Measuring Performance Measuring Performance in the Health Sectorin the Health SectorWhat do international What do international comparisons tell us? comparisons tell us?
Mark PearsonHead, OECD Health Division
Berlin, March 2010
Why do economists need to know Why do economists need to know about health systems?about health systems?
• Money: It is already larger than manufacturing industry in some countries
• Jobs: Health was virtually the only sector that kept on expanding jobs through the economic crisis
• Growth: Country after country identifies health as a sector which will drive growth over the coming years
2
What most economists know What most economists know about healthabout health
3
What we need to do to measure What we need to do to measure performanceperformance
• Identify Inputs• Identify Outputs (quantities of services and goods
produced/consumed)• Identify Outcomes (changes in health status
attributable to outputs; adjust for ‘other factors’ – income, lifestyle)
• Identify policy features which explain differences in performance
Great in theory, but poor quality Outcome measures are a big problem
4
Impact of SHA on national Impact of SHA on national health expenditure estimateshealth expenditure estimates
• Austria: pre-SHA implementation: 7.5% of GDP (2003)post-SHA implementation: 10.2% (2003)
• France: pre-SHA implementation: 10.1% of GDP (2003)post-SHA implementation: 10.9% (2003)
• Portugal:pre-SHA implementation: 8.2% of GDP (1999)post-SHA implementation: 8.8% (2000)
Due mainly to redefining boundaries of health care (e.g. long-term care), identifying other (private) sources of funding, etc.
Health expenditure per capita
2007
1. Health expenditure is for the insured population rather than resident population.2. Current health expenditure.
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
7
5.75.96.46.8
6.87.37.47.67.78.18.28.48.58.7
8.78.9
8.99.19.2
9.39.69.8
9.89.910
.1
10
.1
10
.2
10
.4
10
.8
11.0
16
.0
0
5
10
15
20
Tu
rke
yM
exic
oP
ola
nd
Cze
ch
…K
ore
aL
uxe
mbo
urg
3H
un
ga
ryIr
ela
nd
Slo
va
k …
Ja
pa
nF
inla
nd
Un
ited
…S
pa
inA
ustr
alia
Ita
lyO
EC
DN
orw
ay
Sw
ed
en
Ne
w Z
ea
lan
d2
Ice
lan
dG
ree
ce
De
nm
ark
Ne
the
rla
nds1
Po
rtu
ga
lA
ustr
iaC
an
ad
aB
elg
ium
1G
erm
an
yS
witz
erla
nd
Fra
nce
Un
ited
Sta
tes
Public expenditure Private expenditure
Health expenditure as a share of GDP (2007)
1. Public and private expenditures are current expenditures (excluding investments).2. Current health expenditure..3. Health expenditure is for the insured population rather than resident population.
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
Growth rates in spending in Germany have been low over past 10 years
Annual average real growth in per capita health expenditure, 1997-2007
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
The average length of stay for acute care has fallen in nearly all OECD countries
Average length of stay for acute care
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
Appendectomy procedures per 100,000 population, Appendectomy procedures per 100,000 population, 2007 or latest available year2007 or latest available year
Knee replacement procedures, per 100,000 Knee replacement procedures, per 100,000 population, 2007 or latest available yearpopulation, 2007 or latest available year
Hip replacement procedures, per 100,000 population, Hip replacement procedures, per 100,000 population, 2007 or latest available year2007 or latest available year
Does more spending deliver longer lives?Does more spending deliver longer lives?
Does more spending deliver longer lives?
2007 (or latest year available)
Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).
Quality of care is improvingQuality of care is improving
Avoidable hospital admission rates, 2007Avoidable hospital admission rates, 2007
-2
-1.5
-1
-0.5
0
0.5
1
1.5
2
2.5
3Austria
Belgium
Canada
Denmark
Finland
Germany
Iceland
Ireland
Italy
KoreaNetherlands3
New Zealand
Norway
Poland2
Spain
Sweden
Switzerland
United Kingdom
United States1
Asthma COPD Diabetic acute complications CHF
Out of pocket and private health insurance as Out of pocket and private health insurance as a share of total health expenditure, 2007a share of total health expenditure, 2007
17
Low-income populations report unmet care needs due to cost
* Did not get medical care, missed medical test, treatment or follow-up, did not fill prescription or missed doses.
Unmet care need* due to costs, by income group, 2007
Source: Commonwealth Fund (2008).