The health system is responsible for preventing health problems (i.e. prevention) and addressing acute or chronic health problems when they arise (i.e. treatment). High-quality care is care that is safe, effective and patient-centred. Quality of care can be assessed through measuring structures, processes and outcomes.
Electronic medical records (EMRs) can contribute to greater co-ordination of health services and improved quality of care, especially if they allow information about patients to be shared between practitioners. On average across OECD countries, 82% of primary care physicians’ offices used electronic records in 2016, compared to 73% of medical specialists’ offices. In 8 out of 25 OECD countries, EMRs were already used by 100% of primary care offices in 2016, and by all specialist offices in Denmark, Finland, Greece and Sweden. In contrast, only around one-third of primary care offices in Poland, Mexico (30% each) and Japan (36%) were using EMRs in 2016, and only a small share of specialist offices in Switzerland (18%). Between 2012 and 2016, Denmark achieved the greatest progress in take up of EMR use in both primary care and specialist offices (Figure 14.21).
Primary care is usually the initial point of contact between patients and the health care system, and is responsible for the prevention, early diagnosis and management of both communicable and chronic health conditions. Diabetes is a growing chronic condition with well-established treatments which can, for the most part, be delivered at the primary care level. Thus, high-quality primary care can prevent unnecessary admissions to hospital (OECD, 2019). In 2017, on average across the OECD, the hospitalisation rate for diabetes was 127 per 100 000 people, a decrease of over 10% from 2012. Mexico had the highest rate of potentially avoidable hospital admissions for diabetes (249 per 100 000 population), whereas Iceland (42), Italy (43) and Spain (45) had the lowest. Austria, Ireland and Korea have seen the largest reductions in the rate of diabetes hospitalisations between 2012 and 2017 (Figure 14.22).
Mortality within 30 days after hospital admission for potentially fatal conditions such as ischaemic stroke is a well-recognised indicator of the quality of acute care in hospital. On average across the OECD, in 2017, the age-standardised rate of mortality after hospital admission for ischaemic stroke was 7.6 per 100 admissions in people aged 45 and over, a decrease from 10 in 2012. Japan (3.0) and Korea (3.2) had the lowest rates among OECD countries, and Latvia (20.4) the highest. The United Kingdom (-6.5), the Netherlands (-5.3) and Australia (-5.1) have seen the largest reductions since 2007, while Latvia (0.9) and Colombia (0.4) have seen increases in mortality rates between 2007 and 2017 (Figure 14.23).
