Health at a glance 2015: OECD Indicators

1. Health at a Glance 2015
-
OECD Indicators
Released on November 4, 2015
http://www.oecd.org/health/healthataglance

2. Table of contents
1.Dashboards of health indicators
2.Pharmaceutical spending trends and future challenges
3.Health status
4.Risk factors for health
5.Health workforce
6.Health care activities
7.Access to care
8.Quality of care
9.Health expenditure and financing
10.Pharmaceutical sector
11.Ageing and long-term care
Information on data for Israel: http://oe.cd/israel-disclaimer

3. • Health status
• Risk factors for health
• Access to care
• Quality of care
• Health care resources
1. DASHBOARDS OF
HEALTH INDICATORS

4. Example of dashboard: Risk factors
All countries can achieve progress in certain areas
Top third performers.
Middle third performers.
Bottomthird performers.
Note: Countries are listed in alphabetical order. The number in the cell indicates the position of each country among all countries for
which data is available. For all these indicators, the top performers are countries with the lowest rates.
Indicator Smoking in adults Alcohol consumption Obesity in adults *
Overweight and obesity
in children **
Australia 4 22 30 * 20
Austria 26 34 8 14
Belgium 15 20 9 5
Canada 6 11 29 * 21
Chile 33 10 28 * 28
Czech Rep. 25 32 20 * 5
Denmark 12 17 10 23
Estonia 31 33 18 7
Finland 10 14 26 17
France 30 30 11 13
[…]
United Kingdom 20 19 27 * 32
United States 5 13 34 * 29
* Data on obesity in adults are based on measured height and weight for all the countries marked with an *. These result in more
accurate data and higher obesity rates compared with all other countries that are providing self-reported height and weight.
** Data on overweight or obesity in children are all based on measured data, but refer to different age groups across countries.
Source: Health at a Glance 2015.
Risk factors

5. Example of dashboard: Quality of care
No country is in top performer group for all indicators
Top third performers.
Middle third performers.
Bottomthird performers.
Note: Countries are listed in alphabetical order. The number in the cell indicates the position of each country among all countries for which data
is available. For the indicators of avoidable hospital admissions and case-fatality rates, the top performers are countries with the lowest rates.
Indicator
Asthma and
COPD hospital
admission
Diabetes
hospital
admission
Case-fatality for
AMI (admission-
based)
Case-fatality for
ischemic stroke
(admission-based)
Cervical cancer
survival
Breast cancer
survival
Colorectal
cancer survival
Australia 29 17 1 20 11 5 3
Austria 28 29 27 8 19 19 7
Belgium 16 20 19 20 16 12 4
Canada 18 10 11 26 12 8 13
Chile 6 27 31 16 25 23 n.a.
Czech Rep. 12 23 11 22 13 22 21
Denmark 26 14 7 17 5 11 18
Estonia 27 n.a. 28 29 8 25 22
Finland 10 15 9 4 6 4 7
France 7 21 17 13 n.a. n.a. n.a.
[…]
United Kingdom 22 5 20 19 22 21 20
United States 25 24 5 3 21 2 9
Source: Health at a Glance 2015.
Quality of care

6. • Pharmaceutical spending trends
• Trend in the generic market
2. PHARMACEUTICAL
SPENDING

7. The United States spends the most on pharmaceuticals, followed by
Japan, Greece and Canada
Source: OECD Health Statistics 2015, OECD
2013 (or nearest year)

8. Pharmaceutical spending has been cut
in many countries in recent years
Source: OECD Health Statistics 2015, OECD
Average annual growth in pharmaceutical and total health expenditure per capita, in real
terms, average across OECD countries, 1990 to 2013

9. Growth in the generic market has contributed to the reduction
in pharmaceutical spending…
Source: OECD Health Statistics 2015, OECD
Trend in share of generics in the reimbursed pharmaceutical market, selected countries,
2000 to 2013

10. … but the share of the generic market remains low in some countries
Source: OECD Health Statistics 2015, OECD
Share of generics in the total pharmaceutical market, 2013 (or nearest year)
1. Reimbursed pharmaceutical market. 2. Community pharmacy market.

11. • Life expectancy
• Health inequalities
3. HEALTH STATUS

12. Life expectancy at birth exceeds 80 years on average in OECD
countries – a gain of more than 10 years since 1970
Source: OECD Health Statistics 2015, OECD

13. High GDP per capita is associated with high life expectancy,
although many other factors play a role
2013 (or latest year)
Source: OECD Health Statistics 2015, OECD

14. There remains large gaps in life expectancy between
men and women in OECD countries: on average,
men live 5 years less than women
Source: OECD Health Statistics 2015, OECD
2013 (or nearest year)
Note: Countries are ranked in descending order of life expectancy for the whole population.

15. There are also large gaps in life expectancy by education
level: on average, people with the lowest level of education
live 6 years less than people with the highest level
Source: Eurostat database complemented with national data for Israel, Mexico and the Netherlands.
Gap in life expectancy at age 30 by sex and education level, 2012 (or latest year)
Note: The figures show the gap in the expected years of life remaining at age 30 between adults with the highest level (“tertiary
education”) and the lowest level (“below upper secondary education”) of education.

16. People in the highest income group are also
much more likely to report being in good health
than those in the lowest income group
Source: OECD Health Statistics 2015, OECD (EU-SILC for European countries).
2013 (or nearest year)
Note: Countries are ranked in descending order of perceived health status for the whole population.
1. Results for these countries are not directly comparable with those for other countries, due to methodological differences in the
survey questionnaire resulting in an upward bias. In Israel, data by income group relate to the employed population.

17. 4. RISK FACTORS FOR HEALTH
• Smoking
• Alcohol consumption
• Overweight and obesity among children
and adults

18. Smoking has declined in nearly all countries, although on
average one-fifth of adults still smoke across OECD countries
Source: OECD Health Statistics 2015, OECD
Change in daily smoking in adults, 2000 and 2013 (or nearest years)

19. Alcohol consumption has also declined
in many countries but not all
Source: OECD Health Statistics 2015, OECD; WHO for non-OECD countries.
Alcohol consumption among adults, 2000 and 2013 (or nearest years)

20. Overweight and obesity among children have risen in most
countries, increasing the risk of obesity in adulthood
Source: Currie et al. (2004); Currie et al. (2008); Currie et al. (2012)
Change in self-reported overweight among 15-year-olds, 2001-02, 2005-06 and 2009-10

21. Obesity among adults has increased in all OECD countries, one
in five adults are now obese in 12 OECD countries
1. Data are based on measurements rather than self-reported height and weight.
Source: OECD Health Statistics 2015, OECD

22. • Number of physicians and nurses
• Remuneration of physicians and
nurses
• International migration of physicians
and nurses
5. HEALTH WORKFORCE

23. The number of physicians per capita has increased
in nearly all OECD countries since 2000
1. Data include not only doctors providing direct care to patients, but also those working in the health sector as managers, educators, researchers,
etc. (adding another 5-10% of doctors).
2. Data refer to all doctors licensed to practice (resulting in a large over-estimation of the number of practising doctors in Portugal, of around 30%).
Practising doctors per 1 000 population, 2000 and 2013 (or nearest year)
Source: OECD Health Statistics 2015, OECD

24. Medical specialists greatly outnumber generalists
in most countries: there are more than
2 specialists per every generalist on average
1. Generalists include general practitioners/family doctors and other generalist (non-specialist) medical practitioners.
2. Specialists include paediatricians, obstetricians/gynaecologists, psychiatrists, medical, surgical and other specialists.
3. In Ireland and Portugal, most generalists are not GPs (“family doctors”), but rather non-specialist doctors working in hospitals or
other settings. In Portugal, there is some double-counting of doctors with more than one specialty.
Source: OECD Health Statistics 2015, OECD
Generalists and specialists as a share of all doctors, 2013 (or nearest year)

25. The remuneration of specialists has grown more rapidly
than that of generalists in many countries, but not all
Source: OECD Health Statistics 2015, OECD
Growth in the remuneration of GPs and specialists, 2005-13 (or nearest year)
1. The growth rate for the Netherlands and for Luxembourg is for self-employed GPs and specialists.

26. The number and share of foreign-trained doctors is high
in some OECD countries
1. In Germany and Spain, the data is based on nationality (or place of birth in Spain), not on the place of training.
Source: OECD Health Statistics 2015, OECD
Share of foreign-trained doctors in OECD countries, 2013 (or nearest year)

27. The number of nurses per capita has also increased in
nearly all OECD countries
1. Data include not only nurses providing direct care to patients, but also those working in the health sector as managers, educators, researchers, etc.
2. Data in Chile refer to all nurses who are licensed to practice (less than one-third are professional nurses with a university degree).
3. Austria reports only nurses employed in hospital.
Source: OECD Health Statistics 2015, OECD
Practising nurses per 1 000 population, 2000 and 2013 (or nearest year)

28. The remuneration of nurses has been frozen or cut down
in some countries following the economic crisis, but has
continued to increase in others
Evolution in the remuneration of hospital nurses, selected OECD countries, 2005-13 (or nearest year)
Source: OECD Health Statistics 2015, OECD
1. Index for France, 2006 = 100.
2. Index for Greece, 2009 = 100.

29. The share of foreign-trained nurses is lower than that of
foreign-trained doctors, but is high in some countries
1. Data for some regions in Spain relate to foreign nationality or country of birth, not the place of training.
Source: OECD Health Statistics 2015, OECD
Share of foreign-trained nurses in OECD countries, 2013 (or nearest year)

30. • Diagnostic procedures
• Hospital activities and surgical
procedures
6. HEALTH CARE ACTIVITIES

31. The number of MRI and CT scanners is increasing in all OECD
countries. Japan has by far the highest number per capita
2013 (or nearest year)
1. Equipment outside hospital not included.
2. Only equipment eligible for public reimbursement.
MRI units CT scanners
Source: OECD Health Statistics 2015, OECD

32. The United States, France and Luxembourg perform more MRI
and CT exams per capita than other countries
CT examsMRI exams 2013 (or nearest year)
Source: OECD Health Statistics 2015, OECD
1. Exams outside hospital not included (in Ireland, exams in private hospital also not included).
2. Exams on public patients not included.
3. Exams privately-funded not included.

33. The average length of stay in hospital has fallen
in nearly all OECD countries, reflecting efficiency gains
Average length of stay in hospital, 2000 and 2013 (or nearest year)
1. Data refer to average length of stay for curative (acute) care (resulting in an under-estimation).
Source: OECD Health Statistics 2015, OECD

34. The average length of stay for normal delivery has become
shorter in all OECD countries, but large variations persist
2013 (or nearest year)
Source: OECD Health Statistics 2015, OECD

35. Rates of caesarean delivery have increased in most OECD
countries. On average, more than 1 birth out of 4
involved a C-section in 2013, against 1 out of 5 in 2000
Source: OECD Health Statistics 2015, OECD

36. Ambulatory surgery has increased in most countries:
examples of cataract surgery
Source: OECD Health Statistics 2015, OECD
Share of cataract surgeries carried out as ambulatory cases, 2000 and 2013 (or nearest years)

37. • Financial access
• Geographic access
• Timely access (waiting times)
7. ACCESS TO CARE

38. All OECD countries have achieved universal (or almost
universal) health coverage, except Greece and the USA
Health insurance coverage for a core set of services, 2013
Source: OECD Health Statistics 2015, OECD

39. Unmet health care needs are still reported,
most commonly among low-income groups
Unmet care needs due to cost, by income level, 2013
Source: 2013 Commonwealth Fund International Health Policy Survey,
complemented with data from the national survey for the Czech Republic (2010).
Note: Either did not visit doctor when they had a medical problem, did not get recommended care or did not fill/skipped prescription.

40. Access to doctors varies widely within countries; more
doctors in cities than in rural areas
Source: OECD Regions at a Glance 2015
Physician density, by Territorial Level 2 regions, 2013 (or nearest year)

41. Waiting times for cataract surgery have decreased or
remained stable in several countries,
but have started to go up in others
Cataract surgery, waiting times from specialist assessment to treatment, 2007 to 2014 (or 2013)
Source: OECD Health Statistics 2015, OECD

42. Waiting times for hip replacement have also decreased or
remained stable in several countries,
but have started to go up in others
Hip replacement, waiting times from specialist assessment to treatment, 2007 to 2014 (or 2013)
Source: OECD Health Statistics 2015, OECD

43. • Management of chronic diseases
• Quality of acute care for life-threatening
conditions (cancers and heart attacks)
• Prevention of communicable diseases
8. QUALITY OF CARE

44. Treatment for chronic diseases is not optimal.
Too many persons are admitted to hospitals for asthma and
other chronic respiratory diseases…
Asthma and COPD hospital admission in adults, 2013 (or nearest year)
Source: OECD Health Statistics 2015, OECD
Note: Three-year average for Iceland and Luxembourg.

45. … and too many persons are admitted to hospitals
for diabetes, highlighting the need to improve primary care
Diabetes hospital admission in adults, 2008 and 2013 (or nearest years)
Source: OECD Health Statistics 2015, OECD
Note: Three-year average for Iceland and Luxembourg.

46. Survival for cervical cancer has increased in most countries,
but remain lower in Chile and Poland
Note: 95% confidence intervals represented by |—|.
1. Period analysis.
2. Cohort analysis.
3. Different analysis methods used for different years.
* Three-period average.
Source: OECD Health Statistics 2015, OECD
Cervical cancer five-year relative survival,
1998-2003 and 2008-2013
(or nearest periods)

47. Survival for breast cancer has also increased in most
countries, but remain lower in Estonia and Poland
Source: OECD Health Statistics 2015, OECD
Note: 95% confidence intervals represented by |—|.
1. Period analysis.
2. Cohort analysis.
3. Different analysis methods used for different years.
* Three-period average.
Breast cancer five-year relative survival,
1998-2003 and 2008-2013 (or nearest
periods)

48. Mortality rates following hospital admission for heart attack
have decreased in all OECD countries,
indicating improvements in acute care
Note: 95% confidence intervals represented by |—|. Three-year average for Luxembourg.
Thirty-day mortality after admission to hospital for AMI based on patient data, 2003 to 2013
(or nearest years)
Source: OECD Health Statistics 2015, OECD

49. Mortality rates following hospital admission for stroke
have also come down in all OECD countries
Note: 95% confidence intervals represented by |—|. Three-year average for Luxembourg.
Thirty-day mortality after admission to hospital for ischemic stroke based on patient data,
2003 to 2013 (or nearest years)
Source: OECD Health Statistics 2015, OECD

50. 80% of patients admitted for hip fracture are operated within
the recommended two days on average across OECD countries
Hip fracture surgery initiation after admission to hospital, 2013 (or nearest year)
Source: OECD Health Statistics 2015, OECD
Note: Three-year average for Iceland.

51. Vaccination rates against influenza among people aged 65
and over have fallen in many countries,
increasing the risks of hospitalisation and death
Influenza vaccination coverage, population aged 65 and over, 2003 and 2013 (or nearest years)
Source: OECD Health Statistics 2015, OECD

52. • Expenditure
• Financing
9. HEALTH EXPENDITURE

53. Health expenditure per capita varies widely across OECD countries.
The United States spends two-and-a-half times the OECD average
Health expenditure per capita, 2013 (or nearest year)
Note: Expenditure excludes investments, unless otherwise stated.
1. Includes investments.
2. Data refers to 2012.
Source: OECD Health Statistics 2015, OECD; WHO Global Health Expenditure Database.

54. Several European countries hard hit by the economic crisis
have cut their health spending since 2009
Annual average growth rate in per capita health expenditure,
real terms, 2005 to 2013 (or nearest years)
1. Mainland Norway GDP price index used as deflator. 2. CPI used as deflator.
Source: OECD Health Statistics 2015, OECD

55. 55
OECD countries allocated 8.9% of their GDP to health in 2013
(excluding investments), ranging from over 16% in the United States
to 5-6% in Turkey, Estonia and Mexico
Note: Excluding investments unless otherwise stated.
1. Data refers to 2012.
2. Including investments.
Health expenditure as a share of GDP, 2013 (or nearest year)
Source: OECD Health Statistics 2015, OECD; WHO Global Health Expenditure Database.

56. The share of GDP allocated to health has either stabilised or
decreased since 2009 in most OECD countries,
as health spending remained flat or was cut down
Source: OECD Health Statistics 2015, OECD
Health expenditure as a share of GDP, selected countries, 2005-2013

57. The public sector is the main source of financing in most OECD
countries. Only in Chile and the United States do
public sources account for less than 50% of health financing
1. The Netherlands report compulsory cost-sharing in health care insurance and in Exceptional Medical Expenses Act under social
security rather
than under private out-of-pocket, resulting in an underestimation of the out-of-pocket share.
2. Data refer to total health expenditure (= current health expenditure plus capital formation).
3. Social security reported together with general government.
Expenditure on health by type of financing, 2013 (or nearest year)
Source: OECD Health Statistics 2015, OECD

58. • Pharmaceutical expenditure
• Financing of pharmaceutical expenditure
• Pharmacists and pharmacies
• Pharmaceutical consumption
• Share of generic market
• R&D in the pharmaceutical sector
(See Chapter 2 for key charts on some indicators)
10. PHARMACEUTICAL SECTOR

59. • Rising share of elderly population
• Long-term care recipients and caregivers
• Long-term care expenditure
11. AGEING AND LONG-TERM CARE

60. The share of population aged over 65 and 80 in OECD
countries will increase sharply in the coming decades
Source: OECD Historical Population Data and Projections Database, 2015

61. Less than half of the population aged 65 and over report
being in good health, on average across OECD countries
Source: OECD Health Statistics 2015, OECD
1. Results not directly comparable with other countries due to methodological differences (resulting in an upward bias).
Perceived health status in adults aged 65 years and over, 2013 (or nearest year)

62. Most long-term care continue to be provided
by informal caregivers
Source: OECD estimates based on 2013 HILDA survey for Australia, 2012-13 Understanding Society
survey for the United Kingdom and 2013 SHARE survey for other European countries
Population aged 50 and over reporting to be informal carers, 2013 (or nearest year)

63. The number of people receiving formal
long-term care varies greatly across countries
Proportion of population receiving long-term care, 2013 (or nearest year)
Source: OECD Health Statistics 2015, OECD

64. A growing share of people is receiving long-term care
at home, to respond to their preference and reduce cost
Share of long-term care recipients aged 65 years and over receiving care at home,
2000 and 2013 (or nearest year)
Source: OECD Health Statistics 2015, OECD

65. Public spending on long-term care varies a lot
across countries, reflecting differences
in the development of public programmes
Long-term care public expenditure (health and social components), as share of GDP,
2013 (or nearest year)
Source: OECD Health Statistics 2015, OECD
Note: The OECD average only includes the eleven countries that report health and social LTC.
1. Figures for the United States refer only to institutional care.

66. More information
www.oecd.org/health/healthataglance
@OECD_Social