Health spending and outcomes: Trends in OECD countries, 1960-1998

Health Affairs

Volumn 19, Issue 3, 2000, Pages 150-157

  Anderson, Gerard F ^a,b   Hurst, Jeremy ^c   Hussey, Peter Sotir ^c   Jee Hughes, Melissa ^c  

^a JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH   (United States)

^b Johns Hopkins Ctr Hosp Fin/Mgmt   (United States)

^c OECD   (France)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; COMPARATIVE STUDY; DEVELOPED COUNTRY; ECONOMICS; HEALTH CARE COST; OUTCOME ASSESSMENT; STATISTICS;

DEVELOPED COUNTRIES; HEALTH EXPENDITURES; OUTCOME ASSESSMENT (HEALTH CARE);

EID: 0034183185     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.19.3.150     Document Type: Article

References (32)

1. Organization for Economic Cooperation and Development, OECD Health Data 99: A Comparative Analysis of Twenty-nine Countries (Paris: OECD, 1999). This report can be obtained from the OECD Information Center, Suite 605,2001L Street, N.W., Washington, DC 20036-4922, tel.: 202-785-6323; fax: 202-785-0350; e-mail: washcont@oecd.org. Some of the data presented here are updated from the initial release, which is available on CD-ROM (see www.oecd.org/els/health/software99.htm). Some of the expenditure figures for 1997 are estimates. All expenditure figures for 1998 are projections of the OECD Secretariat.
2. G.F. Anderson and J.P. Poullier, "Health Spending, Access, and Outcomes: Trends in Industrialized Countries," Health Affairs (May/June 1999): 178-187; and G.F. Anderson, "In Search of Value: An International Comparison of Cost, Access, and Outcomes," Health Affairs (Nov/Dec 1997): 163-171.
3. G.F. Anderson and J.P. Poullier, "Health Spending, Access, and Outcomes: Trends in Industrialized Countries," Health Affairs (May/June 1999): 178-187; and G.F. Anderson, "In Search of Value: An International Comparison of Cost, Access, and Outcomes," Health Affairs (Nov/Dec 1997): 163-171.
4. All spending data were adjusted for cost-of-living differences to U.S. dollars using purchasing power parities (PPPs). PPPs are based on the cost of an identical basket of goods in each country (broad-based, not limited to health). Countries included in the calculation of the median were Australia, Austria, Belgium, Canada, the Czech Republic, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Japan, Luxembourg, the Netherlands, New Zealand, Norway, Spain, Sweden, Switzerland, the United Kingdom, and the United States.
5. See, for example, R.E. Leu, "The Public-Private Mix and International Health Care Costs," in Public and Private Health Services, ed. A.J. Culyer and B. Jonsson (Oxford: Basil Blackwell, 1986), 41-62; and P. Barros, "The Black Box of Health Care Expenditure Growth Determinants," Health Economics 7, no. 6 (1998): 533-544.
6. See, for example, R.E. Leu, "The Public-Private Mix and International Health Care Costs," in Public and Private Health Services, ed. A.J. Culyer and B. Jonsson (Oxford: Basil Blackwell, 1986), 41-62; and P. Barros, "The Black Box of Health Care Expenditure Growth Determinants," Health Economics 7, no. 6 (1998): 533-544.
7. In some countries it is difficult to disentangle hospital and physician expenditures because physicians are paid by the hospital. No data on spending for physician services are available for Belgium, the Czech Republic, Finland, Ireland, Norway, and Spain. The calculation of the median does not include these countries.
8. Anderson and Poullier, "Health Spending."
9. Data from Luxembourg should be viewed cautiously, because the country is much smaller than most of the others in the comparison and because there is considerable cross-border provision of medical care, which is difficult to trace.
10. Time-series data on health expenditures presented in Exhibit 1 differ from the values presented in past papers in this series because they have been adjusted for inflation to 1998 dollars using the Consumer Price Index. Also, some countries have updated their information.
11. From 1994 to 1995 real health expenditures grew 2.4 percent in the OECD median and 1.0 percent in the United States; from 1995 to 1996, 1.4 percent in the median and 1.0 percent in the United States; from 1996 to 1997, 5.0 percent in the median and 1.9 percent in the United States; and from 1997 to 1998, 3.4 percent in the median and 2.7 percent in the United States.
12. Health spending per capita is associated with GDP per capita, so differences in the growth of GDP per capita between the United States and the median could explain some of the differences in growth of health spending per capita. Real growth in GDP per capita was 1.8 percent per year in the United States between 1965 and 1980, compared with 0.9 percent per year in the median. It was 1.4 percent per year between 1980 and 1994 in the United States, compared with 0.8 percent in the median. Since the difference was roughly the same between 1965 and 1980 as between 1980 and 1994, that suggests that this is not the reason for the differences in growth of health spending in these periods. Real growth in GDP per capita was calculated using data from the OECD database on GDP per capita adjusted for inflation to 1995 currency units by the GDP price deflator, then adjusted by economywide PPPs.
13. Anderson and Poullier, "Health Spending."
14. Ibid. Japan has more MRIs and CT scanners per capita than the United States has.
15. Ibid.
16. K.G. Manton and J.W. Vaupel, "Survival after the Age of 80 in the United States, Sweden, France, England, and Japan," New England Journal of Medicine (2 November 1995): 1232-1235.
17. M. McClellan and D. Kessler, eds., A Global Analysis of Technological Change in Health Care: Heart Attacks (Ann Arbor, Mich.: University of Michigan Press, forthcoming); and J. Tu et al., "Use of Cardiac Procedures and Outcomes in Elderly Patients with Myocardial Infarction in the United States and Canada," New England Journal of Medicine (22 May 1997): 1500-1505.
18. M. McClellan and D. Kessler, eds., A Global Analysis of Technological Change in Health Care: Heart Attacks (Ann Arbor, Mich.: University of Michigan Press, forthcoming); and J. Tu et al., "Use of Cardiac Procedures and Outcomes in Elderly Patients with Myocardial Infarction in the United States and Canada," New England Journal of Medicine (22 May 1997): 1500-1505.
19. See M.J. Quinn et al., "Variations in Survival from Breast Cancer in Europe by Age and Country, 1978-1989," European Journal of Cancer 34, no. 14 (1998): 2204-2211; R. Supramaniam et al., Survival from Cancer in New South Wales in 1980 to 1995 (Sydney: NSW Cancer Council, 1998); SEER Cancer Statistics Review 1973-1996, National Cancer Institute, online at www-seer.ims.nci.nih.gov; and H. Tsukuma et al., "Statistics on Survival from Osaka Cancer Registry," Japanese Journal of Cancer Research 89, no. 10 (1998). For health expenditure per capita, 1989 figures from OECD Health Data are used for all countries except Poland, where 1990 data are shown. For the United Kingdom, health expenditure data are for the United Kingdom, whereas survival data are for England only.
20. See M.J. Quinn et al., "Variations in Survival from Breast Cancer in Europe by Age and Country, 1978-1989," European Journal of Cancer 34, no. 14 (1998): 2204-2211; R. Supramaniam et al., Survival from Cancer in New South Wales in 1980 to 1995 (Sydney: NSW Cancer Council, 1998); SEER Cancer Statistics Review 1973-1996, National Cancer Institute, online at www-seer.ims.nci.nih.gov; and H. Tsukuma et al., "Statistics on Survival from Osaka Cancer Registry," Japanese Journal of Cancer Research 89, no. 10 (1998). For health expenditure per capita, 1989 figures from OECD Health Data are used for all countries except Poland, where 1990 data are shown. For the United Kingdom, health expenditure data are for the United Kingdom, whereas survival data are for England only.
21. See M.J. Quinn et al., "Variations in Survival from Breast Cancer in Europe by Age and Country, 1978-1989," European Journal of Cancer 34, no. 14 (1998): 2204-2211; R. Supramaniam et al., Survival from Cancer in New South Wales in 1980 to 1995 (Sydney: NSW Cancer Council, 1998); SEER Cancer Statistics Review 1973-1996, National Cancer Institute, online at www-seer.ims.nci.nih.gov; and H. Tsukuma et al., "Statistics on Survival from Osaka Cancer Registry," Japanese Journal of Cancer Research 89, no. 10 (1998). For health expenditure per capita, 1989 figures from OECD Health Data are used for all countries except Poland, where 1990 data are shown. For the United Kingdom, health expenditure data are for the United Kingdom, whereas survival data are for England only.
22. See M.J. Quinn et al., "Variations in Survival from Breast Cancer in Europe by Age and Country, 1978-1989," European Journal of Cancer 34, no. 14 (1998): 2204-2211; R. Supramaniam et al., Survival from Cancer in New South Wales in 1980 to 1995 (Sydney: NSW Cancer Council, 1998); SEER Cancer Statistics Review 1973-1996, National Cancer Institute, online at www-seer.ims.nci.nih.gov; and H. Tsukuma et al., "Statistics on Survival from Osaka Cancer Registry," Japanese Journal of Cancer Research 89, no. 10 (1998). For health expenditure per capita, 1989 figures from OECD Health Data are used for all countries except Poland, where 1990 data are shown. For the United Kingdom, health expenditure data are for the United Kingdom, whereas survival data are for England only.
23. A significant linear regression line can be fitted to these data. However, difficulties exist in interpreting them on an international level. First, collection of survival data in cancer registries differs. The EUROCARE study has presented comparable data on survival rates for European countries. However, caution should be used when comparing the United States, Australia (New South Wales), and Japan among each other and with European countries. Second, different time periods are presented for each country. EUROCARE data represent female breast cancer cases diagnosed between 1985 and 1989. U.S. data come from the SEER registry and represent female cases diagnosed between 1986 and 1991. Japanese data come from the Osaka Cancer Registry representing female cases diagnosed between 1987 and 1989. Australian data come from New South Wales and represent female cases diagnosed between 1988 and 1995. Because survival rates have been increasing over time, rates from earlier time periods may be less than they would have been in more recent periods. Third, variations in screening levels may affect the date of diagnosis as well as survival.
24. The OECD project on Ageing-Related Diseases will collect cross-national data on treatment, costs, and outcomes as well as qualitative data on economic incentives and institutional characteristics, to investigate the causes and consequences of variations in treatments for a selection of diseases affecting the elderly across OECD countries. This project has been initiated and funded by the National Institute on Aging (IAG Y1-AG-8363-01) and is being developed in close collaboration with the National Bureau of Economic Research (NBER).
25. K. Donelan et al., "The Cost of Health System Change: Public Discontent in Five Nations," Health Affairs (May/June 1999): 206-216.
26. See, for example, R.J. Carrol et al., "International Comparison of Waiting Times for Selected Cardiovascular Procedures," Journal of the American College of Cardiology 25, no. 3 (1995): 557-563; S. Silber et al., "Mortality and the Length of Stay on the Waiting List for Coronary Artery Bypass Survery: The Munich Experience," Herz 21, no. 6 (1996): 389-396 (in German); S.J. Bernstein et al., "Waiting for Coronary Revascularization: A Comparison between New York State, the Netherlands, and Sweden," Health Policy 42, no. 1 (1997): 15-27; and M.A. Fitzpatrick, "Audit of Prioritisation for Coronary Revascularisation Procedures: Implications for Rationing," New Zealand Medical Journal 105, no. 932 (1992): 145-147.
27. See, for example, R.J. Carrol et al., "International Comparison of Waiting Times for Selected Cardiovascular Procedures," Journal of the American College of Cardiology 25, no. 3 (1995): 557-563; S. Silber et al., "Mortality and the Length of Stay on the Waiting List for Coronary Artery Bypass Survery: The Munich Experience," Herz 21, no. 6 (1996): 389-396 (in German); S.J. Bernstein et al., "Waiting for Coronary Revascularization: A Comparison between New York State, the Netherlands, and Sweden," Health Policy 42, no. 1 (1997): 15-27; and M.A. Fitzpatrick, "Audit of Prioritisation for Coronary Revascularisation Procedures: Implications for Rationing," New Zealand Medical Journal 105, no. 932 (1992): 145-147.
28. See, for example, R.J. Carrol et al., "International Comparison of Waiting Times for Selected Cardiovascular Procedures," Journal of the American College of Cardiology 25, no. 3 (1995): 557-563; S. Silber et al., "Mortality and the Length of Stay on the Waiting List for Coronary Artery Bypass Survery: The Munich Experience," Herz 21, no. 6 (1996): 389-396 (in German); S.J. Bernstein et al., "Waiting for Coronary Revascularization: A Comparison between New York State, the Netherlands, and Sweden," Health Policy 42, no. 1 (1997): 15-27; and M.A. Fitzpatrick, "Audit of Prioritisation for Coronary Revascularisation Procedures: Implications for Rationing," New Zealand Medical Journal 105, no. 932 (1992): 145-147.
29. See, for example, R.J. Carrol et al., "International Comparison of Waiting Times for Selected Cardiovascular Procedures," Journal of the American College of Cardiology 25, no. 3 (1995): 557-563; S. Silber et al., "Mortality and the Length of Stay on the Waiting List for Coronary Artery Bypass Survery: The Munich Experience," Herz 21, no. 6 (1996): 389-396 (in German); S.J. Bernstein et al., "Waiting for Coronary Revascularization: A Comparison between New York State, the Netherlands, and Sweden," Health Policy 42, no. 1 (1997): 15-27; and M.A. Fitzpatrick, "Audit of Prioritisation for Coronary Revascularisation Procedures: Implications for Rationing," New Zealand Medical Journal 105, no. 932 (1992): 145-147.
30. 2 of 0.88.
31. Donelan et al., "The Cost of Health System Change."
32. 2 was 0.72.