World - OECD comparisons of international health systems

The availability and quality of care at home are key drivers of medical tourism. The latest study by the Organization for Economic Cooperation and Development (OECD) evaluates the state of healthcare in all 34 member nations, including how much each government spends on healthcare, and how much its citizens have to pay out of pocket.

This sixth edition of ‘Health at a Glance’ provides the latest comparable data on different aspects of the performance of health systems in OECD countries. It provides striking evidence of large variations across countries in the costs, activities and results of health systems. This edition presents data for all OECD member countries. Where possible, it also reports data for Brazil, China, India, Indonesia, the Russian Federation and South Africa, as major non-OECD economies. It uses OECD Health Data 2011, the most comprehensive set of statistics and indicators for comparing health systems across the 34 OECD member countries.

The quality of medical care is improving in OECD countries, with higher survival rates for life-threatening diseases. But there is a need for better prevention and management for chronic diseases, such as asthma and diabetes, with too many people unnecessarily admitted to hospitals. Obesity is a key risk factor for many chronic conditions, with severely obese people dying up to 10 years earlier than those of normal weight.  ‘Health at a Glance 2011’ shows that obesity rates have doubled or even tripled in many countries since 1980.  In more than half of OECD countries, 50% or more of the population is now overweight, if not obese.  The obesity rate in the adult population is highest in the United States, rising from 15% in 1980 to 34% in 2008, and lowest in Japan and Korea, at 4%.

In 2009, the country spending the most on health was, by far, the United States, devoting $7,960 per capita, two and a half times the OECD average.  The next highest spending countries, Norway and Switzerland, spend only around two-thirds of the per capita level of the United States, but still spend more than 50% above the OECD average. Despite public concerns about privatisation of health financing, the public sector continues to pay 72% of all health expenditure on average across OECD countries, a share that has not changed over the past 20 years.

Long waiting times are often seen as a reason for people becoming medical travellers. Since there are no universally accepted definitions of waiting times, data derived from different sources and different countries are not be fully comparable. Waiting times for specialist consultations were higher in Canada, Norway and Sweden, with 50% or more of survey respondents waiting at least 4 weeks for an appointment.

In Germany, Switzerland and the United States, more timely access was provided. Waiting times for elective surgeries such as cataract removal or hip replacement also show substantial differences. In 2010, a considerable proportion of patients in Canada, Sweden, Norway, the United Kingdom and Australia reported waiting four months or more for elective surgery. Waiting times can vary within countries.

Though very moderate waiting times for a doctor consultation are reported for Germany, patients in the eastern part of the country report waiting longer. There is evidence from several countries, including England, Germany and Austria, that persons in higher socio-economic groups or with private health insurance have shorter waiting times.

The report warns that it can be cost-effective to maintain short queues of elective patients because the adverse health consequences of short delays are minimal, and there are savings in hospital capacity from allowing queues to form. They may also deter patients who stand to gain only small health benefits from demanding free treatment.

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