JAMA Articles Examine Health Spending in the United States Compared to Other Countries
April 3, 2018
ICYMI, JAMA published a series of articles on health care spending, several of which compared the differences in spending in the United States with other high-income countries. The articles offer a variety of perspectives, which are summarized below:
Health Care Spending in the United States and Other High-Income Countries
(Irene Papanicolas, Liana Woskie, Ashish Jha)
In 2016, the United States 17.8% of the gross domestic product on health care — more than the while 10 other high-income countries spent on average only 11.5%. To understand why the US spends more on health than other countries, Papanicolas and colleagues looked at differences in the structure of health care, access to care, health and social spending, utilization of services, and health outcomes using information from the cross-country Organisation for Economic Co-operation and Development database and other data sources. In general, the authors found that use of services, access to care and health outcomes in the US were similar to other countries. Using limited pricing information to compare across countries, the authors conclude that prices of labor and goods, physician salaries and administrative costs of care contribute to higher spending in the United States.
Challenges in Understanding Differences in Health Care Spending Between the United States and Other High-Income Countries
(Katherine Baicker and Amitabh Chandra)
Comparing health care spending across countries can identify drivers of health care spending, but these comparisons can be difficult. As Baicker and Chandra describe in this editorial, without more granular data about the impact of service intensity on prices, the improvements in quality of care that new treatments or care delivery programs can provide, and the overall supply and demand market dynamics which influence prices may be overlooked. Prices and quantities of health care use are important, but policy makers also must consider the priorities of the voters who make choices about how and what to spend on health care, they explain.
Health Care Spending in the United States Compared With 10 Other High-Income Countries. What Uwe Reinhardt Might Have Said
(Howard Bauchner, Phil B. Fontanarosa)
For over four decades, the late Uwe Reinhardt was a leading voice on health care spending and a long-time member of the JAMA editorial board. As a tribute to Reinhardt, Bauchner and Fontanarosa reflect his voice in their editorial, noting that it is neither new nor surprising that the United States spends more money on health care than other countries. However, updated information by Papanicolas and colleagues reaffirms the need to address critical questions if the United States wants to deal with rising health care costs.
The Real Cost of the US Health Care System
(Ezekiel J. Emanuel)
“It’s the prices, stupid” is a common refrain to describe why the United States spends more than other countries. In this editorial, Emanuel describes why prices alone are unlikely to drive higher health care costs in the United States and outlines three policy considerations to reduce costs. However, whether these or other policies will trim health care spending in the US is up to medical professionals, health systems, payers, policymakers and patients, he writes.
Factors Contributing to Higher Health Care Spending in the United States Compared With Other High-Income Countries
(Stephen T. Parente)
Identifying market-based health reform solutions applicable to the United States requires an understanding of the US health care market features, according to Parente. As he outlines in this editorial, the United States market is unique for two reasons. First, stakeholders have more monopolistic features —commonly associated with higher prices — that are more prevalent in the United States than in other countries. Second, the US health system devotes more resources to beginning and end of life care than other systems. Policy options to change the trajectory of health care spending in the US must acknowledge these market specific dynamics, he writes.