International comparisons of healthcare quality

In our latest update we look at international comparisons of healthcare quality.

Indicator update

Published: 25/06/2020

International comparisons of the performance of health systems are a powerful tool. As well as highlighting areas for quality improvement, they enable us to consider big questions like ‘How good is the NHS?’.

With the coronavirus (Covid-19) outbreak affecting health systems across the world, here at QualityWatch we’ve updated our international indicators, taking a broader look at healthcare quality before the outbreak. There are many challenges in carrying out international comparisons, including underlying societal, population and economic differences which impact health outcomes, differences in patient pathways and how services are delivered, and a lack of high-quality and comparable data across countries. However, comparisons are important, as they are a means of understanding how the UK is progressing over time relative to other countries.

A summary of our international indicators is shown below. Click on the links for more detailed content and analysis.

International comparisons of preventable risk factors

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  • Daily smoking has decreased in most OECD countries since 2000. In Great Britain, the proportion of the population aged 15+ who are daily smokers decreased from 27% in 2000 to 17% in 2017. Sweden had the lowest rate of tobacco smoking in 2017 and Spain had the highest.
  • Obesity has been rising in most OECD countries over the past two decades. In England, the proportion of the total population who are obese increased from 21% in 2000 to 29% in 2017. Japan has consistently had the lowest levels of obesity, while the United States has the highest.
  • In the UK, alcohol consumption decreased from 10.4 litres per capita in 2000 to 9.7 litres per capita in 2017, which is just above the average of the comparator countries. Sweden had the lowest alcohol consumption in 2017 and France had the highest.

Vaccination coverage for children and mothers

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  • The UK’s diphtheria, tetanus and pertussis (DTP) vaccination coverage increased over time to 94% in 2018. However, it still lags behind several OECD countries including Belgium, Greece, Japan and Portugal which all had over 98% coverage in 2018.
  • In 2018, the UK’s vaccination coverage for measles was 92%. Portugal had the highest coverage (99%) while Canada had the lowest (90%).

Adult flu vaccination coverage

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  • In 2017, the UK’s flu vaccination coverage among those aged 65 and over was 73%. The UK and the Netherlands consistently have the highest levels of flu vaccination coverage, while Finland, Denmark and Germany generally have the lowest levels.

Low birth weight

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  • In 2017, 6.9% of live births in the UK were babies weighing less than 2,500 grams – a small improvement from 7.5% in 2000. Compared with similar OECD countries, the UK lies around the middle of the range of values.

Cancer screening

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  • Across England, Wales and Northern Ireland, breast screening coverage has remained relatively steady over time with an average of 76%. While this group outperforms many OECD countries including France and Germany, breast screening coverage is higher in the Netherlands and Finland.
  • Compared to other countries, the UK has one of the highest cervical screening rates, however there has been a gradual decrease in the proportion of women screened from 79% in 2010 to 75% in 2018.

Potentially preventable emergency admissions

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  • In the UK, the age-sex standardised COPD hospital admission rate is around the average of other OECD countries at 208 admissions per 100,000 population in 2017. The hospital admission rate for asthma is the highest of all the comparator countries at 73 admissions per 100,000 population in 2017.
  • In contrast, the UK has one of the lowest hospital admission rates for diabetes of all the comparator countries, at 74 admissions per 100,000 population in 2017.

Do patients feel involved in decisions about their care?

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  • The OECD found that UK patients are more likely than average to report that their regular doctor involved them in decisions about care or treatment, but this declined slightly from 91% in 2010 to 89% in 2016. Patients in the Netherlands were the most likely to report that they were involved in decisions about their care, while patients in Sweden were the least likely.

Antibiotic prescribing

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  • The volume of antibiotics prescribed in primary care in England is about average of the OECD comparator countries. Antibiotic prescribing is high in Greece and France and low in Austria and the Netherlands.
  • In the UK, the proportion of antibiotics prescribed that were cephalosporins or quinolones (second-line antibiotics that are restricted for situations when first-line antibiotics have failed) decreased from 9.3% in 2000 to 3.9% in 2016, and has since remained broadly stable. The UK performs the best out of the comparator countries.

Venous thromboembolism

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  • In the UK, the rate of post-operative deep vein thrombosis (DVT) after hip or knee replacement surgery is relatively low compared to other countries. Between 2011 and 2017, the post-operative DVT rate in the UK decreased from 240 per 100,000 hospital discharges to 198 per 100,000 hospital discharges.

International comparisons of mental health outcomes

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  • The rate of inpatient suicide in all comparator countries is less than 2 per 1,000 patients. The UK has consistently had one of the lowest rates of inpatient suicide, although internationally comparable data on the quality of mental health care is limited.
  • The UK’s suicide rate within 30 days of discharge from hospital among patients diagnosed with a mental disorder is consistently the lowest of the comparator countries for which there is available data.

Amenable mortality rates

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  • The mortality rate from all causes in England and Wales fell between 1995 and 2011, but since then progress has stalled with 965 deaths per 100,000 population in 2018.
  • There is a strong relationship between amenable mortality (deaths that could have been avoided in the presence of optimal quality healthcare) and deprivation in England. In 2017, the amenable mortality rate was 3.8 times higher for men in the most deprived areas compared to the least deprived areas, and for women it was 3.3 times higher in the most deprived areas.
  • The most recent data from the Global Burden of Disease Study shows that in 2015, the UK’s amenable mortality rate was 70 deaths per 100,000. This is higher than 12 of the comparator countries, although rates for most countries are converging.

Infant and neonatal mortality

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  • The infant mortality rate has been decreasing in all OECD countries since 2000. The UK has a relatively high rate of infant mortality, with 3.9 deaths per 1,000 live birth in 2017. The United States has the highest rate each year, while Japan, Finland and Sweden have the lowest rates.
  • The UK’s neonatal mortality rate is also higher than many other countries, at 2.8 deaths per 1,000 live births in 2017.

International comparisons of stroke and heart attack mortality

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  • In the UK, 30-day mortality after admission to hospital for ischaemic stroke decreased rapidly from 18 per 100 patients in 2008 to 12 per 100 patients in 2013, but has since stayed roughly constant. In 2017, the UK had the second highest mortality rate of the comparator countries. The Netherlands has the lowest mortality rate, at 5.7 per 100 patients in 2016.
  • Between 2008 and 2017, 30-day mortality after admission to hospital for acute myocardial infarction (or heart attack) in the UK decreased from 12 per 100 patients to 9 per 100 patients, but this is still slightly higher than most of the comparator countries.

Cancer mortality rates

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  • Breast cancer mortality has been declining in the UK, falling from 38 deaths per 100,000 women in 2001 to 28 deaths per 100,000 women in 2016. However, the UK consistently has a relatively high breast cancer mortality rate compared to other countries.
  • In 2001, the UK had one of the highest cervical cancer mortality rates of all the comparator countries, but by 2016, the UK’s ranking had improved to about average.
  • Colorectal cancer mortality has been slowly decreasing over time in the UK, falling from 26 deaths per 100,000 population in 2001 to 22 deaths per 100,000 population in 2016. The UK’s performance is about average for the comparator countries.

Cancer survival rates

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  • Five-year survival for breast cancer has been improving in the UK over time, reaching 86% in 2010-2014. However, the UK lags behind several other OECD countries including the United States, Australia and Japan.
  • While cervical cancer survival has been improving in the UK, the country is still one of the worst performers compared to other OECD countries, with a five-year survival of only 64% in 2010-2014. In comparison, survival in Japan in the same time period was 71%.
  • The five-year colon cancer survival rate in the UK has also been increasing over time, but in 2010-2014 survival reached only 60%. This is the lowest survival rate of the 18 OECD comparator countries.

For as many indicators as possible, we drew comparisons between the UK and 18 other high-income, industrialised countries: Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, Netherlands, New Zealand, Portugal, Spain, Sweden and the United States.

There are many challenges in collecting high-quality and comparable data across countries, such as differences in data collection which can bias the results. For more information on data sources and comparability, please see the QualityWatch indicator pages.

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