Cost of illness: an international comparison. Australia, Canada, France, Germany and The Netherlands.
OBJECTIVE
To assess international comparability of general cost of illness (COI) studies and to examine the extent to which COI estimates differ and why.


METHODS
Five general COI studies were examined. COI estimates were classified by health provider using the system of health accounts (SHA). Provider groups fully included in all studies and matching SHA estimates were selected to create a common data set. In order to explain cost differences descriptive analyses were carried out on a number of determinants.


RESULTS
In general similar COI patterns emerged for these countries, despite their health care system differences. In addition to these similarities, certain significant disease-specific differences were found. Comparisons of nursing and residential care expenditure by disease showed major variation. Epidemiological explanations of differences were hardly found, whereas demographic differences were influential. Significant treatment variation appeared from hospital data.


CONCLUSIONS
A systematic analysis of COI data from different countries may assist in comparing health expenditure internationally. All cost data dimensions shed greater light on the effects of health care system differences within various aspects of health care. Still, the study's objectives can only be reached by a further improvement of the SHA, by international use of the SHA in COI studies and by a standardized methodology.
Heijink
Richard
R
National Institute for Public Health and the Environment, The Netherlands. Richard.Heijink@rivm.nl
Noethen
Manuela
M
Renaud
Thomas
T
Koopmanschap
Marc
M
Polder
Johan
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002170:Canada; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D005060:Europe; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged