US spends most on health care but has worst health outcomes among high-income countries, new report finds

TODD: ISN’T THAT ALWAYS THE CASE. FIVE ON YOUR HEALTH, SOME HEARTBREAKING STATISTICS, BABIES BORN TO BLACK WOMEN ARE MORE THAN TWICE AS LIKELY TO DIE COMPARED TO WHITE INFANTS, AND BLACK WOMEN ARE MORE THAN THREE TIMES AS LIKELY TO DIE IN OR AFTER PREGNANCY THAN THEIR WHITE COUNTERPARTS. MANY HEALTH LEADERS ARE TRYING TO REVERSE THAT TREND. HERE WITH SOME INSIGHT IS DR. ALLISON BRYANT MANTHA, A MATERNAL FETAL MEDICINE SPECIALIST AND THE SENIOR MEDICAL DIRECTOR FOR HEALTH EQUITY AT MASS GENERAL BRIGHAM. DR. BRYANT MANTHA, WE TALK A LOT ABOUT ACCESS TO CARE IN COMMUNITIES OF COLOR, ARE THESE STARTLING STATISTICS DUE TO HEALTHCARE ACCESS ISSUES? >> I AGREE, IT IS HEARTBREAKING. IT’S COMPLETELY UNNECESSARY. TO ENSURE OUR COMMUNITY’S ACCESS TO CARE BUT THERE ARE MANY OTHERS. IT’S ABOUT HOW WE TREAT PEOPLE WHEN THEY ENTERED THE DOORS AND HOW WE LISTEN TO THEM. IN ALL OF OUR FIELDS OF HEALTH CARE, HIGH QUALITY CARE COULD BE DENIED TO SOME AND WE ARE ON THE PATH TO FIX THAT. INDIVIDUALS SPEND GETTING HEALTH CARE AND IN THEIR OWN COMMUNITIES. ACCESS TO HEALTHY FOODS, TRANSPORTATION AND EDUCATION DRIVE THE STUDIES. IT HAS SO MUCH TO DO A STRUCTURAL, SYSTEMIC RACISM. TODD: THERE ARE MANY EFFORTS UNDERWAY TO TRY TO CHANGE THIS, HOW CAN DOULAS PLAY A ROLE? >> THE PRESENCE AND SUPPORT OF URTULA DURING PREGNANCY AND BIRTH CAN BE PART OF OUR SOLUTION. THEY BRIDGE THE MEDICAL CARE TEAM AND THE PERSON GIVING BIRTH. WE ARE A LITTLE MORE ADEPT AT LISTENING TO THEIR PREFERENCES AND WHERE THEY COME FROM AND EXPLAIN THE PROCESSES OF CARE. AS IT STANDS, HAVING A BIRTH DOULA CAN BE INVALUABLE. TODD: MATERNAL CARE DOESN’T STOP WHEN THE BABY IS BORN. HOW DO YOU HELP NEW MOMS ADJUST AND MAKE THE BEST DECISIONS FOR THEMSELVES AND THEIR BABIES? >> THANKS FOR ASKING. FOR TOO LONG OUR FOCUS HAS BEEN ON CARING FOR INDIVIDUALS IN PREGNANCY AT TIME OF BIRTH. LESS FOCUS ON HEALTH AND WELL-BEING IN THE FOURTH TRIMESTER WHICH IS FROM THE BEGINNING OF THE BIRTH UNTIL A YEAR AFTER WHICH COULDN’T BE A VULNERABLE TIME FOR FUN. MEDICAL COMPLEXITY CAN SNEAK INTO WHAT HAD OTHERWISE BEEN UNCOMPLICATED. A TERRIFYING TIME TO NAVIGATE THE RESPONSIBILITIES OF MOTHERHOOD. WE FOCUS ON THE NEED TO LISTEN TO OUR PATIENTS AND THE SYMPTOMS THAT THEY MAY HAVE FOR THEIR CONCERNS. WHETHER THAT IS IN A CLINICAL SETTING OR DOULA SUPPORT. BUT WE WANT TO PROVIDE STRUCTURAL SUPPORT THROUGH EXTENDED COVERAGE AND FAMILY LEAVE POLICY. THERE IS FURTHER WORK TO BE DONE AND WE HOPE WE ARE IN A PASS TO DO BETTER. TODD: DR. ALLISON BRYANT MANTHA, TH

The United States spends more on health care than any other high-income country but still has the lowest life expectancy at birth and the highest rate of people with multiple chronic diseases, according to a new report from The Commonwealth Fund, an independent research group.The report, released Tuesday, also says that compared with peer nations, the U.S. has the highest rates of deaths from avoidable or treatable causes and the highest maternal and infant death rates."Americans are living shorter, less healthy lives because our health system is not working as well as it could be," the report's lead author, Munira Gunja, senior researcher for The Commonwealth Fund's International Program in Health Policy and Practice Innovation, said in a news release. "To catch up with other high-income countries, the administration and Congress would have to expand access to health care, act aggressively to control costs, and invest in health equity and social services we know can lead to a healthier population."People in the U.S. see doctors less often than those in most other countries, which is probably related to the U.S. having a below-average number of practicing physicians, according to the report, and the U.S. is the only country among those studied that doesn't have universal health coverage. In 2021 alone, 8.6% of the U.S. population was uninsured."Not only is the U.S. the only country we studied that does not have universal health coverage, but its health system can seem designed to discourage people from using services," researchers at the Commonwealth Fund, headquartered in New York, wrote in the report. "Affordability remains the top reason why some Americans do not sign up for health coverage, while high out-of-pocket costs lead nearly half of working-age adults to skip or delay getting needed care."An outlier on spending and outcomesThe researchers analyzed health statistics from international sources, including the Organisation for Economic Cooperation and Development, or OECD, which tracks and reports on data from health systems across 38 high-income countries. The data was extracted in December.The researchers examined how the United States measured against Australia, Canada, France, Germany, Japan, the Netherlands, New Zealand, Norway, South Korea, Sweden, Switzerland and the United Kingdom. They also compared the US with the OECD average for 38 high-income countries.The data showed that in 2021 alone, the U.S. spent nearly twice as much as the average OECD country on health care -- and health spending in the U.S. was three to four times higher than in South Korea, New Zealand and Japan.Globally, health care spending has been increasing since the 1980s, according to the report, driven mostly by advancements in medical technologies, the rising costs of medical care and a higher demand for services.The U.S. has the highest rate of people with multiple chronic health conditions, the data showed, and the highest obesity rate among the countries studied.Life expectancy at birth in the U.S. in 2020 was 77 years -- three years less than the OECD average -- and early data suggests that U.S. life expectancy dropped even further in 2021. Since the start of the COVID-19 pandemic, more people died from coronavirus infections in the U.S. than in any other high-income country, according to the report.Deaths caused by assaults also appeared to be highest in the U.S. compared with all peer countries. The researchers found that deaths from physical assault, which includes gun violence, occurred at a rate of 7.4 deaths per 100,000 people in the U.S. in 2020, significantly higher than the OECD average of 2.7 and at least seven times higher than most other high-income countries in the report.Where the U.S. appeared to do well was in cancer prevention and treating cancers early. Along with Sweden, it had the highest number of breast cancer screenings among women ages 50 to 69, and the U.S. exceeded the OECD average when it came to screening rates for colorectal cancer.A separate paper published in mid-January said that the U.S. cancer death rate has fallen 33% since 1991, which corresponds to an estimated 3.8 million deaths averted.Overall, the new Commonwealth Fund report "continues to demonstrate the importance of international comparisons," Reginald D. Williams II, who leads The Commonwealth Fund's International Program, said in the news release. "It offers an opportunity for the U.S. to learn from other countries and build a better health care system that delivers affordable, high-quality health care for everyone."'We're not getting the best value for our health care dollar'Much of the data in the new report shows trends that have been seen before."It validates the fact that we continue to spend more than anybody else and get the worst health outcomes. So we're not getting the best value for our health care dollar," said Dr. Georges Benjamin, executive director of the American Public Health Association, who was not involved in the new report."The big takeaway for me is that COVID did not become the great equalizer . It did not help our case at all," Benjamin said. "If anything, it exposed the existing holes in our health care system."To help fix the holes in the U.S. health care system, Benjamin referenced three steps the nation can take."We're still the only nation that does not have universal health care or access for all of our citizens," Benjamin said.Second, "we don't do as much primary care prevention as the other nations, and we still have a public health system, which is fractured," he said. "The third thing is, we under-invest compared to other industrialized nations in societal things. They spend their money on providing upfront support for their citizens. We spend our money on sick care."

The report, released Tuesday, also says that compared with peer nations, the U.S. has the highest rates of deaths from avoidable or treatable causes and the highest maternal and infant death rates.

"Americans are living shorter, less healthy lives because our health system is not working as well as it could be," the report's lead author, Munira Gunja, senior researcher for The Commonwealth Fund's International Program in Health Policy and Practice Innovation, said in a news release. "To catch up with other high-income countries, the administration and Congress would have to expand access to health care, act aggressively to control costs, and invest in health equity and social services we know can lead to a healthier population."

People in the U.S. see doctors less often than those in most other countries, which is probably related to the U.S. having a below-average number of practicing physicians, according to the report, and the U.S. is the only country among those studied that doesn't have universal health coverage. In 2021 alone, 8.6% of the U.S. population was uninsured.

"Not only is the U.S. the only country we studied that does not have universal health coverage, but its health system can seem designed to discourage people from using services," researchers at the Commonwealth Fund, headquartered in New York, wrote in the report. "Affordability remains the top reason why some Americans do not sign up for health coverage, while high out-of-pocket costs lead nearly half of working-age adults to skip or delay getting needed care."

An outlier on spending and outcomes

The researchers analyzed health statistics from international sources, including the Organisation for Economic Cooperation and Development, or OECD, which tracks and reports on data from health systems across 38 high-income countries. The data was extracted in December.

The researchers examined how the United States measured against Australia, Canada, France, Germany, Japan, the Netherlands, New Zealand, Norway, South Korea, Sweden, Switzerland and the United Kingdom. They also compared the US with the OECD average for 38 high-income countries.

The data showed that in 2021 alone, the U.S. spent nearly twice as much as the average OECD country on health care -- and health spending in the U.S. was three to four times higher than in South Korea, New Zealand and Japan.

Globally, health care spending has been increasing since the 1980s, according to the report, driven mostly by advancements in medical technologies, the rising costs of medical care and a higher demand for services.

The U.S. has the highest rate of people with multiple chronic health conditions, the data showed, and the highest obesity rate among the countries studied.

Life expectancy at birth in the U.S. in 2020 was 77 years -- three years less than the OECD average -- and early data suggests that U.S. life expectancy dropped even further in 2021. Since the start of the COVID-19 pandemic, more people died from coronavirus infections in the U.S. than in any other high-income country, according to the report.

Deaths caused by assaults also appeared to be highest in the U.S. compared with all peer countries. The researchers found that deaths from physical assault, which includes gun violence, occurred at a rate of 7.4 deaths per 100,000 people in the U.S. in 2020, significantly higher than the OECD average of 2.7 and at least seven times higher than most other high-income countries in the report.

Where the U.S. appeared to do well was in cancer prevention and treating cancers early. Along with Sweden, it had the highest number of breast cancer screenings among women ages 50 to 69, and the U.S. exceeded the OECD average when it came to screening rates for colorectal cancer.

published in mid-January said that the U.S. cancer death rate has fallen 33% since 1991, which corresponds to an estimated 3.8 million deaths averted.

Overall, the new Commonwealth Fund report "continues to demonstrate the importance of international comparisons," Reginald D. Williams II, who leads The Commonwealth Fund's International Program, said in the news release. "It offers an opportunity for the U.S. to learn from other countries and build a better health care system that delivers affordable, high-quality health care for everyone."

'We're not getting the best value for our health care dollar'

Much of the data in the new report shows trends that have been seen before.

"It validates the fact that we continue to spend more than anybody else and get the worst health outcomes. So we're not getting the best value for our health care dollar," said Dr. Georges Benjamin, executive director of the , who was not involved in the new report.

"The big takeaway for me is that COVID did not become the great equalizer [among nations]. It did not help our case at all," Benjamin said. "If anything, it exposed the existing holes in our health care system."

To help fix the holes in the U.S. health care system, Benjamin referenced three steps the nation can take.

"We're still the only nation that does not have universal health care or access for all of our citizens," Benjamin said.

Second, "we don't do as much primary care prevention as the other nations, and we still have a public health system, which is fractured," he said. "The third thing is, we under-invest compared to other industrialized nations in societal things. They spend their money on providing upfront support for their citizens. We spend our money on sick care."

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