American healthcare: How do we measure up?

Transcription

1 American healthcare: How do we measure up? December 2009 September 2009 Lauren Damme Economic Growth Program Next Social Contract Initiative

2 The U.S. is one of the only industrialized nations in the world without a healthcare system that provides universal primary coverage. OECD Country Healthcare System Classification System of Universal Coverage System Lacking Universal Coverage Australia Republic of Korea United States Austria Belgium Canada Czech Republic Denmark Finland France Germany Greece Hungary Iceland Ireland Italy Luxembourg Mexico (in progress) Netherlands New Zealand Poland Portugal Slovakia Spain Sweden Turkey (in progress) United Kingdom Japan

3 Since the 1980s, U.S. spending on healthcare has grown much more rapidly than that of other OECD countries Healthcare expenditure per capita, US$ PPP, iture, US$ PPP Per capita expendi United States United Kingdom Japan Germany Canada OECD health data, 2009,

4 The U.S. now spends 16% of its income (GDP) on health care - almost double the OECD average of 8.9%. OECD Healthcare Expenditure as % of GDP, Australia Austria Belgium Canada Percent of GDP spent on healthcare Czech Republic Denmark Finland France Germany Greece Hungary Iceland Ireland Italy Japan Korea Luxembourg Mexico Netherlands New Zealand Poland Portugal Slovak Republic Spain Sweden Turkey United Kingdom United States OECD average OECD health data, 2009,

5 The U.S. spends about $2500 more per capita on healthcare than any other OECD country each citizen consumes about $7290 in health services each year. Health expenditure per capita, US$ PPP, 2007 $8,000 7,290 $7,000 $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $0 3,763 3,895 3,595 3,137 1,626 3,512 2,840 3,588 3,601 2,727 1,388 3,319 Australia Austria Belgium Canada Czech Republic Denmark Finland France Germany Greece Hungary Iceland Ireland 3,424 2,686 2,581 Italy Japan Korea 1,688 4, ,837 OECD health data, 2009, 2,510 4,763 1,035 2,150 1,555 3,323 2,671 Luxembourg Mexico Netherlands New Zealand Poland Portugal Slovak Republic Spain Sweden 4,417 Turkey 618 United Kingdom 2,992 2,984 United States OECD average

6 This spending is far above that of similarly wealthy countries. GDP per capita (2008) vs Health expenditure per capita (2007) Health expenditure per capita USD PPP (2007) $8,000 $7,000 $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $0 Turkey United States Ireland $0 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 Annual GDP per capita, current prices and current USD PPP (2008) OECD health data, 2009, Luxembourg

7 Besides the higher costs Americans pay for curative care, the U.S. spends more per capita on medical goods and administration associated with healthcare than other countries. $8,000 $7, Composition of health spending per capita USD PPP Health administration and insurance $6,000 1, Prevention and public health $5,000 $4,000 $3,000 $2,000 4, Medical goods Ancillary services Long-term care $1,000 1,465 1,920 2,044 1,839 Curative-rehabilitative $0 U.S. ($7,290) Japan ($2,581) Germany ($3,588) Source: OECD Health Data 2007 France ($3,601) Canada ($3,895)

8 Curative-rehabilitative care is comprised of both inpatient and outpatient care, and is the fastest-growing segment of U.S. healthcare. Outpatient care is the fastest-growing health care sector in the U.S., and accounts for more than 40 percent of total healthcare spending. The U.S. spent $850 billion on outpatient care in 2006: $436 billion more than expected for our level of wealth. The same report states that spending on drugs and healthcare administrative costs is $189 billion more than expected based on U.S. level of wealth. Evaluating overall spending according to country wealth, a McKinsey report estimates that the $2.1 trillion the U.S. spends annually on healthcare is about $650 billion more than expected considering the level of wealth of the U.S. Source: McKinsey Global Institute, Accounting for the cost of US health care: A new look at why Americans spend more

9 Despite lacking universal coverage, the U.S. government spends $1126 more per capita on health care than the OECD average, only spending less than the governments of and Luxembourg, both of which provide universal coverage. Public expenditure per capita, USD PPP, 2007 $4,500 $4,000 $3,500 $3,000 $2,500 $2,000 $1,500 $1,000 $500 $0 $372 Mexico Turkey $2,184 Poland Korea Hungary Slovak Republic Czech Republic Portugal Greece Spain New Zealand Italy Japan Finland Australia OECD average United Kingdom OECD health data, 2009, Belgium Sweden Canada Iceland Germany Ireland France Austria Denmark Netherlands United States Luxembourg $3,310 $4,006

10 With this expenditure, the U.S. government provides some level of healthcare coverage for about 85 million people - the elderly, disabled, and some poor through Medicare, Medicaid, and the State Children s Health Insurance Program (SCHIP) (U.S. Census Bureau, 2008). However, most OECD country governments spend 35 percent less per capita than the U.S. and provide universal primary healthcare.

11 In 2009, 46.3 million Americans 15.4 percent of the population lack health insurance, according to the U.S. Census Bureau. This means U.S. taxpayers pay more per citizen for healthcare than those of other industrialized countries, but do not necessarily receive healthcare in return. A 2009 study published in the American Journal of Public Health, which followed 9,000 people from , found that the uninsured have a 40 percent higher risk of death than the insured, due to their inability to seek medical care, including preventative care (Wilper et al., 2008). The study estimated that almost 45,000 Americans die each year because they lack health insurance, often meaning that they do not have access to preventative care or that when they do seek health care, it may be too little, too late. Source: U.S. Census Bureau,

12 The U.S. ranks 24 th out of 30 (tying with the Czech Republic) on the World Health Organization s healthy life expectancy at birth (HALE) measurement. Healthy life expectancy (HALE) at birth estimates, Hungary Turkey Mexico Poland Slovakia Czech Republic United States S. Korea Portugal Austria Belgium Denmark Finland Greece United Kingdom Canada France Germany Ireland Luxembourg Netherlands New Zealand Years Australia Iceland Italy Spain Sweden Japan World Health Organization, World Health Statistics 2009,

13 The U.S. ranks behind virtually every industrialized nation on adult mortality rates (ahead of only Turkey, Slovakia, Poland, Mexico, and Hungary). Adult mortality rate (probability of dying between 15 to 60 years per 1000 population) Probability of dying between ages (per 1000 people) Iceland Italy Australia Sweden Japan Netherlands Canada New Zealand Spain Ireland Austria Greece United Kingdom Germany Republic of Korea Luxembourg Belgium France Denmark Portugal Finland Czech Republic United States of America Turkey Mexico Slovakia Poland Hungary World Health Organization, World Health Statistics 2009,

14 The U.S. also ranks last among the most advanced nations on infant mortality and under-5 mortality rates (shown below), coming ahead of only Mexico and Turkey Under-5 mortality rate (probability of dying by age 5 per 1000 live births) 8 23 Turkey Iceland Sweden Finland Italy Japan Spain Ireland Austria Greece Germany Luxembourg Belgium France Portugal Czech Republic Netherlands Republic of Korea Denmark Australia Canada New Zealand United Kingdom Poland Hungary United States of America Slovakia Mexico Under-5 Mortality rate (per 1000 live births) World Health Organization, World Health Statistics 2009,

15 The Japanese get the longest healthy life for their money, while Americans have relatively low healthy life expectancies for the amount spent on healthcare. Per capita health expenditure vs Healthy life expectancy at birth Healthy life expectan ncy (years) Turkey Korea Japan Spain United States Health expenditure per capita (US$ PPP) OECD health data, 2009, w w.oecd.org/document/30/0,3343,en_2649_34631_ _1_1_1_37407,00.html WHO, World Health Statistics 2009, w w.w ho.int/w hosis/en/index.html

16 The U.S. has the highest amenable mortality rate among industrialized countries; in other words, we have the highest number of deaths from preventable or treatable conditions, according to a 2008 study published in Health Affairs. There are mixed results for U.S. performance on preventive healthcare and care of acute conditions, although survival rates for some types of cancer are higher in the U.S. than other developed countries, and the American system provides faster access to specialists than most other countries. Source: Ellen Nolte and C. Martin McKee. Measuring The Health Of Nations: Updating An Earlier Analysis. Health Affairs, 27, no. 1 (2008): 58-71