US spends most on healthcare, has worst outcomes, finds Commonwealth Fund

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The U.S. spends far more on healthcare than do other countries, yet it doesn't have the results to show for it.

Despite the higher spending, life expectancy and other health metrics fare far worse in the U.S. than in other locations across the world.

According to a new report from the Commonwealth Fund, healthcare spending, both per person and as a share of GDP, continues to be far higher in the U.S. than in other high-income countries. Yet the U.S. is the only country that doesn't have universal health coverage.

The U.S. also has the lowest life expectancy at birth, the highest death rates for avoidable or treatable conditions, the highest maternal and infant mortality, and among the highest suicide rates. In addition, it has the highest rate of people with multiple chronic conditions and an obesity rate nearly twice the average of the international Organisation for Economic Co-operation and Development, one of the primary sources of the data.

Americans see physicians less often than people in most other countries and have among the lowest rate of practicing physicians and hospital beds per 1,000 people, data showed. Meanwhile, screening rates for breast and colorectal cancer, and vaccination for flu in the U.S. are among the highest, but COVID-19 vaccination trails many nations.

WHAT'S THE IMPACT?

In 2021, the U.S. spent 17.8% of its GDP on healthcare, nearly twice as much as the average OECD country. Health spending as a share of the overall economy has been rising steadily since the 1980s among all countries, with spending growth outpacing economic growth, driven by medical technologies, rising prices and higher demand for services.

Health spending per person in the U.S. was nearly two times higher than in the closest country, Germany, and four times higher than in South Korea. In the U.S., that includes spending for people in public programs like Medicaid, the Children's Health Insurance Program, Medicare and military plans; spending by those with private employer-sponsored coverage or other private insurance; and out-of-pocket health spending.

All countries in the analysis except the U.S. guarantee government, or public, health coverage to all their residents. In addition to public coverage, people in several of the countries have the option to also purchase private coverage. In France, nearly the entire population has both private and public insurance.

In 2021, 8.6% of the U.S. population was uninsured. The U.S. is the only high-income country where a substantial portion of the population lacks any form of health insurance, numbers showed.

Yet despite the high spending, Americans experience worse health outcomes than their peers around the world. For example, life expectancy at birth in the U.S. was 77 in 2020 – three years lower than the OECD average. Provisional data shows life expectancy in the U.S. dropped even further in 2021.

In the U.S., life expectancy masks racial and ethnic disparities, according to the Commonwealth Fund. Average 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 lower, respectively, than it is for non-Hispanic whites (78.8).

Yet life expectancy for Hispanic Americans (81.9) is higher than it is for whites and similar to the life expectancy in the Netherlands, New Zealand and Canada. As a group, Asian Americans have a higher life expectancy (85.6) than people in Japan.

The U.S. also fared poorly on infant mortality, which in 2020 clocked in at 5.4 deaths per 1,000 live births, the highest rate of all the countries in the analysis. In contrast, there were 1.6 deaths per 1,000 live births in Norway.

Women in the U.S. have long had the highest rate of maternal mortality related to complications of pregnancy and childbirth. In 2020, there were nearly 24 maternal deaths for every 100,000 live births in the U.S., more than three times the rate in most other high-income countries. A high rate of cesarean section, inadequate prenatal care and socioeconomic inequalities contributing to chronic illnesses like obesity, diabetes and heart disease may all help explain high U.S. infant and maternal mortality, authors said.

The U.S. also had the highest rates of obesity and deaths from physical assault including gun violence, and was the third-highest in terms of suicide rates.

THE LARGER TREND

For the U.S., a first step to improvement is ensuring that everyone has access to affordable care, the authors wrote. Affordability remains the top reason why some Americans don't sign up for health coverage, while high out-of-pocket costs led nearly half of working-age adults to skip or delay getting needed care, the report stated. The Inflation Reduction Act, which will help reduce the high cost of certain drugs and cap out-of-pocket costs for older Americans, could move the needle, authors said.

Containing costs is another important step, they said. In the U.S., high prices for health services continue to be the primary driver of this elevated spending. Policymakers and health systems could look to some of the approaches taken by other nations to contain overall health spending, including healthcare and administrative costs.

Prevention and management of chronic conditions make up another important step, according to the Commonwealth Fund. Critical to this is developing the capacity to offer comprehensive, continuous, well-coordinated care. Decades of underinvestment, along with an inadequate supply of healthcare providers, have limited many Americans' access to effective primary care, authors said.
 

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com