« Health at a Glance 2 0 0 OECD INDICATORS 2005 5 Health Progress in health care and the development of new medicines have contributed to the steady improvements in health status that OECD countries have enjoyed in recent decades. At the same at a Glance time, spending on health care has never been higher, consuming an ever-increasing share of national income. Health expenditure now accounts for an average of almost 9% of GDP in OECD countries, up from around 7% in 1990 and just over 5% in 1970. In nearly all OECD countries, the public sector finances the greatest share of health spending. Faced with rising health costs, governments in many countries are seeking ways to slow the growth in public-sector spending while at the same time trying to get better value for money. OECD INDICATORS 2005 This third edition of Health at a Glance – OECD Indicators 2005 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, and in the costs, allocation of resources and outputs of health systems. Compared to the previous edition, it contains an expanded set of indicators related to health promotion and disease prevention, reflecting growing policy interest in striking a better balance between spending on prevention and care. Each indicator in the book is presented in a user-friendly format, consisting of charts illustrating H variations across countries and over time, brief commentaries highlighting the key findings conveyed E by the data, and a methodological box on the definition of the indicator. In addition, a statistical A L annex provides additional information for each indicator, often presenting long time series going as T H far back as 1960. A T This publication takes as its basis OECD Health Data 2005, the most comprehensive database A on health and health systems across the 30 OECD member countries. OECD Health Data 2005 is G available on line at www.SourceOECD.org or on CD-ROM from the OECD’s online bookshop L A (www.oecd.org/bookshop). N C E O E C D The full text of this book is available on line via this link: In d http://www.sourceoecd.org/socialissues/9264012621 i c a Those with access to all OECD books on line should use this link: t o http://www.sourceoecd.org/9264012621 r s 2 SourceOECD is the OECD’s online library of books, periodicals and statistical databases. For more information about 0 0 this award-winning service and free trials ask your librarian, or write to us at [email protected]. 5 www.oecd.org/health ISBN 92-64-01262-1 -:HSTCQE=UVW[WW: 2005 81 2005 17 1 P 2005 Health at a Glance OECD INDICATORS 2005 ORGANISATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT ORGANISATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT The OECD is a unique forum where the governments of 30 democracies work together to address the economic, social and environmental challenges of globalisation. The OECD is also at the forefront of efforts to understand and to help governments respond to new developments and concerns, such as corporate governance, the information economy and the challenges of an ageing population. The Organisation provides a setting where governments can compare policy experiences, seek answers to common problems, identify good practice and work to co-ordinate domestic and international policies. The OECD member countries are: Australia, Austria, Belgium, Canada, the Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Japan, Korea, Luxembourg, Mexico, the Netherlands, New Zealand, Norway, Poland, Portugal, the Slovak Republic, Spain, Sweden, Switzerland, Turkey, the United Kingdom and the United States. The Commission of the European Communities takes part in the work of the OECD. OECD Publishing disseminates widely the results of the Organisation’s statistics gathering and research on economic, social and environmental issues, as well as the conventions, guidelines and standards agreed by its members. This work is published on the responsibility of the Secretary-General of the OECD. The opinions expressed and arguments employed herein do not necessarily reflect the official views of the Organisation or of the governments of its member countries. Publié en français sous le titre: Panorama de la santé Les indicateurs de l'OCDE 2005 © OECD 2005 No reproduction, copy, transmission or translation of this publication may be made without written permission. Applications should be sent to OECD Publishing: [email protected] or by fax (33 1) 45 24 13 91. Permission to photocopy a portion of this work should be addressed to the Centre français d'exploitation du droit de copie, 20, rue des Grands-Augustins, 75006 Paris, France ([email protected]). FOREWORD Foreword H ealth expenditure now accounts for an average of almost 9% of GDP in OECD countries, up from just over 5% in1970; and more than 70% of these costs are paid by public sources. In this context, it is understandable that, at the first-ever meeting of OECD Health Ministers in May2004, there was general agreement that all OECD countries are facing major challenges to improve the efficiency and the financial sustainability of their health systems. Ministers also recognised that countries can only benefit from further experimentation to increase value for money spent on health, combined with performance measurement, benchmarking and sharing of information. The meeting of OECD Health Ministers concluded with a renewed mandate for the OECD to work with national administrations to ensure that the OECD health database is both timely and accurate. Ministers also supported the continued implementation of health accounts, with the goal being to ensure that national data supplied to all international organisations are based on a consistent health accounts framework. This third edition of Health at a Glance –OECD Indicators2005 presents a selection of key indicators on health and health systems contained in OECD Health Data2005.* It is designed to provide the basis for a better understanding of a range of factors which affect the health of populations and the performance of health systems in OECD countries, in an easily accessible way. This third edition updates a number of core indicators that featured in the first two editions, but also contains some new ones. In particular, it contains an expanded set of indicators related to health promotion and disease prevention, reflecting growing policy interest in these areas. The publication describes the main variations across countries and over time in these key indicators of health, drawing heavily on graphical illustrations. Care has also been taken to indicate precisely the definition of each indicator and to signal data comparability limitations. Production of OECD Health Data and this publication would not have been possible without the contribution of national data correspondents and health accounts experts in the 30OECD countries. The OECD gratefully acknowledges their effort to report most of the data and qualitative information contained in this publication. The OECD also acknowledges the contribution of other international organisations, especially the World Health Organisation and Eurostat, for sharing some of the data presented in this publication. This report was prepared by the OECD Health Division under the coordination of Gaetan Lafortune and David Morgan. Eva Orosz, Gaëlle Balestat, Michael de Looper (from the Australian Institute of Health and Welfare) and Olga Van der Sloot (from the Dutch Ministry of Health, Welfare and Sport) also contributed to this issue of Health at a Glance. Statistical assistance was provided by Gaëlle Balestat and Noura Takrouri. This publication benefited from many comments and suggestions by OECD colleagues, notably Francesca Colombo, Elizabeth Docteur, Martine Durand, Jeremy Hurst and Peter Scherer. * For more than a decade now, OECD Health Data has offered the most comprehensive source of comparable statistics on health and health systems among developed countries. The data collection on health expenditure and financing is increasingly relying on the OECD manual, A System of Health Accounts (OECD, 2000), thereby enhancing the availability and comparability of these data. OECD Health Data is an electronic database released annually on line and on a CD-Rom. Further information on accessing OECD Health Data can be obtained at www.oecd.org/health/healthdata. HEALTH AT A GLANCE: OECD INDICATORS 2005 – ISBN 92-64-01262-1 – © OECD 2005 3 TABLE OF CONTENTS TTaabbllee ooff CCoonntteennttss Reader’s Guide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Part I. Health Status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 1. Life expectancy at birth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 2. Life expectancy at age 65 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 3. Mortality, all causes and leading causes of death. . . . . . . . . . . . . . . . . . . . . . . . . . 22 4. Cardio-vascular diseases, mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 5. Cancer, mortality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 6. External causes of death. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 7. Infant mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 8. Infant health: low birth weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 9. Dental health among children. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Part II. Health Care Resources andUtilisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 1. Practising physicians. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 2. Practising nurses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 3. Remuneration of health professionals (physicians and nurses). . . . . . . . . . . . . . 42 4. Acute care hospital beds, availability and occupancy rates . . . . . . . . . . . . . . . . . 44 5. Medical technologies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 6. Consultations with doctors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 7. Childhood immunisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 8. Influenza immunisation among elderly people . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 9. Hospital discharges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 10. Average length of stay in hospitals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 11. Cardio-vascular procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 12. Caesarean sections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 13. Cataract surgeries, ambulatory and inpatient. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Part III. Health Expenditure andFinancing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 1. Health expenditure per capita. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 2. Health expenditure per capita, growth trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 3. Health expenditure in relation to gross domestic product (GDP). . . . . . . . . . . . . 70 4. Health expenditure by function. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 5. Pharmaceutical expenditure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 6. Sources of financing for health care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 HEALTH AT A GLANCE: OECD INDICATORS 2005 – ISBN 92-64-01262-1 – © OECD 2005 5 TABLE OF CONTENTS Part IV. Non-medical Determinants ofHealth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 1. Tobacco consumption. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 2. Alcohol consumption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 3. Food consumption. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 4. Overweight and obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Part V. Demographic and Economic Context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 1. Total population and population structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 2. Fertility rates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 3. Gross domestic product (GDP) and income inequality. . . . . . . . . . . . . . . . . . . . . . . 94 Bibliography. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Annex A. Statistical Annex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Annex B. Definition of Health Expenditure and Methodological Notes onDataComparability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 Annex C. List of Variables in OECD Health Data2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 Annex D. Disease and Injury Categories and ICD Codes. . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 This book has... StatLinks A service from OECD Publishing that delivers ExcelTM files from the printed page! Look for the StatLinks at the bottom right-hand corner of the tables and graphs in this book. To download the matching ExcelTM spreadsheet, just type the link into your internet browser, starting with the http://dx.doi.org prefix. If you’re reading the PDF e-book edition, and your pc is connected to the Internet, simply click on the link. You’ll find StatLinks appearing in more OECD books. 6 HEALTH AT A GLANCE: OECD INDICATORS 2005 – ISBN 92-64-01262-1 – © OECD 2005 READER’S GUIDE Reader’s Guide H ealth at a Glance– OECD Indicators2005 presents key health indicators in the form of text, charts and tables. The publication shows cross-country variations and trends over time in core indicators of health status, health systems and non-medical determinants of health, as well as background information on the demographic and economic context. It also provides a brief interpretation of these data. The statistical annex at the end of the publication offers additional data on these indicators. All data presented in this publication are based on OECD Health Data2005 (final update as of September2005), allowing users to replicate all the charts and tables. OECD Health Data itself is a comprehensive database covering over 1000statistical series on health and health systems across OECD countries. The database is the product of a longstanding collaborative effort between the OECD Health Division and national statistical offices. It comes with extensive documentation of indicator definitions, national sources and estimation methods. The structure of Health at a Glance generally follows that of OECD Health Data, although some parts of the database have been combined for the purpose of simplifying this publication. More details on the full content of OECD Health Data2005 are available in AnnexC and at www.oecd.org/health/healthdata. Text and charts Each of the 35topics covered in this publication is presented over two pages, displaying a brief commentary highlighting the key findings conveyed by the data, and a methodological box with the definition of the indicator and any significant national variations from that definition which might affect data comparability. On the facing page is a series of charts. These charts typically show current levels of the indicator, changes or trends over time. In some cases, these are complemented with an additional chart relating the indicator to another variable. Where an OECD average is included in a chart, it is the unweighted average of the countries presented, unless otherwise specified in the accompanying notes. Users should also refer to the corresponding tables for any further methodological information. Tables All tables are contained in the statistical annex (AnnexA) at the end of this publication. Where data for individual countries are not available for the years selected, the tables present the most recent data available, normally up to the previous or following three years. The tables contain a variety of summary statistics depending on the indicator. For the non-expenditure series, the consistent average refers to the unweighted average of only those countries for which data are available over all the considered time periods, in order to present information for a consistent group of countries over time. The number of HEALTH AT A GLANCE: OECD INDICATORS 2005 – ISBN 92-64-01262-1 – © OECD 2005 7 READER’S GUIDE countries included in the consistent average is noted in brackets, with those countries omitted from the average listed directly under the table. In addition to the consistent average, the latest average is presented in most cases, relating to the average for the latest year available only for as many countries as possible. Unless specified, this should be equal to the average shown in the corresponding bar chart. Finally, the median is also presented. By definition, half the countries have values that are greater than the median, and half have values that are lower than the median. Compared with averages, medians minimize the influence of outliers (countries with values either much greater or much smaller than others). Note that medians relate to the group of countries for which data is available in a given year (so they are not valid for comparisons over time). The expenditure tables present the unweighted average over time for a group of countries, as defined for the consistent average described above. Where appropriate, a weighted average is shown, taking into account the proportional size of each country, measured either in terms of population or GDP. Unless otherwise specified, expenditure data are presented in US dollars adjusted for purchasing power parities in order to remove the effect of differences in price levels between countries. For growth rates, nominal expenditures are deflated using suitable price indices. In the absence of widely available and reliable health price indices, an economy-wide (GDP) price index is used in this publication (see AnnexB for additional information regarding the use of purchasing power parities and real growth rates). Missing, not applicable or not available data are noted in the table by “..” and series breaks are marked by a “|” between columns. Any further methodological notesare included directly under the relevant table. Data limitations Limitations in data comparability are indicated both in the text (in the box related to “Definition and deviations”) as well as in footnotes to tables and charts. Readers should exercise particular caution when considering time trends for Germany. Data for Germany up to1990 generally refer to West Germany and data for subsequent years refer to unified Germany. Readers interested in using the data presented in this publication for further analysis and research are encouraged to consult the full documentation of definitions, sources and methods contained in OECD Health Data2005. OECD Health Data2005 can be ordered online at SourceOECD (www.sourceOECD.org) or through the OECD’s online bookshop (www.oecd.org/bookshop). StatLink This publication includes OECD’s unique Statlink service, enabling the reader to download the exact Excel™ versions of the tables and charts featured in Health at a Glance. The Statlink address is printed under each table and chart and behaves exactly like an Internet address. By typing or copying the Statlink address into an Internet browser, the user obtains the corresponding data in Excel™ format allowing further analysis and manipulation. Further information on the Statlink service is available on www.oecd.org/ statistics/statlink. 8 HEALTH AT A GLANCE: OECD INDICATORS 2005 – ISBN 92-64-01262-1 – © OECD 2005 ISBN 92-64-01262-1 Health at a Glance: OECD Indicators 2005 © OECD 2005 Executive Summary HEALTH AT A GLANCE: OECD INDICATORS 2005 – ISBN 92-64-01262-1 – © OECD 2005 9