INTERNATIONAL BENCHMARKING OF THE DANISH HOSPITAL SECTOR A SUMMARY

Transcription

1 1 INTERNATIONAL BENCHMARKING OF THE DANISH HOSPITAL SECTOR A SUMMARY Februar 2010

2 2 International bencharing of the Danish hospital sector a suar Februar 2010 Enquir about the publication can be ade to: Ministr of Health and Prevention Slotsholsgade Copenhagen K Denar Tlf.: Fax: E-post: su@su.d EAN-nr.: ISBN electronic publication: The publication can be found on

3 2 This international bencharing stud copares the Danish hospital sector with that of other countries in the following four fields: Health sstes and health status Expenditure, personnel, capacit and activit The patient and the hospital service Use of resources and qualit of care The bencharing indicators relate priaril to resources, process, services and effects, cf. Figure 1.1. For the coparison, seven European countries have been selected: Sweden, Norwa, Finland, the UK, Geran, the and. In addition, an average is presented where possible. The countries have been selected priaril on the basis of the fact that the are countries with which Denar naturall copares itself due to geographical closeness and coparable living standards. Siilarl, consideration has been given to the fact that the countries hospital sectors are to soe extent coparable and generall considered to hold high international standards. Knowledge of how the Danish hospital sector perfors copared with other countries a give an indication of where there ight be soething to learn fro other countries. Consequentl, the international bencharing stud contributes to aing the perforance of the hospital sector visible for the benefit of the patients. This eans that the bencharing process rests on the sae idea that lies behind the view that the anageent of the Danish regions and hospitals should in future be based to a greater extent on perforance targets that can support an efficient use of resources, cf. Sundhedspae 2009 (Health Pacage 2009). Two out of the three fields which the Danish Governent has proposed as future goals for efficient patient pathwas are also included as indicators in this international bencharing. The are the use of out-patient treatent and the average length of sta in hospitals. Figure 1.1. Model for the bencharing of the Danish hospital sector Resources (input) Process Services (output) Effects (outcoe) Results of the bencharing stud Generall, the bencharing stud shows that the Danish hospital sector perfors well in ost areas copared with the seven countries in the publication and with the average of the countries. With respect to Denar, it should be underlined that access to health care is good with relativel short waiting ties, and that Denar has the lowest proportion of citizens who experience unet needs for edical exaination aong the countries benchared, cf. Box 1.1. In the area of heart disease treatent the qualit is high, whereas Denar perfors less well in the area of cancer treatent. This should, however, be seen in connection with the fact that data for cancer are fro 2007 when the integrated cancer patient pathwas had not et been ipleented, and the extraordinar investents in scanners had not et been ade.

4 3 Box 1.1. Overall results Danes have shorter life expectanc than citizens in the other seven countries in the coparison and the average of the countries. This is due aong other things to lifestle factors (for exaple high consuption of tobacco and alcohol). Life expectanc in Denar was 78.4 ears in 2007 copared with 79.1 ears in the countries on average. In Denar, hospital expenditure accounts for 4.3 per of GDP, whereas the average for the countries is 3.1 per. Hospital expenditure in the seven other countries in the coparison accounts for between 2.8 and 4.1 per of GDP. After Norwa, Denar has the highest nuber of full-tie eploees at public hospitals per 1,000 population. Denar perfors relativel ore surgical procedures on in-patients than the other countries in the coparison and the average of the countries. In Denar, the hospital sector perfors 76 surgical procedures on in-patients per 1,000 population. B coparison, the average in the countries is 71 per 1,000 population. Danish patients sta in hospital for a shorter tie than patients in the other countries. In Denar, the average length of sta for acute care inpatients is 3.5 das, whereas the average for the countries is 6.6 das. In 2007, Denar had the lowest ortalit rate after adission to hospital with acute ocardial infarction and ischeic stroe aong the countries in the coparison. The ortalit rate aong Danish patients was 2.9 per one onth after adission to hospital copared with 4.9 per for the countries on average. In 2007, Danish patients had a higher ortalit rate after heorrhagic stroe than patients in the three other Nordic countries in the coparison and Geran. However, the ortalit rate in Denar was at the sae tie lower than the average. In , Denar raned below the average with respect to the five-ear survival rate for colorectal cancer and cervical cancer, but raned just above the average with respect to the five-ear survival rate for breast cancer. Danish patients have well-developed rights in relation to the other countries in the coparison. Out of the eight countries in the coparison, it is onl Denar that has a generall extended free choice of hospital after one onth s waiting tie. Siilarl, aong the eight countries, Denar has the lowest level of unet needs for edical exaination. In the following, a suar of the ain results of the bencharing stud is presented. Health sstes and health status Even though the countries in the bencharing stud have been selected with coparabilit in ind, there are differences. The differences exist both in the countries organisation of the health care sector and in the populations health status. It is iportant to describe these structural conditions as the constitute the fraewor for the hospital sector activities and are connected to several of the selected indicators and the countries position in the individual areas. The countries different division of health care tass between the hospital sector, practising general practitioners and practising specialists and the local governent health sector respectivel a, aong other things, influence the countries volue of hospital expenditure and hospital staff figures. Two odels for health sstes The eight countries have organised their health sstes differentl. Overall, however, the a be categorized into two ain odels. The Nordic and British odel is characterised b tax-based financing and large-scale public production of hospital services. The other odel, which coprises Geran, the and, is characterised b insurance-based

5 4 financing and a cobination of public and private health services production. Denar has the highest proportion of public financing of health services aong the countries and is placed in the iddle with regard to the proportion of the population with suppleentar private health insurance. The population s health status The population s general health status is of great iportance with respect to the consuption of health services, including hospital services. Various targets for the population s health status such as life expectanc and ortalit are also influenced to a high degree b the citizens lifestle, etc. Therefore, these targets cannot be seen as a reflection of how well the hospital sector wors in the individual countries. The Danish population lives shorter lives on average than the populations in the selected countries, cf. Figure 1.2. Figure 1.2. Life expectanc at birth, nuber of ears. Years Note: : Sweden, Norwa, the, Denar, Finland and Geran: The UK: Lifestle, aong other things, is of great iportance in ters of what diseases citizens contract and, consequentl, in ters of life expectanc. For exaple, ost of the difference in life expectanc between Denar and Sweden can be explained as a result of the populations soing habits and alcohol consuption. Box 1.2. How to explain differences in life expectanc? Life expectanc in Sweden is now alost three ears longer than in Denar. A ver substantial part of the Danish excess ortalit and low life expectanc copared to Sweden can be attributed to high ortalit related to alcohol and tobacco consuption. Overall, alcohol and soing account for alost the entire difference between Danish and Swedish en and for 75 per of the difference between Danish and Swedish woen. Source: Knud Juel: Life expectanc and ortalit in Denar copared to Sweden in Ugesrift for læger, 2008;170(33):2423 The Bencharing stud shows that there is a high proportion of soers in Denar, and that alcohol consuption is correspondingl higher than in ost of the other countries benchared. With regard to the proportion of the population suffering fro obesit, Denar belongs to the iddle group of the selected countries and falls soewhat below the average. Expenditure, personnel, capacit and activit Denar is generall raned high when the benchared countries are copared on expenditure, personnel, capacit and activit. Expenditure Denar is placed in the iddle of the countries included in the coparison with regard to the proportion of GDP accounted for b total health expenditure 1. Denar s health expenditure totals 9.8 per of GDP in 2007, which eans that Denar rans above the 8.9 per of GDP which is the average for the countries, cf. Figure The definition of health expenditure includes expenditure on soe healthcare areas which in Denar is borne b the social sector.

6 5 Figure 1.3. Total expenditure on health as perage of gross doestic product, perage, Perage Note: Data include expenditure paid b public authorities, private insurance schees and private out-of-pocet paents, including expenditure on investents in the health area. Hospital expenditure in Denar accounts for 4.3 per of GDP, whereas the average for the countries is 3.1 per, cf. Figure 1.4. Figure 1.4. Expenditures on hospitals services as perage of gross doestic product, perage, Perage With respect to investents in equipent and construction/building in the health area, Denar s position is in the iddle. Personnel Reuneration costs account for a ver large proportion of total hospital expenditure. The reason is that the health sector, including the hospital sector, is a sector with ver direct patient contact and it is, therefore, a labour intensive area. In Denar, there are approx full-tie eploees at public hospitals per 1,000 population, cf. Figure 1.5. Aong the selected countries, onl Norwa has ore full-tie eploees per 1,000 population. The indicator includes all hospital eploees i.e. not onl health professional personnel. Figure 1.5. Full-tie eploed persons in hospitals. Nuber per 1,000 population, Nuber of eploed per 1,000 population Note: Data refer to expenditure on public and private hospitals. Investents are not included. Data for Norwa are fro However, it is not a goal in itself to use an resources. The overarching goal should be that the resources are used efficientl so as to generate axiu outcoe. and the Danish National Board of Health/the National Wage Statistics Office of Danish local Authorities (Danish data). Note: There a be differences in the various countries calculations of full-tie eploees. Data refer to the nuber of full-tie eploed persons eploed in general and specialit hospitals. Data cannot be broen down b personnel groups. Data for Denar refer exclusivel to public hospitals. Finland, the : There are not sufficient data to draw up an average. Denar educates ore doctors than the other countries and rans in the iddle with respect to newl graduated nurses/social and healthcare assistants. Ever ear, Denar educates 16 doctors per 1,000 population, whereas the

7 6 average is ten edical graduates per 1,000 population. Capacit Denar belongs to the iddle of the field of the countries with respect to both acute care beds and pschiatric beds. Knowledge of the nuber of hospital beds is subject to a liitation in the sense that it onl gives an idea of the capacit to treat in-patients. In line with the ongoing change fro in-patient to out-patient treatent, the nuber of beds has becoe an increasingl incoplete reflection of hospital sector capacit. With respect to scanners, Denar has generall ore CT, MR and PET scanners per illion population than the other countries in the coparison. Activit For in-patients, Denar rans high with regard to the nuber of surgical procedures and the use of bed capacit. In Denar, the hospital sector perfors 76 surgical procedures on in-patients per 1,000 population. B coparison, the average is 71 surgical procedures per 1,000 population, cf. Figure 1.6. Figure 1.6. Nuber of surgical procedures, inpatients, per 1,000 population, Nuber per 1,000 population The Danish health service perfors approx. 75 surgical procedures on out-patients per 1,000 population. The other four countries have between 21 and 86 surgical procedures per 1,000 population. Denar is in the iddle of the countries benchared regarding the nuber of discharges. In Denar, the hospital sector discharged approx. 170 patients per 1,000 population in 2007, whereas the average was 158 patients per 1,000 population. Use of resources and qualit of care Coparing the selected countries on indicators for use of resources, Denar rans high. With regard to qualit of treatent, the picture varies depending on the individual disease areas. Use of resources The Danish hospital sector produces a few ore surgical procedures per full-tie hospital eploee than the other four countries where data exist. In Denar, the hospital sector perfors 8.6 surgical procedures annuall per full-tie eploee. In ters of the nuber of discharges per full-tie hospital eploee, Denar is in the iddle group of the countries included in the bencharing stud. Danish patients sta in hospital for a shorter tie than in the other countries. In Denar, the average length of sta for acute care is 3.5 das, whereas the average is 6.6 das, cf. Figure Note: In Danish data, surgical procedures perfored in casualt departents are excluded.

8 7 Figure 1.7. Average length of sta, acute care, nuber of das, Das Figure 1.8. Nuber of surgical procedures, da cases as perage of total perfored surgical procedures, perage, Perage 0. Note: Data refer to acute care patients, patients aditted to hospital with a view to curative care. In Denar, acute care beds accounted for 82.7 per of all beds in Data for Denar: In Denar, about half the surgical procedures are perfored on out-patients, cf. Figure 1.7. This should be seen in connection with the good experience of accelerated patient treatent processes where the patient treatent processes are organised so that the need for adission to hospital is reduced. As is the case in Denar, several other countries are restructuring in the direction of increased out-patient treatent, both for the sae of the patient and to achieve ore efficient use of resources. The other countries proportion of out-patient treatent covers a range of between approx. 24 and 54 per. Source: (2009): Health at a Glance Note: No average has been drawn up as data are not available for a sufficient nuber of countries. Qualit of care Qualit of care is copared in the two disease areas where ost deaths occur in the industrialised countries, i.e. cardiovascular and cancer diseases. Denar has the lowest 30-da ortalit rate after adission to hospital both with acute ocardial infarction and ischeic stroe. In Denar, a total of 2.9 per of patients die within the first 30 das after adission to hospital with acute ocardial infarction, whereas the average is 4.9 per, cf. Figure 1.9.

9 8 Figure 1.9. In-hospital case-fatalit rates within 30 das after adission for acute ocardial infarction (AMI), rates per 100 patients, Perage bencharing stud with a ortalit rate after 30 das of just under 17 per, whereas the average is approx. 20 per. In the area of cancer, the relative five-ear survival rate for colorectal cancer as well as cervical cancer is low in Denar. For exaple, a total of 54 per of patients suffering fro colorectal cancer were still alive in 2007, five ears after the disease had been diagnosed, cf. Figure The average was 57 per. Source: (2009): Health at a Glance Note: Age-sex standardised rates per population. The rates are inhospital case-fatalit rates i.e. the rates include onl deaths at the hospital where adission too place. Data for the are fro With respect to ischeic stroe, a total of 3 per of patients die within the first 30 das after adission to hospital with ischeic stroe in Denar. The average is 5 per, cf. Figure Figure Five-ear survival rate for colorectal cancer, perage, Perage Figure In-hospital case-fatalit rates within 30 das after adission for ischeic stroe, rates per 100 patients, Perage Source: (2009): Health at a Glance Note: Age standardised rates. Finland ( ). Sweden ( ). Norwa ( ). The UK ( ). The ( ). There are no data for for. There are no national data for Geran. With regard to cervical cancer, a total of 61 per of Danish patients were still alive in 2007, five ears after the disease had been diagnosed, cf. Figure The average was just below 66 per. Source: (2009): Health at a Glance Note: Age-sex standardised rates. The rates are in-hospital casefatalit rates i.e. the rates include onl deaths at the hospital where adission too place. Data for the are fro With regard to the 30-da ortalit rate after hospital adission with heorrhagic stroe, Denar is in the iddle group of countries in the

10 9 Figure Five-ear survival rate for cervical cancer, perage, Perage replaceent operations, waiting ties in Denar are aong the lowest. The waiting tie for breast cancer and bpass operations is shorter than one onth in Denar. In Denar, patient experience of qualit is high copared with the other countries, especiall with regard to out-patients. The patient and the hospital service The bencharing stud shows that Danish patients have well-developed rights in relation to the other countries in the coparison. Source: (2009): Health at a Glance Note: Age standardised rates. Data for are fro There are no national data for Geran. For breast cancer, the five-ear survival rate in Denar belongs to the iddle group of countries benchared, and it is just above the average. In Denar, a total of 82 per of patients suffering fro breast cancer were still alive in The average was approx. 81 per. Data for cancer relate to patients who were diagnosed in 2002, and the relative survival rate is calculated for If this is copared with the 5- ear survival rate for patients diagnosed in 1997, there has been a positive developent with respect to colorectal cancer and breast cancer. All data for cancer survival refer to the tie before the introduction of integrated cancer patient pathwas in Denar. Therefore, the effects of the patient pathwas have not et becoe visible in the coparison. Waiting tie and patient experience of qualit The coparison 2 shows that waiting tie in the Danish hospital sector is low copared with the other countries. With respect to the three selected surgical procedures: breast cancer, bpass and hip 2 The waiting tie inforation derives fro the questionnaire that has been copleted b the health inistries of the benchared countries as there are no re international data. Patients access to health services In Denar, erel 0.2 per of citizens experience unet needs for edical exaination. This is the lowest proportion aong the countries benchared. Furtherore, the coparison shows that all the countries, with the exception of Denar and the UK, have out-of-pocet paent schees for hospital treatent. Out-ofpocet paent is charged in the order of DKK for a hospital visit. Patients rights Patients in Denar have a free choice of hospital (i.e. of public hospitals) without being charged an out-of-pocet paent. In four of the other countries there is also a free choice, in two of the countries a free choice of hospital a ipl outof-pocet paent for the patient, and in one countr there is no free choice of hospital. In Denar, patients have an extended free choice of hospital when the waiting tie in the person s region of residence exceeds one onth. This is the shortest liit aong the countries benchared. The non-nordic countries that have been benchared have no siilar schees. Inforation to patients Danish patients have online access to inforation about hospital qualit and waiting tie on the websites and The inforation is addressed

11 10 to citizens and helps the to exercise their right to free choice of hospital. In Denar, qualit inforation can be used to copare hospitals on a nuber of paraeters. The sae applies to three of the other countries, whereas four of the countries benchared publish either liited or no qualit data targeted at the citizens. It eans that Denar rans high aong the countries included in the bencharing stud. Denar is placed in the iddle group with regard to patient rights assistance before/during treatent, as patients can obtain guidance fro patient offices at regional level.

12 11 All indicators in International Bencharing of the Danish Hospital Sector ( Health Sste 1. Public expenditure on health care as perage of total expenditures on health 2. Perage of the total population with additional private insurance besides the fundaental/basic health care coverage Health Status 3. Life expectanc at birth and change in life expectanc at birth fro 2001 to latest ear 4. Dail soers, perage of population 5. Alcohol consuption in liters per capita (age 15+) 6. Overweight or obese population (BMI>=30), perage of population. 7. Mortalit rates for ischeic hearth disease, nuber of deaths per 100,000 population 8. Danish data for ortalit rates for ischeic hearth disease, nuber of deaths per 100,000 population 9. Mortalit rates for acute ocardial infarction, nuber of deaths per 100,000 population 10. Danish data for ortalit rates for acute ocardial infarction, nuber of deaths per 100,000 population 11. Mortalit rates for alignant neoplass, nuber of deaths per 100,000 population 12. Danish data for ortalit rates for alignant neoplass, nuber of deaths per 100,000 population Expenditure 13. Total expenditure on health as perage of GDP 14. Total expenditure on health as perage of GDP 15. Total expenditure on health per capita, DKK, PPP 16. Reuneration of specialists, DKK exchange rate 17. Reuneration of hospital nurses, DKK exchange rate 18. Expenditure on hospitals services, DKK, PPP 19. Expenditure on hospitals services as perage of GDP 20. Expenditure on hospitals services as perage of total expenditures on health 21. Total investent on edical facilities per capita, DKK, PPP Personnel 22. Nuber of full-tie eploed (FTE) persons eploed in hospitals per 1,000 population 23. Registered phsicians, nuber per 1,000 population 24. Practicing specialist eploed in the health care sector (excluding general practitioners), nuber per 1,000 population 25. Practicing general practitioners eploed in the health care sector, nuber per 1,000 population 26. Practicing professional nurses eploed in the health care sector, nuber per 1,000 population 27. Medical graduates, nubers per 100,000 population 28. Doctors graduated in Denar and eigration as perage of all graduated 29. Doctors graduated in Denar with Nordic citizenship (not Danish) and eigration as perage of these 30. Nursing graduates, nubers per. 100,000 population

13 Foreign-trained phsicians as perage of registered phsicians Capacit 32. Nuber of acute-care beds in hospitals, per 1,000 population 33. Nuber of pschiatric care beds in hospitals, per 1,000 population 34. Nuber of Coputed Toograph scanners, per one illion population 35. Nuber of Magnetic Resonance Iaging units, per one illion population 36. Nuber of Positron Eission Toograph scanners, per one illion population Activit 37. Total surgical in-patients, per 1,000 population 38. Nuber of discharges, in-patients, per 1,000 population 39. Acute care occupanc rate, perage 40. Nuber of total surgical da-cases, per 1,000 population Use of ressources 41. Yearl increase in productivit at Danish Hospitals, perage 42. Nuber of surgical procedures per full-tie eploed in hospitals 43. Nuber of discharges per full-tie eploed in hospitals 44. Average length of sta b in-patients and acute care, das 45. Surgical da cases in perage of total surgical procedures, perage Qualit of care 46. In-hospital case-fatalit rates within 30 das after adission for acute ocardial infarction (AMI), perage 47. In-hospital case-fatalit rates within 30 das after adission for ischeic stroe, perage 48. In-hospital case-fatalit rates within 30 das after adission for heorrhagic stroe, perage 49. Colorectal cancer, five-ear relative survival rate, , perage 50. Breast cancer five-ear relative survival rate, , perage 51. Cervical cancer five-ear relative survival rate, , perage 52. Average waiting tie for elective treatent of coronar b-pass, onths 53. Average waiting tie for elective treatent of breast cancer, onths 54. Average waiting tie for elective treatent of hip replaceent, onths 55. Proportion of out-patients who are satisfied with hospital care, perage 56. Proportion of in-patients who are satisfied with hospital care, perage The patient and the hospital service 57. Proportion of population with unet needs for edical exaination, perage 58. Out-of-pocet-paent on hospital care 59. Is national healthcare legislation explicitl expressed in ters of patients' right? 60. Patients right fro their fundaental/basic health care coverage to choose which hospital to use within the countr 61. Do patients have entitleents, if waiting tie exceeds the defined axiu waiting tie? 62. Patients are entitled to have a specific contact person during hospital treatent lasting ore than one da 63. Patients can get econoic indenit for edical istaes and alpractice without the assistance of the judicial sste, e.g. at a public patient insurance sste 64. Access on internet to hospital qualit raning issued nationall aied at non health professionals 65. Access on internet to coparable hospital and treatent specific national issued inforation on waiting ties 66. Assistance fro the public health authorities/the health insurer before or during their hospital treatent on deriving their various patients rights

14 13 4. Dail soers, perage of population Denar Sweden Norwa Finland United Geran 1. Public expenditure on health care as perage of total expenditures on health Denar Sweden Norwa Finland United Geran Latest ear , per and Health at a Glance 2009 (for ). Note: Data for latest ear: Norwa: 2008, rest of the countries: Data for the onl include current health expenditure. 2. Perage of the total population with additional private insurance besides the fundaental/basic health care coverage Denar Sweden Norwa Finland United Geran Perage Approx with an 20(1) additional private insurance Source: Questionnaires to health inistries in the countries, Note: (1) In Denar in 2008 have additional private insurances and the average price per insured is around 1100 DKK. (2) The copulsor insurance in, and Geran is accounted as public financing because it is a copulsor insurance. 3. Life expectanc at birth and change in life expectanc at birth fro 2001 to latest ear Denar Sweden Norwa Finland United Geran ,6 Latest ear , , 5 per ,9. Note Data for latest ear: : Sweden,, Denar, Norwa, Finland, Geran: 2007, United : average 2007: Data for Ital is not available ,7 Latest ear ,3, per , (1) Note: Data for latest ear: Norwa: 2008., United, Finland: 2007., Denar, Sweden:

15 Geran: (1) Data for Geran is not fro 2001 but fro average 1980: No average has been drawn up as data are not available for a sufficient nuber of countries. 5. Alcohol consuption in liters per capita (age 15+) Denar Sweden Norwa Finland United Geran ,7 Latest ear , ,1 per ,8 Note: Data for latest ear: and : Rest of the countries: Overweight or obese population (BMI>=30), perage of population Denar Sweden Norwa Finland United Geran ,1 Latest ear , ,1 per ,0 Note: Data for latest ear:, United, Sweden, Finland: : Norwa, Denar, Geran: average 2007: Data for Australia is not available. average 2001: Data for Australia, Austria, Greece, Mexico, Slova Republic, Portugal, and Poland are not available. 7. Mortalit rates for ischeic hearth disease, nuber of deaths per 100,000 population Denar Sweden Norwa Finland United Geran ,2 Latest ear , ,2 per ,8 Note: Data for latest ear:, United, Finland: 2007:, Denar, Norwa, Geran, Sweden: average 2007: Data for Belgiu and Ture are not available. average 2001: Data for Belgiu and Ture is not available. 8. Danish data for ortalit rates for ischeic hearth disease, nuber of deaths per 100,000 population Year Mortalit rates Mortalit rates for acute ocardial infarction, nuber of deaths per 100,000 population Denar Sweden Norwa Finland United Geran Nether-

16 15 lands ,0 Latest ear , ,0 per ,6 Note: Data latest ear:, United and Finland: 2007., Denar, Norwa, Geran and Sweden: average 2007: Data for Belgiu, Switzerland and Ture are not available. average 2001: Data for Belgiu, Switzerland and Ture are not available. 10. Danish data for ortalit rates for acute ocardial infarction, nuber of deaths per 100,000 population Year Mortalit rates Latest ear , ,0 per ,4 Note: Data for latest ear:, United, Finland: 2007., Denar, Norwa, Geran, Sweden: average 2007: Data for Belgiu, Ture are not available. average 2001: Data for Belgiu, Ture are not available. 12. Danish data for ortalit rates for alignant neoplass, nuber of deaths per 100,000 population Year Mortalit rates Total expenditure on health as perage of GDP Denar Sweden Norwa Finland United Geran 11. Mortalit rates for alignant neoplass, nuber of deaths per 100,000 population Denar Sweden Norwa Finland United Geran , ,1 Latest ear , ,8, pct 14. Total expenditure on health as perage of GDP Denar Sweden Norwa Finland United Geran Netherla

17 16 nds 1970 (1) , , , , , , ,9 Note: (1) 1970: Denar 1971, No 1970 average has been drawn up as data are not available for a sufficient nuber of countries. average 1995: Data for Slova Republic are not available. average 1990: Data for Hungar, Slova Republic are not available. average 1985: Data for Czech Republic, Greece, Hungar, Ital, Mexico, Poland, and Slova Republic are not available. average 1980: Data for Czech Republic, Hungar, Ital, Mexico, Poland, Slova Republic are not available. average 1975: Data for Czech Republic, Greece, Hungar, Ital, Mexico, Poland, and Slova Republic are not available. 15. Total expenditure on health per capita, DKK, PPP Denar Sweden Norwa Finland United Geran Latest ear per ,5 16. Reuneration of specialists, DKK exchange rate. Denar Sweden Norwa Finland United Geran Latest ear, DKK Latest ear US$ 2001 US$ Latest ear in proportion to average earnings of production worer in proportion to average earnings of production worer. Note: (1) Data for latest ear DKK: Geran, : Denar: 2005, Rest of the countries: 2007 Data 2001: : United : No average has been drawn up as data are not available for a sufficient nuber of countries.

18 17 Data for latest ear for average earnings production worer: Geran, : Denar: 2005, Rest of the countries: Data for 2001 for average earnings production worer: United : Expenditure on hospitals services, DKK, PPP Denar Sweden Norwa Finland United Geran Latest ear per ,9 Note: Data for latest ear: Norwa: Rest of the countries: average 2007: Data for Greece, Iceland, Ital, and United are not available. average 2001: Data for Austria, Belgiu, Greece, Iceland, Ireland, Ital, New Zealand, Poland og United are not available. 19. Expenditure on hospitals services as perage of GDP Denar Sweden Norwa Finland United Geran 17. Reuneration of hospital nurses, DKK exchange rate Denar Sweden Norwa Finland United Geran Latest ear, DKK Latest ear US$ 2001 US$ Latest ear in proportion to average earnings of production worer in proportion to average earnings of production worer. Note: Data for latest ear: DKK: Geran: Denar: Rest of the countries: 2007 Latest ear US$: Geran: Denar: 2005 Rest of the countries: 2007 Data 2001 US$: United : 2000 Data for latest ear for average earnings production worer: Geran: Denar: Rest of the countries: Data 2001 for average earnings production worer: United : 2000 No average has been drawn up as data are not available for a sufficient nuber of countries ,0 Latest ear ,1, per ,1

19 18 Note: Data for latest ear: Norwa: Rest of the countries: 2007 average 2007: Data for United, Luxebourg, Ital, Ireland, Greece are not available, average 2001: Data for United, Luxebourg, Ital, Ireland, Greece are not available, 21. Total investent on edical facilities per capita, DKK, PPP Denar Sweden Norwa Finland United Geran Latest ear per ,9 average 2001: Data for Switzerland og New Zealand are not available. 23. Registered phsicians, nuber per 1,000 population Denar Sweden Norwa Finland United Geran 20. Expenditure on hospitals services as perage of total expenditures on health Denar Sweden Norwa Finland United Geran ,9 Latest ear ,3, per ,6 Note: Data for latest ear: Norwa: Rest of the countries: 2007 average 2007: Data for United, Luxebourg, Ital, Ireland and Greece are not available, average 2001: Data for United, Poland, New Zealand, Iceland, Luxebourg, Ital, Ireland, Greece, Belgiu and Austria are not available, 22. Nuber of full-tie eploed (FTE) persons eploed in hospitals per 1,000 population Denar Sweden Norwa Finland United Geran Latest ear per and the Danish National Board of Health (Denar). Note: Data for Denar onl include public hospitals. Data for latest ear: Finland, : : : Rest of the countries: 2007 No average has been drawn up as data are not available for a sufficient nuber of countries ,6 Latest ear , ,4 per ,5

20 19 Note: Data for latest ear: Denar, Sweden, Finland: Rest of the countries: 2007 average 2007: Data for Czech republic, Greece, Japan, Norwa, Switzerland, Ture and United are not available. average 2001: Data for Czech republic, Greece, Japan, Norwa, Switzerland, Ture, United and Poland are not available. 24. Practicing specialist eploed in the health care sector (excluding general practitioners), nuber per 1,000 population Denar Sweden Norwa Finland United Geran ,7 Latest ear , ,1 per ,9 Note: Data for latest ear: Denar, Sweden and Finland: Estiate for. Rest of the countries: 2007 average.2007: Data for Ital, Japan and Slova Republic are not available. average 2001: Data for Iceland, Ireland, Ital, Japan and Korea are not available. 25. Practicing general practitioners eploed in the health care sector, nuber per 1,000 population Denar Sweden Norwa Finland United Geran ,84 Latest ear , ,04 per ,76 Note: Data for latest ear: Denar, Sweden and Finland: Rest of the countries: average 2007: Data for Japan and Slova Republic are not available. average 2001: Data for Japan, Korea and Spain are not available. 26. Practicing professional nurses eploed in the health care sector, nuber per 1,000 population Denar Sweden Norwa Finland United Geran Latest ear , ,6 per ,4 Note: Danish data includes areas which in Denar are not covered b the health care sector. Data for latest ear: Sweden and Denar: Rest of the countries: Data 2001: : average 2007: Data for Belgiu, Finland, Ireland, Ital, Slova Republic, Switzerland and Ture are not available. No average for 2001 has been drawn up as data are not available for a sufficient nuber of countries. 27. Medical graduates, nubers per 100,000 population Denar Sweden Norwa Finland United Geran

21 ,1 Latest ear , ,8 per ,8 and the Danish National Board of Health (Denar). Note: Data for latest ear: and Sweden: Rest of the countries: 2007 average 2007: Data for Luxebourg and Mexico are not available. average 2001: Data for Luxebourg, Mexico and Poland are not available. 28. Doctors graduated in Denar and eigration as perage of all graduated Year Graduated Eigrated Eigration in 9 per 8 per 8 per 8 per 9 per 11 per per Source: the Danish National Board of Health. 14 per 13 per 29. Doctors graduated in Denar with Nordic citizenship (not Danish) and eigration as perage of these Year Graduated Eigrated Eigration in 50 per 55 per 62 per per Source: the Danish National Board of Health. 59 per 30. Nursing graduates, nubers per 100,000 population Denar Sweden Norwa Finland United 68 per Geran 67 per 69 per 57 per ,9 Latest ear, , ,5 per ,3 Note: For Denar and Geran data onl includes professional nurses. Data for latest ear: Sweden: : United : 2002 Rest of the countries: 2007 average 2007: Data for Mexico is not available. averge 2001: Data for Ital, Mexico, Poland, Ture and United are not available. 31. Foreign-trained phsicians as perage of registered phsicians Denar Sweden Norwa Finland United Geran ,5-5,3 26, ,2 Latest ear 8,8 19,6-11,4 31,4-6,3 3,1-6,1-6,1 4, ,9 per - 45,2-115,1 18, ,9 Note: Data for latest ear: Sweden, Denar,, Finland: Rest of the countries: 2007

22 21 No average has been drawn up as data are not available for a sufficient nuber of countries. 32. Nuber of acute-care beds in hospitals, per 1,000 population Denar Sweden Norwa Finland United Geran ,1 Latest ear , ,3 per ,6 Note: average 2001: Data for Luxebourg, Iceland and New Zealand are not available, average 2007: Data for Iceland and New Zealand are not available. Latest ear , ,1 per ,9 Note: average 2001: Data for Finland, Iceland, Korea, Luxebourg,, New Zealand, Norwa, Poland, Switzerland and Ture are not available. average 2007: Data for Finland, Iceland, New Zealand and Switzerland are not available. 34. Nuber of Coputed Toograph scanners, per one illion population Denar Sweden Norwa Finland United Geran ,8 Latest ear , ,9 per ,3 Note: Data for latest ear:, United : Sweden: Rest of the countries: 2007 average 2007: Data for Norwa and Geran are not available. average 2001: Data for Geran, Greece, Ireland, Ital, Japan,, New Zealand, Portugal, Slova Republic, Sweden and Ture are not available. 35. Nuber of Magnetic Resonance Iaging units, per one illion population Denar Sweden Norwa Finland United Geran 33. Nuber of pschiatric care beds in hospitals, per 1,000 population Denar Sweden Norwa Finland United Geran ,

23 22 Latest ear , per Note: Data for latest ear: Denar: : Sweden: Rest of the countries: 2007 average 2007: data for Norwa and Geran are not available. No average for 2001 has been drawn up as data are not available for a sufficient nuber of countries. 37. Total surgical in-patients, per 1,000 population Denar Sweden Norwa Finland United Geran ,8 Latest ear, , , per ,2 Note: average 2001: Data for Switzerland, Slova Republic, Poland, Norwa, New Zealand, Korea, Japan, Iceland, Hungar and are not available. 38. Nuber of discharges, in-patients, per 1,000 population Denar Sweden Norwa Finland United Geran 36. Nuber of Positron Eission Toograph scanners, per one illion population Denar Sweden Norwa Finland United Geran Latest ear per Note: Data for latest ear: Finland: 2006., United : Rest of the countries: 2007 No average has been drawn up as data are not available for a sufficient nuber of countries ,1 Latest ear, , ,7 per ,7 Note: includes adissions lasting less than 24 hours, resulting in a higher nuber of discharges. Finland, Norwa and Sweden exclude discharges of health babies born at the hospital, which reduces the nuber of discharges. average 2001: Data for Czech Republic, Hungar, Korea, Japan and Poland are not available.

24 Acute care occupanc rate, perage Denar Sweden Norwa Finland United Geran ,4 Latest ear, ,3, per ,1 Note: Data covers both public and private hospitals. Danish data onl covers public hospitals. Data for latest ear: Data for Denar: Data for : Rest of the countries: 2007 average 2007: Data for Finland, Iceland, New Zealand and Sweden are not available.. average 2001: Data for Finland, Iceland, Luxebourg, New Zealand and Sweden are not available. 41. Yearl increase in productivit at Danish Hospitals, perage Year Increase in productivit, per Source: Danish Regions, Ministr of Finance, the National Board of Health, Ministr of Health and Prevention. 40. Nuber of total surgical da-cases, per 1,000 population Denar Sweden Norwa Finland United Geran Latest ear per Note: Data 2001: Geran: No average has been drawn up as data are not available for a sufficient nuber of countries Nuber of surgical procedures per full-tie eploed in hospitals Denar Sweden Norwa Finland United Geran Latest ear per and the Danish National Board of Health (Denar full-tie eploed in public hospitals). Notes: Nuber of surgical procedures includes in-patient and da-cases. Data Latest ear: Finland: Data 2001: Geran: No average has been drawn up as data are not available for a sufficient nuber of countries. 43. Nuber of discharges per full-tie eploed in hospitals Denar Sweden Norwa Finland United Geran Latest ear

25 per and the Danish National Board of Health (Denar full-tie eploed in public hospitals). Data latest ear: Denar (discharges), Finland and : Otherwise: Data 2001: Geran: 2002 No average has been drawn up as data are not available for a sufficient nuber of countries. 44. Average length of sta b in-patients and acute care, das Denar Sweden Norwa Finland United Geran ,8 5,0 5,8 5,0 8,5 9,0 8,6 5,7 7,4 Latest ear 3,5 4,5 5,0 4,6 7,2 7,8 6,3 5,3 6,6-0,3-0,5-0,8-0,4-1,3-1,2-2,3-0,4-0,8 per -7,9-10,0-13,8-8,0-15,3-13,3-26,7-7,0-10,1 Note: Data for Denar onl include public hospitals. Data latest ear: Denar: Otherwise: Surgical da cases in perage of total surgical procedures Denar Sweden Norwa Finland United Geran Latest ear, , per Notes: Data 2001: Geran: 2002 No average has been drawn up as data are not available for a sufficient nuber of countries In-hospital case-fatalit rates within 30 das after adission for acute ocardial infarction (AMI), perage Denar Sweden Norwa Finland United Geran Latest ear, ,9 Source: Health at a Glance Data Latest ear: : Otherwise: In-hospital case-fatalit rates within 30 das after adission for ischeic stroe, perage Denar Sweden Norwa Finland United Geran Latest ear, ,0 Source: Health at a Glance 2009 Note: Data Latest ear: : Otherwise: In-hospital case-fatalit rates within 30 das after adission for heorrhagic stroe, perage

26 25 Denar Sweden Norwa Finland United Latest ear, Source: Health at a Glance 2009 Note: Data Latest ear: : Otherwise: 2007 Geran ,8 49. Colorectal cancer, five-ear relative survival rate, , perage Denar Sweden Norwa Finland United Geran Latest period ,4 Source: Health at a Glance 2009 Note: Latest period: Finland ( ), Sweden ( ), Norwa ( ), United ( ), ( ). There are no data for for. There is no national rate for Geran. 50. Breast cancer five-ear relative survival rate, , perage Denar Sweden Norwa Finland United Geran Latest period, Source: Health at a Glance 2009 Note: There is no national rate for Geran ,2 51. Cervical cancer five-ear relative survival rate, , perage Denar Sweden Norwa Finland United Geran Latest period, Source: Health at a Glance Note: There is no national rate for Geran. 52. Average waiting tie for elective treatent of coronar b-pass, onths Denar Finland England < 1 onth X X 1-3 onths X X 4-6 onths Source: Questionnaires to Health Ministries in the countries, Ma-August 2009 Notes: Onl elective surgeries., March 2008 (thorax operation). Denar, Finland, England, 2007/ Average waiting tie for elective treatent of breast cancer, onths Denar < 1 onth X X 1-3 onths 4-6 onths Source: Questionnaires to Health Ministries in the countries, Ma-August 2009 Note:, Ma Denar: ICD-10 codes: C50.0-C ,7