What does a check-up of the U.S. healthcare system tell us?
This chart collection accompanies our video, "Health of the Healthcare System," a diagnostic look at the state of our healthcare system. How does the U.S. healthcare system compare to health systems of other high-income countries, and how has it fared over time? The video takes us through a check-up of our system by assessing four key areas: how healthy we are, the quality of care we receive, how much it costs, and how accessible it is.
The following charts explore these key areas in more detail.
The U.S. has the lowest life expectancy at birth among OECD comparable countries
Life expectancy at birth in the U.S is lower than comparable OECD countries (countries with above median total GDP and GDP per capita for at least one of the past ten years). In 2011, U.S. life expectancy was just under 79 years, compared to an average of about 82 years for comparable OECD countries.
Life expectancy can be influenced by a number of factors, including those within the domain of the healthcare system (e.g., quality of care, access to preventive health services) as well factors largely outside the control of the health system (e.g. lifestyle, diet, violence and accidents).
Though DALYs have declined in the U.S. and comparable countries since 2000, the U.S. continues to have higher age-adjusted rates of years of life lost to disability and premature death than comparable countries.
Among the major causes of death, the U.S. has lower than average mortality rates for cancers and higher than average rates in the other categories relative to comparable OECD countries. These categories accounted for more than 85 percent of all deaths in the U.S. in 2010.
Researchers have looked at mortality that results from medical conditions for which there are recognized health care interventions that would be expected to prevent death. While the health care system might not be expected to prevent death in all of these instances, differences in mortality for these conditions provides information about how effectively health care is being delivered. In 2006, the last year for which reasonably complete information is available, the U.S. had the highest mortality rate for deaths amenable to health care among the comparable OECD countries.
Lower extremity amputations due to diabetes are higher in the U.S. than in comparable countries, however the U.S. is making significant progress as the rate of such amputations has decreased by 54% between 2006 and 2010.
According to a recent international survey by the Commonwealth, the U.S. has higher rates of medical, medication, and lab errors than comparable countries. This includes medical mistakes, incorrect medications or dosages, lab test errors, or delays receiving abnormal test results.
Circulatory conditions had been the largest contributor to health spending, for at least a decade, until 2012 when they were surpassed in total spending by ill-defined conditions (a category including check-ups, follow-up appointments, preventive care, and treatment of minor conditions such as colds, flus, and allergies). In 2012, about $247 billion was spent on ill-defined conditions, and $241 billion went toward the treatment of circulatory conditions.
Over the past four decades, the difference between health spending as a share of the economy in the U.S. and comparable OECD countries has widened. In 1970 the U.S. spent about 7% of its GDP on health, similar to spending by several comparable countries (the average of comparably wealthy countries was about 5% of GDP in 1970).
The U.S. was relatively on pace with other countries until the 1980s, when its health spending grew at a significantly faster rate relative to its GDP. In 2012 the U.S. spent 17% of its GDP on health, whereas the next highest country (the Netherlands) devoted 12% of its GDP to health.
Along with Switzerland, the U.S. has the fewest physician consultations per capita among higher-income OECD countries. Consistent with this lower physician use, the U.S. also has fewer physicians per capita and about one in every ten adults (11%) report that they either delayed or did not receive needed medical care due to cost in 2013.
U.S. patients on average experience shorter hospital stays than in other OECD comparable countries.
The average price of an angioplasty or bypass in the U.S. is higher than in other comparable countries
The U.S. performs fewer angioplasties and more coronary bypass surgeries than comparable countries, but for both procedures prices are substantially higher than in other countries where data are available. According to the International Federation of Health Plans, the national 95th percentile average for an angioplasty in the US is $61,184.
The average price per coronary bypass surgery in the U.S is 2.4 times higher than in other countries where data are available.
The average price of a caesarean section in the U.S. is more than the price of a normal delivery
The average cost per Caesarean section in the U.S. is 1.7 times higher than in comparable countries where data are available. The average cost of normal delivery in the U.S. is about 13 percent higher than in comparable countries and about 254 percent higher than normal deliveries in the Netherlands (the country with the lowest cost).
In 2013, the U.S. performed 107 MRI exams per 1,000 population. The average price per MRI exam in the U.S is 3.6 times higher than the comparable country average (though most countries do not have data available). According to the International Federation of Health Plans,
the national 25th percentile average price in the US, $532, is still higher than the country average for countries where data are available and the national 95th percentile average in the US is $2,929.
In 2013, the U.S. had the highest average price for Cymbalta (prescribed to treat depression, anxiety, and fibromyalgia). The average price of Cymbalta in the U.S. was almost double the average price in Canada and 4 times the average price in England.
A report by the International Federation of Health Plans (IFHP) found that drug prices in the U.S. are higher on average than prices in similarly wealthy and sizable countries. The following slides provide some examples of specific drugs included in the IFHP report. In 2013, the United States had the highest average price for Celebrex (prescribed for pain).
Data from IFHP indicate that the average price of Celebrex in the U.S. was about 63% higher than in Switzerland (the country with the 2nd highest average price) and about 341% higher than in Canada (the country with the lowest average price).
Nexium is prescribed to treat acid reflux. According to the International Federation of Health Plans, the average price of Nexium in the U.S. in 2013 was almost three times more than the average price in Switzerland, which had the second highest price after the U.S.
The share of household budgets devoted to health expenditures has increased about 18% from 2002-2012. The majority of the increase can be attributed to spending on insurance premiums.
Most Americans do not report cost-related access barriers to health care. Still, a substantial portion of the population – about one in every ten adults (11%) – said that they either delayed or did not receive medical care due to cost in 2013.
About one third (32%) of uninsured adults said they delayed or went without healthcare because of cost reasons.
From 1998 – 2013, lower income adults have consistently reported more cost-related barriers to accessing medical care than higher income adults. Cost-related access problems generally rise during economic downturns.
While there is debate over the best way to measure outcomes for cancer, the U.S. typically performs better in both mortality rates and five-year survival rates for breast and colorectal cancer. In 2010, the mortality rate for breast cancer in the U.S. was slightly better than the comparable country average.
During the same period, there was about a 29% difference in the mortality rate for colorectal cancer in the U.S. (17.6%) and the comparable country average (22.7%).
The five-year survival rates for breast cancer and colorectal cancer in the U.S. are higher than in comparable countries, but the survival rate for cervical cancer is slightly lower. While mortality rates are used to measure the outcomes for most diseases, the quality of cancer care is often assessed through five-year survival rates.
The use of five-year survival rates versus mortality rates has been debated recently, though, as survival rates may be more heavily influenced by the time of diagnosis than the actual longevity of the patient. One study also found that while the U.S. outperforms comparable countries on survival rates for breast and colorectal cancer, this is not the case for all cancers, including lung cancer.
U.S. health care spending has risen at historically low rates recently, but is expected to pick up
Health spending in the U.S. has grown at historically low levels since 2008, likely due to a combination of the economic downturn and slow recovery, as well as structural changes to the health system like higher patient cost-sharing.
Projections published on Health Affairs by the Centers for Medicare and Medicaid Services (CMS), however, suggest that health spending growth is picking back up, averaging 4.9% per year on a per capita basis from 2014-2024. For more on the recent slowdown and projected growth, check out our latest blog post.
In 2013, the U.S. had the lowest insured rate of comparably wealthy countries
With just 86% of the U.S. population covered by health insurance in 2013, the U.S. has a lower rate of coverage than any comparably wealthy country. Greece was the only OECD country to have a lower insured rate, at 79%. The OECD average is 98% and comparable countries cover 100% of their populations. Health insurance shelters people from high medical costs that can result from illness and injury. The latest uninsured rate published by the CDC is 9.0%.
Comparing health spending in the U.S. to other countries is complicated, as each country has unique political, economic, and social attributes that contribute to its spending. Because health spending is closely associated with a country’s wealth, the remaining charts compare the U.S. to similar OECD countries – those that have above median national incomes (as measured by GDP) and also have above median income per person. The average amount spent on health per person in comparable OECD countries ($4,460) is roughly half that of the U.S. ($8,745). The average per capita health expense in the OECD overall (including smaller and lower-income countries) is significantly lower at $3,493 per person, or 40% of that spent in the U.S.