Measuring Healthcare Value in OECD Countries

Abstract

Background Identifying the most efficient healthcare delivery systems and the characteristics that are associated with them may inform the decisions that governments make regarding the structure and regulation of healthcare. This study sought to estimate the value of healthcare delivery systems for 36 countries of the Organization for Economic Cooperation and Development (OECD) and determine which system features are associated with higher value. Methods Disease condition-specific death and incidence data were paired with total health spending per person from each OECD country from 1995 to 2017. A frontier analysis model was used to evaluate condition-specific mortality-incidence ratios for 141 major diseases, adjusting for per capita spending and covariates including smoking rates, age, educational attainment, and obesity to account for differences in the underlying health risks of each country. Inefficiency estimates for each country, year, and disease condition were extracted from the model and combined to create a single estimate of healthcare delivery system value for each country from 1995 to 2017. Associations between estimated healthcare value and 11 healthcare system characteristics were assessed using linear regression. Results The countries with the highest estimated healthcare delivery system value in 2017 were Italy, Estonia, Australia, Spain, and Slovenia. These countries had the lowest mortality-incidence ratios relative to per capita spending and baseline population health. Lithuania, Hungary, Chile, Poland, and Mexico attained the lowest levels of healthcare delivery system value in 2017. Higher insurance coverage rates, more consultations with physicians, and higher physician, nurse and midwife density are associated with higher value systems.