More focus needed on the patient experience

Health at a Glance 2019: OECD Indicators says that the USA spent the most on health care in 2018, equivalent to 16.9% of GDP, above Switzerland, the next highest spending country, at 12.2%.  Germany, France, Sweden and Japan all spent close to 11% of GDP, while a few countries spent less than 6% of their GDP on health care, including Mexico, Latvia, Luxembourg, and Turkey at 4.2%.

Health at a Glance 2019 outlines areas where spending could be more effective:

  • Increased use of generic drugs could save costs, but represents only half the volume of pharmaceuticals sold across OECD countries. Generics accounted for more than three-quarters of the volume of pharmaceuticals sold in Chile, Germany, New Zealand and the United Kingdom, but less than one-quarter in Luxembourg and Switzerland in 2017.
  • Health and social systems employ more workers now than ever before, with about one in every ten of all jobs in OECD countries found in health or social care. Shifting tasks from doctors to nurses and other health professionals can alleviate cost pressures and improve efficiency.
  • Increasing patient safety not only improves health, it can also save money. 5% of hospitalised patients had a health care associated infection in 2015-17.

The report highlights some worrying patterns in health outcomes and unhealthy lifestyles including:

  • A person born today can expect to live almost 81 years on average in OECD countries, but life expectancy gains have slowed recently in most OECD countries, especially in the USA, France and the Netherlands.  In 2015, life expectancy fell in 19 countries.
  • The causes of this slow down include rising levels of obesity and diabetes, that have made it difficult to maintain previous progress in cutting deaths from heart disease and stroke. Respiratory diseases such as influenza and pneumonia have also claimed more lives in recent years, notably amongst older people.
  • Opioid-related deaths have increased by 20% across OECD countries since 2011, and have claimed 400,000 lives in the USA alone. Opioid-related deaths are also relatively high in Canada, Estonia and Sweden.
  • Smoking, drinking and obesity continue to cause people to die prematurely and worsen quality of life. Smoking rates are declining, but 18% of adults still smoke daily. Alcohol consumption averaged 9 litres of pure alcohol per person per year across OECD countries, equivalent to almost 100 bottles of wine. 4% of adults are alcohol dependent. Obesity rates continue to rise in most OECD countries, with 56% of adults overweight or obese and almost one-third of children aged 5-9 overweight.
  • Air pollution caused 40 deaths per 100,000 people across OECD countries. Death rates were much higher in India and China, at around 140 deaths per 100,000 people.

The report argues that more attention should be placed on patient reported outcomes and experiences. Preliminary results from OECD’s new initiative on Patient Reported Indicator Surveys show that hip replacements improve an individual’s quality of life, in terms of mobility, activity, and pain, by 20%.