(Fixes typo in first paragraph)
By Kate Kelland
LONDON, Nov 21 (Reuters) - Total health spending fell in one in three OECD nations between 2009 and 2011, with poor people in countries hardest hit by the financial crisis at risk of longer-term problems due to reduced access to medicines and check-ups, the OECD said on Thursday.
The drop is a sharp reversal of strong growth in health spending in the years prior to the financial crisis, the Paris-based organisation said, and makes it all the more important that governments work to make healthcare systems more productive, efficient and affordable.
Spending per capita fell in 11 of 33 OECD countries between 2009 and 2011, according to the 2013 "Health at a Glance" report.
In Greece, which has been crippled by financial and economic crises in recent years, per capita spending plunged by 11.1 percent, while in Ireland it dropped by 6.6 percent.
Growth also slowed significantly in other countries, including the United States (1.3 percent) and Canada (0.8 percen).
The OECD cautioned that short-term benefits to budgets are likely to be greatly outweighed by the longer-term impacts on health, and health spending.
Only Japan and Israel saw the rate of health spending growth accelerate since 2009 compared with the previous decade. Spending in South Korea continued to grow at more than 6 percent per year from 2009, but more slowly than in previous years.
With recessions, downturns and faltering economic growth hitting many OECD countries, governments have sought to cut spending by reducing prices of medical goods, especially pharmaceuticals, and by capping budgets and introducing wage cuts in hospitals.
The OECD said the market share of generic drugs has increased significantly over the past decade in many countries. Yet generics still represent less than 25 percent of the market in Luxembourg, Italy, Ireland, Switzerland, Japan and France, compared with about 75 percent in Germany and Britain.
More than three-quarters of OECD countries reported a cut in real-term spending on prevention programmes in 2011 over 2010, and half spent less than in 2008.
Cuts to spending on cost-effective prevention programmes on obesity, harmful use of alcohol and smoking are a cause for concern, the report said.
Reductions in the supply of health services and changes in their financing through increases in direct out-of-pocket payments for patients are also affecting access to care.
After years of improvement, waiting times for some operations in Portugal, Spain, England and Ireland are now on the rise, the OECD said.
It also warned that across the OECD, the poorest people are worst affected and may be going without care they need such as medicines or check-ups for chronic conditions.
"This may have long-term health and economic consequences on the most vulnerable in society," it said. (Editing by Ralph Boulton)