The US vs. the Top Countries for Healthcare Quality and Cost

Health Care in the US

Health reform has been a hot political topic for a long time.  From Franklin Roosevelt trying to include publicly funded healthcare programs in Social Security to Barack Obama signing into law the Affordable Care Act, health reform has been a major player in the politics of the United States.  So, after 80 years of constant debate and reform, how is the US doing?  There’s a little bit of good news and a lot of bad news.

The Good News

We lead the world in healthcare research and cancer treatment.  The five year survival rate for breast cancer is higher in the US than in all other OECD countries.  The US is also among the best for colorectal cancer survival.  We are also more likely to survive a stroke.

The Bad News

Americans spend $8,233 per person per year on average on health care.  The next highest in the OECD is Norway at $5,388 and the average per person for the OECD is $3,268.  As a country, 17.6% of our GDP is spent on healthcare.  The next highest is the Netherlands which spends 12% while the average in the OECD is 9.5%.  

Spending more than other countries might be worth it if we were getting better health from it - unfortunately, we aren’t.  On average there are 2.4 physicians for every 1,000 people in the US compared to 3.1 for every 1,000 on average for the OECD.  There is a similar disparity in hospital beds (2.6 per 1,000 for the US and 3.4 for the OECD).  Life expectancy at birth in the US is 78.7 years, more than a year shorter than the OECD average of 79.8. (Health Costs: How the US Compares with Other Countries)

The National Research Council and the Institute of Medicine compared the US to 16 other developed countries like Japan, France and the United Kingdom.  They found that the US has the highest rates of death by violence and car accident by wide margins.  Among developed countries, we also have the highest chance that a child will die before the age of five. We are 2nd in death by coronary heart disease and lung disease and have the highest teen pregnancy rates as well as the highest rate of women dying due to complications from pregnancy.

Top Countries for Healthcare Quality and Cost

In 2000, the World Health Organization ranked the world’s healthcare systems on five categories: health, health equality, responsiveness, responsiveness equality and fair financial contribution (These are the 36 Countries that Have Better Healthcare Systems than the US).  Thirty-six countries were ranked higher than the United States.  Also, Bloomberg recently ranked the most efficient healthcare systems in the world - those countries who get the most for their dollar, not necessarily those with the best health. (Most Efficient Health Care Countries - Bloomberg).  Below are the countries who ranked higher than the US on WHO’s list, and their ranking on Bloomberg’s list in parenthesis.

		Colun1	Con	WHO 2		WHO 3	4
1	France (19)	11	Norway	21	Belgium (34)	31	Finland (23)
2	Italy (6)	12	Portugal (27)	22	Colombia (42)	32	Australia (7)
3	San Marino	13	Monaco	23	Sweden (10)	33	Chile (13)
4	Andorra	14	Greece (30)	24	Cyprus	34	Denmark (38)
5	Malta	15	Iceland	25	Germany (30)	35	Dominica
6	Singapore (2)	16	Luxembourg	26	Saudi Arabia (29)	36	Costa Rica
7	Spain (5)	17	Netherlands (25)	27	United Arab Emirates (12)
8	Oman	18	UK (14)	28	Israel (4)
9	Austria (16)	19	Ireland	29	Morocco
10	Japan (3)	20	Switzerland (9)	30	Canada (17)

What do the Countries that have the best and most efficient healthcare systems have in common?

France, Italy, Singapore, Spain, Austria and Japan are all in the top 10 for WHO’s health care quality and are ranked highly on Bloomberg’s efficiency scale.  Therefore, it makes sense to learn from them.  As you can imagine, their health care systems vary widely; however, they have a few things in common.

1.) Universal, or near universal, Health Care Coverage - France, Italy, Spain, Austria and Japan all have universal health.  Singapore seems to break the mold, but doesn't really - it just does the same thing in a different way.  Instead of requiring all it’s citizens to have health insurance, Singapore requires all its citizens to contribute a percent of their monthly salary to a personal health care fund.

2.) Government Price Control - All six of the example countries control healthcare costs somehow.  Usually, governments do this by setting rates for procedures and medications, and some require that rates be published in hospitals and doctor’s offices.

What can the US Learn from the Top Countries?

The Affordable Care Act will ideally get us to near universal health care coverage, but that is not enough.  As noted in an earlier post, Massachusetts has had near universal health care coverage since 2006 and healthcare costs have not decreased.  The next step for the United States is for the Government to set prices for procedures and medications.  The system we use now, which has health insurance companies and providers negotiating prices until no one knows what a CAT scan or vaccination actually costs, doesn’t work.  The United States doesn’t have to, and shouldn’t, copy another country’s healthcare system, but it is hubris to think that we can’t learn from others.