THE
COMMONWEALTH
FUND
Multinational Comparisons
of Health Systems Data, 2013
David Squires
The Commonwealth Fund
November 2013
2
Health Care Spending and Coverage
THE
COMMONWEALTH
FUND
3
Average Health Care Spending per Capita, 1980–2011
Adjusted for Differences in Cost of Living
Dollars ($US)
9000
US ($8,508)
NOR ($5,669)
8000
SWIZ ($5,643)
7000
NETH ($5,099)
CAN ($4,522)
6000
DEN ($4,495)*
5000
GER ($4,495)
FR ($4,118)
4000
SWE ($3,925)
3000
AUS ($3,800)*
UK ($3,405)
2000
JPN ($3,213)*
1000
NZ ($3,182)
0
1980
1984
1988
* 2010
Source: OECD Health Data 2013.
1992
1996
2000
2004
2008
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COMMONWEALTH
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Health Care Spending as a Percentage of GDP, 1980–2011
Percent
US (17.7%)
18
NETH (11.9%)
16
FR (11.6%)
14
GER (11.3%)
CAN (11.2%)
12
DEN (11.1%)*
10
SWIZ (11.0%)
NZ (10.3%)
8
JPN (9.6%)*
6
SWE (9.5%)
4
UK (9.4%)
NOR (9.3%)
2
AUS (8.9%)*
0
1980
1983
1986
1989
* 2010
GDP refers to gross domestic product.
Source: OECD Health Data 2013.
1992
1995
1998
2001
2004
2007
2010
THE
COMMONWEALTH
FUND
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Health Care Spending per Capita by Source of Funding, 2011
Adjusted for Differences in Cost of Living
Dollars ($US)
9,000
8,508
8,000
987
Out-of-pocket spending
Private spending
7,000
6,000
Public spending
3,454
5,000
5,643
1,455
4,000
4,522
4,495
4,495
666
593
593
527
75
465
672
4,118
307
650
3,000
2,000
3,925
635
86
3,800
490
4,066
3,661
3,827
3,183
3,436
3,161
3,204
FR
SWE
1,000
3,405
733
246
338
3,213
111
464
3,182
203
348
2,578
2,821
2,638
2,631
AUS*
UK
JPN*
NZ
0
US
SWIZ
CAN
* 2010.
Source: OECD Health Data 2013.
DEN*
GER
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COMMONWEALTH
FUND
6
Pharmaceutical Spending per Capita, 2011
Adjusted for Differences in Cost of Living
Dollars ($US)
1,000
995
900
800
752
700
652
641
633
600
587
531
500
487
479
474
388
400
300
300
298
DEN
NZ
200
100
0
US
CAN
JPN*
* 2010.
Source: OECD Health Data 2013.
FR
GER
AUS*
SWIZ
OECD NETH
Median
SWE
NOR
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COMMONWEALTH
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Health Care Supply and Utilization
THE
COMMONWEALTH
FUND
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Hospital Discharges per 1,000 Population, 2011
300
250
244
200
175
172
170
169
163
159
159
147
150
136
125
122
111
100
82
50
0
GER
NOR* DEN*
* 2010.
Source: OECD Health Data 2013.
SWIZ
FR
SWE* AUS* OECD
Median
NZ
UK
US*
NETH
JPN
CAN*
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COMMONWEALTH
FUND
9
Average Length of Hospital Stay for Acute Care, 2011
Days
12
10
8
7.9
7.7
6.5
6.5
6.4
5.8
6
5.6
5.4
5.1
5.1
5.0
4.5
4
2
0
GER
CAN*
SWIZ
* 2010.
Source: OECD Health Data 2013.
UK
OECD NETH
Median
NZ
US
FR
SWE
AUS*
NOR*
THE
COMMONWEALTH
FUND
10
Average Annual Number of Physician Visits per Capita, 2011
14
13.1
12
9.7
10
8
7.4
6.8
6.7
6.6
6
6.6
5.2
5.0
4.6
4.1
4
3.0
2
0
JPN*
GER
CAN*
* 2010.
** 2009.
Source: OECD Health Data 2013.
FR
AUS
NETH
OECD NOR**
Median
UK**
DEN*
US**
SWE
THE
COMMONWEALTH
FUND
11
Number of Practicing Physicians per 1,000 Population, 2011
5
4
3.9
3.8
3.8
3.7
3.5
3.3
3.2
3.1
2.8
3
2.6
2.5
2.2
2
1
0
SWE*
GER
SWIZ
* 2010.
** 2009.
Source: OECD Health Data 2013.
NOR
DEN**
AUS
OECD
Median
FR
UK
NZ
US
JPN*
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COMMONWEALTH
FUND
12
Number of Acute Care Hospital Beds per 1,000 Population, 2011
10
8
8.0
6
5.3
4
3.4
3.4
3.3
3.0
3.0
2.9
2.6
2.6
2.4
2.4
2
2.0
1.7
0
JPN
GER
FR
AUS*
* 2010.
Source: OECD Health Data 2013.
NETH
SWIZ OECD DEN*
Median
NZ
US*
UK
NOR
SWE
CAN*
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COMMONWEALTH
FUND
13
Inpatient Coronary Bypass Grafts per 100,000 Population, 2011
100
80
79.0
74.0
67.5
61.6
60
58.6
54.4
46.1
45.3
40.9
40
37.4
30.9
28.5
20
0
US**
DEN*
GER NOR** CAN* NETH* SWIZ OECD
Median
* 2010.
** 2009.
Source: OECD Health Data 2013.
NZ
SWE
UK
FR
THE
COMMONWEALTH
FUND
14
Magnetic Resonance Imaging (MRI) Exams per Million Population, 2011
120
102.7
100
95.2
80
67.5
61.5
60
49.9
49.8
40
24.1
20
0
US
GER**
* 2010.
** 2009.
Source: OECD Health Data 2013.
FR
DEN
NETH
CAN
AUS
THE
COMMONWEALTH
FUND
15
Health Promotion and Disease Prevention
THE
COMMONWEALTH
FUND
16
Cervical Cancer Screening Rates, 2011
Percent of women screened
100
85.0
78.7
80
76.2
75.0
71.1
68.5
66.3
64.8
56.8
60
37.7
40
20
0
US*
GER**
NOR
NZ
FR*
UK
DEN**
NETH
Note: NOR, NZ, UK, DEN, and AUS based on program data; all other countries based on survey data.
* 2010.
** 2009.
Source: OECD Health Data 2013.
AUS
JPN*
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COMMONWEALTH
FUND
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Flu Immunization Among Adults Age 65 or Older, 2011
Percent
100
80
74.6
74.0
74.0
66.9
65.5
64.4
60
56.1
55.7
55.2
53.0
46.0
45.6
40
20
14.1
0
AUS** NETH**
UK
* 2010.
** 2009.
Source: OECD Health Data 2013.
US
NZ
CAN
GER** OECD
Median
FR
JPN*
SWIZ*
DEN*
NOR
THE
COMMONWEALTH
FUND
18
Adults Who Report Being Daily Smokers, 2011
Percent
40
30
23.3
21.9
20.8
20
20.1
20.1
20.0
19.6
17.0
15.7
15.1
14.8
13.1
10
0
FR*
GER** NETH
* 2010.
** 2009.
Source: OECD Health Data 2013.
JPN
OECD DEN*
Median
UK*
NOR
CAN
AUS*
US
SWE
THE
COMMONWEALTH
FUND
19
Obesity (BMI>30) Prevalence Among Adult Population, 2011
Percent
40
36.5
Self-reported
Measured
35
30
28.3
27.8
25.4
25
24.8
20
14.7
15
13.4
12.9
11.4
11.0
10
4.1
5
0
US*
AUS
NZ**
CAN*
UK
GER**
DEN*
FR*
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.
* 2010.
** 2009.
Source: OECD Health Data 2013.
SWE
JPN
THE
COMMONWEALTH
FUND
20
Quality and Patient Safety
THE
COMMONWEALTH
FUND
21
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
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22
Breast Cancer Five-Year Relative Survival Rate, 2004–2009
(or nearest period)
Percent
100
89.3
87.3
87.1
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 2013.
23
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*
9.8
12.6
12.0
11.0
9.5
9.8
CAN
NOR OECD AUS NETH** FR**
Median
0
UK
SWE
* 2008.
** 2007.
Source: OECD Health Data 2013.
DEN
US*
GER
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COMMONWEALTH
FUND
In-Hospital Mortality After Admission for Acute Myocardial Infarction†
per 100 Patients, 2009
24
9.7
10
8
6.8
6
5.2
3.9
4
3.2
3.2
2.3
2.5
DEN
NOR SWE** AUS
NZ
2.9
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 Data 2013.
THE
COMMONWEALTH
FUND
25
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 Data 2013.
US*
NZ
SWIZ*
THE
COMMONWEALTH
FUND
26
Prices
THE
COMMONWEALTH
FUND
Retail Price Indexes for Basket of In-Patent Pharmaceuticals, 2010
27
US is set at 100
Price level
100
100
95
88
80
61
60
50
49
CAN
AUS
46
40
20
0
US
GER
SWIZ
FR
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 2013 32(4):753–61.
UK
THE
COMMONWEALTH
FUND
28
Diagnostic Imaging Prices, 2012
MRI scanning and imaging fees
$1,200
$1,121
$1,000
CT scanning and imaging fees (head)
$600
$566
$500
$928
$400
$800
$310
$554
$600
$400
$300
$363
$319 $335
$328
$252
$175 $183
$200
$124
$200
$100
$0
$0
NETH UK
FR
NZ
SWIZ
US
CAN UK
Notes: US refers to the commercial average. MRI refers to magnetic resonance imaging;
CT refers to computed tomography.
Source: International Federation of Health Plans, 2012 Comparative Price Report.
FR NETH NZ SWIZ US
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COMMONWEALTH
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29
Hospital Spending per Discharge, 2011
Adjusted for Differences in Cost of Living
Dollars ($US)
24,000
21,018
20,000
15,433
16,000
13,025
11,968
12,000
11,374 11,306
9,894
9,611
8,478
8,363
8,000
7,842
5,339
4,000
0
US*
CAN*
NETH
* 2010.
Source: OECD Health Data 2013.
SWIZ
DEN*
NOR*
SWE*
AUS*
NZ
FR
OECD GER
Median
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COMMONWEALTH
FUND
30
Physician Fee for Hip Replacement, 2008
Adjusted for Differences in Cost of Living
Private payers
Public payers
Dollars ($US)
Dollars ($US)
$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
$0
US
GER
UK
AUS
FR
CAN
US
UK
Source: M. J. Laugesen and S. A. Glied, “Higher Fees Paid to U.S. Physicians Drive Higher Spending
for Physician Services Compared to Other Countries,” Health Affairs, Sept. 2011 30(9):1647–56.
AUS
FR
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COMMONWEALTH
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31
Physician Incomes, 2008
Adjusted for Differences in Cost of Living
Dollars ($US)
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