The OECD (The Organization for Economic Co-operation and Development) mission is to promote policies that will improve the economic and social well-being of people around the world. OECD’s work is based on continued monitoring of events in member countries as well as outside OECD area, and includes regular projections of short and medium-term economic developments. The OECD Secretariat collects and analyses data, after which committees discuss policy regarding this information, the Council makes decisions, and then governments implement recommendations. The OECD Health Datasets offers the most comprehensive source of comparable statistics on health and health systems across OECD countries. It is an essential tool to carry out comparative analyses and draw lessons from international comparisons of diverse health systems.
Healthcare financing can be analyzed from the point of view of financing schemes (financing arrangements through which health services are paid for and obtained by people, e.g. social health insurance), financing agents (organizations managing the financing schemes, e.g. social insurance agency), and types of revenues (e.g. social insurance contributions). Here “financing” is used in the sense of financing schemes as defined in the System of Health Accounts (OECD, Eurostat and WHO, 2011) and includes government schemes, compulsory health insurance as well as voluntary health insurance and private funds such as households’ out-of-pocket payments, NGOs and private corporations. Compulsory health insurance can be offered by private insurers, in some cases without an obligation to contract individuals. Out-of-pocket payments are expenditures borne directly by patients and include cost-sharing arrangements and any informal payments to healthcare providers. Total government expenditure is as defined in the System of National Accounts and includes intermediate consumption, compensation of employees, interest, social benefits, social transfers in kind, subsidies, other current expenditure and capital expenditure payable by central, regional and local governments as well as social security funds. Relating spending from government financing schemes and compulsory insurance schemes to total government expenditure is overestimated to a certain extent for those countries with compulsory health insurance provided by private insurers.
The System of Health Accounts (OECD, Eurostat and WHO, 2017) defines the boundaries of the healthcare system from a functional perspective, with healthcare functions referring to the different types of healthcare services and goods. Current health expenditure comprises personal healthcare (curative care, rehabilitative care, long-term care, ancillary services and medical goods) and collective services (prevention and public health services as well as administration – referring to governance and administration of the overall health system rather than at the health provider level). Curative, rehabilitative and long-term care can also be classified by mode of provision (inpatient, daycare, outpatient and home care). Concerning long-term care, only the health aspect is reported as health expenditure, although it is difficult in certain countries to separate out clearly the health and social aspects of long-term care. Thus, estimations of long-term care expenditure continue to be one of the main factors limiting comparability across countries. For the calculation of growth rates in real terms, economy-wide Gross Domestic Product (GDP) deflators are used. The following main items are defined:
– Curative care, which means the healthcare services during which the principal intent is to relieve symptoms or to reduce the severity of an illness or injury, or to protect against its exacerbation or complication that could threaten life or normal function;
– Rehabilitative care, which means the services to stabilize, improve or restore impaired body functions and structures, compensate for the absence or loss of body functions and structures, improve activities and participation and prevent impairments, medical complications and risks;
– Inpatient care, which means the treatment and/or care provided in a healthcare facility to patients formally admitted and requiring an overnight stay;
– Outpatient care, which means the medical and ancillary services delivered in a healthcare facility to a patient who is not formally admitted and does not stay overnight;
– Daycare, which means the planned medical and paramedical services delivered in a healthcare facility to patients who have been formally admitted for diagnosis, treatment or other types of healthcare and are discharged on the same day;
– Long-term care (health), which means a range of medical and personal care services that are consumed with the primary goal of alleviating pain and suffering and reducing or managing the deterioration in health status in patients with a degree of long-term dependency;
– Home-based care, which means the medical, ancillary and nursing services that are consumed by patients at their home and involve the providers’ physical presence;
– Ancillary services (non-specified by function), which means the healthcare or long-term care related services non-specified by function and non-specified by mode of provision, which the patient consumes directly, in particular during an independent contact with the health system and that are not integral part of a care service package, such as laboratory or imaging services or patient transportation and emergency rescue;
– Pharmaceuticals and other medical non-durable goods (non-specified by function), which means pharmaceutical products and non-durable medical goods intended for use in the diagnosis, cure, mitigation or treatment of disease, including prescribed medicines and over-the-counter drugs, where the function and mode of provision are not specified;
– Therapeutic appliances and other medical goods (non-specified by function), which means medical durable goods including orthotic devices that support or correct deformities and/or abnormalities of the human body, orthopedic appliances, prostheses or artificial extensions that replace a missing body part, and other prosthetic devices including implants which replace or supplement the functionality of a missing biological structure and medico-technical devices, where the function and the mode of provision are not specified;
– Preventive care, which means any measure that aims to avoid or reduce the number or the severity of injuries and diseases, their sequelae and complications;
– Governance, and health system and financing administration, which means services that focus on the health system rather than direct healthcare, direct and support health system functioning, and are considered to be collective, as they are not allocated to specific individuals but benefit all health system users.
The universe of healthcare providers is defined in the System of Health Accounts (OECD, Eurostat and WHO, 2017) and encompasses primary providers, i.e. organizations and actors that deliver healthcare goods and services as their primary activity, as well as secondary providers for which healthcare provision is only one among a number of activities. The following main items are defined:
– Hospitals, which means the licensed establishments that are primarily engaged in providing medical, diagnostic and treatment services that include physician, nursing and other health services to inpatients and the specialized accommodation services required by inpatients and which may also provide daycare, outpatient and home healthcare services;
– Residential long-term care facilities, which means establishments that are primarily engaged in providing residential long-term care that combines nursing, supervisory or other types of care as required by the residents, where a significant part of the production process and the care provided is a mix of health and social services with the health services being largely at the level of nursing care in combination with personal care services;
– Providers of ambulatory healthcare, which means establishments that are primarily engaged in providing healthcare services directly to outpatients who do not require inpatient services, including both offices of general medical practitioners and medical specialists and establishments specializing in the treatment of day-cases and in the delivery of home care services;
– Providers of ancillary services, which means establishments that provide specific ancillary type of services directly to outpatients under the supervision of health professionals and not covered within the episode of treatment by hospitals, nursing care facilities, ambulatory care providers or other providers;
– Retailers and other providers of medical goods, which means establishments whose primary activity is the retail sale of medical goods to the general public for individual or household consumption or utilization, including fitting and repair done in combination with sale;
– Providers of preventive care, which means organizations that primarily provide collective preventive programs and campaigns/public health programs for specific groups of individuals or the population-at-large, such as health promotion and protection agencies or public health institutes as well as specialized establishments providing primary preventive care as their principal activity;
– Providers of healthcare system administration and financing mean establishments that are primarily engaged in the regulation of the activities of agencies that provide healthcare and in the overall administration of the healthcare sector, including the administration of health financing;
– Rest of the economy means other resident healthcare providers not elsewhere classified, including households as providers of personal home health services to family members, in cases where they correspond to social transfer payments granted for this purpose as well as all other industries that offer healthcare as a secondary activity;
– Rest of the world providers means all non-resident units providing healthcare goods and services as well as those involved in health-related activities.
Expenditure on health measures the final consumption of health goods and services (i.e. current health expenditure). This includes spending by both public and private sources on medical services and goods, public health and prevention programs and administration. To compare spending levels between countries, per capita health expenditures are converted to a common currency (US dollar) and adjusted to take account of the different purchasing power of the national currencies, in order to compare spending levels. Economy-wide (GDP) Purchasing Power Parities (PPPs) are used as the most available and reliable conversion rates. For the calculation of growth rates in real terms, economy wide GDP deflators are used for all countries. PPPs are the rates of currency conversion that equalize the purchasing power of different currencies by eliminating the differences in price levels between countries. In their simplest form, PPPs are simply priced relatives that show the ratio of the prices in national currencies of the same good or service in different countries. PPPs are also calculated for product groups and for each of the various levels of aggregation up to and including GDP.
Gross Domestic Product (GDP) is the sum of the final consumption, gross capital formation and net exports. Final consumption of households includes goods and services used by households or the community to satisfy their individual needs. It includes final consumption expenditure of households, general government and non-profit institutions serving households. In countries, such as Ireland and Luxembourg, where a significant proportion of GDP refers to profits exported and not available for national consumption, the gross national income (GNI) may be a more meaningful measure than GDP.
Breaks in the time-related continuity of data on which the indicators values are based are specified in the content of dataset. There are also specified the cases were the methodology used for data collection was different or if the values are estimated.