It is generally accepted among health services researchers that the United States outspends all other high-income countries in terms of healthcare, yet Americans have been dying at younger ages than their peers in the majority of high-income countries for many years. However, many questions and misconceptions remain about what accounts for this paradox. A report released in January by the National Academy of Sciences, entitled, “U.S. Health in the International Perspective: Shorter Lives, Poorer Health,” tackles this problematic puzzle in a comprehensive and systematic comparison of the United States and 16 other peer countries in the Organisation for Economic Co-Operation and Development (OECD). Among the many analyses and tables included in the report, several striking findings emerge:
- Life Expectancy: In 2007, life expectancy for U.S. males was 3.7 fewer years than men in Switzerland, the top-performing country. Similarly, the difference in life expectancy between females in the U.S. and Japan was 5.2 years. Even worse—this difference has been growing (especially for women) for the last three decades.
- Pervasive and Widespread Disadvantage: All age groups under 75 were affected, and the health disadvantage was observed for multiple diseases, biological and behavioral risk factors, and injuries (e.g. even advantaged Americans–those who are white, insured, college-educated or upper income–are in worse health than their respective OECD peers).
- Nine Specific Problem Areas: Birth outcomes, injuries and homicides, adolescent pregnancy and sexually transmitted infections, HIV and AIDS, drug-related mortality, obesity and diabetes, heart disease, chronic lung disease and disability are all areas where Americans as a group fare worse in health outcomes in comparison to other OECD countries.
- “Return on investment”: The United States spends twice as much per capita on healthcare compared to the median per capita spending for all OECD countries (in 2009, the United States spent $7,690 per capita vs. the median of $3,223). Specifically, healthcare spending accounted for 17.9 percent of the U.S. gross domestic product in 2010.
These findings strike down the misconception that this problem can be fully explained by any one factor (e.g. health disparities). Instead, the report argues that the interactions of the fragmented health system, prevalent unhealthy behaviors, high income inequality and poverty rates, the built environment, and other factors yet to be identified have contributed to this issue.
So what now?
While the evidence presented on the U.S. health disadvantage is overwhelming (and truthfully, a bit depressing), the report detailed several recommended next steps for the research and policy communities:
- Researchers, national research agencies, and international research entities partner to harmonize data collected worldwide to align outcomes/indicators and standardize data collection methodologies (e.g. NIH and the National Center for Health Statistics partnering with the World Health Organization)
- Research-funding agencies support the development of more refined analytic methods and innovative study designs for cross-national research.
- Research-funding agencies fund a coordinated portfolio of research devoted to further understanding interplay of factors contributing to the U.S. health disadvantage and identifying potential solutions.
In an invited panel presentation discussing these recommendations, AcademyHealth President and CEO, Dr. Lisa Simpson observed that health services researchers have an opportunity to capitalize on the increased use of electronic data systems as well as existing and future longitudinal studies in the United States in their research to inform this issue. In addition to creating innovative research methods for cross-national comparisons, Dr. Simpson also recommended inquiry into comparative studies which juxtapose state specific indicators (as captured by various reports, e.g. AHRQ’s National Healthcare Quality and Disparities Reports) with OECD to galvanize action at the state level as the Affordable Care Act is implemented.
While future research will further illuminate contributing factors of the U.S. disadvantage, given the overwhelming evidence and breadth of the problem, the report argues that the cost of inaction is high. In fact, in order to stem the continuing decline of health in the United States, the panel recommended a strengthened commitment to existing national health objectives and implementation of known effective strategies and policies. However, this will only be feasible, the report cautions, if the American public is alerted to the issue at hand.
This may be easier said than done. Many Americans are unaware of or resistant to the idea that their families are in worse health than in other OECD countries. In fact (and a bit ironically), the United States rates the highest among peer countries in “self-rated health” (the percentage of American adults who describe their health as “good” or “very good”). In response, robust dissemination of these key messages and outreach are needed to spur a national awareness and discussion of these issues. Now more than ever, the work and findings of health services researchers need to be shared with the public and key decision-makers – in ways they can understand – so that meaningful change can be achieved through effective, documented interventions and innovations.
To learn more about the report, visit the National Academy of Sciences to download a free copy of the report, issue brief and view other resources.