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David Taylor-Gooby compares OECD healthcare outcomes

Written by David Taylor-Gooby Saturday, 20 April 2013 15:51
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David Taylor-Gooby was a senior lecturer at East Durham College, and ran the Health Studies Degree course in conjunction with the University of Sunderland.

 

He later worked for the Commission for Public and Patient Involvement in Health, and completed a research project on public involvement at the university with Dr Stephen MacDonald. He also served on Durham County Council’s Health Overview and Scrutiny Committee. This book is the result of his ideas, and the views expressed are entirely his own, and not those of any of the organisations with which he is associated.

 

The following is extracted from David's book What sort of NHS do we want?

 

The best source to use for statistical data is the OECD (83). 

 

The latest figures available for 2010, indicate:

 

Country

% of GDP spent on health

Life Expectancy  (years)

Australia

  9.1

81.8

Austria

11.0

80.7

Belgium

10.5

80.3

Canada

11.4

80.8

Chile

 8.0

79.0

Czech Republic

 7.5

77.7

Denmark

11.1

79.3

Estonia

 6.3

75.6

Finland

 8.9

80.2

France

11.6

81.3

Germany

11.6                       

80.5

Greece

10.2

80.6

Hungary

 7.8

74.3

Iceland

 9.3

81.5

Ireland

 9.2

81.0

Israel

 7.9

81.7

Italy

 9.3

82.0

Japan

 9.5

83.0

Korea

 7.1

80.7

Luxembourg

 7.9

80.7

Mexico

 6.2

75.5

Netherlands

12.0

80.8

New Zealand

10.1

81.0

Norway

9.4

81.2

Poland

7.0

76.3

Portugal

10.7

79.8

Slovak Republic

9.0

75.2

Slovenia

9.0

79.5

Spain

9.6

82.2

Sweden

9.6

81.5

Switzerland

11.4

82.6

Turkey

6.1

74.3

United Kingdom

9.6

80.6

United States

17.6

78.7

OECD Average

9.5

79.8

 

Looking at these figures several points emerge:

  • Life expectancy in the UK is slightly above the OECD average, and expenditure almost the same as the average.
  • The United States spends significantly more on healthcare than all the other OECD countries, but does not seem to achieve better outcomes. Spain achieves longer life expectancy for roughly the same outlay as the UK.
  • Japan has the longest life expectancy, and only an average outlay on health. 
  • The Scandinavian countries seem to achieve better outcomes for relatively modest expenditure.
  • Switzerland spends proportionately more than these countries, but only achieves slightly better outcomes.
  • Despite its difficulties, Greece does well.

There are many factors which affect health.  Wilkinson and Pickett (2009) argue that Scandinavian countries and Japan have better health outcomes because they are more equal societies. (84)  There may be other factors such as climate or diet.  What I am interested in is whether we can learn from systems which produce better results in a fair way.

 

Norway and Spain both achieve better outcomes than the UK for less resources, so it is worth “drilling down” to see whether there are reasons for this. 

 

Spain attributes its good health to both diet and climate, but it also has a free healthcare system similar to ours. There are also more trained doctors per head of population.  Norway on the other hand has both more doctors and considerably more nurses per head of population (14.4 per 100, compared to 9.6 in the UK.  Source OECD)  The Norwegians put far more emphasis on healthy lifestyles, and have low rates of obesity and diabetes. They also have a publicly funded health system like ours, with more resources, often provided by nurses, in the community.

 

Britain has world-class hospitals of which we are justly very proud. But we appear to have neglected community health services. The countries which can deliver best results seem to have more resources “on the ground”, encouraging healthy lifestyles.  I should emphasise that more work needs to be done considering international comparisons.

 

An interesting fact is that countries with good health outcomes, Spain, Norway and Japan, all have publicly run and accessible health systems.  Japan has compulsory insurance, but fees are regulated by the government and hospitals must be non-profit making institutions run by physicians.This contrasts with America and Switzerland where costs are much higher compared to outcomes.

 

A feature of the British system is that you can only be admitted to hospital if referred by a GP.  In America anyone can admit themselves, provided they wish to pay.  The majority of Americans have some form of health insurance, either provided personally or through their employers.  One of the reasons for the high costs is the legal fees of the insurance companies suing providers.  The present Democratic administration is attempting to require all Americans to have health insurance, and assisting with the costs for those who cannot afford it.  Another feature of the American system is Medicare, which pays fees for those over 65 (although there are limitations).  Overall it is an open-ended system, without tight controls on costs.  A concern of many is that with the new commissioning system a legal culture may enter our system.  The Journal reported on July 11th 2012 that Newcastle Hospitals Foundation Trust may make a legal challenge to a commissioning decision by NHS North of Tyne to take a service away from one of their hospitals (85).

 

The Swiss system has similarities.  All citizens are obliged to have private health insurance.  Again, costs seem to escalate.

 Two conclusions can be drawn from this admittedly brief survey of other health systems.

  1.                                                (i) Publicly run system where costs are controlled seem to do better compared to “open ended” private insurance schemes.
  2.                                              (ii) Health is better where more resources are put into community services aimed at providing better health.  Having good hospitals does not necessarily mean good health outcomes overall.
Last modified on Sunday, 21 April 2013 13:47

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