The 'Compleat' Healthcare System

Secretary-General of the OECD
Page 3 

“Look to your health: and if you have it, praise God.” This quotation is drawn from Izaak Walton’s seminal work, The Compleat Angler, a book which is to be found in the library of every fishing aficionado. Walton lived in the 17th century. At that time, the general belief was that health was “a blessing that money cannot buy”. True, we see around us in friends and family a connection between good genes and longevity. But, unlike the days of Walton, we no longer accept the premise that the benefits of health and consequent longevity are left to God and chance.

Taxpayers’ dollars, education and good public policy, as well as scientific advances, have raised the health of our citizenry within the OECD many-fold in subsequent centuries. That is why at the OECD we have embarked upon an ambitious three-year project to measure and analyse the performance of healthcare systems in member countries. What are the factors that affect performance? Why are outcomes so different, even with seemingly similar inputs?

OECD countries spend an average of 8-10% of GDP on healthcare. And that amount will rise in the years ahead as cost and demand pressures increase. Health, always at the top of the individual’s list of priorities, has moved to the top of the economic as well as the social agenda, especially since the quality of our “human capital” has been recognised as the foundation of economic growth and prosperity in all advanced economies. So, how much money we spend and how we invest it in achieving acceptable levels of healthcare has become a public preoccupation and hence a political imperative.

For example, how is it that the United States spends almost twice as much per person as Canada on healthcare and yet Canadians have a slightly higher life expectancy? France, in turn, spends less per head than Canada and enjoys more hospital beds and doctors for every inhabitant than either Canada or the United States. Why? Are we using the right indicators for measuring performance? Is our information base skewed? If life expectancy is one useful measure of our well-being, does it camouflage the flaws that health systems may have? Of course, longevity also raises economic issues never faced by previous generations. The fact that more of us live longer is something to celebrate, but longevity, in turn, poses daunting challenges to our health and social security systems. These are all areas in which the OECD is deeply involved.

The thrust of the OECD three-year health project is focused on a number of major policy challenges. First is the rising demand for medical services, due mainly to population ageing and the rapid innovation and diffusion of medical technology. Second is the concern about efficiency in provision of healthcare services. And third is the challenge of equity – that is, to address the problems of unequal access and provision.

The OECD Health Project will measure and analyse health system performance, in order to explain the variations between member countries. It will also assess the effectiveness of different ways to integrate healthcare systems with long-term care, including for older and disabled persons. As the Spotlight in this edition of the OECD Observer shows, we will be drawing on the co-operation of leading experts from around the world, including from other international organisations. Businesses, medical professionals, patient and other civil society groups: all of their contributions will be important, so that our work can give policymakers the evidence they need to base reforms on and improve their health systems. It is my hope that in the future OECD countries will emphasise preventive medicine and the important role of education as a determinant of good health. Then, armed with prevention and cure, we will be able to borrow from Izaak Walton’s title and write The Compleat Healthcare System.

I see the OECD Health Project as one of the most important undertaken by the organisation in recent years. Measuring health performance is a vital part of this endeavour and is the subject of a high-level conference of ministers, officials and international experts to be held in Ottawa in early November. Our aim is a very practical one: to help public policymakers meet the health challenges of the 21st century.

©OECD Observer No 229, November 2001

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