Multinational Comparisons of Health Systems Data, 2009

1. Multinational Comparisonsof Health Systems Data, 2009 Gerard F. Anderson and Patricia Markovich Johns Hopkins University November 2009 Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund or its directors, officers, or staff.

2. Average spending on healthper capita ($US PPP) Total expenditures on healthas percent of GDP International Comparison of Spending on Health, 1980–2007 Source: OECD Health Data 2009 (June 2009).

3. Average Annual Growth Rate of Real Health Care Spending per Capita, 1997–2007 Percent * 1996–2006 Source: OECD Health Data 2009 (June 2009).

4. Out-of-Pocket Health Care Spending per Capita, 2007 Adjusted for Differences in Cost of Living Dollars * 2006 Source: OECD Health Data 2009 (June 2009).

5. Health Care Expenditure per Capita by Source of Funding, 2007Adjusted for Differences in Cost of Living Dollars * 2006 Source: OECD Health Data 2009 (June 2009).

6. Dollars Hospital Spending per Discharge, 2007Adjusted for Differences in Cost of Living * 2006 Source: OECD Health Data 2009 (June 2009).

7. Hospital Discharges per 1,000 Population, 2007 * 2006 Source: OECD Health Data 2009 (June 2009).

8. Average Length of Hospital Stay for Acute Myocardial Infarction, 2007 Days * 2006 Source: OECD Health Data 2009 (June 2009).

9. Community Hospital Payment-to-Cost Ratios, by Source of Revenue, 1980-2008 Note: Payment-to-cost ratios show the degree to which payments from each payer cover the costs of treating its patients. They cannot be used to compare payment levels across payers, however, because the service mix and intensity vary. Data are for community hospitals. Medicaid includes Medicaid Disproportionate Share payments. Source: American Hospital Association and Avalere Health, Avalere Health analysis of 2008 American Hospital Association Annual Survey data, for community hospitals, Trendwatch Chartbook 2010, Trends Affecting Hospitals and Health Systems, Table 4.4, p. A-35, at http://www.aha.org/aha/trendwatch/chartbook/2010/appendix4.pdf.

10. Average Annual Number of Physician Visits per Capita, 2007 * 2006 ** 2005 Source: OECD Health Data 2009 (June 2009).

11. Number of Practicing Physicians per 1,000 Population, 2007 * 2006 Source: OECD Health Data 2009 (June 2009).

12. Dollars Pharmaceutical Spending per Capita, 2007Adjusted for Differences in Cost of Living * 2006 Source: OECD Health Data 2009 (June 2009).

13. Drug Prices for 30 Most Commonly Prescribed Drugs, 2006–07US is set at 1.0 Source: IMS Health.

14. Drug Prices for 30 Most Commonly Prescribed Drugs, 2006–07,Brand-Name and GenericUS is set at 1.0 Source: IMS Health.

15. Drug Prices: Lipitor (atorvastatin), 2006–07Price for one dose Dollars Source: IMS Health.

16. Drug Prices: Nexium (esomeprazole), 2006–07Price for one dose Dollars Source: IMS Health.

17. Profitability of Pharmaceutical Manufacturers, 1995-2009 NA NA NA Note: Percent is the median percent net profit after taxes as a percent of firm revenues for all firms in the industry. NA = no longer available. Source: Kaiser Family Foundation and Sonderegger Research Center, Prescription Drug Trends: A Chartbook Update, November 2001, Exhibit 4.11, at http://www.kff.org/insurance/3161-index.cfm, updated with data from Fortune, Fortune 500 Industry Rankings: April 14, 2003, Vol.147, No.7, p. F-26; April 5, 2004, Vol. 149, No.7, p. F-26; April 18, 2005, Vol. 151, No.8, p. F-28; April 17, 2006, Vol.153, No.7, p. F-26; April 30, 2007, Vol.155, No.8, p. F-32; 2007 and 2008 numbers from Fortune 500 online at http://money.cnn.com/magazines/fortune/; 2009 numbers from personal communication with Fortune magazine.

18. Magnetic Resonance Imaging (MRI) Machines per Million Population, 2007 ** 2005 Source: OECD Health Data 2009 (June 2009).

19. MRI Scan and Imaging Fees, 2009 Dollars Source: International Federation of Health Plans, 2009 Comparative Price Report.

21. Volume of Knee and Hip Implants, 2004Implants per 100,000 Knee Replacements Hip Replacements Source: McKinsey & Company, Accounting for the Cost of Health Care in the United States, 2007.

22. Cost of Knee and Hip Prostheses to Providers, 2004GDP Adjusted, US $ Dollars Knee Replacements Hip Replacements Source: McKinsey & Company, Accounting for the Cost of Health Care in the United States, 2007.

23. Coronary Bypass Procedures per 100,000 Population, 2007 * 2006 Source: OECD Health Data 2009 (June 2009).

24. Percentage of Population over Age 65 with Influenza Immunization, 2007 Percent a * 2006 Source: OECD Health Data 2009 (June 2009).

25. Percentage of Adults Who Report Being Daily Smokers, 2007 Percent * 2006 ** 2005 Source: OECD Health Data 2009 (June 2009).

26. Percent Obesity (BMI>30) Prevalence Among Adult Population, 2007 * 2006 ** 2005 Note: BMI = body mass index. For most countries, BMI estimates are based on national health interview surveys (self-reported data). However, the estimates for the US, UK, and New Zealand are based on actual measurements of weight and height, and estimates based on actual measurements are usually significantly higher than those based on self-report. Source: OECD Health Data 2009 (June 2009).

27. Life Expectancy at Birth, 2007 Years * 2006 ** 2005 Source: OECD Health Data 2009 (June 2009).

28. Potential Years of Life Lost Because of Diabetes per 100,000 Population, 2007 * 2006 ** 2005 Source: OECD Health Data 2009 (June 2009).

29. Mortality Amenable to Health Care Deaths per 100,000 population* * Countries’ age-standardized death rates before age 75; includes ischemic heart disease, diabetes, stroke, and bacterial infections.Data: E. Nolte and C. M. McKee, “Measuring the Health of Nations: Updating an Earlier Analysis,” Health Affairs, Jan./Feb. 2008 27(1):58–71. Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008.

30. Distribution of National Health Expenditures, by Type of Service, 2008 Note: Other Personal Health Care includes, for example, dental and other professional health services, durable medical equipment, etc. Other Health Spending includes, for example, administration and net cost of private health insurance, public health activity, research, and structures and equipment, etc. Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; National Health Expenditures by type of service and source of funds, CY 1960-2008; file nhe2008.zip).

31. Relative Contributions of Different Types of Health Services to Total Growth in National Health Expenditures, 1998-2008 Notes: Percentages may not total 100% due to rounding. Other Personal Health Care includes, for example, dental and other professional health services, durable medical equipment, etc. Other Health Spending includes, for example, administration and net cost of private health insurance, public health activity, research, and structures and equipment, etc. Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; National Health Expenditures by type of service and source of funds, CY 1960-2008; file nhe2008.zip).

32. Annual Percentage Change in National Spending for Selected Health Services, 1998-2008 Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; National Health Expenditures by type of service and source of funds, CY 1960-2008; file nhe2008.zip).

33. Distribution of National Health Expenditures, by Type of Service, 1998 and 2008 Hospital Care Physician/ Clinical Services Prescription Drugs Nursing Home Care Home Health Care Other Personal Health Care Other Health Spending Notes: Percentages may not total 100% due to rounding. Other Personal Health Care includes, for example, dental and other professional health services, durable medical equipment, etc. Other Health Spending includes, for example, administration and net cost of private health insurance, public health activity, research, and structures and equipment, etc. Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; National Health Expenditures by type of service and source of funds, CY 1960-2008; file nhe2008.zip).

34. Price (Manufacturer Price Increases) 19% Price (Manufacturer Price Increases) 25% Utilization (# of Prescriptions Dispensed) 42% Utilization (# of Prescriptions Dispensed) 47% Types of Prescription Drugs Used 34% Types of Prescription Drugs Used 34% Relative Contributions of Utilization, Types of Prescription Drugs Used, and Price to Rising Prescription Drug Expenditures, 1993-1997 vs. 1997-2002 1993-1997 1997-2002 Source: Kaiser Family Foundation and Sonderegger Research Center analysis using National Health Expenditures data for prescription drugs from the Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.gov/statistics/nhe/historical/, Table 2; price data from IMS Health, Pharmaceutical Pricing UPDATE, various years; and utilization data from IMS Health, National Prescription Audit Plus, various years, updated with data from the IMS Health web site at http://www.imshealth.com.

37. Health System Functions & Objectives Functions • Stewardship • Financing • Resource development & allocation • Service Delivery Objectives • Responsiveness • Fairness • Health World Health Report, 2000 (Figure 2.1; p. 25)