Health at a Glance

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Health at a Glance provides the latest comparable data and trends on different aspects of the performance of health systems in OECD countries. It provides striking evidence of large variations across countries in indicators of health status and health risks, as well as in the inputs and outputs of health systems.

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Health at a Glance 2011

Health at a Glance 2011

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23 Nov 2011
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This sixth edition of Health at a Glance provides the latest comparable data on different aspects of the performance of health systems in OECD countries. It provides striking evidence of large variations across countries in the costs, activities and results of health systems. Key indicators provide information on health status, the determinants of health, health care activities and health expenditure and financing in OECD countries.   Each indicator in the book is presented in a user-friendly format, consisting of charts illustrating variations across countries and over time, brief descriptive analyses highlighting the major findings conveyed by the data, and a methodological box on the definition of the indicator and any limitations in data comparability.

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  • Foreword
    This 2011 edition of Health at a Glance: OECD Indicators presents the most recent comparable data on key indicators of health and health systems across OECD countries. For the first time, it features a chapter on long-term care.
  • OECD 50th Anniversary
    Work on health at the OECD began in the early 1980s, as part of an examination of the strong growth in health expenditure in the prior decade. In the 1980s and the 1990s, this work focused largely on building a robust database that could be used for comparative analyses of health systems, beginning with comparable data on health spending. This developmental work led to the release of the first version of the OECD manual A System of Health Accounts in 2000. In the ten years since the launch of the OECD Health Project in 2001, OECD work has broadened to address some of the main challenges that policy makers face to improve the performance of their countries’ health systems (see box on next page).
  • Introduction
    Health at a Glance 2011 presents comparisons of key indicators of health and health systems across the 34 OECD countries, as well as for some major non-OECD economies. It includes, for the first time, a special chapter on long-term care. The indicators presented in this publication have been selected on the basis of their policy relevance and data availability and comparability. The data come mainly from official national statistics, unless otherwise indicated.
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  • Expand / Collapse Hide / Show all Abstracts Health Status

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    • Life expectancy at birth
      Life expectancy at birth continues to increase remarkably in OECD countries, reflecting sharp reductions in mortality rates at all ages. These gains in longevity can be attributed to a number of factors including rising living standards, improved lifestyle and better education, and greater access to quality health services. Other factors such as better nutrition, sanitation and housing also play a role, particularly in countries with emerging economies (OECD, 2004a).
    • Premature mortality
      Premature mortality, measured in terms of potential years of life lost (PYLL) before the age of 70 years, focuses on deaths among younger age groups of the population. PYLL values are heavily influenced by infant mortality and deaths from diseases and injuries affecting children and younger adults: a death at five years of age represents 65 PYLL; one at 60 years of age only ten. Premature mortality can be influenced by advances in medical technology, especially in relation to infant mortality and deaths due to heart disease, and in prevention and control measures, reducing untimely or avoidable deaths from injuries and communicable diseases. A number of other variables, such as GDP per capita, occupational status, numbers of doctors and alcohol and tobacco consumption have also been associated with reduced premature mortality (Or, 2000; Joumard et al., 2008).
    • Mortality from heart disease and stroke
      Cardiovascular diseases are the main cause of mortality in almost all OECD countries, and accounted for 35% of all deaths in 2009. They cover a range of diseases related to the circulatory system, including ischemic heart disease (known as IHD, or heart attack) and cerebrovascular disease (or stroke). Together, IHD and stroke comprise two-thirds of all cardiovascular deaths, and between them they caused almost one-quarter of all deaths in OECD countries in 2009.
    • Mortality from cancer
      Cancer is the second leading cause of mortality in OECD countries after diseases of the circulatory system, accounting for 28% of all deaths on average in 2009. In 2009, cancer mortality rates were the lowest in Mexico, Finland, Japan and Switzerland. They were the highest in central and eastern European countries (Hungary, Poland, Slovenia, the Czech and Slovak Republics) and Denmark (Figure 1.4.1).
    • Mortality from transport accidents
      Worldwide, an estimated 1.2 million people are killed in transport accidents each year, most of which are road traffic accidents, and as many as 50 million people are injured or disabled (WHO, 2009a). In OECD countries alone transport accidents were responsible for more than 120 000 deaths in 2009, occurring most often in the United States (45 000), Mexico (17 000), Korea and Japan (7 000 each). In addition, there were 38 000 deaths in the Russian Federation.
    • Suicide
    • Infant mortality
      Infant mortality, the rate at which babies and children of less than one year of age die, reflects the effect of economic and social conditions on the health of mothers and newborns, as well as the effectiveness of health systems.
    • Infant health: Low birth weight
      Low birth weight – defined as newborns weighing less than 2 500 grams – is an important indicator of infant health because of the close relationship between birth weight and infant morbidity and mortality. There are two categories of low birth weight babies: those occurring as a result of restricted foetal growth and those resulting from pre-term birth. Low birth weight infants have a greater risk of poor health or death, require a longer period of hospitalisation after birth, and are more likely to develop significant disabilities (UNICEF and WHO, 2004).
    • Perceived health status
      Most OECD countries conduct regular health surveys which allow respondents to report on different aspects of their health. A commonly-asked question relates to selfperceived health status, of the type: "How is your health in general?". Despite the subjective nature of this question, indicators of perceived general health have been found to be a good predictor of people’s future health care use and mortality (for instance, see Miilunpalo et al., 1997).
    • Diabetes prevalence and incidence
      Diabetes is a chronic disease, characterised by high levels of glucose in the blood. It occurs either because the pancreas stops producing the hormone insulin (Type 1 diabetes), or through a combination of the pancreas having reduced ability to produce insulin alongside the body being resistant to its action (Type 2 diabetes). People with diabetes are at a greater risk of developing cardiovascular diseases such as heart attack and stroke if the disease is left undiagnosed or poorly controlled. They also have elevated risks for sight loss, foot and leg amputation due to damage to nerves and blood vessels, and renal failure requiring dialysis or transplantation.
    • Cancer incidence
      In 2008, an estimated 5.2 million new cases of cancer were diagnosed in OECD countries, at an average of 261 per 100 000 population. Incidence rates varied substantially among countries, being comparatively high in Denmark, Ireland, Australia, Belgium and New Zealand at over 300 (Figure 1.11.1). In a number of OECD and emerging countries including India, Mexico, Indonesia and Turkey, rates were below 150.
    • AIDS incidence and HIV prevalence
      The first cases of Acquired Immunodeficiency Syndrome (AIDS) were diagnosed 30 years ago. The onset of AIDS is normally caused as a result of HIV (human immunodeficiency virus) infection and can manifest itself as a number of different diseases, such as pneumonia and tuberculosis, as the immune system is no longer able to defend the body, leaving it susceptible to opportunistic infections and tumors. There is a time lag between HIV infection, AIDS diagnosis and death, which can be any number of years depending on the treatment administered. Despite worldwide research, there is no cure currently available.
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  • Expand / Collapse Hide / Show all Abstracts Non-medical Determinants of Health

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    • Tobacco consumption among adults
      Tobacco is responsible for about one-in-ten adult deaths worldwide, equating to about 6 million deaths each year (Shafey et al., 2009). It is a major risk factor for at least two of the leading causes of premature mortality – circulatory disease and cancer, increasing the risk of heart attack, stroke, lung cancer, cancers of the larynx and mouth, and pancreatic cancer. Smoking also causes peripheral vascular disease and hypertension. In addition, it is an important contributory factor for respiratory diseases such as chronic obstructive pulmonary disease (COPD), while smoking among pregnant women can lead to low birth weight and illnesses among infants. It remains the largest avoidable risk to health in OECD countries.
    • Alcohol consumption among adults
      The health burden related to excessive alcohol consumption, both in terms of morbidity and mortality, is considerable in most parts of the world (Rehm et al., 2009; WHO, 2004a). High alcohol intake is associated with numerous harmful health and social consequences, such as increased risk of heart, stroke and vascular diseases, as well as liver cirrhosis and certain cancers. Foetal exposure to alcohol increases the risk of birth defects and intellectual impairments. Alcohol also contributes to death and disability through accidents and injuries, assault, violence, homicide and suicide, and is estimated to cause more than 2 million deaths worldwide per year. In the Russian Federation, the sharp rise in premature mortality and decline in life expectancy during the 1990s was due, in part, to excessive alcohol consumption (WHO, 2004a). It is, however, one of the major avoidable risk factors for disease.
    • Overweight and obesity among adults
      The rise in overweight and obesity is a major public health concern. Obesity is a known risk factor for numerous health problems, including hypertension, high cholesterol, diabetes, cardiovascular diseases, respiratory problems (asthma), musculoskeletal diseases (arthritis) and some forms of cancer. Mortality risk also increases sharply once the overweight threshold is crossed (Sassi, 2010).
    • Overweight and obesity among children
      Children who are overweight or obese are at greater risk of poor health, both in adolescence and in adulthood. Being overweight in childhood increases the risk of developing cardiovascular disease or diabetes, as well as related social and mental health problems. Excess weight problems in childhood are associated with an increased risk of being an obese adult, at which point certain forms of cardiovascular diseases, cancer, osteoarthritis, a reduced quality of life and premature death can be added to the list of health concerns (Sassi, 2010).
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  • Expand / Collapse Hide / Show all Abstracts Health Workforce

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    • Employment in the health and social sectors
      The health and social sectors employ a large and growing number of people in OECD countries. The data reported in this section come from general labour force surveys and include not only people working in the health sector but also those working in the social sector (including long-term care, child care and other types of social work). The data include professionals providing direct services to people together with administrative and other support staff.
    • Medical doctors
      This section provides information on the number of doctors per capita in OECD countries, including a disaggregation by general practitioners and specialists. In 2009, there were just over three doctors per 1 000 population across OECD countries. Greece had by far the highest number of doctors per capita (6.1 per 1 000 population), followed by Austria. Chile, Turkey, Korea and Mexico had the lowest number of doctors per capita with between one and two doctors per 1 000 population. The number of doctors per capita is lower in some of the major emerging economies, with less than one doctor per 1 000 population in Indonesia, India and South Africa.
    • Medical graduates
      Maintaining or increasing the number of doctors requires either investment in training new doctors or recruiting trained physicians from abroad. As it takes about ten years to train a doctor, any current shortages can be met only by recruiting qualified doctors from abroad, unless there are unemployed doctors at home. Conversely, any surpluses or sudden fall in demand may mean that new graduates, in particular, struggle to find vacant posts at home.
    • Remuneration of doctors (general practitioners and specialists)
      The remuneration level of doctors is, to a certain extent, related to the overall level of economic development of a country, but there are nevertheless significant variations in their remuneration compared with the average wage in each country. The structure of remuneration for different categories of doctors also has an impact on the financial attractiveness of different medical specialties. In many countries, governments influence the level and structure of physician remuneration directly as a key employer of physicians or as a purchaser of services, or indirectly through regulation.
    • Gynaecologists and obstetricians, and midwives
      Gynaecologists are concerned with the functions and diseases specific to women, especially those affecting the reproductive system, while obstetricians specialise in pregnancy and childbirth. A doctor will often specialise in both these areas, and the data reported in this section does not distinguish between the two. Midwives provide care and advice to women during pregnancy, labour and childbirth and the post-natal period. They deliver babies working independently or in collaboration with doctors and nurses.
    • Psychiatrists
      At any point in time, about 10% of the adult population will report having some type of mental or behavioural disorder (WHO, 2001). People with mental health problems may receive help from a variety of professionals, including general practitioners, psychiatrists, psychologists, psychotherapists, social workers, specialist nurses and others. This section focuses on one category of mental health service provider, psychiatrists, as the availability of comparable data on others, such as psychologists, is more limited. Psychiatrists are responsible for diagnosing and treating a variety of serious mental health problems, including depression, learning disabilities, alcoholism and drug addiction, eating disorders, and personality disorders such as schizophrenia.
    • Nurses
      Nurses are usually the most numerous health profession, greatly outnumbering physicians in most OECD countries. Nurses play a critical role in providing health care not only in traditional settings such as hospitals and long-term care institutions but increasingly in primary care (especially in offering care to the chronically ill) and in home care settings.
    • Nursing graduates
      Many OECD countries have taken steps in recent years to expand the number of students in nursing education programmes in response to concerns about current or anticipated shortages of nurses. Increasing investment in nursing education is particularly important as the nursing workforce is ageing in many countries and the baby boom generation of nurses approaches retirement.
    • Remuneration of nurses
      The remuneration level of nurses is one of the factors affecting job satisfaction and the attractiveness of the profession. It also has a direct impact on costs, as wages represent one of the main spending items in health systems.
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  • Expand / Collapse Hide / Show all Abstracts Health Care Activities

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    • Consultations with doctors
      Consultations with doctors can take place in doctors’ offices or clinics, in hospital outpatient departments or, in some cases, in patients’ own homes. In many European countries (e.g. Denmark, Italy, the Netherlands, Norway, Portugal, the Slovak Republic, Spain and the United Kingdom), patients are required, or given incentives to consult a general practitioner (GP) "gatekeeper" about any new episode of illness. The GP may then refer them to a specialist, if indicated. In other countries (e.g. Austria, the Czech Republic, Iceland, Japan and Korea), patients may approach specialists directly.
    • Medical technologies
      Progress in medical technologies continues to transform health care delivery and to improve life expectancy and quality of life, but it is also one of the main drivers of rising health expenditure across OECD countries. This section presents data on the availability and use of two diagnostic technologies – computed tomography (CT) scanners and magnetic resonance imaging (MRI) units.
    • Hospital beds
      The number of hospital beds provides a measure of the resources available for delivering services to inpatients in hospitals. This section presents data on the total number of hospital beds, including those allocated for curative (acute), psychiatric, long-term and other types of care. It also includes an indicator of bed occupancy rates focussing on curative care beds.
    • Hospital discharges
      Hospital discharge rates measure the number of patients who leave a hospital after receiving care. Together with the average length of stay, they are important indicators of hospital activities. Hospital activities are affected by a number of factors, including the demand for hospital services, the capacity of hospitals to treat patients, the ability of the primary care sector to prevent avoidable hospital admissions, and the availability of post-acute care settings to provide rehabilitative and long-term care services.
    • Average length of stay in hospitals
      The average length of stay in hospitals (ALOS) is often used as an indicator of efficiency. All other things being equal, a shorter stay will reduce the cost per discharge and shift care from inpatient to less expensive post-acute settings. However, shorter stays tend to be more service intensive and more costly per day. Too short a length of stay could also cause adverse effects on health outcomes, or reduce the comfort and recovery of the patient. If this leads to a greater readmission rate, costs per episode of illness may fall only slightly, or even rise.
    • Cardiac procedures (coronary angioplasty)
      Heart diseases are a leading cause of hospitalisation and death in OECD countries (see Indicator 1.3). Coronary angioplasty is a revascularisation procedure that has revolutionised the treatment of ischemic heart diseases (heart attack and angina) over the past 20 years. It involves the threading of a catheter with a balloon attached to the tip through the arterial system into the diseased coronary artery. The balloon is inflated to distend the coronary artery at the point of obstruction. The placement of a stent to keep the artery open accompanies the majority of angioplasties. Drug-eluting stents (a stent that gradually releases drugs) are increasingly being used to stem the growth of scar-like tissue surrounding the stent.
    • Hip and knee replacement
      Significant advances in surgical treatment have provided effective options to reduce the pain and disability associated with certain musculoskeletal conditions. Joint replacement surgery (hip and knee replacement) is considered the most effective intervention for severe osteoarthritis, reducing pain and disability and restoring some patients to nearnormal function.
    • Treatment of renal failure (dialysis and kidney transplants
      End-stage renal failure (ESRF) is a condition in which the kidneys are permanently impaired and can no longer function normally. Some of the main risk factors for end-stage renal failure include diabetes and hypertension, two conditions which are becoming more prevalent in OECD countries. In the United States, diabetes and hypertension alone accounted for over 60% of the primary diagnoses for all ESRF patients (37% for diabetes and 24% for hypertension) (USRDS, 2008). When patients reach end-stage renal failure, they require treatment either in the form of dialysis or through kidney transplants. Treatment through dialysis tends to be more costly and results in a poorer quality of life for patients than a successful kidney transplant, because of its recurrent nature.
    • Caesarean sections
      Rates of caesarean delivery as a percentage of all live births have increased in all OECD countries in recent decades, although in a few countries this trend has reversed over the past few years. Reasons for the increase include reductions in the risk of caesarean delivery, malpractice liability concerns, scheduling convenience for both physicians and patients, and changes in the physician-patient relationship, among others. Nonetheless, caesarean delivery continues to result in increased maternal mortality, maternal and infant morbidity, and increased complications for subsequent deliveries (Minkoff and Chervenak, 2003; Bewley and Cockburn, 2002; Villar et al., 2006). These concerns, combined with the greater financial cost (the average cost associated with a caesarean section is at least two times greater than a normal delivery in many OECD countries; Koechlin et al., 2010), raise questions about the appropriateness of some caesarean delivery that may not be medically required.
    • Cataract surgeries
      In the past two decades, the number of surgical procedures carried out on a same-day basis, without any need for hospitalisation, has grown in most OECD countries. Advances in medical technologies, particularly the diffusion of less invasive surgical interventions, and better anaesthetics have made this development possible. These innovations have also improved patient safety and health outcomes for patients, and have in many cases helped to reduce the unit cost per intervention by shortening the length of stay in hospitals. However, the impact of the rise in same-day surgeries on health spending depends not only on changes in their unit cost, but also on the growth in the sheer number of procedures performed, and needs to take into account any additional cost related to post-acute care and community health services.
    • Pharmaceutical consumption
      The consumption of pharmaceuticals is increasing across OECD countries, not only in terms of expenditure (see Indicator 7.4 "Pharmaceutical expenditure"), but also the volume or quantity of drugs consumed. One of the factors contributing to this rise is a growing demand for drugs to treat ageing-related diseases. However, the rise in pharmaceutical consumption is also observed in countries with younger populations, indicating that other factors, such as physicians’ prescription habits, also play a role.
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  • Expand / Collapse Hide / Show all Abstracts Quality of Care

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    • Avoidable admissions: Respiratory diseases
      Chronic conditions like asthma and chronic obstructive pulmonary disease (COPD) are either preventable or manageable through proper prevention or primary care interventions. Proper management of these chronic conditions in primary care settings can reduce exacerbation and costly hospitalisation. Hospital admission rates serve as a proxy for primary care quality, so high admission rates may point to poor care co-ordination or care continuity. They may also indicate structural constraints such as the supply of family physicians (AHRQ, 2009; Starfield et al., 2005).
    • Avoidable admissions: Uncontrolled diabetes
      Diabetes is one of the most significant non-communicable diseases globally, and is also a leading cause of mortality. In the United States for example, where there are an estimated 26 million diabetics, diabetes was a contributory factor to around 230 000 deaths in 2007. In Europe, an estimated 55 million people live with diabetes. Across the world, the population of diabetics is expected to rise from 285 million in 2010 to 438 million by 2030 (IDF, 2009) (see also Indicator 1.10, "Diabetes prevalence and incidence").
    • In-hospital mortality following acute myocardial infarction
      Although coronary artery disease remains the leading cause of death in most industrialised countries, mortality rates have declined since the 1970s (see Indicator 1.3 "Mortality from heart disease and stroke"). Much of the reduction can be attributed to lower mortality from AMI, due to better treatment in the acute phase. Care for AMI has changed dramatically in recent decades, with the introduction of coronary care units in the 1960s (Khush et al., 2005) and with the advent of treatment aimed at rapidly restoring coronary blood flow in the 1980s (Gil et al., 1999). This success is all the more remarkable as data suggest that the incidence of AMI has not declined for most countries (Goldberg et al., 1999; Parikh et al., 2009). However, numerous studies have shown that a considerable proportion of AMI patients fail to receive evidence-based care (Eagle et al., 2005).
    • In-hospital mortality following stroke
      Stroke and other cerebrovascular disease is the fourth most common cause of death in OECD countries, accounting for over 8% of all deaths on average (OECD, 2011a). Estimates suggest that it accounts for 2-4% of health care expenditure and also significant costs outside of the health care system due to its impact on disability (OECD, 2003a). In ischemic stroke, representing about 85% of cases, the blood supply to a part of the brain is interrupted, leading to a necrosis of the affected part, while in hemorrhagic stroke, the rupture of a blood vessel causes bleeding into the brain, usually causing more widespread damage.
    • Obstetric trauma
      Patient safety has recently become one of the most prominent issues in health policy, as increased evidence of a high rate of errors during the delivery of medical care has begun to undermine the trust that patients and policy makers have historically bestowed on the medical profession. As early as 1991, the landmark Harvard Medical Practice Study found that adverse events occur in 1 to 4% of all hospital admissions (Brennan et al., 1991). The US Institute of Medicine integrated the available evidence on medical errors and estimated that more people die from medical errors than from traffic injuries or breast cancer (Kohn et al., 2000). One recent Swedish study showed that over 12% of hospital admissions had adverse events, of which 70% were preventable, resulting in an increased length of stay of 6 days (Soop et al., 2009). The Council of the European Union adopted in 2009 a Recommendation on patient safety, including the prevention and control of healthcare associated infections (European Union, 2009).
    • Procedural or postoperative complications
      Efforts to improve patient safety have sparked interest in reporting sentinel and adverse events arising from health care. Sentinel events are rare but dramatic incidents where medical errors may lead to tangible harm to patients. These, sometimes referred to as "never events", indicate failure of safeguards to protect patients during care delivery. Foreign body left in during procedure is such an occurrence that reflects serious process problems. The indicator captures errors relating to the failure to remove surgical instruments (i.e. needles, knife blades, gauze swabs) at the end of a procedure. The most common risk factors that might cause retained bodies after surgery are emergencies, unplanned changes in procedure, changes in the surgical team during the procedure and patient obesity (Gawande et al., 2003). Preventive measures include counting procedures, a methodical wound exploration and effective communication among the surgical team.
    • Unplanned hospital re-admissions for mental disorders
      The burden of mental illness is substantial, accounting for between 3 and 16% of total expenditure on health across OECD countries. Severe disorders such as schizophrenia and bipolar disorder are among the top ten causes of years lost due to disability worldwide (WHO, 2008b).
    • Screening, survival and mortality for cervical cancer
      Cervical cancer is preventable and curable if detected early. The main cause of cervical cancer, which accounts for approximately 95% of all cases, is sexual exposure to the human papilloma virus, HPV (IARC, 1995; Franco et al., 1999). Three indicators are presented to reflect variation in cervical cancer care across OECD countries: cervical cancer screening rates in women aged 20-69 years, five-year relative survival rates, and mortality rates.
    • Screening, survival and mortality for breast cancer
      Breast cancer is the most prevalent form of cancer in women, accounting for almost 460 000 deaths worldwide in 2008 (WHO, 2011d). One in nine women will acquire breast cancer at some point in her life and one in thirty will die from the disease. There are a number of risk factors that increase a person’s chance of getting this disease such as age, family history of breast cancer, estrogen replacement therapy, alcohol use and others. Overall spending for breast cancer care typically amounts to about 0.5-0.6% of total health expenditure (OECD, 2003a). Variation in breast cancer care across OECD countries is indicated by mammography screening rates in women aged 50-69 years, relative survival rates, and mortality rates.
    • Survival and mortality for colorectal cancer
      Colorectal cancer is the third most commonly diagnosed form of cancer worldwide, after lung and breast cancer, with approximately one million new cases diagnosed per year (Parkin et al., 2005). There are several factors that place certain individuals at increased risk for the disease, including age, the presence of polyps, ulcerative colitis, a diet high in fat, and genetic background. The disease is more common in the United States and Europe, and is rare in Asia. In Asian countries where people are gradually adopting western diets, such as Japan, the incidence of colorectal cancer is increasing (IARC, 2011). It is estimated that approximately 610 000 people worldwide died due to colorectal cancer in 2008 (WHO, 2011d). Total spending on the treatment of colorectal cancer in the United States is estimated to reach USD 14 billion per year (Mariotto et al., 2011). Two indicators are presented to reflect variation in outcomes for patients with colorectal cancer across OECD countries: five-year relative survival rates and mortality rates.
    • Childhood vaccination programmes
      Childhood vaccination continues to be one of the most cost-effective health policy interventions. All OECD countries or, in some cases, sub-national jurisdictions have established vaccination programmes based on their interpretation of the risks and benefits of each vaccine. Coverage of these programmes can be considered as a quality of care indicator. Pertussis, measles and hepatitis B are taken here as examples as they represent in timing and frequency of vaccination the full spectrum of organisational challenges related to childhood vaccination.
    • Influenza vaccination for older people
      Influenza is a common infectious disease worldwide and affects persons of all ages. For example, on average, between 5% and 20% of the population in the United States contracts influenza each year (CDC, 2009). Most people with the illness recover quickly, but elderly people and those with chronic medical conditions are at higher risk for complications and even death. Between 1979 and 2001, on average, influenza accounted for more than 200 000 hospitalisations and 36 000 deaths per year in the United States (CDC, 2009). The impact of influenza on the employed population is substantial, even though most influenza morbidity and mortality occurs among the elderly and those with chronic conditions (Keech et al., 1998). In Europe, influenza accounts for around 10% of sickness absence from work, while the cost of lost productivity in France and Germany has been estimated to be in the range of USD 9.3 billion to 14.1 billion per year (Szucs, 2004).
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  • Expand / Collapse Hide / Show all Abstracts Access to Care

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    • Unmet health care needs
      Most OECD countries aim to provide equal access to health care for people in equal need. One method of gauging equity of access to services is through assessing reports of unmet needs for health care for some reason. The problems that patients report in getting care when they are ill or injured often reflect significant barriers to care.
    • Coverage for health care
      Health care coverage promotes access to medical goods and services, as well as providing financial security against unexpected or serious illness (OECD, 2004a). However, total health insurance coverage – both public and private – is an imperfect indicator of accessibility, since the range of services covered and the degree of cost-sharing applied to those services can vary across countries.
    • Burden of out-of-pocket health expenditure
      Financial protection through public or private health insurance substantially reduces the amount that people pay directly for medical care, yet in some countries the burden of out-of-pocket spending can still create barriers to health care access and use. Households that have difficulties paying medical bills may delay or forgo needed health care (Hoffman et al., 2005; May and Cunningham, in Banthin et al., 2008). On average across OECD countries, 19% of health spending is paid directly by patients (see Indicator 7.5 "Financing of health care").
    • Geographic distribution of doctors
      Access to medical care requires an adequate number and proper distribution of physicians. Shortages of physicians in a geographic region can lead to increased travel times for patients and higher caseloads for doctors. The maldistribution of physicians is a challenge in a number of OECD countries, especially in territories with remote and sparsely populated areas, with long travelling times to the nearest urban region.
    • Inequalities in doctor consultations
      Measuring rates of health care utilisation, such as doctor consultations, is one way of identifying whether there are access problems for certain populations. Difficulties in consulting doctors because of excess cost, long waiting periods or travelling time, and lack of knowledge or incentive may lead to lower utilisation, and in turn to poorer health status and increased health inequalities.
    • Inequalities in dentist consultations
      Dental caries, periodontal (gum) disease and tooth loss are common problems in OECD countries. Despite improvements, problems in access persist, most commonly among disadvantaged and low income groups. In the United States, over 40% of low income persons aged 20-64 years had untreated dental caries in 2005-08, compared with only 16% of high income persons (NCHS, 2011). In Finland, onequarter of adults with lower education had six or more missing teeth, while less than 10% of those with higher education had the same amount of tooth loss (Kaikkonen, 2007).
    • Inequalities in cancer screening
      Cancer is the second most common cause of death in OECD countries, responsible for 28% of all deaths in 2009. Among women, breast cancer is the most common form, accounting for 30% of new cases each year and 15% of cancer deaths in 2009. Cervical cancer adds an additional 3% of new cases, and 2% of female cancer deaths (see Indicator 1.4, "Mortality from cancer").
    • Waiting times
      Patients may need to wait for health services for a number of reasons, including a lack of medical equipment or no available hospital beds, short-staffing, or inefficiencies in the organisation of services. Excessive waiting times to see a doctor or for non-emergency surgery can sometimes lead to adverse health effects such as stress, anxiety or pain (Sanmartin, 2003). Dissatisfaction and strained patientdoctor relationships also damage public perceptions of the health system.
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  • Expand / Collapse Hide / Show all Abstracts Health Expenditure and Financing

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    • Health expenditure per capita
      OECD countries vary enormously in how much they spend on health and the rate at which health spending grows. This reflects a wide array of market and social factors, as well as countries’ diverse financing and organisational structures of their health systems.
    • Health expenditure in relation to GDP
      Trends in the health spending to GDP ratio are the result of the combined effect of trends in both GDP and health expenditure. Apart from Luxembourg, health spending has grown more quickly than GDP since 2000. This has resulted in a higher share of GDP allocated to health on average across OECD countries.
    • Health expenditure by function
      Spending on the various types of health care services and goods is influenced by a wide range of factors: health system constraints, such as access to hospital beds, medical staff and new technology, the financial and institutional arrangements for health care delivery, as well as national clinical guidelines and the disease burden within a country.
    • Pharmaceutical expenditure
      Pharmaceuticals account for almost a fifth of all health spending on average across OECD countries. The increased consumption of pharmaceuticals due to the diffusion of new drugs and the ageing of populations (see Indicator 4.11 "Pharmaceutical consumption") has been a major factor contributing to increased pharmaceutical expenditure and thus overall heath expenditure (OECD, 2008c). However, the relationship between pharmaceutical spending and total health spending is a complex one, in that increased expenditure on pharmaceuticals to tackle diseases may reduce the need for costly hospitalisations and interventions now or in the future.
    • Financing of health care
      All OECD countries use a mix of public and private sources to pay for health care, but to varying degrees. Public financing is confined to government revenues in countries where central and/or local governments are primarily responsible for financing health services directly (e.g. Spain and Norway). It comprises both general government revenues and social contributions in countries with social insurance-based funding (e.g. France and Germany). Private financing, on the other hand, covers households’ out-ofpocket payments (either direct or as co-payments), thirdparty payment arrangements effected through various forms of private health insurance, health services such as occupational health care directly provided by employers, and other direct benefits provided by charities and the like.
    • Trade in health services (medical tourism)
      Trade in health services and its most high-profile component, medical tourism, has attracted a great deal of media attention in recent years. The impression often given is that large numbers of patients are actively seeking health care abroad or buying their pharmaceuticals over the Internet from foreign providers. The apparent growth in "imports" and "exports" has been fuelled by a number of factors. Technological advances in information communication systems allow patients or third party purchasers of health care the possibility to seek out quality treatment at lower cost and/or more immediately from health care providers in other countries. An increase in the portability of health coverage, whether as a result of regional arrangements with regard to public health insurance systems, or developments in the private insurance market, are also poised to further increase patient mobility. All this is coupled with a general increase in the temporary movement of populations for business, leisure or specifically for medical reasons between countries.
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  • Expand / Collapse Hide / Show all Abstracts Long-term Care

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    • Life expectancy and healthy life expectancy at age 65
      In OECD countries, life expectancy at age 65 has increased significantly for both men and women during the past 50 years. Some of the factors explaining the gains in life expectancy at age 65 include advances in medical care combined with greater access to health care, healthier lifestyles and improved living conditions before and after people reach age 65.
    • Self-reported health and disability at age 65
      Most OECD countries conduct regular health surveys which allow respondents to report on different aspects of their health. A question that is often found among such surveys relates to self-perceived health status, and is usually similar to: "How is your health in general?". Although these questions are subjective, indicators of perceived general health have been found to be a good predictor of people’s future health care use and mortality (see Miilunpalo et al., 1997). However, cross-country differences in perceived health status may be difficult to interpret. This is because survey questions may differ slightly, and cultural factors can affect responses.
    • Prevalence and economic burden of dementia
      Dementia describes a variety of brain disorders which progressively lead to brain damage, and cause a gradual deterioration of the individual’s functional capacity and social relations. Alzheimer’s disease is the most common form of dementia, representing about 60% to 80% of cases. Currently, there is no treatment that can halt dementia, but pharmaceutical drugs and other interventions can slow the progression of the disease.
    • Recipients of long-term care
      The number of people receiving long-term care (LTC) in OECD countries is rising, mainly due to population ageing and the growing number of elderly dependent persons, as well as the development of new programmes and services in several countries. In response to most people’s preference to receive LTC services at home, an important trend in many OECD countries over the past decade has been the implementation of different types of programmes to support home-based care.
    • Informal carers
      Informal carers are the backbone of long-term care systems in all OECD countries, although there are substantial variations across countries on the relative importance of informal care giving by family members compared with the use of more formal long-term care providers. Because of the informal nature of care provided by family members, it is not easy to get comparable data on the number of informal carers across countries, nor on the amount of time that they devote to care giving. The data presented in this section come from national or international health surveys, and refer to people aged 50 years and over who report providing care and assistance to a family member for activities of daily living (ADL).
    • Long-term care workers
    • Long-term care beds in institutions and hospitals
      The number of beds in long-term care (LTC) institutions and in LTC departments in hospitals provides a measure of the resources available for delivering LTC services to individuals outside of their home. Long-term care institutions refer to nursing and residential care facilities which provide accommodation and long-term care as a package. They include specially designed institutions or hospitallike settings where the predominant service component is long-term care for people with moderate to severe functional restrictions.
    • Long-term care expenditure
      Long-term care (LTC) expenditure has risen over the past few decades in most OECD countries and is expected to rise further in the coming years due mainly to population ageing and a growing number of people requiring health and social services on an ongoing basis. LTC cuts across the domains of both health and social care. The component of LTC that is considered under the health boundary for international comparisons comprises continuous episodes of care with a dominant characteristic related to medical or personal care (i.e. support for basic activities of daily living such as eating, dressing and washing). In contrast, spending on LTC services or programmes associated with helping people with disabilities to live as independently as possible (i.e. support for residential services or help with instrumental activities of dailing living, such as preparing meals or managing personal finances) are considered outside the scope of medical or personal care and represent the social component of LTC spending.
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