Health, spending and the effort to improve quality in OECD countries: a review of the data.

The performance of health systems is of concern to both policy-makers and academics and a large body of recent literature has advanced the debate significantly on methods and results of health system performance assessments. In this article, I attempt to summarize what is known about a range of areas of health system performance, specifically in the areas of spending and outcomes, using data from the Organization for Economic Cooperation and Development (OECD) in the areas of health, spending, risk factors and quality of care. In so doing, we use new data from the OECD's Health Care Quality Indicators (HCQI) to examine a factor that is frequently cited at the national level but rarely compared at the international level, namely the quality of the healthcare provided. In keeping with other assessments of trends in health, we show that health has improved dramatically since the 1970s in all of the countries of the OECD. Likewise, all of the OECD countries are spending many times more on health per person than in 1970. However, the gains in health as well as the spending levels vary tremendously across countries. Quality of care is relatively high in some areas such as vaccination rates. In other areas such as breast cancer survival, the HCQI data show that most countries are making progress somewhat universally, but that all countries still have progress to be made. Finally, in other areas, such as inpatient care for acute myocardial infarction (AMI), there is wide variation in quality. Future work will need to be undertaken in order to examine possible best practices at the policy and operational level of health care delivery, their impact on spending and, most importantly, on health outcomes.