International Health Comparisons

International Health Comparisons
A compendium of published information on healthcare systems,

the provision of healthcare and health achievement in 10 countries
International Health Comparisons
A compendium of published information on healthcare systems,

the provision of healthcare and health achievement in 10 countries
The National Audit Office team consisted of:
Ashley McDougall, Paul Duckett and Manjeet
Manku under the direction of James Robertson.
For further information about the National Audit Office

please contact:
National Audit Office

Press Office
157-197 Buckingham Palace Road
Victoria
London
SW1W 9SP
Tel: 020 7798 7400
Email: enquiries@nao.gsi.gov.uk
INTERNATIONAL HEALTH COMPARISONS
Contents
Part 1 Appendices
1. Healthcare delivery systems 28
Making comparisons 1
Australia 28
Introduction 1
Canada 30
Scope and structure of the report 1
England 32
Basis of the compendium 1
France 34
Difficulties in interpreting the information 1
Germany 36
Italy 38
Part 2
Japan 40
New Zealand 42
Healthcare systems 3
Sweden 44
Expenditure on health 3
United States 46
Financing arrangements in different countries 4
2. Death rates from the main cancers over time 48
Part 3
Providing healthcare 9
Health personnel 9
Medical infrastructure 14
Medicines and drugs 14
Medical procedures carried out 14
Preventative medical programmes 14
Part 4
Health achievements 17
Life expectancy 17
Infant and perinatal mortality 17
Main causes of death 19
Health outcomes 21
Performance of healthcare systems 21
Figure Guide
Figure 1: Definitions of 'disability' used in 2 Figure 27: Main cancer killers with death rates 23
calculating disability adjusted life expectancy
Figure 28: Deaths from lung cancer 23
Figure 2: National expenditure on health as a 3
Figure 29: Deaths from breast cancer 24
percentage of Gross Domestic Product (GDP)
in recent years Figure 30: Deaths from main circulatory diseases 24
Figure 3: Health expenditure as a percentage 5 Figure 31: Deaths from ischaemic heart 25
of GDP, 1980 to 2001 disease, 1980 to 1999
Figure 4: Health expenditure per head 5 Figure 32: Five-year survival rates for lung cancer 25
Figure 5: Sources of health expenditure 6 Figure 33: Five-year survival rates for breast cancer 26
Figure 6: The methods of financing healthcare 7 Figure 34: Five-year survival rates for cancer of 26
the colon
Figure 7: Number of practising physicians 9
Figure 35: Five-year survival rates for prostate cancer 27
Figure 8: Level of practising physicians, 10
1980 to 2000 Figure 36: Average length of stay for acute care 27
Figure 9: Number of practising nurses 11 Appendix 1
Figure 10: Acute hospital admissions 11 Figure 1.1 Financing of healthcare in Australia, 1999 29
Figure 11: Practising nurses per 1,000 acute admissions 12 Figure 1.2: Financing of healthcare in Canada, 1999 31
Figure 12: Practising nurses per acute bed day 12 Figure 1.3: Financing of healthcare in England, 1999 33
Figure 13: Number of acute hospital beds 13 Figure 1.4: Financing of healthcare in France, 1999 35
per 1,000 of population
Figure 1.5: Financing of healthcare in Germany, 1995 37
Figure 14: Bed occupancy for acute beds 13 (Values in Billion DM)
Figure 15: Availability of Magnetic Resonance 14 Figure 1.6: Financing of healthcare in Italy, early 1990s 39
Imaging units
Figure 1.7: Financing of healthcare in Japan, early 2000 41
Figure 16: Public expenditure on pharmaceuticals 15
Figure 1.8: Financing of healthcare in New Zealand, 1998 43
and other medical non-durables prescribed for
out-patients Figure 1.9: Financing of healthcare in Sweden, 1999 45
Figure 17: Coronary bypass procedures per 100,000 15 Figure 1.10: Financing of healthcare in the United States, 47
of population early 1990s
Figure 18: Percentage of children immunised 16 Appendix 2
against measles
Figure 2.1: Deaths from cervical cancer, 1980 to 1999 48
Figure 19: Percentage of children immunised against 16
Figure 2.2: Deaths from breast cancer, 1980 to 1999 49
diphtheria, tetanus and pertussis (whooping cough)
Figure 2.3: Deaths from prostate cancer, 1980 to 1999 50
Figure 20: Life expectancy at birth 18
Figure 2.4: Deaths from lung cancer, 1980 to 1999 50
Figure 21: Potential years of life lost 18
Figure 22: Perinatal mortality, 1980 to 2000 19
Figure 23: Infant mortality, 1980 to 2000 20
Figure 24: Main causes of death 21
Figure 25: Deaths from cancer, 1980 to 1999 22
Figure 26: Latest known mortality for all cancers 22
Part 1 Making comparisons
Introduction World Health Organization3, the two reports prepared for

the Chancellor of the Exchequer by Derek Wanless in
1.1 Members of the Committee of Public Accounts have 2001 and 20024, together with the supporting report
expressed interest in comparative material on commissioned by HM Treasury from the European
healthcare in other countries. This compendium of Observatory5, work by The Commonwealth Fund6, and
information has been compiled from published sources the EUROCARE-2 and National Cancer Institute studies
by the National Audit Office and is provided for on cancer survival rates7.
background information. A copy has been placed in the
library of the House of Commons. 1.6 Analysis of the data has been confined to setting out the
comparisons in tabular and graphical form to show
relative positions at a certain date, and the direction of
Scope and structure of the travel, together with brief textual explanations and
compendium highlighting of key differences. The compendium does
not examine the causes of differences between
1.2 This compendium sets out comparative data on countries or draw conclusions on policy issues such as
healthcare systems and health in 10 countries, selected which methods of financing healthcare are best. The
as broadly comparable industrialised nations Department of Health has seen the compendium, and
(specifically, the G7 countries1), or as those innovative has noted that the inconsistencies and incompatibilities
countries frequently included in comparisons (Australia, between data sources in different countries mean that
New Zealand and Sweden). valid comparisons cannot be made on the basis of these
figures alone.
1.3 The structure of the compendium is as follows:
! Part 1: Making comparisons;

Difficulties in interpreting
! Part 2: Healthcare systems;
the information
! Part 3: Providing healthcare; and
! Part 4: Health achievements. Lack of comparability and completeness of
the data
1.4 In addition, two appendices set out more detail on 1.7 The OECD data used extensively in this compendium are
healthcare delivery systems (Appendix 1) and death collected by countries primarily for their own purposes
rates from the main cancers over time (Appendix 2). and methods, timing and definitions vary, see Figure 1 for
example. In addition, available information indicates that
Basis of the report validation procedures vary between countries. In some
countries, for example, data are based on surveys of self-
1.5 The report draws exclusively on published information, reporting individuals. The report notes when a comparison
principally the most recent data for 2002 from is likely to be particularly prone to such problems, but
the Organisation for Economic Co-operation and inevitably a margin of uncertainty remains within the data
Development (OECD)2. Other sources of data include the as presented.
part one
1 Canada, France, Germany, Italy, Japan, the United Kingdom and the United States.
2 OECD Health Data 2002.
3 World Health Report 2000: Health systems: improving performance, World Health Organization, 2000.
4 Securing Our Future Health: Taking a Long-Term View, Interim report, November 2001, Final report, April 2002.
5 Health care systems in eight countries: trends and challenges, European Observatory on Health Care Systems, April 2002. 1
6 Multinational comparisons of health systems data, Anderson G.F. and Hussey P.S., The Commonwealth Fund, 2000.
7 Survival of cancer patients in Europe: the EUROCARE-2 Study, 1999, SEER Cancer Statistics Review 1973-1999, National Cancer Institute, 2002.
1 Definitions of 'disability' used in calculating disability for secondary (hospital) care. As a result there are fewer
adjusted life expectancy in-patient admissions per 1,000 of the population than
in a country such as France, which has no such
! Australia takes disability to be one or more of 17 gatekeeper function. A country where older people
defined conditions. make up a smaller proportion of the population than
! Canada takes disability to be limitations in 19 specific average might be expected to have lower expenditure
activities lasting at least six months - the last survey was per head on healthcare for example. The compendium
in 1991. flags up such problems where applicable.
! France includes as disabled all those in retirement homes
- the last survey was in 1991-92.
! Germany extrapolates to disability days the results of a
There are uncertain relationships between
survey asking about disability in the previous four weeks. cause and effect and the impact of policy
! Japan takes disability to be confinement to bed. changes may not yet be apparent
! New Zealand takes disability to be as self-reported in the 1.10 Complex relationships between cause and effect mean
Household Disability Survey. that it is not straightforward to identify which elements
! United Kingdom available data relate to Great Britain should be changed to achieve desired outcomes. The
households only, although an adjustment for communal indicators may be misleading if used in an uncritical
establishments was made from the 1991 census - disability
way to suggest that healthcare could be improved, for
is self-reported as a long-standing limitation on activities in
any way. example, by a simple matching against the levels of
indicators in other countries.
Source: OECD Health Data 2002
1.11 A further consideration in drawing conclusions is that

the comparisons make no allowance for policy and
1.8 A further difficulty is that published data are more
resourcing changes already in train in this country or
complete on some issues of interest than others. This
elsewhere, aimed at producing improvements, but
inevitably means that only a partial picture can be
which have not had time to work through. In particular,
drawn for some topics.
the Government has allocated an additional £2.4 billion
in 2003-04 to improve the NHS in the United Kingdom,
The nature of healthcare systems impacts on with spending growing by 7.4 per cent a year after
inflation over the five years to 2007-08. Health spending
measured indicators
in England will rise by 7.5 per cent a year. Taking into
1.9 Differences between countries measured by any account these new resources, United Kingdom health
particular indicator may reflect the way that healthcare spending is expected to rise to 9.4 per cent of Gross
systems are organised or demographic factors. They do Domestic Product (GDP) in 2007-08. Current
not necessarily imply that healthcare received by comparisons may not therefore be a reliable guide to the
patients is better or worse. For example, general future or where intervention is needed to raise standards
practitioners in the United Kingdom act as gatekeepers of healthcare.
part one
2
Part 2 Healthcare systems
2.1 There is a lack of systematic published material on the 2.3 For Australia, Canada, France, Germany, Japan, the
details of how healthcare systems are organised across the United Kingdom and the United States, reported data
world, though Appendix 1 gives details of healthcare closely follow the OECD guidelines for reporting health
systems in the 10 comparator countries. Better information expenditure according to a common international
is available on healthcare expenditure and how this standard. Thus the data are believed to be fairly
expenditure is financed, which is set out in this Part. comparable. For New Zealand the definition of
healthcare is sufficiently different that its information is
of limited comparability. For Italy and Sweden, the
Expenditure on health differences are such that the OECD believes they are not
well suited for international comparisons.
2.2 A widely used means of comparison is expenditure as a
proportion of GDP. The OECD data presented here for
2.4 Figure 2 shows that total healthcare expenditure as a
expenditure include public and private expenditure, but
proportion of GDP varied from 7.3 per cent to
there are however definitional and timing differences
13 per cent and was 8.9 per cent on average across the
that may distort the statistics.
10 countries. Total health spending in recent years as a
percentage of GDP was lower in the United Kingdom
2 National expenditure on health as a percentage of Gross Domestic Product (GDP) in recent years
14
12
Expenditure as a percentage of GDP
10 country average of 8.9 per cent
10
7.2 2.5
2.3
2.5
8
2.6 2 1.8 1.3
1.6 1.4
6
4 7.8
7.2 6.6
6.8 6.2 5.9
5.8 6 5.7
5.9
2
0
United Germany France Canada Australia Italy New Sweden Japan United
States (1998) (2000) (2001) (1998) (2001) Zealand (1998) (1999) Kingdom
part two
(2000) (2000) (2000)
The darker tinted bars represent private expenditure. The lighter tinted bars represent public expenditure.
Source: OECD Health Data 2002 3

than in other comparator countries except Japan. The 2.9 Figure 2 also shows that public spending dominates in
United Kingdom Government has subsequently nine of the comparator countries. Sweden (with public
announced increased spending in the 2002 Budget. The expenditure of 84 per cent of total expenditure) and the
Government estimates that this will increase total spend United Kingdom (81 per cent) have the highest publicly
on healthcare to 9.4 per cent of GDP by 2007-08, up financed share of total health spending among the
from 7.3 per cent in 20008. comparator countries. Public spending is the lowest in
the United States (45 per cent), and private funding
2.5 Spending in all countries has increased as a percentage of therefore makes up more than half of total health
GDP over the last 20 years or so, with the exception of expenditure. It is the only country where this is the case
Sweden where it has fallen over a number of years. The - excluding the United States, privately financed
trends are shown in Figure 3. As a result of differing rates healthcare accounts for 23 per cent of the total on
of growth of spending, the spread in percentage GDP average across the other nine countries.
spent across the 10 countries has increased from
3.5 per cent in 1980 to 5.7 per cent in 2000. The United 2.10 The methods of public and private financing vary
States and New Zealand both saw very rapid growth in between countries, but are usually a combination of
the late 1980s. general taxation, social insurance, out of pocket
payments and private insurance. Figure 5 gives a further
2.6 Health expenditure per head is an alternative way of breakdown of the figures in Figure 2 for the comparator
measuring the resources devoted to healthcare but is countries. The United Kingdom is one of six comparator
subject to the additional uncertainty of relying on a countries (Australia, Canada, Italy, New Zealand,
particular exchange rate to make the comparisons. The Sweden) in which general taxes are the main source of
caveats to the figures for healthcare as a proportion of public funds. France, Germany and Japan finance the
GDP figures apply equally: definitional differences as to majority of health spending through specific social
what is included in expenditure, timing differences, and insurance contributions. Private insurance is third
figures may be affected by demographic factors. Age lowest in the United Kingdom, just above Italy and
standardised spends per head are not available. Japan, accounting for just 4 per cent of total funding and
highest in the United States, followed by France. United
2.7 Figure 4 shows the OECD's 2002 estimates based on a Kingdom out of pocket payments are slightly higher than
United States $ exchange rate9. There is a greater than in France but lower than in other comparator countries.
four fold variation between the highest and lowest figures Out of pocket expenditure is highest in Italy, as a
for health expenditure per head, which range from over proportion of total spend, followed by Australia and the
$4,600 per year per person in the United States to just United States.
over $1,000 in New Zealand. Average expenditure per
head of population is $2,220. The United Kingdom figure 2.11 Further details of the funding arrangements are given in
is some 86 per cent of the average of $2,028 for the five Figure 6.
European countries covered (Germany, Sweden, France,
the United Kingdom and Italy in descending order of
spend per head).
Financing arrangements in
different countries
2.8 An important difference between healthcare systems is the
extent to which individuals have private insurance. In the
United States, private insurance is the only means of cover
for much of the population, whilst in other countries it is
held mainly by high income groups who opt out of social
insurance coverage. In Canada private insurers are
generally prevented from offering coverage that duplicates
that provided by the Government, while in the United
Kingdom private insurance is held in addition to cover
provided by the Government. In France and New Zealand,
private insurance is widely used to cover out of pocket
part two
payments, such as some prescription costs.
8 Budget Report 2002, HM Treasury, Chapter 6.

4 9 The exchange rates have been calculated by the International Monetary Fund. They are par or market rates averaged over the year.
3 Health expenditure as a percentage of GDP, 1980 to 2001
14
13
Expenditure on healthcare as a percentage of GDP
12
United States
11
Germany
France
10
Canada
9 Australia
Italy
8 Sweden
New Zealand
7 Japan
United Kingdom
6
4
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
19 7
98
99
00
01
9
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
20
20
Australia Canada France Germany Italy
Japan New Zealand Sweden United Kingdom United States
4 Health expenditure per head
5,000
4,631
4,500
Expenditure per head (at US$ exchange rate)
4,000
3,500
10 country average of US$2,220
3,000
2,696 2,623
2,500
2,146 2,069 2,058
2,000
1,737 1,683
1,492
1,500
1,062
1,000
500
0
United Germany Japan Sweden France Canada United Australia Italy New
States (1998) (1999) (1998) (2000) (2000) Kingdom (1998) (2000) Zealand
part two
(2000) (2000) (2000)
5
5 Sources of health expenditure
14.0
12.0
Expenditure as a percentage of GDP
10.0
8.0
6.0
4.0
2.0
0.0
United Germany France Canada Australia New Italy Japan United
States (1998) (2000) (2001) (1998) Zealand (2001) (1999) Kingdom
(2000) (2000) (2000)
Taxation Social insurance Private insurance
Out of pocket patient costs Other private payments
NOTE
No further recent breakdown of the source of funds is available for Sweden beyond that for public/private expenditure in Figure 2.

part two
6
6 The methods of financing healthcare
Australia
Public finances are raised from a general and compulsory health tax levy on income, through Medicare, the public health insurance
system. Medicare reimburses 75 per cent of the scheduled fee for private in-patient services and 85 per cent of ambulatory services,
including GP consultations.
Out of pocket payments (16 per cent of total health expenditure), are for pharmaceuticals not covered under the Pharmaceutical
Benefits Scheme, patient contributions for pharmaceuticals, dental treatment, the gap between the Medicare benefit and the schedule
fee charged by physicians, and payments for other services such as physiotherapy and ambulance services, not covered by Medicare.
Private insurance accounts for about 8 per cent of health care expenditure and about 45 per cent of the population have private
insurance (mostly supplementary). Mainly not-for-profit mutual insurers cover the gap between Medicare benefits and schedule fees for
in-patient services. Doctors may bill above the scheduled fee. Private insurers also offer private hospital treatment, choice of specialists
and avoidance of queues for elective surgery.
Canada
National health insurance plans (Medicare) are funded by general and dedicated taxation and cover all medically necessary physician
and hospital services.
The majority of the population has supplementary private insurance coverage through group plans, to include dental care, prescription
drugs, rehabilitation services, private care nursing and private rooms in hospitals.
France
Public health finances come from taxes and compulsory social health insurance contributions from employers and employees. The
Sickness Insurance Funds cover 99 per cent of the population. The population have no choice of insurer. They are automatically
affiliated to a health insurance scheme on the basis of their professional status and place of residence.
Mutual Insurance Funds provide supplementary, voluntary insurance to cover cost-sharing arrangements and extra billings. Salaried
workers purchase voluntary insurance from their employers, but this can be purchased on an individual basis. The mutual funds cover
80 per cent of the population, which means that for most of the population, 100 per cent of the cost of the majority of normal
medical procedures is reimbursed.
Private insurance is voluntary for those who do not contribute to the national health insurance system.
There are patient contributions for ambulatory care (around 30 per cent for GP and specialist visits), drugs (between 35 per cent and
65 per cent depending on the therapeutic value) and 40 per cent for laboratory tests. Out of pocket payments account for 10 per cent
of health care expenditure.
Germany
General taxation and compulsory Social Insurance Fund contributions account for the majority of healthcare funding. Employers and
employees make contributions equally. The unemployed, homeless, and immigrants are covered through a special sickness fund
financed through general tax revenues.
Private insurance, based on voluntary individual contributions, covers 8 per cent of the population (the affluent, self-employed and
civil servants).
Cost-sharing is mainly for drugs. Ambulatory care and preventative dental care do not require any patient contributions. User charges
apply to the first 14 days in hospital or rehabilitation each year, ambulance transportation, non-physician care and some dental
treatment, but some groups are exempt (e.g. low income and elderly).
Italy
Taxation is the main source of public finance. There are patient contributions for pharmaceuticals, diagnostic procedures and specialist
visits and direct payments by users for the purchase of private health care services and over the counter drugs.
Mutual fund contributions and private insurance (corporate and non-corporate) account for 9 per cent of health expenditure.
part two
7
6 The methods of financing healthcare (continued)
Japan
Japan's health care system is predominately publicly funded. The majority of public finances comes from the Employees’ Health
Insurance System (Government and non-governmental bodies) and National Health Insurance (self-employed, pensioners, trade
associations and others not covered by workplace based insurance). Most employees and their dependents obtain health insurance
through their employers, financed largely through mandatory payroll contributions from both employers and employees.
New Zealand
Public hospital out-patient and in-patient services are free, but most people meet some costs of primary health care (although some
groups are exempt or have health concession cards) and make a payment for pharmaceuticals. Income-related patient contributions
are required for GP services and non-hospital drugs.
Private insurance is mainly not-for-profit covering private medical care and complementary, used to cover cost-sharing requirements,
elective surgery in private hospitals and specialist out-patient consultations. It does not offer comprehensive health cover. It covers
about a third of the population.
Sweden
The majority of funding comes from taxes and is supplemented by grants from the national Government. There are direct patient fees
for most medical services (flat rate payments), for example, consultation with public physicians in the primary sector, specialists in a
hospital, in-patient stay and consultations with private ambulatory doctors. There is a national ceiling on out of pocket amounts
payable by individuals in any one year. After the ceiling is reached the patient pays no further charges.
The voluntary health insurance market is very small.
United Kingdom
The United Kingdom's healthcare system is predominately public sector with the majority of the funds coming from general taxation
and some from national insurance contributions. About 11.5 per cent of the population have supplementary private medical insurance,
usually for reasons of faster access.
National Health Service care is free at the point of delivery, but charges are levied on prescription drugs, ophthalmic services and
dental services. There are exemptions, for example, for children, elderly, and the unemployed and 85 per cent of prescriptions are
exempt from the charge.
United States
The United States' healthcare system is predominately privately funded, with 55 per cent of the revenue from private sources.
Individuals can purchase private health insurance or it can be funded by voluntary premium contributions shared by employers and
employees on a negotiable basis. It covers 58 per cent of the population.
Public funds (payroll taxes, federal revenues and premiums) fund Medicare, a social insurance programme for the elderly, the disabled,
and end stage renal patients. It covers 13 per cent of the population and accounts for 20 per cent of total health expenditure.
Medicaid, a joint federal-state health insurance programme covers certain groups of the poor. It covers 17 per cent of the population
and accounts for 20 per cent of total health expenditure.
Sources: Securing Our Future Health: Taking a Long-Term View, Wanless, Interim report, November 2001, Final report April 2002; Health care systems in
eight countries: trends and challenges European Observatory on Health Care Systems,2002; Multinational comparisons of health systems data, Anderson
G.F. and Hussey P.S., The Commonwealth Fund, 2000
part two
8
Part 3 Providing healthcare
3.1 This Part of the compendium sets out comparative premature mortality of almost four per cent for women
figures on how healthcare is provided in terms of and about three per cent for men10.
healthcare personnel, medical technology, drugs, the
number of medical procedures carried out and 3.3 Figure 7 provides information about the number of
preventative medical programmes. practising physicians per 1,000 people in the
population. The statistics need very careful
Health personnel interpretation because there are significant definitional
differences. For the United Kingdom, the figures shown
Doctors and nurses update those in the Wanless Review of the future needs
of the NHS11 which also used OECD data. The figures
3.2 Recent OECD research has concluded that the number are based on doctors working in the NHS and exclude
of doctors is the second most important variable (after private sector doctors, locums and clinical academics.
occupation) in terms of explaining variations in In Italy, retired physicians continue to be classified as
premature mortality (deaths under the age of 70) 'practising', and this leads to anomalies. Italy has one of
across countries and over time. They also found that a the lowest expenditures per head on healthcare
10 per cent increase in the number of doctors, holding (see Figure 4), but it has the highest recorded ratio of
all other factors constant, would result in a reduction in doctors to the population.
7 Number of practising physicians
6
6
Number per 1,000 of population
4
3.6
3 2.9
3 2.8
2.5
2.2 2.1
2 1.9 1.8
0
Italy Germany France Sweden United Australia New Canada Japan United
(2000) (2000) (1998) (1999) States (1998) Zealand (2000) (2000) Kingdom
part three
(1999) (2000) (2000)
9
10 Exploring the effects of health care on mortality across OECD countries, OECD Labour market and social policy - Occasional Papers No. 46, January 2001,
paragraph 45.
11 Securing our Future Health: Taking a Long-Term View, Interim report, November 2001.
3.4 The OECD data show the United Kingdom as having the classifications as to what constitutes a nurse and that
lowest number of practising physicians at 1.8 per 1000 while the UK uses full time equivalents, other countries
persons, considerably below the mean of 2.5 (excluding use headcounts. Germany, which has a high number of
Italy). Taking into account data provided by the general doctors, also has a high number of nurses in relation to
Medical Council on the number of practising physicians, the population. These ratios cannot, however, be taken as
the Department of Health estimated in 1996 that there direct measures of the adequacy of provision as the
were 2.6 doctors per 1,000 of population, compared figures take no account of the pattern of healthcare
with the OECD reported figure for the United Kingdom provision in different countries. Factors such as the rate
of 1.7. For 1996, Germany reported 3.4 and France 3.0 of day case procedures or length of stay can have a major
practising physicians per 1,000 of population. impact on the need for in-patient admissions and
throughput. Length of stay in the United Kingdom is one
3.5 The number of physicians in the United Kingdom has of the lowest among the 10 comparator countries.
increased steadily over the last 20 years - by 40 per cent
over this period, Figure 8. But reported provision in 3.7 Acute admission rates are shown in Figure 10, which
other countries has generally increased at a faster rate. puts the United Kingdom in the centre of the 10 country
The result is that the countries have moved further apart range. These figures can be used in conjunction with
and, discounting Italy for definitional reasons, the those for numbers of nurses to standardise for the rate of
spread of provision has increased from 1.0 per 1,000 to admissions and length of stay as in Figures 11 and 12.
1.8 per 1,000.
3.8 In terms of nurses per acute admission, the United
3.6 As well as having the lowest reported number of doctors Kingdom comes at the low end of the range, but both
per head, the United Kingdom also has the second France and Italy have lower provision, Figure 11. In
lowest reported number of practising nurses in relation to terms of nurses per acute day, the United Kingdom is
the population, Figure 9, although the UK nurse numbers above the other European countries in its provision,
are for the NHS only. The Department of Health told us Figure 12.
that UK qualified private sector nurses account for about
a quarter of all qualified nurses. The Department also
noted that different countries still use different
8 Level of practising physicians, 1980 to 2000
7
Physician density per 1,000 of population
Italy
5
Germany
France
4 United States
Canada
Japan
3 United Kingdom
0
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
00
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
20
part three
Canada Fr ance Ger many Italy J apan United Kingdom United States
NOTE
Data are not available for all years for Japan
10
9 Number of practising nurses
12
10 9.7
Practising nurses per 1,000 of population
9.3
8.4 8.3 8.1

8 7.8 7.6
6
6
5.3
4.5
4
0
New Germany Sweden United Australia Japan Canada France United Italy
Zealand (1998) (1999) States (1997) (1998) (2000) (1997) Kingdom (1999)
(2000) (1999) (2000)
10 Acute hospital admissions
250
205.2 204
Acute admissions per 1,000 of population
200
175.7
159 156
150 147
117.6
99.4
100
50
0
Germany France Italy Sweden Australia United United Canada
(2000) (1999) (1998) (1996) (1999) Kingdom States (1999)
(2000) (2000)
NOTE
Acute care is one in which the principal intent is one or more of the following:
! to manage labour (obstetrics)
part three
! to cure illness or to provide definitive treatment of injury

! to perform surgery
! to relieve symptoms of illness or injury (excluding palliative care)
! to reduce severity of an illness or injury
! to protect against exacerbation and/or complication of an illness and/or injury which could threaten life or normal function
! to perform diagnostic or therapeutic procedures
11
11 Practising nurses per 1,000 acute admissions
80
75
70
70
Practising nurses per 1,000 acute admissions
60
51
50
45
40
36
29
30
26
20
10
0
Canada United Australia Germany United France Italy
(1999) States (1997) (2000) Kingdom (1997) (1998)
(1999) (2000)
12 Practising nurses per acute bed day
1.6
1.4
Nursing staff per acute bed day (Full Time Equivalent)
1.4
1.31
1.2
1
1
0.8
0.8
0.6
0.6
0.47
0.4
0.2
0
Australia United United Italy Germany France
(1999) States Kingdom (1998) (2000) (1999)
(2000) (1997)

part three
12
13 Number of acute hospital beds per 1,000 of population
7
6.4
5
Acute beds per 1,000 of population
4.5
4.2
4 3.8
3.3 3.3
3
3
2.4
0
Germany Italy France Australia Canada United United Sweden
(2000) (1999) (2000) (1999) (1999) Kingdom States (2000)
(2000) (2000)
14 Bed occupancy for acute beds
90
83
81.1
80 77.5 77.4
73.3
70
70
Percentage of available acute beds
63.9
60
50
40
30
20
10
0
United Germany Sweden France Italy Australia United
Kingdom (2000) (1996) (1999) (1998) (1999) States
(2000) (2000)

part three
13
Medical infrastructure of prescribing generic drugs which are considerably

cheaper than branded ones and expenditure may not be
3.9 A basic measure of healthcare capacity is the number of a good measure of volume. The effects of different price
beds per head, though it suffers from the same problems regulation systems is another factor, as is the availability
as the statistics for medical staff in being affected by of over the counter drugs in some countries that would
patterns of health care. The ratios shown in Figure 13 be prescription only in others.
range from 6.4 beds per 1,000 of population in
Germany, to 2.4 in Sweden with the United Kingdom at 3.13 Figure 16 shows expenditure on what countries classify
the lower end of this range. as public funding for drugs and other medical non-
durables prescribed for hospital out-patients. There is a
3.10 Taking account of the use made of acute hospital wide range of spending across countries, with the
beds, the United Kingdom has the highest occupancy highest spending per head in France and Japan at almost
of such beds of the countries for which information is three times that in Australia and the United States.
available, Figure 14.
3.11 Magnetic Resonance Imaging units stand as a proxy for Medical procedures carried out
investment in new technology and how up to date
3.14 Comparable information on individual procedures across
medical facilities are. In relation to the size of the
different countries is limited but is available for coronary
population, the figure for England of 3.9 per million
bypass procedures in eight comparator countries. The
people is a little over half of the 10 country average of
United States carries out almost five times as many of
6.9 per million people. However, Figure 15 shows that
these operations as in the United Kingdom per head of
the average is influenced by very high provision in Japan.
population, Figure 17. If the United States is excluded as
Canada has the lowest provision with about two-thirds
an outlier, the average rate for the other countries is just
the numbers in England. Since 2000 there has been an
over 60 procedures per 100,000 of population.
increase in the provision of MRI units in the United
Kingdom, partly through support from the New
Opportunities Fund.
Preventative medical programmes
3.15 A measure of the extent of preventative health measures is
Medicines and drugs the extent of childhood immunisation. A range of caveats
applies including issues such as public perception of the
3.12 Medicines are an essential component of healthcare.
safety of immunisation and the authorities' policy on when
But as with other measures, comparisons can be very
or whether this should be carried out.
misleading. The United Kingdom has pursued a policy
15 Availability of Magnetic Resonance Imaging units
25
23.2
20
Units per million of population
15
10
8.1 7.9
6.7
6.2
5 4.7
3.9
2.8 2.6 2.5
part three
0
Japan United Sweden Italy Germany Australia England France New Canada
(1999) States (1999) (1999) (1997) (2000) (2000) (1999) Zealand (2000)
(1999) (1998)
14
16 Public expenditure on pharmaceuticals and other medical non-durables prescribed for out-patients
300
272 271
250 237
Expenditure per head (US$ exchange rate)
217
201 201
200
157
149
150
133
112
103 101
100
50
0
Japan France Germany Sweden United Italy New Canada Australia United
(1999) (2000) (1998) (1997) Kingdom (2000) Zealand (2000) (1998) States
(2000) (1997) (2000)
17 Coronary bypass procedures per 100,000 of population
250
202.6
200
Coronary bypasses per 100,000 of population
150
100 91.5 90.2
66.4
51.6
50 46.4
41.2
35
0
United Australia Germany Canada New Italy United France
States (1999) (1998) (1999) Zealand (1999) Kingdom (1993)
(1998) (2000) (1996)

part three
15
3.16 Immunisation against measles is reported as close to and the United Kingdom achieved a rate in excess of
universal in Japan, Canada and Sweden, though it falls 91 per cent. Sweden achieved a rate of 99 per cent,
below 90 per cent in Australia, France, Germany and while the lowest rate was in the United States at
Italy, Figure 18. Immunisation against diphtheria, 83 per cent, Figure 19.
tetanus and whooping cough is generally higher
18 Percentage of children immunised against measles
100 96.5 96.2 95.2

92 91
90
84.5 83
80
Prorportion of eligible population (per cent)
75 75
70
60
50
40
30
20
10
0
Japan Canada Sweden United United Australia France Germany Italy
(1999) (1998) (2000) States Kingdom (2000) (1998) (1997) (1999)
(1999) (2001-2002)
Source: OECD Health Data 2002 and Department of Health. Figure for United Kingdom is for Measles, Mumps and Rubella coverage at 24 months
19 Percentage of children immunised for diphtheria, tetanus and pertussis (whooping cough)
100 99.1 98
95
91.8
89.8 88.4
90
85 84.2 83
80
Proportion of eligible population (per cent)
70
60
50
40
30
20
10
part three
0
Sweden France Italy United Australia New Germany Canada United
(2000) (1998) (1999) Kingdom (2000) Zealand (1997) (1998) States
(2000) (1999) (1999)
Source: OECD Health Data 2002 and Department of Health. The United Kingdom figure relates to diptheria, tetanus and polio rather than pertussis but the
16
OECD has calculated that this figure is only marginally different to those given for other countries
Part 4 Health achievements
4.1 This Part presents comparative information relevant to how of 70 die prematurely. This figure needs to be seen in the
well healthcare systems perform. A first measure is the state context of the currently expected life spans at birth of
of health in countries, though this is determined by many around 80 years for women and 75 years for men.
factors other than the healthcare system. A second
measure is the extent to which healthcare systems improve 4.5 The United States loses more potential life years than the
health. Limited comparative information is available on other countries in the comparator group, Figure 21. There
this, though data are available about survival rates after is a considerable variation across countries, and in
cancer treatment. contrast to the data on life expectancy at birth, where the
United Kingdom is among the lowest, on the years lost
measure, the United Kingdom ranks fourth lowest behind
Life expectancy Sweden, Japan and Italy. This illustrates the dangers of
4.2 A fundamental measure of health in a particular country relying on single indicators to draw conclusions.
is life expectancy though while healthcare systems have
an influence on life expectancy, it depends equally if not 4.6 For both sexes, the highest number of years lost
more on a wide range of other factors such as personal (per 100,000 population) is some 80 per cent above the
income, lifestyle, education, nutritional standards, and lowest one. There are also marked differences in the
housing quality. One way of measuring life expectancy number of years of life lost by men and women. In the
is the number of years that individuals born 'now' can United Kingdom, potential years of life lost for males are
on average expect to live if current patterns of mortality 64 per cent higher than for females.
and disability continue to apply. The measure has the
limitation of applying only to the current birth cohort.
Life expectancy has generally risen over time, so life Infant and perinatal mortality
expectancy for the population as a whole will be lower 4.7 An important reason for increased life expectancy at
than indicated by the most recent statistics. birth has been a decline in infant mortality. Among the
explanations for this are better ante and post-natal care
4.3 Figure 20 shows that life expectancy at birth (in recent and widespread immunisation against childhood
years) ranges between about 79 and 85 years for women diseases - influences within the control of health policy
across the 10 comparator countries, and between 74 and makers. Recent research suggests that the number of
78 years for men. This amounts to an 8 per cent range for doctors per capita appears to be the second most
women and 5 per cent for men. Japan has the longest important variable (behind occupation) in explaining
expected life span, followed closely within European both perinatal and infant mortality. The results indicate,
countries by France and Sweden and then Italy and all else equal, that a 10 per cent increase in the number
Germany. The United Kingdom comes towards the lower of doctors would result in almost a 6 per cent decrease
end of the fairly small range for both men and women. in perinatal mortality and a 6½ per cent decrease in
The United Kingdom has, however, one of the smallest infant mortality12. The research found that the overall
differences in life expectancy between women and men level of public financing also appears to be a significant
at 4.8 years, with France at 7.5 years being the largest. factor in reducing both infant and perinatal mortality13.
The OECD hypothesis is that this may reflect the
4.4 An alternative way of assessing life expectancy is based likelihood that publicly funded systems provide more
on the calculation of 'Potential years of life lost'. This equitable health service provision.
part four
measure assumes that all those who die before the age
12 Exploring the effects of health care on mortality across OECD countries, OECD Labour market and social policy - Occasional Papers No. 46, January 2001,
paragraph 55.
17
13 ibid paragraph 56.
20 Life expectancy at birth
86
84.6
84
82.5
82 82
82 81.7 81.6
80.8 80.7
80 79.8
79.4
78 77.6 77.4
Years
76.6
76.3
76 75.7
75 75.3 75
74.7
73.9
74
72
70
68
Japan France Australia Sweden Canada Italy New Germany United United
(2000) (1999) (2000) (2000) (1999) (1997) Zealand (1999) Kingdom States
(1999) (1999) (1999)
The lighter tinted bar represents female patients. The darker tinted bar represents male patients.
NOTE
The life expectancy is calculated on the assumption that age-specific mortality levels remain constant.
21 Potential years of life lost
8,000
Potential years lost below age 70 per 100,000 people
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0
United France New Germany Canada Australia United Italy Japan Sweden
States (1998) Zealand (1999) (1997) (1999) Kingdom (1998) (1999) (1998)
part four
(1998) (1998) (1999)
The lighter tinted bar represents male patients. The darker tinted bar represents female patients.
18 Source: OECD Health Data 2002, based on World Health Organization data
4.8 Figures 22 and 23 show the strong decline in perinatal Deaths from cancer
and infant mortality over the 1980s and the continued
but less marked decrease across most comparator 4.10 Analysis of cancer mortality statistics is a difficult area
countries since then. All these countries have made and variations across countries need careful
steady progress over the last 20 years, with those having interpretation. The chances of dying from cancer depend
the highest rates in 1980 reducing rates a little faster. The on how quickly patients recognise and act on symptoms,
result has been that the spread between the countries for the impact of measures affecting lifestyle (such as
perinatal mortality has reduced from 9.1 deaths per smoking habits) and the existence of screening
1,000 total births in 1980 to 4.5 per 1,000 in 2000. programmes. There are also marked differences in cancer
From 1993, the United Kingdom started to count mortality rates between socio-economic groups, (which
mortality after 24 weeks gestation, rather than the correlate with some of the other factors mentioned).
28 weeks used by other countries. However, the quality of medical intervention is also an
important factor, recognised for example for the United
Kingdom in the NHS Cancer Plan14.
Main causes of death
4.11 Cancer is an illness in the United Kingdom subject to
4.9 The main causes of death for the comparator countries active measures to improve performance and this needs
are shown at Figure 24. The most significant causes of to be borne in mind when considering the statistics. As
death from disease in developed countries are cancer part of the performance improvements expected as a
(malignant neoplasms) and cardio-vascular illness, and result of the increased funding announced in the 2002
patterns are similar in all countries. Budget, the Government requires the NHS to reduce
mortality rates from cancer by at least 20 per cent in
people under 75 by 2010.
22 Perinatal mortality, 1980 to 2000
20
18
16
14
Deaths per 1,000 total births
12
10 United Kingdom
United States
8 France
Italy
Australia
6
Germany
Canada
4 Sweden
New Zealand
2 Japan
0
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
00
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
20

NOTE
Perinatal mortality is the number of deaths within seven days of birth plus foetal deaths of 28 weeks of gestation or more
per 1,000 total births (live and stillbirths). The UK includes deaths from 24-28 weeks of gestation while other countries do not.
part four
14 The NHS Cancer Plan, Department of Health, September 2000. 19

23 Infant mortality, 1980 to 2000
16
14
12
Deaths per 1,000 live births
10
United States
8 United Kingdom
New Zealand
6 Canada
Italy
4
France
Germany
2 Sweden
Japan
0
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
00
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
20
NOTE
Infant mortality is the number of deaths of babies aged under one year that occurred during a year per 1,000 live births
during the same year, expressed as a rate.
4.12 Figure 25 shows the trend in cancer deaths for the 4.15 Further comparative information on death rates from the
10 comparator countries over the last two decades. For main cancers over time is given in Appendix 2.
the last year of complete comparisons, the United Figures 28 and 29 show death rates from lung and
Kingdom and New Zealand jointly had the highest breast cancer.
death rates, although the rates in both countries are on
a downward trend. 4.16 United Kingdom mortality comes towards the middle of
the range for lung cancer, but is above all of these
4.13 Recent data for death rates from all cancers (against a comparator countries for breast cancer.
standardised age profile to take account of different
demographics in countries) are shown in Figure 26.
New Zealand and the United Kingdom report Deaths from circulatory diseases
comparatively high death rates. The rate (per 100,000 4.17 Cardio-vascular diseases include ischaemic heart
population) in France and Germany is about 2½ and disease, myocardial infarction and cerebro-vascular
5 per cent lower than in the United Kingdom respectively. diseases15. As part of the performance improvements
The rate in Sweden, the country with the lowest cancer expected as a result of the increased funding announced
death rate among the 10 countries, is about 18 per cent in the 2002 Budget, the Government requires the NHS
below that of the United Kingdom. to reduce substantially mortality rates from heart disease
by at least 40 per cent in people under 75 by 2010.
4.14 Figure 27 shows the mortality rates for the four main
cancer killers in the comparator countries. Overall, the
part four
United Kingdom is in the top group for overall deaths

although it has the highest rate only for breast cancer.
15 'Ischaemia' means an inadequate supply of blood and is usually the consequence of the gradual narrowing of the arteries supplying blood and oxygen. If a
narrowed coronary artery blocks off suddenly - as it may if a blood clot forms in it - the part of the heart muscle supplied by that artery may die and cause
20 severe chest pain. This is a 'heart attack', also known as a myocardial infarction ('myocardium' referring to the heart muscle and 'infarction' referring to the
death of a part of it). There are two main forms of cerebro-vascular disease leading to stroke - resulting from either ischaemic disease affecting the blood
circulation system of the brain, or from haemorrhage of surface blood vessels.
24 Main causes of death
700
Deaths per 100,000 of population (standardised)
600
500
400
300
200
100
0
United United Germany New Italy Canada Sweden Australia France Japan
Kingdom States (1999) Zealand (1998) (1997) (1998) (1999) (1998) (1999)
(1999) (1998) (1998)
Diseases of circulatory system Malignant neoplasms Diseases of respiratory system Non-medical causes
Endocrine and metabolic diseases Diseases of digestive system Diseases of nervous system
NOTE
Age-standardised death rates take into account the differences in age structure of the populations
4.18 United Kingdom death rates are highest, second highest 4.21 Figures 32 to 35 show the five-year survival rates for the
and third highest respectively across the group of four main cancer killers. The performance of England is
countries for the three circulatory conditions included in consistently at or near the bottom for the comparator
Figure 30. The overall death rate is two and a half times countries, alternating bottom position with Scotland.
that of France, with that for ischaemic heart disease These are based on historical data for patients diagnosed
being four times the rate reported from Japan. between 1985 and 1989. The implementation of the
Calman/Hine report (1995) and the NHS Cancer Plan
4.19 Trends in most countries for ischaemic heart disease (2000) is not, therefore, reflected in these figures, but is
have been downward, most markedly in countries with expected to affect incidence, survival and mortality rates.
highest death rates at the start of the period from 1980
shown in Figure 31.
Performance of healthcare systems
4.22 Healthcare systems are complex and making
Health outcomes judgements about their performance overall is very
4.20 Information about the value added by healthcare difficult. Average length of stay is often used as an
systems in general or in relation to specific interventions indicator of the efficiency with which a system treats
is very limited. The most comprehensive international patients, alongside the assumption that all medically
data relate to cancer survival rates. The standard appropriate treatment is delivered to clinically
part four
measure is the percentage of cancer patients alive five acceptable standards and discharges are medically
years after treatment. This measure has potential approved. On this basis, a lower length of stay indicates
drawbacks, as increases in five-year survival rates may better efficiency in the use of acute beds. Germany has
be the result of better and earlier diagnosis, rather than the longest length of acute (hospital) stay at 9.6 days,
represent a real postponement of death. while the United Kingdom is in the middle of the range 21
of countries at 6.2 days, Figure 36.
25 Deaths from cancer, 1980 to 1999
220
210
200
New Zealand
190 United Kingdom
France
Canada
180 Germany
United States
Italy
170 Australia
Japan
Sweden
160
150
140
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
26 Latest known mortality for all cancers
200
189.1
184.7
180 177.1
180 175.3 174.9 174.8
164.5
160 154.6 152.3
140
120
100
80
60
40
20
0
part four
New United France Canada Germany United Italy Australia Japan Sweden
Zealand Kingdom (1998) (1997) (1999) States (1998) (1999) (1999) (1998)
(1998) (1999) (1998)
22 Source: OECD Health Data 2002

27 Main cancer killers with death rates
140
120
30.9 23.8
26.2 26.7
100
25.4
26.9 27.2 19.2
80 28.8 26.7 24.1
28.9 38.1
25.9 22 23.4
24.8
60 9.3
21.9 9.5
35.7 52.1
40 47.9 42.7 32.6
33.7 32.8 37.2
27.6
22.9
20
28
18.1 19.6 23.5 19 21.4 18.5 18.7
17.6 17.1
0
New Canada United United Germany France Australia Sweden Italy Japan
Zealand (1997) Kingdom States (1999) (1998) (1999) (1998) (1998) (1999)
(1998) (1999) (1998)
Colon Lung Breast Prostate
28 Deaths from lung cancer
80
71.9 71.4
70 68.9
63.9
61.3
60 59.4
49.9 49.7 48.9

50
40 37.6
32.2 31
30 29.1
25.3
20 18.9
16.7
14 12.7
11.2 9.7
10
0
Italy United Canada France United Germany Australia New Japan Sweden
(1998) States (1997) (1998) Kingdom (1999) (1999) Zealand (1999) (1998)
part four
(1998) (1999) (1998)
The lighter tinted bar represents male deaths. The darker tinted bar represents female deaths.

29 Deaths from breast cancer
30 28.9 28.8
26.7
Deaths per 100,000 females (standardised)
25.9
24.8
25 24.1
23.4
22 21.9
20
15
10 9.5
5
9
0
United New Canada Germany France United Italy Australia Sweden Japan
Kingdom Zealand (1997) (1999) (1998) States (1998) (1999) (1998) (1999)
(1999) (1998) (1998)
30 Deaths from main circulatory diseases
160
140
120
100
80
60
40
20
0
United New Sweden United Germany Canada Australia Italy France Japan
Kingdom Zealand (1998) States (1999) (1997) (1999) (1998) (1998) (1999)
(1999) (1998) (1998)
The lightest tinted bar represents ischaemic heart disease.

The darkest tinted bar represents acute myocardial infarction.
part four
The medium tinted bar represents cerebro-vascular disease.
24
31 Deaths from ischaemic heart disease, 1980 to 1999
350
300
250
200
United Kingdom
New Zealand
150 Germany
Sweden
United States
100
Canada
Australia
50 Italy
France
Japan
0
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
32 Five-year survival rates for lung cancer
18
15.9
16 15.4
14 13.8
Five-year survival rate (per cent)
12 11.7
12 11.5
10.8
10.1 9.9
10 9.6
8.7 8.6 8.9 8.8
8
7.1 7
6.3 6.1
6
0
France United States Germany Netherlands Italy Europe Sweden England Scotland
The lighter tinted bar represents female deaths. The darker tinted bar represents male deaths.
part four
Sources: United States figures from SEER Cancer Statistics Review 1973-1999, National Cancer Institute, 2002, cancer first diagnosed between 1986 and
1988. All other countries from Survival of cancer patients in Europe: the EUROCARE-2 study, 1999, cancer first diagnosed between 1985 and 1989
25
33 Five-year survival rates for breast cancer
90
82.8
80.6 80.3
80 76.7
74.4
72.5 71.7
70 66.7 65
Five-year survival rates (per cent)
60
50
40
30
20
10
0
United States Sweden France Italy Netherlands Europe Germany England Scotland
34 Five-year survival rates for cancer of the colon
70
61.6 60.2
60 58.7
55.7 55.5
54
51.8 51.8
49.6 49.9
50 46.9 47 46.8 46.7
41.1 41 41.3
40
30
20
10
0
United States Netherlands France Sweden Germany Italy Europe Scotland England
The lighter tinted bar represents male patients. The darker tinted bar represents female patients.
part four
26
35 Five-year survival rates for prostate cancer
90
81.1
80
70 67.6
64.7
61.7
60
55.7 55.3
50 47.4 47.2
44.3
40
30
20
10
0
United States Germany Sweden France Europe Netherlands Italy Scotland England
36 Average length of stay for acute care
12
10 9.6
8
7.2 7.1
6.2 6.2
6 5.9
5.5
Days
5 4.9
0
Germany Italy Canada Australia United United France Sweden New
(2000) (1998) (1999) (1999) Kingdom States (1999) (2000) Zealand
(2000) (1999) (1998)
Average length of stay is computed by dividing the number of days stayed (from the date of admission in an in-patient institution)
part four
by the number of separations (discharges and deaths) during the year.
27
Appendix 1 Healthcare delivery systems
1.1 This appendix sets out the health care delivery systems in Primary care
the ten comparator countries. The main sources used to
compile it were: Health Care Systems In Eight Countries: 1.4 Private practitioners provide most community-based
Trends and Challenges, European Observatory on Health medical and dental treatment and there is a large private
Care Systems, 2002; Multinational Comparisons of hospital sector. The bulk of primary medical care is
Health Systems Data, Anderson G.F. and Hussey P.S., The provided by GPs. They are mostly self-employed and run
Commonwealth Fund, 2000; and, Securing Our Future their practices as businesses. They are reimbursed by a
Health, Wanless D., Interim Report, November 2001. We fee-for-service system. Patients have a choice of GP with
also used material from the European Observatory no restrictions and may consult more than one GP since
web-site and from web-sites of Government health there is no requirement to enrol with a practice. GPs act
departments of the countries. as gatekeepers to in-patient and out-patient services.
In-patient/secondary care
Australia
1.5 In-patient care is provided by public hospitals (70 per
1.2 Australia offers universal access to health care to all
cent of stock of acute care beds). Patients with private
residents through Medicare. Individuals eligible for
health insurance may chose to be admitted to either
Medicare receive free ambulatory medical care and free
public or private hospitals and may also choose their
accommodation and medical, nursing and other care as
specialist. Medicare subsidises medical costs but not
public patients in state funded hospitals. Alternatively
accommodation costs. Physicians in public out-patient
they may choose treatment as private patients in public
hospitals are either salaried (but may have private
or private hospitals, with some assistance from
practices and fee-for-service income) or paid on a per
Medicare. Figure 1.1 shows the health care delivery
session basis.
system and flows of finance in Australia. Australia has
complex health care system with many types of services
and providers and a range of funding and regulatory
mechanisms. There is a large and vigorous private sector
in health services.
Role of the Government

1.3 The federal Government has control over hospital
benefits, pharmaceuticals, and medical services. The
States are primarily responsible for funding and
administering public hospitals and mental and
community health services, and pay for public hospitals
with federal Government assistance.
appendix one
28
1.1 Financing of healthcare in Australia, 1999
OOP - Out of pocket payments Financial flows

OTC - Over the counter drugs Service flows
FFS - Fee-for-service
Private Health
Insurers
Voluntary contributions
30% rebate on private health

insurance premiums
Commonwealth
Government
Compulsory
health
insurance General and specific purpose payments
levy Taxes Some states have
State & territory
regional health
Governments
authorities
Taxes
Budget and salaries

Public health Budgets
Population
Budgets
Community
Mostly free, may be health services
nominal charges
Some contracting Mostly FFS

General with small
Mostly free, (80%), practitioners sessional &
some OOP & 15% capitation
copayments payments
Specialist FFS or sessional
medical
FFS
Small % are free, most practitioners
pay 15% copayments &
OOP
Reimburse-
ment
Pharmacist
against
Free to health care card
schedule
holder, but copayments,
OOP & OTC charged to
others Case -mix and other
Public hospitals
Patients
Some contracting
Private hospitals
Hotel charges and

significant OOP costs
appendix one
Reimbursement of hotel charges & 15% gap

between Government rebate & schedule of fees
Source: OECD Secretariat
29
Canada Primary care

1.6 Although predominately publicly funded, healthcare is 1.8 Most primary physicians are in private practice and are
largely delivered by private providers, particularly in the remunerated on a fee-for-service basis. Provincial
primary care sector, Figure 1.2. medical associations negotiate the fee schedules for
insured services with provincial health ministries.
Physicians must opt out of the public system of payment
Role of the Government to have the right to charge their own rates.
1.7 The federal Government requires that provincial health
insurance plans cover all medically necessary physician In-patient/secondary care
and hospital services. The provincial governments have
the authority to regulate health providers. However, 1.9 In-patient care takes place in public and private non-
they delegate control over physicians and other profit hospitals that operate under global budgets or
providers to professional "colleges" whose duty is to regional budgets with some fee-for-service payment. Less
license providers and set standards for practice. than 5 per cent of Canadian hospitals are privately
owned and are mainly long-term care facilities.
appendix one
30
1.2 Financing of healthcare in Canada, 2000
OOP - Out of pocket payments Primary financier

RHA - Regional Health Authority Financial flows
Service flows
Private
Insurers
Voluntary contributions
Healthcare services for natives living on

reserves, RCMP, inmates in federal
premiums Federal prisons, veterans & military personnel
Government
Transfers RHAs (except NS

& Ont) funding for
Global service varies by
Taxes budgets
Provincial province
Governments
Transfers
Taxes
Municpal
Governments
Employer Workers
contribution Compensation
Taxes Board
Community
Population and Enterprises health services
OOP Other
institutions
Limited coverage
OOP Dental & Vision
Care, Other
Practitioners
Hospitals
OOP
Physicians
(about 80%
Fee-for-service)
Pharmaceuticals Limited coverage

(incl over the
OOP
counter drugs
Patients
Public Health
appendix one
reimbursements
Source: OECD Secretariat

England 1.14 Ambulatory care is also provided in 36 walk-in clinics

and there is a 24-hour telephone helpline service
1.10 OECD system information is only available for England. (NHS Direct) as a first point of contact.
Other constituent parts of the United Kingdom have
their own structures for delivering a largely publically
funded health service, free at the point of use. In-patient/secondary care
1.15 Access to emergency care is through personal
1.11 Primary care services are mainly provided by GPs and
attendance at Accident and Emergency departments in
multi-professional teams in health centres (under a
acute hospitals. Patients may walk in to such
capitated budget), Figure 1.3. Hospitals are mainly
departments or use the free ambulance service in cases
publicly owned with independent trust status. Private
of extreme urgency. Patients may also be advised to
hospitals mainly provide services to privately insured
attend Accident and Emergency departments by their
patients or those who are willing to pay directly.
GP or NHS Direct.
1.16 Access to in-patient care is through GP referral. Most

referrals are made to local hospitals and follow
1.12 The Government is responsible for health legislation and contractual arrangements between health authorities,
general policy matters and is a purchaser and provider Primary Care Trusts and the hospital. Secondary care is
of health care. provided in general acute NHS trusts, small-scale
community hospitals and highly specialised tertiary
level hospitals. Hospitals are semi-autonomous self-
Primary care governing public trusts that contract with groups of
1.13 GPs act as gatekeepers and are brought together in purchasers. Consultants are salaried.
Primary Care Groups/Trusts with budgets for all care of
enrolled populations. Most ambulatory care is provided
by GPs in group practices. Private general practice is
very small. Physicians are paid directly by the
Government through a combination of methods: salary,
capitation, and fee-for-service.
appendix one
32
1.3 Financing of healthcare in England, 1999
Financial flows
Service flows
Referral flows
Risk related, voluntary premiums Private Health

Insurance
Department of
Health
General taxation and Global budgets for HCHS* and
National Insurance contributions NHS Executive prescribing set by weighted capitation
Regional
Offices
Retail
Pharmacists GP remuneration
and expenses
Prescripton
charges
Prescribing
Prescribed
drugs
Population
Primary Care GP remuneration
Groups (can and expenses Strategic
GP and practice evolve into Health
nursing services Primary Care Global budgets Authorities
Trusts) for HCHS* and
prescribing
Referrals Commissioning
of most HCHS*
Hospital and
community
health services Hospital and
Patients Commissioning of highly
Community
HealthTrusts specialised HCHS*
Direct
payments
Private
Hospitals Direct payments
Reimbursement
Source: Department of Health, England
appendix one
NOTE
* HCHS: Hospital and Community Health Services

33
France In-patient/secondary care

1.17 All legal residents are covered by public health 1.20 In-patient care is provided in public and private hospitals
insurance. They have no choice to opt out. Most have (not-for-profit and for-profit). Doctors in public hospitals
additional private insurance to cover areas that are not are salaried whilst those in private hospitals are paid on
eligible for reimbursement by the public health a fee-for-service basis. Some public hospital doctors are
insurance system and many make out of pocket allowed to treat private patients in the hospital, within
payments to see a doctor. Health care is purchased and limits. A percentage of the private fee is payable to
paid for by health insurance schemes and the the hospital.
Government and provided by private (self-employed)
practitioners and public and private (for-profit and not- 1.21 Most out-patient care is delivered by doctors, dentists
for-profit) hospitals, Figure 1.4. and medical auxiliaries working in their own practices
(62 per cent are in sole practice, the remainder are
in groups). Out-patient care is also provided to a lesser
Role of the Government extent in hospitals and marginally in health centres (run
by local authorities or mutual associations).
1.18 The French Government regulates contribution rates
paid to sickness funds, sets global budgets and salaries
for public hospitals, and supervises national fee
schedule negotiations.
Primary care
1.19 French patients have free choice of provider. They can
visit any GP or specialist practising privately or working
in hospital out-patient, without referral or any limit on
the number of consultations. Ambulatory care is mainly
provided by professionals practising privately. Most GPs
and specialists are paid on a fee-for-service basis
according to agreed fee schedules. Patients pay
physicians' bills and are reimbursed by sickness funds
(public reimbursement model). GPs have no formal
gatekeeper function. The Government introduced a non-
obligatory gatekeeping mechanism in 1987 but only
1 per cent of the patients and 10 per cent of GPs signed
up to this.
NOTES FOR FIGURE 1.4 (OPPOSITE)

Fully private health insurance concerns only a minority of extra-
territorial workers, or cross border workers.
appendix one
(1) ACOSS = Central Social Security Account

(2) CANAM = Health Insurance Fund for self-employed
(3) MSA = Health Insurance Fund for farmers
(4) URSSAFF = Body collecting social contributions
34 Source: OECD Secretariat
1.4 Financing of healthcare in France, 1999
"Mutuelles" & Private health Reimbursement

private health insurance of patients
insurance
premiums
Reimbursement
"Mutuelles", Social of patients
Security, Mandatory
State financial Sickness Funds
funds,
Refinancing of Main health
deficits insurance funds Fee-for-service
(CNAMts) Private clinics
ACOSS (1) CANAM (2)
Payment of
MSA (3) global budgets
to hospitals
Control
Ministry of Social
Affairs, Secretary of Regulation of
State for Health and supply,
Ministry of Finance other public bodies hospitals, drugs
and Industry,
controls balancing
accounts
National target Regional hospital
for health supervisory
spending agencies
Obligatory
employer/employee Target for
medical spending Public hospitals
social contributions Allocation of
(ONDAM) and equivalent
(CSG) global budgets
hospitals
URSSAFF (4) Tax services Private

clinics
Local
Population and Enterprises government
Community
health centres
Agreement with
retail pharmacists
Doctors: RE: generic &
Generalists, substitution drugs
Specialists
Patients
Prescribed auxiliary
and ambulatory
Copayments and services Economic Regulatory
other patient Agency for health
direct payments products
Retail pharmacies (Drug Agency)
and drugs
appendix one
Contracts
Pharmaceutical
industry

Germany Primary care

1.22 92 per cent of the population is covered by statutory 1.24 All ambulatory care, including both primary care and
health insurance, and just under 8 per cent by private out-patient secondary care has been organised almost
health insurance but 0.2 per cent is not covered at all. exclusively on the basis of office-based physicians.
Ambulatory care and hospital care have traditionally Their premises, equipment and personnel are
been distinct domains with almost no out-patient care financed by the physicians' associations. Ambulatory
delivered in hospitals, Figure 1.5. Ambulatory care is physicians offer almost all specialties with all
delivered by private office-based physicians technical equipment up to MRI scanners. Besides
(generalists and specialists). Hospital in-patient care is GPs, the most frequented specialists are internists,
provided by a mix of public and private providers, gynaecologists and paediatricians. They are paid on a
although only a small proportion of total beds is in fee-for-service basis. All treat public and private
for-profit hospitals. patients. There is no formal gatekeeping system as
patients are free to choose their doctor.

1.23 The Government regulates the sickness funds. However,
it has increasingly tended to reduce its interventions in 1.25 Except in emergency conditions, access to in-patient
favour of a self-regulating system. care requires a referral from an ambulatory physician.
Hospitals are public and private (for-profit and not-for-
profit). They are staffed with salaried junior doctors and
fee-for-service senior doctors.
appendix one
36
1.5 Financing of healthcare in Germany, 1995 (Values in Billion DM)
General Public and Private

Government private households
98 employers 211
198
6 57 35 172 39
16 121
■ Mandatory Health Insurance 237

■ Mandatory long-term care insurance 10
■ Pension Fund 39
■ Mandatory Accident Insurance 16
■ Private Health Insurance 26
26 Expenditure on
247
administration
■ In-patient Care 123

■ Ambulatory Care 87
■ Medical Goods (including denture) 82
■ Other benefits 67
61 55
Benefits-in-cash
(income transfers) Benefits-in-kind
Private households
Source: Adapted from Federal Office of Statistics, 1998
NOTE
The benefits-in-cash which are not included in most of the diagrams are included here.

appendix one
37
Italy In-patient/secondary care

1.26 The main providers are local health units (consisting of 1.29 Access to secondary care is through a GP referral.
health districts, hospitals and health promotion Referred patients are free to choose their provider
divisions), public hospital trusts and private accredited among those accredited by the health service.
hospitals, Figure 1.6. Local health units are responsible Specialised ambulatory services are provided either by
for maintaining the balance between the funding local health units or by accredited public and private
provided by the regions and expenditure for service. facilities with which local health units have agreements
and contracts.
Role of the Government 1.30 In-patient care is provided by hospitals. The major
hospitals are given the status of independent trusts. The
1.27 Regional government, through regional health
rest of the public hospitals are kept under the direct
departments, is responsible for ensure the delivery of a
management of local health units. Hospital physicians
benefit package through a network of local health units
delivering secondary care earn a monthly salary.
and public and private accredited hospitals.
Primary care
1.28 Primary care is provided by general practitioners,
paediatricians and self-employed and independent
physicians working alone under a Government contract
who are paid a capitation fee based on the numbers on
their list.
appendix one
38
1.6 Financing of healthcare in Italy, early 1990s
Compulsory Tax subsidies

Ministry Regional health Local Health
social Treasury
of Health authorities Offices (LHO)
contributions
Payments to
Private insurance Private insurance Reimbursements
premiums companies to patients Preventative
care
Health funds Supplemental Reimbursements

health funds to patients Public
hospital Private
service Service Budgets
Private structures Reimbursements

of private
sector to patients Clinics
Direct
payment
of which:
the main Other
services care*
Population and
Enterprises
Reimbursement of patients
Pay beds and intramural professional activity
Patients Prescription charges
Prescription
charges
List Salary Per diem Capitation
prices
Specialists Hospitals
operating within General
Pharmacists under contract to NHS
the NHS practitioners
and nursing homes
'convenzionati' 'convenzionati'
appendix one
Source: Salvini, R. (1991), Il sistema sanitario italiano, ISPE, not published and Hoffmeyer et al, Financing Health Care, Romel, NERA 1994.
NOTE
* Out-patient care, household advisory bureau, therapeutic appliances and thermal services, care for poor people, for Italians who
live abroad and for foreigners who live in Italy.
39
Japan Primary care

1.31 Japan's healthcare system offers universal coverage and 1.33 Physicians have no formal gatekeeper function. Most are
stresses preventative care. Provision is mainly private, in private practice and are paid through a uniform fee
with 80 per cent of Japan's hospitals and 94 per cent of schedule. Medical and pharmaceutical practices are
its physician run clinics being privately owned, often combined, and a large proportion of physicians'
Figure 1.7. Investor-owned for-profit hospitals are incomes is derived from prescriptions.
prohibited. Patients are free to select care providers.
Role of the Government 1.34 Hospitals are mainly private, although there are some
1.32 The Japanese Government acts as regulator and insurer. public ones. Hospitals combine acute and long-term
It determines a fee schedule in consultation with care functions and are paid according to a uniform fee
providers and consumers. All doctors receive the same schedule. Hospital based physicians are salaried.
salary regardless of experience. It also subsidises health
care spending for the elderly, small business employees,
and the self-employed.
appendix one
40
1.7 Financing of healthcare in Japan, early 2000
Financial flows
Service flows
Insurers
Employer for Employees
(Society-Managed HI &
Government-Managed HI)
Insurer
Contributions for Government transfers
(41.7% of THE Employees etc.
or 52.9% of NME
in 1998)
Insurers
for Self-Employed
(National HI)
Subsidies Social Insurance

(25.4% of THE Medical Care
or 32.2% of NME Fee
Government
in 1998) Medical Aid Payment Fund
Programme etc.
Reviews &
Payments
(67.1% of THE
Taxes Subsidies or 85.1% of NME
Public Health in 1998)
Programmes
Health Centres
(Half the cost for
elderly care
except copayment)
Health Service mixed payment

Facilities for
(half the cost for
Elderly etc.
elderly care
except for copayment)
Population
Pharmacy fee-for-service
Patient Copayment
(11.7% of THE
or 14.8% of NME fee-for-service
in 1998) Doctor's Clinic
and non-covered
services
Patients Hospital
(Including
special function
appendix one
fee-for-service
hospitals,
geriatric
hospitals)

New Zealand In-patient/secondary care

1.35 New Zealand's healthcare system covers all residents. 1.38 Patients access secondary care via a GP referral.
All essential services, including hospital and out-patient, Specialist physicians and surgeons provide ambulatory
are provided free through the public health system, with care in community-based public or private clinics or in
the exception of dentistry and ophthamology. Public hospital out-patient departments. Hospital out-patient
hospitals account for just over half the total bed stock departments play a larger role in the health system
including the large tertiary sector. The costs of primary than in other countries since treatment is free
health care are met or subsidised for certain groups. while consultations with community based
About 40 per cent of the population hold concession practitioners are charged.
cards (usually low-income patients, children and higher
users of the services). Health services are delivered by a 1.39 Publicly owned hospitals provide most secondary and
mix of public and private providers, Figure 1.8. tertiary care, while the growing private sector specialises
mainly in elective surgery and long-term care. Public
hospitals are not permitted to treat private patients.
Role of the Government Hospitals are semi-autonomous Government owned
companies that contract with the Health Funding
1.36 New Zealand's Government is a purchaser and provider
Authority. Consultants are salaried.
of healthcare and has responsibility for legislation and
general policy matters.
Primary care
1.37 General practitioners act as gatekeepers and are
predominately private practitioners with two-thirds
working in group practices. Patients have a choice of
GPs and are free to see more than one GP, although in
practice continuity of care is high. They provide most
primary medical services. They are self-employed and
are paid through a combination of payment methods:
fee-for-service, partial Government subsidy, and
negotiated contracts with Health Funding Authority
through Independent Practitioner Associations.
appendix one
42
1.8 Financing of healthcare in New Zealand, 1998
Financial flows
Service flows
Central Ministry
Government of Health
General Taxation Accident

compensation
corporation (ACC)
Levies/Premiums
Population and copayments

Enterprises
Pharmacists* contracts/
subsidies**
Fees Independent
capitation
Practitioners
budgets and
Associations
Patients fee for service
subsidies**
Fees
Non IPA GPs and
other independent Health Funding
practitioners fee for service Authority
Broad risk subsidies/
related budget-holding
premiums capitation**
Hospitals and
Health Services contracts
Reimbursement Fees (HHSs)
Voluntary and contracts

Private
Private Providers
Insurance
Community contracts
Trusts
Private contracts
Hospitals
appendix one
* and other providers such as laboratories and radiology clinics

** relating to contracts with the Health Funding Authority
43
Sweden Primary care

1.40 Ambulatory care is provided by a mix of public doctors, 1.42 Patients can choose between primary care centres or
private doctors and hospital out-patient departments. hospital out-patient departments as the first point of
Hospitals are publicly owned but have independent contact. Higher fees are applicable for out-patient visits
status, with the extent of privatisation varying between compared to visits to primary care centres.
counties, Figure 1.9.
Role of the Government 1.43 Patients can access secondary care directly through a
1.41 The county councils are responsible for the purchasing hospital out-patient department. In many counties
of health services and either act as purchasers patients can also select which hospital to be treated at,
themselves or devolve this responsibility to other and in some cases, without referral. Most hospitals are
purchasing agents. publicly owned.
appendix one
44
1.9 Financing of healthcare in Sweden, 1999
Around 2% of Private Health

health funds insurance
Taxes & National

employer Government
fees
National pay roll tax Social insurance

General tax board
equalisation
& grants Grants (weighted capitation
less FFS payments)
Around 72% of 21 County councils

health funds -
local payroll rax
Municipalities
Population and
Home health care
Enterprises
Public hospitals & Budgets

LT institutions
Some
central
Public primary Salaries purchasing
physicians agencies
Budgets Mixed payment

Public primary
systems Some
health centres
mainly FFS devolved
district health
authorities
Private general FFS
practitioners
Private medical FFS

specialists
Pharmacies Subsidised prices and

Patients prescribed out-patient
medications
appendix one
Reimbursements
and payments Cash benefits

45
United States Primary care

1.44 Health care services are mainly provided by private 1.46 General practitioners have no formal gatekeeper function,
practitioners, Figure 1.10. except within some managed care plans. The majority of
physicians are in private practice and are paid through a
combination of charges, discounted fees paid by private
Role of the Government health plans, capitation rate contracts with private plans,
public programmes, and direct patient fees.
1.45 The federal Government is the single largest health care
insurer and purchaser. There are two principal schemes in
which the Government is involved: Medicaid and In-patient/secondary care
Medicare. Medicaid is a jointly-funded, Federal-State
health insurance programme for certain low-income and 1.47 In-patient care is provided in public and private hospitals
needy people. It covers approximately 36 million (for-profit and not-for-profit). Hospitals are paid through a
individuals including children, the aged, blind, and/or combination of charges, per admission, and capitation.
disabled, and people who are eligible to receive federally
assisted income maintenance payments. Medicare is a
health insurance programme for people 65 years of age
and older, some disabled people under 65 years of age,
and people with End-Stage Renal Disease (permanent
kidney failure treated with dialysis or a transplant). It
currently covers some 39 million Americans.
appendix one
46
1.10 Financing of healthcare in the United States, early 1990s
Premiums
Federal Budget/Trust Fund Private Insurers
Medicare
Government
Traditional Managed Care
Insurers Entities
Budgets
RBRVS
State
Governments FFS (Traditional)/
Various Contracts (Managed)

Various Contracts
(Managed)
Budgets
FFS (Traditional)
State Medicaid Discounted FFS
Programmes and CPC
Physicians
Negotiated
Prices CPC
(DRGS)
Hospitals
Discounted FFS
and CPC
Co-pay & Out-of-Pocket
Pharmacists
FFS/Formularies
Copayments &
Out of pocket
Copayments & payments
Out of pocket payments
Reimbursement for Out of pocket/

General Taxation Copayments (e.g. Medigap) other
Patients benefits (e.g. pharmaceuticals)
General Taxation/Payroll Taxes
Tax-payers Consumers (Mostly) Risk-Related Premia
Source: Financing Health Care, Volume II, Hoffmeyer et al., 1994
CPC: Cost-per-case
FFS: Fee-for-service
RBRVS: Resource-based relative value scale

appendix one
47
Appendix 2 Death rates from the main

cancers over time
2.1 Deaths from cervical cancer, 1980 to 1999
8
5
New Zealand
Germany
4 United Kingdom
United States
3 Japan
Canada
Sweden
2
Australia
France
1 Italy
0
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19


appendix two
48
2.2 Deaths from breast cancer, 1980 to 1999
40
35
30
United Kingdom
New Zealand
25 Germany
Canada
France
20 United States
Italy
Sweden
15 Australia
Japan
10
0
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19

Source: OECD Heath Data 2002
appendix two
49
2.3 Deaths from prostate cancer, 1980 to 1999
45
40
35
Deaths per 100,000 males (standardised)
Sweden
30 New Zealand
Australia
France
25 United Kingdom
Canada
Germany
20
United States
Italy
15 Japan
10
0
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
2.4 Deaths from lung cancer, 1980 to 1999
60
50 United States
Canada
United Kingdom
Italy
40 New Zealand
Australia
France
30 Germany
Japan
Sweden
20
10
0
appendix two
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19
19

50

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International Health Comparisons

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International Health Comparisons

A compendium of published information on healthcare systems,

A compendium of published information on healthcare systems,

For further information about the National Audit Office

National Audit Office

Tel: 020 7798 7400

Part 1 Making comparisons

Introduction World Health Organization3, the two reports prepared for

! Part 1: Making comparisons;

1.11 A further consideration in drawing conclusions is that

Part 2 Healthcare systems

10 country average of 8.9 per cent

(2000) (2000) (2000)

Source: OECD Health Data 2002 3

payments, such as some prescription costs.

8 Budget Report 2002, HM Treasury, Chapter 6.

3 Health expenditure as a percentage of GDP, 1980 to 2001

Source: OECD Health Data 2002

4 Health expenditure per head

(2000) (2000) (2000)

Source: OECD Health Data 2002

5 Sources of health expenditure

Taxation Social insurance Private insurance

Out of pocket patient costs Other private payments

Source: OECD Health Data 2002

6 The methods of financing healthcare

6 The methods of financing healthcare (continued)

Part 3 Providing healthcare

7 Number of practising physicians

(1999) (2000) (2000)

Source: OECD Health Data 2002

8 Level of practising physicians, 1980 to 2000

Data are not available for all years for Japan

9 Number of practising nurses

8.4 8.3 8.1

Source: OECD Health Data 2002

10 Acute hospital admissions

! to cure illness or to provide definitive treatment of injury

11 Practising nurses per 1,000 acute admissions

Source: OECD Health Data 2002

12 Practising nurses per acute bed day

Source: OECD Health Data 2002

13 Number of acute hospital beds per 1,000 of population

Source: OECD Health Data 2002

14 Bed occupancy for acute beds

Source: OECD Health Data 2002

Medical infrastructure of prescribing generic drugs which are considerably

15 Availability of Magnetic Resonance Imaging units

Source: OECD Health Data 2002

17 Coronary bypass procedures per 100,000 of population

100 91.5 90.2

Source: OECD Health Data 2002

18 Percentage of children immunised against measles

100 96.5 96.2 95.2

Part 4 Health achievements

20 Life expectancy at birth

Source: OECD Health Data 2002

21 Potential years of life lost

(1998) (1998) (1999)

22 Perinatal mortality, 1980 to 2000

Australia Canada France Germany Italy

Source: OECD Health Data 2002

14 The NHS Cancer Plan, Department of Health, September 2000. 19

23 Infant mortality, 1980 to 2000