Health at a Glance 2015

OECD

• Publisher: OECD
• Year: 2015
• eBook ISBN: 9789264247680
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

Chapter 1. Dashboards of health indicators1

This chapter presents, for the first time, a set of dashboards which are designed to shed light on how well OECD countries do in promoting the health of their population and improving their health system performance. These dashboards do not have the ambition of identifying which countries have the best health system overall. They summarise some of the relative strengths and weaknesses of countries on a selected set of indicators on health and health system performance, to help identify possible priority areas for actions. These dashboards, which take the form of summary tables, highlight how well OECD countries are doing along five dimensions: 1) health status; 2) risk factors to health; 3) access to care; 4) quality of care; and 5) health care resources. For each of these five dimensions, a selected set of key indicators are presented. The selection of these indicators is based on three main criteria: 1) policy relevance; 2) data availability; and 3) data interpretability (i.e., no ambiguity that a higher/lower value means a better/worse performance). There is, however, one exception to the application of this third criterion: for the fifth dashboard on health care resources, more health spending or more human or physical resources does not necessarily mean better performance. This is why the ranking of countries is displayed differently.

Across the OECD, policy makers have a keen interest to understand how good the health of their people is, and how well their health systems are able to deliver good results. A look at indicators contained in this publication shows that much progress has already been achieved. People in OECD countries are living longer than ever before, with life expectancy now exceeding 80 years on average, thanks to improvements in living conditions and educational attainments, but also to progress in health care. In most countries, universal health coverage provides financial protection against the cost of illness and promotes access to care for the whole population. The quality of care has also generally improved, as illustrated by the reduction in deaths after heart attacks and strokes, and the earlier detection and improved treatments for serious diseases such as diabetes and cancer. But these improvements have come at a cost. Health spending now accounts for about 9% of GDP on average in OECD countries, and exceeds 10% in many countries. Higher health spending is not a problem if the benefits exceed the costs, but there is ample evidence of inequities and inefficiencies in health systems which need to be addressed. There is also a need to achieve a proper balance between spending on disease prevention and treatment.

Despite these improvements, important questions about how successful countries are in achieving good results on different dimensions of health system performance remain. What are the main factors explaining differences in health status and life expectancy across OECD countries? Is the increase in certain risk factors such as inactivity and obesity offsetting some of the gains from the reduction in other risk factors like smoking? To what extent do all citizens have adequate and timely access to care, and good financial protection against the cost of health care? What do we know about the quality and safety of care provided to people with different health conditions? What are the financial, human and technical resources allocated to health systems in different countries? And how does this translate into beneficial activities and better health outcomes?

Answering these questions is by no mean an easy task. But the dashboards presented in this chapter can help shed light on how well countries do in promoting the health of their population and on several dimensions of health system performance. These dashboards do not have the ambition of identifying which countries have the best health system overall. However, they summarise some of the relative strengths and weaknesses of OECD countries on a selected set of indicators on health and health system performance, and can be useful to identify possible priority areas for actions.

These dashboards, which take the form of summary tables, highlight how well OECD countries are doing along five dimensions: 1) health status; 2) risk factors to health; 3) access to care; 4) quality of care; and 5) health care resources. For each of these five dimensions, a selected set of key indicators (ranging from 4 to 7) are presented in a summary table. The selection of these indicators is based on three main criteria: 1) policy relevance; 2) data availability; and 3) data interpretability (i.e., no ambiguity that a higher/lower value means a better/worse performance). There is, however, one notable exception to the application of this third criterion: for the fifth dashboard on health care resources, more health spending or more human or physical resources does not necessarily mean better performance. This is why the ranking of countries is displayed differently (through different colours) in this last dashboard. Box 1.1 at the end of this chapter summarises some of the main limitations in interpreting these dashboards.

In most of the dashboards, countries are classified in three groups: 1) top third performer; 2) middle third performer; and 3) bottom third performer. In addition, the specific ranking of countries is indicated in each cell to provide further information on how close countries may be to the other group. The ranking is based on the number of countries for which data are available for each indicator (with a maximum of 34, when all countries are covered), with countries separated in three equal groups. For the first indicator related to access to care (the percentage of the population with health coverage), the grouping of countries is based on a different method because most countries are at or close to 100% coverage: the top countries are defined as those with a population coverage rate between 95% and 100%, the middle countries with a coverage between 90% and 95%, and the bottom countries with a coverage of less than 90%. The availability of comparable data is also more limited for indicators of access to care, either because of a lack of harmonisation in survey instruments (for indicators related to unmet care needs) or limitations in administrative data (for indicators on waiting times).

Health status

The broad measures of population health status shown in Table 1.1, such as life expectancy at various ages, are not only related to health spending and the performance of health systems, but also to a wide range of non-medical determinants of health (with some of the lifestyle and behavioural factors presented in Table 1.2). Countries that perform well on life expectancy at birth for men and women usually also tend to do well on life expectancy at older ages, and typically have lower rates of mortality from cardiovascular diseases (the main causes of death in nearly all OECD countries).

Japan, Spain, Switzerland, Italy and France are among the countries that have the highest life expectancy at birth and at older ages, although France does not perform so well in terms of life expectancy at birth for men, reflecting higher mortality rates among younger and middle-aged men.

Mexico, Hungary, the Slovak Republic and Turkey have the lowest life expectancy at birth and older ages, although Turkey has achieved huge gains in longevity over the past few decades and is quickly moving towards the OECD average (see the first indicator on life expectancy in Chapter 3 for trends over time).

While higher health spending per capita is generally associated with higher life expectancy, this relationship is less pronounced in countries with the highest health spending per capita. Japan, Spain and Korea stand out as having relatively high life expectancies, and the United States relatively low life expectancies, given their levels of health spending (see Table 1.5). Life expectancy in the United...

Table of contents

• Title page
• Legal and rights
• Foreword
• Executive Summary
• Reader’s guide
• Chapter 1. Dashboards of health indicators
• Chapter 2. Pharmaceutical spending trends and future challenges
• 3. Health status
• 4. Non-medical determinants of health
• 5. Health workforce
• 6. Health care activities
• 7. Access to care
• 8. Quality of care
• 9. Health expenditure and financing
• 10. Pharmaceutical sector
• 11. Ageing and long-term care
• A. Additional information on demographic and economic context, and health expenditure and financing
• About the OECD