US Health System Scorecard - 2022

[Occams Barber]

US Health System Scorecard – 2022

The Commonwealth Fund is a US based health research organisation established in 1918. Its mission is to promote a high performing, equitable US health care system achieving better access, improved quality, and greater efficiency.

The Fund publishes a comparison of US healthcare compared with twelve other high-income nations – Australia, Canada, France, Germany, Japan, the Netherlands, New Zealand, Norway, South Korea, Sweden, Switzerland, and the United Kingdom – along with comparisons to OECD averages (OECD = 38 relatively developed countries).

Despite having the world’s highest health care spending, measured as a share of GDP and as dollars per capita, the US has the overall worst health care outcomes when compared with similar high-income nations.

Findings

The US spends 18% of its GDP on health care, almost double the OECD average (9.6%). The UK comes closest to the US in spending at 12% of GDP.

The US is the only high-income country without guaranteed health cover for all its citizens.

At 77 years, US life expectancy is significantly lower than comparable countries, well below the OECD average of 80.4, and Japan at 84.7 years.

Avoidable mortality refers to preventable and treatable deaths. The US has the highest rate of avoidable mortality (336 per 100,000 pop) compared to second placed Germany at 195. The OECD average is 225.

US infant (12 months & under) mortality is 5.4 per 1,000 life births making it the worst result of any comparable nation. Norway has the best result at 1.6. The OECD average is 4.1.

Maternal mortality (deaths per 1,000 live births) is 23.8 in the US; more than double the OECD average of 9,8 and well above, the second worse, New Zealand, at 13.6 deaths.

The US has the third highest suicide rate of the 13 countries at 14.1 suicides per 100,000, below Korea at 24.1 and Japan at 14.6. The OECD average is 11.1.

The US has 7.4 deaths from assault per 100,000. This is at least 7 times higher than all other comparable countries except New Zealand (1.3) and almost triple the OECD average (2.7).

Obesity in the US is the highest in the Western world at 42.8% of the population. New Zealand is next highest at 34.3% and the OECD average is 25%. Japan has an obesity rate of 4.6%.

Chronic disease burden is defined as adults diagnosed with two or more chronic conditions like asthma, lung disease, cancer, depression, mental health conditions, diabetes, heart disease or high blood pressure. 30.4% of Americans have multiple chronic conditions followed by 29% of Australians. France is the lowest in this category at 17%.

The US has the highest COVID death rate (3,253 per million) followed by the UK on 3,183. At 470 New Zealand has the lowest COVID death rate.

The US has the fourth lowest rate of physician consultations (4 per person per year) compared to 14.7 for Koreans and an OECD average of 5.7 visits per annum.

The US has one of the lowest rates of practicing physicians at 2.6 per 1,000 pop (third lowest). Compare to Norway at 5.2 and the OECD at 3.7.

US average hospital stays are the second lowest at 4.8 days. The Netherlands at 4.5 days is the lowest. OECD average is 7.3

The US ranks fifth lowest in hospital beds (2.8 per 1,000) compared to 12.7 beds in Korea and an OECD average of 4.3.

US influenza vaccination rates (68%) are above the OECD average (51.5%) and ninth highest in the group of comparable countries.

US COVID vaccinations are the third lowest (69%) and comparable to the global average (also 69%).

US breast cancer screening is the second highest in the group (77%) and well above the OECD average of 54.6%.

The US is also second highest in its rate of colorectal cancer screening (68%) and also well above the OECD average (44%).

The US sits mid-field in usage of MRI scans at 107.6 per 1000 pop. Lowest is Australia at 57; highest is Germany at 150. OECD average is 80. US MRI scans are expensive at $1,119 - 40% more than the UK and 420% more than Australia.

Hip replacement rates are indicative of the prevalence of osteoarthritis. At 15.6 per 1,000 over-65 pop the US has the second highest rate of hip replacement indicating high rates of osteoarthritis. The highest (Switzerland) is 16.4 while the OECD average is 9.4.

Summary

U.S. Health Care from a Global Perspective, 2022 | Commonwealth Fund
NEW INTERNATIONAL STUDY: U.S. Health System Ranks Last Among 11 Countries; Many Americans Struggle to Afford Care as Income Inequality Widens | Commonwealth Fund
OB

 

[ThatRobGuy]

I think these findings highlight a couple of points worth noting.

1) the incredible bureaucracy and amount of administrative red tape that comes a long with a privatized system. Most people are under the misapprehension that leaving something to the private sector is a way to reduce red-tape and administrative overhead, I think this shows that's not always the case.

2) you can't outspend a poor diet. Despite spending a ton of money (a large portion of which goes towards managing chronic conditions), and despite the fact that disease screening rates are actually higher here than in other places, we still have a huge percentage of people ending up with preventable chronic conditions. Obesity is upstream of many of the diseases that end up plaguing people. And as the saying goes, "that's not a decision between you and your doctor, that's a decision between you and the waitress"

3) the vast amount of people being content with relying on pharmaceutical interventions instead of making lifestyle changes. (which has given that particular industry a lot of leverage and profit, which they've in-turn used to lobby for policies that make them even more money while making things more expensive for everyone). One statistic that I didn't see on this report is that comprise 5% of the world's population, but take 75% of the world's prescription drugs...and 66% of Americans are on one or more prescription maintenance drugs for chronic conditions. Part of that is likely due to the fact that we're one of the few countries that allows "direct-to-consumer" advertising for prescription drugs.

It's going to be difficult for any healthcare system to succeed or be viable (public or private) if people aren't willing to participate in their own health at least a little bit and are being inundated with ads for "try this drug for your hypertension and you'll be at a fun pool party like these people in the commercial"

Despite being somewhat opposed to single-payer or public healthcare models some years back, I've adjusted my position on it somewhat over the years and see the pros as outweighing the cons...with the disclaimer that in order for us to be able to do it successfully, we're going to need people to start making some lifestyle changes. For all its benefits, I don't think there's any single-payer system structure that could reasonably (in terms of cost) accommodate our current obesity rates and our nation's tendency to reach for a pill bottle because it's "easier" than reaching for vegetables.

 

[comana]

I think these findings highlight a couple of points worth noting.

1) the incredible bureaucracy and amount of administrative red tape that comes a long with a privatized system. Most people are under the misapprehension that leaving something to the private sector is a way to reduce red-tape and administrative overhead, I think this shows that's not always the case.

2) you can't outspend a poor diet. Despite spending a ton of money (a large portion of which goes towards managing chronic conditions), and despite the fact that disease screening rates are actually higher here than in other places, we still have a huge percentage of people ending up with preventable chronic conditions. Obesity is upstream of many of the diseases that end up plaguing people. And as the saying goes, "that's not a decision between you and your doctor, that's a decision between you and the waitress"

3) the vast amount of people being content with relying on pharmaceutical interventions instead of making lifestyle changes. (which has given that particular industry a lot of leverage and profit, which they've in-turn used to lobby for policies that make them even more money while making things more expensive for everyone). One statistic that I didn't see on this report is that comprise 5% of the world's population, but take 75% of the world's prescription drugs...and 66% of Americans are on one or more prescription maintenance drugs for chronic conditions. Part of that is likely due to the fact that we're one of the few countries that allows "direct-to-consumer" advertising for prescription drugs.

It's going to be difficult for any healthcare system to succeed or be viable (public or private) if people aren't willing to participate in their own health at least a little bit and are being inundated with ads for "try this drug for your hypertension and you'll be at a fun pool party like these people in the commercial"

Despite being somewhat opposed to single-payer or public healthcare models some years back, I've adjusted my position on it somewhat over the years and see the pros as outweighing the cons...with the disclaimer that in order for us to be able to do it successfully, we're going to need people to start making some lifestyle changes. For all its benefits, I don't think there's any single-payer system structure that could reasonably (in terms of cost) accommodate our current obesity rates and our nation's tendency to reach for a pill bottle because it's "easier" than reaching for vegetables.

I completely agree with the obesity disease link and people need to want to change their behaviors. It’s an uphill battle against marketing of garbage foods and pharmaceutical marketing. Pharma is marketing a lifestyle of “managing “ our largely preventable/reversible diseases so why put in any effort. I would love to see pharma commercials banned.

 

[wing2000]

3) the vast amount of people being content with relying on pharmaceutical interventions instead of making lifestyle changes. (which has given that particular industry a lot of leverage and profit, which they've in-turn used to lobby for policies that make them even more money while making things more expensive for everyone). One statistic that I didn't see on this report is that comprise 5% of the world's population, but take 75% of the world's prescription drugs...and 66% of Americans are on one or more prescription maintenance drugs for chronic conditions. Part of that is likely due to the fact that we're one of the few countries that allows "direct-to-consumer" advertising for prescription drugs.

IMO, pharmaceutical advertising to the public should be banned.

 

[Larniavc]

The for profit motive that is part of the American milieu is a big part of the problem, I think. Being able to imagine doing something without a profit motive seems beyond America.

 

[ThatRobGuy]

I completely agree with the obesity disease link and people need to want to change their behaviors. It’s an uphill battle against marketing of garbage foods and pharmaceutical marketing. Pharma is marketing a lifestyle of “managing “ our largely preventable/reversible diseases so why put in any effort. I would love to see pharma commercials banned.

While the marketing of garbage foods is a factor, I see the marketing of drugs as the bigger fish to fry.

The reason I say that is because people know which foods are healthy and which ones aren't...as to where, people in general (obviously there's a few exceptions) don't necessarily have the same acumen with regards to prescription drugs and what they do/don't do.

If I showed people two plates (one with 4 slices of pizza and fries, and the other with a 5oz salmon and green beans), I'm pretty confident that 99% of adults could accurately identify which one's the good one and which one's bad. So when a Pizza Hut ad comes on, they know it's an unhealthy thing being marketed to them, they're just opting to give into the temptation.

The same wouldn't be true for prescription drugs. Most aren't going to have the slightest clue of what they do or how they work. Which is why the Rx ads say "ask your doctor about", while the McDonald's ads don't say "ask your nutritionist about"

 

[Fantine]

Poor people are often overweight because fresh vegetables and fruit and meat and fish are expensive.
Ramen noodles and Mac and cheese are cheap and fattening.

 

[Landon Caeli]

Poor people are often overweight because fresh vegetables and fruit and meat and fish are expensive.
Ramen noodles and Mac and cheese are cheap and fattening.

A head of lettuce is only about 95 cents, and with a few boiled eggs and some croutons it makes a bomb snack!

 

[USincognito]

Poor people are often overweight because fresh vegetables and fruit and meat and fish are expensive.
Ramen noodles and Mac and cheese are cheap and fattening.

A head of lettuce is only about 95 cents, and with a few boiled eggs and some croutons it makes a bomb snack!

Then how about cheap, fattening and tasty.

 

[USincognito]

2) you can't outspend a poor diet. Despite spending a ton of money (a large portion of which goes towards managing chronic conditions), and despite the fact that disease screening rates are actually higher here than in other places, we still have a huge percentage of people ending up with preventable chronic conditions. Obesity is upstream of many of the diseases that end up plaguing people. And as the saying goes, "that's not a decision between you and your doctor, that's a decision between you and the waitress"

It's not obesity per se, but the root causes of it which is too much sugar and saturated fats. Those are what lead to type II diabetes and numerous heart related issues. There's also the huge sodium intake which caused hypertension.

I started becoming more aware of product labeling after I was diagnosed with high blood pressure. A couple years after that I was slightly over on my LDL and became even more cognizant of what I was eating. Ironically between overall healthy eating and exercise plus my BP medication, I don't worry about salt as much.

 

[Landon Caeli]

Then how about cheap, fattening and tasty.

Most people lack a sense of self-awareness. They aren't observant of themselves enough to realize that you actually *feel* better after eating good food. They just don't conceptualize the relationship between eating junk and then feeling bad all the time.

 

[CRAZY_CAT_WOMAN]

A head of lettuce is only about 95 cents, and with a few boiled eggs and some croutons it makes a bomb snack!

Actually, lettuce is over a dollar, where I live. And Top Ramen noodles is about 50 cents. Eggs were $8 for 18 extra-large eggs. People seem to go easy and cheaper.

 

[CRAZY_CAT_WOMAN]

Michelle Obama tried to improve children and people's health. And some people in American didn't like it. To be honest, some groups in American fight for the rights for kids/adults to be un health. And not have decent insurance. Let's not forget the bad example some people were setting when COVID-19 was at it worst. Not wearing a mask, social distance. And fighting for their rights to not wear mask and infect who ever. Some American people don't care about people or improving health education. And other things.

 

[ThatRobGuy]

Poor people are often overweight because fresh vegetables and fruit and meat and fish are expensive.
Ramen noodles and Mac and cheese are cheap and fattening.

I know that's a common talking point with regards to obesity and poverty.

However, I don't know if that aspect is as sweeping as people seem to think it is.

We have a very stark regional component to obesity in this country.

There's a distinct food culture in the south (anyone who has lived down there, or has family down there like I do, knows what I'm talking about)

When you're down there, people (poor, middle-class, and rich) all seem to have "larger than average" waistlines.

There was a tongue-in-cheek joke that "In the South, Baptist is the 2nd most popular religion right behind fried food"

In many cases, some of the staple foods could actually have the potential to be somewhat healthy (or at the very least, not as fattening) if not for the preparation method of dipping everything in lard or oil and deep frying it.

The side of the family that lives down there isn't poor, they've got a decent house and money...but when you go there for a family get together, it's reminiscent of the Klump's dinner table seen in the Nutty Professor movies. Just piles of fried chicken, every vegetable is either fried, cooked in bacon, or swimming in gravy, and consumed with 2-3 buttery biscuits per person.

And despite a 24pk of bottled water being cheaper, they always have some form of soda with with it.

 

[comana]

I know that's a common talking point with regards to obesity and poverty.

However, I don't know if that aspect is as sweeping as people seem to think it is.

We have a very stark regional component to obesity in this country.

View attachment 331106

There's a distinct food culture in the south (anyone who has lived down there, or has family down there like I do, knows what I'm talking about)

When you're down there, people (poor, middle-class, and rich) all seem to have "larger than average" waistlines.

There was a tongue-in-cheek joke that "In the South, Baptist is the 2nd most popular religion right behind fried food"

In many cases, some of the staple foods could actually have the potential to be somewhat healthy (or at the very least, not as fattening) if not for the preparation method of dipping everything in lard or oil and deep frying it.

The side of the family that lives down there isn't poor, they've got a decent house and money...but when you go there for a family get together, it's reminiscent of the Klump's dinner table seen in the Nutty Professor movies.

From that graphic it seems the entire country needs to take a close look at what is going on in CO And take notes.

 

[Whyayeman]

So the people to blame are - the people!

Americans get a poor deal for their money when it comes to health care. It is by far the most expensive in the world while far from being the best. Maybe the system is wrong.

 

[Occams Barber]

While the entire report was a bit of an eye opener, the data I found most shocking was the huge rate of maternal mortality and (sadly) infant mortality (infants are defined as children under one year old).

US infant (12 months & under) mortality is 5.4 per 1,000 life births making it the worst result of any comparable nation. Norway has the best result at 1.6. The OECD average is 4.1.

Maternal mortality (deaths per 1,000 live births) is 23.8 in the US; more than double the OECD average of 9,8 and well above, the second worse, New Zealand, at 13.6 deaths.

OB

 

[ThatRobGuy]

From that graphic it seems the entire country needs to take a close look at what is going on in CO And take notes.

Colorado is the 2nd slimmest state in US

In addition to the nation’s lowest rates of heart disease and diabetes, Colorado also has the second-lowest obesity levels among U.S. states.

kdvr.com

There's actually some interesting aspects of Colorado.

In that, income, racial, and age demographics seem to be thinner than their counterparts in other states.
(meaning, if you're a poor Hispanic 22 year old there, you're less likely to be obese than someone with the same profile living in TX or OK)

So it would be interesting to see what they're doing differently.

Slate had a theory that's worth considering

It's that, much like there's a culture of "big deep fried meals" in the South, Colorado has an active outdoor culture, in that their climate is conducive to an "outdoorsy" lifestyle of hiking, skiing, biking, etc...

If you're spending a lot of time doing calorie-burning outdoorsy activities, you have a little more wiggle room with regards to what you can eat and still stay at a healthy body weight.

If you have a state where people want to flock to it specifically because it's a great place to do those kinds of activities, you're more likely to end up with a healthier state overall.

While I do think there's an obesity-poverty link, I don't think that link accounts for all (or even most) of the problem. You look at states like California and New York, there's poor people living there...they're not as overweight as their poor counterparts living in the previously mentioned deep south states...and it's not as if CA and NY have a shortage of places to eat that offer calorie dense options. I consumed a lot of calories the last time I was in NYC lol...it's a gauntlet of amazing pizza places.


I think one potential challenge facing more rural states is that there's fewer opportunities for people to have a "walking city". For instance, in NYC and LA, you don't need a car...in fact, that's one of the few perks of living in those cities. You can be within walking distance of a lot of things and that's a way to save a lot of $$$ by not having to worry about a car payment...as to where living in a more rural state, it doesn't make sense to walk 8 miles to go get food from the nearest store.

 

[Occams Barber]

Colorado is the 2nd slimmest state in US

In addition to the nation’s lowest rates of heart disease and diabetes, Colorado also has the second-lowest obesity levels among U.S. states.

kdvr.com

There's actually some interesting aspects of Colorado.

In that, income, racial, and age demographics seem to be thinner than their counterparts in other states.
(meaning, if you're a poor Hispanic 22 year old there, you're less likely to be obese than someone with the same profile living in TX or OK)

So it would be interesting to see what they're doing differently.

Slate had a theory that's worth considering

It's that, much like there's a culture of "big deep fried meals" in the South, Colorado has an active outdoor culture, in that their climate is conducive to an "outdoorsy" lifestyle of hiking, skiing, biking, etc...

If you're spending a lot of time doing calorie-burning outdoorsy activities, you have a little more wiggle room with regards to what you can eat and still stay at a healthy body weight.

If you have a state where people want to flock to it specifically because it's a great place to do those kinds of activities, you're more likely to end up with a healthier state overall.

While I do think there's an obesity-poverty link, I don't think that link accounts for all (or even most) of the problem. You look at states like California and New York, there's poor people living there...they're not as overweight as their poor counterparts living in the previously mentioned deep south states...and it's not as if CA and NY have a shortage of places to eat that offer calorie dense options. I consumed a lot of calories the last time I was in NYC lol...it's a gauntlet of amazing pizza places.


I think one potential challenge facing more rural states is that there's fewer opportunities for people to have a "walking city". For instance, in NYC and LA, you don't need a car...in fact, that's one of the few perks of living in those cities. You can be within walking distance of a lot of things and that's a way to save a lot of $$$ by not having to worry about a car payment...as to where living in a more rural state, it doesn't make sense to walk 8 miles to go get food from the nearest store.

The Fund also does a state-by-state health system analysis.

While the current version has a COVID focus, it does cover the generic health issues and scores for individual states.

2022 Scorecard on State Health System Performance

The 2022 Scorecard on State Health System Performance identifies a range of health care system deficiencies, and how they have been exacerbated by the pandemic.

www.commonwealthfund.org

OB

 

[Whyayeman]

American government (and mine) needs to get a grip on the processed food industries. They are killing us.

I have just read that 60% of the British diet is ultra-processed. It is true that we should all be paying much more attention to what we put in our bodies. Our representatives in the legislatures should be on our side in this. Instead they are nicely tucked up under the duvet with Big Food.