How US healthcare compares to other countries
The US has similar healthcare utilization as other high-income countries but spends more and tends to have worse health outcomes, according to a new study.
In 2016, the US spent 17.8% of its gross domestic product on healthcare. For 10 other high-income countries, spending ranged from 9.6% to 12.4%.
However, sizes of physician and nursing workforces were comparable between the countries, numbers of hospital discharges were similar, and lengths of hospital stay were lower in the US than in most other countries.
Meanwhile, the US had the lowest life expectancy and the highest rate of infant mortality.
This research was published in JAMA.
“There’s been a lot of interest in international comparisons between America and other high-income countries, and there’s been a lot of vagueness about why exactly our [US] spending is so much higher and our health outcomes are not necessarily better and often worse,” said study author Ashish K. Jha, MD, of Harvard T. H. Chan School of Public Health in Boston, Massachusetts.
“This study really tries to fill in gaps, I think, across a wide range of issues, from structural capacity to utilization to prices to outcomes.”
For this study, Dr Jha and his colleagues analyzed recent healthcare data, primarily from 2013 to 2016. The team compared differences in healthcare spending, performance, and structural features between the US and 10 high-income countries—UK, Canada, Germany, Australia, Japan, Sweden, France, Netherlands, Switzerland, and Denmark.
Spending
In 2016, healthcare spending, as a percentage of gross domestic product, was as follows:
US—17.8%
Switzerland—12.4%
Sweden—11.9%
Germany—11.3%
France—11%
Japan—10.9%
Denmark—10.8%
Netherlands—10.5%
Canada—10.3%
UK—9.7%
Australia—9.6%.
“The big differences in spending really seem to be driven by prices,” Dr Jha said, noting that salaries for doctors and nurses, administrative expenditures, and pharmaceutical costs are “much higher” in the US.
The total spending on pharmaceuticals per capita was $1443 in the US but ranged from $466 (Netherlands) to $939 (Switzerland) in the other countries.
Administrative costs accounted for 8% of the total national health expenditure in the US but 1% (France, Japan) to 3% (Germany) in the other countries.
Outpatient care expenditures ranged from 22% (Netherlands) to 42% (US). Inpatient care expenditures ranged from 17% (Canada) to 32% (Netherlands), with 19% for the US. And expenditures for medical goods ranged from 10% (Denmark) to 20% (Germany), with the US at 14%.
Physicians’ and nurses’ salaries were higher in the US than other countries. For example, generalist physicians earned $218,173 in the US in 2016 but anywhere from $86,607 (Sweden) to $154,126 (Germany) in the other countries.
Utilization
Although US doctors and nurses earned more than their counterparts in comparator countries, there were no substantial between-country differences in the size of the physician and nursing workforces.
The number of working physicians for every 1000 people ranged from 2.1 (UK) to 4.3 (Switzerland), with the US at 2.6. The number of working nurses for every 1000 people ranged from 8.2 (UK) to 17.4 (Switzerland), with 11.1 for the US.
The US had comparable numbers of hospital beds as some of the other countries. The range was 2.5 (Sweden) to 13.2 (Japan) beds per 1000 people, with the US at 2.8.
The US ranked 6th when it came to hospital discharges for acute myocardial infarction (AMI, 192 per 100,000 people; range, 89 to 287), mental and behavioral issues (679 per 100,000 people; range, 119 to 1719), pneumonia (365 per 100,000 people; range, 187 to 567), and chronic obstructive pulmonary disease (230 per 100,000 people; range, 45 to 352).
