Getting better, and affording it

A Disease-based Comparison of Health Systems: What is best and at what cost?

Measuring the value of health care is a tricky business. Traditional data, for instance, might give the number of hospital beds or doctors per 100,000 inhabitants, but what if some people using health care are getting better while others are not? Or what if they are getting better but at much greater expense than in other countries?

Using costly diagnostic and treatment procedures does not necessarily translate into better health, according to A Disease-based Comparison of Health Systems, a new OECD book that considers various approaches to health care in 17 countries. This book, written by leading experts from OECD countries, including David Cutler from Harvard University and editor of Health Economics, Alan Garber, a Stanford physician and economist, and Bengt Jönsson, a Swedish health economist, assesses treatments for three diseases: ischaemic heart disease, stroke and breast cancer. It compares the costs of medical treatment with patient fatality rates. It is one of the first multi-country studies to analyse expenditure on health care in this way.

The study points out that national health care systems are essentially natural economic experiments, with each country using different financial and delivery arrangements towards a common goal: improving the health of its citizens. It also finds that there is a need to change how comparisons are traditionally made among different national health systems. Instead of merely considering the financial expenses incurred by each country, patients should be followed up after the diagnostic stage to determine whether the money spent on their care was worth it.

After analysing data from a variety of sources, the three-year long project found that insurance-based systems tend to use high levels of expensive technology. Conversely, those public integrated health care systems that exert a stronger control over costs use expensive technologies more sparingly.

A Disease-based Comparison of Health Systems asserts that significant differences in approaches to treatment in OECD countries cannot be reduced to differences in medical knowledge, and thus, affirms the need to adopt more efficient approaches. If we are to ensure that people receive the best possible care, technologically driven or otherwise, modern society will need to consider the implications outlined in this study so that health care delivers value for money, as well as good health.

©OECD Observer No 237, May 2003

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