This analysis draws upon data from the Organization for Economic Cooperation and Development and other cross-national analyses to compare health care spending, supply, utilization, prices, and health outcomes across 13 high-income countries: Australia, Canada, Denmark, France, Germany, Japan, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. These data predate the major insurance provisions of the Affordable Care Act. In 2013, the U.S. spent far more on health care than these other countries. Higher spending appeared to be largely driven by greater use of medical technology and higher health care prices, rather than more frequent doctor visits or hospital admissions. In contrast, U.S. spending on social services made up a relatively small share of the economy relative to other countries. Despite spending more on health care, Americans had poor health outcomes, including shorter life expectancy and greater prevalence of chronic conditions.
Health care spending in the U.S. far exceeds that in other countries, despite a global slowdown in spending growth in recent years. At 17.1 percent of GDP, the U.S. devotes at least 50 percent more of its economy to health care than do other countries. Even public spending on health care, on a per capita basis, is higher in the U.S. than in most other countries with universal public coverage.
How can we explain the higher U.S. spending? In line with previous studies,19 the results of this analysis suggest that the excess is likely driven by greater utilization of medical technology and higher prices, rather than use of routine services, such as more frequent visits to physicians and hospitals.
High health care spending has far-reaching consequences in the U.S. economy, contributing to wage stagnation, personal bankruptcy, and budget deficits, and creating a competitive disadvantage relative to other nations.20 One potential consequence of high health spending is that it may crowd out other forms of social spending that support health. In the U.S., health care spending substantially outweighs spending on social services. This imbalance may contribute to the country’s poor health outcomes. A growing body of evidence suggests that social services play an important role in shaping health trajectories and mitigating health disparities.21,22 Additional cross-national research is needed to better understand the relationship between social services and health, as well as other health determinants like lifestyle and environment.
New care models that reward health care providers based on their patient population’s health outcomes (e.g., accountable care organizations) are an interesting development. Such accountability could create a business case for health care providers to invest in certain social services or other nonclinical interventions, if doing so would be a cost-effective way to improve patients’ health.23 Over the long term, such a strategy could potentially alter the current balance between health and social services spending.
The costs of health care must be addressed before any realistic and significant reductions in health care premiums can be accomplished.
European health care, which costs much less than ours, doesn't have marbled palaces for hospitals. Their doctors are on salaries, ad are paid to keep people well, not perform fee for service. They have sensible placement of expensive equipment, rather than in every competing hospital. They negotiate drug prices.
They have government managed health care. And until we take similar steps, we'll just keep paying through the nose.
And then, we can address single payer as an additional cost saver. Both Vermont and California found that single payer won't work until costs are brought way down.
Half way measures are like putting a band aid in a hemorrhaging artery.