US leads in health care spending, but is last for health outcomes among rich nations

The United States spends up to four times more on health care than most wealthy nations, but it doesn't have much to show for it.

Life expectancy in America continues to decline even though this country spends nearly 18% of its gross domestic product on health care, according to a new report from the nonprofit Commonwealth Fund.

"The U.S. stands out as the only nation in the Organization for Economic Co-operation and Development [OECD] without universal health coverage, our life expectancy is dropping, and we have higher rates of avoidable deaths than other nations," said report author Munira Gunja. She is a senior researcher for the Commonwealth Fund's International Program in Health Policy and Practice Innovation, in New York City.

Besides the lack of universal health care coverage, the United States has too few primary care providers and doesn't spend enough on primary care, which makes it difficult for folks to get basic preventive health care and sets them up for chronic conditions, she added.

In the report, Gunja's team compared health care spending and outcomes in the United States with those of 12 other high-income nations and the averages for 38 OECD member nations between January 2020 and December 2021.

What did the team find? The United States fell short on many measures.

Americans had the lowest life expectancy at 77, which is three years younger than the average among people in other wealthy nations.

Despite spending more on health care than other nations, the United States also continues to have the highest rates of preventable deaths from diabetes, high blood pressure-related diseases and certain cancers, and the highest rate of people living with multiple chronic conditions, the report found. The obesity rate in the United States is nearly double what is seen in other OECD nations.

What's more, the United States also had the highest rate of death from COVID-19 compared with other nations. And Americans are more likely to die from physical assault, including gun violence, while the country has the highest infant and maternal death rates among OECD nations.

Even though screening rates for breast and colon cancer and flu shots in the United States are among the highest in the world, COVID-19 vaccination rates are falling behind many nations, the new report showed.

There has been some progress in expanding access to health insurance in the United States, but more work is needed to fill in the gaps and get people the health care they need, the researchers said.

Enacted in 2010, the Affordable Care Act (ACA, or "Obamacare") opened up a marketplace for purchasing affordable health insurance. More than 3 million new people signed up for health insurance under the ACA this year, raising enrollment numbers to a record 16.3 million Americans.

Despite the ACA, millions of Americans still can't afford coverage and/or live in health care deserts without access to physicians. "Many states haven't expanded Medicaid, so they have no good affordable options," Gunja noted.

"We have to make sure everyone has access to a health insurance plan that is affordable and that preventive care is free with no co-payment," Gunja said. "We need to invest in the primary care workforce, provide incentives for physicians to enter primary care, and enact loan forgiveness for medical school debt, or we will never be able to solve this crisis."

But it's still possible to turn things around. "Other countries did it, so we should be able to do it, too," she said.

U.S. health care policy experts have ideas about how to solve the health care crisis in the United States.

"We are financially out of control in the U.S. and spend too much on what others get for far less money, with no effect on the health outcomes," said Dr. Arthur Caplan, a bioethicist and founder of the division of medical ethics at NYU's Grossman School of Medicine in New York City.

In addition to improving access to health insurance, the United States needs to make sure that health care is available everywhere, Caplan added. "We need to find ways to get services to rural or poor people, because even if they have insurance, it doesn't mean that there is a physician nearby," he said.

Better use of technology, including telemedicine, may help fill some of these gaps, he said. Primary care delivered by physician assistants, nurse practitioners and pharmacists can also improve access to health care.

"We have to get more creative than we have been to get services out there," Caplan said.

Focusing on prevention and wellness in schools and other community settings may also help people live longer, Caplan suggested.

Improving access to primary care doctors is an important part of the solution, said Emma Wager, a policy analyst at Kaiser Family Foundation, in San Francisco.

"We have fewer physicians than other countries, and fewer Americans see a primary care doctor every year, and that is a major reason why we have poorer health outcomes," said Wager, because people who see primary care doctors tend to fare better.

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