Letter to the editor: Your healthcare special raises some interesting points about the role of insurance and the differences across OECD countries (Observer No. 229, November 2001, also available online). But maybe your expectations of private insurance provision are a little optimistic.

Stronger co-operation between governments, charitable foundations and bio/pharmaceutical industries in developed and developing countries could be an effective and cost-efficient path to long-term health security in a world where disease threatens social and economic stability in many areas. That was one conclusion from an OECD conference on Biotechnology for Infectious Diseases, which brought together politicians, scientists, industry and health policy experts in Lisbon in October.

Cigarette smoking has fallen sharply across OECD countries in the past 40 years, as governments waged health campaigns and raised taxes on tobacco to discourage the habit. Sweden can claim the lowest smoking rate among OECD countries, with 18.9% of the population admitting to being regular smokers in 2000, down from 25.8% in 1990, followed by the US with 19.0%, down from 25.6% a decade earlier. The Japanese can meanwhile claim the dubious distinction of being the heaviest smokers, with 34.3% of people taking a puff daily in 1999, just slightly lower than 37% in 1990, figures in the latest edition of OECD Health Data show.

Hungarians were consulting their doctors on average almost 20 times a year in the late 1990s, a 79% increase from the frequency in 1980, making them the heaviest users of medical services in the OECD. Hungarians were also among the most likely to be admitted to hospital, with 237.5 admissions per 1,000 population in the late 1990s, second only to Austria (286.3) and Finland (265), according to the latest Health at a Glance study.

Health before wealth is one of the oldest sayings in the book. Yet, while good health is obviously a foundation of human welfare, a lot of wealth is absorbed in its pursuit. 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. Who cares, some might say, as long as we are living longer and healthier than ever before? If only the question were that simple.

This article was originally written as an introduction to a series of articles on healthcare, all of which can be found on http://www.oecdobserver.org/healthcare

“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.

Industrial countries spend a large proportion of GDP on healthcare. But how can they be sure they are getting value for money? One way is to use performance indicators, but these can have their drawbacks, as well as their advantages.

Healthcare costs are rising as patients become more demanding and new technologies spread. The trend is likely to accelerate in coming years as the ageing of the baby-boom generation and lengthening lifetimes cause the number of elderly people in OECD countries to rise sharply. But how much will it cost to take care of this elderly population, and should we adapt public health spending to cope?

The right to privacy and medical confidentiality is taken as read in OECD countries. Yet with new genetic technologies, information about a patient can give clues to the health and physical attributes of the patient¡¦s whole family, and even future children. There are calls to improve data performance in healthcare, but are existing data protection systems strong enough to cover these new realities?

All people are consumers of health services. It is about time they were treated as such. Only then will quality be improved.

Long-term care is a particularly thorny issue for healthcare policymakers because it is so intertwined with other areas of public policy, like housing and social security. Yet it is an increasingly important area of healthcare. Quality indicators can help to achieve improvements.

Citizens in all OECD countries want to know that they will get the high-quality health services they need, when they need them. They also want to know that they are getting value for their money. Governments face the dual challenge of improving healthcare performance and demonstrating that improvement if they are to preserve public confidence in health systems and institutions.

In the section that follows, five health ministers from OECD countries have been invited to answer a straightforward question:

“What action are you taking to improve health-service performance in your country and how will you gauge that improvement?”

Last year the World Health Organization dedicated its World Health Report 2000 to improving the performance of health systems. We did so because we recognised that the good health of nations is key to human development and economic growth and we felt it was important to analyse health systems’ performance and to share what we knew with governments and the international community.

OECD countries tend to be great rivals when it comes to comparing their healthcare. What do the patients think? Results from a recent survey reveal some interesting common features, and disparities too.

Patients increasingly expect choice as well as quality in healthcare. But in order to make informed choices, they need to know how well different hospitals or doctors are performing compared with their colleagues elsewhere. This consumer power helps hospitals to improve, as the case of Dr Foster, a UK company, shows.

Today’s doctors face a bewildering array of choices and constraints, from technological discovery to increasing budget pressures. Their dilemmas go beyond diagnosis and treatment to weighing the benefits of new discoveries and whether society is willing to pay for them.

Fertility levels – the number of children being born to assure the next generation – are generally low in OECD countries. This is a cause of primary concern to governments because it contributes to ageing societies and means fewer taxpayers to fund pensions, health services and so on. Yet, almost a century of policies to encourage larger families has failed to boost birth rates. The case of Sweden may help explain why. (For PDF article with graph, see bottom of article.)

The future performance of OECD health systems will depend on how healthcare is progressing globally. A greater effort, including investment, is needed to improve health systems in other (particularly poorer) countries.

Health is a public service almost by definition, though private insurance is expected to play a greater financing role. Finding the right balance between public and private health coverage and building the appropriate regulatory framework is an ongoing policy challenge.

With medical professionals and institutions responsible for devising their own separate quality systems, achieving a coherent quality framework for the Netherlands is proving a harder job than many had bargained for.

“You are as old as you feel”: maybe, but are you as healthy as you feel? If that is the case, most people in OECD countries are doing fine, with US, Canadian and French men topping the feelgood factor list, with more than 90% of them reporting good health.

General health in OECD countries may be improving in many areas, but not when it comes to obesity, which is rising fast almost everywhere.