Take a long enough lens, say, 25 years – and it seems that health care in America is undeniably improving.
People are living longer than a quarter of a century ago. The burden of disease, a metric that includes premature deaths and disability, has decreased. The number of avoidable hospitalizations and hospital errors is lower.
But beneath those rosy numbers is the truth: American healthcare has lagged other countries in the developed world for decades.
Life expectancy has increased, but less in the United States than in the wealthy nations of Europe and Asia. Also, the improvement in disease burden has been less impressive than in comparable countries. Meanwhile, to achieve those mediocre results, the United States continues to spend more money on health care than any other country in the world; While health spending in the US is not increasing faster than in other countries, it was higher at first and continues to rise. We have maintained a considerable advantage in health care spending while underperforming countries that spend the least.
And all of that was true even before the United States experienced one of the worst Covid-19 outbreaks in the world.
Kaiser Family Foundation researchers recently warned of a “further widening of the gap” between the United States and other countries as a result of the pandemic. Life expectancy in the US had already stagnated in recent years, driven by an increase in drug overdoses and suicides; now Covid-19 will shorten it even more. The disease burden had been trending upward in the US while declining elsewhere; The Covid-19 pandemic is likely to widen that disparity as well.
You could say that the trajectory of American healthcare before, during, and after the pandemic is like that of a vulnerable individual patient: He was sicker to begin with, was hit hard by Covid-19, and will deal with lingering effects. over a period of time. long time.
The United States was already lagging behind the rest of the world in health care.
When it comes to getting value for money in healthcare, the United States has slowly but noticeably lagged behind other developed countries for the past 25 years.
It starts with life expectancy, the strongest measure of how well your healthcare system serves people. Life expectancy in the developed world has steadily improved over the past decades, driven primarily by major advances in the treatment of heart disease and other cardiovascular problems. , which are among the first among the causes of death in rich nations.
But not so much in the United States as in other countries. According to a KFF analysis of healthcare trends from 1991 to 2016Americans saw their life expectancy increase by 3.1 years during that period, a significant improvement, no doubt, but substantially less than the 5.2 years gained in comparable countries.
And in America specifically, that progress has stalled in recent years. With tens of thousands of people dying from opioid overdoses each year and a sustained increase in the number of suicides, American life expectancy actually began to decline in 2014, according to a 2019 analysis published in JAMA. The gap between the US and other rich countries was already growing before Covid-19 hit.
In addition, the burden of disease had steadily improved until a recent recession separated the US from other countries. The reasons for the improvement were the same: better medical treatment for chronic diseases. But once again America did not improve to the extent that comparable countries did, with an improvement of 12 percent versus 22 percent elsewhere. In the United States, the burden of heart, lung, kidney, and liver disease, as well as diabetes, remains stubbornly high compared to the rest of the developed world.
And the reasons for America’s recent stagnation are the same, too: Suicides and drug overdoses, plus an increase in the number of young people with chronic illnesses, are robbing people of years of healthy life.
The same pattern applies to medical errors. They have been declining in the US for the past 25 years, but are still more common in the US than in the countries it is being compared to. Avoidable hospitalizations and adverse drug events have decreased, but not as much as in wealthy nations in Europe or Asia. Americans are roughly twice as likely to experience an error in their healthcare as their counterparts around the world.
A metric, known as mortality susceptible to health care – combines all these characteristics and rates a country’s health system according to its performance in preventing deaths from conditions that should be treatable with timely access to medical care. The United States ranked behind the largest countries in Europe, as well as Japan, as of 2016.
A country like Taiwan, which performed much worse than the United States on the same metric 30 years ago, is now about the same.
And for those intermediate results, the US. spend more on health care than other countries: 18 percent of their GDP versus 11 percent in comparable nations. Health spending has risen at the same rate in the US and its peers over the past few decades, and yet those other countries have seen more improvements in their health outcomes.
In other words, they are getting more value from their healthcare systems than the United States.
“One could conclude that the improvement in the value of comparable countries was greater,” KFF researchers wrote in 2018, “even though they started with a higher threshold in terms of better results and a lower percentage of GDP consumed to achieve this. . “
One possible explanation for America’s poor performance: We don’t invest enough in social spending and overspend on healthcare compared to other developed countries. If you combine spending on social services and spending on health, the US and its peers actually spend roughly the same amount of money – just over 30 percent of its GDP. But spending in those other countries is more skewed toward social services, while the United States spends more on health care.
America’s underinvestment exacerbates the disparities between the haves and the have-nots: 18 percent of Americans live in poverty versus 10 percent in other rich countries. We know that lower-income people have structural challenges – access to healthy food, clean water, and fresh air to begin with – that lead to worse health outcomes. When they get sick, it is harder for them to find a doctor and pay for their medical care.
“Economic inequality is increasingly linked to disparities in life expectancy in income distribution, and these disparities appear to be increasing over time,” wrote the authors of a 2018 review of relevant research on Health matters. Poor health also tends to lead to lower incomes, creating a feedback loop known as the “health-poverty trap.”
And those disparities, between rich and poor, black and white, only worsened during the Covid-19 pandemic.
Covid-19 will have long-term consequences for American health
The gap between the United States and other wealthy nations is expected to grow due to the pandemic. The United States has lost more than 600,000 people to Covid-19, the highest confirmed death toll in the world. Adjusting for population, The United States has lost more people per capita than most European and Asian countries to which it is compared.
Official death counts can be somewhat arbitrary because they rely on evidence to identify cases. Experts consider excess deaths, the number of deaths from all causes above what would be expected in a normal year, to be a more reliable indicator. Also on that metric, and adjusting for population, the United States is one of the worst performing countries among the rich nations.
“The colossal effect of the pandemic on the US will likely widen the existing gap in death rates between the US and other countries,” wrote the authors of an October 2020 analysis of Covid-19 death rates and life expectancy.
The United States is also likely to experience a higher burden of disease (that is, years of quality of life lost to premature death and disability) as a result of its pandemic failures. People under 65 in the US have died from Covid-19 at higher rates than their peers elsewhere.
A prolonged mental health crisis can linger after a year of interrupted social life and isolation. More than 4 in 10 Americans reported experiencing symptoms of anxiety or depression in 2020, according to US Census Surveys.
Health spending actually slowed in 2020, a historic aberration, as people put off health care during the pandemic. But medical spending didn’t slow down as much as the rest of the economy: In October 2020, it had fallen 0.5 percent versus an overall contraction of 1.8 percent. So even when spending fell, health care probably consumed an even larger share of America’s GDP than in previous years.
And falling short-term spending could have long-term consequences. Last year, 24 percent of Americans said in a census survey who did not receive necessary medical care during the pandemic, and 33 percent said they delayed care. To give an example, cervical cancer screenings fallen about 80 percent of normal levels in spring 2020, and although they recovered later in the year, they were still 25 percent below at the end of September.
While overall patient volume has rebounded, we still don’t know what the long-term effects will be for people not receiving medical care or receiving late diagnoses. And there are tens of millions of people who are recovering from a Covid-19 infection; up to 15 million of them may have problems with the “long Covid” in the foreseeable future, according to a new analysis in the New England Journal of Medicine That called the long Covid-19 “our next public health disaster in the making.” Those direct health aftershocks of the pandemic will be a further burden on the US healthcare system long after the coronavirus begins to wane.
Long-term spending trends were already prompting health plans to impose more of the cost of healthcare on patients. Deductibles and worker premiums have been increasing for years.
After Covid-19, at least as a relative part of the economy, healthcare is consuming even more of the country’s resources. America’s health outcomes have been affected by the pandemic and the spending crisis is intensifying.