Agência para o Investimento e Comércio Externo de Portugal


Health systems in the OECD are under renewed financial pressure, owing to competing priorities for public funding, according to a new OECD report. 

The 2023 edition of OECD Health at a Glance estimates that healthcare spending in OECD countries corresponded to 9.2% of GDP in 2022, down from 9.7% in 2021. While this exceeds the 2019 levels, in 11 OECD countries, health spending as a share of GDP in 2022 was lower than in 2019.


Average per capita health spending in OECD countries reached nearly USD 5,000 in 2022. The United States was the top healthcare spender among the OECD countries with USD 12,555 per capita spending, followed by Switzerland with USD 8,049 and Germany with USD 8,011 (when adjusting for differences in purchasing power). Per capita health spending is estimated to have been lowest in Mexico, Colombia and Costa Rica, with USD 1,181, USD 1,640 and USD 1,658 spending respectively.


This edition of Health at a Glance 2023 includes a special focus on digital health and its potential to transform health systems. The COVID-19 pandemic response accelerated the digital transformation in OECD countries. However, much still needs to be done. In line with the OECD Recommendation on Data Governance, Health at a Glance 2023 provides a policy checklist for stronger digital health systems.


Core population health indicators show that societies have not yet fully recovered from the pandemic, as many people still struggle 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.


The health and social care workforce continues to grow, but concerns about shortages are becoming more acute. Population ageing is increasing the demand for healthcare and long-term care workers. At the same time, worsening working conditions have weakened the attractiveness of healthcare professions. Across the OECD countries, 57% of hospital physicians and nurses perceive staffing levels and work pace to be unsafe. High inflation has eroded wages recently, including in the health sector. Looking at longer-term trends, while real wages in the health sector have increased in most OECD countries, Finland, Italy, Portugal, Spain and United Kingdom have experienced stagnant or declining real wages over the past decade.


Heart attack, strokes and other circulatory diseases caused more than one in four deaths in 2021, while COVID-19 caused 7% of all deaths. Almost one-third of all deaths could have been avoided through more effective and timely prevention and healthcare interventions.


Barriers to healthcare access persist, despite universal health coverage in most OECD countries, as gaps in financial protection make healthcare difficult to afford for low-income households. Out-of-pocket payments make up just under a fifth of health spending across the OECD. Individuals in the lowest income quintile are on average three times more likely to delay or not seek care than individuals in the highest income quintile.


Waiting times for non-emergency surgery, a longstanding issue in many countries, were exacerbated by the COVID-19 pandemic. Waiting times for hip and knee replacements, two common elective surgeries, have decreased since the height of the pandemic, but remain higher than pre-pandemic levels in most countries.


Quality of care has improved in terms of safety and effectiveness, with greater attention to making healthcare more people-centred. Safe prescribing in primary care has advanced in most countries, with reductions in the average volume of antibiotics, opioids and long-term prescriptions of anticoagulants.


The presentation of the report is webcast live via this link.