US Healthcare: Paying More for Less?

Healthcare spending and access to care are important contributors to the effectiveness of public health nationally and globally. The highest healthcare spending in the world has not correlated with better health outcomes for the US; America remains the sole industrialized nation which fails to provide universal healthcare. Organisation for Economic Co-operation and Development (OECD) data show that the US is paying much more for, at best, similar public health outcomes compared with peer industrialized countries.

In 2007, the US spent $7,290 per capita on healthcare, equating to 16% of the gross domestic product (GDP). Mean per capita healthcare spending for OECD countries was $2965 in 2007, accounting for a mean 8.9% GDP ¹. So, while other OECD countries are paying around half of what the US pays for healthcare, they provide universal coverage and similar or often better health outcomes. It seems that the American free market has gone awry in terms of healthcare costs, and a clear public health focus has been obscured by vested interests.

I assumed that people wouldn’t die in America specifically for lack a healthcare insurance plan. However, the authors of a recent study found that ‘lack of health insurance is associated with as many as 44789 deaths per year in the United States’ and that ‘preventable illnesses are a consequence of uninsurance’ ².  In 2008 approximately 15.4% individuals in the US, an estimated 46.3 million people had no access to healthcare; this was up from 45.7 million in 2007 ³.

Employer sponsored healthcare premiums in America have risen by 110% since 1999 ⁴. Between 2000 and 2008, increases of 3.7% in healthcare costs occurred ¹; between 2007 and 2008 there were 3.6% decreases in median household income ⁵.  Accelerating spending costs ad infinitum will benefit few Americans. Comments suggesting that the ‘US can afford to spend more on healthcare, (and doesn’t) need to spend less on healthcare’ ⁶ are non-sensical. Why should the US continue to pay more for less? Surely effective and expanded provision of public health care and movement towards an economically sustainable health care system should be the focus of the American healthcare debate?

I wondered how dramatic the differences between American healthcare costs and public health benefits to those of other similarly developed countries. The Group of Eight (G8) was initiated in the mid 1970s, originally as the G6 until Canada joined in 1977, then Russia in 1991. The initial aim of this informal group of industrialized democratic countries was to address the mid-seventies economic crises ⁷. I thought it would be useful to consider key health parameters between the G8 countries (excluding Russia where, for an industrialized country, life expectancy is low (65yrs), infant mortality high (13 deaths per 1000 live births) ⁸, and healthcare spending per capita limited ($638) ⁹).

The US had the highest rate of infant mortality, the lowest life expectancy, the highest number of diabetes-related deaths, the highest rate of obesity and the lowest number of doctor consultations among it’s G8 peers, Canada, France, Germany, Italy, Japan and UK, excluding Russia. UK had the highest mortality rates for  cancer and respiratory diseases, Germany and Italy had the highest mortality rates acute myocardial infarction and cerebr0vascular diseases, respectively; US mortality rates as a result of these health issues were around or above average. The US did have fewer smokers (15.4%) than other countries. In contrast, with the exception of the highest percentage of smokers (25.7%), Japan had the best overall public health parameters ¹⁰.

There are no clear public health, or economic, advantages for Americans in paying more for healthcare or not providing health coverage for all when compared to it’s peers. Looking to other countries may provide clearer evidence of the necessity and possibility of healthcare reform. Poor individual health has consequences which impact the wider population; for example, communicable diseases, including pandemic viruses such as H1N1, illustrate that a national healthcare approach must appreciate broad public health consequences.

Elevated healthcare costs, lack of evidence of better public health outcomes and limited coverage of the population show an ailing US healthcare that requires treatment.

It’s time to take the American healthcare system into the ER.

1. OECD. Frequently requested health data. Organisation for economic co-operation and development 2009;    http://www.oecd.org/dataoecd/46/2/38980580.pdf

2. Wilper AP, Woolhandler S, Lasser KE, McCormick D, Bor DH, Himmelstein DU. Health Insurance and Mortality in US Adults. Am J Public Health 2009;    http://pnhp.org/excessdeaths/health-insurance-and-mortality-in-US-adults.pdf

3. DeNavas-Walt C. PBD, Smith J.C.,. Income, poverty, and health insurance coverage in the United States: 2008 (Table 7). US Census Bureau 2009; US Dept of Commerce   http://www.census.gov/prod/2009pubs/p60-236.pdf

4. An J. SR, Tisdale R., Ranji U. . US Healthcare Costs: Background brief. Kaiser Family Foundation 2009;    http://www.kaiseredu.org/topics_im.asp?id=358&imID=1&parentID=61

5. DeNavas-Walt C. PBD, Smith J.C.,. Income, poverty, and health insurance coverage in the United States: 2008 (Table 1). US Census Bureau 2009; US Dept of Commerce   http://www.census.gov/prod/2009pubs/p60-236.pdf

6. Lehrer B. No rest for the weary. Interview with Betsy McCaughey. WNYC Radio 2009;    http://www.wnyc.org/shows/bl/episodes/2009/08

7. History of the G8. G8 Summit 2009;    http://www.g8italia2009.it/G8/Home/Approfondimenti/G8-G8_Layout_locale-1199882116809_StoriaDelG8.htm

8. UNICEF. Russian Federation statistics. 2009;    http://www.unicef.org/infobycountry/russia_statistics.html#58

9. WHO. Russian Federation Statistics 2006. World Health Organisation 2008; World Health Statistics http://www.who.int/countries/rus/en/

10. OECD. OECD Health Data 2009 – Frequently requested data (excel download). Organisation for economic co-operation and development 2009; 

http://www.oecd.org/document/16/0,3343,en_2649_34631_2085200 _1_1_1_1,00.html