published Thursday, September 22nd, 2011

Cleaveland: U.S. leads industrialized world in health care spending

Compared to 11 other industrialized countries -- Australia, Canada, Denmark, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom -- the United States continues to spend far more each year on health care.

A July study by the Commonwealth Fund analyzes both the costs and the results of these expenditures. The study uses data for 2010 from the Organization for Economic Cooperation and Development.

Per capita health expenditures for Americans were two-times greater than the median for the nations and one-third higher than Switzerland and Norway, the next most costly countries in terms of health expenditures.

The United States continues to spend a substantially larger portion of its gross domestic product on health services (17.6 percent in 2010). In each country in the survey health-care costs routinely exceeded the rate of inflation. Since 1980, the rate of increase in U.S. health-care spending has far exceeded that of the other nations.

Surprisingly, the U.S. has fewer physicians who are visited less often. We have fewer hospital beds and in-patient stays are shorter. Our population is younger. However, we spend a greater proportion of our health-care dollars on hospital care, imaging and prescription drugs.

* Hospital costs. We spend three times more per hospital discharge than the group's median. Canada, in second place, spends 75 per cent as much per hospital discharge. Fragmented care and administrative costs contribute to higher in-patient costs in America. Americans with chronic health conditions such as emphysema, diabetes and congestive heart failure were much more likely to be hospitalized in the United States.

* Imaging. Except for Australia, the United States has more CT scanners and MRI machines than other nations in the study group. Machines here are used more frequently and charges are higher. Personal experience reveals charges for individual MRI scans that often exceed $2500 per test plus separate billing for interpretation.

* Prescription drugs. Americans are more likely to take multiple prescription drugs than residents of other nations. We pay substantially more for the 30 most frequently prescribed prescription drugs. In four nations the average cost of the 30 drugs is less than half the cost here. The rate of increase in spending for drugs was highest in the United States.

The world's most costly health-care system does not ensure the best outcomes for sick people. Our health-care dollars buy us better outcomes for some cancers -- breast, colorectal, and cervical -- compared to the overall group. However, we have higher in-hospital death rates for myocardial infarctions and hemorrhagic strokes. We do less well in care of chronically ill persons. Other studies document that we lag in adult life-expectancy and maternal and child health. There are significant disparities in access to health services among our minority populations.

Census data released earlier this month places the number of Americans without health insurance at 49.9 million. The other countries in the survey provide universal health care through a variety of systems that range from government-owned and operated to blends of public and private programs.

Traditions for providing care vary from country to country. Expectations of citizens and health care practitioners also differ. The Commonwealth Fund study does identify areas of potential savings within American health care. Hospital care can be better coordinated and administrative costs reduced. Lower costs can be negotiated by health plans for prescription drugs. Stricter criteria for the use of imaging technology can be developed. These changes can be accomplished without reducing quality of care.

Higher costs have not guaranteed superior outcomes. This is a fundamental challenge as we undertake reform of our present, dysfunctional system of health care.

Contact Clif Cleaveland at cleaveland1000@comcast.net.

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