1、Health at aGlance 2023OECD INDICATORSHealth at a Glance2023OECD INDICATORSThis work is published under the responsibility of the Secretary-General of the OECD.The opinions expressed andarguments employed herein do not necessarily reflect the official views of the Member countries of the OECD.This do

2、cument,as well as any data and map included herein,are without prejudice to the status of or sovereignty overany territory,to the delimitation of international frontiers and boundaries and to the name of any territory,city or area.The statistical data for Israel are supplied by and under the respons

3、ibility of the relevant Israeli authorities.The use ofsuch data by the OECD is without prejudice to the status of the Golan Heights,East Jerusalem and Israeli settlements inthe West Bank under the terms of international law.Please cite this publication as:OECD(2023),Health at a Glance 2023:OECD Indi

4、cators,OECD Publishing,Paris,https:/doi.org/10.1787/7a7afb35-en.ISBN 978-92-64-95793-0(print)ISBN 978-92-64-94896-9(pdf)ISBN 978-92-64-77767-5(HTML)ISBN 978-92-64-44682-3(epub)Health at a GlanceISSN 1995-3992(print)ISSN 1999-1312(online)Photo credits:Cover Medical-R/S;Images-Health status:Thitiporn

5、taingpan/S;Risk factors for health:CandyRetriever/S;Access:Affordability,availability and use of services LightField Studios/S;Quality and outcomes of care:YAKOBCHUK VIACHESLAV/S;Health expenditure:Doubletree Studio/S;Health workforce:wavebreakmedia/S;Pharmaceutical sector:Fahroni/S;Ageing and long-

6、term care:Inside Creative House/S.Corrigenda to OECD publications may be found on line at:www.oecd.org/about/publishing/corrigenda.htm.OECD 2023The use of this work,whether digital or print,is governed by the Terms and Conditions to be found at https:/www.oecd.org/termsandconditions.|3 HEALTH AT A G

7、LANCE 2023 OECD 2023 Foreword Health at a Glance compares key indicators for population health and health system performance across OECD member countries,accession candidates and key partner countries.Analysis draws from the latest comparable official national statistics and other sources.This 2023

8、edition presents the latest comparable data,illustrating differences across countries and over time in terms of health status,risk factors for health,access to and quality of care,and health resources.This edition includes a thematic chapter on digital health,which measures the digital readiness of

9、OECD countries health systems,and outlines what countries need to do to accelerate the digital health transformation.This publication would not have been possible without the contribution of national data correspondents from the countries covered in this report,who provided most of the data and meta

10、data,as well as detailed feedback to a draft of the report.The OECD also recognises the contribution of other international organisations,notably Eurostat and the World Health Organization,for providing data and comments.The opinions expressed and arguments employed herein do not necessarily reflect

11、 the official views of the OECD member countries,the European Union or other international organisations.Health at a Glance 2023 was prepared by the OECD Health Division under the co-ordination of Chris James.Chapter 1 was prepared by Chris James,Pauline Fron and Gabriel Di Paolantonio;Chapter 2 by

12、Eric Sutherland,Rishub Keelara and Yukiko Shu;Chapter 3 by Gabriel Di Paolantonio,Tom Raitzik Zonenschein,Joanna Krajewska and Doron Wijker;Chapter 4 by Marion Devaux,Pauline Fron,Antoine Penpenic and Elina Suzuki;Chapter 5 by Chris James,Galle Balestat,Marie-Clmence Canaud,Pauline Fron,Michael Muel

13、ler,Caroline Penn,Caroline Berchet and Rishub Keelara;Chapter 6 by Rie Fujisawa,Pauline Fron,Joana Krajewska,Kadri-Ann Kallas,Gabriel Di Paolantonio,Nicols Larrain,Ekin Dagistan,Melanie Steentjes,Candan Kendir and David Morgan;Chapter 7 by Caroline Penn,Paul Lukong,Michael Mueller,Luca Lorenzoni and

14、 David Morgan;Chapter 8 by Gaetan Lafortune,Galle Balestat,Marie-Clmence Canaud and Gabriel Di Paolantonio;Chapter 9 by Suzannah Chapman,Lisbeth Waagstein,Rishub Keelara,Paul Lukong,Michael Mueller and Valrie Paris;Chapter 10 by Elina Suzuki,Lisbeth Waagstein,Gabriel Di Paolantonio,Ricarda Milstein,

15、Michael Mueller,Jose Carlos Ortega Regalado and Paola Sillitti.The OECD databases used in this publication are managed by Galle Balestat,Marie-Clmence Canaud,Gabriel Di Paolantonio,Rie Fujisawa,David Morgan and Michael Mueller.This publication also benefited from comments by Francesca Colombo,Mark P

16、earson and Stefano Scarpetta.Editorial assistance was provided by Marie-Clmence Canaud,Lucy Hulett and Lydia Wanstall.|5 HEALTH AT A GLANCE 2023 OECD 2023 Table of contents Foreword 3Readers guide 9Executive summary 131 Indicator overview:Country dashboards and major trends 17Introduction 18 Health

17、status 20 Risk factors for health 22 Access to care 24 Quality of care 26 Health system capacity and resources 28 To what extent does health spending translate into better health outcomes,access and quality of care?30 2 Digital health at a glance 33Introduction 34 Framework for digital health readin

18、ess assessment 36 Indicators of digital health readiness 40 Assessing digital health as a determinant of health 54 Concluding thoughts 56 References 56 Notes 58 3 Health status 61Life expectancy at birth 62 Trends in all-cause mortality 64 Main causes of mortality 66 Avoidable mortality(preventable

19、and treatable)68 Major public health threats 70 Mortality from circulatory diseases 72 Cancer mortality 74 Chronic conditions 76 Maternal and infant mortality 78 Mental health 80 Self-rated health 82 6|HEALTH AT A GLANCE 2023 OECD 2023 4 Risk factors for health 85Smoking 86 Alcohol consumption 88 Il

20、licit drug use 90 Diet and physical activity 92 Overweight and obesity 94 Environment and health 96 5 Access:Affordability,availability and use of services 99Population coverage for healthcare 100 Unmet needs for healthcare 102 Extent of healthcare coverage 104 Financial hardship and out-of-pocket e

21、xpenditure 106 Consultations with doctors 108 Digital health 110 Hospital beds and occupancy 112 Hospital activity 114 Diagnostic technologies 116 Hip and knee replacement 118 Ambulatory surgery 120 Waiting times for elective surgery 122 6 Quality and outcomes of care 125Routine vaccinations 126 Can

22、cer screening 128 Safe prescribing in primary care 130 Avoidable hospital admissions 132 Diabetes care 134 People-centredness of ambulatory care 136 Safe acute care workplace culture and patient experiences 138 Safe acute care surgical complications and obstetric trauma 140 Mortality following acute

23、 myocardial infarction(AMI)142 Mortality following ischaemic stroke 144 Patient-reported outcomes in acute care 146 Care for people with mental health disorders 148 Integrated care 150 7 Health expenditure 153Health expenditure in relation to GDP 154 Health expenditure per capita 156 Prices in the h

24、ealth sector 158 Health expenditure by financing scheme 160 Public funding of health spending 162 Health expenditure by type of service 164 Health expenditure on primary healthcare 166 Health expenditure by provider 168 Capital expenditure in the health sector 170|7 HEALTH AT A GLANCE 2023 OECD 2023

25、 8 Health workforce 173Health and social care workforce 174 Doctors(overall number)176 Doctors(by age,sex and category)178 Geographic distribution of doctors 180 Remuneration of doctors 182 Nurses 184 Remuneration of nurses 186 Hospital workers 188 Medical graduates 190 Nursing graduates 192 Interna

26、tional migration of doctors and nurses 194 9 Pharmaceutical sector 197Pharmaceutical expenditure 198 Pharmacists and pharmacies 200 Pharmaceutical consumption 202 Generics and biosimilars 204 Pharmaceutical research and development 206 10 Ageing and long-term care 209Demographic trends 210 Life expe

27、ctancy and healthy life expectancy at age 65 212 Self-rated health and disability at age 65 and over 214 Dementia 216 Safe long-term care 218 Access to long-term care 220 Informal carers 222 Long-term care workers 224 Long-term care settings 226 Long-term care spending and unit costs 228 End-of-life

28、 care 230 Look for the 12 at the bottom of the tables or graphs inthis book.To download the matching Excelspreadsheet,just typethe link into your Internet browser or click on the link from the digitalversion.This book has.A service that delivers Excelfiles fromthe printed page!Follow OECD Publicatio

29、ns on:https:/ AT A GLANCE 2023 OECD 2023|9 HEALTH AT A GLANCE 2023 OECD 2023 Readers guide Health at a Glance 2023:OECD Indicators compares key indicators for population health and health system performance across the 38 OECD member countries.Accession candidates and key partner countries are also i

30、ncluded for some indicators Argentina,Brazil,Bulgaria,Peoples Republic of China(China),Croatia,India,Indonesia,Peru,Romania and South Africa.Data presented in this publication come from official national statistics,unless otherwise stated.Conceptual framework The conceptual framework underlying Heal

31、th at a Glance assesses health system performance within the context of a broad view of the determinants of health(Figure 1).It draws from the framework endorsed by the OECD workstream on healthcare quality and outcomes,which recognises that the ultimate goal of health systems is to improve peoples

32、health.Figure 1.Mapping of Health at a Glance indicators to a conceptual framework for health system performance assessment Source:Adapted from and building on Carinci,F.et al.(2015),“Towards Actionable International Comparisons of Health System Performance:Expert Revision of the OECD Framework and

33、Quality Indicators”,International Journal for Quality in Health Care,Vol.27,No.2,pp.137-146.Health status(Chapter 3,dashboard 1)Risk factors for health(Chapter 4,dashboard 2)Health system performanceIs healthcare accessible to all?Is healthcare of high quality(safe,effective)?Is healthcare people-ce

34、ntred?Does the health system offer good value for money?How resilient is the health system?Demographic,economic&social contextAccess(Chapter 5,dashboard 3)Quality(Chapter 6,dashboard 4)Health system capacity and resources(dashboard 5)Health expenditure and financing(Chapter 7)Health workforce(Chapte

35、r 8)Sub-sector analysisPharmaceutical sector(Chapter 9)Ageing and long-term care(Chapter 10)10|HEALTH AT A GLANCE 2023 OECD 2023 The performance of a healthcare system has a strong impact on a populations health.When health services are of high quality and are accessible to all,peoples health outcom

36、es are better.Achieving access and quality goals,and ultimately better health outcomes,depends on there being sufficient spending on health.Health spending pays for health workers to provide needed care,as well as the goods and services required to prevent and treat illness.Such resources are also c

37、ritical in ensuring health systems are resilient in the face of COVID-19 and other emerging health threats.However,such spending will only improve health and health system outcomes if they are spent wisely,with value-for-money considerations also important.At the same time,many factors outside the h

38、ealth system influence health status,notably income,education,and the physical environment in which an individual lives.The demographic,economic and social context also affects the demand for and supply of health services.Finally,the degree to which people adopt healthy lifestyles,a key determinant

39、of health outcomes,depends on both effective health policies and wider socio-economic factors.Structure of the publication Health at a Glance 2023 compares OECD countries on each component of this general framework.It is structured around ten chapters.Chapter 1 presents an overview of health and hea

40、lth system performance,based on a subset of core indicators from the report.Chapter 2 offers a more in-depth analysis on a particular theme,which in this edition is on digital health.The next eight chapters then provide detailed country comparisons across a range of health and health system indicato

41、rs.Where possible,time trend analysis and data disaggregated by demographic and socio-economic characteristics are included.Chapter 3 on health status highlights cross-country differences in life expectancy,the main causes of mortality,mental health,self-assessed health,and other indicators of popul

42、ation health.Chapter 4 analyses risk factors for health such as smoking,alcohol,obesity,and environmental health risks.Chapter 5 on access investigates the affordability,availability,and use of services,with special attention given to socio-economic inequalities.Chapter 6 assesses quality and outcom

43、es of care in terms of patient safety,clinical effectiveness,and whether healthcare is responsive to peoples needs.Indicators across the full lifecycle of care are included,from prevention to primary,chronic and acute care.Chapter 7 on health expenditure and financing compares how much countries spe

44、nd on health,how such spending is financed,and what funds are spent on.Chapter 8 examines the health workforce,particularly the supply and remuneration of doctors and nurses.Chapter 9 takes a closer look at the pharmaceutical sector.Chapter 10 focuses on ageing and long-term care.This includes facto

45、rs that influence the demand for long-term care,and the availability of high-quality health services.Presentation of indicators Except for the first two chapters,indicators are presented in short sections.Each section first defines the indicator set analysed,highlights key findings conveyed by the d

46、ata and related policy insights,and signals any significant national variation in methodology that might affect data comparability.After this text is a corresponding set of figures.These show current levels of the indicator and,where possible,trends over time.When an OECD average is included in a fi

47、gure,it is the unweighted average of the OECD countries presented,unless otherwise specified.The number of countries included in this OECD average is indicated in the figure,and for charts showing more than one year this number refers to the latest year.The latest available comparable data is shown,

48、typically from 2020-22.Figures sometimes include data for a few countries that only have earlier pre-pandemic data available.In these cases,the year is indicated in a footnote under the figure.Data limitations Limitations in data comparability are indicated both in the text(in the box related to“Def

49、inition and comparability”),as well as in footnotes underneath the figures.Data sources Readers interested in using the data presented in this publication are encouraged to consult the online database OECD Health Statistics on OECD.Stat at https:/oe.cd/ds/health-statistics.Full documentation of defi

50、nitions,sources and methods are available online at https:/oe.cd/health-statistics-data-sources-methods.More information on OECD Health Statistics is available at www.oecd.org/health/health-data.htm.|11 HEALTH AT A GLANCE 2023 OECD 2023 Population figures The population figures used to calculate rat

51、es per capita throughout this publication come from Eurostat for European countries,and from OECD data based on the UN Demographic Yearbook and UN World Population Prospects(various editions)or national estimates for non-European OECD countries(data extracted as of June 2023).Mid-year estimates are

52、used.Population estimates are subject to revision,so they may differ from the latest population figures released by the national statistical offices of OECD member countries.Note that some countries such as France,the United Kingdom and the United States have overseas territories.These populations a

53、re generally excluded.However,the calculation of GDP per capita and other economic measures may be based on a different population in these countries,depending on the data coverage.Table 1.OECD country ISO codes Australia AUS Japan JPN Austria AUT Korea KOR Belgium BEL Latvia LVA Canada CAN Lithuani

54、a LTU Chile CHL Luxembourg LUX Colombia COL Mexico MEX Costa Rica CRI Netherlands NLD Czech Republic CZE New Zealand NZL Denmark DNK Norway NOR Estonia EST Poland POL Finland FIN Portugal PRT France FRA Slovak Republic SVK Germany DEU Slovenia SVN Greece GRC Spain ESP Hungary HUN Sweden SWE Iceland

55、ISL Switzerland CHE Ireland IRL Trkiye TUR Israel ISR United Kingdom GBR Italy ITA United States USA Table 2.Accession candidate and key partner country ISO codes Argentina ARG India IND Brazil BRA Indonesia IDN Bulgaria BGR Peru PER China CHN Romania ROU Croatia HRV South Africa ZAF|13 HEALTH AT A

56、GLANCE 2023 OECD 2023 Executive summary Health systems are under financial pressure.This reflects a challenging economic climate,with competing priorities squeezing the public funds available for health In 2019,prior to the pandemic,OECD countries spent on average 8.8%of GDP on healthcare,a figure r

57、elativelyunchanged since 2013.By 2021,this proportion had jumped to 9.7%.However,2022 estimates point to a significant fallin the ratio to 9.2%,reflecting a reduced need for spending to tackle the pandemic but also the impact of inflation.Per person,spending on health was just under USD 5 000 on ave

58、rage,ranging from USD 12 555 in the United States,to USD 1 181 in Mexico(adjusted for differences in purchasing power).While the health and social care workforce continues to grow,concerns about shortages are becoming even more acute.Population ageing is one reason why demand for healthcare and long

59、-term care workers appears to be outstrippingsupply,with 18%of the population aged 65 and over on average in 2021.High inflation has eroded health sector wages recently in some countries,making it harder to attract and retain healthprofessionals.Analysing longer trends,real wage growth of health wor

60、kers has varied markedly,with large increases inmost Central and Eastern European countries since 2011,whereas Finland,Italy,Portugal,Spain and theUnited Kingdom had stagnant or declining real wages.Core population health indicators show that societies have not yet fully recovered from the pandemic,

61、with many people still struggling 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.Heart attack,stro

62、kes and other circulatory diseases caused more than one in four deaths;one in five deaths were due to cancer,and COVID-19 caused 7%of all deaths(recorded figures)in 2021.Almost one-third of all deaths could have been avoided through more effective and timely prevention and healthcare interventions.M

63、ore than one-third of people aged 16 and over reported living with a longstanding illness or health problem,on average.Socio-economic disparities are large:43%of people in the lowest income quintile reported a longstanding issue on average,compared to 27%in the richest quintile.Indicators point to a

64、 slight improvement in population mental health as we recover from the pandemic,but mental ill-health remains elevated:the share of the population reporting symptoms of depression in 2022 remains at least 20%higher than pre-pandemic.Unhealthy lifestyles and poor environments cause millions of people

65、 to die prematurely.Smoking,harmful alcohol use,physical inactivity and obesity are the root cause of many chronic conditions Obesity rates continue to rise in most OECD countries,with 54%of adults overweight or obese,and 18%obese onaverage.Healthy diet and physical activity are critical,yet on aver

66、age only 15%of adults consumed five or more portionsof fruit and vegetables per day,and only 40%performed at least 150 minutes of moderate-to-vigorous intensity physicalactivity per week.14|HEALTH AT A GLANCE 2023 OECD 2023 While daily smoking rates continue to fall in most OECD countries,on average

67、 16%of people aged 15 and over still smoke daily and regular use of e-cigarette products(vaping)is on the rise.Smoking rates were over 25%in France and Trkiye,and also in China,Bulgaria and Indonesia.Nearly one in five adults(19%)reported heavy episodic drinking at least once a month,on average,with

68、 rates over 30%in Germany,Luxembourg,the United Kingdom and Denmark.Premature deaths from ambient(outdoor)air pollution have declined by 31%on average between 2000 and 2019,but still cause an estimated 29 deaths per 100 000 people on average.Barriers to access persist,despite universal health covera

69、ge in most OECD countries.A renewed focus on primary care and prevention is one important way to simultaneously improve accessibility and efficiency Gaps in financial protection make healthcare less affordable.Household out-of-pocket payments make up just under a fifth of health spending on average,

70、and over 40%in Mexico.The least well-off are on average three times more likely than individuals from the highest income quintile to delay or not seek care.Primary care accounted for 13%of spending on average in 2021,a similar share to 2019.While large increases in spending on prevention were observ

71、ed over the same period,much of this growth can be attributed to time-limited,emergency measures related to COVID-19 management rather than long-term planned investments into population health.Waiting times,a longstanding issue in many countries,were exacerbated by COVID-19.Waiting times for hip and

72、 knee replacements,two common elective surgeries,have generally improved since the height of the pandemic,but remain higher than pre-pandemic levels in most countries.Teleconsultations can improve access,particularly in remote areas.Teleconsultations have substantially increased since the pandemic a

73、nd made up on average 19%of all doctor consultations in 2021.Quality of care is improving in terms of safety and effectiveness,with greater attention to making healthcare more people-centred Patient safety indicators show encouraging results:for example,safe prescribing in primary care has improved

74、in most countries over time,with reductions in the average volume of antibiotics,opioids and long-term prescriptions of anticoagulants.Still,patient safety remains a concern,with 57%of hospital physicians and nurses perceiving staff levels and work pace to be unsafe.Avoidable hospital admissions hav

75、e fallen in most OECD countries over the past decade,with large reductions observed in Lithuania,Mexico,Poland and the Slovak Republic.This is an indication that primary care is helping to keep people well and treating uncomplicated cases.Acute care services continue to improve in their fundamental

76、task of keeping people alive.In almost every OECD country,30-day mortality rates following a heart attack or stroke are lower than ten years ago.However,these mortality rates slightly increased between 2019 and 2021 on average,due to treatment delays during the pandemic.A deeper understanding of qua

77、lity of care requires measuring what matters to people.Patient-reported outcomes show,for example,average quality of life 6-12 months after hip surgery improved in all countries,reaching a score equivalent to 80%or higher,up from scores equivalent to 35-50%pre-surgery(based on the Oxford Hip Score).

78、Digital health has enormous potential to transform health systems.However,many countries are ill-prepared for a digital health transformation A countrys readiness for the digital transformation depends on strong health data governance,coherent approaches to digital security,and the capacity to respo

79、nsibly use digital tools(including artificial intelligence)for the public good.While 90%of OECD countries have an electronic health portal in place,only 42%reported that the public could both access and interact with all their data through the portal.Around one-third(38%)of countries have no clinica

80、l standards or vendor certification of electronic health record systems,limiting the interoperability of health data.|15 HEALTH AT A GLANCE 2023 OECD 2023 Infographic 1.Key facts and figures National estimates of prevalence of depression or symptoms ofdepression,%,2019-2022(or nearest year)Health sp

81、ending as a share of GDP fell in 2022 compared to2021 in 33 of 38 OECD countries.Waiting times was the main reason cited for unmet healthcareneeds in most countries,with cost also an important barrier.Levels of anxiety and depression have improved slightly insome countries,but still remain much high

82、er thanpre-pandemic levels.Safer prescribing can help combat thelooming threat of antimicrobial resistanceMany countries are ill-prepared for adigital health transformationThe least well-off people find it harder toget the healthcare they needVolume of antibiotics prescribed,2011 and 2021,Defined da

83、ily doses per 1 000 population per dayHealth spendingGDPAntibiotic prescriptions have fallen in 90%of OECD countries,but antimicrobial resistance is still a major concern,and isprojected to cost about USD PPP 26 per person annually.Almost 90%of responding OECD countries reported havingan online heal

84、th portal in place.However,only 42%reportedthat the public could both access and interact with all theirhealth data through the portal.Fewer people are smoking tobacco,butvaping is increasing in many countries%of regular users of vaping products,2016 and 2021(or nearest year)Vaping has increased in

85、around two-thirds of OECDcountries(among countries with available data).It is alsomore common among young people(6.1%vs.3.2%overall).The least well-off people are.Mental health has still not recovered fromthe pandemic2016202120162021Health systems are under financialpressure024681012EstoniaNew Zeala

86、ndFranceUKCanadaUSItaly0510152025FranceItalyKoreaOECDFinlandSloveniaGermany202120112019202220510152025USKoreaGermanyFranceMexicoUKBelgium42%-6-4-202468102016201820202022Annual real growth in health expenditure and GDP,per capita,OECD average,2016-20223xmore likely than the highestearners to delay or

87、 not seek care.|17 HEALTH AT A GLANCE 2023 OECD 2023 This chapter analyses a core set of indicators on health and health systems.Country dashboards and OECD snapshots shed light on how countries compare across five dimensions:health status,risk factors for health,access,quality,and health system cap

88、acity and resources.Quadrant charts illustrate how much health spending is associated with health outcomes,access and quality of care.1 Indicator overview:Country dashboards and major trends 18|HEALTH AT A GLANCE 2023 OECD 2023 Introduction Health indicators offer an“at a glance”perspective on how h

89、ealthy populations are,and how well health systems perform.This introductory chapter provides a comparative overview of OECD countries across 20 core indicators,organised around five dimensions of health and health systems(Table 1.1).Indicators are selected based on how relevant and actionable they

90、are from a policy perspective;as well as the more practical consideration of data availability across countries.The extent to which health spending is associated with health outcomes,access and quality of care is also explored.Such analysis does not indicate which countries have the best-performing

91、health systems,particularly as only a small subset of the many indicators in Health at a Glance are included here.Rather,this chapter identifies some relative strengths and weaknesses.This can help policy makers determine priority action areas for their country,with subsequent chapters in Health at

92、a Glance providing a more detailed suite of indicators,organised by topic area.Table 1.1.Population health and health system performance:Core indicators Dimension Indicator Health status(Chapter 3)Life expectancy years of life at birth Avoidable mortality preventable and treatable deaths(per 100 000

93、 people,age-standardised)Chronic conditions diabetes prevalence(%adults,age-standardised)Self-rated health population in poor health(%population aged 15+)Risk factors for health(Chapter 4)Smoking daily smokers(%population aged 15+)Alcohol litres consumed per capita(population aged 15+),based on sale

94、s data Obesity population with body mass index(BMI)30(%population aged 15+)Ambient air pollution deaths due to ambient particulate matter,especially PM2.5(per 100 000 people)Access to care(Chapter 5)Population coverage,eligibility population covered for core set of services(%population)Population co

95、verage,satisfaction population satisfied with availability of quality healthcare(%population)Financial protection expenditure covered by compulsory prepayment schemes(%total expenditure)Service coverage population reporting unmet needs for medical care(%population)Quality of care(Chapter 6)Safe prim

96、ary care antibiotics prescribed(defined daily dose per 1 000 people)Effective primary care avoidable hospital admissions(per 100 000 people,age-and sex-standardised)Effective preventive care mammography screening within the past two years(%of women aged 50-69)Effective secondary care 30-day mortalit

97、y following acute myocardial infarction and ischaemic stroke(per 100 admissions for people aged 45 and over,age-and sex-standardised)Health system capacity and resources(Chapters 5,7 and 8)Health spending total health spending(per capita,USD using purchasing power parities)Health spending total heal

98、th spending(%GDP)Doctors number of practising physicians(per 1 000 people)Nurses number of practising nurses(per 1 000 people)Hospital beds number of hospital beds(per 1 000 people)Note:Avoidable hospital admissions cover asthma,chronic obstructive pulmonary disease,congestive heart failure and diab

99、etes.Based on these indicators,country dashboards are produced.These compare a countrys performance to that of other countries and to the OECD average.Comparisons are made based on the latest year available.For most indicators this refers to 2021,or to the nearest year if 2021 data are not available

100、 for a given country.Country classification for each indicator is into one of three colour-coded groups:blue when the countrys performance is close to the OECD average green when the countrys performance is considerably better than the OECD average red when the countrys performance is considerably w

101、orse than the OECD average.The exception to this grouping is the dashboard on health system capacity and resources,where indicators cannot be easily classified as showing better or worse performance.Here,lighter and darker shades of blue signal whether a country has considerably less or more of a gi

102、ven healthcare resource than the OECD average.Accompanying these country dashboards are OECD snapshots and quadrant charts.OECD snapshots provide summary statistics for each indicator.Quadrant charts illustrate simple associations(not causal relationships)between how much countries spend on health a

103、nd how effectively health systems function.Figure 1.1 shows the interpretation of each quadrant,taking health outcome variables as an example.Further information on the methodology,interpretation and use of these country dashboards,OECD snapshots and quadrant charts is provided in the boxed text bel

104、ow.|19 HEALTH AT A GLANCE 2023 OECD 2023 Figure 1.1.Interpretation of quadrant charts:Health expenditure and health outcome variables Methodology,interpretation and use Country dashboards The classification of countries as being close to,better or worse than the OECD average is based on an indicator

105、s standard deviation(a common statistical measure of dispersion).Countries are classified as“close to the OECD average”(blue)whenever the value for an indicator is within one standard deviation from the OECD average for the latest year.Particularly large outliers(larger than three standard deviation

106、s)are excluded from calculations of the standard deviation to avoid statistical distortions.For a typical indicator,about 65%of countries will be close to the OECD average,with the remaining 35%performing significantly better(green)or worse(red).When the number of countries that are close to the OEC

107、D average is higher(lower),it means that cross-country variation is relatively low(high)for that indicator.Changes over time are also indicated in the dashboard.OECD snapshots For each indicator,the OECD average,highest and lowest values are shown,as are the three countries with the largest improvem

108、ents over time in terms of changes to absolute values.Quadrant charts Quadrant charts plot health expenditure per capita against another indicator of interest(on health outcomes,access and quality of care).They show the percentage difference of each indicator compared to the OECD average.The centre

109、of each quadrant chart is the OECD average.Data from the latest available year are used.A limitation is that lagged effects are not taken into account for example,it may take some years before higher health spending translates into longer life expectancy.Higher life expectancy Higher health expendit

110、ure Higher expenditureHigher life expectancyLower expenditureLower life expectancyHigher expenditureLower life expectancyLower expenditureHigher life expectancyHigher avoidable mortality Higher health expenditure Lower expenditureHigher avoidable mortalityHigher expenditureLower avoidable mortalityH

111、igher expenditureHigher avoidable mortalityLower expenditureLower avoidable mortality20|HEALTH AT A GLANCE 2023 OECD 2023 Health status Four health status indicators reflect core aspects of both the quality and quantity of life.Life expectancy is a key indicator for the overall health of a populatio

112、n;avoidable mortality focuses on premature deaths that could have been prevented or treated.Diabetes prevalence shows morbidity for a major chronic condition;self-rated health offers a more holistic measure of mental and physical health.Figure 1.2 presents a snapshot of health status across OECD cou

113、ntries,and Table 1.2 provides more detailed country comparisons.Figure 1.2.Health status across the OECD,2021(or nearest year)Note:Largest improvement shows countries with largest changes in absolute value over ten years(%change in brackets).Source:OECD Health Statistics 2023;IDF Diabetes Atlas 2021

114、.Japan,Switzerland and Korea lead a large group of 27 OECD countries in which life expectancy at birth exceeded 80 years in 2021.A second group,including the United States,had life expectancy between 75 and 80 years.Latvia,Lithuania,Hungary and the Slovak Republic had the lowest life expectancy,at l

115、ess than 75 years.While life expectancy has increased in most countries over the past decade,many of these gains were wiped out during the pandemic.Avoidable mortality rates(from preventable and treatable causes)were lowest in Switzerland and Japan,where fewer than 135 per 100 000 people died premat

116、urely.Avoidable mortality rates were also relatively low(under 150 per 100 000 people)in Israel,Korea,Iceland,Australia,Italy and Luxembourg.Mexico,Latvia,Lithuania and Hungary had the highest avoidable mortality rates,at over 400 premature deaths per 100 000 people.Diabetes prevalence in 2021 was h

117、ighest in Mexico,Trkiye,Chile and the United States,with over 10%of adults living with diabetes(data age-standardised to the world population).Prevalence rates have been broadly stable over time in many OECD countries,especially in western Europe,but they increased markedly in Trkiye and Iceland.Suc

118、h upward trends are due in part to rising rates of obesity and physical inactivity.Almost 8%of adults considered themselves to be in poor health in 2021,on average across OECD countries.This ranged from over 13%in Korea,Japan,Portugal,the Slovak Republic,Latvia and Lithuania to under 3%in Colombia,N

119、ew Zealand and Canada.However,socio-cultural differences,the share of older people and differences in survey design affect cross-country comparability.People with lower incomes are generally less positive about their health than people on higher incomes in all OECD countries.Investing more in health

120、 systems contributes to gains in health outcomes by offering more accessible and higher-quality care.Differences in risk factors such as smoking,alcohol and obesity also explain cross-country variation in health outcomes.Social determinants of health matter too notably income levels,better education

121、 and improved living environments.LOWHIGHLife expectancy Years of life at birthAvoidable mortalityDeaths per 100 000 population(age-standardised)Chronic conditions Diabetes prevalence (%adults,age-standardised)Self-rated healthPopulation in poor health(%population aged 15+)OECDLARGEST IMPROVEMENTTrk

122、iye+4.3(6%)Korea+3.4(4%)Colombia+2.5(3%)Korea-74(34%)Hungary-62(13%)Slovak Republic-55(15%)New Zealand-2.4(28%)Ireland-2.2(42%)Poland-2.2(24%)Hungary-8.2(50%)Israel-7.6(41%)Lithuania-6.8(34%)80.373.184.57090LatviaJapan2376651330700SwitzerlandMexico7.03.016.9020IrelandMexico8114020ColombiaKorea|21 HE

123、ALTH AT A GLANCE 2023 OECD 2023 Table 1.2.Dashboard on health status,2021(unless indicated)Life expectancy Avoidable mortality Chronic conditions Self-rated health Years of life at birth Deaths per 100 000 population(age-standardised)Diabetes prevalence(%adults,age-standardised)Population in poor he

124、alth(%population aged 15+)OECD 80.3+237+7.0-7.9+Australia 83.3+144+6.4+3.7+Austria 81.3+198+4.6+7.4+Belgium 81.9+178+3.6+8.0+Canada 81.6+171+7.7+2.8=Chile 81.0+247-10.8-6.8-Colombia 76.8+328-8.3+1.3 N/A Costa Rica 80.8+237-8.8+3.4 N/A Czech Republic 77.2-335-7.1-8.6+Denmark 81.5+174+5.3+7.7+Estonia

125、77.2+363+6.5+12.1+Finland 81.9+186+6.1-6.2+France 82.4+160+5.3+8.9-Germany 80.8+195+6.9-12.4-Greece 80.2-204-6.4-6.5+Hungary 74.3-404+7.0-8.2+Iceland 83.2+142+5.5-5.9+Ireland 82.4+172+3.0+5.2-Israel 82.6+141+8.5-10.9+Italy 82.7+146+6.4-8.1+Japan 84.5+134+6.6+13.6+Korea 83.6+142+6.8+13.8+Latvia 73.1=

126、531-5.9+13.1+Lithuania 74.2+481+5.8+13.1+Luxembourg 82.7+147+5.9-5.9+Mexico 75.4+665-16.9-N/A N/A Netherlands 81.4+161+4.5+5.2+New Zealand 82.3+179+6.2+2.1+Norway 83.2+156+3.6+9.0-Poland 75.5-344-6.8+10.3+Portugal 81.5+180+9.1+13.3+Slovak Republic 74.6-321+5.8-13.2+Slovenia 80.7+221+5.8+8.3+Spain 83

127、.3+163+10.3-7.7-Sweden 83.1+150+5.0-6.4-Switzerland 83.9+133+4.6+3.9-Trkiye 78.6+233+14.5-8.4+United Kingdom 80.4=222-6.3-7.4-United States 76.4-336-10.7-3.1=Better than the OECD average.Close to the OECD average.Worse than the OECD average.1.2020 data.2.2018/19 data.3.2016/17 data.Note:The symbol+i

128、ndicates an improvement over time,a deterioration over time,=no change.Latvia,Lithuania and Mexico are excluded from the standard deviation calculation for avoidable mortality,while Mexico and Trkiye are excluded from diabetes prevalence.22|HEALTH AT A GLANCE 2023 OECD 2023 Risk factors for health S

129、moking,alcohol consumption and obesity are the three major individual risk factors for non-communicable diseases,contributing to a large share of worldwide deaths.Air pollution is also a critical environmental determinant of health.Figure 1.3 presents a snapshot of risk factors for health across OEC

130、D countries,and Table 1.3 provides more detailed country comparisons.Figure 1.3.Risk factors for health across the OECD,2021(or nearest year)Note:Largest improvement shows countries with largest changes in absolute value over the past decade(%change in brackets).For obesity,values are self-reported

131、except if marked with an asterisk when measured data are used.Air pollution data from 2019.Source:OECD Health Statistics 2023;OECD Environment Statistics 2020.Smoking causes multiple diseases,and the World Health Organization estimates that tobacco smoking kills 8 million people in the world every y

132、ear.The share of people smoking daily in 2021 ranged from around 25%or more in Trkiye and France to below 10%in Iceland,Costa Rica,Norway,Mexico,Canada,the United States and Sweden.Daily smoking rates have decreased in most OECD countries over the last decade,taking the average from 20.4%in 2011 to

133、15.9%in 2021.In the Slovak Republic,Luxembourg and Trkiye,however,smoking rates have risen slightly.Alcohol use is a leading cause of death and disability worldwide,particularly among people of working age.Measured through sales data,Latvia and Lithuania reported the highest levels of consumption in

134、 2021(above 12 litres of pure alcohol per person per year),followed by the Czech Republic,Estonia and Austria.Trkiye,Costa Rica,Israel and Colombia had comparatively low consumption levels(under 5 litres).Average consumption has fallen in 23 OECD countries since 2011.Still,harmful drinking is a conc

135、ern among certain population groups,and nearly one in five adults reported heavy episodic drinking at least once a month.Obesity is a major risk factor for many chronic conditions,including diabetes,cardiovascular diseases and cancer.On average in 2021,19.5%of the population were obese,and 54%of the

136、 population were overweight or obese(based on self-reported data).Obesity rates were highest in Mexico,the United States and New Zealand,and lowest in Japan and Korea(based on a combination of self-reported and measured data).Caution should be used when comparing countries with reporting differences

137、,however,since obesity rates are generally higher when using measured data.Air pollution is not only a major environmental threat but also causes a wide range of adverse health outcomes.OECD projections estimate that ambient(outdoor)air pollution may cause 6-9 million premature deaths a year worldwi

138、de by 2060.Premature deaths attributable to ambient particulate matter ranged from over 70 per 100 000 people in Poland and Hungary to less than 7 per 100 000 people in Iceland,New Zealand and Sweden in 2019.Mortality rates have fallen in a majority of OECD countries since 2000,but they increased in

139、 seven:Japan,Costa Rica,Korea,Chile,Mexico,Colombia and Trkiye.LOWHIGHSmokingDaily smokers(%population aged 15+)Alcohol Litres consumed per capita (population aged 15+)Obesity Population with BMI 30 (%population aged 15+)Air pollution Deaths due to pollution (per 100 000 population)OECDLARGEST IMPRO

140、VEMENTNorway-9.0(53%)Estonia-8.3(32%)Ireland-8.0(33%)Lithuania-2.6(18%)Ireland-2.2(19%)France-1.9(15%)Spain-1.7(10%)Greece-0.9(5%)Latvia-30.2(34%)United Kingdom-28.4(57%)Estonia-25.3(68%)16.07.228.0030IcelandTrkiye8.61.412.2015LatviaTrkiye295730100IcelandPoland19.54.3(7*)33.5(42.8*)045United StatesK

141、orea|23 HEALTH AT A GLANCE 2023 OECD 2023 Table 1.3.Dashboard on risk factors for health,2021(unless indicated)Smoking Alcohol Obesity Air pollution(2019)Daily smokers(%population aged 15+)Litres consumed per capita(population aged 15+)Population with BMI30(%population aged 15+)Deaths due to polluti

142、on(per 100 000 population)OECD 16.0+8.6+19.5-28.9+Australia 11.2+9.5 N/A 19.5(30.4*)N/A 7.1+Austria 20.6+11.1+16.6-26.7+Belgium 15.4+9.2+15.9(21.2*)-30.3+Canada 8.7+8.3-21.6(24.3*)-10.1+Chile 17.6 N/A 7.1=26.4-30.8-Colombia N/A N/A 4.1+N/A N/A 26.0-Costa Rica 7.8+3.1+31.2*-18.6-Czech Republic 17.6+1

143、1.6-19.3-58.5+Denmark 13.9+10.4+18.5-22.5+Estonia 17.9+11.1+21-12.0+Finland 12.0+8.1+23(26.8*)-7.0+France 25.3+10.5+14.4(15.6*)-20.3+Germany 14.6+10.6+16.7-32.4+Greece 24.9+6.3+16.4+54.6+Hungary 24.9+10.4+23.9(33.2*)-71.7+Iceland 7.2+7.4-21.4-4.6+Ireland 16.0+9.5+21(23*)-11.0+Israel 16.4+3.1-17-26.8

144、+Italy 19.1+7.7-12-40.8+Japan 16.7+6.6+4.6*-31.3-Korea 15.4+7.7+4.3(7*)-42.7-Latvia 22.6+12.2-23.9*-58.6+Lithuania 18.9 N/A 12.1+18.3-45.7+Luxembourg 19.2-11+16.5-14.8+Mexico 8.6+5.1-36*-28.7-Netherlands 14.7+8.1+13.9-26.7+New Zealand 9.4+8.8+34.3*-6.3+Norway 8.0+7.4-16-7.3+Poland 17.1+11-18.5-73.3+

145、Portugal 14.2+10.4+16.9-20.4+Slovak Republic 21-9.6+19.4-63.6+Slovenia 17.4+10.6=19.4-39.6+Spain 19.8+10.5-14.9+19.0+Sweden 9.7+7.6-15.3-6.5+Switzerland 19.1+8.5+11.3-16.0+Trkiye 28-1.4+21.1(28.8*)-49.9-United Kingdom 12.7+10-25.9(28*)-21.4+United States 8.8+9.5-33.5(42.8*)-14.5+Better than the OECD

146、 average.Close to the OECD average.Worse than the OECD average.1.2020/22 data.2.2019 data.3.2017/18 data.Notes:The symbol+indicates an improvement over time,a deterioration,and=no change.For obesity,values are self-reported except if marked with an asterisk when measured data are used.Measured data

147、are typically higher and more accurate than self-reported data,but with less country coverage.24|HEALTH AT A GLANCE 2023 OECD 2023 Access to care Ensuring equitable access is critical for high-performing health systems and more inclusive societies.Population coverage measured by the share of the pop

148、ulation eligible for a core set of services and those satisfied with the availability of quality healthcare offers an initial assessment of access to care.The proportion of spending covered by prepayment schemes gives further insight into financial protection.The share of populations reporting unmet

149、 needs for medical care offers a measure of effective service coverage.Figure 1.4 presents a snapshot of access to care across OECD countries,and Table 1.4 provides more detailed country comparisons.Figure 1.4.Access to care across the OECD,2021(or nearest year)Notes:Largest improvement shows countr

150、ies with largest change in absolute value over ten years(%change in brackets).Eligibility for population coverage is 100%in 22 countries.Population satisfaction data from 2022.Source:OECD Health Statistics 2023,Gallup World Poll 2023,Eurostat based on EU-SILC.In terms of the share of the population

151、eligible for coverage,most OECD countries have achieved universal(or near-universal)coverage for a core set of services.However,in Mexico,population coverage was 72%in 2021,and coverage was below 95%in a further five countries(Costa Rica,the United States,Poland,Chile and Colombia).Satisfaction with

152、 the availability of quality health services offers further insight into effective coverage.On average across OECD countries,67%of people were satisfied with the availability of quality health services where they live in 2020.Citizens in Switzerland and Belgium were most likely to be satisfied(90%or

153、 more),whereas fewer than 50%of citizens were satisfied in Chile,Colombia,Hungary and Greece.On average,satisfaction levels have decreased slightly over time.The degree of cost sharing applied to those services also affects access to care.Across OECD countries,around 75%of all healthcare costs were

154、covered by government or compulsory health insurance schemes in 2021.However,in Mexico only about 50%of all health spending was covered by publicly mandated schemes,and in Greece,Korea,Chile and Portugal only around 60%of all costs were covered.In terms of service coverage,on average across 25 OECD

155、countries with comparable data,only 2.3%of the population reported that they had unmet care needs due to cost,distance or waiting times in 2021.However,over 5%of the population reported unmet needs in Estonia and Greece.Socio-economic disparities are significant in most countries,with the income gra

156、dient largest in Greece,Latvia and Trkiye.LOWHIGHPopulation coverage,eligibility Population eligible for core services(%population)Population coverage,satisfaction Population satisfied with availability ofquality health care(%population)Financial protection Expenditure covered by compulsoryprepaymen

157、t(%total expenditure)Service coverage Population reporting unmet needs for medical care(%population)OECDLARGEST IMPROVEMENTLithuania+7.4(8%)United States+6.4(8%)Estonia+1.9(2%)United States+35(71%)France+9(12%)Latvia+6(9%)Poland-10.8(81%)Sweden-10.5(90%)Hungary-7.7(87%)Estonia+18(40%)Greece+15(52%)P

158、oland+9(21%)97.972.470100Mexico76508640100MexicoCzech Republic2.38.10.1010NetherlandsEstonia67399430100ChileSwitzerland|25 HEALTH AT A GLANCE 2023 OECD 2023 Table 1.4.Dashboard on access to care,2021(unless indicated)Population coverage,eligibility Population coverage,satisfaction(2022)Financial pro

159、tection Service coverage Population eligible for core services(%population)Population satisfied with availability of quality health care(%population)Expenditure covered by compulsory prepayment(%total expenditure)Population reporting unmet needs for medical care(%population)OECD 97.9-66.8-75.9+2.3+A

160、ustralia 100=71-71.9+N/A N/A Austria 99.9=84-78.3+0.2+Belgium 98.6-90+77.6+1.7+Canada 100=56-72.9+N/A N/A Chile 94.3+39+62.7+N/A N/A Colombia 94.7-41-78.4+N/A N/A Costa Rica 90.9-70+74.5+N/A N/A Czech Republic 100=77+86.4+0.3+Denmark 100=81=85.2+1.2+Estonia 95.9+63+76.2+8.1+Finland 100=70+79.8+4.3+F

161、rance 99.9=71-84.8+2.8+Germany 99.9+85-85.5+0.1+Greece 100.0=44+62.1-6.4+Hungary 95.0-44-72.5+1.2+Iceland 100=68-83.7+3.4+Ireland 100=67+77.4+2.0+Israel 100=69=68.2+N/A N/A Italy 100=55=75.5-1.8+Japan 100=76+84.9+N/A N/A Korea 100=78+62.3+N/A N/A Latvia 100=57+69.5+4.0 N/A Lithuania 98.8+51=68.6-2.4

162、 N/A Luxembourg 100=86-86.0+1.1+Mexico 72.4-57-50.2-N/A N/A Netherlands 99.9+83-84.9+0.1+New Zealand 100=64-80.3-N/A N/A Norway 100=80-85.6+0.9+Poland 94.0-51+72.5+2.6+Portugal 100=63+63.2-2.3-Slovak Republic 95-54-79.7+2.9+Slovenia 100=68-73.7+4.7-Spain 100+64-71.6-1.1+Sweden 100=74-85.9+1.2+Switze

163、rland 100=94=67.7+0.5+Trkiye 98.8+53-78.8-2.4 N/A United Kingdom 100=67-83.0+N/A N/A United States 91.3+75+83.6+N/A N/A Better than the OECD average.Close to the OECD average.Worse than the OECD average.1.2020 data.2.2018 data.Notes:The symbol+indicates an improvement over time,a deterioration,and=n

164、o change.Mexico is excluded from standard deviation calculation for population coverage.26|HEALTH AT A GLANCE 2023 OECD 2023 Quality of care High-quality care requires health services to be safe,appropriate,clinically effective and responsive to patient needs.Antibiotic prescriptions and avoidable h

165、ospital admissions are examples of indicators that measure the safety and appropriateness of primary care.Breast cancer screening is an indicator of the quality of preventive care;30-day mortality following acute myocardial infarction(AMI)and stroke measures the clinical effectiveness of secondary c

166、are.Figure 1.5 presents a snapshot of quality and outcome of care across OECD countries,and Table 1.5 provides more detailed country comparisons.Figure 1.5.Quality of care across the OECD,2021(or nearest year)Note:Largest improvement shows countries with largest changes in absolute value over ten ye

167、ars(%change in brackets).Source:OECD Health Statistics 2023;ECDC 2023(for EU/EEA countries on antibiotics prescribed).The overuse,underuse or misuse of antibiotics and other prescription medicines contribute to increased antimicrobial resistance and represent wasteful spending.The total volumes of a

168、ntibiotics prescribed in 2021 varied three-fold across countries:Austria,the Netherlands and Germany reported the lowest volumes,whereas Greece,France,Poland and Spain reported the highest volumes.Across OECD countries,the volume of antibiotics prescribed has decreased slightly over time.Asthma,chro

169、nic obstructive pulmonary disease,congestive heart failure and diabetes are all chronic conditions that can largely be treated in primary care hospital admissions for such conditions may signal quality issues in primary care,with the proviso that very low admission rates may also partly reflect limi

170、ted access.Aggregated together,such avoidable hospital admissions were highest in Trkiye,Germany and the United States in 2021,among 32 countries with comparable data.In almost all countries,these avoidable hospital admissions have been declining over the past decade.Breast cancer is the cancer with

171、 the highest incidence among women in all OECD countries,and the second most common cause of cancer death among women.Timely mammography screening is critical to identify cases,allowing treatment to start at an early stage of the disease.In 2021,mammography screening rates were highest in Denmark,Fi

172、nland,Portugal and Sweden(80%or higher among women aged 50-69).Screening rates were lowest in Mexico,Trkiye,the Slovak Republic and Hungary(all under 30%).Despite favourable long-term trends for many countries,COVID-19 had a large impact on screening programmes,and the average screening rate was 5 p

173、ercentage points lower in 2021 than in 2019.Mortality following AMI and stroke are long-established indicators of the quality of acute care.Both have been declining steadily in the last decade in most countries,yet important cross-country differences still exist.Taking the two indicators together,Me

174、xico and Latvia had by far the highest 30-day mortality rates in 2021,and rates were also relatively high in Estonia and Lithuania.Iceland,Norway,the Netherlands and Australia had the lowest rates(comparisons based on unlinked data,as defined in Chapter 6).LOWHIGHSafe primary careAntibiotics prescri

175、bed(defined daily dose per 1 000 people)Effective primary careAvoidable hospital admissions(per 100 000 people,age-sex standardised)Effective preventive care Mammography screening within the past two years(%of women aged 50-69 years)Effective secondary care30-day mortality following AMI(per 100 admi

176、ssions,age-sex standardised rate)OECDLARGEST IMPROVEMENTGreece-9.8(31%)Finland-9.1(49%)Luxembourg-8.7(37%)Lithuania-802(59%)Poland-441(40%)Slovak Republic-417(40%)Chile+16.5(85%)Greece+16.1(32%)Lithuania+12.9(40%)Chile-4.7(39%)Iceland-3.8(69%)Japan-3.7(31%)13.17.221.7030GreeceAustria4631958270900Trk

177、iyeMexico55.120.283.00100DenmarkMexico6.81.723.7030IcelandMexico|27 HEALTH AT A GLANCE 2023 OECD 2023 Table 1.5.Dashboard on quality of care,2021(unless indicated)Safe primary care Effective primary care Effective preventive care Effective secondary care Antibiotics prescribed(defined daily dose per

178、 1 000 people)Avoidable hospital admissions(per 100 000 people,age-sex standardised)Mammography screening within the past 2 years(%women aged 50-69)AMI Stroke 30-day mortality following AMI or stroke(per 100 admissions aged 45 years and over,age-sex standardised)OECD 13.1+463+55.1-6.8 7.8+Australia

179、16.8-654+47.1-3.3 4.8+Austria 7.2+483+40.1 N/A 5.8 6.6+Belgium 16.0+633-56.1-4.3 8.2+Canada 9.0 N/A 388+59.7+4.7 7.7+Chile N/A N/A 220+35.8+7.2 8.3+Colombia N/A N/A N/A N/A N/A N/A 5.6 6.1+Costa Rica N/A N/A 278+36+N/A N/A N/A Czech Republic 11.5 N/A 577+58.3+6.2 9.4=Denmark 12.6+538+83.0=4.8 4.9+Es

180、tonia 8.7+354+58.7+11.3 9.0-Finland 9.4+490+82.2-7.3 9.1+France 19.3+601+46.9-5.5 7.3+Germany 8.1+728+47.5-8.6 6.6+Greece 21.7+N/A N/A 65.7+N/A N/A N/A Hungary 10.8+N/A N/A 29.8-N/A N/A N/A Iceland 15.7+308+54.0-1.7 3.1+Ireland 16.3+498+62.4-5.4 6.3+Israel 14.4+440+71.9+5.2 5.4+Italy 15.9+214+55.9-5

181、.3 6.6+Japan 12.2+N/A N/A 44.6+8.3 2.9+Korea 16.0+375+69.9+8.4 3.3+Latvia 10.1+N/A N/A 30.8-15.9 20.5-Lithuania 11.7 N/A 554+45.5+10.3 15.4+Luxembourg 14.6+502-53.8-9.9 6.0+Mexico N/A N/A 195+20.2+23.7 17.2+Netherlands 7.6+318+72.7-2.9 4.9+New Zealand N/A N/A N/A N/A 63.3-4.1 5.9+Norway 12.8+477+65.

182、5-2.6 3.1+Poland 18.8-663+33.2 N/A 5.2 11.8+Portugal 13.7+266 N/A 80.2-8.0 10.4+Slovak Republic 14.5+615+25.5-7.4 9.9+Slovenia 8.7+367+77.2+5.1 12.1+Spain 18.4-356+73.8-6.5 9.4+Sweden 8.6+361+80.0 N/A 3.6 5.5+Switzerland N/A N/A 424-49+5.1 5.6+Trkiye 11.3+827 N/A 20.5-6.0 7.6 N/A United Kingdom N/A

183、N/A 403+64.2-6.7 9.0+United States N/A N/A 725+76.1-5.5 4.3-Better than the OECD average.Close to the OECD average.Worse than the OECD average.1.2020 data.2.2019 data.3.2017/18 data.4.2014/15 data.Notes:The symbol+indicates an improvement over time,a deterioration,and=no change.Latvia and Mexico are

184、 excluded from the standard deviation calculation for AMI and stroke mortality.OECD averages shown here differ slightly from those in chapter 6 due to differences in country coverage.Avoidable hospital admissions cover asthma,chronic obstructive pulmonary disease,congestive heart failure and diabete

185、s.28|HEALTH AT A GLANCE 2023 OECD 2023 Health system capacity and resources Having sufficient healthcare resources is critical to a resilient health system.More resources,though,do not automatically translate into better health outcomes the effectiveness of spending is also important.Health spending

186、 per capita summarises overall resource availability.The number of practising doctors and nurses provide further information on the supply of health workers.The number of hospital beds is an indicator of acute care capacity.Figure 1.6 presents a snapshot of health system capacity and resources acros

187、s OECD countries,and Table 1.6 provides more detailed country comparisons.Figure 1.6.Health system capacity and resources across the OECD,2021(or nearest year)Note:Largest increase shows countries with largest changes in absolute value over ten years(%change in brackets).Health spending data from 20

188、22.Source:OECD Health Statistics 2023.Overall,countries with higher health spending and higher numbers of health workers and other resources have better health outcomes,access and quality of care.However,the absolute quantity of resources invested is not a perfect predictor of better outcomes risk f

189、actors for health and the wider social determinants of health are also critical,as is the efficient use of healthcare resources.The United States spent considerably more than any other country(USD 12 555 per person,adjusted for purchasing power)in 2021,and also spent the most when measured as a shar

190、e of gross domestic product(GDP).Health spending per capita was also relatively high in Switzerland,Germany,Norway,the Netherlands and Austria.Mexico,Colombia,Costa Rica and Trkiye spent the least,at less than USD 2 000 per capita.While health spending has typically grown faster than GDP over the pa

191、st decade,its share in the overall economy has fallen in most countries since the height of the pandemic,reflecting the challenging current economic climate.A large part of health spending is translated into wages for the workforce.The number of doctors and nurses is therefore an important indicator

192、 to monitor how resources are being used.In 2021,the number of doctors ranged from less than 2.5 per 1 000 population in Trkiye to over 5 per 1 000 in Norway,Austria,Portugal and Greece.However,numbers in Portugal and Greece are overestimated as they include all doctors licensed to practise.On avera

193、ge,there were just over 9 nurses per 1 000 population in OECD countries in 2021,ranging from less than 3 per 1 000 in Colombia,Trkiye and Mexico to over 18 per 1 000 in Finland,Switzerland and Norway.In Switzerland,associate professional nurses explain this high density.The number of hospital beds p

194、rovides an indication of resources available for delivering inpatient services.COVID-19 highlighted the need to have sufficient hospital beds(particularly intensive care beds),together with enough doctors and nurses.Still,a surplus of beds may cause unnecessary use and therefore costs notably for pa

195、tients whose outcomes may not improve from intensive care.Across OECD countries,there were on average 4.3 hospital beds per 1 000 people in 2021.Over half of OECD countries reported between 3 and 8 hospital beds per 1 000 people.Korea and Japan,however,had far more hospital beds(12-13 per 1 000 peop

196、le),while Mexico,Costa Rica and Colombia had relatively few.LOWHIGHHealth spendingPer capita(USD based on PPPs)Health spending%GDPDoctorsPractising physicians(per 1 000 population)NursesPractising nurses(per 1 000 population)Hospital bedsPer 1 000 populationOECDLARGEST INCREASEUnited States+4.2K(50%

197、)Germany+3.3K(69%)New Zealand+2.8K(87%)Portugal+1.6(41%)Chile+1.4(86%)Ireland+1.4(51%)Korea+4.1(86%)Switzerland+3.2(21%)Australia+2.6(26%)Korea+3.2(34%)Trkiye+0.4(15%)Colombia+0.2(16%)Korea+3.7(61%)Latvia+3.4(63%)Chile+2.0(28%)5.0K12.5K1.2KMexicoUnited States3.76.32.208TrkiyeGreece9.218.91.6020Colom

198、biaFinland4.312.81.0015MexicoKorea9.216.64.3020TrkiyeUnited States|29 HEALTH AT A GLANCE 2023 OECD 2023 Table 1.6 Dashboard on health system capacity and resources,2021(unless indicated)Health Spending(2022)Doctors Nurses Hospital beds Per capita(USD based on purchasing power parities)%GDP Practisin

199、g physicians(per 1 000 population)Practising nurses(per 1 000 population)Per 1 000 population OECD 4 986+9.2+3.7+9.2+4.3-Australia 6 372+9.6+4.0+12.8+3.8+Austria 7 275+11.4+5.4+10.6 N/A 6.9-Belgium 6 600+10.9+3.3+11.1+5.5-Canada 6 319+11.2+2.8+10.3+2.6-Chile 2 699+9.0+2.9+3.7+2.0-Colombia 1 640+8.1+

200、2.5+1.6+1.7+Costa Rica 1 658+7.2-N/A N/A N/A N/A 1.2-Czech Republic 4 512+9.1+4.3+9.0+6.7-Denmark 6 280+9.5-4.4+10.2+2.5-Estonia 3 103+6.9+3.4+6.5+4.4-Finland 5 599+10.0+3.6+18.9+2.8-France 6 630+12.1+3.2+9.7+5.7-Germany 8 011+12.7+4.5+12.0+7.8-Greece 3 015+8.6-6.3+3.8+4.3-Hungary 2 840+6.7-3.3+5.3

201、N/A 6.8-Iceland 5 314+8.6+4.4+15.0+2.8-Ireland 6 047+6.1-4.0+12.7 N/A 2.9 N/A Israel 3 444+7.4+3.4+5.4+2.9-Italy 4 291+9.0+4.1+6.2+3.1-Japan 5 251+11.5+2.6+12.1+12.6-Korea 4 570+9.7+2.6+8.8+12.8+Latvia 3 445+8.8+3.4+4.2-5.2-Lithuania 3 587+7.5+4.5+7.9+6.1-Luxembourg 6 436+5.5+3.0+11.7+4.1-Mexico 1 1

202、81+5.5-2.5+2.9+1.0-Netherlands 6 729+10.2-3.9+11.4+3.0-New Zealand 6 061+11.2+3.5+10.9+2.7-Norway 7 771+7.9-5.2+18.3+3.4-Poland 2 973+6.7+3.4 N/A 5.7+6.3-Portugal 4 162+10.6+6+7.4+3.5+Slovak Republic 2 756+7.8+3.7+5.7-5.7-Slovenia 4 114+8.8+3.3+10.5+4.3-Spain 4 432+10.4+4.5+6.3+3.0-Sweden 6 438+10.7

203、-4.3+10.7-2.0-Switzerland 8 049+11.3+4.4+18.4+4.4-Trkiye 1 827+4.3-2.2+2.8+3.0+United Kingdom 5 493+11.3+3.2+8.7+2.4-United States 12 555+16.6+2.7+12.0+2.8-Above the OECD average.Close to the OECD average.Below the OECD average.1.2020 data.2.2018 data.3.2016/17 data.Notes:The symbol+indicates an inc

204、rease over time,a reduction,and=no change.Japan and Korea are excluded from standard deviation calculation for hospital beds.The United States is excluded from standard deviation calculation for spending per capita and as a share of GDP.30|HEALTH AT A GLANCE 2023 OECD 2023 To what extent does health

205、 spending translate into better health outcomes,access and quality of care?Quadrant charts plot the association between health spending and selected indicators of health system goals.They illustrate the extent to which spending more on health translates into stronger performance across three dimensi

206、ons:health outcomes,access and quality of care.Note,though,that only a small subset of indicators for these three dimensions are compared against health spending,with quadrant charts showing simple statistical correlations rather than causal links.Health spending and health outcomes Figure 1.7 and F

207、igure 1.8 illustrate the extent to which countries that spend more on health have better health outcomes(note that such associations do not guarantee a causal relationship).Figure 1.7.Life expectancy and health expenditure Figure 1.8.Avoidable mortality(preventable and treatable)and health expenditu

208、re There is a clear positive association between health spending per capita and life expectancy at birth(Figure 1.7).Among the 38 OECD countries,18 spend more and have higher life expectancy than the OECD average(top right quadrant).A further 11 countries spend less and have lower life expectancy th

209、an the OECD average(bottom left quadrant).Of particular interest are countries that deviate from this basic relationship.Eight countries spend less than the OECD average but achieve higher life expectancy overall(top left quadrant).This may indicate relatively good value for money of health systems,

210、notwithstanding the fact that many other factors also have an impact on health outcomes.These eight countries are Korea,Spain,Italy,Israel,Portugal,Chile,Costa Rica and Slovenia.The only country in the bottom right quadrant is the United States,with much higher spending than all other OECD countries

211、 but lower life expectancy than the OECD average.For avoidable mortality,there is also a clear association in the expected direction(Figure 1.8).Among OECD countries,18 spend more and have lower avoidable mortality rates(bottom right quadrant),and 10 spend less and have more deaths that could have b

212、een avoided(top left quadrant).Nine countries spend less than average but have lower avoidable mortality rates Israel,Korea,Italy,Spain,Portugal,Greece,Slovenia,Trkiye and Costa Rica(bottom left quadrant).The United States spends more than the OECD average and has worse avoidable mortality rates.AUS

213、AUTBELCANCHLCOLCRICZEDNKESTFINFRADEUGRCHUNISLISRLTULUXNLDNZLNORPOLSVKSWECHETURGBRUSA0.90.9511.0500.511.522.5Health spendingLife expectancy(LE)SpendLESpendLESpendLESVNKORESPITAPRTJPNMEXLVAAUSAUTBELCHLCOLCRICZEDNKESTDEUGRCHUNISLIRLISRITAJPNKORLVALTUMEXNLDNZLNORPOLPRTSVKSVNESPCHETURGBRUSA00.511.522.530

214、0.511.522.5Health spendingAvoidable mortality(AM)Spend AMSpend AMSpend AMLUXFRA|31 HEALTH AT A GLANCE 2023 OECD 2023 Health spending,access and quality of care Figure 1.9 and Figure 1.10 illustrate the extent to which countries that spend more on health deliver more accessible and better-quality car

215、e(note that such associations do not guarantee a causal relationship).Figure 1.9.Satisfaction with availability of quality services and health expenditure Figure 1.10.Breast cancer screening and health expenditure In terms of access,Figure 1.9 shows a clear positive correlation between the share of

216、the population satisfied with the availability of quality healthcare where they live and health spending per capita.Among OECD countries,14 spent more and had a higher share of the population satisfied with availability than the OECD average(top right quadrant).The converse was true in 14 countries(

217、bottom left quadrant).In Canada,health spending was 27%higher than the OECD average,but only 56%of the population were satisfied with the availability of quality healthcare(compared to 67%on average across OECD countries).In Korea and the Czech Republic,health spending per capita was relatively low,

218、but a noticeably greater share of the population were satisfied with the availability of quality healthcare than the OECD average.In terms of quality of care,Figure 1.10 shows the relationship between health spending and breast cancer screening rates.While there is an overall weak positive correlati

219、on between health spending and the share of women screened regularly,nine countries spent less than the OECD average yet had higher cancer screening rates(top left quadrant),while seven countries spent more than the OECD average and had lower cancer screening rates(bottom right quadrant).AUSAUTBELCA

220、NCHLCOLCRICZEDNKESTFINFRADEUGRCHUNISLIRLISRITAJPNKORLVALTULUXMEXNLDNZLNORPOLPRTSVKSVNESPSWECHETURGBR00.511.500.511.522.5Health spendingAccess(satisfaction with services)Spend AccessSpendAccessSpendAccessUSAAUSAUTBELCANCHLCRICZEDNKESTFINFRADEUGRCHUNISLIRLISRITAJPNKORLVALTULUXNLDNZLNORPOLPRTSVKSVNESPS

221、WEGBRUSA0.40.60.811.21.41.600.511.522.5Health spendingQuality(cancer screening)SpendQualitySpend QualitySpend Quality|33 HEALTH AT A GLANCE 2023 OECD 2023 OECD countries are struggling to maximise the value from digital health because technologies and the data environment are often outdated and frag

222、mented.This chapter explores the concept of digital health readiness assessing the policy,analytic,technical and social environment that enables successful use of digital health.The concept of readiness is taking on increased urgency with the realisation that digital health is an emerging determinan

223、t of health.The chapter first looks at the policy components of an integrated digital health ecosystem to establish dimensions of digital health readiness analytic,data,technology and human factor readiness.It then compiles and analyses indicators to measure readiness in these dimensions.The chapter

224、 concludes with a brief exploration of digital transformation as a determinant of health,providing some examples of the benefits of digital health in acute care to lower costs and improve the patient experience.2 Digital health at a glance 34|HEALTH AT A GLANCE 2023 OECD 2023 Introduction Digital to

225、ols and the use of health data are transforming how health services are delivered,how public health is protected,and how chronic conditions are managed and prevented.Digital health1 is playing an ever-increasing role in health systems through electronic health records(EHRs),the use of population hea

226、lth data for monitoring and policy,and the integration of digital tools such as telemedicine into routine clinical care.An integrated approach to digital health also supports the responsible use of artificial intelligence(AI)and analytics,by sharing quality health data through secure technical conne

227、ctions across all modes of care and administration.Digital transformation has been described as a determinant of health,as digital technologies,access,and literacy increasingly influence health,well-being and health transformations.OECD countries are striving to realise the potential of digital heal

228、th while minimising possible harms.While health has been slower than other sectors of the economy to leverage the potential of digital transformation,the COVID-19 pandemic has accelerated change.However,there are still significant barriers to overcome for countries to be ready for digital transforma

229、tion.For example,health systems continue to rely on fax machines,with 75%of global fax traffic used for medical services(Gintux,20231);life-saving innovations are discovered,but it can take 17 years for published leading practice to become common practice(Morris,Wooding and Grant,20112);health provi

230、ders express concern over their new digital burden while not receiving benefits from modern technologies(OECD,20193);and the public cannot engage meaningfully in their care without access to their own health records.Meanwhile,the digital landscape is complicated by the different stakeholders involve

231、d.Alongside public systems,some large multi-national private sector entities offer specific interventions,such as subscription models for integrated care that,without suitable regulation,create data silos.Conflicting,uncoordinated systems of health data use and access risk health systems being unawa

232、re of inequities and preventing the utilisation of data for public health protection and health system improvement.Through the pandemic,the eyes of the public and policy makers were opened to the necessity of timely and quality data to inform evidence-based policy making during the crisis.The public

233、 began to engage with their own health data and providers virtually,and learned a new language of statistics,R-values,positive testing rates and vaccinations.The pandemic furthered interest in health data privacy,security and governance,in addition to opportunities for innovative analytics.For examp

234、le,digital health enabled:Canada,Latvia,Spain,the United Kingdom and the United States to scale up remote disease management and monitoring;Costa Rica,the Czech Republic,Finland,Latvia,Spain and the United States to improve care co-ordination and integration;Australia,Austria,the Czech Republic,Luxe

235、mbourg and Spain to improve electronic prescribing.Governance,legal,and regulatory changes are necessary to support adaptation to a digital health future without loss of protections for the public(OECD,20234).In early 2023,with the backdrop of increased attention to ChatGPT,the potential of AI caugh

236、t public interest and concern.There are opportunities for AI in health from automating administrative processes to aiding health professionals in diagnosis,powering medical devices for improved treatment,virtually testing millions of antibiotics for superbugs,and discovering new methods to prevent o

237、r better treat chronic conditions.There are also risks with,but not always caused by AI,including biased algorithms that exacerbate inequities,lack of clinical validation that risks patient safety,and potential for privacy breaches.At the same time,with greater reliance on digital health are growing

238、 risks of cyberattacks.Some project that the cost of cyberattacks(across all industries)may reach USD 10.5 trillion by 2025(Forbes,20235).Health is a prime target for cybercrime given the sprawl of health technologies,the value of health data,and the risk of disruption in health services from techni

239、cal outages.Most countries are pursuing these opportunities while addressing risks through the implementation of digital health strategies.These strategies acknowledge the importance of taking the lessons learned from the COVID-19 pandemic and providing better health services and outcomes for the pu

240、blic,while addressing the digital divide.There is an opportunity for investments in digital strategy to generate potential returns of USD 3 for every USD 1 of investment.These returns come from improved health outcomes,reduction of waste,and minimised duplication,while also supporting more resilient

241、 health systems(OECD,20193).Countries ability to recognise the above factors in health data systems and to develop infrastructure,strategies,and governance frameworks to use in improving health systems is a signal of“digital health readiness”.This is a measure of the ability to make use of analytics

242、,data,and technology for beneficial individual,community,and public health outcomes.Digital health readiness is the foundation from which data can be leveraged for primary and secondary uses to improve well-being,health outcomes,and resilience.|35 HEALTH AT A GLANCE 2023 OECD 2023 This thematic chap

243、ter examines countries digital health readiness“at a glance”,with a focus on indicators of readiness to realise benefits from digital health while minimising its harms.These indicators are not exhaustive;nor are all indicators specific to the health sector.The chapter provides the groundwork for a m

244、ore comprehensive approach to a robust suite of digital health indicators for readiness.While data are not currently available across all dimensions of digital health readiness(Box 2.1),this chapter details the dimensions of a framework and signals the need for more regular data collection and polic

245、y discussions about the indicators.Looking forward,it may be appropriate to consider aspects of integration with social data(e.g.social determinants of health,social programme usage)for an overall view of health and well-being.Box 2.1.Definition of digital health and dimensions of digital health rea

246、diness Despite the increased importance of digital health,consistent terminology is elusive;this impairs cross-border collaboration and prevents scaling of innovation for better health outcomes.The scope of digital health can be limited to the type and use of digital technologies;it could be focused

247、 on improvement of healthcare delivery;or it could be a strategy for fulsome health system transformation(HIMSS,20206).The Global Strategy on Digital Health 2020-25 of the World Health Organization(WHO)brings together primary uses of digital tools with secondary uses for populations and the public.A

248、 connection between secondary generation of insights and their use in healthcare,promotion,and prevention creates a continuous improvement cycle that benefits everyone(WHO,20217).As such,digital health readiness provides a foundation for primary uses(e.g.by clinicians and patients for care,and by in

249、dividuals for their agency)and secondary uses(e.g.for population health,health system continuous improvement,public health,and research and innovation).Building on the WHO definition,this document defines digital health as follows(with added parts in bold):The field of knowledge and practice associa

250、ted with the development and use of health data and digital technologies to improve health.Digital health expands the concept of eHealth to include digital consumers,with a wider range of smart devices,connected equipment,and digital therapeutics.It also encompasses other uses of data and digital te

251、chnologies for health such as the Internet of things,artificial intelligence,big data and robotics,and predictive and prescriptive analytics.Analytics can be for health system improvement,public health preparedness,or research and innovation.In this context,the dimensions of digital health readiness

252、 include analytic readiness(for responsible analytics);health data readiness(for integrated health data);technology readiness(for robust technology);and human factor readiness(for capacity,co-operation,and oversight).Collectively,these need to be designed to work together to optimise health outcomes

253、 while minimising harms.When responsible analytics,integrated health data and reliable technology are brought together,they form an integrated digital health ecosystem.Figure 2.1.Integrated Digital Health Ecosystem Source:Sutherland,E.(forthcoming8),“Policy checklist for integrated digital health ec

254、osystems”.Robust technologyPrimary use(Information and analytics)Secondary use(Information and analytics)Human factorsIntegrated health data36|HEALTH AT A GLANCE 2023 OECD 2023 The chapter first outlines the dimensions of digital health readiness across analytics,health data and technology,as well a

255、s the human factors that provide trust,coherence,and sustainability.Indicators are mapped to a subset of components with some proxy measures to analyse the performance of OECD countries within the framework.Second,the chapter discusses the indicators and their findings through the dimensions of digi

256、tal health readiness,which include analytic readiness,data readiness,technology readiness,and human factor readiness.The chapter further identifies countries that perform well consistently across the chosen digital health readiness indicators.Third,the chapter looks at sample health outcomes and the

257、ir relationship with dimensions of readiness to explore digital health readiness as a determinant of health.Further,this chapter discusses examples and opportunities to evaluate the relationship between digital health readiness and effects on costs and health outcomes.Finally,the chapter summarises

258、findings from the first three sections.It concludes with a call for further work on developing measures of digital health readiness to improve understanding of its relationship with positive health outcomes,lower costs,and higher levels of innovation.Framework for digital health readiness assessment

259、 The performance of digital health is not as easy to measure as indicators in other chapters in Health at a Glance,as it is both a new discipline and one that is constantly changing.The issue is exacerbated by the somewhat elusive definition of digital health(as discussed in Box 2.1).Digital health

260、readiness is a measure of the ability to make use of analytics,data,and technology for beneficial individual,community,and public health outcomes.Hence,“readiness”is a composite of abilities and structures across analytics,data,and technology.In addition,readiness requires human factors outlined abo

261、ve for capacity,co-operation,and oversight.Dimensions of digital health readiness are categorised as follows:Analytic readiness assesses the readiness for analytics to be created and used to generate action that improve health outcomes for individuals,communities,and the public.The objective of anal

262、ytic readiness is responsible analytics that are trusted and inform equitable health outcomes.In health,this includes readiness to develop and deploy responsible AI to help doctors and nurses in their routine tasks(e.g.documenting cases)or diagnostics(e.g.interpreting radiology images).Data readines

263、s assesses the readiness for data to be collected,accessed,and used in analytics.The objective of data readiness is integrated and quality health data that are available for healthcare,public health,health system improvement,research,and innovation.For example,data readiness includes policies that e

264、nable data protection,de-identification,access,and linking to help improve the safety of health systems.Technology readiness assesses the readiness for technology to support the secure input,storage,and movement of data.The objective of technology readiness is robust technology that is resilient to

265、digital security risks and technology outages while maintaining data integrity.This includes aspects of technical interoperability that,when combined with semantic interoperability,allow health systems to communicate with each other with high data quality and timeliness.Human factor readiness assess

266、es the readiness of the digital health ecosystem(including analytics,data,culture,and technology)to achieve its objectives with sufficient resources and to be resilient to shocks.The objective of human factor readiness is to foster trust among stakeholders,acquire sufficient financial and human reso

267、urces,encourage co-operation and re-use for mutual benefit,and adapt to emerging issues and challenges.Included in this is digital health literacy to ensure that the public,providers,and policy makers have the knowledge necessary to use the digital health ecosystem effectively,including its necessar

268、y protections.Collectively,a health system that has high digital health readiness is designed to optimise positive health outcomes while minimising harms from analytic,data,or technology misuse.High digital health readiness is aligned with OECD legal instruments for artificial intelligence(AI),healt

269、h data governance,and digital security,and digital identity(see Box 2.2).|37 HEALTH AT A GLANCE 2023 OECD 2023 Box 2.2.OECD legal instruments and digital health readiness Health data governance In 2017,OECD countries endorsed a Recommendation on Health Data Governance that encourages adoption of a n

270、ational health data governance framework,12 components of that framework,and co-operation on definition and implementation of interoperability standards.In practice,the Recommendation covers a broader perspective around digital health,all of which contributes to digital health readiness.The table be

271、low maps which parts of the Recommendation apply to which parts of digital health readiness,noting that all areas are ultimately required for digital health.Recommendation on health data governance Dimensions of digital readiness Engagement and participation of stakeholders in the development of a n

272、ational health data governance framework Human factors Co-ordination within government and co-operation among organisations processing personal health data to encourage common data-related policies and standards Human factors Reviews of the capacity of public sector health data systems to serve and

273、protect public interests Human factors Clear provision of information to individuals about the processing of their personal health data including notification of any significant data breach or misuse Technology The processing of personal health data by informed consent and appropriate alternatives D

274、ata The implementation of review and approval procedures to process personal health data for research and other health-related public interest purposes Data Transparency through public information about the purposes for processing of personal health data and approval criteria Human factors Maximise

275、the development and use of technology for data processing and data protection Technology Mechanisms to monitor and evaluate the impact of the national health data governance framework,including health data availability,policies,and practices to manage privacy,protection of personal health data and d

276、igital security risks Human factors Training and skills development of personal health data processors Human factors Implementation of controls and safeguards within organisations processing personal health data including technological,physical,and organisational measures designed to protect privacy

277、 and security Data Technology Requiring that organisations processing personal health data demonstrate that they meet the expectations set out in the national health data governance framework Human factors Source:OECD(20169),Recommendation of the Council on Health Data Governance,https:/legalinstrum

278、ents.oecd.org/en/instruments/OECD-LEGAL-0433.Artificial Intelligence(AI)In 2019,the OECD published value-based principles for AI.These apply to the development of AI,although they are appropriate for general practices in analytics.The principles for AI are consistent with and complementary to the OE

279、CD Recommendation on Health Data Governance.Recommendation on artificial intelligence Description Dimensions of digital readiness Inclusive growth,sustainable development,and well-being Stakeholders should proactively engage in responsible stewardship of trustworthy AI in pursuit of beneficial outco

280、mes for people and the planet Analytic Human-centred values and fairness AI actors should respect the rule of law,human rights,and democratic values,throughout the AI system lifecycle Analytic Transparency and explainability AI actors should commit to transparency and responsible disclosure regardin

281、g AI systems Analytic Robustness,security,and safety AI systems should be robust,secure,and safe throughout their entire lifecycle so that in conditions of normal use,foreseeable use or misuse,or other adverse conditions they function appropriately and do not pose unreasonable safety risk Analytic A

282、ccountability AI actors should be accountable for the proper functioning of AI systems and for the respect of the above principles,based on their roles and the context,and consistent with the state of the art Analytic Source:OECD(201910),Recommendation of the Council on Artificial Intelligence,https

283、:/legalinstruments.oecd.org/en/instruments/OECD-LEGAL-0449.38|HEALTH AT A GLANCE 2023 OECD 2023 Digital security In 2022,OECD countries endorsed a Recommendation on Digital Security Risk Management that provides a set of nine principles for digital security and encourages OECD countries to adopt nat

284、ional approaches to digital security risk management.These will help to minimise the risk of successful cyberattacks and the impacts if an attack should be successful.The principles for digital security risk management are consistent with and complementary to the OECD Recommendation on Health Data G

285、overnance.Recommendation on digital security risk management Description Dimensions of digital readiness Digital security culture:awareness,skills,and empowerment All stakeholders should create a culture of digital security based on an understanding of digital security risk and how to manage it Tech

286、nology Responsibility and liability All stakeholders should take responsibility for the management of digital security risk based on their roles,the context,and their ability to act Technology Human rights and fundamental values All stakeholders should manage digital security risk in a transparent m

287、anner and consistently with human rights and fundamental values Technology Co-operation All stakeholders should co-operate,including across borders Technology Strategy and governance Leaders and decision makers should ensure that digital security risk is integrated in their overall risk management s

288、trategy and managed as a strategic risk requiring operational measures Technology Risk assessment and treatment Leaders and decision makers should ensure that digital security risk is treated based on continuous risk assessment Technology Security measures Leaders and decision makers should ensure t

289、hat security measures are appropriate to and commensurate with the risk Technology Resilience,preparedness and continuity Leaders and decision makers should ensure that a preparedness and continuity plan based on digital security risk assessment is adopted,implemented,and tested,to ensure resilience

290、 Technology Innovation Leaders and decision makers should ensure that innovation is considered Technology Source:OECD(202211),Recommendation of the Council on Digital Security Risk Management,https:/legalinstruments.oecd.org/en/instruments/OECD-LEGAL-0479.Governance of Digital Identity In June of 20

291、23,the OECD adopted Recommendations on the Governance of Digital Identity.These aim to support domestic approaches to digital identity that are user-centred and trusted.The recommendations on digital identity are consistent with and complementary to the OECD Recommendation on Health Data Governance.

292、Recommendation on digital identity Description Dimensions of digital readiness User-centred and inclusive digital identity systems Designing and implementing digital identity systems that are effective,usable,and responsive to the needs of users and service providers,while prioritising inclusion,red

293、ucing barriers to access,and preserving non-digital ways to prove identity Data Strengthening the governance of digital identity Defining roles and responsibilities and align legal and regulatory frameworks across the digital identity ecosystem(s).Protecting privacy and prioritising security to ensu

294、re trust in digital identity systems Data Cross-border use of digital identity Co-operating internationally to establish the basis for trust in other jurisdictions digital identity systems and issued identities.Understanding needs of users and service providers in different cross-border scenarios Da

295、ta Source:OECD(202312),Recommendation of the Council on the Governance of Digital Identity,https:/legalinstruments.oecd.org/en/instruments/OECD-LEGAL-0491.|39 HEALTH AT A GLANCE 2023 OECD 2023 Digital health readiness is the foundation for primary and secondary uses of data and technology across all

296、 sectors of healthcare delivery and management.When considerations of the links to and from other parts of the digital health ecosystem and the readiness of the environment to support their long-term,sustainable use are lacking,the result is fragmented solutions that cannot be integrated.Understandi

297、ng the policies required for a digital health ecosystem will help to guide the selection of indicators for digital health readiness that support the ability to integrate solutions into broader policies for care,safety,and system effectiveness.In systems with high digital health readiness,these polic

298、ies should be designed together to orchestrate activities across analytics,data,and technology;this also reduces overlap and avoids policy inconsistencies or contradictions.Figure 2.2 represents a checklist of policies for digital health ecosystems.Figure 2.2.Checklist of policies for an integrated

299、digital health ecosystem(IDHE)Source:Sutherland,E.(forthcoming8),“Policy checklist for integrated digital health ecosystems”.As digital health readiness is a fundamental component of an efficient and modern health system,efforts should be made to facilitate regular capture and analysis of appropriat

300、e indicators to monitor it.Ideally,digital health readiness would have indicators for each of the policy areas in Figure 2.2.These could start by measuring the existence of the relevant policy and evolve into indicators that measure the effectiveness of implementation of that policy.Currently,there

301、is no comprehensive capture of such indicators.Table 2.1 includes a set of initial measures of digital health readiness.Proxies have been used where direct data are not available.Most proxies are not specific to health.Analytics and use:Creates value from data to continuously improve individual and

302、system outcomesIntegrated health data:Links data across domains with high quality,encouraging re-use with privacy protection in placeRobust technology:Interfaces between technologies and people optimising for security and user experienceHuman factors:Oversight,engagement,funding,capacity,and capabil

303、ity to sustain the IDHE and adapt Algorithmic integrityIndicatorsAccess for primary useAccess for secondary useAccess for commercial useAnalytic risk managementDigital identityData life cycle managementOwnership,stewardship and custodianshipAccess and privacy risk managementSemantic interoperability

304、Indigenous and community dataTechnology procurement and managementDigital security risk managementTechnical interoperabilityInformation architectureInterfacesTelecommunicationsUsesBuilt onLiteracy,capacity and capabilityKnowledge management and sharingPublic,provider,and stakeholder involvementCommu

305、nicationStrategic governance and financeOperational governance40|HEALTH AT A GLANCE 2023 OECD 2023 Table 2.1.Initial indicators for digital health readiness including proxy measures Dimension of digital health readiness Associated policy area Indicator or proxy presented in this chapter Comment Anal

306、ytic readiness Access for primary use Access for secondary use Dataset availability,maturity and use score(OECD)Patient access to their own health data(OECD)Algorithmic integrity Global AI Index(third party)Proxy measure Data readiness Data lifecycle management Dataset governance score(OECD)Digital

307、identity Digital Government Index(OECD)Proxy measure Semantic interoperability Technical interoperability Interoperability standard adoption(OECD)Should extend to semantic data standards Technology readiness Internet availability Internet connectivity for individuals(OECD)For entire population Digit

308、al security Digital security(OECD)Technology procurement Certification of vendors(OECD)Human factor readiness Strategic governance Digital health strategies(various)Literacy,capacity and capability Digital skills in Europe(third party)Proxy measure Public,provider and stakeholder involvement Digital

309、 citizen engagement index(third party)Proxy measure These indicators are presented in more depth in the next section.Indicators of digital health readiness Digital health is emerging as an essential component of health systems,with recent literature indicating that digital transformation is a determ

310、inant of health(The Lancet Digital Health,202113).To manage digital health better,it is necessary to measure the effectiveness and efficiency of the creation of analytics,data,and technology.This will help to strengthen the foundations of healthcare for the digital age.This section reviews each of t

311、he dimensions of readiness defined in the above section based on the indicators from Table 2.1.These indicators are an incomplete view of readiness for digital health;however,they may provide inspiration for future work to better define comprehensive indicators and support routine data collection.Su

312、ch work would also help to identify leaders in digital health(to share expertise)as well as gaps where there is mutual benefit in collaboration.Analytic readiness indicators Analytics are the part of digital health that generates value for people,communities,and society.This value is generated in di

313、verse ways for example,by providing better precision healthcare for individuals,addressing health inequities for marginalised communities,protecting the public from health emergencies,supporting more effective health monitoring and financing policies,and discovering new life-saving innovations.Three

314、 areas that are essential for analytic readiness are the ability to access and link data for healthcare and secondary use,the ability for individuals to access their own data,and the ability to apply analytic techniques,as with AI.Ability to access and link data primary and secondary uses The readin

315、ess to create meaningful analytics and ensure their appropriate use is dependent on timely access to quality data and the ability to link data across datasets.Primary uses of these data are for healthcare whenever and wherever necessary across primary care,acute care,and individual data use.Secondar

316、y uses of data include patient safety,public health preparedness,health service management and planning,health system improvement,and research and innovation.In 2022,the OECD performed a five-year review of the Recommendation on Health Data Governance(OECD,20169).This reported on capabilities to lin

317、k and use data across critical data domains.The score for analytic readiness demonstrated wide variation among OECD countries(see Figure 2.3).|41 HEALTH AT A GLANCE 2023 OECD 2023 Figure 2.3.Ability to access and link datasets in healthcare Note:Lithuania and Spain have reported this capability,but

318、no data were available in the survey when it was conducted.Source:OECD(202214),Health Data Governance for the Digital Age:Implementing the OECD Recommendation on Health Data Governance,https:/doi.org/10.1787/68b60796-en.The dataset availability score is a composite indicator that incorporates eight

319、measures including:timely data access that covers the national population across care settings and clinical registries;use of interoperable clinical data standards and identifiers that enable linking across datasets;use of linked data for primary and secondary health purposes.In this indicator,Denma

320、rk had the highest composite score,followed by Korea,Sweden,Finland and Latvia.Denmark scored highest in seven of the eight measures:the country reported that data were extracted from electronic records for all key datasets,coded using clinical data standards,covering more than 80%of the population,

321、and linkable by a unique patient identifier.Further,linked data were used for healthcare quality,performance,research,and monitoring.Only Latvia scored higher than Denmark on timeliness of data,with a greater percentage of data available for use within one week.Korea performed similarly to Denmark,e

322、xcept for linking a registry for cardiovascular disease with other data.Sweden also performed similarly,except for linking primary care data and only having one dataset available within one week of the original data creation at source.Ability to access and link data individual use Both the OECD Reco

323、mmendation on Health Data Governance(OECD,20169)and WHOs Global Strategy on Digital Health 2020-2025(WHO,20217)call for individuals to have access to their own health records.With this access,individuals will be more knowledgeable about the state of their well-being.It will facilitate conversations

324、with health providers as the individual will no longer need to remember their prior vaccinations,prescriptions,test results,or medical treatments.In more advanced EHR systems,the individual can contribute information to their health record to report on symptoms,correct errors,or progress with health

325、 treatments.In 2021,the OECD published a Survey of Electronic Health Record System Development,Use and Governance.This showed variation in availability of portals,the ability to access all records,and the ability to interact with data.The findings are summarised in Table 2.2.Almost 90%of responding

326、OECD countries reported having an electronic portal in place;however,only 42%reported that the public could both access and interact with all their data through the portal.Fewer than half of responding countries indicated that all patients could access their data via portals.Denmark,Italy,Lithuania,

327、Luxembourg and Trkiye reported having a portal for patients to access their comprehensive health data that was available to their entire population.Further,their portals allowed patients to interact with their data.012345678Dataset availability score42|HEALTH AT A GLANCE 2023 OECD 2023 Table 2.2.Pat

328、ient access to and interaction with their own EHRs through a secure internet portal Access via portal Access to ALL records Interaction with portal Access via portal Access to SOME records Interaction with portal Access via portal Access to ALL records NO interaction with portal NO access via portal

329、 11 Australia Denmark 9 Germany Belgium Italy Canada Lithuania Costa Rica Luxembourg Czech Republic Netherlands Finland Slovenia Iceland 3 3 Sweden Israel Estonia Korea Switzerland Portugal Hungary Mexico Trkiye United States Japan Norway Note:Countries in bold reported that 100%of patients are cove

330、red.Some OECD countries,like the Netherlands,use multiple EHR portals.Spain also has this capability,but no data was available in this survey.Source:Slawomirski,L.et al.(202315),“Progress on implementing and using electronic health record systems:Developments in OECD countries as of 2021”,https:/doi

331、.org/10.1787/4f4ce846-en.Artificial Intelligence(AI)and algorithmic integrity Readiness of analytics is also dependent on integrity of the methods used to create the analytics.This issue has gained more prominence owing to increased awareness of the potential benefits and risks of AI.AI holds the po

332、tential to revolutionise healthcare by improving diagnostics,helping with development of new treatments,supporting providers,and extending healthcare beyond the health facility and to more people.Projections have suggested that the use of AI could lead to vaccines against cancer and cardiovascular a

333、nd autoimmune diseases by the end of this decade(The Guardian,202316).AI is already being used to find new antibiotics(McMaster University,202317).However,AI also has significant risks due to potential biases and lack of transparency of the algorithms created.Implementation of AI has both the potential to help address issues of equity and the potential to expand inequities.Broad measures of AI are