Everyone puts off visits to the doctor and dentist at one point or another; but how often do people forego a check-up, treatment, or decide not to fill a prescription just because it costs too much?

The developing world needs millions of trained health workers immediately just to provide the most basic healthcare, yet doctors are leaving poor countries to go to richer ones.

The pharmaceutical industry’s important role in the OECD economy is reflected in expenditure, with a total of US$569 billion on pharmaceuticals (excluding pharmaceuticals for in-patients) in 2005.

Diabetes has become one of the most serious public health challenges of the 21st century. Over 150 million adults are affected worldwide, with the number expected to double in the next 25 years.

In 2002, the cost of diabetes in the United States was an estimated $92 billion in medical expenditures and $40 billion in lost productivity, according to the American Diabetes Federation.

“Attitudes are the real disability”, says Henry Holden, a well-known comedian and advocate for the disabled. Education is clearly important in this respect, but ironically, schools themselves have much to do in how they deal with disabled students.

You rightly point out that “the supply of medical staff reflects global movements of labour” (No 262, Databank, July 2007). But many of us might disagree with your upbeat headline: “Healthy immigration”. In a report published in 2005, the Royal African Society argues that while recruitment of African medical professionals has shored up western health services, it has left the health sector in sending countries facing permanent crisis or even complete collapse.

Everyone accepts that education is vital for a healthy economy, but now there is strong evidence that it contributes to a healthy body too. Understanding the Social Outcomes of Learning makes the claim that those with more schooling also tend to have better health, as well as more civic engagement.

Ageing will boost demand for healthcare, but at a time when healthcare professionals are themselves ageing, how can that demand be met? Suppose a scenario with no growth in the demand for doctors in a country, and no migration either.

There are roughly 45 million disabled people living in Europe, but how do they and elderly people like to get around? They would call a taxi. The combination of the personal service that taxis offer, their wide availability and door-to-door operations enable them to respond particularly well to this population’s special travel needs. Although several countries have made progress in improving the accessibility of taxi services, much remains to be done.

In October 2006, 16-year-old Lisa Norris died at home in Scotland after receiving 17 overdoses of radiation treatment for a brain tumour. Nearly 200,000 people could be dying each year in the US because of in-hospital medical errors, suggests a 2004 study by healthcare company Health Grades. According to a recent survey conducted for the European Commission by Eurobarometer, four out of five Europeans think that medical error is an important issue in their country, and nearly one in four said that they or a member of their family had been personally affected by clinical mistakes.

The supply of medical staff also reflects global movements of labour. Indeed, there were some 1.3 million foreign born health professionals–nurses, doctors, pharmacists, dentists, etc.–living in OECD countries in 2000, according to a special report in the latest International Migration Outlook.

Whole communities in the developing world are being crippled by neglected infectious diseases. Changing the way intellectual property rights are managed is vital for attracting the pharmaceutical investment needed to tackle them. Every eight months a new infectious disease appears, joining the roster of those that already affect one in six people on earth. The vast majority of those infected live in developing nations.

Are you a left-brain or a right-brain person? Do you learn while you sleep? Do men and boys have different brains than women and girls? Popular misconceptions such as these pepper ads, magazine covers and conversations. What is fiction and what is fact, and where did they originate?

Traditionally a male bastion in many countries, the medical profession has seen the proportion of female doctors steadily increasing, accounting now for an average of 38% of all doctors in OECD countries, up from 24% a quarter of a century ago.

The performance of health care systems is under scrutiny. The Health Care Quality Indicator Project can help identify what works and what does not. And that will help policy decisions too.

Switzerland’s health system is arguably one of the world’s best, but at what cost? This is a question raised in a new report produced jointly by the OECD and the World Health Organization (WHO).

The public cost of health and long-term care in OECD countries will double by 2050 if current trends continue, a new OECD report finds. The rising medical demands of ageing and wealthier populations could send average health costs in the OECD area up from 6.7% of GDP to 12.8%. Even if governments manage to contain that rise, spending would still reach the equivalent of around 10% of GDP by the middle of the century.

Is there a connection between health spending and life expectancy? Not necessarily. As the latest edition of the OECD in Figures 2005 points out, the Japanese have the highest life expectancy in the OECD area, but their health spending, at nearly 8% of GDP, is far from being the highest. The US on the other hand has the highest health spending at some 15%, yet it clocks in at just 22nd when it comes to life expectancy–Americans can nevertheless expect to live past 77. The lowest spender is Korea (5.6% of GDP), with a life expectancy also of 77 years.

The US was the highest per capita drug spender in 2003, at more than US$700 per person, followed by France at just over $600, and Canada and Italy at about $500 each.

OECD inhabitants are living longer and healthier lives. But while health is an important driver of welfare expenses, the cost of elderly care also has a major impact on budgets. When the cohorts of the babyboom generation reach the oldest age groups over the next three decades, demand for long-term care will rise steeply. That is why many OECD countries have stepped up services that allow older people to stay at home as long as possible. Home care now accounts for more than 30% of public resources in more than a third of the OECD countries.

The value of shared learning and mutual understanding: this was a key message of the OECD Health Ministers Meeting last May. The agenda showed the myriad areas where economic analysis can enrich policy design: from quality, efficiency and cost-effective provision, to the economics of prevention and the incentives for innovation.

Record numbers of people are moving to OECD countries to find jobs or join their families, despite an economic downturn in some countries. More than a million permanent immigrants entered the US in 2001 and 2002, some 25% more than in 2000, according to the latest issue of the OECD’s Trends in International Migration.

Every year, 1.2 million people are killed worldwide as a result of road accidents and up to 50 million more are injured. Most of these are in non-OECD countries, but no one can feel complacent. In Europe, more than 100,000 people die, while a further 2 million people are injured. Road accidents are the principal cause of death for young men under 25.

Infectious diseases can emerge and spread with deadly and debilitating effects. But they can be stopped, as experience from SARS shows.

A new study by the OECD’s Development Assistance Committee (DAC) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) demonstrates a clear trend toward rising aid donations to fight HIV/AIDS.

In an age obsessed with economic efficiency and tax cuts, it is ironic that by allowing health systems in developing countries to deteriorate, the industrialised world is engaged in one of the most dangerous experiments in false economy in history.

Biotech is set for a great future in healthcare. Here is why.The history of business enterprise is filled with heroes and villains. In the 20th century, we had our pick of industries to hate, including cigarette purveyors, alcohol producers, automobile manufacturers, and so on, that could be accused of damaging our health, polluting our air, endangering our children or, in general, putting their profits above society’s well-being.

This is a pivotal time in the fight against cancer. Since the National Cancer Act of 1971, the United States has made conquering cancer a national priority. The great strides made in research have led to the understanding that cancer, once a seemingly mysterious and unconquerable foe, is a disease process whose mechanisms can be elucidated and controlled.

Every year, over 2.2 million workers die in over 270 million occupational accidents, or from 160 million new cases of reported occupational diseases. Many more are injured or incapacitated because of their work.

Investment in health is not only a desirable, but also an essential priority for most societies. However, our health systems face tough and complex challenges, in part derived from new pressures, such as ageing populations, growing prevalence of chronic illnesses, and intensive use of expensive yet vital health technologies.

More new drugs, and with a higher price tag, have pushed pharmaceutical expenditure up in OECD countries in the past decade. The higher cost of drugs has increased the share of the total health budget devoted to pharmaceuticals in most OECD countries, the latest edition of the OECD’s Health at a Glance shows.

Hospital stays are getting shorter, and concerns are being raised in some OECD countries that mothers are being sent home too soon after giving birth, the latest OECD Health Data shows.

Letter to the editor: Your healthcare special raises some interesting points about the role of insurance and the differences across OECD countries (Observer No. 229, November 2001, also available online). But maybe your expectations of private insurance provision are a little optimistic.

OECD societies are healthier than ever, and yet spend more on health care. To some, this appears as a paradox, in that the fitter you become, the less you should need to invest in getting better. To others, we are healthier because we spend more. For policymakers, the question is simple: is the rise in costs affordable and are health care systems becoming more efficient, delivering more value for money?

Obesity is a growing problem in OECD countries, OECD Health Data 2003 shows. Its prevalence varies from country to country, from a low of 3% of the population in Korea and Japan in 2001, to a high of 31% in the United States in 1999.

Measuring the value of health care is a tricky business. Traditional data, for instance, might give the number of hospital beds or doctors per 100,000 inhabitants, but what if some people using health care are getting better while others are not? Or what if they are getting better but at much greater expense than in other countries?

The following is a government health warning: just when you thought your health spending was under control, the cost pressures are likely to start rising again.

Health before wealth is more than just an old adage, and in the build-up to the WTO meeting at Cancún in September, we look at why programmes that aim to protect and improve the health of poor people can help in the battle against global poverty.

As the Tour de France celebrates its 100th anniversary, it seems an opportune time to praise the healthy virtues of cycling. In many countries, cycling is firmly established as a standard way of getting around. In Nordic countries, as well as in some British and German towns, cycle lanes are increasingly commonplace, sometimes as part of an integrated park-and-ride scheme with rail or bus. And, of course, bicycles have long been supreme in the Netherlands.

The current concerns about severe acute respiratory syndrome (SARS) serve as a stern reminder of the potential impact of infectious diseases, bringing home to us the economic as well as the human costs. Since WHO issued its first SARS alert on 12 March, 17 countries have been affected, over 100 people have died and nearly 3,000 people have been infected. The indirect effect of SARS on normal day to day life in affected areas and on the economy of Hong Kong in particular has of course been much wider.

French President Jacques Chirac’s recent horror at French roads being among the most dangerous in Europe was borne out by recent figures from the European Conference of Ministers of Transport (ECMT), which is based at the OECD. These show that while the highest number of road deaths in absolute terms in 2001 occurred in Russia, up 4.4% from a year earlier at 30,898, France came second, up 1% at 7,720.

Stronger co-operation between governments, charitable foundations and bio/pharmaceutical industries in developed and developing countries could be an effective and cost-efficient path to long-term health security in a world where disease threatens social and economic stability in many areas. That was one conclusion from an OECD conference on Biotechnology for Infectious Diseases, which brought together politicians, scientists, industry and health policy experts in Lisbon in October.

Cigarette smoking has fallen sharply across OECD countries in the past 40 years, as governments waged health campaigns and raised taxes on tobacco to discourage the habit. Sweden can claim the lowest smoking rate among OECD countries, with 18.9% of the population admitting to being regular smokers in 2000, down from 25.8% in 1990, followed by the US with 19.0%, down from 25.6% a decade earlier. The Japanese can meanwhile claim the dubious distinction of being the heaviest smokers, with 34.3% of people taking a puff daily in 1999, just slightly lower than 37% in 1990, figures in the latest edition of OECD Health Data show.

Hungarians were consulting their doctors on average almost 20 times a year in the late 1990s, a 79% increase from the frequency in 1980, making them the heaviest users of medical services in the OECD. Hungarians were also among the most likely to be admitted to hospital, with 237.5 admissions per 1,000 population in the late 1990s, second only to Austria (286.3) and Finland (265), according to the latest Health at a Glance study.

Health before wealth is one of the oldest sayings in the book. Yet, while good health is obviously a foundation of human welfare, a lot of wealth is absorbed in its pursuit. OECD countries spend an average of 8-10% of GDP on healthcare. And that amount will rise in the years ahead as cost and demand pressures increase. Who cares, some might say, as long as we are living longer and healthier than ever before? If only the question were that simple.

This article was originally written as an introduction to a series of articles on healthcare, all of which can be found on http://www.oecdobserver.org/healthcare

Industrial countries spend a large proportion of GDP on healthcare. But how can they be sure they are getting value for money? One way is to use performance indicators, but these can have their drawbacks, as well as their advantages.

Healthcare costs are rising as patients become more demanding and new technologies spread. The trend is likely to accelerate in coming years as the ageing of the baby-boom generation and lengthening lifetimes cause the number of elderly people in OECD countries to rise sharply. But how much will it cost to take care of this elderly population, and should we adapt public health spending to cope?

The right to privacy and medical confidentiality is taken as read in OECD countries. Yet with new genetic technologies, information about a patient can give clues to the health and physical attributes of the patient¡¦s whole family, and even future children. There are calls to improve data performance in healthcare, but are existing data protection systems strong enough to cover these new realities?

All people are consumers of health services. It is about time they were treated as such. Only then will quality be improved.

Long-term care is a particularly thorny issue for healthcare policymakers because it is so intertwined with other areas of public policy, like housing and social security. Yet it is an increasingly important area of healthcare. Quality indicators can help to achieve improvements.

Citizens in all OECD countries want to know that they will get the high-quality health services they need, when they need them. They also want to know that they are getting value for their money. Governments face the dual challenge of improving healthcare performance and demonstrating that improvement if they are to preserve public confidence in health systems and institutions.

In the section that follows, five health ministers from OECD countries have been invited to answer a straightforward question:

“What action are you taking to improve health-service performance in your country and how will you gauge that improvement?”

OECD countries tend to be great rivals when it comes to comparing their healthcare. What do the patients think? Results from a recent survey reveal some interesting common features, and disparities too.

Patients increasingly expect choice as well as quality in healthcare. But in order to make informed choices, they need to know how well different hospitals or doctors are performing compared with their colleagues elsewhere. This consumer power helps hospitals to improve, as the case of Dr Foster, a UK company, shows.

Today’s doctors face a bewildering array of choices and constraints, from technological discovery to increasing budget pressures. Their dilemmas go beyond diagnosis and treatment to weighing the benefits of new discoveries and whether society is willing to pay for them.

Fertility levels – the number of children being born to assure the next generation – are generally low in OECD countries. This is a cause of primary concern to governments because it contributes to ageing societies and means fewer taxpayers to fund pensions, health services and so on. Yet, almost a century of policies to encourage larger families has failed to boost birth rates. The case of Sweden may help explain why. (For PDF article with graph, see bottom of article.)

The future performance of OECD health systems will depend on how healthcare is progressing globally. A greater effort, including investment, is needed to improve health systems in other (particularly poorer) countries.

Health is a public service almost by definition, though private insurance is expected to play a greater financing role. Finding the right balance between public and private health coverage and building the appropriate regulatory framework is an ongoing policy challenge.

With medical professionals and institutions responsible for devising their own separate quality systems, achieving a coherent quality framework for the Netherlands is proving a harder job than many had bargained for.

“You are as old as you feel”: maybe, but are you as healthy as you feel? If that is the case, most people in OECD countries are doing fine, with US, Canadian and French men topping the feelgood factor list, with more than 90% of them reporting good health.

General health in OECD countries may be improving in many areas, but not when it comes to obesity, which is rising fast almost everywhere.