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• Foreword

  This 2015 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. For a subset of indicators, it also reports data for partner countries, including Brazil, China, Columbia, Costa Rica, India, Indonesia, Latvia, Lithuania, the Russian Federation and South Africa. This edition includes two new features: a set of dashboard indicators on health and health systems, presented in , summarising the comparative performance of OECD countries, and a special chapter on recent trends in pharmaceutical spending across OECD countries, presented in .

• Executive Summary

  Health at a Glance 2015 presents cross-country comparisons of the health status of populations and the performance of health systems in OECD countries, candidate countries and key emerging economies. This edition offers two new features: a set of dashboard indicators on health outcomes and health systems (presented in ), which summarise the comparative performance of OECD countries; and a special chapter on recent trends in pharmaceutical spending across OECD countries. The key findings of this publication are as follows.

• Reader's guide

  Health at a Glance 2015 presents comparisons of key indicators of health and health system performance across the 34 OECD countries, as well as for candidate and key partner countries where possible (Brazil, China, Colombia, Costa Rica, India, Indonesia, Latvia, Lithuania, the Russian Federation and South Africa). The data presented in this publication come mainly from official national statistics, unless otherwise indicated.

• Dashboards of health indicators

  This chapter presents, for the first time, a set of dashboards which are designed to shed light on how well OECD countries do in promoting the health of their population and improving their health system performance. These dashboards do not have the ambition of identifying which countries have the best health system overall. They summarise some of the relative strengths and weaknesses of countries on a selected set of indicators on health and health system performance, to help identify possible priority areas for actions. These dashboards, which take the form of summary tables, highlight how well OECD countries are doing along five dimensions: 1) health status; 2) risk factors to health; 3) access to care; 4) quality of care; and 5) health care resources. For each of these five dimensions, a selected set of key indicators are presented. The selection of these indicators is based on three main criteria: 1) policy relevance; 2) data availability; and 3) data interpretability (i.e., no ambiguity that a higher/lower value means a better/worse performance). There is, however, one exception to the application of this third criterion: for the fifth dashboard on health care resources, more health spending or more human or physical resources does not necessarily mean better performance. This is why the ranking of countries is displayed differently.

• Pharmaceutical spending trends and future challenges

  Across OECD countries, pharmaceutical spending reached around USD 800 billion in 2013, accounting for about 20% of total health spending on average when pharmaceutical consumption in hospital is added to the purchase of pharmaceutical drugs in the retail sector. This chapter looks at recent trends in pharmaceutical spending across OECD countries. It examines the drivers of recent spending trends, highlighting differences across therapeutic classes. It shows that while the consumption of medicines continues to increase and to push pharmaceutical spending up, cost-containment policies and patent expiries of a number of top-selling products have put downward pressure on pharmaceutical prices in recent years. This resulted in a slower pace of growth over the past decade. The chapter then looks at emerging challenges for policy makers in the management of pharmaceutical spending. The proliferation of high-cost specialty medicines will be a major driver of health spending growth in the coming years. While some of these medicines bring great benefits to patients, others provide only marginal improvements. This challenges the efficiency of pharmaceutical spending.

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• Expand / Collapse Hide / Show all Abstracts Health status

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  • Life expectancy at birth

    Life expectancy at birth continues to increase steadily in OECD countries, going up on average by 3 to 4 months each year, with no sign of slowing down. These gains in longevity can be attributed to a number of factors including improved lifestyle and better education, and progress in health care.

  • 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 83.1 years in 2013, compared with 77.8 years for men, a gap of 5.3 years ().

  • Mortality from cardiovascular diseases

    Despite substantial declines in recent decades, cardiovascular diseases remain the main cause of mortality in most OECD countries, accounting for nearly one-third (32.3%) of all deaths in 2013. Prospects for further reductions may be hampered by a rise in certain risk factors such as obesity and diabetes (OECD, 2015). Cardiovascular diseases cover a range of illnesses related to the circulatory system, including ischemic heart disease (often referred to as heart attack) and cerebrovascular diseases such as stroke.

  • Mortality from cancer

    Cancer is the second leading cause of mortality in OECD countries after cardiovascular diseases, accounting for 25% of all deaths in 2013, up from 15% in 1960. In a number of countries, cancer is now the most frequent cause of death. The rising share of deaths due to cancer reflects the fact that mortality from other causes, particularly cardiovascular diseases, has been declining more rapidly than mortality from cancer.

  • Mortality from transport accidents

    Injuries from transport accidents – most of which are due to road traffic – are a major public health problem in OECD countries, causing the premature deaths of more than 100 000 people in 2013 (more than 1% of all deaths). Almost three-quarters of these deaths occurred among men. In addition, more than 5 million people were injured in road accidents. The direct and indirect financial costs of transport accidents are substantial, with estimates ranging from 1 to 3% of GDP annually (OECD/ITF, 2015).

  • Suicide

    Suicide is a significant cause of death in many OECD countries, accounting for over 150 000 deaths in 2013. A complex set of reasons may explain why some people choose to attempt or commit suicide. A high proportion of people who have attempted or committed suicide are suffering from psychiatric disorders such as severe depression, bipolar disorder and schizophrenia. The social context in which an individual lives is also important. Low income, alcohol and drug abuse, unemployment and social isolation are all associated with higher rates of suicide.

  • Infant mortality

    Infant mortality, the rate at which babies and children of less than one year of age die, reflects the effect of economic and social conditions on the health of mothers and newborns, the social environment, individual lifestyles as well as the characteristics and effectiveness of health systems.

  • Infant health: Low birth weight

    Low birth weight – defined as newborns weighing less than 2 500 grams – is an important indicator of infant health because of the close relationship between birth weight and infant morbidity and mortality. There are two categories of low birth weight babies: those occurring as a result of restricted foetal growth and those resulting from pre-term birth. Low birth weight infants have a greater risk of poor health or death, require a longer period of hospitalisation after birth, and are more likely to develop significant disabilities. Risk factors for low birth weight include maternal smoking, excessive alcohol consumption, poor nutrition, low body mass index, lower socio-economic status, and having had in-vitro fertilisation treatment and multiple births.

  • 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).

  • 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).

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• Expand / Collapse Hide / Show all Abstracts Non-medical determinants of health

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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, 2015). Tobacco is a major risk factor for at least two of the leading causes of premature mortality – cardiovascular diseases and cancer, increasing the risk of heart attack, stroke, lung cancer, cancers of the larynx and mouth, and pancreatic cancer, among others. In addition, it is a dominant contributing factor for respiratory diseases such as chronic obstructive pulmonary disease (US DHHS, 2014). Smoking in pregnancy can lead to low birth weight and illness among infants. Smoking remains the largest avoidable risk factor for health in OECD countries and worldwide.

  • 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, 2014; OECD, 2015). 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. The use of alcohol is estimated to cause more than 3.3 million deaths worldwide per year, and accounts for 5.1% of the global burden of disease (WHO, 2014). Health care costs associated with excessive drinking in the United States are estimated at USD 25.6 billion (Bouchery et al., 2011). 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, 2012). The use of alcohol also has broader societal consequences, accounting for large losses in work productivity through absenteeism and premature mortality, as well as injuries and death among non-drinkers (e.g. because of traffic accidents caused by drivers under the influence of alcohol).

  • Fruit and vegetable consumption among adults

    Nutrition is an important determinant of health. Insufficient consumption of fruit and vegetables is one factor that can play a role in increased risk of morbidity (Bazzano et al., 2003; Riboli and Norat, 2003). Food insecurity, that is the inability to afford enough food for a healthy and active life, is also associated with adverse health effects (Seligman et al., 2010). 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.

  • Obesity among adults

    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. The rise in overweight and obesity is a major public health concern, threatening progress in tackling cardiovascular diseases (OECD, 2015).

  • 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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• 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 countries. In 2013, Greece had the highest number (with 6.3 doctors per 1 000 population), followed by Austria. Turkey and Chile had the lowest number among OECD countries, with slightly less than two doctors per 1 000 population. The OECD average was just over three doctors per 1 000 population. The number of doctors per capita is much lower in some partner countries. 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 significantly since 2000 ().

  • 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 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 that the retirement of doctors often only occurs gradually and that their retirement age is increasing (Pong, 2011). The rising share of female doctors may affect the overall supply of medical 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. 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, forthcoming), but large variations remain across countries.

  • International migration of doctors

    The international migration of doctors and other health workers is not a new phenomenon, but has drawn a lot of attention in recent years because of concerns that it might exacerbate shortages of skilled health workers in certain countries, particularly in some developing countries that are already suffering from critical workforce shortages. 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.

  • 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.

  • 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.

  • 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, forthcoming). 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, as well as the future employment prospects of nurses.

  • International migration of nurses

    In nearly all OECD countries, the proportion of foreign-trained nurses is much lower than that of foreign-trained doctors. However, given that the overall number of nurses is usually much greater than the number of doctors, the absolute number of foreign-trained nurses tends to be greater than that of foreign-trained doctors (OECD, forthcoming).

  • 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 direct impact on costs, as wages represent one of the main spending items in health systems.

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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 countries (e.g., Denmark, Italy, Netherlands, Norway, Portugal, 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, 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 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 measure of the resources available for delivering services to inpatients in hospitals. This section presents data on the number of hospital beds overall and for different types of care (curative care, psychiatric care, long-term care and other functions). It also includes an indicator of bed occupancy rates focussing on curative care beds.

  • Hospital discharges

    Hospital discharge rates measure the number of patients who leave a hospital after 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 (ALOS) is often regarded as an indicator of efficiency. All other things being equal, a shorter stay will reduce the cost per discharge and shift care from inpatient to less expensive post-acute settings. However, shorter stays tend to be more service intensive and more costly per day. Too short a length of stay could also cause adverse effects on health outcomes, or reduce the comfort and recovery of the patient. If this leads to a greater readmission rate, costs per episode of illness may fall only slightly, or even rise.

  • Cardiac procedures

    Heart diseases are a leading cause of hospitalisation and death in OECD countries (see indicator on Mortality from cardiovascular diseases in ). 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.

  • 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.

  • Caesarean sections

    Rates of caesarean delivery have increased 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 preferences of some women to have a caesarean section. 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 delivery 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 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 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 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 interventions.

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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. However, the percentage of the population covered by such insurance 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 medical care and dental care

    Access to health care may be prevented for a number of reasons related either to the functioning of the health care system itself (like the cost of a doctor visit or medical treatment, the distance to the closest health care facility, or waiting lists) or to personal reasons (like 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 jeopardize their health status. Any inequalities in unmet care needs may result in poorer health status and increase health inequalities.

  • 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 face difficulties paying medical bills may delay or even forgo needed health care. On average across OECD countries, 19% of health spending is paid directly by patients (see indicator Financing of health care in on Health expenditure).

  • Geographic distribution of doctors

    Access to medical care requires an adequate number and proper distribution of doctors in all parts of the country. Any shortage of doctors in certain regions can increase travel times or waiting times for patients, and result in unmet care needs. The uneven distribution of doctors is an important policy issue 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.

  • Waiting times for elective surgery

    Long waiting times for health services is an important 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 Quality of care

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  • 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, as well as 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 lost. Across the OECD countries, diabetes is a leading cause of cardiovascular disease, blindness, kidney failure, and lower limb amputation. Globally it is estimated that over 380 million people had diabetes in 2014 and by 2035 it is projected that close to 600 million people will have the condition. Diabetes caused close to 5 million deaths in 2014 (IDF, 2014). Many countries have established comprehensive approaches to diabetes care, but there are indications that more can be done to prevent the disease (OECD, 2014). Cholesterol-lowering drugs and medications to reduce blood pressure are recommended in most national guidelines for the care of diabetes patients (see indicator Prescribing in primary care in )

  • Prescribing in primary care

    Beyond consumption and expenditure information (see ), prescribing can be used as an indicator of health care quality. 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. Their use should be restricted to ensure availability of effective second-line therapy should first-line antibiotics fail. Total volume of antibiotics prescribed, and second-line as a proportion of total volume, have been validated as markers of quality in the primary care setting. In May 2015, the World Health Assembly endorsed a global action plan to tackle antimicrobial resistance (http://who.int/drugresistance/global_action_plan), which is also reflected in several national strategies.

  • Mortality following acute myocardial infarction (AMI)

    Mortality due to coronary heart disease has declined substantially since the 1970s (see indicator Mortality from cardiovascular diseases in ). Advances in the prevention such as smoking (see indicator Tobacco consumption among adults in ) and treatment of cardiovascular diseases outpaced those of many other diseases (OECD, 2015a).

  • Mortality following stroke

    Stroke and other cerebrovascular diseases accounted for around 7% of all deaths in OECD countries in 2013. Ischemic stroke represented 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).

  • Waiting times for hip fracture surgery

    The main risk factors for hip fracture are associated with ageing – 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. High rates of error 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). Robust comparison of performance with peers is fundamental to securing improvement. Two types of patient safety event can be distinguished for this purpose: never events, those events that should never occur, such as failure to remove surgical foreign bodies at the end of a procedure; and adverse events, such as post-operative sepsis, which can not be avoided in all cases given the high-risk nature of some procedures, although increased incidence at an aggregate level may indicate a systemic problem.

  • Obstetric trauma

    Patient safety during childbirth can be assessed by looking at potentially avoidable tearing of the perineum during vaginal delivery. Tears that 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.

  • 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 (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 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 exposure to the human papilloma virus (HPV) through sexual activity (IARC, 2005).

  • Screening, survival and mortality for breast cancer

    Breast cancer is the most prevalent form of cancer in women across OECD countries. One in nine women will have 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 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. Colorectal cancer incidence is high in Korea, the Slovak Republic, Hungary, Denmark and the Netherlands at 40 or more cases per 100 000 population while it is low in Mexico, Greece, Chile and Turkey at less than half this rate. Incidence is significantly higher for men than women across countries. 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.

  • Childhood vaccination programme

    All OECD countries have established vaccination programmes based on their interpretation of the risks and benefits of each vaccine. show that the overall vaccination of children against measles and diphtheria, tetanus and pertussis (DTP) is high in OECD countries. On average, 95% of children receive the recommended DTP vaccination and 94% receive measles vaccinations in accordance with national immunisation schedules. Rates for DTP vaccinations are below 90% only in Indonesia, Austria, Mexico, India and South Africa. Rates for measles vaccinations are below 90% in Denmark, France, Mexico, Indonesia, Austria, India and South Africa.

  • Influenza vaccination for older people

    Influenza is a common infectious disease affecting 5%-10% of adults and 20%-30% of children. There are an estimated 3 to 5 million cases of severe influenza-related illness worldwide each year, and 250 000 to 500 000 deaths (WHO, 2014). Influenza can also have a major impact on health care systems. In the United States, it is estimated that each year, more than 200 000 people are hospitalised for respiratory and heart condition illnesses associated with seasonal influenza virus infections (Thompson et al., 2004). At certain times of the year, influenza can place health systems under significant stress. For example, in Ontario, Canada, the average annual rate of emergency department visits attributable to seasonal influenza is 500 per 100 000 population. This rate increased to an estimated 1 000 per 100 000 population during the H1N1 pandemic in 2009 (Schanzer et al., 2013).

  • 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 experience empowers patients and the public, involves them in decisions on health care delivery and governance, and provides insight into the extent to which they are health-literate and have control over the treatment they receive. Across countries, using the health care user as a direct source of information is becoming more prevalent for health system monitoring, planning and decision making, and efforts to measure and monitor patient experiences have actually led to health care quality improvements (Fujisawa and Klazinga, forthcoming).

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

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  • Health expenditure per capita

    The amount that each country spends on health, for both individual and collective services, and how this changes over time can be 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

    The change in how much a country spends on healthcare in relation to spending on all the other goods and services in the economy can depend on both fluctuations in the rate of health spending itself as well as growth in the economy as a whole. The 2000s were characterised by a period of health spending growth above that of the overall economy so that health expenditure as a share of GDP rose sharply in many OECD countries. However, the economic crisis that took hold in 2008 resulted in an initial rise followed by a reduction in the health spending to GDP ratio across many OECD countries.

  • Health expenditure by function

    Spending on inpatient care and outpatient care combined covers the major part of health expenditure across OECD countries – almost two-thirds of current health expenditure on average in 2013 (). A further 20% of health spending was allocated to medical goods (mainly pharmaceuticals), while 12% went towards long-term care and the remaining 6% on collective services, such as public health and prevention services as well as administration.

  • 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 mostly 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.

  • 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 impact of population ageing and changing disease patterns on spending. Furthermore, the linking of health expenditures 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).

  • Capital expenditure in the health sector

    Knowing how much a health system is investing in hospitals, medical technology and other equipment is very relevant for policy making and analysis. Although health systems remain a highly labour-intensive sector, capital has been increasingly important as a factor of production of health services over recent decades. This is illustrated, for example, by the growing importance of diagnostic and therapeutic equipment or the expansion of information, computer and telecommunications technology in health care over the last few years. The availability of statistics on capital expenditure is essential to the analysis of the health system’s production capacity (that is, whether capacity is appropriate, deficient or excessive), which is needed in turn to inform policy implementation (for example, if excess capacity exists, the marginal cost of expanding coverage will be lower than if the health care system is already straining to fill current demand).

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  • Pharmaceutical expenditure

    Pharmaceuticals play a vital role in the health system and policy makers must balance the access of patients to new effective medicines with limited health care budgets, while providing the right incentives to manufacturers to develop new generations of drugs. After inpatient and outpatient care, pharmaceuticals represent the third largest expenditure item of health care spending and accounted for more than a sixth (17%) of health expenditure on average across OECD countries in 2013, not taking into account spending on pharmaceuticals in hospitals.

  • Financing of pharmaceutical expenditure

    In all OECD countries, pharmaceuticals are financed by a mix of public and private spending. Tax-funded schemes or social health insurance cover a significant amount of prescribed pharmaceuticals in most countries, sometimes complemented by private health insurance. Patients typically have to cover some part of the cost of prescription drugs themselves, although exemptions often exist for vulnerable segments of the population such as children, the elderly and patients suffering from certain chronic illnesses. Over-the-counter (OTC) pharmaceuticals are normally financed entirely by private households.

  • Pharmacists and pharmacies

    Pharmacists assist people in obtaining medication and ensuring that these are used in a safe and proper fashion. The role of the pharmacists has changed over the recent years. Although their main role is still to dispense medications in community pharmacies, pharmacists are increasingly providing direct care to patients (e.g. flu vaccinations in Ireland), 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 demand 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. Consumption is measured in defined daily doses (DDD) (see the box on Definition and comparability).

  • Share of generic market

    All OECD countries see 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 2013, generics accounted for more than three-quarters of the volume of pharmaceuticals sold in the United States, the United Kingdom, Chile, Germany and New Zealand, while they represented less than one-quarter of the market in Luxembourg, Switzerland, Italy, and Greece.

  • Research and development in the pharmaceutical sector

    The pharmaceutical industry devotes significant resources to research and development (R&D). In 2011, the industry spent USD 92 billion on R&D (OECD, 2015). This represents 10-15% of industry revenues.

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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 Life expectancy indicator 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 5.5 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 (DeSalvo, 2005; Bond et al., 2006). 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, more than half of all LTC recipients are aged over 80 and nearly four in five are aged over 65 (). Rising life expectancies mean that older people make up an increasing proportion of the populations of OECD countries. The risk of dementia (see indicator on Dementia prevalence) and other debilitating conditions increases with age, so demand for LTC services is likely to increase – although this effect may be partially offset by improving health in old age. As a result, the average proportion of the population receiving LTC in OECD countries has risen from 1.9% in 2000 to 2.3% in 2013.

  • Informal carers

    Family and friends are the most important source of care for people with 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) expenditure has risen over the past few decades in most OECD countries and is expected to rise further in the coming years, with population ageing leading to more people needing ongoing health and social care, rising incomes leading to higher expectations of quality of life in old age, the supply of informal care potentially shrinking and productivity gains difficult to achieve in such a labour-intensive sector (De La Maisonneuve and Oliveira Martins, 2013).

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