October 23rd, 2012
A PBS NewsHour report looks at how America stacks up against other countries in terms of healthcare.
They interviewed Mark Pearson, who is the head of Division on Health Policy at the Organization for Economic Co-operation and Development (OECD), an organization with 34 member countries. NewsHour asked him questions like how US spending ranks compared to other OECD countries, how some other countries are keeping down their costs, and why some procedures cost so much more here than they do in other countries.
First, and unsurprisingly, Pearson points out that the United States spends “by far” the most in the world on health care. While the U.S. spent $8,233 on health per person in 2010, the next-highest spenders (Norway, the Netherlands and Switzerland) all spent at least $3,000 less per person. And the average for all of the other 33 OECD countries was $3,268 per person.
Other countries keep their costs down in a number of ways, including a consistent fee schedule; government intervention in costs if they see something getting out of hand; keeping down administrative costs; and embracing technology (for example, in Sweden, all drugs are prescribed electronically, with a message sent directly from the doctor’s office to the pharmacy, which reduces medical errors as well as saving 1-2 hours of work by pharmacists per day).
NewsHour: Are there particular areas the U.S. is doing poorly compared to other OECD countries?
Overall, the life expectancy of a U.S. citizen, at 78.2 years, is shorter than the average among OECD countries of 79.5 years and there are a number of specific areas where U.S. health care is weak when compared with other countries.
The U.S. needs stronger policies in tackling lifestyles that lead to poor health. While many states are making efforts to reduce smoking, there are fewer policies to tackle the harmful use of alcohol in the U.S. than you would find in other OECD countries, such as higher taxes on alcohol or minimum prices.
The U.S. could certainly do a lot more on obesity. It’s a big risk factor for poor health in the U.S., more so than you find in other OECD countries. Adult overweight and obesity rates are the highest in the OECD, and have kept growing even in the last couple of years, while they have nearly stabilised in some other OECD countries, such as England, France and Italy. Child overweight and obesity rates are also very high, but they have been relatively stable over the past 10 years. The slides below show that the U.S. does poorly both in terms of diet and physical activity, even in comparison with other high-obesity countries, across all age groups.
The first lady’s “Let’s move” campaign is great, but it cannot achieve a lot if it isn’t supported by other measures. Support for physician counseling and programs to help encourage healthier lifestyles vary widely with different insurance arrangements. The U.S. has a national program to cover breast and cervical cancer screening for low-income women, why not have one to cover lifestyle counseling for low-income people? Advertising regulation is left to the food and beverage industry (e.g. the IFBA “Pledges”) and this is not likely to have a major impact.
In terms of health care services, the biggest areas of concern are the quality of primary care services and coordination of care for long-term conditions. Asthma, a condition readily managed by general practitioners in the community, should require hospital admission on very few occasions. In the U.S. however, hospital admission rates for asthma are more than double the OECD average (120.6 per 100,000 population compared to an OECD average of 51.8, 2009).
A similar picture emerges for chronic obstructive pulmonary disease (230 admissions per 100,000 population compared to an OECD average of 198, 2009). These outcomes can be improved through better health care. In a Commonwealth Fund survey of seven nations (Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States), 16 percent of American patients reported delays in being notified about an abnormal test result (the highest proportion reported) and only 75 percent of primary care physicians reported often or always receiving correspondence from specialists after referral, suggesting systemic problems with care coordination.