In recent years, there has been a large national conversation about the ways in which the U.S. health care system excels, and those where it lags behind those of similar countries. Past examinations have shown that Americans tend to spend more on their care and coverage and deal with worse health outcomes than other nations. Now a new study shows just what we do well, and also where it falls short.
The United States' per-capita health care spending is roughly double that of nine other comparably developed nations, and mortality from preventable and treatable causes significantly outpaces nations like Canada and Japan, among others. According to the new study, "Health Insurance Systems: An International Comparison," conducted by Dr. Thomas Rice of the Fielding School of Public Health at the University of California Los Angeles, this is largely because Americans pay far more for health care and prescription drugs, rather than because they are less healthy or access care more often.
Indeed, nearly 10% of Americans are without any kind of health insurance and even more have insufficient coverage. And because the cost of even normal procedures, including childbirth, can be as much as 3.5 times that of comparable nations, roughly 1 in 3 Americans say they face cost barriers to getting the care they need. In the nine other countries examined, that number was closer to 1 in 6.
Building on past findings
This data may be new, but the story it tells is not: Last year, the Peter G. Peterson Foundation showed that the U.S. spends 17% of its GDP on health care expenditures. Among all 37 wealthy nations in the Organisation for Economic Co-operation and Development, the average was just 8.6%, and the second-ranked nation on the list (Switzerland) was well behind the U.S. at just 12.1%.
Per-capita spending in the U.S. is staggering, as well: north of $11,000 each year, more than double the OECD average of just under $5,500. Here, too, Switzerland was a distant second, at $7,732, and only Germany ($6,646) saw per-capita expenditures of more than $5,800. The reason for this is disproportionately driven by the non-care expenses associated with coverage and care, as well. In the U.S., per-capita administrative health costs paid each year added up to $937 — accounting for almost 9% of total spending — while the OECD average was just $173. Despite all these costs, the U.S. ranks 10th-lowest of the 37 member nations in life expectancy at birth, and fifth-lowest in infant mortality.
Understanding the systems at play
There are a number of highly developed nations with at least some sort of universal health care system in place, and each one obviously varies in significant ways from the others. Those who live under these systems experience pluses and minuses with things like higher taxes and longer wait times offsetting some of the conveniences Americans enjoy, according to U.S. Insurance Agents. In addition, even in nations with some sort of universal insurance system, private coverage still exists; in Canada, for instance, 30% of health care costs go toward private coverage above and beyond basic, universal coverage. Meanwhile, in Germany, employers and employees pay into funds that cover health costs, in much the same way Americans do for things like unemployment insurance — these costs usually amount to 8% of the average German's income.
On the other hand, higher taxes or other means of paying for universal coverage come in lieu of paying insurance premiums, deductibles, co-pays and more. And many Americans who have required non-emergency procedures such as hip surgery can experience wait times of months, much like one might see in foreign countries.
What about mental health care?
Beyond physical health, Americans are also in a unique situation when it comes to obtaining mental health care. The U.S. is now seeing mental health spending top $225 billion per year as of 2019, up more than 50% from a decade earlier, as roughly 1 in every 5 Americans deal with at least some mental health issues, a recent CNBC report said. However, data suggests that, particularly in rural areas, many people may not have access to the care they need on this front — close to one-third of the nation's residents live in states where mental health care providers are hard to come by.
Moreover, even if people live in areas where there are numerous options for mental health care, and if they have health insurance, there's no guarantee that they will be able to obtain affordable treatment. That's because only slightly more than half of psychiatrists in the U.S. accept health insurance, far less than the 90% of physical health care providers who do the same.
All of the above issues need to be monitored going forward, because people need access to the kind of care that can keep them physically and mentally healthy without putting them in dire financial straits. In the meantime, insurers would be wise to ensure they are communicating with policyholders on an ongoing basis so they fully understand all their options.