This chapter presents comparisons on the supply and use of different types of health services and goods in OECD countries. The provision of these services and the purchase of goods such as pharmaceuticals account for a large part of the health expenditure described in Chapter 7.

Consultations with doctors can take place in doctors’ offices or clinics, in hospital outpatient departments or, in some cases, in patients’ own homes. In many European countries (e.g. Denmark, Italy, Netherlands, Norway, Portugal, Slovak Republic, Spain and United Kingdom), patients are required, or given incentives, to consult a general practitioner (GP) “gatekeeper” about any new episode of illness. The GP may then refer them to a specialist, if indicated. In other countries (e.g. Austria, Czech Republic, Iceland, Japan, Korea and Sweden), patients may approach specialists directly.

The diffusion of modern medical technologies is one main driver of rising health expenditure across OECD countries. This section presents data on the availability and intensity of use of two diagnostic technologies – computed tomography (CT) scanners and magnetic resonance imaging (MRI) units.

The number of hospital beds provides a measure of the resources available for delivering services to inpatients in hospitals. It does not capture, however, the capacity of hospitals to furnish same-day emergency or elective interventions. Furthermore, this section focuses solely on hospital beds allocated for acute care, not taking into accounts beds in psychiatric care or long-term care units.

Hospital discharge rates are a measure of the number of people who need to stay overnight in a hospital each year. Together with the average length of stay, they are important measures of hospital activities. However, overall discharge rates do not take into account differences in case-mix (the mix of the conditions leading to hospitalisation).

The average length of stay in hospitals (ALOS) is often treated as an indicator of efficiency. All other things being equal, a shorter stay will reduce the cost per discharge and shift care from inpatient to less expensive post-acute settings. However, shorter stays tend to be more service intensive and more costly per day. Too short a length of stay could also cause adverse effect on health outcomes, or reduce the comfort and recovery of the patient. If this leads to a rising readmission rate, costs per episode of illness may fall little, or even rise.

Heart diseases are a leading cause of hospitalisation and death in OECD countries (see Indicator 1.4). Coronary artery bypass graft and angioplasty are two revascularisation procedures that have revolutionised the treatment of ischemic heart diseases in recent decades.

End-stage renal failure (ESRF) is a condition in which the kidneys are permanently impaired and can no longer function normally. Some of the main risk factors for end-stage renal failure include diabetes and hypertension, two conditions which are generally becoming more prevalent in OECD countries. In the United States, diabetes and hypertension alone accounted for over 60% of the primary diagnoses for all ESRF patients (37% for diabetes and 24% for hypertension) (USRDS, 2008). When patients reach endstage renal failure, they require treatment either in the form of dialysis or through kidney transplants. Treatment in the form of dialysis tends to be more costly and results in a poorer quality of life for patients than a successful kidney transplant, because of the recurrent nature of dialysis.

Rates of caesarean delivery (as a percentage of all live births) have increased in all OECD countries in recent decades. Reasons for the increase include reductions in the risk of caesarean delivery, malpractice liability concerns, scheduling convenience for both physicians and patients, and changes in the physician-patient relationship, among others. Nonetheless, caesarean delivery continues to result in increased maternal mortality, maternal and infant morbidity, and increased complications for subsequent deliveries (Minkoff and Chervenak, 2003; Bewley and Cockburn, 2002; Villar et al., 2006). These concerns, combined with the greater financial cost, raise the question of whether the costs of caesarean delivery may exceed the benefits.

In the past 20 years, the number of surgical procedures carried out on a day care basis has steadily grown in OECD countries. Advances in medical technologies, particularly the diffusion of less invasive surgical interventions, and better anaesthetics have made this development possible. These innovations have improved effectiveness and patient safety. They also help to reduce the unit cost of interventions by shortening the length of stay. However, the overall impact on cost depends on the extent to which any greater use of these procedures may be offset by a reduction in unit cost, taking into account the cost of post-acute care and community health services.

The consumption of pharmaceuticals is increasing across OECD countries not only in terms of expenditure (see Indicator 7.4 “Pharmaceutical expenditure”), but also in terms of volume (or quantity) of drugs consumed. One of the factors contributing to the rise in pharmaceutical consumption is the ageing of the population, which leads to growing demand for drugs to treat or at least control different ageing-related diseases. But the trend rise in pharmaceutical consumption is also observed in countries where the population ageing process is less advanced, indicating that other factors such as physicians’ prescription habits or the degree of cost-sharing with patients also play a role.