International Health Care Systems

Healthcare cost and quality in 9 European countries

The latest special issue of Health Economics is very interesting.  It looks at healthcare cost and quality metrics across nine European countries using clinical vignettes from the HealthBasket dataset.  The nine countries included in the project were: Denmark, England, France, Germany, Hungary, Italy, The Netherlands, Poland, and Spain.  The vignettes were used in order to collect standardized data across the diversity of medical care practiced in these nine countries.  The ten vignettes were:

  • Appendectomy; male aged 14–25; inpatient; emergency
  • Normal delivery; female aged 25–34; inpatient; elective
  • Hip replacement; female aged 65–75; inpatient; elective
  • Cataract; male aged 70–75; outpatient; elective
  • Stroke; female aged 60–70; inpatient; emergency
  • Acute myocardial infarction; male aged 50–60; inpatient; emergency
  • Cough; male aged 2; outpatient; emergency
  • Colonoscopy; male aged 55–70; outpatient; elective
  • Tooth filling; child aged 12; outpatient; emergency
  • Physiotherapy; male aged 25–35; outpatient; elective

The authors found that “Hungary, Poland, and Spain were – as expected – below the nine-country average [in terms of medical cost]. However, after adjustment for episode-specific PPPs…costs of these three countries turned out to be average, or even among the highest for some vignettes…The prices that were charged varied greatly, not least because of variation in applied technologies.  The hip replacement vignette, for example, was reimbursed at a (average) level of €8963 in Italy, compared with €1795 in Hungary… The AMI vignette showed some remarkable variations as well. In the Netherlands, the ‘price’ for an AMI treatment was €8722; whereas in neighbouring Germany, it was ‘only’ €3114.”

While the technology used had a large impact on cost, structural varaiables (e.g.: number of beds per hospital, staff per beds, beds in the relevant specialty, or staff in the relevant specialty) had little correlation with procedural costs.

Other articles in this special issue examine each one of the ten vignettes in more detail.

Reinhard Busse, Jonas Schreyögg, Peter C. Smith  “ Variability in healthcare treatment costs amongst nine EU countries – results from the HealthBASKET project” Health Economics, Volume 17, Issue S1  (p S1-S8)