International comparison of total health expenditure
This page presents comparisons of total UK health expenditure with other EU member states for the latest year available. Most countries in the EU either compile total health information according to A System of Health Accounts, or are working towards this goal.
The internationally standard framework, set out in A System of Health Accounts, defines total expenditure on health as the economic resources spent on health care goods and services, including administration and health insurance, plus gross capital formation in health care industries. ONS is using this definition as the basis for its figures of total UK expenditure on health, because of the desire to compare the UK with other countries around the world. The use of such a framework with its consistent definitions, also permits improved analyses over time even though the NHS continues to adapt. The definitions in A System of Health Accounts have been discussed at an international level, are promulgated by the OECD, and supported by the World Health Organisation, the World Bank and the European Commission.
Chart 1 presents total health expenditure as a percentage of Gross Domestic Product (GDP) for the latest period for EU member states, along with the simple average across these countries. Ten of the other fourteen EU countries devoted proportionately more of their resources to health than the UK in the latest year available - either 2000, 2001 or 2002. The latest year for which all EU member states have provided total health expenditure figures was 2000, when the simple average across these countries was 8.1 per cent of GDP. Germany spent the greatest percentage of its resources on health within the EU, at 10.7 per cent of GDP in 2001, whilst Luxembourg spent the least, at 5.6 per cent in 2000.
Chart 1: total health expenditure as a percentage of Gross Domestic Product in the EU
Source: ONS, OECD
Chart 2 presents the public share of total health expenditure for the latest period for EU member states, along with the simple average across these countries. In all EU countries, the main source of financing for health care is the public sector. In most countries, the public share of total health expenditure is around 70-80 per cent.
Chart 2: public share of total health expenditure in the EU
Source: ONS, OECD
The UK figures in Charts 1 and 2 do not conform entirely with the internationally agreed definitions. There are two deviations. A System of Health Accounts recommends that (i) household production of health care services (unpaid health care services provided in the home) and (ii) occupational health care (therapeutic and preventive care given by employers to employees) are treated as health expenditure. As with many other countries, the UK has not yet estimated a value for these components.
Other countries' deviations from the international definitions are documented in OECD Health 2003. In particular, ONS is aware that there are questions over the international comparability of estimates for long term nursing care, as legislation in different countries provides for different activities to be carried out by nurses under the banner of nursing care. Consequently what is recorded nationally as nursing care may in many cases differ from what is deemed nursing care in the international definitions. The OECD is currently investigating how to compile further guidance for estimating this component in order to improve international comparisons.
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