HSC 4630Understanding U.S. Healthcare

Comparative Health Systems: Part 1

Companion to Jonas & Kovner’s Health Care Delivery in the United States, Chapter Four, 

“Comparative Health Systems”

Presentation Objectives

• Compare U.S. health outcomes to other counties

• Compare U.S. health spending to other counties

• Review the concept of health care as a right throughout the world

• Define classifications of national health systems

Life Expectancy at Birth

Source: University of Washington, Institute for Health Metrics and Evaluation (IHME)

Life Expectancy Decline in U.S.

• Opioid epidemic: 137% increase in opioid-related deaths between 2000 and 2014.

• Suicide rate up 24% between 1999 & 2014http://fortune.com/2018/02/09/us-life-expectancy-dropped-again/Reuters Opioid and Suicide

Life Expectancy at 60 Years

http://gamapserver.who.int/gho/interactive_charts/mbd/life_expectancy/atlas.html

United States = 23 years (30th)

Life Expectancy and Spending

https://www.washingtonpost.com/news/wonk/wp/2017/03/08/this‐chart‐is‐a‐powerful‐indictment‐of‐our‐current‐healthcare‐system/?utm term=.3375231dd3a0

Infant Mortality Rates

https://data.oecd.org/healthstat/infant-mortality-rates.htm

Commonwealth Fund Ranking

Best Health Care System?

“I believe that the [ACA] will kill jobs in America, ruin the best health care system in the world, and 

bankrupt our country. That means we have to do everything we can to try to repeal this bill and replace it with common sense reforms to bring down the cost 

of health care.”– Speaker of the House, John Boehner in 2011

"We do start with the notion, however, that we have the best health care in the world.“

‐ Senate Minority Leader Mitch McConnell in 2012

Colon Cancer, 5-year Relative Survival (%)

Breast Cancer, 5-year Relative Survival (%), 2005-09

Allemani, C., Weir, H. K., Carreira, H., Harewood, R., Spika, D., Wang, X. S., ... & Marcos-Gragera, R. (2015). Global surveillance of cancer survival 1995–2009: analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2). The Lancet, 385(9972), 977-1010.

Waiting Time to See Specialist

Organization for Economic Cooperation and Development (OECD) with Commonwealth Fund International Health Policy Surveys data.

Patient Satisfaction

See text, Figure 1A.8 Source: Khoury, C. & Brown I.T. (2009. Among OECD nations, U.S. lags in personal health. Not feeling health benefits of high spending. Accessed September 9, 2010, from http://www.gallup.com/poll/117205/americans-not-feeling-health-benefits-high-spending.aspx. Reprinted with permission from Gallup World Poll.

International Comparison of Spending on Health

Source: Using OECD data, Squires, D.A. (2010). “The U.S. Health System in Perspective: A Comparison of Twelve Industrialized Nations” Issues in International Health Policy. The Commonwealth Fund. 

Why U.S. Spends More

• Higher staff to patient ratios 1

• Adoption of newer technologies sooner 1

• Administrative inefficiencies 2

• Lack of waiting lists for services 2

• Higher prices of personnel, higher utilization of costly services 1, 2

• Malpractice litigation/defensive medicine 2

• Provider incentives 31. G.F. Anderson et al., “Health Spending in the United States and the Rest of the Industrialized World,” Health Affairs 24, no. 4 (2005): 903–914.2. Anderson, G. F., Reinhardt, U. E., Hussey, P. S., & Petrosyan, V. (2003). It’s the prices, stupid: why the United States is so different from other countries.Health Affairs, 22(3), 89‐105.3. Vahidi, R. G., Mojahed, F., Jafarabadi, M. A., Gholipour, K., & Rasi, V. (2012). A Systematic Review of the Effect of Payment Mechanisms on Family Physicians Service Provision and Referral Rate Behavior.

Is Medical Care a Right?

• U.S. education as a model• A continuum from clean water to medical

care for all1

• Right to health recognized in international law

• Racial and ethnic disparities may violate treaty 2

1. Kinney, E. D. (2000). International Human Right to Health: What Does this Mean for Our Nation and World, The. Ind. L. Rev., 34, 1457. 2. Yamin, A. E. (2005). The right to health under international law and its relevance to the United States. American journal of public health, 95(7), 1156‐1161.

Why Study Different Health Care Systems?

• May provide important clues to assessing our own system

• Many industrialized countries either provide: – Health care directly through the government– Publicly funded health insurance with

comprehensive coverage

Classification of Health Care Systems

• Traditional sickness insurance – A private insurance market approach with government

subsidy • National health insurance

– National-level health insurance system• National health services

– National-level provision (delivery) of health care• Mixed systems

– Contain elements of both traditional sickness insurance and national health insurance

Conclusions

• U.S. ranks poorly on many measures of health outcomes

• U.S. outperforms others in many medical intervention-oriented health outcomes

• U.S. spends vastly more on healthcare• There are many different types of national

healthcare systems in world

Next Lecture

• United Kingdom• Germany• Canada• Japan• Conclude with comparable components of

the U.S. system