Health at a Glance

Frequency :
Biennial
ISSN :
1999-1312 (online)
ISSN :
1995-3992 (print)
DOI :
10.1787/19991312
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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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Also available in: French, German
 
Health at a Glance 2013

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Health at a Glance 2013

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Author(s):
OECD
Publication Date :
21 Nov 2013
Pages :
210
ISBN :
9789264219984 (EPUB) ; 9789264204225 (HTML) ; 9789264205024 (PDF) ; 9789264200715 (print)
DOI :
10.1787/health_glance-2013-en

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This seventh 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 2013 edition of Health at a Glance – OECD Indicators presents the most recent comparable data on key indicators of health and health systems across the 34 OECD member countries. Where possible, it also reports comparable data for Brazil, China, India, Indonesia, the Russian Federation, and South Africa, as key emerging countries.

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    Editorial: From expenditure growth to productivity growth in the health sector

    Almost six years since the start of the global financial and economic crisis, economic conditions vary widely across OECD countries, with the United States, Canada and Japan on a path to recovery, while the economic prospects of many European countries remain subdued. After a period in which, as part of the stimulus packages, greater resources were channelled to welfare and social protection programmes, the shift towards restoring sound fiscal conditions has often implied substantial cuts in public spending. Like other government programmes, health care has been the target of spending cuts in many OECD countries.

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    Executive summary

    Health at a Glance 2013 presents the trends and influences shaping health status, services and policies in OECD countries and the BRIICS. Although indicators such as life expectancy or infant mortality suggest that things are improving overall, inequalities in wealth, education and other social indicators still have a significant impact on health status and access to health services. These health disparities may be explained by differences in living and working conditions, as well as differences that show up in the health-related lifestyle data presented here (e.g., smoking, harmful alcohol drinking, physical inactivity, and obesity).

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    Reader's guide

    Health at a Glance 2013 presents comparisons of key indicators of health and health systems across the 34 OECD countries, as well as for key emerging countries (Brazil, China, India, Indonesia, the Russian Federation and South Africa). The indicators presented in this publication have been selected on the basis of their policy relevance as well as 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 has increased greatly over the past few decades in all OECD countries and many emerging economies. Improvement in living conditions, a reduction of certain risk factors (e.g., smoking rates) and progress in health care are the main factors explaining increased longevity.

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      Life expectancy by sex and education level

      There remain large gaps in life expectancy between women and men in all OECD countries. On average across OECD countries, life expectancy at birth for women reached 82.8 years in 2011, compared with 77.3 years for men, a gap of 5.5 years ().

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      Mortality from cardiovascular diseases

      Cardiovascular diseases are the main cause of mortality in most OECD countries, and accounted for 33% of all deaths in 2011. They cover a range of diseases related to the circulatory system, including ischemic heart disease (often referred to as heart attack) and cerebrovascular diseases such as stroke.

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      Mortality from cancer

      Cancer accounts for over one-fourth of all deaths in OECD countries and, after diseases of the circulatory system, it is the second leading cause of death. The proportion of deaths that are due to cancer has increased over time, and in countries such as Canada, Denmark, France, Japan and the Netherlands it has become the number one cause of death. This rise reflects the fact that mortality from other causes, particularly circulatory diseases, has been declining at a faster pace than the mortality rate for cancer.

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      Mortality from transport accidents

      Worldwide, an estimated 1.3 million people are killed in transport accidents each year, most of which are due to road traffic accidents. Globally, road transport accidents account for 0.5% of deaths among women aged 15-45 but over 10% for men in this age group (Lozano et al., 2012). In OECD countries, 107 000 lives were lost due to transport accidents in 2011. Seventy-four per cent of these fatalities occurred among men. The largest number of road transport accidents occurs among younger age groups with the risk of dying due to a road accident peaking at ages 15-24 (Walls et al., 2012; OECD/ITF, 2013).

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      Suicide

      Suicide is a significant cause of death in many OECD countries, and accounted for over 150 000 deaths in 2011. There is a complex set of reasons why some people choose to attempt or commit suicide, with multiple risk factors that can predispose a person to attempt to take their own life. Over 90% of people who have attempted or committed suicide have been diagnosed with psychiatric disorders such as severe depression, bipolar disorder and schizophrenia (Nock et al., 2008). The social context in which an individual lives is also important. Low income, alcohol and drug abuse, unemployment and unmarried status are all associated with higher rates of suicide (Qin et al., 2003; Crump et al., 2013).

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      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, the social environment, individual lifestyles as well as the characteristics and effectiveness of health systems.

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      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). Risk factors for low birth weight include maternal smoking and excessive alcohol consumption, poor nutrition, low body mass index, lower socio-economic status, and having had in-vitro fertilisation treatment and multiple births.

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      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 self--perceived 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 (DeSalvo et al., 2005; Bond et al., 2006).

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      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 reduced ability to produce insulin (Type-2 diabetes). People with diabetes are at a greater risk of developing cardiovascular diseases such as heart attack and stroke. 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.

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      Smoking and alcohol consumption among children

      Regular smoking and excessive drinking in adolescence have both immediate and long-term health consequences. Children who establish smoking habits in early adolescence increase their risk of cardiovascular diseases, respiratory illnesses and cancer. They are also more likely to experiment with alcohol and other drugs. Alcohol misuse is itself associated with a range of social, physical and mental health problems, including depressive and anxiety disorders, obesity and accidental injury (Currie et al., 2012).

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      Overweight and obesity among children

      Children who are overweight or obese are at greater risk of poor health in adolescence, as well as in adulthood. Among young people, orthopaedic problems and psychosocial problems such as low self-image, depression and impaired quality of life can result from being overweight. Excess weight problems in childhood are associated with an increased risk of being an obese adult, at which point cardiovascular disease, diabetes, certain forms of cancer, osteoarthritis, a reduced quality of life and premature death become health concerns (Lobstein, 2010; Currie et al., 2012).

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      Fruit and vegetable consumption among children

      Nutrition is important for children’s development and long-term health. Eating fruit during adolescence, for example in place of foods high in fat, sugar and salt, can protect against health problems such as obesity, diabetes, and cardiovascular diseases. Moreover, eating fruit and vegetables when young can be habit forming, promoting healthy eating in adult life.

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      Physical activity among children

      Undertaking physical activity in adolescence is beneficial for health, and can set standards for adult physical activity levels, thereby influencing health outcomes later in life. Research suggests that physical activity has a role in child and adolescent development, learning and well-being, and in the prevention and treatment of a range of youth health issues including asthma, mental health, and bone health. More direct links to adult health are found between physical activity in adolescence and its effect on overweight and obesity and related diseases, breast cancer rates and bone health in later life. The health effects of adolescent physical activity are sometimes dependent on the activity type, e.g. water physical activities in adolescence are effective in the treatment of asthma, and exercise is recommended in the treatment of cystic fibrosis (Hallal et al., 2006; Currie et al., 2012).

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      Tobacco consumption among adults

      Tobacco kills nearly 6 million people each year, of whom more than 5 million are from direct tobacco use and more than 600 000 are non-smokers exposed to second-hand smoke (WHO, 2013). 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 contributing factor for respiratory diseases such as chronic obstructive pulmonary disease (COPD). Smoking in pregnancy can lead to low birth weight and illness among infants. It remains the largest avoidable risk factor for health in OECD countries.

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      Alcohol consumption among adults

      The health burden related to harmful alcohol consumption, both in terms of morbidity and mortality, is considerable in most parts of the world (Rehm et al., 2009; WHO, 2011d). Alcohol use is associated with numerous harmful health and social consequences, including an increased risk of a range of cancers, stroke, and liver cirrhosis, among others. Foetal exposure to alcohol increases the risk of birth defects and intellectual impairment. Alcohol also contributes to death and disability through accidents and injuries, assault, violence, homicide and suicide, and is estimated to cause more than 2.5 million deaths worldwide per year (WHO, 2011d). WHO estimates that 4% of the global burden of disease is attributable to alcohol, which accounts for about as much mortality and disability as tobacco and hypertension (Rehm et al., 2009). In the United States, excessive alcohol consumption is the third leading cause of death, accounting for 80,000 deaths per year and 2.3 million potential years of life lost (CDC, 2012). Health care costs associated with excessive drinking in the United States are estimated at USD 25.6 billion (Bouchery et al., 2006). In the Russian Federation, alcohol misuse was a major contributing factor to the sharp rise in premature mortality and decline in life expectancy during the 1990s (OECD, 2012c).

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      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 also increases progressively once the overweight threshold is crossed (Sassi, 2010).

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      Fruit and vegetable consumption among adults

      Nutrition is an important determinant of health. Inadequate consumption of fruit and vegetables is one factor that can play a role in increased morbidity. Proper nutrition assists in preventing a number of chronic conditions, including cardiovascular disease, hypertension, Type-2 diabetes, stroke, certain cancers, musculoskeletal disorders and a range of mental health conditions.

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  • Expand / Collapse Hide / Show all Abstracts Health workforce

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      Doctors (overall number)

      The number of doctors per capita varies widely across OECD and emerging countries. In 2011, Greece had by far the highest number of doctors per capita (6.1 per 1 000 population), followed by the Russian Federation and Austria. Chile, Turkey and Korea had the lowest number of doctors per capita among OECD countries, with around two doctors per 1 000 population. This compares with an OECD average of just over three doctors per 1 000 population. The number of doctors per capita is much lower in some emerging countries, with less than one doctor per 1 000 population in Indonesia, India and South Africa ().

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      Doctors by age, sex and category

      Beyond the overall number of doctors, the age and gender composition of the medical workforce and the mix between different categories of doctors also have important implications on the current and future supply of medical services. The ageing of doctors in OECD countries has, for many years, raised concerns that there may not be sufficient new recruits to replace them, although there is evidence in several countries that the retirement of doctors often only occurs gradually and that their retirement age is increasing (Pong, 2011). The rising share of female doctors (the feminisation of medical professions) affects the overall supply of services, as women tend to work fewer hours than men, although it appears that working time preferences are becoming more similar among new generations of men and women doctors (Maiorova, 2007). The growing imbalance in favour of greater specialism over generalist medicine raises concerns in many countries about ensuring adequate access to primary care for all the population.

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      Gynaecologists and obstetricians, and midwives

      Gynaecologists are concerned with the functions and diseases affecting the female 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.

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      Psychiatrists and mental health nurses

      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 two categories of mental health service providers, psychiatrists and mental health nurses, as the availability of comparable data for other providers 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. A mental health nurse has usually completed a formal training in nursing at a university level and work in mental health care services (WHO, 2011e).

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      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 struggle to find vacant posts at home.

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      Remuneration of doctors (general practitioners and specialists)

      The remuneration of doctors is to a certain extent related to the overall level of economic development of a given 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 relative 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 through regulating their fees.

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      Nurses

      Nurses greatly outnumber 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.

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      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.

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      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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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/consultations-with-doctors_health_glance-2013-32-en
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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, Netherlands, Norway, Portugal, the Slovak Republic, Spain and United Kingdom), patients are required or given incentives to consult a general practitioner (GP) about any new episode of illness. The GP may then refer them to a specialist, if indicated. In other countries (e.g. Austria, Czech Republic, Iceland, Japan and Korea), in practice patients may approach specialists directly.

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/medical-technologies_health_glance-2013-33-en
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      Medical technologies

      New medical technologies are improving diagnosis and treatment, but they are also increasing health spending. This section presents data on the availability and use of two diagnostic technologies: computed tomography (CT) scanners and magnetic resonance imaging (MRI) units. CT scanners and MRI units help physicians diagnose a range of conditions by producing images of internal organs and structures of the body. Unlike conventional radiography and CT scanning, MRI exams do not expose patients to ionising radiation.

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      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.

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      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.

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      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.

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/cardiac-procedures_health_glance-2013-37-en
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      Cardiac procedures

      Heart diseases are a leading cause of hospitalisation and death in OECD countries (see ). Coronary artery bypass graft and angioplasty have revolutionised the treatment of ischemic heart diseases in the past few decades. A coronary bypass is an open-chest surgery involving the grafting of veins and/or arteries to bypass one or multiple obstructed arteries. A coronary angioplasty is a much less invasive procedure involving the threading of a catheter with a balloon attached to the tip through the arterial system 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.

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/hip-and-knee-replacement_health_glance-2013-38-en
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      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 near normal function.

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/caesarean-sections_health_glance-2013-39-en
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      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 at least slightly in 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 Che-rvenak, 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.

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/cataract-surgeries_health_glance-2013-40-en
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      Cataract surgeries

      In the past few decades, the number of surgical procedures carried out on a same-day basis, without any hospitalisation, has increased markedly in 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 reduced 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 volume of procedures performed. There is also a need to take into account any additional cost related to post-acute care and community health services following the intervention.

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/pharmaceutical-consumption_health_glance-2013-41-en
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      Pharmaceutical consumption

      Growth in pharmaceutical spending slowed down in many OECD countries in recent years (see Indicator 7.4 Pharmaceutical expenditure). However, for many categories of pharmaceutical drugs, the quantities consumed continue to increase, partly driven by growing demand for drugs to treat ageing-related and chronic diseases.

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/pharmaceutical-generic-market-share_health_glance-2013-42-en
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      Pharmaceutical generic market share

      All OECD countries see the development of generic markets as a good opportunity to increase efficiency in pharmaceutical spending, by offering cheaper products than on-p-atent drugs for an equivalent health outcome. However, in 2011, generics accounted for about three-quarter of the volume of pharmaceuticals covered by basic health coverage in Germany, the United Kingdom, New Zealand and D-enmark, while they represented less than one-quarter of the market in Luxembourg, Italy, Ireland, Switzerland, Japan and France ().

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  • Expand / Collapse Hide / Show all Abstracts quality of care

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/avoidable-hospital-admissions_health_glance-2013-43-en
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      Avoidable hospital admissions

      Most health systems have developed a primary level of care whose functions include managing new health complaints that pose no immediate threat to life, managing long-term conditions and supporting the patient in deciding when referral to hospital-based services is necessary. A key aim is to keep people well, by providing a consistent point of care over the longer term, tailoring and co-ordinating care for those with multiple health care needs and s-upporting the patient in self-education and self-management (Kringos, 2010). In the context of increasing prevalence of chronic il-lnesses in many OECD countries (see , and ) achieving high quality primary care is a key priority in nearly every health system.

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/prescribing-in-primary-care_health_glance-2013-44-en
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      Prescribing in primary care

      Beyond consumption and expenditure (see Pharmaceutical consumption and 7.4 Pharmaceutical expenditure), information on prescribing can be used as an indicator of health care quality. Two related indicators are shown: the total volume of antibiotics and, more specifically, the volume of quinolones and cephalosporins prescribed as a proportion of all antibiotics.

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/mortality-following-acute-myocardial-infarction-ami_health_glance-2013-45-en
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      Mortality following acute myocardial infarction (AMI)

      Mortality due to coronary heart disease has declined substantially since the 1970s (see Mortality from cardiovascular disease). This reduction can, in part, be attributed to better treatments, particularly in the acute phases of myocardial infarction (AMI). Care for AMI has changed dramatically in recent decades, with the introduction of coronary care units and treatments aimed at rapidly restoring coronary blood flow (Khush et al., 2005). Clinical practice guidelines provide clinicians with information on how to optimise treatments and studies have shown that greater compliance with guidelines improve health outcomes (e.g., Schiele et al., 2005; Eagle et al., 2005). However, some AMI patients do not receive recommended care, raising concerns over the quality of care in some countries (Brekke and Gjelsvik, 2009; Kotseva et al., 2009).

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/mortality-following-stroke_health_glance-2013-46-en
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      Mortality following stroke

      Stroke and other cerebrovascular diseases accounted for over 8% of all deaths in OECD countries. Ischemic stroke represents around 85% of all cerebrovascular disease cases. It occurs when the blood supply to a part of the brain is interrupted, leading to a necrosis (i.e. the cells that die) of the affected part. Treatment for ischemic stroke has advanced dramatically over the last decade. Clinical trials have demonstrated clear benefits of thrombolytic treatment for ischemic stroke as well as receiving care in dedicated stroke units to facilitate timely and aggressive diagnosis and therapy for stroke victims (Hacke et al., 1995; Seenan et al., 2007). Despite their clear clinical benefit, there is widespread variability in access to stroke units across and within countries (AIHW, 2013; Kapral et al., 2011; Indredavik, 2009).

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/surgical-complications_health_glance-2013-47-en
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      Surgical complications

      Patient safety remains one of the most prominent issues in health policy and public debate. High rates of errors during the delivery of medical care have been demonstrated repeatedly, including the landmark report by the Institute of Medicine which estimated that more people die from medical errors than from traffic injuries or breast cancer (Kohn et al., 2000). Two types of patient safety event can be distinguished: sentinel events that should never occur such as failure to remove surgical foreign bodies (e.g. gauze swabs) at the end of a procedure; and adverse events, such as post-operative sepsis, which can never be fully avoided given the high-risk nature of some procedures, although increased incidence at an aggregate level may indicate a systemic failing.

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/obstetric-trauma_health_glance-2013-48-en
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      Obstetric trauma

      Patient safety during childbirth can be assessed by looking at potentially avoidable tearing of the perineum during vaginal delivery. Such tears extend to the perineal muscles and bowel wall and require surgery. They are more likely to occur in the case of first vaginal delivery, high baby’s birth weight, labour induction, occiput posterior baby position, prolonged second stage of labour and instrumental delivery. Possible complications include continued perineal pain and incontinence. A recent study found that around 10% of women who had such tears will suffer from faecal incontinence initially and almost 45% of women will have on-going symptoms after four to eight years (Sundquist, 2012).

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/unplanned-hospital-re-admissions-for-patients-with-mental-disorders_health_glance-2013-49-en
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      Unplanned hospital re-admissions for patients with mental disorders

      The burden of mental illness is substantial. Mental and behavioural disorders, including major depressive disorder, anxiety disorders, and schizophrenia accounted for 7.4% of healthy years lost due to disability worldwide in 2010. -Furthermore, the burden attributable for this group of diseases grew by 5.9% between 1990 and 2010, with schizophrenia and bipolar disorders among the major contributors to this growth (Murray et al., 2013).

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/excess-mortality-from-mental-disorders_health_glance-2013-50-en
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      Excess mortality from mental disorders

      Excess mortality is a ratio of the mortality rate for patients with a mental disorder compared with the mortality rate of the general population. A ratio value that is greater than one implies that people with mental disorders face a higher risk of death than the rest of the population.

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/screening-survival-and-mortality-for-cervical-cancer_health_glance-2013-51-en
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      Screening, survival and mortality for cervical cancer

      Cervical cancer is highly preventable if precancerous changes are detected and treated before progression occurs. 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). Countries follow different policies with regards to the prevention and early diagnosis of cervical cancer.

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      Screening, survival and mortality for breast cancer

      Breast cancer is the most prevalent form of cancer in women. One in nine women will acquire breast cancer at some point in their life and one in thirty will die from the disease. Risk factors that increase a person’s chance of getting this disease include, but are not limited to, age, family history of breast cancer, oestrogen replacement therapy, lifestyle, diet, and alcohol.

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/survival-and-mortality-for-colorectal-cancer_health_glance-2013-53-en
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      Survival and mortality for colorectal cancer

      Colorectal cancer is the third most commonly diagnosed form of cancer worldwide, after lung and breast cancers, with over 1.2 million new cases diagnosed annually. Incidence rates are significantly higher for males than females (IARC, 2011). 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. But in countries where people have adopted western diets, such as Japan, the incidence of colorectal cancer is increasing. Total spending on the treatment of colorectal cancer in the United States is estimated at USD 14 billion per year (Mariottoet al., 2011).

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/childhood-vaccination-programmes_health_glance-2013-54-en
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      Childhood vaccination programmes

      All OECD countries have established vaccination programmes based on their interpretation of the risks and benefits of each vaccine. There is strong evidence that vaccines provide safe and effective protection against diseases such as diphtheria, tetanus, pertussis (whooping cough), measles and hepatitis B. The percentage of children protected from these diseases can be considered as a quality of care indicator for such childhood vaccination programmes.

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/influenza-vaccination-for-older-people_health_glance-2013-55-en
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      Influenza vaccination for older people

      Influenza is a common infectious disease that affects between 5 and 15% of the population each year (WHO, 2009). Most people with the illness recover quickly, but elderly people and those with chronic medical conditions are at higher risk of complications and even death. Influenza can also have a major impact on the health care system. In the United Kingdom, an estimated 779 000 general practice consultations and 19 000 hospital admissions were attributable to influenza per year (Pitman et al., 2006). At certain times of the year, influenza can place health systems under enormous stress. For example, in Toronto, C-anada, every 100 local cases of influenza resulted in an increase of 2.5 hours per week of ambulance diversion; this is a clear sign of emergency department overcrowding (Hoot et al., 2008; Schull et al., 2004).

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/patient-experience-with-ambulatory-care_health_glance-2013-56-en
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      Patient experience with ambulatory care

      Delivering health care that is responsive and patient-centered is playing a greater role in health care policy across OECD countries. Measuring and monitoring patient experiences empowers patients and the public, involves them in decisions on health care delivery and governance, and provides insight to the extent that they are health-literate and have control over the treatment they receive.

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  • Expand / Collapse Hide / Show all Abstracts Access to care

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/coverage-for-health-care_health_glance-2013-57-en
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      Coverage for health care

      Health care coverage through public or private health insurance promotes access to medical goods and services, and provides financial security against unexpected or serious illness (OECD, 2004a). However, the percentage of the population covered does not provide a complete indicator of accessibility, since the range of services covered and the degree of cost-sharing applied to those services also affects access to care.

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      Out-of-pocket medical 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 (Banthin et al., 2008). On average across OECD countries, 20% of health spending is paid directly by patients (see Financing of health care).

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/geographic-distribution-of-doctors_health_glance-2013-59-en
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      Geographic distribution of doctors

      Access to medical care requires an adequate number and proper distribution of physicians in all parts of the country. Shortages of physicians in certain regions can increase travel times or waiting times for patients, and result in unmet care needs. The uneven distribution of physicians is an important concern in most OECD countries, especially in those countries with remote and sparsely populated areas, and those with deprived urban regions which may also be underserved.

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/inequalities-in-doctor-consultations_health_glance-2013-60-en
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      Inequalities in doctor consultations

      Problems of access to health care can be measured by the actual utilisation of health care services and reported unmet health care needs. Any inequalities in health care utilisation and unmet care needs may result in poorer health status and increase health inequalities.

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      Inequalities in dentist consultations

      Problems in access to dentists persist in many countries, most commonly among disadvantaged and low income groups. For example, 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).

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/inequalities-in-cancer-screening_health_glance-2013-62-en
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      Inequalities in cancer screening

      Cancer is the second most common cause of death in OECD countries, responsible for 26% of all deaths in 2011. The early detection of breast, cervical, and colorectal cancers through screening programmes has contributed to increased survival rates over the past five years (see to ), and many countries have opted to make screening widely available. In most countries, more than half of women in the target age groups have had a recent mammogram, and a pelvic exam or Pap smear (see and ).

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      • http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2013/waiting-times-for-elective-surgery_health_glance-2013-63-en
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      Waiting times for elective surgery

      Long waiting times for health services is an important health policy issue in many OECD countries (Siciliani et al., 2013). Long waiting times for elective (non-emergency) surgery, such as cataract surgery, hip and knee replacement, generates dissatisfaction for patients because the expected benefits of treatments are postponed, and the pain and disability remains. While long waiting times is considered an important policy issue in many countries, this is not the case in others (e.g., Belgium, France, Germany, Japan, Korea, Luxembourg, Switzerland, United States).

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  • Expand / Collapse Hide / Show all Abstracts Health expenditure and financing

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      Health expenditure per capita

      How much OECD countries spend on health and the rate at which it grows reflects a wide array of market and social factors, as well as countries’ diverse financing and organisational structures of their health s-ystems.

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      Health expenditure in relation to GDP

      Changes in the health spending to GDP ratio are the result of both fluctuations in the rate of health spending as well as growth in the economy as a whole. The economic crisis that began in 2008 ended a long period during which health spending had grown faster than GDP in many OECD countries. This has resulted in very different trends in the health-spending-to-GDP ratio across OECD countries.

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      Health expenditure by function

      Spending on inpatient care and outpatient care combined accounts for a large proportion of health expenditure across OECD countries – around 62% of current health expenditure on average in 2011 (). A further 20% of health spending was allocated to medical goods (mainly pharmaceuticals, which accounted for 17% of total health spending), 12% on long-term care and the remaining 6% on collective services, such as public health and prevention services and administration.

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      Pharmaceutical expenditure

      Spending on pharmaceuticals accounted for more than a sixth (17%) of all health expenditure on average across OECD countries in 2011, making it the third largest spending component after inpatient and outpatient care.

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      Expenditure by disease and age

      Attributing health care expenditure by disease and age is important for health policy makers in order to analyse resource allocations in the health care system. This information can also play a role in assessing the recent and possible future impact of ageing populations and changing disease patterns on spending. Furthermore, the linking of health expenditure by disease to appropriate measures of outputs (e.g. hospital discharges by disease) and outcomes (e.g. survival rates after heart attack or cancer) helps in monitoring the performance of health care systems at a disease-based level (Heijink et al., 2006).

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      Financing of health care

      Across all OECD countries, health care is financed by a mix of public and private spending. In some countries, public health spending is generally confined to spending by the government using general revenues. In others, social insurance funds finance the bulk of health expenditure. Private financing of health care consists mainly of payments by households (either as standalone payments or as part of co-payment arrangements) as well as various forms of private health insurance intended to replace, complement or supplement publicly financed coverage.

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      Trade in health services

      Trade in health services and its most high-profile component, medical tourism, has attracted a great deal of media attention in recent years. The growth in imports and exports has been fuelled by a number of factors. Technological advances in information systems and communication allow patients or third party purchasers of health care 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 Ageing and long-term care

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      Demographic trends

      Population ageing is characterised by a rise in the share of the elderly population resulting from longer life expectancy (see ) and declining fertility rates (OECD, 2011b).

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      Life expectancy and healthy life expectancy at age 65

      Life expectancy at age 65 has increased significantly for both men and women during the past 50 years across both OECD countries and emerging economies. Some of the factors explaining these 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.

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      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 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 (DeSalvo, 2005; Bond et al., 2006). However, cross-country differences in perceived health status may be difficult to interpret as survey questions may differ slightly, and cultural factors can affect responses.

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      Dementia prevalence

      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. C-urrently, there is no treatment that can halt dementia, but pharmaceutical drugs and other interventions can slow the progression of the disease.

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      Recipients of long-term care

      The number of people receiving long-term care (LTC) services in OECD countries is rising, mainly due to population ageing and the growing number of elderly dependent persons, as well as the development of services and facilities in many countries.

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      Informal carers

      Family carers are the backbone of long-term care systems in all OECD countries, although there are substantial variations across countries in the relative importance of informal caregiving 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 family carers across countries, nor on the frequency of their c-aregiving. 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 family members and friends.

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      Long-term care workers

      The provision of long-term care (LTC) is a labour-intensive activity. Formal LTC workers are defined as paid workers, typically nurses and personal carers, providing care and/or assistance to people limited in their daily activities at home or in institutions. Formal long-term care is complemented by informal, usually unpaid, care by family and friends, which accounts for a large part of care for older people in all OECD countries (see Indicator 8.6).

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      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.

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      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 care services on an on-going basis.

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    Bibliography
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    Additional information on demographic and economic context, and health expenditure and financing

    The statistical data for Israel are supplied by and under the responsibility of the relevant Israeli authorities. The use of such data by the OECD is without prejudice to the status of the Golan Heights, East Jerusalem and Israeli settlements in the West Bank under the terms of international law.

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