Jan 31, 2023 - Health

America's worsening return on health investment

Share of GDP spent on health, by select country
Data: Gunja, et al., 2023, "U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes," OECD Health Statistics 2022; Chart: Axios Visuals

The U.S. continues to far outspend other developed nations while seeing worsening health outcomes.

Driving the news: A report from the Commonwealth Fund today shows poorer U.S. health outcomes — such as Americans being more likely to suffer from multiple chronic illnesses, die from avoidable causes including maternal mortality and assault, and having a shorter life expectancy — all while America pays the most per capita for those outcomes.

"The problem is getting worse," Munira Gunja, senior researcher at the Commonwealth Fund's International Health Policy Program.

  • "In these sorts of studies where we make cross-national comparisons, we can see we are still behind our peer countries and need to start implementing methods they've developed into our own system," she said.

By the numbers: The U.S. spends nearly $12,000 on health care per capita, including more than $1,200 in household out-of-pocket spending a year, according to a Commonwealth Fund study released today.

  • That's more than $4,500 than its nearest peer, Germany, which spends about $7,4000 on health care per person in a year. It's also more than three times what South Korea, New Zealand and Japan spend, respectively.
  • In 2021, the U.S. spent nearly 18 % of its gross domestic product on health care, nearly twice as much as the average country in the Organization for Economic Cooperation and Development, or OECD.

State of play: The report found more than 30% of Americans surveyed reported suffering multiple conditions. No other country reported more than 26% of its residents surveyed had multiple chronic conditions.

  • The U.S. had the highest rate of avoidable deaths in 2020 by far at 336 deaths per 100,000 people. The next closest comparison was Germany at 195 deaths per 100,000 people.
  • That included infant and maternal mortality rates, as well as deaths from assault which far outpaced other OECD nations.
  • In 2020, life expectancy at birth in the U.S. was 77 years, three years lower than the OECD average, per the report. Preliminary CDC data shows life expectancy in the U.S. fell again in 2021.

The big picture: The report comes on the heels of a Peterson-KFF Health System Tracker report out Monday showing the impact the cost of U.S. healthcare is having on access.

  • At least one in 11 U.S. adults reported they delayed or did not get care because of cost reasons in 2021, per the tracker which used National Health Interview Survey data.
  • Adults who are in worse health were twice as likely as those in better health to delay or not get care due to cost reasons, the tracker found.

Between the lines: The U.S. is the only OECD nation not to have guaranteed health coverage. It also averages fewer primary care physician visits and fewer primary care physicians than most peer countries.

  • "Even though we have made some steps over the past decade to improve health access and coverage, the rates are getting worse," Gunja said. "It's a big wakeup call for the health policy and health care industry that we are in a crisis and we need to make changes."
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