Total health spending has fallen in one of three OECD countries between 2009 and 2011, with those hardest hit by the crisis most affected. This is a sharp reversal from the strong growth in the years prior to the crisis, according to a new OECD report.
Health at a Glance 2013 says that this makes it all the more important that countries make their healthcare systems more productive, efficient and affordable.
Spending per capita fell in 11 of 33 OECD countries between 2009 and 2011, notably by 11.1% in Greece and 6.6% in Ireland. Growth also slowed significantly in others, including Canada (0.8%) and the United States (1.3%).
Only Israel and Japan saw the rate of health spending growth accelerate since 2009 compared with the previous decade. Health spending in Korea has continued to grow at more than 6% per year since 2009 but more slowly than in previous years.
Governments have worked to lower spending through cutting prices of medical goods, especially pharmaceuticals, and by budget restrictions and wage cuts in hospitals.
More than three-quarters of OECD countries reported a cut in real-term spending on prevention programmes in 2011 over 2010, and half spent less than in 2008. Cuts to spending on cost-effective prevention programmes on obesity, harmful use of alcohol and smoking are a cause for concern, says the report. Any short-term benefits to budgets are likely to be greatly outweighed by the long-term impact on health and spending.
Reductions in the supply of health services and changes in their financing through increases in direct out-of-pocket payments for patients are also affecting access to care. After years of improvement, waiting times for some operations in Portugal, Spain, England and Ireland show some increase.
Across the OECD, low-income groups are worst affected and may be foregoing needed care such as medicines or check-ups for chronic conditions, says the OECD. This may have long-term health and economic consequences on the most vulnerable in society.
On other measures, the impact of the crisis on health has been mixed: while suicide rates rose at the start of the crisis, they have stabilised since. Mortality from traffic accidents has declined, most likely because the crisis has led to fewer cars on the roads so fewer accidents. Alcohol and tobacco consumption has fallen in many countries too.
Among Health at a Glance 2013’s other findings are that:
•For the first time, average life expectancy exceeded 80 years across OECD countries in 2011, an increase of ten years since 1970. This trend shows no sign of slowing down. Those born in Switzerland, Japan and Italy can expect to live the longest among OECD countries.
•Chronic diseases such as diabetes and dementia are increasingly prevalent. In 2011, close to 7% of 20-79 year-olds in OECD countries, or over 85 million people, had diabetes. This number is likely to increase in the years ahead, given the high and often growing rates of obesity across the developed world.
•The market share of generic drugs has increased significantly over the past decade in many countries. However, generics still represent less than 25% of the market in Luxembourg, Italy, Ireland, Switzerland, Japan and France, compared with about 75% in Germany and the United Kingdom.
•The burden of out-of-pocket spending creates barriers to health care access in some countries. On average in the OECD, 20% of health spending is paid directly by patients; this ranges from less than 10% in the Netherlands and France to over 35% in Chile, Korea and Mexico.
•Across OECD countries, more than 15% of people aged 50 and older provide care for a dependent relative or friend, and most informal carers are women.