International Health Care Systems

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Is International Healthcare Spending Converging?

September 22, 2011 in International Health Care Systems | 5 comments

It is a well known fact that the U.S. spends more on health care per person than any other country.  But maybe healthcare spending is converging between countries?

At least for the years 2000-2008, there is mixed evidence.  U.S. healthcare spending per person grew by 3.4%.  This is slower than Spain (4.7%), the U.K. (4.6%), the Netherlands (4.3%), Belgium (4.2%), and Sweden (3.6%).  However, spending as a share of GDP grew fastest in the U.S. of any country over this time period.  The U.S. experienced a 2.6 percentage point gain in health care spending as a share of GDP.  The next closest country was Belgium with a 2.1 percentage point increase in healthcare spending as a share of GDP and the Netherlands with a 1.9 percentage point increase.

In 2008, the disparities in healthcare spending as a share of GDP were still immense.  The U.S. spent 16% of its economic production on health care.  The next closest countries are France (11.2%), Belgium (11.1%), Switzerland (10.7%), Germany (10.5%), Austria (10.5%), Canada (10.4%), and the Netherlands (9.9%).

Even if the U.S. doesn’t reduce it’s health spending level, if the current health care spending rate does not slow, this country could be bankrupt sooner rather than later.

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Why are more than 35 percent of elderly Swedes on disability?

May 31, 2011 in Health Care Around the World, International Health Care Systems | 1 comment

“The proportion of men collecting disability benefits at older ages varies greatly across countries — for example, more than 35 percent of 64-year-old men in Sweden and more than 25 percent of those in the Netherlands are on DI, versus 10 percent or less in Belgium, Italy, and Spain. Does this reflect differences in the underlying health status of older individuals in these countries? Or do differences in the provisions of the DI systems explain this variation in DI take-up rates?”

This is the question the Milligan and Wise attempt to answer in their Introduction to Social Security and Retirement around the World.  The Healthcare Economist suspects the answer is the latter.  Most people consider a quadriplegic disabled and those who are fully healthy are not disabled.  Many individuals, however, have partial disability. Many workers, for instance, suffer from back pain.  Measure the severity of the back pain is typically very difficult; some workers can continue working in physically strenuous jobs, others could continue to work in less physically strenuous jobs (e.g., blogging?), and for a minority the back pain is so severe that working at all is not feasible.  Because partial disability is not only common but also difficult to verify, public programs leniency regarding disability program eligibility likely affects the number of beneficiaries more than the underlying health status of the country.

Sure enough, Milligan and Wise come to the same conclusion.  Using “natural experiments” in which a country’s disability insurance reforms were not prompted by changes in health status or by changes in the employment circumstances of older workers, the researchers find that reforms have a large effect on the labor force participation of older workers.

Source:

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How does the U.S. stack up?

November 18, 2010 in International Health Care Systems | 1 comment

According to the Commonwealth Fund:

“An 11-country survey focusing on health care access, cost, and insurance coverage found that adults in the United States are by far the most likely to go without care because of costs, have trouble paying medical bills, encounter high medical bills even when insured, and have disputes with insurers or payments denied.”

A summary of the findings can be found here.  Thirty five percent of Americans have out-of-pocket costs of more than $1000 and 20% have a serious problem paying health insurnace bill.  The full report is available here.

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Olympic Post III: China and India Healthcare Statistics

August 13, 2008 in HC Statistics, International Health Care Systems | Permalink

Below is a side-by-side comparison of health care and economic statistics from China and India.

Category China India
Population 1.33 billion 1.15 billion
Life Expectancy (2008) 73.18 69.25
Infant Mortality Rate (per 1000 live births) 21.16 32.31
GDP (PPP) – 2007 $6.99 billion $2.99 trillion
GDP/capita (PPP) – 2007 $5,300 $2,700
GDP growth – 2007 11.4% 9.2%
GDP/capita Growth (1994-2004) 7.8% 4.4%
% below poverty line (PL) 13.7% 31.1%
% below PL after medical expenses 16.2% 34.8%
Healthcare spending/GDP (1988) 3.3% 3.5%
Healthcare spending/GDP (2002) 5.5% 5.0%
Gov’t health spending/total health spending (1980s) ~30% ~30%
Gov’t health spending/total health spending (2002) ~15% ~15%
Health Insurance Coverage 56% (urban); 21% (rural) 15%
OOP Medical Expense (1990) 21% 70%
OOP Medical Expense (2002) 58% 80%
% of pop. over 65 (2000) 10.2% 7.6%
% of pop. over 65 (2050) 29.9% 20.6%
For-profit hospital market share (2004) 13.8% N/A
For-profit clinic market share (2004) 72.0% N/A
Pop. covered by commercial insurance (2004) 5.6% N/A
Pop. living with HIV/AIDS 5.1 million 0.8 million
HIV/AIDS deaths (2003) 44,000 310,000
Prevalent food and waterbourne diseases: bacterial diarrhea, hepatitis A & E, and typhoid fever bacterial diarrhea, hepatitis A, and typhoid fever
Prevalent vectorborne diseases: chikungunya, dengue fever, Japanese encephalitis, and malaria Crimean Congo hemorrhagic fever, Japanese encephalitis, and malaria
Prevalent animal contact diseases: rabies rabies
Prevalent Water Contact Diseases N/A leptospirosis

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Americans have the best cancer survival rates

July 22, 2008 in International Health Care Systems, Medical Studies | Permalink

On Friday I reported that the U.S. scored poorly on the Commonwealth Fund’s National Scorecard. Those in favor of universal health care are probably rejoicing. “The U.S. system is dysfunctional beyond repair and we need universal health care!”

Yesterday, the Economist reported on an article in The Lancet Oncology journal which found that the U.S. has the best five year survival probabilities for breast and prostate cancer. Score one for those against universal health care. “The American free market is always the best!”

How can this be? How can we reconcile these two results?

The Lancet Oncology article controls also for other covariates which are related to survival probabilities, but do not relate to the quality of health care. For instance, if Americans get cancer later in life than people from other countries this is taken into account since people who are older are more likely to die of almost all causes, including cancer. Further, if traffic mortalities or the homicide rate are higher in the U.S. than in other countries, this will likely decrease the probability a cancer patient survival for 5 years, but is unrelated to the quality of medical care. If Americans are more likely to be obese, this also will decrease their survival probabilities, but should not be an indictment against the health care system. For these reasons, the 5 year cancer survival probabilities are adjusted to take into account the age and death rates in the general population. After these effects are taken into account, the U.S. scores very well in terms of cancer survival.

Of course cancer survival is only one of a myriad of ways of measuring the quality of the American health care system. Further, the U.S. spends the most money on healthcare (in total and per capita) compared to any other country. While the U.S. may (or may not) be the best, it is certainly the most expensive.

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U.S. Health Care scores poorly

July 18, 2008 in International Health Care Systems, Quality | Permalink

The Washington Post reports that U.S. Health Care [is] Still Ill. This conclusion comes from a report from the Commonwealth Fund titled Results from the National Scorecard on U.S. Health System Performance, 2008. Even though the U.S. still spends more money on medical care than any other nation, performance on the Scorecard has not improved between 2006 and 2008.

Today, let’s look into some of these measures in detail.

  • Preventable Deaths/100,000 Population. This is calculated as the annual ratio of people below age 75 or below who die from diseases such as heart disease, stroke, bacterial infection, diabetes. These figures are age-adjusted so that if one country has a lot of old people, this does not count against them. This is a very good aggregate metric of how well the health care system is doing and it turns out that the U.S. is in last place.
  • Percent of adults (18+) who received all recommended screening and preventive care. Here we see pretty much no change between 2002 and 2005 (49% to 50%). However, using a metric such as all preventive care hides some improvements along the margin. For instance, let us assume that there are 5 key vaccines. If and half the population get all the vaccines and half of the population did not, then we would have a 50% score on this metric. On the other hand, if we had a huge improvement where the people who were not getting vaccinated now got 3 of the 5 vaccines, we would still be at the same 50% mark.
  • Quality of Care. We note that in most of the measurable quality metrics, performance increased. The number of diabetics with HbA1C<9% increased; the percent of people who received the proper care for heart attacks, heart failure and pneumonia increased as well. We see that more and more patients now receive written instructions after they are discharged from a hospital. Much of this improved quality may be coming from pay-for-performance interventions. As I have mentioned in earlier blog posts, P4P may improve the quality of care on measured dimensions, while reducing the quality of care in unmeasured areas.
  • Nursing Home hospitalizations. The percent of nursing home patients who were hospitalized in a year increased. This may be due to worse care, or an older–and thus generally sicker–population of adults being the ones who enter into nursing homes.
  • Off-Hours care: Although there was some improvement from 2005, Americans in 2007 were the least likely to be able to receive non-emergency care on nights, weekends, and holidays.
  • Access: The percent of people who are uninsured has risen greatly between 2000 and 2006. Further, 41% of adults have an outstanding medical debt of bill problem.
  • Coordination of care. When Americans have test done, they are the least likely to have these results available at the time of the next appointment. Among countries in the Commonwealth Report, only Canadians primary care physicians (PCPs) are less likely to use electronic medical records than American PCPs.

Can these report cards help improve care? Yes an no. Of course, pointing out short-comings in the American system is the first step that is needed in order to improve care. The report, however, does not really explain why these short falls are occurring or how to fix them. Are adult preventive care levels low because physicians are not doing their job, or are patients avoiding needed checkups? The answer to this question will determine whether a physician-focused or public health-focused approach would work best. Similarly, we see that nursing home hospitalization are increasing. Why is this? Is this because of worse nursing home care or are the patients who enter into nursing homes sicker on average in more recent years? The the former is the culprit, what specific problems are leading to more hospitalizations and how can we fix them.

I applaud the Commonwealth Fund for collecting this data. As they wisely state, “what receives attention gets improved.” However, more detail studies are needed if we really want to improve the quality, access and efficiency of health care in the 21st century.

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