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					World in Your Pocket
A Handbook of International
Health Economic Statistics
2007
The Institute of Health Economics (IHE) is an independent,
not-for-profit organization that performs research in health economics
and synthesizes evidence in health technology assessment to assist
health policy making and best medical practice.



Board members
Dr. Lorne Tyrrell - Chair, Institute of Health Economics
and Professor and GSK Virology Chair, University of Alberta
Government
Ms. Paddy Meade - Deputy Minister, Alberta Health and Wellness
Dr. Kevin Keough - President and CEO, Alberta Heritage Foundation
for Medical Research
Dr. Chris Eagle - Executive Vice President and Chief Clinical Officer,
Calgary Health Region
Dr. Tom Feasby - Vice President of Academic Affairs, Capital Health
Academia
Dr. Grant Gall - Dean, Faculty of Medicine, University of Calgary
Dr. Franco Pasutto - Dean, Faculty of Pharmacy and Pharmaceutical Sciences,
University of Alberta
Dr. Gary Kachanoski - Vice President (Research), University of Alberta
Dr. Elizabeth Wilman - Head, Department of Economics, University of Calgary
Dr. Dennis Salahub - Vice President (Research and International),
University of Calgary
Dr. Tom Marrie - Dean, Faculty of Medicine and Dentistry, University of Alberta
Dr. Andre Plourde - Chair, Department of Economics, University of Alberta
Industry
Mr. Terry McCool - Vice President, Corporate Affairs, Eli Lilly Canada Inc.
Mr. Geoffrey Mitchinson - Vice President, Public Affairs, GlaxoSmithKline Inc.
Dr. Penny Albright - Vice-President, Government and Health Economics,
Janssen-Ortho Inc. (Canada)
Mr. William Charnetski - Vice President, Corporate Affairs and
General Counsel, AstraZeneca Canada Inc.
Mr. Gregg Szabo - Vice President, Corporate Affairs, Merck Frosst Canada Ltd.
Preface
World In Your Pocket - a Handbook of International Health Economic
Statistics is designed to be an easy and portable international reference
guide to indicators of health care and health economics. We define
“economic” broadly to include both means (personal and formal
resources) and ends (health outcomes).
The chart book is intended to provide the user with a reasonably
comprehensive overview of how we use health resources, and how
well we use them. We have included the most recent data available
from a broad array of sources. Variables are subject to reporting lag
and not all data are reported for each year.



Project Staff
Anderson Chuck
Ken Eng
Rhonda Lothammer
Janice Varney

Project Advisors
Philip Jacobs
Egon Jonsson
Don Schopflocher




WORLD IN YOUR POCKET                                                    i
Introduction
How the chartbook is organized
World In Your Pocket - a Handbook of International Health Economic
Statistics includes the most current available data, presented in separate
sections on health status, health care costs, health resources, health
resource utilization and health system performance. The basic unit of
observation is the individual country. Indicators are reported at the
international level.
Space limitations require us to limit the number of countries in
the international charts. We selected a group of countries with
approximately the same level of economic development as Canada,
including Australia, Finland, France, Germany, Italy, Japan, the
Netherlands, New Zealand, Spain, Sweden, the United Kingdom and
the United States. Data was not available for all countries in every chart.
We also included a number of developing countries in a select number
of international charts. We selected a group of countries that have
approximately the lowest Gross Domestic Product (GDP) in Africa,
South America, and Asia. These countries include Malawi, Rwanda,
Democratic Republic of the Congo, Chad, Kenya, Ethiopia, Bolivia,
Haiti, Vietnam, Cambodia, Nepal, Lao People’s Democratic Republic,
India and Bangladesh.

Source of Data
A variety of topics are included in the broad subject matter of health
economic indicators. Thus, an array of data is summarized in the
chart book from sources including the Organization for Economic
Cooperation and Development and World Health Organization.

Feedback
We hope you will find this chartbook useful and would appreciate
your comments, questions and suggestions. Please contact us by email
at info@ihe.ca or by telephone at 780-448-4881.


ii                                    INSTITUTE OF HEALTH ECONOMICS
Table of Contents
Health Status ................................................................................... page 01
     HALE ........................................................................................... page 02
     Life Expectancy at Birth ........................................................ page 03
     Infant Mortality ......................................................................... page 05
     Population Reporting Good or Better Health ............... page 07
     Physical Activity ....................................................................... page 08
     Consumption of Fruits and Vegetables ........................... page 09
     Percentage of Population Who Smoke Daily ................. page 10
     Prevalence of Obesity ............................................................. page 11
Costs .................................................................................................... page 13
     Health Care Expenditure per Capita ................................ page 14
     Health Care Expenditure as % of GDP ........................... page 15
     Pharmaceutical Expenditure ................................................ page 16
     Family Physician Salaries ....................................................... page 17
     Specialist Physician Salaries ................................................. page 18
     Per Person Spending by Age .................................................. page 19
     Per Person Spending by Service Catagory and Age ...... page 20
     Elderly Dependency Ratio ...................................................... page 21
     Cost at End of Life ..................................................................... page 22
     Total Health Care Cost in Alberta ....................................... page 23




WORLD IN YOUR POCKET                                                                                            iii
Table of Contents continued
Health Resources .......................................................................... page 25
     Number of Physicians ............................................................. page 26
     Number of Nurses .................................................................... page 27
     Number of Pharmacists ......................................................... page 28
     Number of Dentists ................................................................. page 29
     Number of CT Imaging Scanners ...................................... page 30
     Number of MRI Imaging Scanners ................................... page 31
     Number of Hospital Beds ...................................................... page 32
Health Resource Utilization ..................................................... page 33
     Average Length of Stay in Hospital .................................. page 34
     Hospital Discharge Rate ........................................................ page 35
Health System Performance ..................................................... page 37
     Unemployment Rate ............................................................... page 38
     Public Satisfaction in Health Care ..................................... page 39
     Median Waiting Times ........................................................... page 40
     Health Expenditure and Life Expectancy ......................... page 41
     Health Expenditure and Infant Mortality.......................... page 43
QALY League Tables .................................................................. page 45
     Cataract Surgery ....................................................................... page 46
     Organ Transplantation ........................................................... page 47
     Hip Replacement ....................................................................... page 48
     Vaccination .................................................................................. page 49




iv                                                       INSTITUTE OF HEALTH ECONOMICS
Health Status
Health Status


                                        Health Adjusted
                                        Life Expectancy (HALE)
                                         In Selected Countries

                      United States                                           71
                                                               67
                    United Kingdom                                                           74
                                                                    69
                             Finland                                               72
                                                                    69
                        Netherlands                                                               75
                                                                    69
                           Germany                                                 72
                                                                         70
                      New Zealand                                                            74
                                                                         70
                             France                                                     73
                                                                         70
                                Italy                                                             75
                                                                         70
                            Canada                                                           74
                                                                         70
                           Sweden                                                                 75
                                                                              71
                              Spain                                                          74
                                                                              71
                           Australia                                                              75
                                                                                   72
                              Japan                                                                         78
                                                                                        73


                                        60   62    64   66     68   70        72        74        76   78        80
                                        Health adjusted life expectancy in years (2002)

                                             Female          Male




                    Note: Health Adjusted Life Expectancy (HALE) represents the number
                    of expected years of life equivalent to years in full health.
                    Source: Statistical annex table 4. Healthy life expectancy (HALE) in all
                    WHO member states, estimates for 2004. World Health report, 2004:
                    Changing history. Geneva: World Health Organization; 2004.


                2                                            INSTITUTE OF HEALTH ECONOMICS
                                                                                         Health Status
                   Life Expectancy at Birth
                    In Selected Countries

  United States                        77.5

United Kingdom                                 78.5

        Finland                                78.5

    Netherlands                                 78.6

      Germany                                   78.6

   New Zealand                                        79.2

        France                                         79.4

           Italy                                         79.7

        Canada                                               79.9

       Sweden                                                 80.2

         Spain                                                 80.3

       Australia                                               80.3

         Japan                                                           81.8


                   75     76     77     78     79       80          81   82     83
                   Life expectancy at birth in years (2003)




Source: OECD health data; 2006.


HEALTH STATUS                                                                        3
Health Status


                                           Life Expectancy at Birth
                                           In Selected Developing Countries

                                Malawi               41
                                                     41
                               Rwanda                          47
                                                          44
                           Dem. Repub.                         47
                           of the Congo              42
                                  Chad                          48
                                                           45

                                 Kenya                              50
                                                                     51
                               Ethiopia                              51
                                                                    49
                                 Bolivia                                                           66
                                                                                              63
                                   Haiti                                       56
                                                                          53
                               Vietnam                                                                        74
                                                                                                         69
                             Cambodia                                               58
                                                                                         61
                                 Nepal                                                   61
                                                                                         61
                          Lao People’s                                               60
                    Democratic Republic                                             58
                                  India                                                       63
                                                                                         61
                            Bangledesh                                                     63
                                                                                          62


                                           35   40        45    50        55        60        65        70    75   80
                                           Life expectancy at birth in years (2004)


                                                Female          Male




                       Source: World health statistics, 2006. Geneva: World Health Organization; 2006.
                       Available at: www.who.int/whosis/whostat2006.pdf.


                4                                                   INSTITUTE OF HEALTH ECONOMICS
                                                                                            Health Status
                   Infant Mortality
                   In Selected Countries

         Japan                                   2.8

United Kingdom                                       3.1

       Sweden                                        3.1

        Finland                                        3.3

         Spain                                             3.5

        France                                                   3.9

   Netherlands                                                    4.1

           Italy                                                  4.1

      Germany                                                     4.1

      Australia                                                         4.7

       Canada                                                                 5.3


                   0         1         2         3           4           5          6
                   Life expectancy at birth in years (2004)




Note: Canada is 2003 data;
Source: OECD health data; 2006.


HEALTH STATUS                                                                           5
Health Status


                                           Infant Mortality
                                           In Selected Developing Countries

                                Malawi                                                     109

                               Rwanda                                                        118

                           Dem. Repub.
                                                                                                   129
                           of the Congo

                                  Chad                                                       117

                                 Kenya                                         78

                               Ethiopia                                                     110

                                 Bolivia                           54

                                   Haiti                                      74

                               Vietnam             17

                             Cambodia                                                97

                                 Nepal                                                     109

                          Lao People’s
                                                                         65
                    Democratic Republic

                                  India                                  62

                            Bangledesh                              56


                                           0      20      40       60         80    100     120     140
                                           Infant mortality per 1,000 live births (2004)




                       Source: World health statistics, 2006. Geneva: World Health Organization; 2006.
                       Available at: www.who.int/whosis/whostat2006.pdf.


                6                                              INSTITUTE OF HEALTH ECONOMICS
                                                                                        Health Status
                    Percentage of People
                    Reporting Good or Better
                    Health Status (2003)
                    In Selected Countries

          Japan                   36.7%
                                     40.9%
            Italy                             55.0%
                                                      65.0%
         Finland                                        68.2%
                                                       65.9%
          Spain                                      63.5%
                                                             73.2%
United Kingdom                                                74.3%
                                                               74.7%
       Sweden                                            69.3%
                                                             75.5%
    Netherlands                                              73.9%
                                                                 80.4%
         France                                                77.0%
                                                                   82.1%
        Canada                                                          87.1%
                                                                         89.3%

   New Zealand                                                          89.8%
                                                                        89.4%

  United States                                                         87.7%
                                                                         89.5%


                20%      30%     40%    50%   60%     70%     80%      90% 100%
                    Percentage of population reporting good or better
                    health status (2003)

                        Female         Male




Note: France, Japan, Finland, Netherlands, Sweden and United States are 2004 data
Source: OECD health data; 2006.


HEALTH STATUS                                                                       7
Health Status


                                       Physical Activity
                                       In Selected Countries

                    United Kingdom                      40%
                                                                           61%
                             France                              51%
                                                                                 67%
                       United States                                53%
                                                                                 68%
                            Sweden                                        59%
                                                                                   72%
                            Canada                               50%
                                                                                        76%
                             Finland                                      57%
                                                                                         77%
                           Germany                                                70%
                                                                                               85%


                                   20%       30%    40%       50%      60%      70%     80%    90%
                                       Percentage of population who report exercising at least
                                       twice per week (1997/1998)

                                           Female         Male




                    Source: Currie C, Hurrelmann K, Settertobulte W, Smith R, Todd J, editors. Health
                    and health behaviour among young people: Health behaviour in school-aged children:
                    A WHO cross national study (HBSC) international report. Copenhagen: World Health
                    Organization; 2000.


                8                                         INSTITUTE OF HEALTH ECONOMICS
                                                                                          Health Status
                   Consumption of Fruits
                   and Vegetables
                   In Selected Countries

         Japan                    159.4

        Finland                    162.6

       Sweden                               193.6

       Australia                            197.3

      Germany                                203.7

United Kingdom                                   207.4

  United States                                          237.0

        France                                           238.4

       Canada                                             239.5

  New Zealand                                              244.6

   Netherlands                                               255.5

         Spain                                               256.0

           Italy                                                              309.3


               100     125 150     175     200    225 250         275   300    325
                   Kilograms of fruit and vegetables consumed per capita (2003)




Source: OECD health data; 2006.


HEALTH STATUS                                                                         9
Health Status


                                        Percentage of Population
                                        Who Smoke Daily
                                        In Selected Countries

                             Canada                 15.0%

                            Sweden                    16.2%

                       United States                    17.0%

                            Australia                     17.7%

                       New Zealand                                22.0%

                              France                                23.0%

                             Finland                                23.0%

                     United Kingdom                                       25.0%

                               Japan                                                29.4%

                         Netherlands                                                30.0%


                                    10%         15%         20%       25%         30%          35%
                                        Percentage of population over age 15 who smoke daily (2004)




                     Note: The OECD defines daily smokers as the percentage of the population
                     aged 15 or more years who report that they are daily smokers.
                     Source: OECD health data; 2006.


                10                                          INSTITUTE OF HEALTH ECONOMICS
                                                                                 Health Status
                   Prevalence of Obesity
                   In Selected Countries

         France                  9.5%

        Sweden                    9.8%

    Netherlands                     10.9%

         Finland                                  14.0%

        Canada                                                     22.4%

United Kingdom                                                      23.0%


                   5%          10%               15%      20%         25%
                   Percentage of population who are obese (2004)




Note: Obesity is defined as Body Mass Index (BMI)>= 30.0 where
BMI= Mass(kg)/height(m)
United States data is unavailable from source.
Source: OECD health data; 2006.


HEALTH STATUS                                                               11
Costs
                                Total Health Expenditure
                                Per Capita in Selected Countries
Costs




               New Zealand                  $2,083

                       Spain                $2,094

                     Finland                 $2,235

                       Japan                 $2,249

                        Italy                 $2,392

             United Kingdom                     $2,546

                    Sweden                        $2,825

                    Australia                      $2,876

                   Germany                            $3,005

                Netherlands                           $3,041

                      France                          $3,159

                     Canada                            $3,165

               United states                                                       $6,102


                            $1,000 $2,000       $3,000    $4,000   $5,000    $6,000     $7,000
                                USA dollar purchasing power parity (2004)




             Note: Purchasing power parity is a currency conversion rate that both converts
             to a common currency and equalizes the purchasing power of different
             currencies. It eliminates the differences in price levels between countries
             in the process of conversion.
             Data for Japan, France, Germany, and Australia are for 2003.
             Source: OECD health data; 2006.


        14                                            INSTITUTE OF HEALTH ECONOMICS
                   Total Health Expenditure
                   As a Percentage of GDP in
                   Selected Countries




                                                                                    Costs
        Finland                       7.4%

United Kingdom                        7.9%

         Spain                        7.9%

   New Zealand                           8.0%

         Japan                             8.0%

           Italy                           8.2%

    Netherlands                                 9.1%

       Australia                                  9.2%

       Sweden                                     9.3%

       Canada                                       9.9%

        France                                         10.4%

       Germany                                           10.9%

  United States                                                        15.2%


                   4%      6%       8%        10%          12%   14%   16%

                   Percent of GDP (2003)




Source: OECD health data; 2006.


COST                                                                           15
                                 Total Pharmaceutical
                                 Expenditure
                                 Per Capita in Selected Countries
Costs




                       Japan                     $425

                    Germany                       $438

                       Spain                            $477

                         Italy                             $512

                     Canada                                       $559

                      France                                         $599

               United States                                                           $752


                             $300         $400       $500         $600       $700        $800
                                 USA dollar purchasing power parity (2004)




             Note: Purchasing power parity is a currency conversion rate that both converts
             a common currency and equalizes the purchasing power of different currencies.
             It eliminates the differences in price levels between countries in the process
             of conversion.
             Data for Japan and Germany are for 2003.
             Source: OECD health data; 2006.


        16                                           INSTITUTE OF HEALTH ECONOMICS
                    Family Physician Salaries
                    In Selected Countries




                                                                                            Costs
        Australia                            $87,878
                      n/a
          France                                $94,058
                      n/a
         Canada                                    $103,050
                      n/a
United Kingdom                                       $106,891
                      n/a
    Netherlands                                           $113,153
                      n/a
        Sweden        n/a
                                  $62,468

         Finland      n/a
                                  $64,387
   United States                                                                 $154,200
                                                                  $134,600


               $40,000             $80,000             $120,000           $160,000
                    USA dollar purchasing power parity (2003)


                        Self-Employed          Salaried




Note: Purchasing power parity is a currency conversion rate that both converts
a common currency and equalizes the purchasing power of different currencies.
It eliminates the differences in price levels between countries in the process
of conversion.
Data for Sweden is for 2002.
Data for the United States is for 2001.
Source: OECD health data; 2006.


COST                                                                                 17
                                Specialist Physician Salaries
                                In Selected Countries
Costs




                      France                                $148,880
                                  n/a
                     Canada                                   $154,947
                                  n/a
                    Australia                                                   $237,936
                                  n/a
                     Sweden       n/a
                                           $71,001
                      Finland     n/a
                                            $74,773
                    Germany       n/a
                                             $76,987
               New Zealand        n/a
                                               $88,652
                 Netherlands                                                      $252,727
                                                         $130,911
               United States                                                   $229,500
                                                                    $170,300
             United Kingdom       n/a
                                                             $149,972


                            $40,000 $90,000            $140,000 $190,000 $240,000 $290,000

                                USA dollar purchasing power parity (2003)


                                        Self-Employed         Salaried




             Note: Purchasing power parity is a currency conversion rate that both converts
             a common currency and equalizes the purchasing power of different currencies.
             It eliminates the differences in price levels between countries in the process
             of conversion.
             Data for the United States is for 2001.
             Data for Sweden is for 2002.
             Data for United Kingdom is for 2004.
             Data for Germany is for 2004.
             Source: OECD health data; 2006.


        18                                              INSTITUTE OF HEALTH ECONOMICS
                   Per Person Spending by Age
                   In the United States for 2000




                                                                                        Costs
            0-5          $1,525

           6-64              $2,888

          65-75                                 $9,094

           75+                                                           $15,756

  All age groups                  $3,962


             $1,000      $3,000    $6,000   $9,000 $12,000 $15,000 $18,000

                   Per person spending in 2000 by age group




Source: Meara E, White C, Cutler D. Trends in medical spending by age,
1963-2000. Health Affairs 2004;23(4):176-83.


COST                                                                               19
                                   Per Person Spending by
                                   Service Category and Age
                                   In the United States (2000)
Costs




                 Hospital care                   $976
                                                                                   $4,192
                Physicians and                  $792
                  clinical care                                   $2,460
             Prescription drugs          $347
                                                      $1,249
                  Home health          $88
                                               $693
                         Other               $513
                                                 $982
                 Nursing home          $45
                                                                     $2,696


                                  $0         $1,000      $2,000   $3,000      $4,000   $5,000
                                  Per person spending by age in USA (2000)


                                        Under Age 65           Age 65+




              Source: Meara E, White C, Cutler D. Trends in medical spending by age,
              1963-2000. Health Affairs 2004;23(4):176-83.


        20                                               INSTITUTE OF HEALTH ECONOMICS
                    Elderly Dependency Ratio
                    In Selected Countries




                                                                                        Costs
       Australia                               18.0%
                                                 19.8%
         Canda                                  18.7%
                                                  20.7%
         France                                          24.4%
                                                          25.3%
       Germany                                           24.0%
                                                                  29.6%
            Italy                                            26.9%
                                                                  31.4%
          Japan                                           25.0%
                                                                      33.8%
        Sweden                                              27.1%
                                                         24.7%
United Kingdom                                           24.6%
                                                          25.9%
  United States                                 19.0%
                                                 19.8%


                    0%    5%      10%    15% 20%       25%   30%    35% 40%
                    Percentage of elderly dependency


                         Female         Male




Note: The elderly population dependency ratio is defined as the population age 65 and
over as a percentage of the working-age population (i.e. the population aged 15-64).
Source: Jacobzone S, Cambois E, Robine JM. Is the health of older persons in
OECD countries improving fast enough to compensate for population aging?
OECD Economic Studies; 2000.


COST                                                                               21
                                 End of Life Total Costs
                                 and Utilization
                                 in Alberta (any service)
Costs




              Sudden Death                        $10,223
                                         $4,447
              Terminal Illness                                                    $36,652
                                                $9,665
               Organ Failure                                                         $39,947
                                                            $18,026
                       Frailty                                             $31,881
                                                            $17,876
                    Survivors          $1,349
                                      n/a


                                 $0       $10,000      $20,000        $30,000   $40,000     $50,000
                                 Cost (Canadian dollars 2001-2002)


                                       LYL: Last Year of Life            2nd LYL: Second Last Year of Life




             Source: Fassbender K, Smythe JG, Carson M, Finegan BA, Booth PM. Report
             of the Institute for Public Economics Health Research Group to Alberta Health
             and Wellness: cost and utilization of health care services at end of life in
             Alberta, 1999-2002. Edmonton, AB: University of Alberta; 2006.


        22                                               INSTITUTE OF HEALTH ECONOMICS
                     Total Health Care Costs
                     In Alberta for 2001-02
                     by Cost Category




                                                                                     Costs
       In-patient                                                     1397
                                    318
       Physician                                               1019
                         42
    Emergency/                                        799
     Outpatient          31
Long Term Care                       384
                              110
     Home Care                126
                        22
         Alberta                    339
     Blue Cross         21


                    0        200    400    600     800   1000 1200 1400 1600
                    Cost (millions of Canadian dollars 2001-2002)


                         Survivors               Descendents




Source: Fassbender K, Smythe JG, Carson M, Finegan BA, Booth PM. Report
of the Institute for Public Economics Health Research Group to Alberta Health
and Wellness: cost and utilization of health care services at end of life in
Alberta, 1999-2002. Edmonton, AB: University of Alberta; 2006.


COST                                                                            23
Health Resources
                                           Number of Physicians
                                            In Selected Countries

                                 Japan                2.0

                               Canada                    2.1

                        United Kingdom                          2.3

                          United States                        2.4

                                Finland                        2.4
Health Resources




                                 Spain                                          3.4

                              Germany                                           3.4

                                France                                          3.4

                           Netherlands                                                3.6

                                   Italy                                                          4.2


                                           1.5     2.0         2.5    3.0      3.5          4.0         4.5
                                           Physicians per 1,000 population (2004)




                        Source: OECD health data; 2006.


                   26                                            INSTITUTE OF HEALTH ECONOMICS
                  Number of Nurses
                  In Selected Countries

         France                   7.5

          Spain                  7.4

        Finland                    7.6

United Kingdom                               9.2

   New Zealand                                9.5




                                                                                         Health Resources
       Germany                                 9.6

        Canada                                     9.9

    Netherlands                                                              14.2


                  5     6    7     8     9    10         11   12   13   14     15
                  Nurses per 1,000 population (2004)




Note: Includes both Registered Nurses (RN) and Licensed Practical Nurses (LPN).
Source: OECD health data; 2006.


HEALTH RESOURCES                                                                    27
                                            Number of Pharmacists
                                            In Selected Countries

                            Netherlands                  0.2

                        United Kingdom                                0.5

                               Germany                                      0.6

                                Canada                                            0.7

                           New Zealand                                                  0.8
Health Resources




                               Australia                                                0.8

                                  Spain                                                       0.9

                                 France                                                              1.1

                                    Italy                                                                  1.2

                                  Japan                                                                          1.3


                                            0      0.2         0.4     0.6         0.8         1.0    1.2         1.4
                                            Number of pharmacists per 1,000 population (2004)




                        Notes: Data for Australia and United Kingdom are for 2003.
                        Source: OECD health data; 2006.


                   28                                                INSTITUTE OF HEALTH ECONOMICS
                   Number of Dentists
                   In Selected Countries

   New Zealand               0.4

United Kingdom                           0.5

          Spain                          0.5

    Netherlands                          0.5

       Australia                         0.5




                                                                                          Health Resources
           Italy                                 0.6

        Canada                                   0.6

          Japan                                          0.7

         France                                          0.7

       Sweden                                                    0.8

      Germany                                                    0.8

        Finland                                                          0.9


               0.3        0.4      0.5         0.6     0.7     0.8     0.9     1.0
                   Practicing dentists per 1,000 population (2004)




Note: Data for Australia, New Zealand and Sweden are from 2003.
Source: OECD health data; 2006.


HEALTH RESOURCES                                                                     29
                                           Number of CT
                                           Imaging Scanners
                                           In Selected Countries

                        United Kingdom               7.0

                                France                7.5

                               Canada                           10.8

                          New Zealand                               12.1
Health Resources




                                 Spain                                      13.3

                                Finland                                      14.2

                              Germany                                              15.4

                                   Italy                                                       20.6


                                           5     7         9   11      13     15     17   19   21     23
                                           Scanners per 1 million population (2004)




                        Source: OECD health data; 2006.


                   30                                           INSTITUTE OF HEALTH ECONOMICS
                    Number of MRI
                    Imaging Scanners
                    In Selected Countries

         France           3.2

   New Zealand              3.7

       Australia            3.7

        Canada                    4.9




                                                                                       Health Resources
United Kingdom                    5.0

       Germany                          6.6

          Spain                               7.7

            Italy                                        10.2

        Finland                                                       14.0


                    2       4       6         8     10          12   14      16
                    Scanners per 1 million population (2004)




Note: Data for New Zealand is for 2003.
Source: OECD health data; 2006.


HEALTH RESOURCES                                                                  31
                                           Number of Hospital Beds
                                           In Selected Countries

                               Sweden                      2.2

                          United States                          2.8

                                 Spain                           2.8

                           Netherlands                           2.8

                                Finland                              3.0
Health Resources




                               Canada                                3.0

                               Australia                                   3.6

                        United Kingdom                                     3.7

                                   Italy                                   3.7

                                France                                      3.8

                              Germany                                                     6.6

                                 Japan                                                              8.5


                                           0     1     2         3          4     5   6   7     8    9
                                           Hospital beds per 1,000 population (2003)




                        Source: OECD health data; 2006.


                   32                                                INSTITUTE OF HEALTH ECONOMICS
Health Resource Utilization
                                           Average Length of Stay
                                           in Hospital
                                           In Selected Countries

                                Finland                   4.8

                                France                      5.6

                          United States                     5.7

                               Australia                    6.1

                        United Kingdom                          6.8

                                   Italy                        6.8

                                 Spain                          6.8

                                Canada                            7.3
Utilization
Health Resources




                              Germany                                    8.9

                                 Japan                                                        20.7


                                           0          5                 10      15       20          25
                                           Average length of stay in days (2003)




                        Source: OECD health data; 2006.


                   34                                                 INSTITUTE OF HEALTH ECONOMICS
                   Hospital Discharge Rate
                   In Selected Countries

        Canada                 8,800

    Netherlands                  9,707

         Spain                   10,937

  United States                     11,946

           Italy                           13,999

       Sweden                               14,722

       Australia                              15,749

      Germany                                             20,149

   New Zealand                                            20,727




                                                                                        Health Resources
                                                                                                Utilization
United Kingdom                                                 23,033

        Finland                                                    25,975

        France                                                          26,804


               5,000       10,000        15,000      20,000   25,000      30,000
                   Rate per 100,000 population (2003)




Source: OECD health data; 2006.


HEALTH RESOURCE UTILIZATION                                                        35
Health System Performance
                                        National Unemployment Rate
                                        In Selected Countries

                       New Zealand                             4.6%

                     United Kingdom                            4.8%

                              Japan                               5.2%

                           Australia                                5.7%

                            Sweden                                    5.8%

                            Canada                                           7.6%

                                Italy                                               8.9%

                             Finland                                                9.0%

                             France                                                    9.7%

                           Germany                                                         9.9%

                              Spain                                                               11.3%


                                        0%      2%       4%       6%         8%      10%          12%
                                        Unemployment rate as a percentage of labour force (2004)
Performance
Health System




                     Source: OECD health data; 2006.


                38                                         INSTITUTE OF HEALTH ECONOMICS
                    Public Satisfaction with
                    Health Care System
                    In Selected Countries

            Italy          26%

   United States                      40%

        Canada                              46%

          Spain                              48%

       Germany                                  50%

United Kingdom                                     56%

        Sweden                                        59%

    Netherlands                                                  73%

         Finland                                                  74%

         France                                                      78%


                20%       30%     40%     50%      60%    70%      80%     90%
                    Percent satisfied with health care system (1999-2000)


                                                                                        Health System
                                                                                         Performance




Note: United States and Canada data from Harvard School of Public Health (2000).
Source: Blendon R, Minah K, Benson J. The public versus the world health
organization on health system performance. Health Affairs 2001;20(3):10-20.


HEALTH SYSTEM PERFORMANCE                                                          39
                                         Median Waiting Times
                                         In Selected Countries

                                                           98
                             Australia                          120
                                                                120
                              Canada                             126
                                                                  136
                     British Columbia                     80
                             Canada                            105
                                                               105
                            Manitoba         n/a
                            Canada                                         162
                                                                                                291
                      Saskatchewan           n/a
                                                                      148
                              Finland                                          202
                                                                             189
                                                                                 221
                     United Kingdom                                                       261
                                                                             182


                                         0         50     100        150     200    250      300      350
                                         Days (2000)


                                               Cataract
                                               Knee Replacement
                                               Hip Replacement
Performance
Health System




                     Note: Waiting time is defined as time after making appointment with a specialist.
                     Data unavailable for Alberta and most other Canadian provinces.
                     Source: Sicilani L, Hurst J. Explaining waiting times variations for elective surgery
                     across OECD countries, OECD economic studies no. 38. OECD: Paris; 2004.


                40                                              INSTITUTE OF HEALTH ECONOMICS
                                        Health Expenditure
                                        & Life Expectancy
                                        In Selected Countries

                                 16       United States


                                 14


                                 12                       Germany
                                                                    France
                                                                          Canada
                                 10
Health Expenditure as % of GDP




                                                        Netherlands            Sweden
                                                                                 Australia
                                                              New Zealand                    Japan
                                           United Kingdom
                                 8
                                                                        Italy
                                                                                Spain
                                                          Finland
                                 6


                                 4


                                 2


                                 0
                                      77.0 77.5 78.0 78.5 79.0 79.5 80.0 80.5 81.0 81.5 82.0 82.5
                                       Life Expectancy (years)


                                                                                                          Health System
                                                                                                           Performance




Note: Data is for 2004.
Source: OECD health data; 2006.


HEALTH SYSTEM PERFORMANCE                                                                            41
                                                            Health Expenditure
                                                            & Life Expectancy
                                                            In Selected Developing Countries


                                                      12                               Cambodia



                                                                     Malawi
                                                      10


                                                                                          Haiti
                                                      8
                                                                              Chad                         Bolivia
                     Health Expenditure as % of GDP




                                                                                     Ethiopia
                                                      6                                                 Nepal        Vietnam

                                                                                     Kenya
                                                                           Congo                         India
                                                      4                                                    Bangledesh
                                                                           Rwanda
                                                                                                  Lao

                                                      2



                                                      0
                                                           30         40             50             60               70        80
                                                            Life Expectancy (years)
Performance
Health System




                                                                Female         Men




                     Note: Data is for 2004.
                     Source: World health statistics, 2006. Geneva: World Health Organization;
                     2006. Available at: www.who.int/whisis/whostat2006.pdf.



                42                                                                        INSTITUTE OF HEALTH ECONOMICS
                                      Health Expenditure
                                      & Infant Mortality
                                          In Selected Countries

                                 12                                               Germany

                                                                         France                   Canada
                                                                  Sweden
                                 10                                              Netherlands
                                                                                                 Australia

                                                               Japan    UK   Spain
                                                                                         Italy
                                 8
                                                                       Finland
Health Expenditure as % of GDP




                                 6



                                 4



                                 2



                                 0
                                      0         1          2            3            4             5         6
                                      Infant Mortality Rate (per 1000 live births)


                                                                                                                      Health System
                                                                                                                       Performance




Note: Infant mortality rate for Canada is 2003 data.
Source: World Health Organization, The World Health Report 2006.


HEALTH SYSTEM PERFORMANCE                                                                                        43
                                                            Health Expenditure
                                                            & Infant Mortality
                                                            In Selected Developing Countries

                                                      12
                                                                                                         Cambodia


                                                      10
                                                                                                               Malawi



                                                      8                                          Haiti
                                                                                 Bolivia
                     Health Expenditure as % of GDP




                                                                                                                     Chad
                                                                                                         Ethiopia
                                                      6          Vietnam
                                                                                      India
                                                                                                 Kenya           Nepal
                                                                                                                            Congo
                                                      4                          Bangledesh
                                                                                                                    Rwanda
                                                                                           Lao
                                                      2



                                                      0
                                                           0        20      40      60             80    100        120      140
                                                           Infant Mortality Rate (per 1000 live births)
Performance
Health System




                     Source: World health statistics, 2006. Geneva: World Health Organization; 2006.
                     Available at: www.who.int/whisis/whostat2006.pdf.


                44                                                                          INSTITUTE OF HEALTH ECONOMICS
Quality-Adjusted Life Years (QALY)
League Tables
                   Quality-Adjusted Life Years
                   (QALY) League Tables
                   for Cataract Surgery


                    Cataract Surgery

                                       Intervention VS Comparator                      $/QALY in
                    Year of Pub        in Target population                            2002 US$

                    2003               Cataract and posterior chamber                      $1,600
                                       intraocular lens implantation VS
                                       No treatment IN patients with
                                       bilateral cataracts with 20/83
                                       vision – age 73
                    2002               Initial cataract surgery VS.                        $2,100
                                       Observation IN patients who
                                       undergo initial cataract surgery
                    2003               Second-eye cataract surgery VS.                     $2,800
                                       Preexisting unilateral pseudophakia
                                       IN Cohort of US patients with prior
                                       successful cataract surgery in
                                       fellow eye – median age 73
                    2002               Cataract surgery VS. No Cataract                    $4,500
                                       surgery IN patients scheduled for
                                       cataract extraction in one eye




                   Note: A QALY League table provides a rank ordering of interventions in ascending
Tables
QALY League




                   order of their incremental cost effectiveness ratio. A low cost per QALY appearing
                   towards the top of the league table does not necessarily mean that the program/
                   intervention is more worthwhile from a societal perspective than a program/
                   intervention appearing lower down the table.
                   Source: Centre for the Evaluation of Value and Risk in Health. Tufts – New
                   England Medical Centre. Available at: http://www.tufts-nemc.org/cearegistry/data/
                   docs/PhaseIIIACompleteLeagueTable.pdf.


              46                                         INSTITUTE OF HEALTH ECONOMICS
Quality-Adjusted Life Years
(QALY) League Tables
for Organ Transplantation


 Organ Transplantation

                    Intervention VS Comparator                      $/QALY in
 Year of Pub        in Target population                            2002 US$

 2003               Cadaveric donor renal                               $1,600
                    transplantation with no wait VS
                    Continued dialysis IN non-diabetic
                    patients who are stable on dialysis
                    – age 65+
 2003               Living donor renal transplantation                $24,000
                    with 4 year wait VS Continued
                    dialysis IN non-diabetic patients ho
                    are stable on dialysis – age 65+
 2003               Cadaveric renal transplantation with             $210,000
                    2 year wait VS. Continued dialysis
                    IN non-diabetic patients who are
                    stable on dialysis – age 65+
 2003               Cadaveric donor renal                            $210,000
                    transplantation with 4 year wait VS
                    Continued dialysis in non-diabetic
                    patients who are stable on dialysis
                    – age 65+


Note: A QALY League table provides a rank ordering of interventions in ascending
                                                                                          QALY League
                                                                                                Tables




order of their incremental cost effectiveness ratio. A low cost per QALY appearing
towards the top of the league table does not necessarily mean that the program/
intervention is more worthwhile from a societal perspective than a program/
intervention appearing lower down the table.
Source: Centre for the Evaluation of Value and Risk in Health. Tufts – New
England Medical Centre. Available at: http://www.tufts-nemc.org/cearegistry/data/
docs/PhaseIIIACompleteLeagueTable.pdf.


QALY LEAGUE TABLES                                                                   47
                   Quality-Adjusted Life Years
                   (QALY) League Tables
                   for Hip Replacement


                    Hip Replacement

                                       Intervention VS Comparator                      $/QALY in
                    Year of Pub        in Target population                            2002 US$

                    2002               Total hip replacement surgery                       $1,200
                                       VS. No total hip replacement
                                       surgery IN females undergoing hip
                                       replacement surgery – age 60-69
                    2002               Total hip replacement surgery                       $1,500
                                       VS. No total hip replacement
                                       surgery IN males undergoing hip
                                       replacement surgery – age 60-69
                    2002               Total hip replacement surgery                       $2,000
                                       VS. No total hip replacement
                                       surgery IN females undergoing hip
                                       replacement surgery – age 70-79
                    2002               Total hip replacement surgery                       $2,500
                                       VS. No total hip replacement
                                       surgery IN males undergoing hip
                                       replacement surgery – age 70-79




                   Note: A QALY League table provides a rank ordering of interventions in ascending
Tables
QALY League




                   order of their incremental cost effectiveness ratio. A low cost per QALY appearing
                   towards the top of the league table does not necessarily mean that the program/
                   intervention is more worthwhile from a societal perspective than a program/
                   intervention appearing lower down the table.
                   Source: Centre for the Evaluation of Value and Risk in Health. Tufts – New
                   England Medical Centre. Available at: http://www.tufts-nemc.org/cearegistry/data/
                   docs/PhaseIIIACompleteLeagueTable.pdf.


              48                                         INSTITUTE OF HEALTH ECONOMICS
Quality-Adjusted Life Years
(QALY) League Tables
for Vaccination


 Vaccination

                    Intervention VS Comparator                      $/QALY in
 Year of Pub        in Target population                            2002 US$

 2003               Four doses of seven-valent                        $25,000
                    pneumococcal conjugate vaccine
                    VS. No vaccination IN 80% of the
                    Canadian population
 2003               Universal infant vaccination                      $81,000
                    program with a hypothetical
                    7-valent conjugated pneumococcal
                    vaccine VS No vaccination
                    IN infants and children in the
                    Netherlands – birth to age 10




Note: A QALY League table provides a rank ordering of interventions in ascending
                                                                                          QALY League
                                                                                                Tables




order of their incremental cost effectiveness ratio. A low cost per QALY appearing
towards the top of the league table does not necessarily mean that the program/
intervention is more worthwhile from a societal perspective than a program/
intervention appearing lower down the table.
Source: Centre for the Evaluation of Value and Risk in Health. Tufts – New
England Medical Centre. Available at: http://www.tufts-nemc.org/cearegistry/data/
docs/PhaseIIIACompleteLeagueTable.pdf.


QALY LEAGUE TABLES                                                                   49
Figures Index
Health Status ................................................................................ page             01
  HALE in Selected Countries .......................................... page                                    02
  Life Expectancy at Birth in Selected Countries ......... page                                                 03
  Life Expectancy at Birth in Selected
  Developing Countries ...................................................... page                              04
  Infant Mortality in Selected Countries .......................... page                                        05
  Infant Mortality in Selected Developing Countries ..... page                                                  06
  Percentage of People Reporting Good or Better
  Health Status (2003) in Selected Countries ............. page                                                 07
  Physical Activity in Selected Countries ....................... page                                          08
  Consumption of Fruits and Vegetables
  in Selected Countries ...................................................... page                             09
  Percentage of Population Who Smoke Daily
  in Selected Countries ...................................................... page                             10
  Prevalence of Obesity in Selected Countries ............ page                                                 11
Costs .................................................................................................. page   13
  Health Care Expenditure Per Capita
  in Selected Countries ...................................................... page                             14
  Health Care Expenditure as % of GDP
  in Selected Countries ...................................................... page                             15
  Pharmaceutical Expenditure Per Capita
  in Selected Countries ...................................................... page                             16
  Family Physician Salaries in Selected Countries ...... page                                                   17
  Specialist Physician Salaries in
  Selected Countries .......................................................... page                            18
  Per Person Spending by Age in the
  United States for 2000 ...................................................... page                            19




50                                                           INSTITUTE OF HEALTH ECONOMICS
    Per Person Spending by Service Category
    and Age in the United States (2000) ............................. page                      20
    Elderly Dependency Ratio in Selected Countries ....... page                                 21
    End of Life Total Cost and Utilization in Alberta........... page                           22
    Total Health Care Cost in Alberta ................................... page                  23
Health Resources ....................................................................... page   25
  Number of Physicians in Selected Countries ............. page                                 26
  Number of Nurses in Selected Countries ................... page                               27
  Number of Pharmacists in Selected Countries ......... page                                    28
  Number of Dentists Practitioners
  in Selected Countries ...................................................... page             29
  Number of CT Imaging Scanners
  in Selected Countries ....................................................... page            30
  Number of MRI Imaging Scanners
  in Selected Countries ....................................................... page            31
  Number of Hospital Beds in Selected Countries ...... page                                     32
Health Resource Utilization ................................................... page 33
  Average Length of Stay in Hospital
  In Selected Countries ...................................................... page 34
  Hospital Discharge Rate in Selected Countries ........ page 35
Health System Performance ................................................. page                37
  National Unemployment Rate
  in Selected Countries ...................................................... page             38
  Public Satisfaction with Health Care System
  in Selected Countries ...................................................... page             39
  Median Waiting Times in Selected Countries ............ page                                  40




WORLD IN YOUR POCKET                                                                            51
Figures Index continued
     Health Expenditure & Life Expectancy
     in Selected Countries ........................................................         page 41
     Health Expenditure & Life Expectancy
     in Selected Developing Countries ...................................                   page 42
     Health Expenditure & Infant Mortality
     in Selected Countries ..............................................................   page 43
     Health Expenditure & Infant Mortality
     in Selected Developing Countries .......................................               page 44
QALY League Tables .................................................................. page      45
  QALY League Tables for Cataract Surgery ................. page                                46
  QALY League Tables for Organ Transplantation ....... page                                     47
  QALY League Tables for Hip Replacement ................ page                                  48
  QALY League Tables for Vaccination ........................... page                           49




52                                                     INSTITUTE OF HEALTH ECONOMICS
IHE Publications
  Cost-effectiveness in the detection of syphilis
  The use and benefit of teleoncology services
  Screening newborns for hearing
  Screening newborns for cystic fibrosis
  The use of nitric oxide in acute respiratory distress syndrome
  Routine Pre-operative testing – is it necessary?
  Consensus Statement on Self-monitoring in Diabetes
  Consensus Statement on How to Prevent Low Birth Weight




Institute of Health Economics
1200 - 10405 Jasper Avenue
Edmonton AB Canada T5J 3N4
Tel. 780.448.4881 Fax. 780.448.0018
info@ihe.ca
World In Your Pocket–a Handbook of International
Health Economic Statistics includes the most current available
data, presented in separate sections on health status, health
care costs, health resources, health resource utilization and
health system performance.




www.ihe.ca


ISBN 978-0-9780024-6-6

				
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