Health at a Glance

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1999-1312 (online)
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1995-3992 (print)
http://dx.doi.org/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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Health at a Glance 2017

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Health at a Glance 2017

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OECD
10 Nov 2017
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212
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http://dx.doi.org/10.1787/health_glance-2017-en

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This new edition of Health at a Glance presents the most recent comparable data on the health status of populations and health system performance in OECD countries. Where possible, it also reports data for partner countries (Brazil, China, Colombia, Costa Rica, India, Indonesia, Lithuania, Russian Federation and South Africa). The data presented in this publication come from official national statistics, unless otherwise stated.

This edition contains a range of new indicators, particularly on risk factors for health. It also places greater emphasis on time trend analysis. Alongside indicator-by-indicator analysis, this edition offers snapshots and dashboard indicators that summarise the comparative performance of countries, and a special chapter on the main factors driving life expectancy gains.

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  • Foreword

    Health at a Glance 2017 presents the latest comparable data and trends on key indicators of health outcomes and health systems across the 35 OECD member countries. These indicators shed light on the performance of health systems, with indicators reflecting health outcomes, non-medical determinants of health, the degree of access to care, the quality of care provided, and the financial and material resources devoted to health. For a subset of indicators, data are reported for partner countries, including Brazil, China, Colombia, Cost Rica, India, Indonesia, Lithuania, the Russian Federation and South Africa.

  • Executive summary

    Health at a Glance 2017 presents up-to-date cross-country comparisons of the health status of populations and health system performance in OECD and partner countries. Alongside indicator-by-indicator analysis, this edition offers snapshots and dashboard indicators that summarise the comparative performance of countries, and a special chapter on the main factors driving life expectancy gains.

  • Reader's guide

    Health at a Glance 2017 presents comparisons of key indicators for health and health system performance across the 35 OECD countries. Candidate and key partner countries are also included where possible (Brazil, China, Colombia, Costa Rica, India, Indonesia, Lithuania, the Russian Federation and South Africa). The data presented in this publication come from official national statistics, unless otherwise stated.

  • Indicator overview: OECD snapshots and country dashboards

    This chapter presents a set of selected indicators on health and health system performance, designed to shed light on how well OECD countries perform along five dimensions: health status, risk factors for health, access to care, quality and outcomes of care, and health care resources. These indicators, taken from the main chapters of the publication, are presented in the form of OECD snapshots and country dashboards. The former illustrates time trends for the OECD as a whole, together with a snapshot of the latest available data (OECD average, top and bottom performers). The dashboards summarise how each country performs on all indicators compared to the OECD average.The selection of the indicators presented in this chapter was based on policy relevance, data availability and ease of interpretation. The selection and comparison of indicators is meant to capture relative strengths and weaknesses of countries to help identify possible areas for priority action, though not to identify which countries have the best health system overall.

  • What has driven life expectancy gains in recent decades? A cross-country analysis of OECD member states

    Countries with higher national income and health spending tend to have longer life expectancies. But these factors can only account for a part of life expectancy differences across countries. This chapter analyses the factors contributing to health status, including a closer assessment of the determinants of health that go beyond the health system. It shows that on average, a 10% increase in health spending per capita is associated with a gain of 3.5 months of life expectancy. The same rate of improvement in healthier lifestyles (10%) is associated with a gain of 2.6 months of life expectancy. Wider social determinants are also important: a 10% increase in income per capita is associated with a gain of 2.2 months of life expectancy, and a 10% increase in primary education coverage with 3.2 months. For income, minimum absolute levels are particularly critical to protecting people’s health.The main policy implication emerging from this analysis is the significant opportunities for health improvement from coordinated action across ministries responsible for education, the environment, income and social protection, alongside health ministries. This includes inter-sectoral action to address health-related behaviours. Collaboration with the private sector will also be important, especially with employers in relation to working conditions.

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  • Expand / Collapse Hide / Show all Abstracts Health status

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    • Life expectancy at birth

      Life expectancy at birth was on average 80.6 years across OECD countries in 2015 (). There have been substantial gains in life expectancy over time, with life expectancy at birth on average ten years higher today than it was in 1970. A number of countries reported slight falls in life expectancy between 2014 and 2015, though preliminary data for 2016 suggest these reductions were temporary.

    • 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 was 83.1 years in 2015, compared with 77.9 years for men, a gap of 5.2 years (). The gender gap in life expectancy increased substantially in many OECD countries during the 1970s and early 1980s to reach a peak of almost seven years in the mid-1980s, but it has narrowed since, reflecting higher gains in life expectancy among men than women. This can be attributed at least partly to narrowing of differences in risk-increasing behaviours such as smoking, accompanied by sharp reductions in mortality rates from circulatory diseases among men.

    • Main causes of mortality

      Over 10 million people died in 2015 across OECD countries, which equates to an average of 793 deaths per 100 000 population. Diseases of the circulatory system and cancer are the two leading causes of death in most countries. Across the OECD, more than one in three deaths were caused by ischaemic heart diseases, stroke or other circulatory diseases; and one in four deaths were related to cancer.

    • Mortality from circulatory diseases

      Despite substantial declines in recent decades, circulatory diseases remain the main cause of mortality in most OECD countries, accounting for more than one-third (36%) of all deaths in 2015. Prospects for further reductions may be hampered by a rise in certain risk factors such as obesity and diabetes (OECD, 2015). Circulatory diseases cover a range of illnesses related to the circulatory system, particularly ischaemic heart disease (including heart attack) and cerebrovascular diseases such as stroke.

    • Mortality from cancer

      Cancer is the second leading cause of mortality in OECD countries after circulatory diseases, accounting for 25% of all deaths in 2015, up from 15% in 1960. In a number of countries such as Denmark, France, Japan, the Netherlands, Canada, the United Kingdom, Spain, Belgium and Australia, the mortality rate for cancer is higher than for circulatory diseases. The rising share of deaths due to cancer reflects the fact that mortality rates from other causes, particularly circulatory diseases, has been declining more rapidly than for cancer.

    • Infant health

      Infant mortality, the rate at which babies and children of less than one year of age die, is the most fundamental measure of infant health. In OECD countries, around two-thirds of the deaths that occur during the first year of life are neonatal deaths (i.e. during the first four weeks). Birth defects, prematurity and other conditions arising during pregnancy are the main factors contributing to neonatal mortality in developed countries. For deaths beyond a month (post-neonatal mortality), there tends to be a greater range of causes – the most common being SIDS (sudden infant death syndrome), birth defects, infections and accidents.

    • Mental health

      Mental illness represents a considerable – and growing – proportion of the global burden of disease. An estimated one in two people will experience a mental illness in their lifetime, and around one in five working-age adults suffer from mental ill-health at any given time (OECD, 2012; OECD, 2015). Depression alone affects millions of individuals each year. shows self-reported prevalence of depression in Europe. On average, 12-month prevalence of depression was 7.9% of the population. Women reported higher rates of depression in all countries; in Spain, Lithuania, Hungary, Poland women were more than 50% more likely to report experiencing depression in the previous year than men, rising to 66% in Portugal. People in Iceland or Ireland were close to three times more likely to report depression than people in the Czech Republic (). These differences are in part driven by different attitudes and understandings around mental ill-health and depression. Lower stigma around depression may contribute to higher rates of self-reported illness, and higher rates of diagnosis.

    • 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 is of the type: “How is your health in general?”. Despite the subjective nature of this question, indicators of perceived general health are a good predictor of people’s future health care use and mortality (Palladino et al., 2016).

    • Cancer incidence

      In 2012, an estimated 5.8 million new cases of cancer were diagnosed in OECD countries, 54% (around 3.1 million) occurring in men and 46% (around 2.7 million) in women. The most common were breast cancer (12.9% of all new cancer cases) and prostate cancer (12.8%), followed by lung cancer (12.3%) and colorectal cancer (11.9%). These four cancers represented half of the estimated overall burden of cancer in OECD countries (Ferlay et al., 2014).

    • Diabetes prevalence

      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 because the cells of the body do not respond properly to the insulin produced (Type 2 diabetes). People with diabetes are more likely to suffer from cardiovascular diseases such as heart attack and stroke, sight loss, foot and leg amputation and renal failure.

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  • Expand / Collapse Hide / Show all Abstracts Risk factors for health

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    • Smoking among adults

      The health consequences of tobacco smoking are numerous, and include cancers, stroke, and coronary heart disease, among others. It is also 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. Smoking causes the largest share of overall years of healthy life lost in 15 OECD countries, and ranks second in another 16 OECD countries (Forouzanfar et al., 2016). The WHO has estimated that tobacco smoking kills 7 million people per year across the world, of which 890,000 are due to second-hand smoke. It is the leading cause of death, illness and impoverishment.

    • Alcohol consumption among adults

      Harmful alcohol use is a leading cause of death and disability worldwide, particularly in those of working age (OECD, 2015). Alcohol use is among the top ten leading risk factors in terms of years of healthy life lost in 32 OECD countries (Forouzanfar et al., 2016), and consumption in OECD countries remains well above the world average. In 2015, alcohol use lead to 2.3 million deaths, caused by cancers, heart diseases and liver diseases, among others. Most alcohol is drunk by the heaviest-drinking 20% of the population. Heavy drinking is associated with a lower probability of employment, more absence from work, and lower productivity and wages.

    • Smoking and alcohol consumption among children

      Smoking and excessive drinking during adolescence have both immediate and long-term health consequences. Establishing smoking habits early on increases the risk of cardiovascular diseases, respiratory illnesses, and cancer (Currie et al., 2012). Smoking during adolescence has immediate adverse health consequences, including addiction, reduced lung function and impaired lung growth, and asthma (Inchley et al., 2016). It is also associated with an increased likelihood of experimenting with other drugs, as well as engaging in other risky behaviours (O’Cathail et al., 2011). Early and frequent drinking and drunkenness is associated with detrimental psychological, social and physical effects, such as dropping out of high school without graduating (Chatterji and DeSimone, 2005).

    • Healthy lifestyles among adults

      Low fruit consumption, low vegetable consumption, and low levels of physical activity are among the ten leading risk factors in terms of years of healthy life lost in 24, 6, and 16 OECD countries respectively (Forouzanfar et al., 2016). Worldwide, diets low in fruit were the cause of nearly 3 million deaths in 2015, while low vegetable consumption caused nearly 2 million deaths, and low physical activity caused 1.6 million deaths. Including fruit and vegetables in the daily diet reduces the risk of coronary heart disease, stroke, as well as certain types of cancer (WHO, 2014). They include dietary fibre which lowers blood pressure and regulates insulin, possibly impacting the risk of type 2 diabetes (InterAct Consortium, 2015). Regular physical activity improves muscular and cardiorespiratory fitness, and reduces the risk of hypertension, coronary heart disease, stroke, diabetes, and various cancers (WHO, 2017). It has also been shown to positively impact mental health (Lindwall et al., 2012). In adults, the WHO recommends at least 150 minutes of moderate-intensity physical activity per week, at least 75 minutes of vigorous-intensity physical activity per week, or an equivalent combination of the two (WHO, 2017).

    • Healthy lifestyles among children

      Consuming a healthy diet and performing regular physical activity when young can be habit forming, promoting a healthy lifestyle in adult life. Daily consumption of fruit and vegetables can help reduce the risk of coronary heart diseases, strokes, and certain types of cancer (Hartley et al., 2013; World Cancer Research Fund, 2007). The most common guideline recommends consuming at least five portions of fruit and vegetables daily. Moderate-to-vigorous physical activity is beneficial to adolescents’ physical, mental and psycho-social health, as it helps build and maintain healthy bones and muscles, reduces feelings of depression and anxiety, and improves academic achievement (Janssen and LeBlanc, 2010; Singh et al., 2012). The WHO recommends 60 minutes of moderate-to-vigorous daily physical activity for those aged 5-17 years.

    • Overweight and obesity among adults

      Overweight and obesity are major risk factors for many chronic diseases, including diabetes, cardiovascular diseases, and cancer. High body mass index (BMI) led to nearly 4 million deaths in 2015, a 19.5% increase since 2005 worldwide. It is the leading risk factor in terms of healthy years of life lost in Turkey, second leading in six other OECD countries, and third leading in another 24 member countries (Forouzanfar et al., 2016). Obesity has risen quickly in the OECD in recent decades, and projections show that this trend will continue (OECD, 2017). It has affected all population groups, regardless of gender, age, race, income or education level, though to varying degrees (Sassi, 2010).

    • Overweight and obesity among children

      Childhood obesity has become one of the most serious public health challenges of the 21st century. Obesity can affect a child’s physical health, through cardiovascular, endocrine, or pulmonary diseases, and psycho-social health, through the development of poor self-esteem, eating disorders, and depression (Inchley et al., 2016). Obesity can also affect educational attainment (Cohen et al., 2013). Furthermore, childhood obesity is a strong predictor of adult obesity, which has health and economic consequences (WHO, 2016).

    • Air pollution

      Air pollution is a major environment-related health threat, especially to children and the elderly, as it can cause respiratory diseases, lung cancer, and cardiovascular diseases. It has also been linked to low birth-weight, dementia, and damage to DNA and the immune system (WHO, 2017). Outdoor air pollution in both cities and rural areas was estimated to cause 3 million premature deaths worldwide in 2012 (WHO, 2016), and can also have substantial economic and social consequences, from health costs to building restoration needs and agricultural output (OECD, 2015). Of particular concern for outdoor air pollution are carbon monoxide, nitrogen oxide and ozone, but also fine particulates, or PM2.5, whose diameter is 2.5 μm or smaller. These are potentially more dangerous than the larger particulates (PM10), as they can penetrate deeper into the respiratory tract, and cause severe health effects. In 2015, particulate matter pollution was the cause of over 4.2 million deaths worldwide (Forouzanfar et al., 2016). The WHO has claimed that air pollution is one of the most pernicious threats facing global public health today and on a bigger scale than HIV or Ebola (WHO, 2017).

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

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    • Population coverage for health care

      Health care coverage, through government schemes and private health insurance, provides financial security against unexpected or serious illness. However, the percentage of the population covered by such schemes 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.

    • Unmet needs for health care due to cost

      Access to health care may be prevented for a number of reasons. These can be due to the functioning of the health care system (such as the cost of health care, distance to the closest health care facility, or waiting lists) or to personal reasons (including fear of not being understood by the doctor or not having the time to seek care). People who forgo health care when they need it may jeopardise their health status.

    • Out-of-pocket medical expenditure

      Financial protection through compulsory or voluntary health coverage can substantially reduce the amount that people need to 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 face difficulties paying medical bills may delay or even forgo needed health care. On average across OECD countries, a fifth of all spending on health care comes directly from patients (see indicator “Financing of health care”).

    • Geographic distribution of doctors

      Access to medical care requires an adequate number and proper distribution of doctors in all parts of the country. Concentration of doctors in one region and shortages in others can lead to inequities in access such as longer travel or waiting times. The uneven distribution of doctors and the difficulties in recruiting and retaining doctors in certain regions is an important policy issue in most OECD countries, especially those with remote and sparsely populated areas, and those with deprived rural and urban regions.

    • Waiting times for elective surgery

      Long waiting times for health services is an important policy issue in many OECD countries (Siciliani et al., 2013), although less relevant in some (e.g. Belgium, France, Germany, Japan, Korea, Luxembourg, Switzerland, United States). 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 remain.

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  • Expand / Collapse Hide / Show all Abstracts Quality and outcomes of care

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    • Patient experience with ambulatory care

      Delivering health care that is responsive and patient-centred is playing a greater role in health care policy across OECD countries. Considering the health care user as a direct source of information is becoming more prevalent. Since the mid-1990s, there have been efforts to institutionalise measurement and monitoring of patient experiences. This empowers patients and the public, involves them in decisions on health care delivery and governance, and provides insight to the extent to which they are health-literate and have control over the treatment they receive

    • Prescribing in primary care

      Prescribing can be used as an indicator of health care quality supplementing consumption and expenditure information (see ). Antibiotics, for example, should be prescribed only where there is an evidence based need to reduce the risk of resistant strains. Likewise, quinolones and cephalosporins are considered second-line antibiotics in most prescribing guidelines. They should generally be used only when first line antibiotics are ineffective. Total volume of antibiotics prescribed, and second-line antibiotics as a proportion of total volume have been validated as markers of quality in the primary care setting.

    • Avoidable hospital admissions

      Most health systems have developed a ‘primary level’ of care whose functions include health promotion and disease prevention, managing new health complaints, managing long-term conditions and referring patients to hospital-based services when appropriate. 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 supporting the patient in self-education and self-management.

    • Diabetes care

      Diabetes is a chronic disease that occurs when the body’s ability to regulate excessive glucose levels in the blood is diminished. It is a leading cause of cardiovascular disease, blindness, kidney failure and lower limb amputation. Globally it is estimated that over 400 million adults had diabetes in 2015 and by 2040 it is projected this will grow to over 640 million adults. Diabetes caused 5 million deaths in 2015 (IDF, 2015).

    • Mortality following ischaemic stroke

      Worldwide an estimated 26 million people have experienced a stroke, with over 10 million people having an initial stroke each year. Stroke is the second leading global cause of death behind heart disease and accounted for just under 12 percent of total deaths worldwide in 2013 (American Heart Association, 2017). Stroke is also the second leading cause of disability. A stroke occurs when the blood supply to a part of the brain is interrupted, leading to a necrosis (i.e. cell death) of the affected part.

    • Mortality following acute myocardial infarction (AMI)

      Mortality due to coronary heart disease has declined substantially since the 1970s (see indicator “Mortality from circulatory diseases” in ). Important advances in both prevention policies, such as for smoking (see indicator “Smoking among adults” in ), and treatment of cardiovascular diseases have contributed to these declines (OECD, 2015a).

    • Hospital mortality rates

      Variations in acute myocardial infarction (AMI) 30-day case fatality rates at the national level are influenced by the level of within-country variation in rates across hospitals. Most OECD countries have established national hospital performance measurement and public reporting programmes to monitor efforts to improve the cost, quality and access of hospital care.

    • Waiting times for hip fracture surgery

      The main risk factors for hip fractures are associated with ageing, including an increased risk of falling and loss of skeletal strength from osteoporosis. With increasing life expectancy across most OECD countries, it is anticipated that hip fracture will become a more significant public health issue in coming years.

    • Surgical complications

      Patient safety remains one of the most prominent issues in health policy and public debate. Evidence suggests that over 15% of hospital expenditure and activity in OECD countries can be attributed to treating safety failures, many of which are preventable (OECD, 2017a; OECD, 2017b). In the United States an estimated USD 28 billion has been saved between 2010 and 2015 by systematically improving safety (AHRQ, 2016).

    • Obstetric trauma

      Patient safety during childbirth can be assessed by looking at potentially avoidable tearing of the perineum during vaginal delivery (Harvey, 2015). Such tears extend to the perineal muscles and bowel wall require surgery. They are more likely to occur in the case of first vaginal delivery, high baby birth weight, labour induction, occiput posterior baby position, prolonged second stage of labour and instrumental delivery. Possible complications include continued perineal pain and incontinence. These types of tears are not possible to prevent in all cases, but can be reduced by employing appropriate labour management and high quality obstetric care. Hence, the proportion of deliveries involving higher degree lacerations is a useful indicator of the quality of obstetric care.

    • Care for people with mental health disorders

      The burden of mental illness is substantial, affecting an estimated one in four of the OECD population at any time, and one in two across the life course (see indicator on “Mental health” in ; OECD, 2014a). High quality, timely care has the potential to improve outcomes and may help reduce suicide and excess mortality for individuals with psychiatric disorders.

    • Screening, survival and mortality for breast cancer

      Breast cancer is the cancer with both the highest incidence and prevalence for women across OECD countries. One in nine women will have breast cancer at some point in their life. Risk factors that increase a person’s chance of getting this disease include age, family history of breast cancer, genetic predisposition, reproductive factors, oestrogen replacement therapy, and lifestyles including obesity, physical inactivity, diet and alcohol consumption.

    • Survival and mortality for colorectal cancer

      Colorectal cancer is the third most commonly diagnosed form of cancer after prostate and lung cancers, for men, and the second most common cancer after breast cancer, for women, across OECD countries (see indicator “Mortality from cancer” in ). There are several factors that place certain individuals at increased risk for the disease, including age, ulcerative colitis, a personal or family history of colorectal cancer or polyps, and lifestyle factors such as a diet high in fat and low in fibre, lack of physical activity, obesity, and tobacco and alcohol consumption. Incidence is significantly higher for men than women across countries. Generally, rectal cancer is more difficult to cure than colon cancer due to a higher probability of spreading to other tissue, recurrence and postoperative complications.

    • Survival and mortality for leukaemia in children

      Leukaemia is the most common childhood cancer and accounts for over 30% of all cancers diagnosed in children aged below 15 years old in the world (IARC, 2012). Causes of leukaemia are not well known, but some known risk factors include inherited factors such as Down syndrome and a family history of leukaemia and non-inherited factors including exposure to inonising radiation. There are different types of leukaemia but about three-quarters of cases among children are acute lymphoblastic leukaemia (ALL). The second most frequent type is acute myeloid leukaemia. Prognosis of leukaemia is different depending on various factors including age, initial white blood cell count, gender, initial reaction to induction treatment and type of leukaemia. Children with acute leukaemia who are free of the disease for 5 years are considered to have been cured as remission after 5 years is rare.

    • Vaccinations

      All OECD countries have established vaccination programmes based on their interpretation of the risks and benefits of each vaccine. For children, vaccination rates for diphtheria, tetanus and pertussis (DTP), measles, and hepatitis B at age 1 are high across OECD countries (). On average, over 95% of children receive the recommended DTP or measles vaccinations, while almost 94% receive a recommended hepatitis B vaccination. Vaccination rates for DTP are below 90% in Indonesia, Mexico, and India. Vaccination rates for measles are below 90% in Italy, Indonesia, and India while vaccination rates for hepatitis B are below 90% in Mexico, France, Indonesia, India, and Germany.

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  • Expand / Collapse Hide / Show all Abstracts Health expenditure

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    • Health expenditure per capita

      The financial resources that a country devotes to health care, both for individuals and for the population as a whole, and how this changes over time is the result of a wide array of social and economic factors, as well as the financing and organisational structures of a country’s health system.

    • Health expenditure in relation to GDP

      How much a country spends on health care over time relative to spending on all other goods and services in the economy can be down to both growth in health spending itself as well as how well the economy is performing overall. In 2016, health spending is estimated to have accounted for 9.0% of GDP on average across OECD countries, largely unchanged in recent years. This comes after a period of health spending growth above that of the overall economy in the 1990s and 2000s that saw health expenditure as a share of GDP rise sharply in many OECD countries.

    • Financing of health care

      Health care can be paid for through a variety of financing arrangements. In some countries, health care might be predominantly covered by government schemes by which individuals are automatically entitled to care based on their residency. In other cases, compulsory health insurance schemes (either through public or private entities) finance the bulk of health spending. In addition to these, a varying proportion of health care spending consists of payments by households (either as standalone payments or as part of co-payment arrangements) as well as various forms of voluntary health insurance intended to replace, complement or supplement automatic or compulsory coverage.

    • Sources of health care financing

      In all OECD countries, the various schemes that pay for the health care goods and services rely on a mix of different sources of revenues. Government schemes, for example, typically receive budget allocations out of the overall government revenues (e.g. from income and corporate taxation, value-added tax, etc.). Social health insurance is usually financed out of social contributions payable by employees and employers. However, these schemes may also receive a varying proportion of their revenues from governmental transfers. The main sources of revenue for private health insurance are either compulsory or voluntary prepayments, which typically take the form of regular premium payments as part of an insurance contract. Out-of-pocket payments are exclusively financed from households’ own revenues. Some health financing schemes (e.g. non-profit or enterprise schemes) may also receive donations or additional income from investments or rental. Resident financing schemes can also receive transfers from abroad as part of bilateral co-operations with foreign governments or other development partners. However, these transfers play no role in the vast majority of OECD countries.

    • Health expenditure by type of service

      How health spending is split between the various services and goods reflects a variety of factors, from disease burden and system priorities to organisational aspects and costs. Spending on inpatient and outpatient care combined accounts for the major part of health expenditure across OECD countries – almost two-thirds of health spending on average in 2015 (). A further 19% of health spending was accounted for by medical goods (mainly pharmaceuticals), while 14% went on long-term care services. The remaining 6% was spent on prevention and public health services as well as on the overall governance and administration of the health system.

    • Health expenditure by provider

      Across OECD countries, the delivery of health care services and goods takes place in many different organisational settings, ranging from hospitals and medical practices to pharmacies and even private households caring for family members. A breakdown by provider allows the tracking of health expenditure from an organisational point of view, a useful complement to the functional breakdown of health expenditure (see indicator “Health expenditure by type of service”).

    • Capital expenditure in the health sector

      Although health systems remain a highly labour-intensive sector, capital has been an increasingly important factor of production of health services over recent decades, as reflected for example by the growing importance of diagnostic and therapeutic equipment or the expansion of information and communications technology (ICT) in health care (see previous indicator on eHealth adoption in general practice and hospital). However, the level of resources invested in infrastructure, equipment and ICT tends to fluctuate more with economic cycles than current spending on health services, as investment decisions are often more discrete and can more easily be postponed or brought forward depending on economic circumstances. In making capital investment decisions, policy-makers need to carefully assess not only the short-term costs, but also the potential benefits in the short, medium and longer-term. Slowing down investment in health infrastructure and equipment may also reduce the capacity to treat patients and contribute to increases in waiting times for different types of services.

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  • Expand / Collapse Hide / Show all Abstracts Health workforce

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    • Health and social care workforce

      Employment in health and social care represents a large and growing share of the labour force in many countries across the world (UN High-Level Commission on Health Employment and Economic Growth, 2016). In the OECD, health and social work activities constituted around 10% of total employment on average in 2015 (). The employment share is particularly pronounced in the Scandinavian countries, Finland and the Netherlands, where jobs in health and social work represent 15-20% of these countries’ workforces.

    • Doctors (overall number)

      The number of doctors per capita varies widely across OECD countries. In 2015, Greece had the highest number with 6.3 doctors per 1 000 population, but this number is an over-estimation as it includes all doctors who are licensed to practice but may no longer be practising for various reasons. Greece was followed by Austria (5.1 doctors per 1 000 population). Turkey, Chile and Korea had the lowest number among OECD countries at around two doctors per 1 000 population. The OECD average was 3.4 doctors per 1 000 population. Among the partner countries, the number of doctors per capita is significantly lower: there was less than one doctor per 1 000 population in Indonesia, India and South Africa. In China, the number of doctors per capita is still about half the OECD average, but it has grown by 44% since 2000 ().

    • Doctors by age, sex and category

      The age and gender composition of the medical workforce and the mix between different categories of doctors have important implications on the availability 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 that the retirement of doctors often only occurs gradually and that their retirement age is increasing (OECD, 2016). The growing imbalance in favour of greater specialisation over general medicine raises concerns in many countries about access to primary care for all the population.

    • Medical graduates

      The number of new medical graduates in a given year reflects to a large extent government decisions taken a few years earlier on the number of students admitted in medical schools (so-called numerus clausus policies). Since 2000, most OECD countries have increased the number of students admitted to medical education in response to concerns about current or possible future shortages of doctors (OECD, 2016), but large variations remain across countries.

    • Remuneration of doctors (general practitioners and specialists)

      The remuneration level for different categories of doctors has an impact on the financial attractiveness of different medical specialties. In many countries, governments influence the level and structure of physician remuneration by being one of the main employers of physicians or purchaser of their services, or by regulating their fees. With the increasing international mobility of doctors across national borders (see the indicator on migration of doctors and nurses), the relative levels of remuneration across countries can play an important role in influencing these movements.

    • Nurses

      Nurses greatly outnumber physicians in most OECD countries, and they 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 settings (especially to manage the care of the chronically ill) and in home care settings.

    • Nursing graduates

      Many OECD countries have taken steps over the past decade or so to increase the number of students admitted in nursing schools in response to concerns about current or possible future shortages of nurses (OECD, 2016). Nonetheless, there are wide variations across countries in training efforts of new nurses, which may be explained by: differences in the current number and age structure of the nursing workforce (and hence the replacement needs); in the capacity of nursing schools to take on more students; and the future employment prospects of nurses.

    • Remuneration of nurses

      The remuneration level of nurses is one of the factors affecting their job satisfaction and the attractiveness of the profession. It also has a sizeable impact on costs, since wages of nurses represent one of the largest spending items in health systems.

    • Foreign-trained doctors and nurses

      International migration of doctors and nurses is not a new phenomenon, but it has drawn considerable attention in recent years due to concerns that it might exacerbate shortages of skilled health workers in some countries. The Global Code of Practice on the International Recruitment of Health Personnel, adopted by the World Health Assembly in May 2010, was designed to respond to these concerns. It provides an instrument for countries to promote a more ethical recruitment of health personnel, encouraging countries to achieve greater “self-sufficiency” in the training of health workers, while recognising the basic human right of every person to migrate.

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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, Netherlands, Norway, Portugal, Slovak Republic, Spain and the United Kingdom), patients are required or even incentivised to first consult a general practitioner (GP) about any new episode of illness. The GP may then refer them on to a specialist, if indicated. In other countries, patients may approach specialists directly.

    • 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 imaging technologies: computed tomography (CT) scanners and magnetic resonance imaging (MRI) units. CT and MRI exams help physicians diagnose a range of conditions. Unlike conventional radiography and CT scanning, MRI exams do not expose patients to ionising radiation.

    • Hospital beds

      The number of hospital beds provides a measurement of the resources available for delivering services to inpatients in hospitals. This section presents data on the number of overall hospital beds in 2000 and 2015 and for different types of care (curative care, rehabilitative care, long-term care and other functions). It also presents an indicator of bed occupancy rates over time, focussing on curative care beds.

    • Hospital discharges

      Hospital discharge rates measure the number of patients who leave a hospital after staying at least one night. 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 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 is often regarded as an indicator of efficiency. All else being equal, a shorter stay will reduce the cost per discharge and shift care from inpatient to less expensive post-acute settings. Longer stays can be indicative of poor-value care: inefficient hospital processes may cause delays in providing treatment; errors and poor-quality care may mean patients need further treatment or recovery time; poor care co-ordination may leave people stuck in hospital waiting for ongoing care to be arranged. At the same time, some people may be discharged too early, when staying in hospital longer could have improved their outcomes or reduced chances of re-admission.

    • 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 and hip fractures, reducing pain and disability and restoring some patients to near normal function.

    • Caesarean sections

      Rates of caesarean delivery have increased over time in nearly all OECD countries, although in a few countries this trend has reversed, at least slightly, in the past few years. Reasons for the increase include the rise in first births among older women and in multiple births resulting from assisted reproduction, malpractice liability concerns, scheduling convenience for both physicians and patients, and the increasing preference of some women to have a caesarean delivery. Nonetheless, caesarean delivery continues to result in increased maternal mortality, maternal and infant morbidity, and increased complications for subsequent deliveries, raising questions about the appropriateness of caesarean deliveries that may not be medically required.

    • Ambulatory surgery

      In the past few decades, the number of surgical procedures carried out on a same-day basis has markedly increased in OECD countries. Advances in medical technologies – in particular the diffusion of less invasive surgical interventions – and better anaesthetics have made this development possible. These innovations have improved patient safety and health outcomes, and have also, 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 overall health spending may not be straightforward since the reduction in unit cost (compared to inpatient surgery), may be offset by the overall 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 interventions.

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  • Expand / Collapse Hide / Show all Abstracts Pharmaceutical sector

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    • Pharmaceutical expenditure

      Pharmaceuticals play a vital role in the health system. Policymakers need to balance access for new medicines while providing the right incentives to industry and acknowledging that health care budgets are limited. After inpatient and outpatient care, pharmaceuticals represent the third largest expenditure item of health care spending; accounting for more than a sixth (16%) of health expenditure on average across OECD countries in 2015 (not taking into account spending on pharmaceuticals in hospitals).

    • Pharmacists and pharmacies

      Pharmacists are educated and trained health care professionals who manage the distribution of medicines to consumers/patients and help ensure their safe and efficacious use. The role of the pharmacist has changed over recent years. Although their main role is to dispense medications in retail pharmacies, pharmacists are increasingly providing direct care to patients (e.g. flu vaccinations in Ireland and New Zealand, medicine adherence support in Australia, Japan, England and New Zealand), both in community pharmacies and as part of integrated health care provider teams.

    • Pharmaceutical consumption

      In general, pharmaceutical consumption continues to increase, partly driven by a growing need for drugs to treat ageing-related and chronic diseases, and by changes in clinical practice. This section examines consumption of four categories of pharmaceuticals: antihypertensive, cholesterol-lowering, antidiabetic and antidepressant drugs.

    • Generics and biosimilars

      All OECD countries view the development of generic markets as a good opportunity to increase efficiency in pharmaceutical spending, but many do not fully exploit the potential of generics (). In 2015, generics accounted for more than three-quarters of the volume of pharmaceuticals sold in the United States, Chile, Germany, New Zealand and the United Kingdom, while they represented less than one-quarter of the market in Luxembourg, Italy, Switzerland and Greece.

    • Research and development in the pharmaceutical sector

      Funding for pharmaceutical research and development (R&D) is the result of a complex mix of private and public sources. Governments mainly support basic and early-stage research. Such funding is made through direct budget allocations, research grants, publicly-owned research institutions and funding of higher education institutions. The pharmaceutical industry translates and applies knowledge generated by basic research to develop products, and invests in large clinical trials required to gain market approval. The industry also receives direct R&D subsidies or tax credits in many countries.

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  • Expand / Collapse Hide / Show all Abstracts Ageing and long-term care

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    • Demographic trends

      Longer life expectancies (see indicators on life expectancy in ) and declining fertility rates mean that older people make up an ever-increasing proportion of the populations of OECD countries.

    • Life expectancy and healthy life expectancy at age 65

      Life expectancy at age 65 has increased significantly for both men and women over the past few decades in OECD countries, rising by 5.4 years on average since 1970 (). 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.

    • 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. These surveys often include a question on self-perceived health status, along the lines of: “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 future health care use and mortality (Hirosaki et al., 2017; Schnittker and Bacak, 2014). However, cross-country differences may be difficult to interpret, as survey questions may differ slightly and cultural factors can affect responses.

    • 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. There is currently no cure or disease modifying treatment, but better policies can improve the lives of people with dementia by helping them and their families adjust to living with the condition and ensuring that they have access to high quality health and social care.

    • Recipients of long-term care

      As people age, they are more likely to develop disabilities and need support from family, friends and long-term care (LTC) services. As a result, while LTC services are delivered to younger disabled groups, the majority of LTC recipients are older people. On average across the OECD, 13% of people over 65 receive long-term care (). The proportion of over-65s receiving long-term care varies from 2% in Portugal and 6% in Estonia to more than 20% in Israel and Switzerland.

    • Informal carers

      Family and friends are the most important source of care for people with long-term care (LTC) needs in OECD countries. Because of the informal nature of care that they provide, it is not easy to get comparable data on the number of people caring for family and friends across countries, nor on the frequency of their caregiving. 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.

    • Long-term care workers

      Long-term care (LTC) is a labour-intensive service. Formal LTC workers are defined as paid staff, typically nurses and personal carers, providing care and/or assistance to people limited in their daily activities at home or in institutions, excluding hospitals. Formal care is complemented by informal, usually unpaid, support from family and friends, which accounts for a large part of care for older people in all OECD countries (see indicator on “Informal carers”).

    • 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 expenditure

      Long-term care (LTC) spending has seen the highest growth across the various functions (see Indicator on “Health expenditure by type of service”) and is expected to rise further in the coming years. Population ageing leads to more people needing ongoing health and social care; rising incomes increase expectations on the quality of life in old age; the supply of informal care is potentially shrinking; and productivity gains are difficult to achieve in such a labour-intensive sector. All these factors create upward pressures on spending.

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