American Healthcare: A Bad Investment?
This month, a report came out examining the health of 17 affluent countries, leaving members of the National Research Council and Institute of Medicine surprised at the results. The U.S. was pretty much at the bottom of the list. Despite spending the most money on healthcare, Americans are unhealthy among developed countries. First glance leaves the impression that American healthcare spending is getting a poor return on its investment.
The Study and Its Findings
This landmark study was published as a culmination of the works of an expert panel which examined the data from various national and international sources including the Center for Disease Control and the World Health Organization. Countries studied were Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Netherlands, Norway, Portugal, Spain, Sweden, Switzerland, and the United Kingdom, in addition to the U.S. Perhaps the most telling factor studied was life expectancy. For men, the U.S. stood last in the group and for women, second to last. According to the data, an American man will, on average, live to 75.64, nearly four years less than a man from Switzerland. A woman will live, on average, to 80.78, five years less than a woman from Japan. Presuming that the goal of medicine is to allow people to live lengthy, healthy lives, there is quite a disparity between the U.S. and the countries at the top of the list. Four to five years is a long time!
Of other factors examined in the study, the U.S. was found to rank poorly in the prevalence of adult obesity, childhood obesity, heart disease, and diabetes.
So, the U.S. spends more money on healthcare, yet has poorer health than most developed nations. In examining how this breaks down, it really isn't so surprising. The lion's share of our healthcare costs come from tending to the ramifications of the diseases that are more prevalent in the U.S. Open heart surgeries to fix the clogged arteries and dialysis for the failed kidneys from dialysis are extremely costly. End of life care in the intensive care units across America when the diseases begin to win the battle also take a toll. In truth, the healthcare spending in the U.S. is less like an investment into health and more like a tax for disease.
We are continually putting patches on something that is broken. The solution is less about fixing the problem and more about preventing the problem. The common factor for so many of America's diseases (heart disease, stroke, diabetes and even cancer) is obesity. The common factor in obesity is that Americans eat more and move less.
Changing the Mindset
In the U.S., there are a lot of medical tests. We are great at examining the blood, scanning this and that. We do a great job diagnosing disease and then dealing with it. As a primary care doctor, however, I'm tired of disease. Let's invest more of our time and resources toward health. This will require a huge paradigm shift. We have ubiquitous fixtures to contend with: McDonalds fattens us up and iPads slow us down. These national trends send a stark message that we need to shift the focus quickly from the nation as a whole to the individual American and his/her behaviors.
Put simply, if we want to live longer and better, we must live differently.
Reference: "U.S. Health In Internationsl Perspective: Shorter Lives, Poorer Health," National Research Council and Institute of Medicine, January 9, 2013