Health spending, access, and outcomes: Trends in industrialized countries

Health Affairs

Volumn 18, Issue 3, 1999, Pages 178-192

  Anderson, Gerard F ^a   Poullier, Jean Pierre ^b  

^a JOHNS HOPKINS UNIVERSITY   (United States)

^b WORLD HEALTH ORGANIZATION   (Switzerland)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; COMPARATIVE STUDY; DEVELOPED COUNTRY; DRUG COST; EUROPE; HEALTH CARE COST; HEALTH CARE DELIVERY; HEALTH INSURANCE; HEALTH SURVEY; HOSPITAL COST; HUMAN; INFORMATION PROCESSING; INSURANCE; OUTCOME ASSESSMENT; STATISTICS; UNITED STATES;

DATA COLLECTION; DEVELOPED COUNTRIES; DRUG COSTS; EUROPE; HEALTH EXPENDITURES; HEALTH SERVICES ACCESSIBILITY; HEALTH STATUS INDICATORS; HOSPITAL COSTS; HUMANS; INSURANCE COVERAGE; INSURANCE, HEALTH; OUTCOME ASSESSMENT (HEALTH CARE); UNITED STATES;

EID: 0041341376     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.18.3.178     Document Type: Article

References (29)

1. OECD Health Data 98: A Comparative Analysis of Twenty-nine Countries can be obtained by contacting the OECD Information Center, Suite 605, 2001 L Street, NW, Washington, DC 20036-4922 (tel.: 202-785-6323, fax: 202-785-0350, e-mail: washington.contact@oecd.org). Some of the data presented here are updated from the initial release, which is available on CD-ROM.
2. PPPs are used to adjust for differences in cost of living across countries by comparing prices for a fixed basket of goods and services. The basket of goods and services used here is broad-based, not health-based.
3. Total health spending includes spending for hospitals, physicians, nursing homes, pharmaceuticals, therapeutic appliances, biomedical research and development, public health, administration, construction, and other services. International comparisons of health spending must recognize that countries include slightly different services in the health care sector and that numbers are continually being revised as new information becomes available. Some of the numbers for 1996 are estimates. All figures for 1997 are projections. For ranking purposes, data from recent years are sometimes substituted if data for the desired year are missing for a particular country, rather than omitting the country completely from the analysis. For example, PPPs have not been calculated for the Czech Republic, Hungary, and Poland for 1997, so the figures for per capita health spending for 1996 were used.
4. The median was chosen because it is less influenced by outliers than the mean is. The median is calculated based on the countries for which data are reported in that year. In some years that will not include all twenty-nine countries.
5. For example, the Maastricht Treaty requires countries to limit their public finance deficit to less than 3 percent of GDP for the country to be eligible for the Euro. This places considerable pressure on countries to control health spending to keep the public finance deficit low.
6. Change in the percentage of GDP spent on health care reflects the change in GDP as well as the change in health care spending. GDP grew in all OECD countries from 1960 to 1997, although at different rates. The countries with the most rapid growth in GDP in 1960-1997 were Greece, Ireland, and Turkey. Countries with relatively slow growth were Sweden, Switzerland, and the United Kingdom. The OECD median growth in GDP was seventeenfold. The rate of growth of GDP in the United States was fourteenfold, or twentieth of twenty-four countries during the time period.
7. Growth in GDP could not be calculated for the Czech Republic, Hungary, Korea, Mexico, and Poland.
8. Current Population Reports, Series P60-202 (Washington: U.S. Bureau of the Census, September 1998).
9. This may be an accounting issue for Austria. An upward revision is likely, expected to bring Austria into the 40 percent range.
10. In Canada the inpatient admission rate declined from 15 percent of the population in 1960 to 11 percent in 1996. In the United States the decline was from 13.9 percent to 12.2 percent. Inpatient admissions data were available for fourteen countries for 1960 and 1995 or 1996.
11. A portion of the variation in length-of-stay could be attributable to differences in how hospitals are defined.
12. Part of the explanation for the much longer average length-of-stay in Japan is the lack of a fully developed nursing home industry. Among the countries reporting data on nursing home beds, Japan has one of the lowest numbers of nursing home beds per capita. As a result, patients requiring long-term care may be treated in acute care hospitals. In Japan 45 percent of inpatients over age sixty-five remain in the hospital for more than six months. See N. Ikegami,
13. "Overview: Health Care in Japan," in Containing Health Care Costs in Japan, ed. N. Ikegami and J.C. Campbell (Ann Arbor, Mich.: University of Michigan Press, 1996), 9.
14. J.P. Newhouse, "An Iconoclastic View of Health Cost Containment," Health Affairs (Supplement 1993): 152-171.
15. Sometimes the figures reflect total employees and not FTE employees per bed.
16. In most countries hospital-based physicians are salaried employees of the hospital, and their costs cannot be separated from the other expenditures. Only the United States separates physician fees from other hospital spending when a patient is treated in the hospital. If physician fees were included in hospital expenditures, hospital spending per capita and per day would be even higher.
17. Denmark's hospital expenditures per day may be high because nursing homes were not included in some calculations. The OECD definition of inpatient includes nursing homes.
18. Physician income after practice expenses and malpractice insurance but before Income tax.
19. For more detailed information, contact Gerard Anderson, Johns Hopkins University, Center for Hospital Finance and Management, 624 North Broadway, Baltimore, Maryland 21205.
20. W.B. Weeks et al., "A Comparison of the Educational Costs and Incomes of Physicians and Other Professionals," New England Journal of Medicine 330, no. 18 (1994): 1280-1286.
21. The United States had the highest level of income inequality of fifteen OECD countries as measured by the Gini index. A.B. Atkinson, L Rainwater, and T.M. Smeeding, Income Distribution in OECD Countries: Evidence from the Luxembourg Income Study (Paris: OECD, 1995), 46.
22. D.A. Kindig, Purchasing Population Health; Paying for Results (Ann Arbor, Mich.: University of Michigan Press, 1997).
23. See, for example, M. Weinstein and W. Stason, "Foundations of Cost-Effectiveness Analysis for Health and Medical Practices," New England" Journal of Medicine 296, no. 13 (1977): 716-721; and C.J.L. Murray, "Quantifying the Burden of Disease: The Technical Basis for Disability-Adjusted life Year," Bulletin of the World Health Organization 72, no. 3 (1994): 429-445.
24. See, for example, M. Weinstein and W. Stason, "Foundations of Cost-Effectiveness Analysis for Health and Medical Practices," New England" Journal of Medicine 296, no. 13 (1977): 716-721; and C.J.L. Murray, "Quantifying the Burden of Disease: The Technical Basis for Disability-Adjusted life Year," Bulletin of the World Health Organization 72, no. 3 (1994): 429-445.
25. J. Ware, "The Status of Health Assessment in 1994," Annual Review of Public Health 16 (1995): 327-354; and D. Patrick and M. Bergner, "The Measurement of Health Status in the 1990s," Annual Review of Public Health 11 (1990): 165-183.
26. J. Ware, "The Status of Health Assessment in 1994," Annual Review of Public Health 16 (1995): 327-354; and D. Patrick and M. Bergner, "The Measurement of Health Status in the 1990s," Annual Review of Public Health 11 (1990): 165-183.
27. N. Roos et al., "Population Health and Health Care Use: An Information System for Health Policy Makers," Milbank Memorial Fund Quarterly 74, no. 1 (1996): 3-29. The United Kingdom is piloting an information system that will allow comparison of health status along a number of dimensions. Other attempts are under way in Australia, Canada, the Netherlands, New Zealand, and other countries.
28. Life expectancy at age sixty-five is probably lower in Turkey, where it is not calculated.
29. The OECD defines potential years of life lost (PYLL) as a summary measure of premature mortality that provides an explicit way of weighting deaths occurring at younger ages that are considered preventable. The calculation for PYLL involves adding up deaths occurring at each age and multiplying this by the number of remaining years to live until a selected age limit. A limit of seventy years was chosen for the calculations in OECD Health Data 98.