Americans outspend other wealthy nations on healthcare

 

Americans continue to far outspend other wealthy nations on health care but do not have better health outcomes, says 'US health care from a global perspective' report from The Commonwealth Fund

The USA spent more per person on health care than 12 other high-income nations in 2013, while seeing the lowest life expectancy and some of the worst health outcomes among this group. The analysis shows that in the USA, which spent an average of $9,086 per person annually, life expectancy was 78.8 years. Switzerland, the second-highest-spending country, spent $6,325 per person and had a life expectancy of 82.9 years. Mortality rates for cancer were among the lowest in the USA but rates of chronic conditions, obesity, and infant mortality were higher than those abroad.

This analysis draws upon data from the Organization for Economic Cooperation and Development and other cross-national analyses to compare health care spending, supply, utilization, prices, and health outcomes across 13 high-income countries: Australia, Canada, Denmark, France, Germany, Japan, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

The data predates the major insurance provisions of the Affordable Care Act. In 2013, the U.S. spent far more on health care than these other countries. Higher spending appeared to be largely driven by greater use of medical technology and higher health care prices, rather than more frequent doctor visits or hospital admissions. In contrast, U.S. spending on social services made up a relatively small share of the economy relative to other countries. Despite spending more on health care, Americans had poor health outcomes, including shorter life expectancy and greater prevalence of chronic conditions.

Cross-national comparisons allow it to track the performance of the U.S. health care system, highlight areas of strength and weakness, and identify factors that may impede or accelerate improvement.

Thirteen high-income countries are included: Australia, Canada, Denmark, France, Germany, Japan, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

Healthcare spending in the USA far exceeds that of other high-income countries, though spending growth has slowed in the USA and in most other countries in recent years. Even though the USA is the only country without a publicly financed universal health system, it still spends more public dollars on health care than all but two of the other countries.

Americans have relatively few hospital admissions and doctor visits but are greater users of expensive technologies like magnetic resonance imaging machines. Available cross-national pricing data suggest that prices for health care are notably higher in the USA. Despite its heavy investment in health care, the USA sees poorer results on several key health outcome measures such as life expectancy and the prevalence of chronic conditions. Mortality rates from cancer are low and have fallen more quickly in the USA than in other countries, but the reverse is true for mortality from ischemic heart disease.

In 2013, the average US resident spent $1,074 out-of-pocket on health care, for things like co-payments for doctor’s office visits and prescription drugs and health insurance deductibles. Only the Swiss spent more at $1,630, while France and the Netherlands spent less than one-fourth as much ($277 and $270, respectively). As for other private health spending, including on private insurance premiums, USA spending towered over that of the other countries at $3,442 per capita—more than five times what was spent in Canada ($654), the second-highest spending country.

Public spending on health care amounted to $4,197 per capita in the USA in 2013, more than in any other country except Norway ($4,981) and the Netherlands ($4,495), despite the fact that the USA was the only country studied that did not have a universal health care system. Public programmes including Medicare and Medicaid cover 34 %.

Data published by the International Federation of Health Plans suggest that hospital and physician prices for procedures were highest in the USA in 2013. The average price of bypass surgery was $75,345 - more than $30,000 higher than in the second-highest country, Australia, where the procedure costs $42,130, MRI and CT scans were also most expensive in the USA.

  • People in the USA visit their doctor four times per year; only residents of Switzerland, New Zealand, and Sweden have fewer visits. Americans also go to the hospital relatively infrequently, with 126 visits per 1,000 people, compared to 252 visits in Germany, where the rate is highest.
  • Americans receive the most diagnostic imaging exams, including MRIs, CT scans, PET exams. The average adult also takes more prescription drugs than adults in all the other countries except New Zealand.
  • Prescription drugs are most expensive in the USA, with prices twice as high as in the UK, Australia, and Canada.
  • Prices for health services are considerably higher in the USA than elsewhere. On average, heart bypass surgery costs $75,345 compared to $15,742 in the Netherlands, where the procedure is least expensive.
  • The USA does well on cancer care. It has comparatively good health outcomes when it comes to cancer care. Rates of cancer deaths were lower than in most other nations—164 for every 100,000 people, compared to 220 in Denmark, 196 in the Netherlands, and 193 in the UK.
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