JANUARY
1857_mossialos_intl_profiles_2015_v6 1857_mossialos_intl_profiles_2015_v6
Table 1. Health Care System Financing and Coverage in 18 Countries Australia Government role Regionally administered, joint (national & state) public hospital funding; universal public medical insurance program (Medicare) HEALTH SYSTEM AND PUBLIC/PRIVATE INSURANCE ROLE Public system financing General tax revenue; earmarked income tax BENEFIT DESIGN Private insurance role (core benefits; cost-sharing; noncovered benefits; private facilities or amenities; substitute for public insurance) Caps on cost-sharing Exemptions and low-income protection ~47.3% buy complementary (e.g., private hospital and dental care, optometry) and supplementary coverage (increased choice, faster access for nonemergency services, rebates for selected services) Caps for pharmaceutical OOP expenditure only, dependent on income and total OOP expenditure in the same year Low-income and older people: Lower cost-sharing; lower pharmaceutical OOP cap and lower OOP maximum for 80% Medicare services rebate a Canada China Denmark Regionally administered universal public insurance program that plans and funds (mainly private) provision Supervision by health authorities (Health and Family Planning Commissions) at the national, provincial and local levels; some direct provision through public ownership of hospitals National health care system. Regulation, central planning, and funding by national government; provision by regional and municipal authorities. Provincial/federal general tax revenue There are three main publicly financed health insurance types with local-area risk-pooling: urban employer-based (mainly payroll taxes, for formally employed urban residents), urban resident basic (mainly government funded, for urban nonemployed residents), and rural cooperative medical scheme (government-funded, for rural residents) Earmarked income tax England National health service (NHS) General tax revenue (includes employment-related insurance contributions) France Germany Statutory health insurance system, with all SHI insurers incorporated into a single national exchange Statutory health insurance (SHI) system, with 124 competing SHI insurers (“sickness funds” in a national exchange); high income can opt out for private coverage Employer/employee earmarked income and payroll tax; general tax revenue, earmarked taxes Employer/employee earmarked payroll tax; general tax revenue ~67% buy complementary coverage for noncovered benefits (e.g., private rooms in hospitals, drugs, dental care, optometry) Complementary to cover cost-sharing and gaps, as well as better health care quality and/or higher reimbursements. No data on coverage, but growth has been rapid. ~39% have complementary coverage (cost-sharing, noncovered benefits such as physiotherapy), ~26% have supplementary coverage (access to private providers) ~11% buy supplementary coverage for more rapid and convenient access (including to elective treatment in private hospitals) ~95% buy or receive government vouchers for complementary coverage (mainly cost-sharing, some noncovered benefits); limited supplementary insurance ~11% opt out from statutory insurance and buy substitutive coverage. Some complementary (minor benefit exclusions from statutory scheme, copayments) and supplementary coverage (improved amenities). India Children and adolescents
Table 2. Selected Health Care System Indicators for 17 Countries Population, 2013 Spending, 2013 (unless otherwise noted) Australia Canada China o Denmark France Germany Israel Italy Japan Netherlands New Zealand Norway Singapore Sweden Switzerland United Kingdom United States Total population (millions) 23.132 35.317 1,360.720 5.615 63.790 80.646 8.057 60.233 127.296 16.804 4.472 5.080 5.312 g 9.600 8.089 64.107 316.129 Percentage of population over age 65 Percentage of GDP spent on health care 14.4% 15.2% 9.7% 17.8% 17.7% 21.1% 10.7% 21.0% 25.1% 16.8% 14.2% 15.6% 10.0% g 19.0% 17.3% 17.1% 14.1% 9.4% a 10.7% 5.4% 11.1% 11.6% 11.2% 7.4% b n/a 10.2% 11.1% e 11.0% 9.4% 4.7% g 11.5% 11.1% e 8.8% 17.1% Health care spending per capita d $4,115 a $4,569 $636 $4,847 $4,361 $4,920 $2,232 b n/a $3,713 $5,131 e $3,855 $6,170 $2,881 h $5,153 $6,325 e $3,364 $9,086 Average annual growth rate of real health care spending per capita, 2009–13 2.42% l 0.22% 15.41% –0.17% 1.35% 1.95% 2.61% m n/a 3.83% 1.73% e 0.82% 1.40% n/a 6.95% e 2.54% e –0.88% 1.24% Out-of-pocket health care spending per capita d $771 a $623 $216 $625 $277 $649 $627 $666 $503 a $270 $420 $855 n/a $726 $1,630 $321 $1,074 Physicians, 2013 (unless otherwise noted) Hospital spending, utilization, and capacity, 2013 (unless otherwise noted) Medical technology, 2013 (unless otherwise noted) IT, 2015 Hospital spending per capita d $1,645 a $1,338 $392 $2,070 $1,600 $1,423 $772 b n/a 1,673 a $1,849 n/a $2,285 a n/a $1,907 $2,289 n/a $2,964 Spending on pharmaceuticals per capita d $590 a $761 $263 r $288 $622 $678 287 b $572 $756 a $397 n/a $437 n/a $496 $696 n/a $1,034 Number of practicing physicians per 1,000 population Average annual number of physician visits per capita Number of acute care hospital beds per 1,000 population 3.39 2.48 a 2.04 3.62 a 3.10 4.05 3.43 3.90 2.29 a n/a 2.81 4.31 1.9 g,c 4.01 a 4.04 2.77 2.56 7.1 7.7 a 5.4 4.6 6.4 9.9 n/a 6.8 12.9 a 6.2 3.7 a 4.2 n/a 2.9 3.9 a n/a 4.0 c 3.36 a 1.71 a 4.55 2.47 3.35 5.34 1.90 2.75 b 7.92 3.32 a 2.59 2.29 2.0 i,b 1.94 2.91 2.28 2.48 a Hospital spending per discharge d $9,529 a $15,916 a $2,033 $11,471 c $9,622 $5,641 $4,797 b n/a $14,408 b 14,980 a n/a $11,361 c n/a n/a $13,437 a n/a $20,991 c Hospital discharges per 1,000 population Average length of stay for curative care (days) Magnetic resonance imaging (MRI) machines per million population 173 a 83 a 140 172 c 166 252 159 124 111 b 119 a 146 175 c n/a 163 c 166 a 129 125 c 4.8 a 7.6 a 8.9 n/a 5.7 a 7.7 4.3 6.8 17.2 6.4 a 5.3 5.5 n/a 5.6 a 5.9 5.9 5.4 b 13.4 8.8 3.2 p n/a 9.4 n/a 3.1 24.6 a 46.9 b 11.5 11.2 n/a 8.3 j,c n/a n/a 6.1 35.5 MRI exams per 1,000 population 27.6 52.8 42.7 p 60.3 90.9 n/a 30.5 n/a n/a 50.0 b n/a n/a n/a n/a n/a n/a 106.9 Physicians’ use of EMRs (% of primary care physicians) f 92% 73% n/a n/a 75% 84% n/a n/a n/a 98% 100% 99% n/a 99% 54% 98% 84% Health risk factors, 2013 Percentage of adults who report (unless being daily smokers 12.8% 14.9% 28.1% q 17% 24.1% a 20.9% 16.2% 21.1% 19.3% 18.5% 15.5% 15.0% 13.3% k 10.7% 20.4% a 20.0% a 13.7% otherwise noted) Obesity (BMI>30) prevalence 28.3% b 25.8% 11.9% q 14.2% n 14.5% a,n 23.6% 15.7% n 10.3% n 3.7% 11.1% n 30.6% 10.0% a,n 10.8% k,c 11.7% n 10.3% a,n 24.9% 35.3% a Source: OECD Health Data 2015 (November) unless otherwise noted. a 2012. b 2011. c 2010. d Adjusted for differences in the cost of living. e Current spending only, and excludes spending on capital formation of health care providers. f Commonwealth 2015 Survey of Primary Care Physicians. g Source: World Bank, 2014. h Source: World Bank, 2014; 2005 purchasing power parity (PPP) adjustment. i Source: World Bank, 2014; may include chronic care beds as well as acute care beds. j Source: World Health Organization, 2014. k Source: Singapore Health Promotion Board, 2014. l 2009–12. m 2009–11. n Self-reported as opposed to measured data. o China indicators are from China Health and Family Planning Statistical Yearbook 2014 unless otherwise noted. p Calculated by using data from China Health and Family Planning Statistical Yearbook and Gu, X., D. He, X. Hu et al., Forecast analysis of MRI allocation in China. China Health Resources 2013, 16(1):41–43. q National Health and Family Planning Commission of China, 2015. Report on Nutrition and Non-communicable Disease Status of Chinese Residents 2015. r China National Health Development Research Center. China National Health Accounts Report 2014. International Profiles of Health Care Systems, 2015 7
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Table 2. Selected Health Care System Indicators for 17 Countries<br />
Population,<br />
2013<br />
Spending,<br />
2013<br />
(unless<br />
otherwise<br />
noted)<br />
Australia Canada China o Denmark France Germany Israel Italy Japan Netherlands<br />
New<br />
Zealand Norway Singapore Sweden Switzerland<br />
United<br />
Kingdom<br />
United<br />
States<br />
Total population (millions) 23.132 35.317 1,360.720 5.615 63.790 80.646 8.057 60.233 127.296 16.804 4.472 5.080 5.312 g 9.600 8.089 64.107 316.129<br />
Percentage of population over<br />
age 65<br />
Percentage of GDP spent on<br />
health care<br />
14.4% 15.2% 9.7% 17.8% 17.7% 21.1% 10.7% 21.0% 25.1% 16.8% 14.2% 15.6% 10.0% g 19.0% 17.3% 17.1% 14.1%<br />
9.4% a 10.7% 5.4% 11.1% 11.6% 11.2% 7.4% b n/a 10.2% 11.1% e 11.0% 9.4% 4.7% g 11.5% 11.1% e 8.8% 17.1%<br />
Health care spending per capita d $4,115 a $4,569 $636 $4,847 $4,361 $4,920 $2,232 b n/a $3,713 $5,131 e $3,855 $6,170 $2,881 h $5,153 $6,325 e $3,364 $9,086<br />
Average annual growth rate of<br />
real health care spending per<br />
capita, 2009–13<br />
2.42% l 0.22% 15.41% –0.17% 1.35% 1.95% 2.61% m n/a 3.83% 1.73% e 0.82% 1.40% n/a 6.95% e 2.54% e –0.88% 1.24%<br />
Out-of-pocket health care<br />
spending per capita d $771 a $623 $216 $625 $277 $649 $627 $666 $503 a $270 $420 $855 n/a $726 $1,630 $321 $1,074<br />
Physicians,<br />
2013<br />
(unless<br />
otherwise<br />
noted)<br />
Hospital<br />
spending,<br />
utilization,<br />
and capacity,<br />
2013<br />
(unless<br />
otherwise<br />
noted)<br />
Medical<br />
technology,<br />
2013<br />
(unless<br />
otherwise<br />
noted)<br />
IT, 2015<br />
Hospital spending per capita d $1,645 a $1,338 $392 $2,070 $1,600 $1,423 $772 b n/a 1,673 a $1,849 n/a $2,285 a n/a $1,907 $2,289 n/a $2,964<br />
Spending on pharmaceuticals<br />
per capita d $590 a $761 $263 r $288 $622 $678 287 b $572 $756 a $397 n/a $437 n/a $496 $696 n/a $1,034<br />
Number of practicing physicians<br />
per 1,000 population<br />
Average annual number of<br />
physician visits per capita<br />
Number of acute care hospital<br />
beds per 1,000 population<br />
3.39 2.48 a 2.04 3.62 a 3.10 4.05 3.43 3.90 2.29 a n/a 2.81 4.31 1.9 g,c 4.01 a 4.04 2.77 2.56<br />
7.1 7.7 a 5.4 4.6 6.4 9.9 n/a 6.8 12.9 a 6.2 3.7 a 4.2 n/a 2.9 3.9 a n/a 4.0 c<br />
3.36 a 1.71 a 4.55 2.47 3.35 5.34 1.90 2.75 b 7.92 3.32 a 2.59 2.29 2.0 i,b 1.94 2.91 2.28 2.48 a<br />
Hospital spending per<br />
discharge d $9,529 a $15,916 a $2,033 $11,471 c $9,622 $5,641 $4,797 b n/a $14,408 b 14,980 a n/a $11,361 c n/a n/a $13,437 a n/a $20,991 c<br />
Hospital discharges per 1,000<br />
population<br />
Average length of stay for<br />
curative care (days)<br />
Magnetic resonance imaging<br />
(MRI) machines per million<br />
population<br />
173 a 83 a 140 172 c 166 252 159 124 111 b 119 a 146 175 c n/a 163 c 166 a 129 125 c<br />
4.8 a 7.6 a 8.9 n/a 5.7 a 7.7 4.3 6.8 17.2 6.4 a 5.3 5.5 n/a 5.6 a 5.9 5.9 5.4 b<br />
13.4 8.8 3.2 p n/a 9.4 n/a 3.1 24.6 a 46.9 b 11.5 11.2 n/a 8.3 j,c n/a n/a 6.1 35.5<br />
MRI exams per 1,000 population 27.6 52.8 42.7 p 60.3 90.9 n/a 30.5 n/a n/a 50.0 b n/a n/a n/a n/a n/a n/a 106.9<br />
Physicians’ use of EMRs<br />
(% of primary care physicians) f 92% 73% n/a n/a 75% 84% n/a n/a n/a 98% 100% 99% n/a 99% 54% 98% 84%<br />
Health risk<br />
factors, 2013 Percentage of adults who report<br />
(unless being daily smokers<br />
12.8% 14.9% 28.1% q 17% 24.1% a 20.9% 16.2% 21.1% 19.3% 18.5% 15.5% 15.0% 13.3% k 10.7% 20.4% a 20.0% a 13.7%<br />
otherwise<br />
noted)<br />
Obesity (BMI>30) prevalence 28.3% b 25.8% 11.9% q 14.2% n 14.5% a,n 23.6% 15.7% n 10.3% n 3.7% 11.1% n 30.6% 10.0% a,n 10.8% k,c 11.7% n 10.3% a,n 24.9% 35.3% a<br />
Source: OECD Health Data 2015 (November) unless otherwise noted.<br />
a 2012.<br />
b 2011.<br />
c 2010.<br />
d Adjusted for differences in the cost of living.<br />
e Current spending only, and excludes spending on capital formation of health care providers.<br />
f Commonwealth 2015 Survey of Primary Care Physicians.<br />
g Source: World Bank, 2014.<br />
h Source: World Bank, 2014; 2005 purchasing power parity (PPP) adjustment.<br />
i Source: World Bank, 2014; may include chronic care beds as well as acute care beds.<br />
j Source: World Health Organization, 2014.<br />
k Source: Singapore Health Promotion Board, 2014.<br />
l 2009–12.<br />
m 2009–11.<br />
n Self-reported as opposed to measured data.<br />
o China indicators are from China Health and Family Planning Statistical Yearbook 2014 unless otherwise noted.<br />
p Calculated by using data from China Health and Family Planning Statistical Yearbook and Gu, X., D. He, X. Hu et al., Forecast analysis of<br />
MRI allocation in China. China Health Resources 2013, 16(1):41–43.<br />
q National Health and Family Planning Commission of China, 2015. Report on Nutrition and Non-communicable Disease Status of Chinese<br />
Residents 2015.<br />
r China National Health Development Research Center. China National Health Accounts Report 2014.<br />
International Profiles of Health Care Systems, 2015<br />
7
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