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Although Ireland has seen remarkable improvements in the health of its population in the last decades, several challenges lie ahead for its health system. Based on available OECD analyses, further progress could be made to promote efficient use of hospital resources, strengthen primary care, address high pharmaceutical spending and prevent the spread of risk factors including obesity and alcohol consumption.
In this report we present an assessment of public health strategies designed to tackle behavioural risk factors for chronic diseases that are closely linked with obesity, including aspects of diet and physical inactivity, in Brazil, China, India, Mexico, Russia, and South Africa.
Health systems in the United Kingdom have, for many years, made the quality of care a highly visible priority, internationally pioneering many tools and policies to assure and improve the quality of care. A key challenge, however, is to understand why, despite being a global leader in quality monitoring and improvement, the United Kingdom does not consistently demonstrate strong performance on international benchmarks of quality. This report reviews the quality of health care in the England, Scotland, Wales and Northern Ireland, seeking to highlight best practices, and provides a series of targeted assessments and recommendations for further quality gains in health care. To secure continued quality gains, the four health systems will need to balance top-down approaches to quality management and bottom-up approaches to quality improvement; publish more quality and outcomes data disaggregated by country; and, establish a forum where the key officials and clinical leaders from the four health systems responsible for quality of care can meet on a regular basis to learn from each other’s innovations.
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Italy’s indicators of health system outcomes and quality are consistently good. This is despite levels of health spending below other high-income OECD countries. However, Italy is lagging behind in some areas, like long-term care and prevention of non-communicable diseases.
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The French health care system performs relatively well. Health outcomes are better than the OECD average and citizens enjoy good access to care. However, France is lagging behind other OECD countries in some areas including for example antibiotics prescribing or alcohol consumption.
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Finland appears to have a high performing health system, with remarkable good quality in both primary and hospital care. The country also achieves good health status at relatively low level of health spending. Despite these advances, there are specific areas where improvements can be made such as preventing the spread of obesity and addressing gaps in mental health.
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The growth rate in health spending per capita in Canada has slowed down markedly in recent years, being close to zero in real terms since 2011. Life expectancy in Canada is one year higher than the OECD average, but rising alcohol consumption and obesity rates are growing risk factors to health. Canada could further improve the quality of care in order to cope better with rising prevalence of chronic diseases.
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The Australian health system is a complex mix of federal and state government funding and responsibility, making it difficult for patients to navigate. Despite its complexity, Australia’s universal health system achieves good results relatively efficiently.
Ten years after the introduction of publically-funded universal health insurance, the Mexican health system finds itself at a critical juncture. Unquestionably, some measures of health and health system performance have improved: those previously uninsured now use health services more often, whilst numbers reporting impoverishing health expenditure having fallen from 3.3% to 0.8%. Other indicators, however, remain worrying. Rates of survival after heart attack or stroke are markedly worse than in other OECD countries. Prevention is a particular concern: with 32% of the adult population obese, Mexico ranks as the second most obese nation in the OECD and almost 1 in 6 adults are diabetic. Other key metrics imply deep-rooted inefficiencies in the system: administrative costs, at 8.9% of total health spending, are the highest in the OECD and have not reduced over the past decade. Likewise, out-of-pocket spending has stuck at nearly 50% of total health spending - the highest in the OECD - and implies that individuals feel the need to visit private clinic despite having health insurance. In short, Mexico’s massive public investment in its health system has failed to translate into better health and health system performance to the extent wished and a programme of continued, extensive reform is needed. This report sets out the OECD’s recommendations on the steps Mexico should take to achieve this.
Colombia’s record in extending health insurance and health services to its population is impressive. In 1990, around 1 in 6 of the population had health insurance. Now, nearly 97% do, with greatest expansion occurring amongst poorer households. Likewise, in 1993 out-of-pocket spending made up 52% of total national expenditure on health. By 2006, this had fallen to less than 15%. Although Colombia has high rates of income inequality (with a Gini coefficient of 53.5 in 2012, compared to the OECD average of 32.2), access to health care services is much more equal. In urban populations, for example, 1.8% of children aged less than two years of age are recorded as having received no routine vaccinations, compared to 1.0% of rural children. Colombia nevertheless faces important challenges to maintain and improve the performance of its health system. This report looks at Colombia’s health care system in detail and offers recommendations on what Colombia can do to ensure accessibility, quality, efficiency and sustainability.