The 2023 edition of the OECD’s ‘Health at a Glance’ estimates that healthcare spending in OECD countries corresponded to 9.2 per cent of GDP in 2022, down from 9.7 per cent in the previous year. While the total exceeds the levels seen in 2019, in 11 OECD countries, health spending as a share of GDP in 2022 was lower than in 2019.

Average per capita health spending in OECD countries reached nearly US$5000 in 2022. The United States spent the most on healthcare with US$12,555 per capita spending, followed by Switzerland with US$8049 and Germany with US$8011, adjusting for differences in purchasing power. Per capita health spending is estimated to have been lowest in Mexico, Colombia and Costa Rica, at US$1181, US$1640, and US$1658 spending, respectively.

“Amid the increasing demand for services as a result of the combined effect of population ageing and unhealthy lifestyles, health systems need to facilitate better and timelier access to affordable healthcare, while addressing the lingering after-effects of Covid-19 on mental and physical health,” said OECD secretary-general Mathias Cormann.

Reflecting further on the report’s assessment and where focus by policymakers should be directed, Cormann said: “Accelerating the digital transformation of our healthcare systems and the adoption of digital health technologies can further transform health systems, improving their effectiveness. Timely and affordable access to high-quality healthcare is an economic as well as a social imperative, as it enables people to participate fully in our societies, boosting labour force participation and worker productivity.”

The latest edition of ‘Health at a Glance 2023’ includes a special focus on digital health and its potential to transform health systems. The Covid-19 pandemic response accelerated digital transformation in OECD countries, but many commentators would argue that there is still much capacity to improve in this field. In line with the OECD recommendation on data governance, ‘Health at a Glance 2023’ provides a policy checklist to deliver stronger digital health systems.

Pandemic problems persist

Core population health indicators show that societies have not yet fully recovered from the pandemic, as many people still struggle both mentally and physically. Life expectancy fell by 0.7 years on average across OECD countries between 2019 and 2021. While provisional data for 2022 point to a recovery in some countries, life expectancy remains below pre-pandemic levels in 28 countries.

The health and social care workforce continues to grow, but concerns about shortages are becoming more acute, especially as population ageing is increasing demand for health services and long-term care workers. At the same time, worsening working conditions have undermined the healthcare professions as appealing career paths. Across the OECD countries, 57 per cent of hospital physicians and nurses perceive staffing levels and work pace to be unsafe. Recent high inflation has eroded wages broadly, including in the health sector. Looking at longer-term trends, while real wages in the health sector have increased in most OECD countries, Finland, Italy, Portugal, Spain and the UK have experienced stagnant or declining real wages over the past decade.

Heart attack, strokes and other circulatory diseases caused more than one in four deaths in 2021, while Covid-19 caused 7 per cent of all deaths. Almost one-third of all deaths could have been avoided through more effective and timely prevention and healthcare interventions, the report concludes.

Access to care

And despite universal health coverage existing in most OECD countries, barriers to access to care persist, with gaps in financial protection making healthcare difficult to afford for low-income households. Out-of-pocket payments make up just under a fifth of health spending across the OECD. Individuals in the lowest income quintile are, on average, three times more likely to delay or not seek care than individuals in the highest income quintile.

Waiting times for non-emergency surgery, a longstanding issue in many countries, were exacerbated by the Covid-19 pandemic. In the case of hip and knee replacements, two common elective surgeries, waiting times have fallen since the peak of the pandemic, but in most countries, they remain higher than pre-Covid levels.

Quality of care has improved in regard to safety and effectiveness, with greater attention to making healthcare more people-centred, the report finds. Safe prescribing in primary care has advanced in most countries, it adds, with reductions in the average volume of antibiotics, opioids and long-term prescriptions of anticoagulants.