One of the hottest items for discussion on cable news networks and over dinner tables everywhere in the country is how good the US healthcare system is compared to other developed countries. People who are pushing for healthcare reform focus exclusively on the bad stuff, while those against are trying to convince everyone that our healthcare system is by far the best in the world. What I will try to do in this post is to address the issue in a systematic, scientific, and most importantly, non-political manner.
When healthcare experts sit down to assess the healthcare system of a certain country, they look at three main dimensions: cost, quality and access. Cost is basically how much is spent on healthcare in the country. Quality is how the care provided is. Access is whether people can get the healthcare that they need.
First, in terms of cost, The US spends more on healthcare than any other country in the World. In 2005, we spent $6,401 on healthcare per person per year, while the average for developed countries is around $2,922. We also spend the highest percentage of our Gross Domestic Product (GDP) on healthcare (15.3%) than any other developed country (median spending for those centuries is only 9.1%). What that basically means is for every dollar spent in the US, 15.3 cents go to healthcare!
The most widely used measure of quality is life expectancy, which is basically how many years, on average, an individual can expect to live. Obviously, the more, the better. In the US, life expectancy at birth is about 78.1 years, which is lower than life expectancy in Great Britain, France, Germany, Japan, Holland and Switzerland. Basically, all the countries that we care compare ourselves to. Why is that the case? The main reason is high infant morality rates in the US as compared to those other countries.
However, some people argue that life expectancy is not a very good measure of quality and that there are significant differences in how it is measured in each country. So let’s look at other measures and see how the US ranks compared to other countries. On cervical cancer screening rates and incidence of measles, we rank first in the world! On smoking rates, breast cancer survival rates and colorectal cancer survival rates, we rank 2nd overall. Finally, some good news... However, on asthma mortality rates we rank 21st, on incidence of hepatitis, we rank 15th, and on mammography screening rates, for example, we rank 12th. So the messages are mixed when it comes to quality.
What about access? I have talked in length in previous posts about the plight of the uninsured and underinsured in the US. While 100% of people over 65 are covered, only 82% of people under 65 are covered by health insurance. Compare that to 100% coverage in Japan, Switzerland, France and Great Britain, and 98.9% coverage in Holland and Germany.
So looking at those three main dimensions, we can definitely say that we have the most expensive system in the world, we provide the least access among all developed countries, and quality of care can vary depending on what condition you are looking at. Not exactly what I would call the best system in the world.
In the near future, I will look at some of those other developed countries and try to explain how their systems are different from ours.