Tuesday, May 3, 2016

US Health Care in International Context

Health Care at a Glance 2015 is an OECD databook: that is, a bit of text, but mainly charts and figures. It serves up the standard comparisons of US health care spending in the context of the rest of the world,  along with a number of detailed comparisons of health status, the health care workforce, access to health care, quality of care, and others.

Let me start with the comparisons of US health care spending to the rest of the world, which are both familiar to me and also never fail to astonish my eye. US per capita health care spending is more than one-third bigger than any other country; moreover, it's two-and-a-half times as large as the average of OECD countries.

The US doesn't just spend more because it's a higher-income economy. As a share of GDP, the US spends more than five percentage point of GDP more than the second-place country; in addition, it spends nearly twice as much on health car as a share of GDP than the OECD average.

There's also an ongoing argument about whether the passage of the Patient Protection and Affordable Care Act of 2010 slowed down US health care spending. As I've argued, the decline in the growth rate of US health care spending started well before the 2010 legislation, and moreover it was part of a global slowdown in the rise of health care spending. Here's a figure looking at the rise in health care costs across countries from 2005 to 2009, and also from 2009 to 2013. US health care costs rose more slowly than the international average in the earlier period, but have have risen faster than the international average since then.

It's also well-known that despite the relatively high levels of US health care spending, US public health statistics aren't  especially good. Although the US doesn't measure up very well to other countries on access to health care, given that about 27 million Americans still lack health insurance, the causes of poor health go a lot deeper than the health care system. As the report notes:
"Life expectancy in the United States is lower than in most other OECD countries because of higher mortality rates from various health-related behaviors (including higher calorie consumption and obesity rates, higher consumption of legal and illegal drugs, higher deaths from road traffic accidents and homicides), adverse socio-economic conditions affecting a large segment of the US population, and poor access and co-ordination of care for certain population groups."
So what is the US getting for its health care spending? Here are some tips and clues from the report. I'll let you look up the specific tables yourself, if you wish, and just cut to some of the comparisons that caught my eye.

Countries with a high number of doctors, like Germany, Sweden, and Austria, have 4-5 doctors per 1,000 people. The average for OECD countries is 3.3 doctors per 1,000 people. In the US, it's 2.6 doctors per 1,000 people.

When it comes to hospital beds, Japan by far leads the way with 13.3 per 1,000 population. For comparison, Germany has 8.3 hospital bed per 1,000 population, France has 6.3 hospital beds per 1,000 population, the OECD average is 4.8 beds per hospital population, and the US has 2.9 hospital bed per 1,000 population.

Some measures are a way of capturing how well the health care system deals with chronic diseases like diabetes or asthma. The working assumption is that if complications from these conditions are leading to hospitalization fairly often, then they aren't being especially well-managed. The US doesn't do especially well on these measures. Rates of hospital admissions for asthma and chronic obstructive pulmonary disease (COPD) were about 240 per 100,000 population for the average OECD country, but about 320 per 100,000 in the US. Hospital admissions for diabetes are about 150 per 100,000 in the average OECD country, but about 200 per 100,000 in the US.

However, when it comes to measures of the efficacy of high-tech medical interventions, the US health care system performs well. For example, one such measure is the share of people over-45 admitted to a hospital with acute myocardial infarction (AMI) who die with 30 days. The OECD average is about 8 per 100 cases, while in the US it's 6 per 100 cases. Similarly, if you look at the thirty-day mortality rate after admission to hospital for ischemic stroke, the OECD average is about 8 per 100 admissions, while in the US it's about 4 per 100 admissions.

When it comes to MRI scanners, Japan leads the way by far with 46.9 per million population, but the US isn't far behind at 35.3 per million population. The OECD average is 14.1 MRI scanners per million population. CT scanners are a similar story. Japan again leads by far with 101.3 per million population, but the US is in the top three with 43.5 per million population.

A few years back, I tackled the broader question of "Why does the US Spend More on Health Care than Other Countries?" (May 14, 2012).  Here, I'll just note that the US ends up with a health care system that excels at high tech, high cost care, but does an average to below-average job at other aspects of health care. The OECD report notes that the US manages to have one of the highest five-year survival rates for those with breast cancer, but a substantially below-average five-year survival rate for cases of cervical cancer.

Here's a final figure, which divides up total health care spending into inpatient care, outpatient care, long-term care, medical goods, and collective services. Strikingly, the US is at the bottom in term of share of spending on inpatient care, but at top in share spent on outpatient care and near the top in the share spent on "medical goods."

Many discussions of the US health care system take most of how it operates for granted, and then argue over "single payer" or "health care exchanges" or expanding Medicare. My sense is that  specific comparisons across countries can be a useful way to shake up thinking. For another recent post with this element, see "A Cross-National View of Health Care Systems: Thoughts on Canada, the UK, and Germany" (March 10, 2016).