An analysis by the Commonwealth Fund has revealed that people in the United States experience shorter life expectancies and poorer overall health compared to those in other high-income countries, even though the U.S. spends approximately 18 percent of its gross domestic product on health care.
The US Health Care from a Global Perspective report is published every year by the Commonwealth Fund. This report assesses the American health spending, outcomes, status, and service use by conducting a cross-national comparison of the health system performance. Data sources for this comparison include the Organisation for Economic Cooperation and Development (OECD) which has compiled health data from 38 high-income countries and the 2020 Commonwealth Fund International Health Policy Survey that gathered data from a nationally representative sample of noninstitutionalized adults age 18 and older in 11 countries, consisting of the United States. Furthermore, the comparison was supplemented with data from Our World in Data which has collated data on COVID-19 deaths and vaccination rates around the world. It should be noted though that differences in how the countries record and report their data can limit the accuracy of certain indicators.
According to the report, healthcare costs in the US have been rising since the 1980s and are nearly twice as high as the average in other high-income countries in the Organisation for Economic Co-operation and Development (OECD). As a result, the US is the most expensive country examined in the study. The reason behind the increasing costs is attributed to better medical technology, greater demand for services, and higher prices in the health sector. Unlike other high-income countries that ensure public health coverage for their citizens, the US does not have such a policy. In 2021, 8.6% of the US population was uninsured, making it the only high-income country with a significant portion of its population without health insurance. These results suggest that the US healthcare system requires change to ensure that every citizen can receive healthcare and coverage.
Despite its high healthcare spending, the US’s life expectancy at birth and health outcomes overall fall below the average of the Organisation for Economic Cooperation and Development (OECD). This average is highly reflective of racial and ethnic disparities, with non-Hispanic Black Americans and non-Hispanic American Indians or Alaska Natives experiencing four and seven years lower life expectancy, respectively, than non-Hispanic whites. Furthermore, the US has the highest rate of avoidable mortality, infant mortality, and maternal mortality related to pregnancy and childbirth compared to all countries in the analysis. Lastly, the US has the third-highest suicide rate in the world and has seen an increase in this rate since the onset of the COVID-19 pandemic.
Moreover, the United States has been found to have the greatest proportion of obese individuals in comparison to the other nations analyzed in a recent report, twice that of the Organisation for Economic Cooperation and Development (OECD). Additionally, it was determined that among those surveyed in 2020, three out of ten adults in the US had been diagnosed with two or more chronic ailments, almost double the rate of France’s. Furthermore, since the commencement of the COVID-19 pandemic, the US has been the high-income nation with the highest death rate per 1 million cases. Factors such as a lack of healthy living environments, unregulated food and agriculture sectors, socio-economic status, and higher instances of behavioral health difficulties have been seen to contribute to this issue.
In addition, the report revealed that although US health care spending is the highest in the world, Americans only visit physicians four times per year. This is lower than many other high-income countries, which could be due to the comparatively low physician supply in the US. Furthermore, the study found that US citizens have one of the lowest rates of vaccine administration for COVID-19. However, older adults in the US have a similar rate of flu vaccination to those in other high-income countries. In terms of cancer prevention, the US has the highest rate of breast cancer screenings among women aged 50 to 69 and surpasses the OECD average in colorectal cancer screenings. MRI units are also available in the US, though at an expensive rate of $1,119 per service. Lastly, the report indicated that worldwide, hip replacements are becoming more common, a sign of the growing prevalence of osteoarthritis.
The researchers did note some limiations to their analysis. According to the researchers, the study had a lack of data availability for 2020 and beyond for all countries, given the impact of the COVID-19 pandemic on health outcomes. The study also did not include data by race and ethnicity, despite significant health disparities among different racial and ethnic groups in the U.S. and other countries. Additionally, while the study used the most reliable and up-to-date data sources available, there may be differences in how countries collect their health data, which could limit the comparability of the results.
The report suggests several steps that the US can take to improve its health system. The first step is to ensure that all Americans have access to affordable care, as the US is the only high-income country without universal health coverage. High out-of-pocket costs often deter Americans from seeking medical care. The second step is to contain healthcare costs, as high prices for health services are the primary driver of the US’s elevated healthcare spending. Policymakers could learn from the approaches taken by other nations to contain overall health spending, including healthcare and administrative costs. Finally, the US must invest in the prevention and management of chronic conditions, which requires comprehensive, continuous, and well-coordinated care. The report suggests that these steps are critical to improving the US healthcare system’s functions and that other high-income countries have successfully implemented them.