.1%)
8
SWE (9.6%)
UK (9.6%)
6
JPN (9.5%)*
NOR (9.4%)
4
AUS (9.1%)*
2
0
1980
1984
1988
* 2009
GDP refers to gross domestic product.
Source: OECD Health Data 2012.
1992
1996
2000
2004
2008
THE
COMMONWEALTH
FUND
5
Health Care Spending per Capita by Source of Funding, 2010
Adjusted for Differences in Cost of Living
Dollars ($US)
9,000
8,233
8,000
Out-of-pocket spending
970
Private spending
7,000
Public spending
6,000
3,296
5,269
5,000
1,325
4,000
508
4,463
4,445
4,338
589
631
571
436
75
656
3,974
290
623
3,000
2,000
3,758
80
632
3,670 3,433
682
474
3,967
3,437
3,800
3,158
3,331
3,061
3,046
FR
SWE
1,000
306
270
3,035
106
2,515
2,857
AUS*
UK
3,022
485 190 317
2,443
2,515
JPN*
NZ
0
US
SWIZ
DEN
* 2009.
Source: OECD Health Data 2012.
CAN
GER
THE
COMMONWEALTH
FUND
6
Pharmaceutical Spending per Capita, 2010
Adjusted for Differences in Cost of Living
Dollars ($US)
1,000
983
900
800
741
700
640
634
630
600
541
500
510
508
481
474
395
400
369
331
300
285
200
100
0
US
CAN
GER
* 2009.
** 2008.
Source: OECD Health Data 2012.
FR
JPN*
AUS*
SWIZ OECD NETH
Median
SWE
NOR
UK**
DEN
NZ
THE
COMMONWEALTH
FUND
7
Health Care Supply and Utilization
THE
COMMONWEALTH
FUND
8
Hospital Discharges per 1,000 Population, 2010
300
250
240
200
175
172
169
169
163
155
155
150
147
136
131
116
100
107
83
50
0
GER
NOR
DEN
* 2009.
** 2008.
Source: OECD Health Data 2012.
SWIZ
FR
SWE
AUS* OECD
Median
NZ
UK
US*
NETH* JPN** CAN*
THE
COMMONWEALTH
FUND
Average Length of Hospital Stay for Acute Myocardial Infarction, 2010
9
Days
12
10.6
10
8.2
8
7.9
7.8
7.0
6.5
6.2
6
6.0
5.6
5.0
4.7
4
4.0
3.9
NOR
DEN
2
0
GER
NZ
SWIZ
* 2009.
Source: OECD Health Data 2012.
UK
OECD NETH*
Median
FR
CAN*
AUS*
US*
SWE
THE
COMMONWEALTH
FUND
Inpatient Coronary Bypass Procedures per 100,000 Population, 2010
10
125
116
100
79
74
75
62
50
61
58
56
43
43
42
37
30
28
SWIZ
FR
25
0
GER
US*
DEN
* 2009.
Source: OECD Health Data 2012.
NOR* CAN* NETH* AUS* OECD SWE
Median
NZ
UK
THE
COMMONWEALTH
FUND
11
Average Annual Number of Physician Visits per Capita, 2010
14
13.1
12
10
8.9
8
6.7
6.6
6.5
6.3
5.5
6
5.2
5.0
4.6
3.9
4
2.9
2.9
NZ
SWE
2
0
JPN*
GER
FR
* 2009.
** 2008.
Source: OECD Health Data 2012.
NETH
AUS
OECD CAN*
Median
NOR*
UK*
DEN
US**
THE
COMMONWEALTH
FUND
12
Number of Practicing Physicians per 1,000 Population, 2010
5
4.1
3.8
4
3.8
3.7
3.5
3.1
3.1
3
2.7
2.6
2.4
2.2
2
1
0
NOR
SWIZ
SWE*
* 2009.
Source: OECD Health Data 2012.
GER
DEN*
AUS*
OECD
Median
UK
NZ
US
JPN
THE
COMMONWEALTH
FUND
13
Number of Acute Care Hospital Beds per 1,000 Population, 2010
10
8.1
8
5.7
6
4
3.5
3.4
3.1
3.1
3.0
2.9
2.6
2.4
2.4
2
2.0
1.7
0
JPN
GER
FR
* 2009.
** 2008.
Source: OECD Health Data 2012.
AUS** SWIZ OECD NETH
Median
DEN
US*
NOR
UK
SWE
CAN*
THE
COMMONWEALTH
FUND
Magnetic Resonance Imaging (MRI) Units per Million Population, 2010
14
50
43.1
40
31.6
30
20
15.4
12.2
10.5
10
9.5
8.2
7.0
5.9
5.6
FR
UK
AUS
0
JPN**
US
* 2009.
** 2008.
Source: OECD Health Data 2012.
DEN*
NETH
NZ
OECD
Median
CAN
THE
COMMONWEALTH
FUND
Computed Tomography (CT) Scanners per Million Population, 2010
100
15
97.3
80
60
42.8
40
34.3
32.6
27.6
20
15.6
15.6
14.2
12.3
11.8
NETH
FR
8.2
0
JPN**
AUS
US***
** 2008.
*** 2007.
Source: OECD Health Data 2012.
SWIZ
DEN
OECD
Median
NZ
CAN
UK
THE
COMMONWEALTH
FUND
16
Positron Emission Tomography (PET) Scanners
per Million Population, 2010
6
5.6
4.8
5
4.2
4
3.7
3.2
3
2
1.4
1.2
1.2
1.2
CAN
OECD
Median
NZ
1
0.9
0
DEN*
NETH
* 2009.
** 2008.
Source: OECD Health Data 2012.
US**
JPN**
SWIZ
AUS
FR
THE
COMMONWEALTH
FUND
17
Health Promotion and Disease Prevention
THE
COMMONWEALTH
FUND
18
Cervical Cancer Screening Rates, 2010
Percent of women screened
100
85.0
78.7
80
78.5
78.5
75.3
75.2
71.1
66.3
65.7
58.2
60
37.7
40
20
0
US
GER*
NOR*
UK
CAN**
NZ
FR
DEN*
NETH
AUS*
Note: Norway, UK, NZ, Denmark, and Australia based on program data; all other countries based on survey data.
* 2009.
** 2008.
Source: OECD Health Data 2012.
JPN
THE
COMMONWEALTH
FUND
19
Flu Immunization Among Adults Ages 65 or Older, 2010
Percent
100
80
74.6
74.0
70.3
66.0
65.8
64.0
63.9
61.1
60
59.4
57.5
53.0
46.0
45.6
SWIZ
DEN
40
20
0
AUS*
NETH*
UK
* 2009.
** 2008.
Source: OECD Health Data 2012.
FR
NZ
SWE**
US
GER**
CAN
OECD
Median
JPN
THE
COMMONWEALTH
FUND
20
Adults Who Report Being Daily Smokers, 2010
Percent
40
30
23.3
21.9
21.5
20
20.9
20.9
20.0
19.5
19.0
16.3
15.1
15.1
AUS
US
14.0
10
0
FR
GER*
UK*
* 2009.
Source: OECD Health Data 2012.
NETH OECD DEN
Median
JPN
NOR
CAN
SWE
THE
COMMONWEALTH
FUND
21
Obesity (BMI>30) Prevalence Among Adult Population, 2010
Percent
40
35.9
Self-reported
Measured
35
30
27.8
26.1
25
24.2
20
14.7
15
13.4
12.9
12.9
11.4
10
10.0
3.5
5
0
US
NZ*
UK
CAN**
GER*
DEN
FR
SWE
NETH
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.
* 2009.
** 2008.
Source: OECD Health Data 2012.
NOR**
JPN
THE
COMMONWEALTH
FUND
22
Quality and Patient Safety
THE
COMMONWEALTH
FUND
23
Mortality Amenable to Health Care
Deaths per 100,000 population*
1997–98
150
2006–07
134
109
99
100
88
89
76
81
116
127
115
106
113
120
97
97
88
50
55
57
60
61
61
FR
AUS
ITA
JPN
SWE
64
66
67
74
76
77
78
79
80
83
FIN
GER
GRE
IRL
NZ
DEN
UK
96
0
NOR NETH AUT
* 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, 2011.
US
THE
COMMONWEALTH
FUND
24
Breast Cancer Five-Year Relative Survival Rate, 2004–2009
(or nearest period)
Percent
100
89.3
87.3
86.6
86.5
86.0
84.5
84.4
83.3
82.0
81.3
NZ
NETH
GER
DEN
UK
80
60
40
20
0
US
JPN
CAN
NOR
SWE
THE
COMMONWEALTH
FUND
Source: OECD Health Data 2011.
25
Diabetes Lower Extremity Amputation Rates
per 100,000 Population, 2009
40
32.9 33.7
30
18.1
20
10
4.8
5.7
7.0
7.4
NZ
SWIZ*
9.9
12.6
12.0
11.0
9.5
9.9
CAN
NOR OECD AUS NETH** FR**
Median
0
UK
SWE
* 2008.
** 2007.
Source: OECD Health Data 2011.
DEN
US*
GER
THE
COMMONWEALTH
FUND
In-Hospital Mortality After Admission for Acute Myocardial Infarction†
per 100 Patients, 2009
26
9.7
10
8
6.8
6
5.2
3.9
4
2.9
2.3
2.5
DEN
NOR SWE**
3.2
3.2
NZ
AUS
4.3
4.5
5.3
4.6
2
0
CAN
US*
SWIZ* OECD
Median
UK
NETH** GER
JPN*
†
In-hospital case-fatality rates within 30 days of admission. Age-sex standardized rates.
* 2008.
** 2007.
Source: OECD Health Care Data 2012.
THE
COMMONWEALTH
FUND
27
Foreign Object Left in Body During Procedure
per 100,000 Hospital Discharges, 2009
15
13.8
12
9.8
CAN
AUS
8.7
9
6
3
9.7
4.9
2.6
5.5
5.7
FR
UK
3.4
1.8
0
DEN**
SWE
GER
Note: Age-sex-SDX standardized rates.
* 2008.
** 2010.
Source: OECD Health Care Data 2012.
US*
NZ
SWIZ*
THE
COMMONWEALTH
FUND
28
Postoperative Sepsis per 100,000 Hospital Discharges, 2009
1,500
1,200
1,452
1,455
NZ
AUS
1,077
858
900
754
769
DEN***
CAN
926
541
600
354
300
0
SWIZ*
GER
Note: Age-sex-SDX standardized rates.
* 2008.
** 2007.
*** 2010.
Source: OECD Health Care Data 2012.
FR
SWE
US*
THE
COMMONWEALTH
FUND
29
Prices
THE
COMMONWEALTH
FUND
Drug Prices for 30 Most Commonly Prescribed Drugs, 2006–2007
30
US is set at 1.0
1.0
1.00
0.77
0.8
0.76
0.63
0.6
0.51
0.49
0.45
0.44
0.4
0.34
0.2
0.0
US
CAN
GER
SWIZ
UK
AUS
NETH
FR
NZ
THE
COMMONWEALTH
FUND
Source: IMS Health; analysis by Gerard Anderson, Johns Hopkins University.
31
Diagnostic Imaging Prices, 2011
MRI scanning and imaging fees
$1,200
CT scanning and imaging fees (head)
$600
$1,080
$510
$500
$1,000
$903
$400
$800
$319
$599
$600
$300
$272
$200
$400
$141
$281
$200
$100
$0
$0
US
Commercial
Average
SWIZ
GER
FR
US
Commercial
Average
Note: MRI refers to magnetic resonance imaging; CT refers to computed tomography.
Source: International Federation of Health Plans, 2011 Comparative Price Report.
SWIZ
GER
FR
THE
COMMONWEALTH
FUND
32
Hospital Spending per Discharge, 2010
Adjusted for Differences in Cost of Living
Dollars
20,000
19,319
18,000
16,000
14,896
14,000
13,134
12,650
11,295 11,219 11,021
12,000
9,990
10,000
9,531
8,049 7,856
8,000
6,000
7,180
5,192
4,000
2,000
0
US*
CAN* NETH* JPN**
* 2009.
** 2008.
Source: OECD Health Data 2012.
DEN
SWIZ NOR*
SWE
AUS*
FR
NZ
OECD GER
Median
THE
COMMONWEALTH
FUND
33
Physician Fee for Hip Replacement, 2008
Adjusted for Differences in Cost of Living
Dollars
Private payers
Public payers
$1,800
$4,200
$1,634
$3,996
$1,600
$3,600
$1,400
$1,251
$1,200
$3,000
$1,181
$1,046
$2,400
$1,000
$2,160
$1,943
$800
$674
$652
$1,800
$1,340
$600
$1,200
$400
$600
$200
$0
$0
US
GER
UK
AUS
FR
CAN
US
UK
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. 2011 30(9):1647–56.
AUS
FR
THE
COMMONWEALTH
FUND
34
Physician Incomes, 2008
Adjusted for Differences in Cost of Living
Dollars
Orthopedic surgeons
Primary care doctors
500,000
450,000
442,450
400,000
350,000
324,138
300,000
250,000
208,634 202,771
200,000
187,609
186,582
159,532
154,380
150,000
131,809
125,104
95,585 92,844
100,000
50,000
0
US
UK
CAN
GER
AUS
FR
US
UK
GER
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. 2011 30(9):1647–56.
CAN
FR
AUS
THE
COMMONWEALTH
FUND