U.S. spends the most on healthcare but has the worst results, Commonwealth Fund says

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The US spends far more on healthcare than other countries, but it doesn’t have results to show.

Despite higher costs, life expectancy and other health indicators in the US are much worse than elsewhere around the world.

Health care spending, both per capita and as a percentage of GDP, is still much higher in the US than in other high-income countries, according to a new report from the Commonwealth Fund. However, the US is the only country that does not have universal health insurance.

The US also has the lowest life expectancy at birth, the highest death rate from preventable or treatable conditions, the highest maternal and infant mortality, and one of the highest suicide rates. It also has the highest rate of people with multiple chronic diseases and an obesity rate nearly double the average for the International Organization for Economic Co-operation and Development, one of the main data sources.

The data showed that Americans visit doctors less frequently than people in most other countries and have one of the lowest rates of medical practitioners and hospital beds per 1,000 people. Meanwhile, US breast and colorectal cancer screening and flu vaccination rates are among the highest, but COVID-19 vaccination lags behind many countries.

WHAT INFLUENCES

In 2021, the US spent 17.8% of its GDP on health care, nearly double the OECD average. Health care spending as a share of the economy as a whole has risen steadily since the 1980s in all countries, with spending growth outpacing economic growth driven by medical technology, rising prices and higher demand for services.

Per capita health care spending in the US was almost twice that of the nearest country, Germany, and four times that of South Korea. In the US, this includes spending on people in government programs such as Medicaid, Children’s Health Insurance, Medicare, and military plans; the costs of those with employer-sponsored private insurance or other private insurance; and out-of-pocket health care spending.

All countries in the analysis, with the exception of the United States, guarantee state or public health insurance for all their residents. In addition to public coverage, people in some countries have the option to also purchase private coverage. In France, almost the entire population has both private and public insurance.

In 2021, 8.6% of the US population was uninsured. The US is the only high-income country where a significant portion of the population does not have any form of health insurance.

Yet despite high spending, the health of Americans is worse than that of their peers around the world. For example, life expectancy at birth in the US in 2020 was 77 years, three years lower than the OECD average. Preliminary data show that life expectancy in the US has declined further in 2021.

In the US, life expectancy masks racial and ethnic differences, according to the Commonwealth Foundation. Life expectancy in 2019 for non-Hispanic black Americans (74.8) and non-Hispanic Native Americans or Alaska Natives (71.8) is four and seven years respectively lower than for non-Hispanic whites (78.8).

However, the life expectancy of Hispanic Americans (81.9) is higher than that of whites and is similar to life expectancy in the Netherlands, New Zealand and Canada. As a group, Asian Americans have a higher life expectancy (85.6 years) than Japanese.

The U.S. also fared poorly with infant mortality, which stood at 5.4 deaths per 1,000 live births in 2020, the highest of any country in the analysis. In contrast, Norway had 1.6 deaths per 1,000 live births.

Women in the US have long had the highest rate of maternal deaths related to complications of pregnancy and childbirth. In 2020, there were almost 24 maternal deaths for every 100,000 live births in the US, more than three times the rate in most other high-income countries. High rates of caesarean sections, inadequate prenatal care, and socioeconomic inequalities that contribute to chronic diseases such as obesity, diabetes, and heart disease may help explain high infant and maternal mortality in the US, the authors say.

The US also had the highest rates of obesity and deaths from physical assault, including gun violence, and had the third highest suicide rate.

BIG TREND

The authors write that for the US, the first step towards improvement is to ensure that everyone has access to affordable health care. Affordability remains the top reason some Americans don’t subscribe to health insurance, while high out-of-pocket costs are causing nearly half of working-age adults to miss or delay getting needed care, the report says. The Inflation Reduction Act, which will help reduce the high cost of some drugs and limit out-of-pocket spending for older Americans, could get the ball rolling, the authors say.

Another important step is to contain costs, they said. In the US, high medical costs continue to be a major driver of rising costs. Health policy makers and systems could take advantage of some of the approaches taken by other countries to contain overall health spending, including health and administrative costs.

According to the Commonwealth Fund, another important step is the prevention and treatment of chronic diseases. Critical to this is developing the ability to offer comprehensive, continuous and well-coordinated care. Decades of underinvestment, along with an inadequate supply of healthcare providers, have limited many Americans’ access to effective primary health care, the authors say.

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