For Health Care, Americans Pay More and Get Less

Margot Sanger-Katz

The U.S. vastly outspends other countries on health care but still ranks low when it comes to the health status of its residents, according to a report comparing developed countries.

By every measure, the U.S. pays more for its medical system—more dollars per person, a greater percentage of GDP, and higher prices for doctors, hospitals, administrative costs, and drugs. Total health care spending costs about $8,000 per person here, compared with the second-biggest spender, Norway, which spends less than $5,500 per person. 

“The U.S. is just this astonishing outlier compared to everyone else,” said Mark Pearson, the head of the social policy division of the Organization for Economic Cooperation and Development, which produced the study of 34 countries.

Much of the difference comes from prices. Patients in the U.S. don’t spend more time in the hospital or visit more doctors than patients in other OECD countries, but they do pay more for everything.

Doctor’s fees are more than double the average cost, for example, while drugs and hospital care cost 60 percent more. The U.S. system also has a much higher-than-average rate of certain expensive procedures like MRI scans, angioplasty, and total knee-replacement surgery.

When it comes to results, however, the U.S. does not come out on top.

U.S. life expectancy in 2009 was 78.2 years, below the OECD average of 79.5. That puts us close to the Czech Republic and Chile, “not countries you would usually expect the U.S. to be compared to,” Pearson said.

The U.S. also has one of the worst records when it comes to premature mortality overall and mortality from heart disease in particular.

Americans have the highest rate of obesity—with more than a third of the population considered obese. They also have among the highest rates of hospital admission for illnesses that are best managed by primary-care doctors, including asthma, chronic obstructive pulmonary disease (including emphysema), and diabetes.

It’s not all bad news. The report points out that the U.S. does an excellent job of cancer care, with very high survival rates and low mortality rates. Mortality from stroke is well below average in the United States. And rates of smoking among Americans have plummeted in recent years to a level well below average for the study group.

Supporters of U.S. health care reform have used the OECD figures for years to justify the need for changes. The non-profit Commonwealth Fund, which conducts research to support its pro-health-reform agenda, does similar studies. The OECD reports have shown for years that the U.S. gets less bang for its health care buck than other countries.