Friday, July 28, 2023

The State of U.S. Healthcare

America has one of the lowest ranked healthcare systems of an developed nation anywhere in the world despite being one of the most expensive. Among the top seven most industrialized nations, the U.S. is ranked dead last.

When it comes to life expectancy, America comes in at 47th among 201 countries. We average 79.4 years of age, with women living to be around 82 while men tend to live to age 77. Although that sounds pretty good, it's actually considered pretty low when compared to some of the top ranked nations such as Italy where the average age is 84.20 or any of the Scandinavian countries where most people live to around 83 years of age.

So, with the United States ranking among the lowest developed nations in terms of healthcare, who are at the top? The top three are all Asian countries, namely  Japan, Macao, and Hong Kong with overall life expectancies of 84.95, 85.51, and 85.83 respectively.  

The majority of top tier industrial nations are also in the top 20. The few exceptions include China in the 52nd spot with an average age of 78.79, Poland in 54th place with a expectancy of 78.60, and Saudi Arabia at 60th with a average expectancy of 78.10.  It should be noted that in every instance, women outlive men by an average of roughly ten years.

In terms of infant mortality, America again ranks last. The average is currently 5.4 per 1000 births, making us the highest of any top tier country. It's worth noting that as of 2021, the U.S. spent 17.8% of its  Gross Domestic Product (GDP) on healthcare, which is two times that spent by any other top industrial nation.

The primary reasons cited  is poor prenatal care such as smoking, drug and alcohol abuse, failure to take proper medications, and improper diet. Other factors include the high rate of cesarean sections as well as high rates of poverty which contributes to other health problems such as obesity, high blood pressure, heart disease, and diabetes. 

In addition, the groups most affected tend to be minorities, especially Native Americans, Black Americans, and Hispanics (as an aside, these same groups also tend to have the lowest life expectancies). 

When it comes to prescription prices, the U.S. spends more per capita than any other top tier nation. On average, we spend $1000+ per person annually on prescription drugs while average in other top tier nations is just $552 per person. At the same time, three in four Americans report being unable to afford the price of their medication. Spending on medication from 2004 through 2019 increased 69% in the U.S. while elsewhere it increased by just 41% on average.

Why is that? In part, it's because prescription drugs are, on average, nearly three times more expensive for a given drug than in any other country. A Humira Pen, for instance, used to treat inflammation in diseases like arthritis, averages nearly $5000 dollars per injection while in other industrial countries the same pen would cost about just under $3000 dollars.  The result is that many Americans are forced to chose to either do without or to ration their medication which often means not taking them as prescribed.

Another key reason is the emphasis of the healthcare industry on treatment (and thus writing more prescriptions) and less of emphasis on prevention. It also worth pointing out in other industrial nations, doctors are less time restricted when it comes to treating patients while in the U.S. physicians are typically capped at 15 minutes per individual and follow a quota system. The result is a focus on profitability and less on the long term welfare of the patient.  As the expression goes, "a cured patient is a lost customer".  

In addition, the United States also ranks at the bottom when it comes to the availability of hospital beds, and subsequently the length of the average stay of a patient. In the U.S. there are approximately 2.8 hospital beds available per 1000 individuals.

In terms of long term care, the costs per patient is the fourth  lowest at $924.00 dollars per patient. Italy is the cheapest at $422.00 dollars per patient, followed by Australia and Japan. The UK is next after the U.S. at $952 dollars. The most expensive costs per patient for long term care is the Netherlands at $1,858.00 dollars. Also among the most expensive are Sweden, Switzerland, and Germany at $1,567.00, $1559.00, and $1,445.00 respectively.

Among the other top industrial nations, that number is 4.3 beds per 1000. The lack of beds obviously affects the length of an average hospital stay. In the U.S. the typical patient is in the hospital for about 4.8 days (only the Netherlands is less, at 4.7 days). In Canada, Germany, and Switzerland is roughly 8.5 days. In France it's 9.1 days, and in South Korea it's a whopping 19.1 days! Can you imagine eating hospital food for nearly three weeks? Blah!

Lastly, we need to look at how the United States compares other industrialized countries when it comes to the availability of physicians. Based on the latest data, which is from 2019, the U.S. has least number of practicing physicians of the top 13 industrial nations.

The U.S. has just 2.6 doctors per 1000 individuals. That compares to France where the ratio is 3.2 per 1000. Australia has 3.7 per 1000 while Germany and Switzerland has 4.3. In Austria that number is 5.2 doctors available per 1000 potential patients. 

As an aside, the American healthcare system has more nurses than does comparable healthcare systems worldwide, and while the U.S. has more hospital staff than other nations, the majority of them are clerical/non-medical administrative personnel.  

As a result, the U.S. is tops when it comes to medically related administrative costs; an average of $925.00 per patient compared to an average of $204.00 among the top wealthiest countries. Sweden and Japan by comparison spend just $70.00 dollars per patient.

Lastly, what about quality of life? According the World Population Review, Northern Europeans clearly have the highest quality of life. In fact, the top ten nations are almost always include the Scandinavian countries of Iceland, Finland, Sweden, Norway, and Denmark, along with Germany, Switzerland, Netherlands, Canada, New Zealand, and Australia.

As for the United States, we currently rank 20th in the world, just behind Spain. You'll note that the countries with the highest quality of life also tend to have the longest life expectancies and the better healthcare.  

What does this say for the United States? The majority of the countries which rank higher than the U.S. in terms of life expectancy, healthcare, prescription prices, and so forth all focus on prevention first followed by treatment. They also place a greater emphasis on the overall wellbeing of the patient and less on meeting quotas or cost per patient ratios.

The majority of the countries follow a decentralized national healthcare system which is available to all its citizens. The healthcare is government managed with about 75% - 85% of the costs paid by tax revenue collected at the local and national levels. Prescription prices are often negotiated by the State rather than insurance companies or hospitals to ensure the best quality at the lowest cost.

Dental coverage for children are typically free while adults can buy dental insurance which is often subsidized by the government. There is also cost sharing between the patient and state based on the patient's income with costs being capped overall.  The costs of various medical services such as ambulances are typically bore by the State.

Hospitals and medical practices are given various financial incentives to improve efficiency and productivity. As stated previously, the State also encourages health conscious lifestyles such as regular exercise, longer vacation times and extra time off for "mental health", healthy diets, while encouraging cessation to bad health behavior such as smoking, poor diets and obesity.  

Free clinics can be found nearly everywhere, which is in part to help encourage males to seek treatment (men are notoriously for not wanting to get checkups, thus contributing to their higher mortality rate). Maternity leave is typically paid and extended to include the fathers as well.

The American healthcare system is a primarily profit driven enterprise with an emphasis on treatment and less on prevention. That has to change. While Americans are keenly tax adverse, a single payer tax system provided by the government would go a long toward improving overall healthcare, lower costs in the long run, and ensure health coverage for all, which would reduce costs now picked up by taxpayers.   

It would have the added benefit of allowing small businesses unable to afford health coverage for employees to compete with larger companies who can. Insurance can still be purchased by those looking for additional coverage.

Finally, doctors and medical professionals need to spend more time with patients and focus more on care and less on quotas. There also need to be more emphasis on mental illness treatment, which would go a long in alleviating some of the homeless problems facing communities today. Government funded research must pay along costs savings to the public. In addition, each state should negotiate prescription prices with the manufacturer to ensure patients receive the lowest cost possible for their medicine.

Meanwhile, there needs to be an additional effort made by the State and employers to encourage healthier lifestyles, including perhaps providing free or low costs classes in dietary choices, exercise, mental health, prenatal care, growing gardens, and so forth. 


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