Health Care Spending in the United States and Other High-Income Countries
Level 4 - case-series / case-control
Level 4 by design analogy (cross-sectional, ecological comparative analysis of aggregated country-level data)
OpenAlex W2790706219 · doi:10.1001/jama.2018.1150
What was done
Analyzed international health systems, structural capacity, utilization, and macroeconomic data primarily from 2013 to 2016 sourced from the OECD and country-specific databases. The study compared the United States against 10 other high-income countries: the United Kingdom, Canada, Germany, Australia, Japan, Sweden, France, the Netherlands, Switzerland, and Denmark.
What was found
In 2016, the US spent 17.8% of GDP on health care compared to 9.6% (Australia) to 12.4% (Switzerland) in peer nations. US health insurance coverage was 90% (55.3% private) versus 99%–100% in comparator countries. US life expectancy was the lowest (78.8 years vs 80.7–83.9 years; 11-country mean 81.7 years), and infant mortality was the highest (5.8 vs 3.6 per 1,000 live births overall). Adult overweight/obesity was 70.1% in the US versus a peer range of 23.8%–63.4%, while daily smoking was lower (11.4% vs 16.6% mean). Physician supply (2.6 per 1,000), nurse supply (11.1 per 1,000), and hospital beds (2.8 per 1,000) were similar, as were common inpatient discharge and procedure rates. However, the US had higher imaging utilization (118 MRI and 245 CT scans per 1,000), higher administrative costs (8% of spending vs 1%–3%), higher per-capita pharmaceutical spending ($1,443 vs $466–$939), and higher physician compensation (generalist salary $218,173 vs $86,607–$154,126).
Why it matters
This study shows that the US spends nearly twice as much as peer nations on health care despite similar overall healthcare utilization rates. The findings indicate that policy efforts to curb spending must address high prices for pharmaceuticals, administrative overhead, and labor costs rather than focusing solely on reducing service utilization.
Limits
The study is an observational, ecological cross-sectional analysis using country-level aggregate data, which cannot establish causality or capture intra-country disparities. Data completeness varied across nations, requiring supplementation with non-OECD country-specific data sources that may have differing reporting standards.
Cited by
- context The United States spends twice as much per capita on healthcare as any other nation, and three to five times as much as many countries.