U.S.hlthsystems International Perspective

8/3/2019 U.S.hlthsystems International Perspective

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The U.S. Health Care System inInternational Perspective

Victor G. RodwinWagner School/NYU


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Lifee

xpectancy

atbi

rth,

total(years)

Lin

GDP per capita in 1995 international dollars Log

Africanregion

EasternMediterrane

an region

Europeanregion

Pan-American

region

South-EastAsia region

WesternPacificregion

Life expectancy 2001


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Higher health spending per capita is generally associated with higher life expectancy,

although this link tends to be less pronounced in countries with higher spending.

Other factors also influence life expectancy

2007 (or latest year available)

Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).


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A Typology of Healthcare Systems

Provision Financing

GovernmentSocial

Security/NHIPrivate

InsuranceOut-of-pocket

GovernmentOwned 1 2 3 4

Private not-

for-profit/Quasigovernment

5 6 7 8

Private for

profit 9 10 11 12


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Healthcare Financing & Provider Reimbursement


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46 Million Americans-- About 1 in 7 Are Uninsured

Primary Source of Health Insurance in U.S.

Source: Kaiser Family Foundation: www.statehealthfacts.org , 20097


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8

Amercans Perceptions/Misperceptions ofGovernment Role in Health Care


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Percentage ofGross Domestic ProductSpent on Health Care in 2007

11.0%

10.1%

8.4%

16.0%

10.4%

8.1%

9.0%

9.8%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

France Canada United

Kingdom

United

States

Germany Japan Italy Netherlands

Source: OECD Health Data 2009 (June 2009)

9

a

a 2006b estimate

b


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Health Care Spending per Capita in 2007Adjusted for Differences in Cost of Living

(PPPs)

$6,401

$3,374 $3,326 $3,287$3,128 $3,094

$2,724

$2,330

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

United

States

France Canada Germany Australia Netherlands United

Kingdom

New

Zealand

Source: OECD Health Data 2009 (June 2009)

ab

a 2006b estimate


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International Comparison of Spending onHealth Care, 19802007

Average spending on healthper capita ($US PPP)

Total expenditures on healthas percent ofGDP

Source: OECD Health Data 2009 (June 2009).11


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Pharmaceutical Spending per Capita in 2005Adjusted for Differences in Cost of Living

$291$318

$415

$498

$554

$589

$792

$0

$100

$200

$300

$400

$500

$600

$700

$800

$900

United

States

Canada France Germany Australia Netherlands New

Zealand

a2004

b2002

a b

Source: OECD Health Data 2007 (October 2007)

12


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Health Care Expenditure per Capitaby Source of Funding in 2005

Adjusted for Differences in Cost of Living

$2,884 $2,693 $2,527 $2,337

$2,064 $2,110 $1,829

$2,676

$448$328 $507 $832

$390

$121

$842

$233$431 $482

$392

$2,110

$352

$0$250

$627

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

United

States

France Germany Canada Netherlands Australia United

Kingdom

New

Zealand

Out-of-Pocket Spending

Private Spending

Public Spending

ab

a2004b

2002Source: OECD Health Data 2007 (July2007)


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205 204

151

118

99

155

0

50

100

150

200

250

Germany France Australia England United States Canada

Source: OECD Health Data 2002; U.K. Department of Health

Hospital Admissions for Acute Care

per 1,000 Population in 2000

a 1999

aa


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Average Length of Stay for Acute Carein 2005

5.45.65.6

6.16.16.8

7.3

8.6

0

2

4

6

8

10

Germany Canada Netherlands Australia United

Kingdom

New

Zealand

United

States

France

a 2004b Source: NZ Ministry of Health, 2004

aa

b



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Average Annual Numberof Physician Visitsper Capita in 2005

7.06.6

6.1 6.0

5.45.1

3.8

3.2

0

1

2

3

4

5

6

7

8

Germany France Australia Canada Netherlands United

Kingdom

United

States

New

Zealand

a2004b2003

a a

a b

a



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#1: Financial Barriers to Access

Among wealthy nations, we are the oddman out in maintaining significantfinancial barriers to health care access.

National Health Insurance Systems(Bismarck) have eliminated financialbarriers.

National Health Service Systems(Beveridge) have also eliminated financialbarriers


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Commonwealth Fund/HarrisInteractive Survey Methods

Telephone interviews with random, representative samples ofpeople 18 yrs+

Between March-May, 2004

17 minute average interview in English with French option in

Canada and Spanish option in U.S. Sample size:1,400 in Australia, 1,410 in Canada, 1,400 in NZ, 3,061

in UK and 1,401 in U.S

Margin of sampling error is approx plus or minus 3 percentagepoints for differences between countries and plus or minus 2

percentage points for country averages at 95% confidence level.


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Davis, K., Learning from High Performance Health Systems around the Globe, 2007


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Why the High Health Care Expenditures?

Sicker population?

More health care resources?

High malpractice leading to defensive medicine?

Too much insurance? More technology?

More biomedical research?

Higher prices for labor, goods and services?

20


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Prevalence and Treated Prevalence in the United Statesand Ten European Countries, 2004

Source: Thorpe, K et. al. Differences in disease prevalence as a source of the U.S.-European health care spending gap.Health Aff. Oct. 2007.Web excl.

21


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Anderson GF, et al. Health spending in the United States and the rest of the industrialized world.

Health Aff (Millwood). 2005 Jul-Aug;24(4):903-14.

Malpractice Claims and Payments in FourCountries, 2001


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The Number Of MRI Units And CT Scanners Is Increasing In

All OECD Countries(Japan Has The Highest Number Per Capita)

2007 (or latest year available)

Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).23


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The U. S. Has The Highest Number Of MRI And CT Exams

Per Capita, Followed By Luxembourg, Belgium And Iceland

1. Only include exams for out-patients and private in-patients (excluding exams in public hospitals).

Note: Several countries, including Japan, have not provided any data.

2007 (or latest year

available)

Source: OECD Health Data 2009, OECD (http://www.oecd.org/health/healthdata).

24


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25

Drug Prices for 30 Most Commonly Prescribed Drugs,200607

US is set at 1.0

0.34

0.440.450.490.51

0.63

0.760.77

1.00

0.0

0.2

0.4

0.6

0.8

1.0

US CAN GER SWITZ UK AUS NETH FR NZ

Source: IMS Health.Anderson, G. Doughnut holes and price controls. Hth Affairs. July/Aug. 2004


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Drug Prices for 30 Most Commonly PrescribedDrugs, 200607, Brand-Name and Generic

US is set at 1.0

AUS CAN FR GER NETH NZ SWITZ UK US

Brand-Name

Drugs0.40 0.64 0.32 0.43 0.39 0.33 0.51 0.46 1.00

Generic Drugs 2.57 1.78 2.85 3.99 1.96 0.90 3.11 1.75 1.00

SourceIM: S Health.Anderson, G. Doughnut holes and price controls. Hth Affairs. July/Aug. 2004


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Drug Prices: Lipitor (atorvastatin), 200607Price For One Dose

Dollars

Source: IMS Health.Anderson, G. Doughnut holes and price controls. Hth Affairs. July/Aug. 2004


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Cost of Knee and Hip Prostheses to Providers, 2004GDP Adjusted, US $

4,866

3,035

2,5612,390

2,239

0

1,000

2,000

3,000

4,000

5,000

6,000

US ITA FR UK GER

Source: McKinsey & Company, Accounting for the Cost of Health Care in the United States, 2007.

$4,821

$1,537$1,380

$1,168 $1,165

US ITA UK GER FR

Knee ReplacementsHip Replacements

Do

llars


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#2: Prices for Health Care Goodsand Services

Among wealthy nations, we have amongthe highest prices for most goods andservices in the health care sector.

For ex. The Medicare Modernization Actdoes not allow Medicare to negotiateprices with the pharmaceutical industry.But it doesnt have to be that way!

Medicaid and the VHA negotiate priceswith suppliers of health care goods andservices. So does Medicare when it comes

to hospitals and physicians.


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Contrasts Among InsuranceSystems with Universal Coverage

# of HealthCare Insurers

Private HealthExpenditure as %of Total Health CareExpenditures(THCE)

Out-of-Pocketexpendituresas % of THCE

Per Capita Out-of-PocketExpenditures in $U.S. PurchasingPower Parities

Taiwan 1 Small 37% NA

France 3+ 11 21% 7.4% $232

Canada 15 30% 15% $550

Germany 180 23% 13% $460

Netherlands 15 NA 5.7% $203Switzerland 93 (51-71 in @

Canton)40% 30% $1,280

U.S. >1000 55% 12.3% $854

Source for expenditure data: OECD Health Data, 2009.

U.S.hlthsystems International Perspective

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