Multinational Comparisons
of Health Systems Data, 2009
Gerard F. Anderson and Patricia Markovich
Johns 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.
2
International Comparison of Spending on Health, 1980–2007
Total expenditures on health
as percent of GDP
Average spending on health
per capita ($US PPP)
16
7000
6000
5000
4000
U.S.
Norway
Switzerland
Canada
Netherlands
France
Germany
Sweden
U.K.
Italy
New Zealand
Australia
14
12
10
8
6
2000
4
1000
2
0
0
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
3000
U.S.
France
Switzerland
Germany
Canada
Netherlands
New Zealand
Sweden
Norway
Italy
U.K.
Australia
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
8000
THE
COMMONWEALTH
FUND
Source: OECD Health Data 2009 (June 2009).
3
Average Annual Growth Rate of
Real Health Care Spending per Capita, 1997–2007
Percent
5.0
4.9
4.5
4.2
4.1
4.0
4.0
3.8
3.8
3.7
3.0
2.5
2.4
2.4
2.3
2.0
1.7
1.0
0.0
UK
NZ
NETH
SWE
OECD CAN
Median
* 1996–2006
Source: OECD Health Data 2009 (June 2009).
AUS*
US
FR
ITA
NOR
SWITZ
GER
THE
COMMONWEALTH
FUND
4
Out-of-Pocket Health Care Spending per Capita, 2007
Adjusted for Differences in Cost of Living
Dollars
1,400
1,350
1,200
1,000
890
800
720
580
600
571
542
528
485
470
351
400
343
246
213
200
0
SWITZ
US
NOR
CAN
* 2006
Source: OECD Health Data 2009 (June 2009).
AUS*
ITA
SWE OECD GER
Median
NZ
UK
FR
NETH
THE
COMMONWEALTH
FUND
Health Care Expenditure per Capita by Source of Funding, 2007
5
Adjusted for Differences in Cost of Living
Dollars
8,000
7,000
Out-of-pocket spending
890
Private spending
Public spending
6,000
5,000
3,092
720
38
4,000
1,350
3,000
449
580
589
246
510
470
360
528
79
571
441
2,000
343
204
542
88
4,005
3,307
2,618
2,726
2,844
2,758
2,716
2,124
1,000
2,446
2,056
0
US
NOR
SWITZ
* 2006
Source: OECD Health Data 2009 (June 2009).
CAN
FR
GER
SWE
AUS*
UK
ITA
THE
COMMONWEALTH
FUND
6
Hospital Spending per Discharge, 2007
Adjusted for Differences in Cost of Living
Dollars
18,000
17,206
16,000
14,000
12,163
12,000
11,988
10,000
9,398
9,131
9,026
8,000
7,312
7,312
7,295
6,000
4,667
4,527
FR
GER
4,000
2,000
0
US*
CAN*
NETH
SWITZ
* 2006
Source: OECD Health Data 2009 (June 2009).
NOR*
SWE
NZ
OECD
Median
AUS*
THE
COMMONWEALTH
FUND
7
Hospital Discharges per 1,000 Population, 2007
300
274
250
227
200
172
166
165
163
162
150
139
135
126
126
109
100
84
50
0
FR
GER
NOR
SWITZ
* 2006
Source: OECD Health Data 2009 (June 2009).
SWE
OECD AUS*
Median
ITA*
NZ
US*
UK
NETH
CAN*
THE
COMMONWEALTH
FUND
Average Length of Hospital Stay for Acute Myocardial Infarction, 2007
8
Days
12
11.0
10
8.9
8.0
7.9
8
7.1
7.1
6.8
6.4
6.2
6
5.4
4.8
4.6
SWE
NOR
4
2
0
GER
UK
ITA*
SWITZ
* 2006
Source: OECD Health Data 2009 (June 2009).
NETH
OECD
Median
CAN*
FR
AUS*
US*
THE
COMMONWEALTH
FUND
9
Average Annual Number of Physician Visits per Capita, 2007
8
7.5
7.0
7
6.3
6.3
6.3
5.8
6
5.7
5.0
4.7
5
4.0
4
3.8
2.8
3
2
1
0
GER
ITA**
AUS
FR
* 2006
** 2005
Source: OECD Health Data 2009 (June 2009).
OECD
Median
CAN*
NETH
UK
NZ
SWITZ
US*
SWE*
THE
COMMONWEALTH
FUND
10
Number of Practicing Physicians per 1,000 Population, 2007
4
3.9
3.9
3.9
3.7
3.6
3.5
3.4
3.2
3
2.8
2.5
2.4
2.3
2.2
2
1
0
NETH
NOR
SWITZ
ITA
SWE*
* 2006
Source: OECD Health Data 2009 (June 2009).
GER
FR
OECD
Median
AUS*
UK
US
NZ
CAN
THE
COMMONWEALTH
FUND
11
Pharmaceutical Spending per Capita, 2007
Adjusted for Differences in Cost of Living
Dollars
900
$878
800
$691
700
$588
600
$542
$518
500
$454
$446
$446
$431
$422
$381
400
300
$241
200
100
0
US
CAN
FR
GER
* 2006
Source: OECD Health Data 2009 (June 2009).
ITA
SWITZ
SWE
OECD
Median
AUS*
NETH
NOR
NZ
THE
COMMONWEALTH
FUND
12
Drug Prices for 30 Most Commonly Prescribed Drugs, 2006–07
US is set at 1.0
1.00
1.0
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
SWITZ
UK
AUS
NETH
FR
NZ
THE
COMMONWEALTH
FUND
Source: IMS Health.
13
Drug Prices for 30 Most Commonly Prescribed Drugs, 2006–07,
Brand-Name and Generic
US is set at 1.0
AUS
CAN
FR
GER
NETH
NZ
SWITZ
UK
US
Brand-Name
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
THE
COMMONWEALTH
FUND
Source: IMS Health.
14
Drug Prices: Lipitor (atorvastatin), 2006–07
Price for one dose
Dollars
$3
$2.82
$2
$1.83
$1.52
$1.46
$1.45
$1.45
$1.35
$1.01
$1
$0.71
$0
US
CAN
SWITZ
AUS
UK
NETH
GER
FR
NZ
THE
COMMONWEALTH
FUND
Source: IMS Health.
15
Drug Prices: Nexium (esomeprazole), 2006–07
Price for one dose
Dollars
$4
$3.91
$3
$2.15
$1.97
$2
$1.32
$1.28
$1.22
$1.02
$1
$0.88
$0
US
SWITZ
CAN
UK
NETH
FR
AUS
GER
THE
COMMONWEALTH
FUND
Source: IMS Health.
16
Magnetic Resonance Imaging (MRI) Machines
per Million Population, 2007
30
25.9
20
18.6
14.4
10
8.8
8.5
8.2
8.2
6.7
6.6
5.7
5.1
0
US
ITA
SWITZ
NZ
** 2005
Source: OECD Health Data 2009 (June 2009).
OECD
Median
GER
UK
CAN
NETH**
FR
AUS
THE
COMMONWEALTH
FUND
17
MRI Scan and Imaging Fees, 2009
Dollars
1,400
1,200
1,200
1,000
839
824
800
567
600
436
400
179
200
0
US
GER
CAN
NETH
FR
UK
THE
COMMONWEALTH
FUND
Source: International Federation of Health Plans, 2009 Comparative Price Report.
18
Volume of Knee and Hip Implants, 2004
Implants per 100,000
Knee Replacements
Hip Replacements
300
200
258
164
150
250
208
137
121
95
100
197
200
150
65
141
139
ITA
US
100
50
50
0
0
US
UK
GER
FR
ITA
GER
FR
UK
THE
COMMONWEALTH
FUND
Source: McKinsey & Company, Accounting for the Cost of Health Care in the United States, 2007.
19
Cost of Knee and Hip Prostheses to Providers, 2004
GDP Adjusted, US $
Dollars
Knee Replacements
Hip Replacements
6,000
5,000
4,866
$4,821
4,000
3,035
3,000
2,561
2,390
2,239
2,000
$1,537
$1,380
$1,168
$1,165
GER
FR
1,000
0
US
ITA
FR
UK
GER
US
ITA
UK
THE
COMMONWEALTH
FUND
Source: McKinsey & Company, Accounting for the Cost of Health Care in the United States, 2007.
20
Coronary Bypass Procedures per 100,000 Population, 2007
150
132
125
100
85
81
77
76
75
73
73
59
58
56
45
50
32
31
FR
SWITZ
25
0
GER
US*
NOR*
NZ
* 2006
Source: OECD Health Data 2009 (June 2009).
AUS*
ITA*
CAN*
OECD NETH
Median
SWE
UK
THE
COMMONWEALTH
FUND
21
Percentage of Population over Age 65
with Influenza Immunization, 2007
Percent
80
77.5
77.0
73.5
69.0
70
66.7
64.9
64.3
63.7
58.9
60
56.0
56.0
GER
SWITZ
50
40
30
20
10
0
a
AUS*
NETH
UK
FR
* 2006
Source: OECD Health Data 2009 (June 2009).
US
ITA
CAN
NZ
OECD
Median
THE
COMMONWEALTH
FUND
22
Percentage of Adults Who Report Being Daily Smokers, 2007
Percent
30
29
25
25
23
22
22
22
21
20
20
18
18
17
15
15
15
10
5
0
NETH
FR*
GER**
ITA
OECD NOR
Median
* 2006
** 2005
Source: OECD Health Data 2009 (June 2009).
UK
SWITZ
CAN
NZ
AUS
US
SWE*
THE
COMMONWEALTH
FUND
23
Obesity (BMI>30) Prevalence Among Adult Population, 2007
Percent
35
34.3
30
26.5
24.0
25
20
15.4
15
13.6
11.2
10.5
10.2
9.9
10
9.0
8.1
5
0
US*
NZ
UK
CAN
GER**
NETH
FR*
SWE
ITA
NOR
SWITZ
* 2006
** 2005
Note: BMI = body mass index. 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).
THE
COMMONWEALTH
FUND
24
Life Expectancy at Birth, 2007
Years
Female
90
80
84.4
84.2
77.5
84.0
79.2
Male
83.7
83.0
82.9
83.0
82.4
82.2
82.3
82.3
81.1
80.7
79.0
78.9
78.4
78.4
78.2
78.2
78.0
77.2
77.2
77.1
75.4
70
60
50
40
30
20
10
0
FR
SWITZ*
ITA*
AUS
CAN*
* 2006
** 2005
Source: OECD Health Data 2009 (June 2009).
SWE
NOR*
GER*
NETH
OECD
Median
NZ
UK**
US*
THE
COMMONWEALTH
FUND
25
Potential Years of Life Lost Because of Diabetes
per 100,000 Population, 2007
100
99
80
64
60
37
40
36
36
35
33
31
29
25
19
20
0
US**
NZ**
NOR*
SWE*
* 2006
** 2005
Source: OECD Health Data 2009 (June 2009).
OECD
Median
GER*
NETH
ITA*
FR*
UK
SWITZ*
THE
COMMONWEALTH
FUND
26
Mortality Amenable to Health Care
Deaths per 100,000 population*
1997–98
150
2002–03
130
116
109
99
Canada
101
103
103
104
110
United States
Italy
New Zealand
Spain
Finland
Australia
Germany
Japan
Austria
74
90
Greece
74
84
Sweden
71
82
Netherlands
71
82
93
80
84
96
Norway
65
77
France
50
Portugal
84
88
Ireland
88
97
97
89
115
113
106
United Kingdom
76
81
89
128
Denmark
100
115
134
0
* Countries’ age-standardized death rates before age 75; includes ischemic heart disease, diabetes,
stroke, and bacterial infections.
Data: E. Nolte and C. M. McKee, “Measuring the Health of Nations: Updating an Earlier Analysis,”
Health Affairs, Jan./Feb. 2008 27(1):58–71.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008.
THE
COMMONWEALTH
FUND