Bottom Line: The United States spent nearly twice as much as other high-income countries on medical care but did less well on many population health outcomes despite similar utilization. Spending differences were driven primarily by prices for labor and goods, including pharmaceuticals, devices and administrative costs.
Why The Research Is Interesting: It is well known that the United States spends more on health care than other countries but less is understood about what explains those differences.
What and When: Analysis of data from 2013-2016 comparing differences in health care spending, performance and structural features between the United States and 10 high-income countries (United Kingdom, Canada, Germany, Australia, Japan, Sweden, France, the Netherlands, Switzerland, and Denmark).
Authors: Irene Papanicolas, Ph.D., Harvard T.H.Chan School of Public Health, Boston and coauthors
Results
The United States:
- Spent 17.8% of its gross domestic product on health in 2016, other countries ranged from 9.6% to 12.4%
- Had the lowest life expectancy and highest infant mortality rate
- Spent more to plan, regulate and manage health systems and services
- Had higher per capita pharmaceutical costs
- Paid higher salaries to physicians and nurses
Study Limitations: While the data were generally comparable, there were modest differences in approaches to collecting and standardizing data across countries.
Study Conclusions: Efforts targeting health care usage alone are unlikely to reduce growth in health care spending in the United States, and a more concerted effort to reduce prices and administrative costs is likely needed.
Related material: The following related elements also are available on the For The Media website:
-- A summary video is available for download or to embed on your website. Download the video as a high-quality MP4 file by right-clicking on this link and then clicking the down-pointing arrow in the control bar at the bottom of the video. In addition, you may copy and paste the html code below to embed the video on your website.
-- An audio author interview is available on this page
The following editorials and Viewpoint:
- The Real Cost of the U.S. Health Care System
- Challenges in Understanding Differences in Health Care Spending Between the United States and Other High-Income Countries
- Factors Contributing to Higher Health Care Spending in the United States Compared With Other High-Income Countries
- Health Care Spending in the United States Compared With 10 Other High-Income Countries
- Hip and Knee Replacements (Viewpoint)
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For more details and to read the full study, please visit the For The Media website.
(doi:10.1001/jama.2018.1150)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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Journal
JAMA