Multinational Comparisonsof Health Systems Data, 2009

Gerard F. Anderson and Patricia MarkovichJohns 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.

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2International Comparison of Spending on Health, 1980–2007

0

1000

2000

3000

4000

5000

6000

7000

8000

19

80

19

81

19

82

19

83

19

84

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

U.S.NorwaySwitzerlandCanadaNetherlandsFranceGermanySwedenU.K.ItalyNew ZealandAustralia

Average spending on healthper capita ($US PPP)

0

2

4

6

8

10

12

14

16

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

U.S.FranceSwitzerlandGermanyCanadaNetherlandsNew ZealandSwedenNorwayItalyU.K.Australia

Total expenditures on healthas percent of GDP

Source: OECD Health Data 2009 (June 2009).

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3Average Annual Growth Rate of

Real Health Care Spending per Capita, 1997–2007

1.7

2.32.42.42.5

3.73.83.8

4.04.14.2

4.5

4.9

0.0

1.0

2.0

3.0

4.0

5.0

UK NZ NETH SWE OECDMedian

CAN AUS* US FR ITA NOR SWITZ GER

* 1996–2006Source: OECD Health Data 2009 (June 2009).

Percent

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4Out-of-Pocket Health Care Spending per Capita, 2007

Adjusted for Differences in Cost of Living

213246

343351

470485528542571580

720

890

1,350

0

200

400

600

800

1,000

1,200

1,400

SWITZ US NOR CAN AUS* ITA SWE OECDMedian

GER NZ UK FR NETH

* 2006Source: OECD Health Data 2009 (June 2009).

Dollars

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5Health Care Expenditure per Capita by Source of Funding, 2007

Adjusted for Differences in Cost of Living

3,3074,005

2,618 2,726 2,844 2,7582,124

2,4462,056

3,092

449589 510

360

441

890

720

1,350 580 246 470528

571

542

2,716

38

88

20479 343

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

US NOR SWITZ CAN FR GER SWE AUS* UK ITA

Out-of-pocket spending

Private spending

Public spending

* 2006Source: OECD Health Data 2009 (June 2009).

Dollars

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6Hospital Spending per Discharge, 2007

Adjusted for Differences in Cost of Living

17,206

12,163 11,988

9,398 9,131 9,026

7,312 7,312 7,295

4,667 4,527

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

US* CAN* NETH SWITZ NOR* SWE NZ OECDMedian

AUS* FR GER

* 2006Source: OECD Health Data 2009 (June 2009).

Dollars

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7Hospital Discharges per 1,000 Population, 2007

84

109

126126135139

162163165166172

227

274

0

50

100

150

200

250

300

FR GER NOR SWITZ SWE OECDMedian

AUS* ITA* NZ US* UK NETH CAN*

* 2006Source: OECD Health Data 2009 (June 2009).

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8Average Length of Hospital Stay for Acute Myocardial Infarction, 2007

4.64.85.4

6.26.46.8

7.17.1

7.98.0

8.9

11.0

0

2

4

6

8

10

12

GER UK ITA* SWITZ NETH OECDMedian

CAN* FR AUS* US* SWE NOR

* 2006Source: OECD Health Data 2009 (June 2009).

Days

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Community Hospital Payment-to-Cost Ratios, by Source of Revenue, 1980-2008

Note: Payment-to-cost ratios show the degree to which payments from each payer cover the costs of treating its patients. They cannot be used to compare payment levels across payers, however, because the service mix and intensity vary. Data are for community hospitals. Medicaid includes Medicaid Disproportionate Share payments.

Source: American Hospital Association and Avalere Health, Avalere Health analysis of 2008 American Hospital Association Annual Survey data, for community hospitals, Trendwatch Chartbook 2010, Trends Affecting Hospitals and Health Systems, Table 4.4, p. A-35, at http://www.aha.org/aha/trendwatch/chartbook/2010/appendix4.pdf.

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10Average Annual Number of Physician Visits per Capita, 2007

7.57.0

6.3 6.3 6.3

5.8 5.7

5.04.7

4.03.8

2.8

0

1

2

3

4

5

6

7

8

GER ITA** AUS FR OECDMedian

CAN* NETH UK NZ SWITZ US* SWE*

* 2006 ** 2005Source: OECD Health Data 2009 (June 2009).

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11Number of Practicing Physicians per 1,000 Population, 2007

2.2

3.9 3.9 3.93.7

3.63.5

3.43.2

2.8

2.52.4

2.3

0

1

2

3

4

NETH NOR SWITZ ITA SWE* GER FR OECDMedian

AUS* UK US NZ CAN

* 2006Source: OECD Health Data 2009 (June 2009).

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12Pharmaceutical Spending per Capita, 2007

Adjusted for Differences in Cost of Living

$241

$381$422$431$446$446$454

$518$542

$588

$691

$878

0

100

200

300

400

500

600

700

800

900

US CAN FR GER ITA SWITZ SWE OECDMedian

AUS* NETH NOR NZ

* 2006Source: OECD Health Data 2009 (June 2009).

Dollars

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13Drug Prices for 30 Most Commonly Prescribed Drugs, 2006–07

US is set at 1.0

0.34

0.440.450.490.51

0.63

0.760.77

1.00

0.0

0.2

0.4

0.6

0.8

1.0

US CAN GER SWITZ UK AUS NETH FR NZ

Source: IMS Health.

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14Drug Prices for 30 Most Commonly Prescribed Drugs, 2006–07,

Brand-Name and GenericUS is set at 1.0

Source: IMS Health.

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

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15Drug Prices: Lipitor (atorvastatin), 2006–07

Price for one dose

$0.71

$1.01

$1.35$1.45$1.45$1.46$1.52

$1.83

$2.82

$0

$1

$2

$3

US CAN SWITZ AUS UK NETH GER FR NZ

Source: IMS Health.

Dollars

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16Drug Prices: Nexium (esomeprazole), 2006–07

Price for one dose

$0.88$1.02

$1.22$1.28$1.32

$1.97$2.15

$3.91

$0

$1

$2

$3

$4

US SWITZ CAN UK NETH FR AUS GER

Source: IMS Health.

Dollars

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Profitability of Pharmaceutical Manufacturers, 1995-2009

Note: Percent is the median percent net profit after taxes as a percent of firm revenues for all firms in the industry. NA = no longer available. Source: Kaiser Family Foundation and Sonderegger Research Center, Prescription Drug Trends: A Chartbook Update, November 2001, Exhibit 4.11, at http://www.kff.org/insurance/3161-index.cfm, updated with data from Fortune, Fortune 500 Industry Rankings: April 14, 2003, Vol.147, No.7, p. F-26; April 5, 2004, Vol. 149, No.7, p. F-26; April 18, 2005, Vol. 151, No.8, p. F-28; April 17, 2006, Vol.153, No.7, p. F-26; April 30, 2007, Vol.155, No.8, p. F-32; 2007 and 2008 numbers from Fortune 500 online at http://money.cnn.com/magazines/fortune/; 2009 numbers from personal communication with Fortune magazine.

NA

NA

NA

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18Magnetic Resonance Imaging (MRI) Machines

per Million Population, 2007

25.9

18.6

14.4

8.8 8.5 8.2 8.26.7 6.6

5.75.1

0

10

20

30

US ITA SWITZ NZ OECDMedian

GER UK CAN NETH** FR AUS

** 2005Source: OECD Health Data 2009 (June 2009).

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19MRI Scan and Imaging Fees, 2009

1,200

839 824

567

436

179

0

200

400

600

800

1,000

1,200

1,400

US GER CAN NETH FR UK

Source: International Federation of Health Plans, 2009 Comparative Price Report.

Dollars

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20

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21Volume of Knee and Hip Implants, 2004

Implants per 100,000

164

137

121

95

65

0

50

100

150

200

US UK GER FR ITA

Source: McKinsey & Company, Accounting for the Cost of Health Care in the United States, 2007.

258

208197

141 139

0

50

100

150

200

250

300

GER FR UK ITA US

Knee Replacements Hip Replacements

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22Cost of Knee and Hip Prostheses to Providers, 2004

GDP Adjusted, US $

4,866

3,035

2,5612,390

2,239

0

1,000

2,000

3,000

4,000

5,000

6,000

US ITA FR UK GER

Source: McKinsey & Company, Accounting for the Cost of Health Care in the United States, 2007.

$4,821

$1,537$1,380

$1,168 $1,165

US ITA UK GER FR

Knee Replacements Hip ReplacementsDollars

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23Coronary Bypass Procedures per 100,000 Population, 2007

3132

132

8581

77 7673 73

59 58 56

45

0

25

50

75

100

125

150

GER US* NOR* NZ AUS* ITA* CAN* OECDMedian

NETH SWE UK FR SWITZ

* 2006Source: OECD Health Data 2009 (June 2009).

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24Percentage of Population over Age 65

with Influenza Immunization, 2007

77.5 77.073.5

69.066.7

64.9 64.3 63.7

58.956.0 56.0

0

10

20

30

40

50

60

70

80

AUS* NETH UK FR US ITA CAN NZ OECDMedian

GER SWITZ

* 2006

a

Source: OECD Health Data 2009 (June 2009).

Percent

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25Percentage of Adults Who Report Being Daily Smokers, 2007

1515

29

25

2322 22 22

21 20

18 1817

0

5

10

15

20

25

30

NETH FR* GER** ITA OECDMedian

NOR UK SWITZ CAN NZ AUS US SWE*

* 2006** 2005Source: OECD Health Data 2009 (June 2009).

Percent

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26

34.3

26.5

24.0

15.413.6

11.2 10.5 10.2 9.99.0

8.1

0

5

10

15

20

25

30

35

US* NZ UK CAN GER** NETH FR* SWE ITA NOR SWITZ

Obesity (BMI>30) Prevalence Among Adult Population, 2007

* 2006** 2005Note: 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).

Percent

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27Life Expectancy at Birth, 2007

81.1 80.782.282.382.382.482.983.083.083.784.084.284.4

78.2 77.1 75.477.278.077.278.278.978.479.078.479.277.5

0

10

20

30

40

50

60

70

80

90

FR SWITZ* ITA* AUS CAN* SWE NOR* GER* NETH OECDMedian

NZ UK** US*

Female Male

* 2006** 2005Source: OECD Health Data 2009 (June 2009).

Years

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28Potential Years of Life Lost Because of Diabetes

per 100,000 Population, 2007

19

2529313335363637

64

99

0

20

40

60

80

100

US** NZ** NOR* SWE* OECDMedian

GER* NETH ITA* FR* UK SWITZ*

* 2006** 2005Source: OECD Health Data 2009 (June 2009).

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29Mortality Amenable to Health Care

Deaths per 100,000 population*

* 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.

7681

88 8489 89

99 9788

97

109 106116 115 113

130134

128

115

65 71 71 74 77 80 82 82 84 84 90 93 96104103103101

110

74

0

50

100

150

Fra

nce

Japan

Austr

alia

Spain

Italy

Canada

Norw

ay

Neth

erlands

Sw

eden

Gre

ece

Austr

ia

Germ

any

Fin

land

New

Zeala

nd

Denm

ark

United K

ingdom

Irela

nd

Port

ugal

United S

tate

s

1997–98 2002–03

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Distribution of National Health Expenditures, by Type of Service, 2008

Note: Other Personal Health Care includes, for example, dental and other professional health services, durable medical equipment, etc. Other Health Spending includes, for example, administration and net cost of private health insurance, public health activity, research, and structures and equipment, etc.

Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; National Health Expenditures by type of service and source of funds, CY 1960-2008; file nhe2008.zip).

Physician/ Clinical Services 21.2%

Hospital Care 30.7%

Other Personal Health Care

12.9%

Nursing Home Care, 5.9%

Prescription Drugs10.0%

Home Health Care, 2.8%

Other Health Spending 16.5%

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Relative Contributions of Different Types of Health Services to Total Growth in National

Health Expenditures, 1998-2008

Nursing Home Care4.3%

Home Health Care2.7%

Other Personal Health Care

11.7%

Hospital Care29.8%

Prescription Drugs12.7%

Physician and Clinical Services

20.9%

Other Health Spending18.0%

Notes: Percentages may not total 100% due to rounding. Other Personal Health Care includes, for example, dental and other professional health services, durable medical equipment, etc. Other Health Spending includes, for example, administration and net cost of private health insurance, public health activity, research, and structures and equipment, etc.

Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; National Health Expenditures by type of service and source of funds, CY 1960-2008; file nhe2008.zip).

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Annual Percentage Change in National Spending for Selected Health Services, 1998-

2008

Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; National Health Expenditures by type of service and source of funds, CY 1960-2008; file nhe2008.zip).

4.5

5.96.97.2

7.48.08.2

8.2

5.65.0

3.2

5.05.85.7

7.37.3

8.57.9

8.5

7.0

5.26.4

3.2

4.5

8.7

5.8

8.4

10.5

14.014.7

15.3

18.1

14.1

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Hospital Care

Physician and Clinical Services

Prescription Drugs

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Distribution of National Health Expenditures, by Type of Service, 1998 and 2008

Notes: Percentages may not total 100% due to rounding. Other Personal Health Care includes, for example, dental and other professional health services, durable medical equipment, etc. Other Health Spending includes, for example, administration and net cost of private health insurance, public health activity, research, and structures and equipment, etc.

Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; National Health Expenditures by type of service and source of funds, CY 1960-2008; file nhe2008.zip).

21.5%

7.4% 7.5%

2.8%

15.1%

10.0%

31.6%

14.0%

16.5%

2.8%

12.9%

5.9%

21.2%

30.7%

0%

10%

20%

30%

40%1998 2008

Hospital Care

Physician/ Clinical Services

Prescription Drugs

Nursing Home Care

Home Health Care

Other Personal

Health Care

Other Health

Spending

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Relative Contributions of Utilization, Types of Prescription Drugs Used, and Price to Rising

Prescription Drug Expenditures, 1993-1997 vs. 1997-2002

Source: Kaiser Family Foundation and Sonderegger Research Center analysis using National Health Expenditures data for prescription drugs from the Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.gov/statistics/nhe/historical/, Table 2; price data from IMS Health, Pharmaceutical Pricing UPDATE, various years; and utilization data from IMS Health, National Prescription Audit Plus, various years, updated with data from the IMS Health web site at http://www.imshealth.com.

1993-1997 1997-2002

Price (Manufacturer

Price Increases)19% Utilization

(# of Prescriptions Dispensed)

47%Types of

Prescription Drugs Used

34%

Price (Manufacturer

Price Increases)25%

Utilization (# of

Prescriptions Dispensed)

42%

Types of Prescription Drugs Used

34%

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35

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36

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Health System Functions & Objectives

Functions

• Stewardship

• Financing

• Resource development & allocation

• Service Delivery

Objectives

• Responsiveness

• Fairness

• Health

World Health Report, 2000 (Figure 2.1; p. 25)