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Comparing health system performance in OECD countries. Organization for Economic Cooperation and Development.

We present data from the Organization for Economic Cooperation and Development and the World Health Organization on the performance of the health care systems in twenty-nine industrialized countries in 1998. We also compare the performance of the United States with the other industrialized countries for selected indicators in 1960, 1980, and 1998. On most indicators the U.S. relative performance declined since 1960; on none did it improve.

Delivery of Health Care↗
PubMed1994

Confirmation study, using nitrobenzene, of the Combined Repeat Dose and Reproductive/Developmental Toxicity Test protocol proposed by the Organization for Economic Cooperation and Development (OECD).

A confirmatory familiarization study of the Combined Repeat Dose and Reproductive/Developmental Toxicity Screening (ReproTox) test protocol proposed by the Organization for Economic Cooperation and Development (OECD) was performed using nitrobenzene, a testicular toxicant. The agent was given daily by gavage to groups of 10 male and 10 female Sprague-Dawley rats at doses of 100, 60, 20 and 0 mg/kg body weight. Some of the high dose animals exhibited neurological signs, and two males and 9 females died. Hemolytic anemia due to methemoglobin formation was evident in treated males. Histopathologically, treated males showed atrophy of seminiferous tubules of the testis, reactive changes secondary to hemolytic anemia in the hematopoietic organs, and hepatocellular swelling. Cerebral gliosis was observed in middle and high dose males. Male fertility was not affected. The body weights of pups from treated dams were lowered, and their postnatal loss was increased. Most of the known toxicological properties of this chemical was demonstrated in the present study, with the exception of reduced fertility. Therefore, the ReproTox protocol was concluded as being useful as a screening test of existing high production volume chemicals. It should be noted that while the reproductive toxicity test alone is insensitive for detection of male fertility disturbances associated with testicular toxicity, the latter easily be distinguished on morphological grounds.

Animals↗
PubMed2006

Assessment of persistency and bioaccumulation in pesticide registration frameworks within the Organization for Economic Cooperation and Development.

This article describes the results of a survey conducted in 2003 on methods used by different member countries within the Organization for Economic Cooperation and Development (OECD) to evaluate persistent and bioaccumulative pesticides. The objectives were to establish the differences in taking persistence (P) and bioaccumulation (B) into account in the decision-making process and to establish the influence of the assessors' subjectivity to data interpretation and data selection. Fifteen countries participated in the survey, which generated a vast amount of information on decision making, risk assessment, risk classification, and data treatment. Survey results indicated clear differences in approaches to the use of P, B, and toxicity (T) information in scientific risk assessment. Using the same data for 2 different pesticides, several OECD member countries responded differently in classifying both substances as P, B, and T. Differences in regulatory decision-making were also apparent because, based on identical classifications, several OECD member countries adopted different decisions on pesticide registration; recommendations were based, with respect to technical guidance, on data handling, training of assessors, and handling of uncertainty in risk assessment.

Data Collection↗
PubMed2003

The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970-1998.

OBJECTIVE: To assess the contribution of primary care systems to a variety of health outcomes in 18 wealthy Organization for Economic Cooperation and Development (OECD) countries over three decades. DATA SOURCES/STUDY SETTING: Data were primarily derived from OECD Health Data 2001 and from published literature. The unit of analysis is each of 18 wealthy OECD countries from 1970 to 1998 (total n = 504). STUDY DESIGN: Pooled, cross-sectional, time-series analysis of secondary data using fixed effects regression. DATA COLLECTION/EXTRACTION METHODS: Secondary analysis of public-use datasets. Primary care system characteristics were assessed using a common set of indicators derived from secondary datasets, published literature, technical documents, and consultation with in-country experts. PRINCIPAL FINDINGS: The strength of a country's primary care system was negatively associated with (a) all-cause mortality, (b) all-cause premature mortality, and (c) cause-specific premature mortality from asthma and bronchitis, emphysema and pneumonia, cardiovascular disease, and heart disease (p<0.05 in fixed effects, multivariate regression analyses). This relationship was significant, albeit reduced in magnitude, even while controlling for macro-level (GDP per capita, total physicians per one thousand population, percent of elderly) and micro-level (average number of ambulatory care visits, per capita income, alcohol and tobacco consumption) determinants of population health. CONCLUSIONS: (1) Strong primary care system and practice characteristics such as geographic regulation, longitudinality, coordination, and community orientation were associated with improved population health. (2) Despite health reform efforts, few OECD countries have improved essential features of their primary care systems as assessed by the scale used here. (3) The proposed scale can also be used to monitor health reform efforts intended to improve primary care.

Cross-Sectional Studies↗
PubMed2002

Toward an international case mix index for comparisons in OCED countries. Organization for Economic Cooperation and Development.

During the last 20 years, a number of studies have examined the effect of Diagnosis Related Group (DRG)-based health care prospective payment systems on the cost and quality of services. To examine these issues, it is necessary to control for variations in patient mix and the related resources needed by incorporating some form of a case mix index. As part of our ongoing research on comparative DRG-based health care payment systems, we develop a preliminary, international case mix index using the Organization for Economic Cooperation and Development (OECD) health care database. We illustrate the application of our case mix index and use it to devise a standardized cost per case and a standardized cost per day for several countries. We also provide some preliminary analysis of the data demonstrating the observable and predictable effects of DRG-based payments on case m ix index, length of stay,cost per day, and cost per case.

Benchmarking↗
PubMed2004

Experiences of Organization for Economic Cooperation and Development countries with recruiting and retaining physicians in rural areas.

OBJECTIVE: This present study discusses the potential pitfalls in measuring physician shortages in rural areas and presents existing evidence of the effectiveness of policy interventions designed to influence the geographical distribution of physicians. DESIGN: Information on the geographical distribution of physicians was derived from a survey of Organization for Economic Cooperation and Development (OECD) countries and a desk review of the academic literature and policy documents of OECD governments. MAIN OUTCOME MEASURE: Whether policies have been effective in recruiting and retaining physicians in rural areas. RESULTS: Existing measures of physician shortages in rural areas may be misleading as they do not account for a number of supply side factors (e.g. physician productivity, mobility of physicians across areas) and demand-side factors (e.g. patient needs for physician services). Increases in the national number of physicians have narrowed, but not eliminated, shortages in rural areas. Some success in increasing physician supply to rural areas has been reported with educational, regulatory and financial policies; whereas countries' experiences with education-related funding policies are mixed. There is some evidence suggesting that the effectiveness of these policies can be enhanced by supporting occupational opportunities for the spouse/partner, education of children and accommodation. CONCLUSIONS: Although there has been little evaluation of policy interventions, physician shortages in rural areas may be reduced by supply side policies that focus on the physician in combination with measures to sustain the economic and social viability of rural communities.

Delivery of Health Care↗
PubMed2004

The effects of pharmaceutical consumption and obesity on the quality of life in the organization of economic cooperation and development (OECD) countries.

OBJECTIVE: The objective of this study is to validate our earlier work on life expectancy with more recent data and, more importantly, to extend it to examine quality of life, not only the length of life. DESIGN AND SETTING: The analysis focuses on the production of health, disaggregating healthcare into pharmaceutical consumption and other healthcare. Going beyond our earlier work, measures of health include life expectancy and disability-adjusted life expectancy (DALE). Also, we consider the impact of obesity. The sample was 18 Organization of Economic Cooperation and Development (OECD) countries. The measure of pharmaceutical consumption is the best that is available for these countries. MAIN OUTCOME MEASURES AND RESULTS: Confirming our earlier work, pharmaceutical consumption has a positive and statistically significant effect on life expectancy at 40 and 60 years (significant at the 0.05 level, based on a two-tailed test). The effects are slightly larger than in the earlier work. Turning to DALE, pharmaceutical consumption has a positive and statistically significant effect at birth and at 60 years (significant at the 0.05 and 0.01 levels, respectively), based on a two-tailed test. The effects on DALE are larger than the effects on life expectancy. CONCLUSIONS: Increased pharmaceutical consumption helps improve quality of life, as well as life expectancy.

Developed Countries↗
PubMed1995

The distribution of "big ticket" medical technologies in OECD countries. Organization for Economic Cooperation and Development.

Five "big ticket" medical technologies (BTTs) in 1990 were compared in the 24 OECD countries in relation to population, the number of physicians, gross domestic product (GDP), and health care expenditures (HCE). Wide variations were observed between and within countries for all measures. Regression analysis revealed that HCE explains part of the variation in the distribution of computed tomography scanners (excluding Japan), magnetic resonance imaging units, and radiation therapy units (R2 between 0.40 and 0.69), but not extracorporeal shock wave lithotripters. To a lesser extent, GDP was also found to correlate with the distribution of these technologies, but no correlation was found with number of physicians. Other factors affecting the diffusion of these technologies are proposed for study.

Developed Countries↗
PubMed1994

Health system performance in OECD countries, 1980-1992. Organization for Economic Cooperation and Development.

U.S. health expenditure levels and rates of increase continue to exceed those of other Western industrialized nations. The pluralistic U.S. health care system has the highest excess health care inflation and opportunity costs of forgone nonhealth consumption and investment when compared with other major industrialized countries. While poor U.S. performance in terms of life expectancy at birth and infant mortality may partially result from social problems, there is little quantifiable evidence of value for money or equity in terms of health system performance.

Europe↗
PubMed1984

Biodegradation of 4-nitrophenol in standardized aquatic degradation tests.

During the years 1978-1981 both the European Economic Community (the EEC) and the Organization for Economic Cooperation and Development (the OECD) organized various interlaboratory comparison programs on standardized screening methods to study the biodegradability of chemicals in water. While the ring test results were generally rather heterogenous, one of the compounds studied, 4-nitrophenol, turned out to be particularly problematic as the compound was found either easily biodegradable or not biodegradable by various laboratories in various tests. This paper describes some more detailed studies on 4-nitrophenol degradation in two different tests, the modified OECD screening test (MOST test) and the Zahn-Wellens test, respectively. The test variables investigated include inoculum characteristics and pretreatment, test duration, and 4-nitrophenol concentration. The results are discussed in relation to toxicity and degradation pathways of 4-nitrophenol. It is concluded that in order to improve the comparability of results from standardized aquatic biodegradation tests, test strategies should allow the option of performing a test with a preadapted inoculum in the event of negative test results with freshly collected inocula. Increasing the inoculated concentration of microorganisms in some tests may also contribute to the attainment of more consistent test results.

Biodegradation, Environmental↗
PubMed1998

Health observation and health reporting in Europe.

The need and demand for comparable comprehensive health data and health information is growing in Europe. Many countries have intensified development of their health information systems and health reporting. The World Health Organization (WHO), the Organization for Economic Cooperation and Development (OECD) and other international organizations collect health data and publish comparative health reports. The European Union (EU) has initiated several new activities to improve health statistics and to develop health monitoring. Sometimes they overlap with other international activities. Also, EU Agencies have been set up in several health related fields. EU public health programmes on specified health problems also monitor health. The Health Monitoring Programme (HMP) adopted in 1997 is intended to pave the way for permanent EU health monitoring. After an unfortunate delay, the first HMP decisions to fund projects were made in July 1998. A feasibility analysis resulting in proposals for the organization of EU health monitoring was carried out in 1997. Other recent developments in the EU are the establishment of a communicable disease network, and the Commission's communication on future public health policy. The Amsterdam Treaty attaches more importance to public health. Much work needs to be done before a coherent EU health monitoring system can be put in place. The current momentum must be used to speed up positive developments. The HMP should support projects which pave the way for permanent EU health monitoring and its work should be clearly prioritised. Also, the expertise in health monitoring and the ability to steer the HMP and related EU developments should be strengthened. This can best be done by close collaboration with experienced expert institutes from the Member States, and by collaboration with WHO and OECD.

Europe↗
PubMed2006

Expression profiling of endocrine-disrupting compounds using a customized Cyprinus carpio cDNA microarray.

Exposure to a variety of anthropogenic compounds has been shown to interfere with normal development, physiology, and reproduction in a wide range of organisms, both in laboratory studies and wildlife. We have developed a Cyprinus carpio cDNA microarray consisting of endocrine-related genes. In the current study, we investigated the applicability of this microarray (1) to study the molecular effects induced by exposure to a variety of endocrine-disrupting compounds (EDCs) in fish and (2) to discriminate the specific transcriptional profiles associated with these compounds. To that purpose, gene expression profiles were generated in livers of juvenile carp exposed to 14 Organization of Economical Cooperation Development (OECD)-recommended reference EDCs (17beta-estradiol, 17alpha-ethinylestradiol, 4-nonylphenol, bisphenol A, tamoxifen, 17alpha-methyltestosterone, 11-ketotestosterone, dibutyl phthalate, flutamide, vinclozolin, hydrocortisone, CuCl(2), propylthiouracil, and a mixture of L-triiodothyronine and L-thyroxine). Our results show that, in addition to some expression similarities between analogous acting substances, each individual compound produced its own unique expression pattern on the array, distinct from the profiles generated by the other compounds. In addition, we were able to identify a minimal subset of genes, which also allowed to discriminate between the different compounds. Overall, our findings suggest that the developed cDNA array has great promise to screen new and existing chemicals on their endocrine-disruptive potential and to identify distinct classes of EDCs.

Animals↗
PubMed2006

The need for developmental neurotoxicity studies in risk assessment for developmental toxicity.

The estimated frequencies of neurodevelopmental disorders in children are relatively high, i.e. around 12%. The developing central nervous system appears to be especially susceptible to toxic insults and several developmental neurotoxicants, some with widespread occupational or consumer exposure, have been identified in humans and experimental animals. Cross-species comparability between human and experimental animals supports the assumption that developmental neurotoxicity (DNT) effects in animals indicate a potential to affect development in humans. The proposed Organization for Economic Cooperation and Development (OECD) developmental neurotoxicity study (TG 426) provides an outline of behavioural and morphological endpoints that are relevant to human neurodevelopment, and the guideline is expectedly adopted during 2006. Hopefully, this may contribute to inclusion of sufficient regulatory testing for DNT in the new EU chemical regulation REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals). At present, DNT testing is not included in REACH and that gives rise to concern, as there is a recognized need for DNT testing in order to protect the susceptible developing brain.

Animals↗