U.S. health system is performing better, though still lagging behind other countries

To monitor the performance of the U.S. health system over time and in relation to other countries, our newly expanded Health System Dashboard includes a number of indicators across four domains: health spending, quality of care, access & affordability, and health & wellbeing. The dashboard examines trends in the U.S. health system, compares the U.S. to a group of other large and wealthy countries (“comparable counties”), and also highlights differences and disparities across demographic groups. Data in this dashboard come from a variety of sources, analyzed by Kaiser Family Foundation experts. The tool is updated continuously as new information becomes available.

In this post, we take a step back to look at the bigger picture of what these data tell us about how well the health system is working. We find that, while the U.S. health system has generally improved over the past few decades in its ability to promote health and provide high-quality care, there are recent signs of worsening outcomes. Indicators of longevity and disease burden have worsened in the U.S. in recent years, driven in part by the opioid crisis. While many similarly large and wealthy countries also saw life expectancy drop slightly in 2015, those countries have since rebounded, while the U.S. saw continued worsening.

Although the U.S. spends much more on healthcare than similar countries, the rate of health spending growth in the U.S. has recently moderated and is now similar to the growth rate of peer countries. In addition, following coverage gains under the Affordable Care Act, there are signs that access to and affordability of care has generally improved in the U.S. in recent years.

Below is a sample of findings across 10 key indicators of health system performance, with more details on each of these indicators in the dashboard (which tracks more than 50 indicators over time).

HEALTH & WELLBEING

1. Life expectancy at birth has improved over the past decades, rising by 4.9 years since 1980. However, life expectancy has declined slightly in recent years, driven in part by opioid overdoses. Furthermore, comparable countries have an average life expectancy of 82.2 years – nearly four years longer than the U.S. life expectancy of 78.6 years – and the gap is growing.

2. Disease burden, a measure that accounts for both longevity and quality of life, has generally improved over the past quarter century, dropping 12% between 1990 and 2017, with particular improvement seen for circulatory diseases. However, in the past few years the disease burden rate has worsened in the U.S. (similarly driven by substance use disorders, as well as an uptick in injuries) while continuing to improve in similar countries, on average. Disease burden rates are 31% higher in the U.S. than in comparable countries on average, and the gap has been widening.

QUALITY OF CARE

3. Despite some progress, the U.S. continues to lag behind similarly large and wealthy countries in preventing deaths that in many cases could have been averted by timely and effective care. The Healthcare Quality and Access (HAQ) Index reflects the rate of deaths amenable to healthcare with a score from zero (lower quality) to 100 (higher quality). The U.S. has an HAQ Index rating of 88.7, ranking the lowest among comparable countries, which average a score of 93.7. Although the U.S. has made progress in reducing deaths amendable to healthcare, this improvement has not kept pace with similar countries.

4. The rate of potentially preventable hospital admissions has improved, decreasing 32% from 2000 to 2015. Relative to comparable countries, admission rates are higher in the U.S. than in comparable countries for several diseases that could possibly be prevented or treated in a non-emergency setting, like congestive heart failure (55% higher), asthma (143%), and diabetes (38%). For hypertension, however, admission rates are 48% lower in the U.S than in comparable countries on average.

5. The occurrence of hospital-acquired conditions (such as surgical infections or medication errors) has improved, declining an estimated 13% (from about 2.94 to 2.55 million events) from 2014 to 2017. This suggests patient safety may have improved.

ACCESS & AFFORDABILITY

6. Due to gains in health coverage as a result of the Affordable Care Act, the uninsured rate among the nonelderly dropped from 18% in 2010 to 11% in 2017. Even with 91% of the total U.S. population now insured, coverage lags behind comparable countries, all of which provide essentially universal coverage.

7. Fewer adults are reporting problems paying medical bills. From 2011 to 2017, the share of people reporting difficulty paying medical bills dropped by a quarter.

8. The share of adults delaying or foregoing needed care due to costs has remained steady after dropping from 12% in 2009 to 8% in 2015.

HEALTH SPENDING

9. Health spending per person has grown steeply from $355 per capita in 1970 to $10,739 in 2017. On average, other wealthy countries spend about half as much per person. This spending differential is primarily due to higher prices for health care in the U.S., as care utilization is similar – and in some cases lower – in the U.S. Since 2010, per capita spending in the U.S. has grown at an average rate of 3.7% per year, which is similar to that of comparable countries.

10. Health spending continues to grow faster than the economy, but the difference has moderated in recent years. U.S. health consumption expenditures accounted for 17.1% of GDP in 2017 – much more than comparable countries, where health spending averages 10.6% of GDP.

Although there is general improvement across many indicators, there are often disparities across racial or ethnic groups, genders, age, health status, and income levels. For example, in 2016, while White life expectancy was similar to the national average of 78.6 years, life expectancy was 3.8 years shorter among Blacks and 3.2 years longer among Hispanics. In 2017, 15.8% of all non-elderly adults reported difficulty paying medical bills, with a substantial gap between lower- and higher-income adults: 26.3% of those who earn below 200% of the Federal Poverty Level reported difficulty paying medical bills, compared to 12.1% of those earning 200% FPL and above. Where possible, dashboard data are broken out across demographic groups to highlight these disparities.

Some cross-national differences in health outcomes and costs may be due to a variety of social, economic, and environmental factors that influence health and are not solely or directly influenced by the health system. The dashboard, therefore, also includes indicators relating to health determinants to offer context, and a separate chart collection and brief explore social determinants of health in the U.S. and comparable countries in more detail.

The dashboard is limited to some extent by what data are available at the health system level, particularly for indicators of health system quality (see our in-depth discussion here). While health spending, access, and health status data are more readily available and standardized, some indicators of quality of care are less standardized and often only available nationally for the Medicare population. The quality measures included in the dashboard were selected through consultation with a number of experts in the field and present a comprehensive look at treatment outcomes, patient safety, appropriateness of treatments, use of preventive services, and the resources of the health system.

For some indicators, the dashboard is a starting point for exploring unfolding trends, and it is important to keep in mind that not all indicators will change at the same pace.  For example, data on health outcomes may not yet exhibit the impact of recent changes in policy or in risk factor prevalence.

Looking broadly at key data regarding health system performance, we see that overall, health outcomes and quality of care in the U.S. are improving in many areas, albeit often more slowly than in comparable countries and with some recent reversals in direction. Additionally, though still much higher than comparable countries, health spending in the U.S. has moderated recently, and there has been improvement in access to care for people in worse health. Visit the dashboard for a more in-depth exploration of these other telling trends.

Methods

Data were collected and analyzed by researchers at the Kaiser Family Foundation using a variety of data sources (which can be found for specific indicators in the indicator page on the dashboard). The dashboard includes more than 50 indicators of health system performance, organized into four domains – a structure based largely on the framework put forth in the National Academy of Medicine’s 2015 Vital Signs: Core Metrics for Health and Health Care Progress. Indicators on the dashboard were selected through consultation with other experts in the field and a review of various additional sources of data on quality and outcomes measurement, including (among others): National Quality Forum; Healthcare Effectiveness Data and Information Set (HEDIS); Consumer Assessment of Healthcare Providers and Systems (CAHPS); America’s Health Rankings; Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); CMS Hospital Compare; US News and World Report; Medicare Shared Savings; and America’s Health Insurance Plans (AHIP)/CMS Core Quality Measures Collaborative; Commonwealth Fund; as well as a review of sources for data on health spending, such as the Bureau of Economic Analysis (BEA), National Health Expenditure Accounts (NHEA), and the Medical Expenditure Panel Survey (MEPS). The Healthcare Quality and Access (HAQ) Index is a metric developed by the Institute for Health Metrics and Evaluation and based on the Global Burden of Disease (GBD) study.