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UK healthcare spend exceeded OECD average in 2009, new figures show

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d7720 (Published 29 November 2011) Cite this as: BMJ 2011;343:d7720
  1. Sophie Arie
  1. 1London

Spending on healthcare in the United Kingdom exceeded the average of the Organisation of Economic Co-operation and Development member countries for the first time in 2009, a new report shows. Health spending accounted for 9.8% of gross domestic product (GDP) in the UK, whereas the OECD average was 9.6%.

The share of the UK’s GDP allocated to health rose steadily throughout the whole of the past decade, particularly during the 2008-9 recession. It rose from 8.4% in 2007 to 9.8% in 2009.

The Health at a Glance report, the sixth in a series of annual reports, shows that spending on health is rising worldwide but that not enough is being done to prevent and manage chronic diseases.

It shows that across the 34 OECD countries health spending rose on average by 4% a year over the decade to 2009 and that the proportion of GDP spent on health rose to 9.6%, up 0.8% on the previous year and from less than 4% of GDP in 1960.

The quality of medical care has risen too, with higher survival rates for life threatening diseases. Only 4% of people hospitalised after a heart attack now die in the 30 days after admission, half the 8% in 2000. And the proportion of women surviving five years after diagnosis of breast cancer rose to 84%, from 79% in 1997.

But not enough is being done to prevent and manage chronic diseases such as asthma and diabetes, and too many patients with these diseases are being admitted to hospital unnecessarily, says the report.

Despite efforts to promote healthy eating and active lifestyles, the prevalence of obesity has doubled or even tripled in many countries since 1980, and 50% or more of the population is now overweight if not obese in more than half of OECD countries. The obesity rate in the adult population is highest in the United States, despite it also being the biggest spender on health, rising from 15% of the population in 1980 to 34% in 2009, and lowest in Japan and Korea, at 4%.

“It’s a failure, when we’re spending so much, if we are still not managing to address lifestyle issues properly,” Mark Pearson, head of the OECD’s health division, told the BMJ.

Mr Pearson warned that a general trend shown in the report towards increasing numbers of specialists and a widening pay gap between specialists and primary care doctors (with the UK the only country to buck that trend) doesn’t encourage the much needed strengthening of primary care services, which are the most cost effective way to deliver healthcare. And OECD calculations indicate that, for a relatively low cost, a better combination of lifestyle change campaigns, regulation, and advice from GPs could save hundreds of thousands of lives lost to chronic disease.

The UK spent $3487 (£2240; €2610) per person on health in 2009, just above the OECD average of $3233, while the US tops the ranking, at $7960. The lowest spenders were Mexico ($918) and Turkey ($902).

The UK ranks well in terms of general health and life expectancy and has a particularly low prevalence of diabetes. But it has high levels of alcohol consumption and obesity in comparison with other OECD countries.

The NHS also performs well in terms of waiting times and length of stays in hospital and does not record excessive or strikingly low numbers of various procedures, from caesarean sections to coronary angioplasties.

But the UK emerges as one of several countries where admissions to hospital for asthma are high, and it has one of the lowest rates of cancer survival. The UK’s five year relative survival rate for breast cancer for 2004-9 was 81% (up from 75% in 1997-2002) but still lower than the 84% average. The UK’s survival rate for cervical cancer was 59% (OECD average 66%).

Rates at which countries use different types of treatment also vary widely (for example, the number of cases of coronary angioplasty in Germany is triple that in France), which suggests that there is not enough overall understanding of what care is appropriate.

“You have to be worried about these differences,” says Mr Pearson. “If there are such stark variations, it must mean that in too many areas certain procedures are being carried out unnecessarily—countries are not delivering value for money.”

On average across the OECD countries, some 72% of all health expenditure still comes from the public sector, a share that has not changed over the past 20 years. In Britain the figure is 84%.

Notes

Cite this as: BMJ 2011;343:d7720

Footnotes