Why the U.S. Spends So Much More Than Other Nations on Health Care

From today’s New York Times:

The United States spends almost twice as much on health care, as a percentage of its economy, as other advanced industrialized countries — totaling $3.3 trillion, or 17.9 percent of gross domestic product in 2016.

But a few decades ago American health care spending was much closer to that of peer nations.

What happened?

A large part of the answer can be found in the title of a 2003 paper in Health Affairs by the Princeton University health economist Uwe Reinhardt: “It’s the prices, stupid.

The study, also written by Gerard Anderson, Peter Hussey and Varduhi Petrosyan, found that people in the United States typically use about the same amount of health care as people in other wealthy countries do, but pay a lot more for it.

Ashish Jha, a physician with the Harvard T.H. Chan School of Public Health and the director of the Harvard Global Health Institute, studies how health systems from various countries compare in terms of prices and health care use. “What was true in 2003 remains so today,” he said. “The U.S. just isn’t that different from other developed countries in how much health care we use. It is very different in how much we pay for it.”

A recent study in JAMA by scholars from the Institute for Health Metrics and Evaluation in Seattle and the U.C.L.A. David Geffen School of Medicine also points to prices as a likely culprit. Their study spanned 1996 to 2013 and analyzed U.S. personal health spending by the size of the population; its age; and the amount of disease present in it.

They also examined how much health care we use in terms of such things as doctor visits, days in the hospital and prescriptions. They looked at what happens during those visits and hospital stays (called care intensity), combined with the price of that care.

The researchers looked at the breakdown for 155 different health conditions separately. Since their data included only personal health care spending, it did not account for spending in the health sector not directly attributed to care of patients, like hospital construction and administrative costs connected to running Medicaid and Medicare.

Over all, the researchers found that American personal health spending grew by about $930 billion between 1996 and 2013, from $1.2 trillion to $2.1 trillion (amounts adjusted for inflation). This was a huge increase, far outpacing overall economic growth. The health sector grew at a 4 percent annual rate, while the overall economy grew at a 2.4 percent rate.

You’d expect some growth in health care spending over this span from the increase in population size and the aging of the population. But that explains less than half of the spending growth. After accounting for those kinds of demographic factors, which we can do very little about, health spending still grew by about $574 billion from 1996 to 2013.

Did the increasing sickness in the American population explain much of the rest of the growth in spending? Nope. Measured by how much we spend, we’ve actually gotten a bit healthier. Change in health status was associated with a decrease in health spending — 2.4 percent — not an increase. A great deal of this decrease can be attributed to factors related to cardiovascular diseases, which were associated with about a 20 percent reduction in spending.

Read the complete article here.

Health Secretary Resigns After Drawing Fire for Expensive Chartered Flights

From today’s New York Times by Peter Baker:

Tom Price, the health and human services secretary, resigned under pressure on Friday after racking up at least $400,000 in travel bills for chartered flights and undermining President Trump’s promise to drain the swamp of a corrupt and entitled capital.

Already in trouble with Mr. Trump for months of unsuccessful efforts to repeal and replace President Barack Obama’s health care program, Mr. Price failed to defuse the president’s anger over his high-priced travel by agreeing to pay a portion of the cost and expressing “regret” for his actions.

“I’m not happy, O.K.?” Mr. Trump told reporters as he was about to head to his New Jersey golf club for the weekend, barely an hour before the resignation was announced. “I can tell you, I’m not happy.” He called Mr. Price “a very good man” but added that the secretary’s offer to reimburse the government for just part of the cost of the flights “would be unacceptable.”

The White House announcement of Mr. Price’s departure was spare, with none of the customary praise of his work or thanks for his service. The statement issued by the White House press secretary, Sarah Huckabee Sanders, said simply that Mr. Price had “offered his resignation earlier today and the president accepted.”

Mr. Trump tapped Don J. Wright, a deputy assistant secretary for health and the director of the Office of Disease Prevention and Health Promotion, to serve as acting secretary. Possible candidates for a successor include Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, and Scott Gottlieb, the commissioner of the Food and Drug Administration.

Read the complete article here.