Organization For Economic Cooperation And Development Health Research Articles

Development of the Patient-Reported Indicator Surveys (PaRIS) conceptual framework to monitor and improve the performance of primary care for people living with chronic conditions

BackgroundThe Organisation for Economic Co-operation and Development (OECD) Patient-Reported Indicator Surveys (PaRIS) initiative aims to support countries in improving care for people living with chronic conditions by collecting information on...

Effects of Senility on Disease Burden: Panel Analysis Using 2010 to 2019 OECD Health Data.

In this study, the geniatric status of OECD (Organisation for Economic Co-operation and Development) countries was measured, and the effects of aging status on disease patterns in each country were quantitatively assessed. A theoretical model explaining the effects was suggested, and the implications were discussed. Data used in this study were the OECD Health Statistics data and WHO Global Burden of Disease data. The values for each country were paired with disability-adjusted life years (DALYs) presented by the WHO and Institute for Health Metrics and Evaluation (IHME). A cross-country panel analysis was conducted to analyze the effects of senility on the burden of disease in OECD countries. Geniatric status had effects on the burden of disease (P = .048). Total health expenditure significantly reduced the burden of disease (P = .001). In the panel model with YLL (Year of Life Lost) as the outcome variable, geniatric status had twice greater effects on the burden of disease than that in the model with DALY (P = .003). In medical insurance-related policies, the characteristics of the disease should be considered. In particular, chronic diseases have not received much attention compared to their risk. However, the disease that actually affects the burden of disease is a disease that becomes chronic and requires long-term treatment rather than a disease with a high fatality rate. And, as a result of this study, the higher the level of resource consumption for treatment in OECD countries, where aging is progressing, the burden of disease was rather reduced. Therefore, if there is institutional support to receive appropriate treatment, it will be possible to reduce the national burden of disease.

Role of nurses and midwives in improving patient safety during childbirth: Evidence from obstetric trauma in OECD countries

ObjectivesTo measure the role of nurses and midwives in reducing obstetric trauma as a proxy for safety failures during childbirth in member countries of Organization for Economic Co-operation and Development (OECD). MethodsThe number of practicing nurses' and midwives' density per 1000 population and the proportion of third- and fourth-degree obstetric trauma during vaginal delivery with instrument (OT1) and without instrument (OT2) in crude rates per 100 vaginal deliveries for patients aged 15 and over collected from World Development Indicators and OECD Health Statistics in 17 OECD countries during 2010–2017 period. The statistical technique of panel data analysis was applied to estimate the impact of nurses and midwives on improving patient safety during childbirth. The number of physicians per 1000 population, health care expenditure (HCE) per capita and total number of hospital beds per 1000 population were added in data analysis as control variables. ResultsThe results of panel co-integration test and dynamic long-run models confirm that there were meaningful relationships from the level of nursing and midwifery staff to reducing OECD's obstetric trauma indicators with long-run magnitudes of −15.8614 for OT1 and −0.0519 for OT2. In addition, the results of panel error-correction model argue that if the long-run relationships between nursing and midwifery staff and obstetric trauma indicators are disturbed by the shortage in the needed nurses and midwives, then it takes at least 25 years for OT1 and 18 years for OT2 to reduce and restore back to equilibrium; that is quite a long time. ConclusionA higher proportion of nursing and midwifery staff is associated with higher patient safety during childbirth in OECD countries. Overall, our findings alert policy makers to consider the deleterious impacts of shortage in the level of nursing and midwifery staff on declining patient safety during childbirth as well as quality of acute care in OECD.

Nurse staffing and life expectancy at birth and at 65 years old: Evidence from 35 OECD countries

ObjectiveTo measure the possible magnitude of the role nurse staffing has on increasing life expectancy at birth and at 65 years old. MethodsThe statistical technique of panel data analysis was applied to investigate the relationship from the number of practicing nurses’ density per 1000 population to life expectancy at birth and at 65 years old. Five control variables were used as the proxies for the levels of medical staffing, health care financial and physical resources, and medical technology. The observations of 35 member countries of Organization for Economic Co-operation and Development (OECD) were collected from OECD Health Statistics over 2000–2016 period. ResultsThere were meaningful relationships from nurse staffing to life expectancy at birth and at 65 years with the long-run elasticities of 0.02 and 0.08, respectively. Overall, the role of nursing characteristics in increasing life expectancy indicators varied among different health care systems of OECD countries and in average were determined at the highest level in Japan (0.25), followed by Iceland (0.24), Belgium (0.21), Czech Republic (0.21), Slovenia (0.20) and Sweden (0.18). ConclusionA higher proportion of nursing staff is associated with higher life expectancy in OECD countries and the dependency of life expectancy to nursing staff would increase by aging. Hence, the findings of this study warn health policy makers about ignoring the effects nursing shortages create e.g. increasing the risk of actual age-specific mortality, especially in care of elderly people.

Role of nurses in improving patient safety: Evidence from surgical complications in 21 countries

ObjectivesTo analyze the role of nurse staffing in improving patient safety due to reducing surgical complications in member countries of Organization for Economic Co-operation and Development (OECD). MethodsThe number of practicing nurses’ density per 1000 population and five surgical complications indicators including foreign body left in during procedure (FBL), postoperative pulmonary embolism (PPE) and deep vein thrombosis (DVT) after hip and knee replacement, postoperative sepsis after abdominal surgery (PSA) and postoperative wound dehiscence (PWD) were collected in crude rates per 100,000 hospital discharges for age group of 15 years old and over within 30 days after surgery based on surgical admission-related and all admission-related methods. The observations of 21 OECD countries were collected from OECD Health Statistics during 2010-2015 period. The statistical technique of panel data analysis including unit root test, co-integration test and dynamic long-run analysis were used to estimate the possible relationship between our panel series. ResultsThere were significant relationships from nurse-staffing level to reducing FBL, PPE, DVT, PSA and PWD with long-run magnitudes of −2.91, −1.30, −1.69, −2.81 and −1.12 based on surgical admission method as well as −6.12, −14.57, −7.29, −1.41 and −0.88 based on all admission method, respectively. ConclusionsA higher proportion of nurses is associated with higher patient safety resulting from lower surgical complications and adverse clinical outcomes in OECD countries. Hence, we alert policy makers about the risk of underestimating the impact of nurses on improving patient safety as well as the quality of health care services in OECD countries.

Estimation of Association between Healthcare System Efficiency and Policy Factors for Public Health

Objective: To assess the association between the healthcare system’s efficiency and policy factors (the types of healthcare systems and various health policy indicators). Methods: In this study, a data envelopment analysis (DEA) with bootstrapping was applied to the healthcare system’s efficiency to correct the bias of efficiency scores and to rank countries appropriately. We analyzed data mainly from the OECD (Organization for Economic Co-operation and Development) Health Data from 2014. After obtaining the efficiency score result, we analyzed which policy factor caused the inefficiency of the healthcare system by Tobit Regression. Results: Based on five types of healthcare system classification, the result suggested that the social health insurance (e.g., Austria, Germany, Switzerland) showed the lowest efficiency score on average when compared to other types of systems, but evidence of a statistically significant difference in healthcare efficiency among four types of healthcare systems was not found. It was shown that the pure technological efficiency of the healthcare system was negatively influenced by two main factors: user choice for basic insurance coverage and degree of decentralization to sub-national governments. Conclusions: Our findings suggest that countries with relatively low healthcare system efficiency may learn from countries that implement policies related to a low level of user choice and a high level of centralization to achieve more economical allocation of their healthcare resources.

The great challenge of the public health system in Spain.

Article 43 of the Spanish Constitution of 1978 establishes the right to health protection and healthcare for all citizens (1). The political organization of the Spanish state is made up of the central state and 17 highly decentralized regions (termed autonomous communities) with their respective governments and parliaments. In terms of health care, political devolution to regional governments has been incrementally implemented over the last 35 years. The taking-up of responsibilities in the field of health by the autonomous communities brings the management of healthcare closer to citizens and guarantees (2): Equity: access to benefits and right to health protection under conditions of effective equality throughout the country and free movement of all citizens. Quality: in the evaluation of the benefit delivered by clinical actions, incorporating only those which contribute added value to the improvement of health, implicating the healthcare system. Participation: public of citizens both in respect for the autonomy of their individual decisions as well as in the consideration of their expectations as users of the healthcare system. Spanish health system Over the last years, the establishment of health systems providing universal coverage in the most advanced European countries has contributed to a permanent improvement in many health indicators like population health status parameters, health care amenable outcomes, coverage, access and financial equity parameters, health care quality, users’ satisfaction and system legitimated by the population. According to the last OECD (Organisation for Economic Co-operation and Development) health statistics report, Spanish life expectancy is the highest in Europe (2.7 years above average) (3), clinical results are at the level of the most advanced countries (same cancer survival rates as in Sweden, France or Germany) (4) and its cost is on the average of the 35 OECD economies, in terms of total spending on gross domestic product (GDP), 9%, and below the average if we compare it in terms of per capita spending (5,6). In addition, it is an international benchmark for its universality and level of access compared to many other developed countries. This improvement in all these parameters has been associated to a continued increase in health spending. In all EU countries (including Spain), during most of the second half of the 20th century, health expenditure has been growing faster than national income. The same is happening in all member countries of the OECD, so this situation calls into question whether the economic sustainability of healthcare systems, most of which were created and developed in times of greater prosperity, will be guaranteed in the future (7). In the context of a worldwide economic crisis, the impact of financial difficulties of healthcare systems has become particularly evident in Spain, where unemployment rate is one of the highest in the European Union.

Descriptive, cross-country analysis of the nurse practitioner workforce in six countries: size, growth, physician substitution potential.

ObjectivesMany countries are facing provider shortages and imbalances in primary care or are projecting shortfalls for the future, triggered by the rise in chronic diseases and multimorbidity. In order to assess the potential of nurse practitioners (NPs) in expanding access, we analysed the size, annual growth (2005–2015) and the extent of advanced practice of NPs in 6 Organisation for Economic Cooperation and Development (OECD) countries.DesignCross-country data analysis of national nursing registries, regulatory bodies, statistical offices data as well as OECD health workforce and population data, plus literature scoping review.Setting/participantsNP and physician workforces in 6 OECD countries (Australia, Canada, Ireland, the Netherlands, New Zealand and USA).Primary and secondary outcome measuresThe main outcomes were the absolute and relative number of NPs per 100 000 population compared with the nursing and physician workforces, the compound annual growth rates, annual and median percentage changes from 2005 to 2015 and a synthesis of the literature on the extent of advanced clinical practice measured by physician substitution effect.ResultsThe USA showed the highest absolute number of NPs and rate per population (40.5 per 100 000 population), followed by the Netherlands (12.6), Canada (9.8), Australia (4.4), and Ireland and New Zealand (3.1, respectively). Annual growth rates were high in all countries, ranging from annual compound rates of 6.1% in the USA to 27.8% in the Netherlands. Growth rates were between three and nine times higher compared with physicians. Finally, the empirical studies emanating from the literature scoping review suggested that NPs are able to provide 67–93% of all primary care services, yet, based on limited evidence.ConclusionsNPs are a rapidly growing workforce with high levels of advanced practice potential in primary care. Workforce monitoring based on accurate data is critical to inform educational capacity and workforce planning.

1970-2014년 경상의료비 및 국민보건계정: SHA2011의 적용

A new manual of System of Health Accounts (SHA) 2011, was published jointly by the Organization for Economic Cooperation and Development (OECD), Eurostat, and World Health Organization in 2011. This offers more complete coverage than the previous version, SHA 1.0, within the functional classification in areas such as prevention and a precise approach for tracking financing in the health care sector using the new classification of financing schemes. This paper aims to demonstrate current health expenditure (CHE) and National Health Accounts of the years 1970-2014 constructed according to the SHA2011. Data sources for public financing include budget and settlement documents of the government, various statistics from the National Health Insurance, and others. In the case of private financing, an estimation of total revenue by provider groups is made from the Economic Census data and the household income and expenditure survey, Korean healthcare panel study, etc. are used to allocate those totals into functional classifications. CHE was 105 trillion won in 2014, which accounts for 7.1% of Korea's gross domestic product. It was a big increase of 7.7 trillion won, 7.9%, from the previous year. Public share (government and compulsory schemes) accounting for 56.5% of the CHE in 2014 was still much lower than the OECD average of about 73%. With these estimates, it is possible to compare health expenditures of Korea and other countries better. Awareness and appreciation of the need and gains from applying SHA2011 for the health expenditure classification are expected to increase as OECD health expenditure figures get more frequently quoted among health policy makers.

Improving Japanese Physicians’ Gender-Role Attitudes: Career Education and Adjusted Work Systems

Improving Japanese Physicians’ Gender-Role Attitudes: Career Education and Adjusted Work Systems

Why has medicine expanded? The role of consumers

In the past 50years, the field of medicine has expanded dramatically in many Western societies. Despite substantial improvements in objective health measures, there has not been a commensurate increase in assessments of subjective health. We hypothesize that medical expansion may lower people’s subjective health perceptions, leading to an increase in health care utilization, and, in turn, fueling further medical expansion. We use OECD (Organization for Economic Co-operation and Development) Health Data, World Development Indicators, the World Values Survey, and the European Values Study to fit a difference-in-differences model that removes unobserved cross-national heterogeneity and any period trend that is shared across nations. We find that three dimensions of medical expansion at the societal level (medical investment, medical professionalization/specialization, and an expanded pharmaceutical industry) negatively affect individual subjective health. These findings are robust to different model specifications. We conclude by discussing possible explanations for the adverse effect of medical expansion on subjective health, and how this effect may be related to other mechanisms through which medicine expands.

Disease management index of potential years of life lost as a tool for setting priorities in national disease control using OECD health data

Limited healthcare resources make it necessary to maximize efficiency in disease management at the country level by priority-setting according to disease burden. To make the best priority settings, it is necessary to measure health status and have standards for its judgment, as well as consider disease management trends among nations.We used 17 International Classification of Diseases (ICD) categories of potential years of life lost (YPLL) from Organization for Economic Co-operation and Development (OECD) health data for 2012, 37 disease diagnoses YPLL from OECD health data for 2009 across 22 countries and disability-adjusted life years (DALY) from the World Health Organization (WHO). We set a range of 1–1 for each YPLL per disease in a nation (position value for relative comparison, PARC). Changes over 5 years were also accounted for in this disease management index (disease management index, DMI).In terms of ICD categories, the DMI indicated specific areas for priority setting for different countries with regard to managing disease treatment and diagnosis.Our study suggests that DMI is a realistic index that reflects trend changes over the past 5 years to the present state, and PARC is an easy index for identifying relative status. Moreover, unlike existing indices, DMI and PARC make it easy to conduct multiple comparisons among countries and diseases. DMI and PARC are therefore useful tools for policy implications and for future studies incorporating them and other existing indexes.

Association between Antidepressant Prescribing and Suicide Rates in OECD Countries: An Ecological Study

We have conducted an ecological study to assess the association between antidepressant prescribing and suicide rates using the Organisation for Economic Co-operation and Development (OECD) health data, making this the largest ecological study in recent times. Data were derived for the years 1995-2008 from the OECD health data set. The residuals for all variables were adjusted for country and year within each country. These were then analysed to identify predictors of suicide rate. Pearson's rank correlation coefficient and linear regression model were employed to assess associations and identify significant predictors of suicide rate. Suicide rate has significant positive correlations with antidepressant rates (p=0.031) and unemployment (p=0.028). It also has a significant negative correlation with inpatient psychiatric beds (p=0.039). The actual coefficients are less than ±0.16, indicating weak relationships. After adjusting for other variables, the only variable that is a statistically significant predictor of suicide rate is antidepressant prescribing (p=0.005, r²=0.09). Our analysis using this large data set suggests a statistically significant, albeit weak positive, association between antidepressant prescribing and suicide rates.

Correlation or causation? Income inequality and infant mortality in fixed effects models in the period 1960–2008 in 34 OECD countries

Income inequality is strongly associated with infant mortality across countries, but whether this association is causal has not been established. In their commentary in this issue of Social Science & Medicine, Regidor et al. (2012) argue that this association has disappeared in recent years, and question the premise of a causal link. This paper empirically tests the impact of income inequality on infant mortality in a fixed effects model that exploits the evolution of income inequality over a 38-year period, controlling for all time-invariant differences across countries. Data came from the Standardized World Income Inequality Database, containing yearly estimates for the period 1960–2008 in 34 countries member of the Organization for Economic Co-operation and Development (OECD), linked to infant mortality data from the OECD Health database. Infant mortality was modelled as a function of income inequality in a country and year fixed effects model, incorporating controls for changing economic and labour conditions. In a model without country fixed effects, a one-point increase in the Gini coefficient was associated with a 7% increase in the infant mortality rate (Rate ratio[RR] = 1.07, 95% Confidence Interval [CI] 1.04, 1.09). Controlling for differences across countries in a country fixed effects model, however, income inequality was no longer associated with infant mortality (RR = 1.00, 0.98, 1.01). Similar results were obtained when using lagged values of income inequality for up to 15 years, and in models that controlled for changing labour and economic conditions. Findings suggest that in the short-run, changes in income inequality are not associated with changes in infant mortality. A possible interpretation of the discrepancy between cross-country correlations and fixed effects models is that social policies that reduce infant mortality cluster in countries with low income inequality, but their effects do not operate via income. Findings highlight the need to examine the impact of more specific social policies on infant mortality.

Health care system performance of 27 OECD countries

The article is based on a multidimensional conception of healthcare system performance. Our objectives are to assess the performance of the healthcare systems of 27 Organisation for Economic Co-operation and Development (OECD) countries and to discern the countries' profiles according to the homogeneity of their healthcare systems' levels of performance. The analyses were carried out on data collected from the 27 high-income OECD countries, primarily using the OECD Health Data 2007 database, the World Health Organization 2008 statistics, OECD Health at a Glance and OECD Social Indicators. Each healthcare system's performance was assessed on the basis of the volume of available resources, services produced and health outcomes achieved and efficiency, effectiveness and productivity, thus characterizing the investments made in proportion to the available resources and services produced. Overall performance profiles were constructed taking into account simultaneously the level of all these components. Using multiple clusters analysis, we were able to group the countries into four profiles (satisfactory, promising, weak-polarized and limited) according to the homogeneity of their performance levels. This article offers a broad overview of the performance of these healthcare systems. The results will enable decision-makers to know the strengths and weaknesses of their own health care system and also to compare it with those of other countries.

The diagnosis of healthcare policy problems in Korea

The definition of a policy problem is important in all stages of the policy processes, and especially in presidential election seasons, which usually open the political window. We propose priorities among the policy problems of Korean healthcare by the positioning approach, which compares Korea with Organization for Economic Cooperation and Development (OECD) countries using OECD health data. The range of positioning is 1 to -1 where 1 is the best or highest level among OECD countries, 0 is the average level, and -1 is the worst or lowest level. The positioning results show that the overall health status of Korea is good (positioning=0.34), but the suicide rate (-1.00) is a major problem. Healthcare human resources are scarce (-0.46), but rapidly increasing. Hospital beds and medical equipments are over-supplied (respectively 0.37, 0.33), but medical equipments that are utilized mainly in tertiary hospitals are below average. The utilization of healthcare is at the top level in doctors’ consultations (0.97) and average length of stay (0.65). The quality of in-patient care is good (0.35), but quality of out-patient care is poor (-0.36). Healthcare costs are low (-0.73), but their growth rate is high. Among healthcare costs, the policy problems are large pharmaceutical expenditures and many households with catastrophic expenditures. This study determined the priorities of healthcare policy problems in Korea. The next step is to search for the factors that influence these policy problems and develop their solutions.

Health and social services expenditures: associations with health outcomes

ObjectiveTo examine variations in health service expenditures and social services expenditures across Organisation for Economic Co-operation and Development (OECD) countries and assess their association with five population-level health outcomes.DesignA pooled,...

Testing for structural breaks in panel varying coefficient models: with an application to OECD health expenditure

In this article, we propose a model selection approach for testing structural breaks in a semiparametric panel varying coefficient model. Monte Carlo evidence shows that the proposed model selection approach performs well in finite sample settings. Applying the method to an empirical data, we find evidence of structural breaks in Organisation for Economic Co-operation and Development (OECD) health expenditure data by allowing for income elasticity to be state (income)-dependent. The relationship between health expenditure and income is subject to two types of structural changes: smooth changes over income and structural breaks in the time dimension. The findings hold for both foreign exchange rate-converted and Purchasing Power Parity-converted expenditure and GDP.

The Association Between Public Social Expenditure and Suicides: Evidence from OECD Countries

This study aimed to examine the association between public social expenditure (PSE) and suicides in the 27 countries of the Organization for Economic Cooperation and Development (OECD) from 1980 to 2003. The age-standardized suicide rates and their annual change (%) were obtained from the OECD Health Data 2007. As a measure of social protection, the PSE (% GDP) was used. The covariates included the annual divorce rate (/100,000 population), fertility rate (number of children/woman aged 15 to 49 years), GDP per capita (US$PPP), male unemployment rate (%), life expectancy (years) and alcohol consumption (liter/capita) for each country, which were all obtained from the OECD Health Data 2007 and the OECD Social Indicators 2006. Using hierarchical linear models that included these covariates, the effects of PSE on suicides (Model 1) and the annual percent change (Model 2) were examined (Model 3). Also, sub-sample analyses were done for six countries that experienced political/economic transition. We could not find significant effects of PSE on suicides (Model 1), but we observed significantly negative effects on the annual percent change for men and women (Model 2). Such findings were replicated in the sub-sample analysis, and moreover, the effect size was much larger (Model 3). Our finding suggests that social welfare protection can be a pivotal factor for suicide epidemiology, and especially in countries experiencing a social crisis or transition.

The Economics of Thrombolysis

See related article, pages 1952–1955. Stroke leads to significant long-term disability with important ongoing human and economic costs. Although the clinical and economic benefits of thrombolysis have been demonstrated in previous analyses,1 efficacious large volume stroke care requires systematic organization and commitment on the part of healthcare payers. Canada benefits from a universal single-payer system which faces increasing cost pressures attributable to an ageing population and increasing costs of healthcare technology. The Organization for Economic Cooperation and Development (OECD) estimates that healthcare spending could double as a proportion of GDP in this country by 2050.2 The Canadian Institutes of Health Information note that Canadian jurisdictions spent 38.7% of all expenditures on health care in 2005 to 2006.3 Development and maintenance of stroke care systems will require well executed economic analyses to influence policy makers. In this regard, stroke is an ideal condition to treat from an economic perspective because its incidence is strongly age-linked …