Healthcare is delivered by a wide variety of health providers, ranging from hospitals and medical practices to ambulatory facilities and retailers, which can affect the expenditure patterns for different goods and services. Analysing health spending by provider can be particularly useful when considered alongside the functional breakdown of health expenditure (see section “Health expenditure by type of service”), giving a fuller picture of the organisation of health systems.
The organisational differences in healthcare delivery across OECD countries can be substantial, resulting in wide variation in the distribution of health spending across providers. At 39%, activities delivered in hospitals accounted for the largest proportion of health system funding across OECD countries. This average was largely exceeded in Türkiye and Costa Rica, where hospital activities received half or more of all financial resources, as well as in accession countries Indonesia and Thailand (Figure 7.18). On the other hand, Canada, Germany and Mexico spent less than 30% of the total health budget on hospitals.
After hospitals, the largest provider category is ambulatory providers. This covers a wide range of facilities with most spending related to either medical practices including GPs and specialists (as in Austria, France and Germany) or ambulatory healthcare centres (as in Finland, Ireland and Sweden). Across OECD countries, care delivered by ambulatory providers accounts for around a quarter of all health spending on average. Within this, around two‑thirds of all spending relates to GP and specialist practices and ambulatory healthcare centres, and roughly one‑fifth relate to dental practices. Overall, every third health dollar was spent on ambulatory providers in Belgium, Mexico, Finland, Luxembourg and the United States but this share was below 20% in Türkiye, Greece and the Slovak Republic.
Other main provider categories include retailers (mainly pharmacies), which accounted for one‑sixth of all health spending across OECD countries and residential long-term care facilities (mainly providing inpatient care to dependent people), to which 9% of the total health spending can be attributed. The latter provider group plays a much more central role in the health systems in the Netherlands, Sweden and Finland than elsewhere.
Across OECD countries, there is wide variation in the range of activities that may be performed by the same category of provider, reflecting differences in the organisation of health systems. These cross-country differences are most pronounced in the hospital sector (Figure 7.19). Although inpatient curative and rehabilitative care define the primary activity of hospitals, they can also be important providers of outpatient care in many countries – for example, through accident and emergency departments, specialist outpatient units, or laboratory and imaging services. In Finland and Denmark, outpatient care accounts for more than half of hospital expenditure, since specialists typically receive patients in hospital outpatient departments. In Germany and Greece, on the other hand, hospitals are generally mono-functional, with the vast majority (around 90%) of spending dedicated to the provision of inpatient care services, and very little outpatient and day care spending. Over recent decades, many countries have shifted some inpatient services to day care departments aiming to achieve potential efficiency gains and a reduction in waiting times. As a result, day care services account for 15% or more of all hospital expenditures in Belgium, Ireland and Portugal.
