The United States lags behind other developed nations in life expectancy, yet spends far more on health care than any other nation. This is not news. Now if someone could definitively tell us why, that would be news. Life expectancy’s a dangerously blunt measure of the efficacy of a nation’s health care system, as there more confounding factors than anyone can possibly account for.
Neverthless, Columbia-affiliated public health researchers publishing in the latest edition of Health Affairs (free to AHCJ members!) have taken a stab at it, doing their best to tease out the biggest confounds and determine why Americans don’t live as long as their counterparts in the other 12 large, historically developed nations, all of which happen to provide universal health care of one variety or another. The paper looked at 15-year survival rates for 45- and 65-year-olds, in order to avoid the confusion introduced into life-span statistics by each country’s different reproductive (and end-of-life) policies. It’s a little complicated, so I’ll let the authors explain:
In this paper we explore changes in fifteen-year survival at middle and older ages, alongside per capita health care spending, in the United States and twelve other wealthy nations. We then examine the extent to which the survival and cost variations over time among these nations can be explained by demographics, obesity, smoking, or mortality events that are not closely related to health care, such as traffic accidents and homicide. By comparing health system costs and mortality rates over time, it is possible to assess whether trends in risk factors for health or causes of death can explain the observed relative decline in broad health outcomes among American men and women over the past thirty years.
As it turns out, those risk factors don’t appear to explain anything. In the 30 years between 1975 and 2005, the American system has weakened relative to equivalent countries despite the fact that smoking rates declined, obesity rates grew more slowly than they did overall in the other 12 nations and accident and homicide rates remained the same. So, while risk factors stayed steady (or improved), America continued spending more and getting less in return.
The researchers didn’t come up with a perfect explanation, of course, but they have their suspicions. On the Health Affairs blog, Chris Fleming summarizes their conclusion:
Rising health spending itself, the authors conclude, might be responsible for the relative decline in survival. They cite three consequences of rising health spending: an increase in the number of people with inadequate health insurance; the inability to allocate financial resources to life-saving programs; and unregulated fee-for-service reimbursement and an emphasis on specialty care that leads to unneeded procedures and fragmented care. As a result, they conclude, “meaningful reform may not only save money over the long term: it may also save lives.”