US Health care — Expenditure and Outcomes

Adesh Kumar Mishra
6 min readNov 9, 2021

If I ask how, you prioritize your health over other aspects? The probable answer would be a top priority or significant priority.

If one wants to achieve material success, one must be physically and mentally fit. Today, with the advancement in modern medicine. Treating chronic and complicated health problems has become easy.

As the capitalistic system moved ahead, there had a lot of emphasis on productivity. Prominence on productivity decreased the importance of leisure activities like chilling, enjoying, and socializing. When you see the outside world, everyone is in a hurry. If we see on-road or catching a bus/auto, everyone wants to get the things done at the earliest. While there is no wrong in doing things in a hurry, there should not be a rush. As the saying goes, hurry up, do not haste.

When you haste in doing things, it leads to bad decisions/bad execution; in the end, it wastes our efforts. Continuous wasting creates frustration which further creates stress, as the list goes on.

As healthy citizens create a healthy nation, it is necessary to take care of health care needs. This article will talk about the United States of America’s spending on health care and related outcomes. This article will try to identify why health care expenditure is not synonymous with health care outcomes?

The United States spends more on health care than any other country. Annual health expenditures are forecast to exceed four trillion US dollars in 2020, and overall spending on health care was estimated to be around 10,500 US dollars per resident.

Recent developments tell us that the United States will spend 18 percent of its gross domestic product on health care in 2020. The United States has the highest health spending based on G.D.P share among developed countries.

As per the statistics of OECD, 2018, the United States of America spent 16.9% of its GDP on health care needs. The average was 8.8% for the OECD countries.

Even though primary care accounts for 48% of physician office visits each year and influences up to 90% of total health care costs through referrals, testing, procedures, and hospitalizations, the United States spends on aver, only 5%-7% of its overall health care spending on primary care.

90% of the United States’ $3.8 trillion in annual health care expenditures are for people with chronic and mental health conditions. Chronic diseases have significant health and economic costs in the United States. Preventing chronic diseases, or managing symptoms when prevention is not possible, can reduce these costs. Some chronic diseases and related cost are presented below -

1 — Heart disease and stroke — $214 billion per year and causing $ 138 billion in lost productivity on the job.

2 — Cancer — Cancer care continues to rise and is expected to reach $174 billion by 2020.

3 — Diabetes — Diabetes can cause serious complications, including heart disease, kidney failure, and blindness. In 2017, the total estimated cost of diagnosed diabetes was $327 billion in medical cost and lost productivity.

4 — Obesity- obesity costs the Us health care system $147 billion a year.

5 — Arthritis — the total cost attributed to arthritis and related conditions was about $ 304 billion in 2013.

6 — Alzheimer’s disease — In 2010, the costs of treating Alzheimer’s disease were estimated to fall between $ 159 billion and $ 215 billion.

The heavy cost of disease burden is responsible for US’s major spending on its health care system. But the heavy spending is not translating into health outcomes. Let us see -

The United States of America’s health rankings built upon the World Health Organization definition of health: “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”

The United States of America’s Health Rankings model, shown below, includes four drivers, or determinants of health: social and economic factors, physical environment, clinical care, and behaviors, all of which influence the fifth model category, health outcomes. Here we will see the health outcomes category exclusively -

The United States of America ranks last overall in the health care outcomes domain (Exhibit 1). On nine of the ten component measures, the United States of America’s performance is lowest among the countries (Appendix), including having the highest infant mortality rate (5.7 deaths per 1,000 live births) and lowest life expectancy at age 60 (23.1 years). The United States of America ranks last on the mortality measures included in this report, except for 30-day in-hospital mortality following stroke. The United States of America’s rate of preventable mortality (177 deaths per 100,000 population) is more than double the best-performing country, Switzerland (83 deaths per 100,000). The United States of America has exceptionally inferior performance on two other health care outcome measures. Maternal mortality is one: the United States of America rate of 17.4 deaths per 100,000 live births is twice that of France, the country with the next-highest rate (7.6 deaths per 100,000 live births).

[https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly]

The second is the 10-year trend in avoidable mortality. All countries reduced their rate of avoidable mortality over ten years. But the United States of America, with the highest level in 2007, reduced it by the least amount — a 5 percent reduction in deaths per 100,000 population by 2017 — compared to 25 percent in Switzerland (by 2017) and 24 percent in Norway (by 2016).

achieving better health outcomes will require policy changes within and beyond health care.

Health Outcomes, what needs to do be done?

As we have seen, the health expenditure of the United States of America is not in line with its health outcomes. Many countries spending less than the United States of America, have achieved better health outcomes than the U.S.A Below policy decisions can be looked at while striving for better health outcomes.

1 — Top-performing countries provide universal health care coverage. So that people can get care effectively, efficiently with equity.

2 — Top-performing countries pay a lot of emphasis on primary health care facilities while the United States of America spends a meager amount on primary health care.

3- The United States of America health care professionals have to handle administrative work. Along with their core function, which hinders their ability to treat people effectively. Reducing their administrative work and increasing their Medicare compensation will motivate them to work efficiently.

4 — Merely spending on health care to make citizens healthy is not a particularly desirable choice. We should be spending on nutrition, education, childcare, community safety, housing, transportation, and worker benefit that led to a healthier population and fewer avoidable demands on health care.

Health care outcomes are influenced by social, economic, and cultural factors. Public policies and public investments in education, housing, transportation, early childhood care, and the environment help to improve health outcomes. Evidence-based policymaking and spending can improve US’s health outcomes a lot.

References: -

1 — https://www.americashealthrankings.org/learn/reports/2020-annual-report

2 — https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly

3 — https://www.oecd.org/newsroom/health-spending-set-to-outpace-gdp-growth-to-2030.htm

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