The Cost of Healthcare in the U.S.

Everyone knows  that the cost of medical care in the U.S. is very high.   We buy insurance to help pay the cost which we may not otherwise be able to afford.   Some of us can't afford the insurance so we go without.  The Organization for Economic Cooperation and Development is a group that keeps track of the costs and other issues in medical care.  The statistics mentioned in this blog are from them via PBS. Most Americans believe and many politicians will tell you that we have the best health care system in the world.  The reality is that we pay much more than anyone else and our outcomes are often not as good.

 Health care costs in the U.S. are $2.6 trillion a year.  This is 17.6% of GDP.  Let's compare some numbers.  The average per person, per year cost of health care in the U.S. is $8,233.  That is two and a half times the OECD average cost of $3,268.   We spend more in all categories.  We spend $900 per person per year just on  administrative costs.  By comparison France spends $300.  We have been slow to embrace technology and cut down on waste.

Hospital services cost 85% more in the U.S.  The average hospital stay costs $18,000.  The average cost of a hospital stay for OECD countries is one third at $6200.  These counties have strong regulation to set prices that hospitals can charge.   The quality of care is comparable and universities still attract the best students to medicine.   In the U.S. the prices for certain procedures are much higher resulting in higher incomes for physicians.  U.S. physicians also use more expensive diagnostic procedures.  Studies have shown that one-fourth to one-third of all hospital patients suffer harm from adverse events that occur during their stays. Sixty-five per cent of these adverse events are due to failures in communication.

In the U.S. we have fewer practicing physicians.  We have 2.4 per 1000  people as opposed to 3.1 average in OECD countries.  The U.S. uses a "fee for service" system that charges for each visit, procedure, and test.  The more doctors do,  the more money they make.  The pay depends on insurance.  So it comes down to if your insurance will pay for something whether you need it or not.   OECD countries use a "common fee" schedule by which doctors and health services are paid similar rates for most patients.  If certain costs exceed what is budgeted, they are flexible in lowering the fees they will pay in that area.  There are few methods for controlling rising costs in private insurance in the U.S.  They pass the increase along to patients rather than asking providers to contain costs. 

The U.S. is known for over-testing and over-treating.   Tests are subject to the doctor's opinion as to whether they are desirable or not.  The reasons sighted for this over-kill are: 1. fear of litigation; 2. more pay for more service regardless of necessity;  3. patients ask for more tests and services regardless of need  with insurance that will pay all or most of the extra.  Despite this extra testing and services the U.S. life expectancy is 78.2 years compared to the average OECD country expectancy of 79.5 years.  

To be fair the U.S. leads the world in health care research and cancer treatment .  On the other hand we very much need stronger policies in tackling poor health lifestyles.   As a nation we are getting older with more chronic diseases and obesity. 

Well, I thought about that ... and here's what I think.   First of all, we have to take control and responsibility for our own health and health care.   We need to remember that the health care system is there to help us, not control us.   With more and more large corporations and practices  we need to remember that they focus on bottom line.  We need to focus on and decide what is best for us.  They can provide the medical knowledge and experience to make decisions, but they are our decisions. 

Here's what you can do:  1. Pay attention; 2. Ask questions; 3. Never assume that any doctor or hospital is error free.   Be a list maker.  Write it down.  Keep track of what you are taking and doing and why.  Write down your questions for your nurse or doctor.   Work towards the healthiest lifestyle you can.   There is also a book you may want to consider.  "The Patient's Checklist:  10 Simple Hospital Checklists to Keep You Safe, Sane, and Organized" by Elizabeth Bailey.

Be well!