How does the United States health care system rank in comparison to similar countries? We exceed other countries by a wide margin in the percentage of GNP that we spend on health care. Does this massive expense lead to a satisfactory outcome?
Medical care is a basic human need. I embrace an ethical, I could say religious view which would regard basic medical care as a human right that should be extended to all members of our society, especially so in light of our relative prosperity; we have the resources. Medical care is not specifically mentioned in our constitution, "Bill of Rights" or Declaration of Independence, but it is mentioned in the Universal Declaration of Human Rights, Article 25. Aside from this, however, the ethical question confronts us: do we embrace a commitment to basic medical care for every person?
It is unfortunate that discussions of social and political issues at present are highly politicized, therefore emotionally charged, and subject to a corruption of information presented to us. Memes are circulated which spread false, or incomplete, or ideologically inflammatory information that has the intention and the end result of creating conflict and increasing polarization. My goal herein is to share objective information and data relevant to the issue at hand. No information source is ideologically pure and totally objective, however, if the sources are named, based on research and data, and is public, at least the reader can evaluate and develop an informed opinion.
The following comparisons are taken from two collections of reports, one produced by the Commonwealth Fund, which has a rating of "High" in factual reporting by the website Media Bias / Fact Check, and additional data from the Peterson Center on Health Care and the Kaiser Family Foundation, which also has a rating of "High" in factual reporting by the website Media Bias / Fact Check.
The data presented below includes comparisons among industrialized countries that are indicated, plus some comparison to the 36 members of the OECD (Organization for Economic Cooperation and Development). By my count, fourteen countries are represented in the various data points presented. Obviously, some of the largest countries in the world do not share medical statistics; these comparisons do not include them, nor do they include what are sometimes called developing nations.
As such, we can recognize that every country represented in this data has a very good overall health care system. The question for us in examination of the U.S. health care system is: Given that we spend far more money than any other country, is our quality medical care made widely available, accessible, affordable, from coast to coast and among all people? This article sets forth basic international data. In future articles we will explore additional issues about how health care is funded, how it is delivered, how it is accessed by the children, the seniors, the individuals and the families, for us all in our time of medical need.
Multinational Comparisons of Health Systems Data, 2019
1.Healthcare Spending as a Percent of GDP, 2018
1. United States (16.9%) 2. Switzerland (12.2%) 3. Germany (11.2%) 4. France (11.2%) 5. Sweden (11%) 6. Canada (10.7%) 7. Norway (10.2%) 8. Netherlands (9.9%) 9. United Kingdom (UK) (9.8%) 10. Austria (9.3%) 11. New Zealand (9.3%)
The Petersen / Kaiser Family Foundation Health Tracker indicates very similar data in placing the U.S. highest at 17.7%, with the "Comparable Country Average" of 10.4%, and, in addition to the eleven countries in the Commonwealth Fund figures above, also includes Japan at 10.9%, Belgium at 10.4%, and Australia at 9.3%.
2. Health Care Spending per Capita
This chart shows that public spending on health care, per-capita, is comparable to most of the countries on this list, but our "out of pocket" spending is higher than all countries except Sweden, and the "private spending" is roughly 10 to 20 times higher than almost all of the other similar countries represented.
3. Rank of Life Expectancy at Birth, 2017
1. Switzerland (83.6) 2. Norway (82.) 3. France (82.6) 4. Australia (82.6) 5. Switzerland (82.5) 6. Canada (82) 7. New Zealand (81.9) 8. Netherlands (81.8) 9. United Kingdom (81.3) 10. Germany (81.1) 11. U.S. (78.6) . The Peterson / Kaiser data includes Japan, with the highest life expectancy of 84.2 (2017 data).
4. Adults with Multiple Chronic Conditions, 2016
Average of the 11 countries: 17.5
United States: 28 (ranked last among the 11)
5. Practicing Physicians per 1,000 population, 2018
Average of the 37 OEDC: 3.5
(OEDC = Organization for Economic Cooperation and Development)
Above this average: Norway, Sweden, Germany, Sweden, Australia, Netherlands
Below this average: New Zealand, France, UK, Canada, and 11th in rank, US at 2.6 physicians per 1,000 population.
6. Average Physician Visits per Year, 2017
OEDC Average: 6.8
Above this average: Austria, Netherlands, Germany
Below this average: Sweden, New Zealand, US (4.0 per year), Switzerland, Norway, France
7. Cancer Treatment Mortality Rate, per 100,000 (2015 data)
The U.S. ranks near the top in all cancer treatment:
1. Japan (179 per 100,000) 2. Switzerland (184) 3. U.S. (190) 4. Sweden (193) 5. Australia (195) 6. Austria (198) 7. France (205) 8. Belgium (207) 9. Canada (208) 10. UK (223) 11. Netherlands (232)
(Peterson / KFF data)
8. Breast Cancer Survival Rate, 2010 - 2014
OEDC Average: 85%
All eleven countries in this data are above the OEDC average.
#1 Rank - U.S. at 90%
#11 Rank - U.K. at 86%
9. Cervical Cancer Survival Rate, 2010-2014
OEDC Average: 66%
7 countries are above this average
4 countries are below this average, with US ranked last among the eleven at 63%
10. Diseases of the Circulatory System Mortality Rate, per 100,000 (2015 data)
Comparable Country Average: 215
1. Japan (146) 2. France (151) 3. Canada (183) 4. Australia (186) 5. Netherlands (203) 6. Switzerland (208) 7. Belgium (212) 8. Sweden (249) 9. U.S. (257) 10. Austria (318)
(Peterson / KFF data)
11. Mortality Amenable to Health Care 2016 (defined as a measure of the rates of death considered preventable by timely and effective health care)
Deaths per 100,000
In order of highest rank to lowest rank: Switzerland (54 per 100,000), France, Norway, Australia, Sweden, Netherlands, Canada (72), New Zealand, UK (74), Germany (86), US (112 per 100,000).
12. Percent of adults who made a same day or next day appointment when in need of care:
1. Netherlands (77%) 2. Austraila (67%) 3. U.K. (57%) 4. France (56%) 5. Germany (53%) 6. U.S. (51%) 7. Sweden (49%) 8. Canada (43%), with the Comparable Country Average of 57%.
Sources:
Multinational Comparisons of Health System Data, Commonwealth Fund
https://www.commonwealthfund.org/sites/default/files/2020-01/Tikkanen_multinational_comparisons_hlt_sys_data_2019_01-30-2020.pdf
Peterson / Kaiser Family Foundation Health System Tracker
https://www.healthsystemtracker.org/
https://mediabiasfactcheck.com/commonwealth-fund/