By Kenneth E. Thorpe, David H. Howard, Katya Galactionova
Health Affairs
October 2, 2007
Abstract:
The United States spends more on health care than any European country. Previous studies have sought to explain these differences in terms of system capacity, access to technologies, gross domestic product, and prices. We examine differences in disease prevalence and treatment rates for ten of the most costly conditions between the United States and ten European countries using surveys of the noninstitutionalized population age fifty and older. Disease prevalence and rates of medication treatment are much higher in the United States than in these European countries. Efforts to reduce the U.S. prevalence of chronic illness should remain a key policy goal.
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.26.6.w678
And…
Health Spending In OECD Countries In 2004: An Update
By Gerard F. Anderson, Bianca K. Frogner and Uwe E. Reinhardt
Health Affairs
September/October 2007
To summarize, the United States continued to have much higher real health care spending per capita and as a percentage of GDP in 2004 than all other OECD countries. However, the availability of health care resources and the actual use of services in the United States were below those of most industrialized countries. The average annual growth rate in real health care spending per capita in the United States was actually similar to the OECD median growth rate between 1994 and 2004. Chronic disease prevalence and mortality were high in the United States compared to other OECD countries, which may be associated with the fact that a large proportion of the U.S. population was overweight or obese.
http://content.healthaffairs.org/cgi/content/abstract/26/5/1481?ck=nck
Comment:
By Don McCanne, MD
Are we spending so much more on health care than the other OECD nations because we have a much higher prevalence of chronic disease in older individuals, or are we spending much more merely because our prices are higher?
The study by Thorpe, et al looked at the treated prevalence of disease (as a product of disease prevalence and medication use) and concluded that “we cannot directly calculate the link between higher treatment rates and spending, but we show that U.S. health care spending would be lower if treatment rates were reduced to European levels.”
The study by Anderson, et al looked at physician visits per capita, acute care bed days, and average length of inpatient stay and concluded that “the United States had 30 percent fewer inpatient hospital days and 36 percent fewer physician visits per capita than the OECD median in 2004.”
So is our higher health care spending due to higher prices or higher treatment rates? Or does it really matter?
What matters more is that we do have a very high prevalence of chronic disease, and we have a very high level of health care spending that has failed to provide better health outcomes than in other OECD nations. So what can we do about it?
The most important measure is prevention. The two most important modalities, good nutrition and exercise, are not really much in the purview of the health care delivery system, but are more complex societal issues. Public and private resources must be directed to improving diet and exercise and other preventive measures, but that topic will not be addressed here.
Given that we do have high spending and a high prevalence of chronic disease, what is the best approach to managing these problems? Some would suggest that we need to reform the health care delivery system to improve chronic disease management. Others suggest that we need to reform health care financing so that our resources are more appropriately directed.
Well, we need to do both. If we can get a handle on the financing, then we can rebuild our primary care infrastructure that would provide the appropriate environment for clinical disease management, whether acute or chronic.
Just don’t wait around for the private insurance industry to do that for us.