Roosa Tikkanen
The Commonwealth Fund
Multinational Comparisonsof Health Systems Data, 2017
Health Care Spending
3
Current expenditures on health per capita, adjusted for current US$ purchasing power parities (PPPs). Based on
System of Health Accounts methodology, with some differences between country methodologies (Dutch and Swiss data
excludes spending on capital formation of health care providers; Data for Australia uses narrower definition for long-
term care spending than other countries).
Source: OECD Health Data 2017.
HEALTH CARE SPENDING
Health Care Spending per Capita, 2000–2016Adjusted for Differences in Cost of Living
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
10,000
11,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
US ($9,892)
SWIZ ($7,919)
NOR ($6,647)
GER ($5,551)
SWE ($5,488)
NETH ($5,385)
AUS ($4,708)
CAN ($4,644)
FRA ($4,600)
UK ($4,192)
NZ ($3,590)
Dollars ($US)
4
* Data from 2014 in Australia, and 2013 for New Zealand. Current expenditures on health, adjusted for US$ purchasing
power parities (PPPs). Numbers may not sum to total health care spending per capita due to excluding capital
formation of health care providers, and some uncategorized health care spending. ^ Spending by government and
compulsory schemes, including private insurance schemes.
Source: OECD Health Data 2017.
HEALTH CARE SPENDING
Health Care Spending per Capita by Source of Funding, 2015*Adjusted for Differences in Cost of Living
2848 3024 3286 3575 31814406 4521 4275
5286 4821 4692
267630 229
647688
60 161 373
20 579
3761
430
839610 308 664
800 671 649
883
2136
1054
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
10,000
NZ AUS UK FRA CAN SWE GER NETH NOR SWIZ US
Out-of-pocket spending Private, voluntary spending Public spending^
Dollars ($US)
5
Note: Growth rates for Norway calculated using the GDP Deflator for Mainland Norway.
Source: OECD Health Data 2017,
HEALTH CARE SPENDING
Annual Growth Rate of Real Health Care Spending per Capita, 2015-2016Adjusted for Differences in Cost of Living
0.08 0.09 0.21
0.34
1.00
1.47
2.32
2.56 2.70 2.73
3.45
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
UK NETH FR NZ CAN NOR GER AUS US SWE SWIZ
Percent (%)
OECD
MEDIAN
6
* Or nearest year; data from 2014 for Australia and Canada, 2012 for the Netherlands, 2010 for the US. No recent data
for New Zealand (since 2007). Data calculated as: (Current expenditures on hospitals in current prices, current PPPs /
Number of discharges).
Source: OECD Health Data 2017.
HEALTH CARE SPENDING
Hospital Spending per Discharge, 2015*Adjusted for Differences in Cost of Living
6,122
10,874 11,149
13,201 13,43314,375 14,905 15,483
16,244
21,186
0
5,000
10,000
15,000
20,000
25,000
GER AUS FR SWE UK NETH NOR SWIZ CAN US
Dollars ($US)
OECD
MEDIAN
7
Notes: US refers to the commercial average. Data on non-US fees come from both government sources and data files
of IFHP member plans.
Source: International Federation of Health Plans (IFHP), 2015 Comparative Price Report.
HEALTH CARE SPENDING
Total Hospital and Physician Costs, 2015Adjusted for Differences in Cost of Living
$14,579
$24,059$28,888
$32,480
$34,224
$78,318
$0
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
$80,000
$90,000
SPA UK AUS NZ SWIZ US
Bypass Surgery
$2,003
$3,814
$6,040$6,199
$8,009
$15,930
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
$16,000
$18,000
$20,000
SPA AUS SWIZ NZ UK US
Appendectomy
Dollars ($US) Dollars ($US)
8
* Or nearest year; data from 2014 for Canada and Australia. No recent data available for New Zealand (since 2007).
Current expenditures on pharmaceuticals (prescribed and over-the-counter medicines) and other medical non-durables, per capita,
adjusted for current US$ PPPs), representing retail spending of pharmaceuticals delivered outside provider settings.
Source: OECD Health Data 2017.
HEALTH CARE SPENDING
Pharmaceutical Spending per Capita, 2015*Adjusted for Differences in Cost of Living
417474 497 519
617668
766 786
1,056
1,162
0
100
200
300
400
500
600
700
800
900
1,000
1,100
1,200
NETH NOR UK SWE AUS FR GER CAN SWIZ US
Dollars ($US)
OECD
MEDIAN
9
* Or nearest year; data from 2014 for Australia and Canada. No recent data for New Zealand (since 2007). Data reflect
current spending on governance and health system and financing administration, in current prices, current PPPs.
Source: OECD Health Data 2017.
HEALTH CARE SPENDING
Spending on Health Insurance Administration per Capita, 2015*Adjusted for Differences in Cost of Living
3489 90
123 141
206255 272 286
787
0
100
200
300
400
500
600
700
800
900
NOR SWE UK AUS CAN NETH GER FR SWIZ US
Dollars ($US)
OECD
MEDIAN
10
Source: E.H. Bradley, L.A. Taylor, H.V. Fineberg, The American Health Care Paradox: Why Spending
More is Getting Us Less, Public Affairs, 2013.
HEALTH CARE SPENDING
Health vs Social Care Spending, % GDPAdjusted for Differences in Cost of Living
12% 12% 11% 12%16%
9% 8% 9% 10% 9%
21% 21%
18% 15%9%
16%15% 11% 10%
11%
0%
5%
10%
15%
20%
25%
30%
35%
40%
FR SWE GER NETH US NOR UK NZ CAN AUS
Health care Social care
Percent (%)
Health Care Resource Supply & Workforce
12
Data reflect head counts per 1,000 population. Data for physicians represent practicing physicians except for Canada,
France, Netherlands and Switzerland (Professionally Active Physicians). Data for nurses reflect practicing nurses except
for France, Netherlands and US (Professionally Active Nurses). *2014 data; ** 2013 data.
Source: OCED Health Data 2017
HEALTH CARE RESOURCE SUPPLY & WORKFORCE
Doctors and Nurses, 2000-2015
0
2
4
6
8
10
12
14
16
18
20
2000 2005 2010 2015
SWIZ (18.0)
NOR (17.3)
GER (13.3)
NETH(12.2**)
AUS (11.5)
US (11.3)
SWE (11.1*)
NZ (10.3)
FR (9.9)
CAN (9.9)
UK (7.9)0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
2000 2005 2010 2015
NOR (4.4)
SWIZ (4.3)
GER (4.1)
SWE (4.2*)
AUS (3.5)
FR (3.3)
NETH(3.3**)
NZ (3.0)
UK (2.8)
CAN (2.7)
US (2.6*)
Physicians NursesPer 1,000 population Per 1,000 population
13
Total hospital beds per 1,000 population. *2014 data; **2013 data.
Source: OCED Health Data 2017
HEALTH CARE RESOURCE SUPPLY & WORKFORCE
Hospital Beds, 2000-2015Per 1,000 population
0
1
2
3
4
5
6
7
8
9
10
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
GER (8.1)
FRA (6.1)
SWIZ (4.6)
NETH (4.2**)
NOR (3.8)
AUS (3.8*)
US (2.8*)
NZ (2.7)
CAN (2.6)
UK (2.6)
SWE (2.4)
Beds per 1,000
Health Utilization
15
* Or nearest year; 2014 for France; 2012 for Switzerland and New Zealand; 2011 for United States. No recent data for
the UK (since 2009). Data reflect consultations delivered in all settings, including in the patient’s home, but excluding
telephone and email contacts.
Source: OECD Health Data 2017.
HEALTH UTILIZATION
Doctor Consultations per Capita, 2015*
2.9
3.7 3.9 4.04.3
6.3
7.47.7
8.2
10.0
0
2
4
6
8
10
12
SWE NZ SWIZ US NOR FR AUS CAN NETH GER
OECD
MEDIAN
Consultations/capita
16
* Or nearest year; data from 2014 for New Zealand; 2012 for Netherlands; and 2010 for the US. No recent data for
Australia (since 1999).
Source: OECD Health Data 2017.
HEALTH UTILIZATION
Hip Replacements, 2015*Inpatient cases
148161
182
204
228 233 240 244
299 308
0
50
100
150
200
250
300
350
CAN NZ UK US NETH SWE FR NOR GER SWIZ
Surgical procedures per 100,000 population
OECD
MEDIAN
17
*2014 data; **2012 data; ***2010 data. Length of inpatient stays reflect all hospitals, except for Canada and the
Netherlands, data for which reflect curative care average length of stay (excluding rehabilitative care, long-term care
and palliative care). Discharges reflect total number for all causes.
Source: OECD Health Data 2017.
HEALTH UTILIZATION
Hospital length of stay and discharges, 2000-2015*
0
50
100
150
200
250
300
2000 2005 2010 2015
GER (255)
AUS (174*)
SWIZ (170)
NOR (168)
FR (163)
SWE (153)
NZ (150*)
UK (128)
US (126***)
NETH (119**)
CAN (84)
Discharges
0
2
4
6
8
10
12
14
2000 2005 2010 2015
FRA(10.1*)
GER (9.0)
SWIZ (8.4)
CAN (7.4)
UK (7.0)
NZ (6.8*)
NOR (6.7)
NETH(6.2)
US (6.1*)
SWE (5.9)
AUS (5.5*)
Average Length of Inpatient Stay
Days Per 1,000
Prevention and Population Health
19
^ Or nearest year: * 2014 data; ** 2013 data; *** 2012 data. (M) Measured; (SR) Self-reported.
Source: OECD Health Data 2017.
PREVENTION AND POPULATION HEALTH
Select population health indicators, 2015^Life expectancy at birthYears
Infant mortality Deaths per 1,000 live births
Obesity rate Percent (%) SM, self-reported; M, measured
Daily smokers Percent (%) of population over 15 years
Australia 82.5 3.2 27.9 (M)* 13**
Canada 81.7 ** 4.8 *** 25.8 (M) ** 14*
France 82.4 3.7 15.3 (SR) * 22.4*
Germany 80.7 3.3 23.6 (M) *** 20.9**
Netherlands 81.6 3.3 12.8 (SR) 19
New Zealand 81.7 5.0 ** 30.7 (M) 15
Norway 82.4 2.3 12.0 (SR) 13
Sweden 82.3 2.5 12.3 (SR) 11.2
Switzerland 83 3.9 10.3 (SR) *** 20.4***
United Kingdom 81 3.9 26.9 (M) 19*
United States 78.8 5.8 * 38.2 (M) * 11.4*
OECD average 80.6 3.9 19.1 (M/SR) 18.9
20
* Or nearest year; 2014 data for Netherlands, Germany; 2012 data for Switzerland; 2011 data for Canada.
^ OECD median based on program data.
Note: US, Switzerland, based on survey data; all other countries based on program data. No data for Sweden.
Source: OECD Health Data 2017.
PREVENTION AND POPULATION HEALTH
Breast Cancer Screening Rates, 2015*Among women 50-69 years
80 7975 75
72
55 54 5249 47
0
20
40
60
80
100
US NETH NOR UK NZ AUS GER FR CAN SWIZ
Percent (%) screened
OECD MEDIAN ^
21
Data reflect influenza immunizations. * Or nearest year; 2010 data for Switzerland. No recent data for Australia (since
2009). Change in methodology for Germany between 2012-2013; data for 60+ for Germany. For Sweden, data are
collected only during the winter season. Change in survey in the Netherlands in 2010. Change in survey instrument for
Canada in 2015.
Source: OECD Health Data 2017.
PREVENTION AND POPULATION HEALTH
Flu Immunizations, 2005 and 2015*Among older adults aged 65 or older
59
44
61
77
34
71
79
49
61
51
71 69 67 6762
51 4946
37
27
0
20
40
60
80
100
UK US NZ NETH CAN FR SWE SWIZ GER NOR
2005 2015
Percent (%) immunized
22
* Or nearest year; data from 2013 for Switzerland, France, UK; 2012 for Canada, New Zealand. Data reflect deaths
caused by neoplasms. All countries (except Denmark) use ICD 9 in 1994 and ICD10 for 2014.
Source: OECD Health Data 2017.
PREVENTION AND POPULATION HEALTH
Mortality as a result of cancer, 1994 and 2014*
244 249
213
250 244252
264253
267 272 279
182192 193 193
203 205 207 212 215227
238
0
50
100
150
200
250
300
SWIZ AUS SWE US NOR FR GER CAN NZ UK NETH
1994 2014
Deaths per 100,000 population
23
* Or nearest year; data from 2013 for Switzerland, France, UK; 2012 for Canada, New Zealand. Data reflect deaths
caused by all types of ischemic heart diseases including acute myocardial infarction. All countries (except Denmark)
use ICD 9 in 1994 and ICD10 for 2014.
Source: OECD Health Data 2017.
PREVENTION AND POPULATION HEALTH
Mortality as a result of ischemic heart disease, 1994 and 2014*
79
159
216
150
241
205
261
234223 229
257
3948
72 7885
93 98 99 106113
129
0
50
100
150
200
250
300
FR NETH NOR SWI SWIZ CAN UK SWE GER US NZ
1994 2014
Deaths per 100,000 population
Quality Indicators
25
* Or nearest year; data from 2012 in Switzerland, US and New Zealand. Data from 2011 in Netherlands. Data are for
individuals aged 15 years and older, reflecting age- and sex-adjusted rates.
Source: OECD Health Data 2017.
QUALITY INDICATORS
Diabetes Hospital Admissions in Adults, 2013*
44
64 6876
95
111
141
181187
198
216
0
50
100
150
200
250
SWIZ UK NETH NOR CAN SWE AUS FR NZ US GER
Age-sex standardized rates per 100,000
OECD MEDIAN
26
* Or nearest year; data from 2012 in Switzerland, US and New Zealand. Data from 2011 in Netherlands. Data are for
individuals aged 15 years and older, reflecting age- and sex-adjusted rates.
Source: OECD Health Data 2017.
QUALITY INDICATORS
COPD Hospital Admissions in Adults, 2013*
101120
164
192213 217 222
243 245
324 326
0
50
100
150
200
250
300
350
SWIZ FRA NETH SWE UK US NOR CAN GER AUS NZ
Age-sex standardized rates per 100,000
OECD MEDIAN
27
QUALITY INDICATORS
Mortality Amenable to Health Care, 2000 and 2014*
*Trends in amenable mortality for selected countries, 2000-2014. Data from 2014 in all countries except Canada (2011),
France (2013), Netherlands (2013), NZ (2012), Switzerland (2013), UK (2013). WHO Mortality files (number of deaths by age
group) and populations (except Human Mortality Database for Canada, UK and the USA). List of amenable causes: Nolte &
McKee 2004 (Australia, Canada, NZ, Nor, US) Calculations by European Observatory on Health Systems and Policies (2016),
Amenable mortality causes based on Nolte & McKee, 2004.Mortality and population data from WHO mortality files,
released September 2016 (population data for Canada and the USA from Human Mortality Database). Age-specific rates
standardised to European Standard Population 2013.
Source: Marina Karanikolos, European Observatory on Health Systems and Policies (2017).
90 90
108117
111
121
110
131
145
135
149
5561 62 64
69 7278
83 85 87
112
0
20
40
60
80
100
120
140
160
SWIZ FRA AUS NOR SWE NETH CAN GER UK NZ US
2000 2014
Deaths per 100,000
Aging Populations
29
Source: OECD Health Data 2017.
AGING POPULATIONS
Share of older adults, 2016
11 11 11 12 1214 13 13 13
15 15
3.6 3.8 3.94.2 4.2
4.4 4.8 5 5.95.1
5.8
0
5
10
15
20
25
NZ US AUS NOR CAN NETH UK SWIZ FRA SWE GER
65-79 year-olds 80+ year-olds
Percent of total population (%)
30
Source: OECD Health Data 2017.
AGING POPULATIONS
Trends in the share of older adults aged 80 years and older, 1980-2015
0
1
2
3
4
5
6
7
1980 1985 1990 1995 2000 2005 2010 2015
FR (5.9)
GER (5.8)
SWE (5.1)
SWIZ (5.0)
UK (4.8)
NETH (4.4)
CAN (4.2)
NOR (4.2)
AUS (3.9)
US (3.8)
NZ (3.6)
Percent of total population (%)
31
*2014 data; **2013 data; ***2012 data. Note: The diagnosis of dementias relies on clinical judgement and as such is subject to interpersonal variation. Further, prevalence data is influenced by changes to diagnostic criteria and advances in diagnostic technology over time, as well as public awareness of dementia. These factors may introduce heterogeneity within and between countries. Time trends must therefore be interpreted with caution. See further details in Wu, et al. Nat Rev Neurol 2017;13:327-39.
Source: OECD Health Data 2017.
AGING POPULATIONS
Mortality from dementia, 2000-2015
0
10
20
30
40
50
60
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
NETH (53.9)
UK (53.9**)
SWE (43.2)
SWIZ (42.7**)
US (41.3*)
CAN (36.6***)
NOR (36.5*)
AUS (34.9*)
NZ (30.4***)
GER (24.7*)
FR (17.2**)
Deaths per 100,000
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