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The US Health System Over the Last 25 Years

By December 10, 2018Commentary

I am not sure why comparing our health system to others really tells us anything useful, but people like to do it.  A brief report from the Peterson-Kaiser Health System Tracker analyzes the last 25 years of experience in the US Health System.   (PK Brief)   Using data from 1991 to 2016, the report says that spending rose from $788 billion, or 12.8% of GDP, to $3.3 trillion, or 17.9% of GDP, over this time period.  Did we get some bang for the buck?  Well, we know from other research that providers, drug and device manufacturers, etc., certainly did, because their price increases account for almost all that spending increase, not utilization rises.  Life expectancy in the US over this period rose 3.1 years, to 78.6, a 4% improvement.  Disability adjusted life years, a measure of disease burden, dropped 12%.  Years lost to premature death improved by 22%, while years living with disability increased by 2%.  The former reflects tremendous reduction in heart attack and other circulatory disease deaths and the latter is due to the medical system keeping people with disease alive longer, which may or may not be good.  In the last two years, however, life expectancy has actually dropped some, due to opioid and other substance abuse issues and maternal mortality has also increased.  Both are due to social and cultural factors that can’t fairly be attributed to the performance of the medical system in my opinion.

And of course, once again we supposedly suck compared to other developed countries.  Those countries on average improved life expectancy by 7%, disease burden by 22% and had a cumulative rise in share of GDP devoted to health of 40%, compared to our 43%.  My opinion on this hasn’t changed.  We spend more because of prices (we actually do a way better job than most countries of appropriate use of health resources) and we appear to have worse outcomes because of social issues, i.e. we have a lot of really irresponsible people and we incent them to stay irresponsible.  And this report supports that.  We have twice the rates of obesity, which is often concentrated among lower-income people.  We have more people living in poverty, which is associated with a syndrome of poor behaviors, including health ones.  Interestingly, this report claims we have more errors in the course of care than other developed countries, but I would be surprised if that is true and is probably a reporting artifact caused by more detailed reporting systems in the US compared to other countries.  Our greater rates of the uninsured is also supposedly tied to worse outcomes but I am also dubious that is actually supported by research, and is more likely correlation than causation.  Still be good if we could lower our spending and lessen the pain on individuals, but if we don’t outright penalize people for bad health behaviors, not likely to see any change.

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