Health of the Healthcare System: An Overview


How does the U.S. healthcare system compare to health systems of other high-income countries, and how has it fared over time? This chart collection accompanies our animated video, “Health of the Healthcare System,”  a diagnostic look at the state of our healthcare system. In the video and chart collection, comparable countries are defined as those in the OECD that are similarly large and wealthy based on GDP and income per capita. 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 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).

 

 

Disease burden is higher in the U.S. than in comparable countries


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.

For most of the leading causes of death, mortality rates are higher in the U.S. than in comparable countries


For most of the leading causes of death, mortality rates are higher in the U.S. than in comparable countries.

The U.S. has the highest rate of deaths amenable to health care among comparable countries


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 countries.

Foot and leg amputations due to diabetes are decreasing in the U.S. and comparable 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.

The U.S. has higher rates of medical, medication, and lab errors than comparable countries


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 and ill-defined conditions, such as check-ups, are the largest category of spending


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.

Since 1980, the gap has widened between U.S. health spending and that of other countries


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.

The U.S. has fewer physician consultations per capita than most comparable countries


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.

Patients in the U.S. have much shorter average hospital stays than patients in comparable countries


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).

The average price of an MRI in the U.S. is significantly higher than in other comparable countries


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.

The average price of Cymbalta in the U.S. is 76% more than the average price in Canada


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.

The average price of Celebrex in the U.S. is about 63% higher than in Switzerland


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).

The average price of Nexium in the U.S. is almost 3 times more than the average price in Switzerland


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.

On average, larger shares of household budgets are devoted to health expenses than 10 years ago


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.

Uninsured adults are more likely to delay or go without care due to cost


About one third (32%) of uninsured adults said they delayed or went without healthcare because of cost reasons.

Lower income adults report more cost-related access problems than higher income adults


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.

Mortality rates for breast and colorectal cancer in the U.S. are lower than in comparable countries


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%).

Five-year survival rates for certain cancers are higher in the U.S. than in comparable countries


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 per capita 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 all OECD 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%.

On average, other wealthy countries spend about half as much per person on health than the U.S. spends