US health care: doing less with more

World Health Matters (U.S.A.) – by Gary Finnegan – The United States is paying far more for health services than 12 comparable industrialised nations but the quality of care is highly variable, according to new research by The Commonwealth Fund.

The higher levels of spending found in the US is linked to the tendency to pay higher prices and greater use of medical technology, rather than more frequent hospital admissions or doctor visits.

In 2009, the US spent nearly $8,000 per person on health care while Norway and Switzerland paid two thirds of this figure and recorded similar health outcomes. Japan and New Zeland, where care is also highly rated, spent one third of the US figure.

While the US performs well on breast and colorectal cancer survival rates, it has among the highest rates of potentially preventable deaths from asthma and amputations due to diabetes, and rates that are no better than average for in-hospital deaths from heart attack and stroke.

David Squires, senior research associate at The Commonwealth Fund said US health care spending amounted to more than 17% of GDP, compared with 12% or less in other study countries. Japan’s spending, which was the lowest, amounted to less than 9% of GDP.

There were 2.4 physicians per 100,000 population in the US in 2009, fewer than in all the countries in the study except Japan. The US also had the fewest doctor consultations (3.9 per capita) of any country except Sweden.

Relative to the other countries in the study, the US also had few hospital beds, short lengths of stay for acute care, and few hospital discharges per 1,000 population. On the other hand, US hospital stays were far more expensive than those in other countries – more than $18,000 per discharge. By comparison, the cost per discharge in Canada was about $13,000, while in Sweden, Australia, New Zealand, France, and Germany it was less than $10,000.

“It is a common assumption that Americans get more health care services than people in other countries, but in fact we do not go to the doctor or the hospital as often,” said Dr Squires. “The higher prices we pay for health care and perhaps our greater use of expensive technology are the more likely explanations for high health spending in the US Unfortunately, we do not seem to get better quality for this higher spending.”

Prices for the 30 most commonly used prescription drugs were a third higher in the US compared to Canada and Germany, and more than double the amount paid for the same drugs in Australia, France, the Netherlands, New Zealand, and the United Kingdom. Magnetic imaging (MRI) and computed tomography (CT) scans were also more expensive in the US, and American physicians received the highest fees for primary care office visits and hip replacements.