A few days ago a friend asked me if I knew why, despite the U. S. spending more on healthcare, our outcomes were not as good as those of other countries that spend less than we do. I volunteered that even though quality guidelines exist, they often are not followed, or that another answer might be the evidence of measurable health disparities. In fact, when I researched this question I found a lot of data, no agreement on what constitutes a relevant outcome measure and no convincing answers. Does anyone out there have a good explanation of why our outcomes fall short of those demonstrated by those of other developed countries?
It is well established that the United States spends more on health care than any other developed countries. In 2003 the U.S. expenditures were almost $6,000 per capita; this was 24% higher than Luxembourg (the next highest), “and over 90% higher than in many other countries that we would consider global competitors.” (Snapshots: Health Care Spending in the United States and OECD Countries, Kaiser Family Foundation, 2007).
I think that for a start it would be good to agree on what constitutes significant outcome measures and, curiously, I didn’t find consistent mention of any outcome measure in particular. Life expectancy and infant mortality are considered “crude proxies for health status and are not very sensitive to changes in the health care financing and delivery systems.” Other outcome measures that are being developed are “quality-adjusted life years”, “disability-adjusted life years” and “health–adjusted life years”. Another suggested measure is “potential years of life lost” (the number of years before age seventy a person died from causes that could have been prevented. (Health Spending, Access, And Outcomes: Trends In Industrialized Countries, Health Affairs, Vol. 18, Number 3). Even if we don’t use something as sophisticated as “potential years of life lost”, and we do use plain-old life expectancy, United States’ life expectancy ranks 27th in the world. Cuba’s life expectancy ranks 28th in the world, and Cuba spends about 1/25th of what the U.S. spends (Health Care Spending, ucatlas.ucsc.edu/health/accessprint.html).
Performance measures include quality care, access, efficiency, equity and healthy lives (Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care, The Commonwealth Fund, Volume 59, May 15, 2007). Some reasons suggested for our underperformance are lack of universal health insurance coverage (less likely to receive preventive care), lack of technology and high administrative costs.
We know that we are a global society and, as such, we can compare what we spend to what other OECD (Organization of Economic Cooperation and Development) countries spend. Some countries are accomplishing with clean drinking water and preventative health care what we are trying to accomplish with clean drinking water, preventative health care, public and private health insurance, information technology and pharmaceuticals.
What we don’t know is what we’re really getting for the money we spend (compared to other countries), and what reliable universal or global measure will help us to know.
Snapshots: Health Care Spending in the United States and OECD Countries, Kaiser Family Foundation, 2007.
Health Spending, Access, And Outcomes: Trends In Industrialized Countries, Health Affairs, Vol. 18, Number 3.
Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care, The Commonwealth Fund, Volume 59, May 15, 2007
About the Author
Dr. Flippin brings a wealth of experience, starting with her long tenure as an attending physician at the Cook County Hospital Emergency Department. She is currently Corporate Compliance and HIPAA Privacy Officer at major Chicago hospital.
She is a keynote speaker focusing on the health care crisis facing corporations today (http://www.flippinonhealth.com/).