single payer health care: America already
Health costs How U S Compares with other countries.
How much is good health worth to you how s 8233 year U S expenditure per person.
This figure is more than two and a half times more than most developed countries in the world, including the relatively rich European countries like France, Sweden and the UK On a global scale, this means that the costs health care in the United States now eat 17 June percent of GDP.
A significant portion of Americans, some politicians of high rank, the cost may be regrettable, but the U S has the best health care in the world.
But let us consider that 17 cents of every dollar is buying US According to the latest report from the Organization for Economic Co-operation and Development OECD international economic group composed of 34 member countries, it is not as much as many Americans expect.
There are fewer doctors per person than in most other OECD countries in 2010, for example, U S had 4 February practicing physicians per 1000 people well below below the OECD average of 3 1 Place.
The number of hospital beds in the U S was 2 6 1 000 inhabitants in 2009, below the OECD average of 3 beds 4.
Life expectancy at birth has increased almost nine years between 1960 and 2010, but is lower than the increase of more than 15 years in Japan and 11 years on average in OECD countries The American lives on average 78 seven years in 2010, more than a year below the average of 79 for 8 years.
It's hand to be sure that the United States leads the world in search of health care and treatment of cancer, for example, the survival rate at five years for breast cancer is higher in the US than in other OECD countries and the survival of colorectal cancer is also among the best, according to the group.
This week on the show NewsHour PBS correspondent Betty Ann Bowser health explore the unusual approach of a hospital system to improve performance while reducing the costs of a model based on the assembly line Toyota to manufacture cars the concept is quite simple if the waste is plucked off the assembly line process, the result will be better cars or health outcomes in this case and lower costs at Virginia Mason Medical Center in Seattle , officials have decided that the hospital waste can look like anything from unnecessary tests to develop the waiting rooms in poorly designed floor plans Tune in for the full report.
Meanwhile, for a more detailed update on where the U S differs from its peers in the world, we spoke to Mark Pearson, head of the Policy Division of the OECD health.
Let's start NewsHour widely Where U healthcare spending S stand relative to other OECD countries.
Pearson is measured against its population or economy of the United States as far away from happening in the world of health care.
The United States spent 8233 on health per person in 2010, Norway, the Netherlands and Switzerland are following the most extravagant, but in the same year, they all spent at least 3 000 less per person average spending on health care among the 33 other developed OECD countries was 3268 per person.
The United States is a very rich country, but still, he devotes much of its economy on June 17 percent of GDP in 2010 to health than any other country in the Netherlands is the next highest at 12 percent of GDP, and the average of OECD countries was almost half that of the US at 9 5 percent of GDP.
NewsHour What are Japan and France making, for example, to reduce costs.
Pearson France and Japan show that it is possible to control costs at the same time as paying doctors using tools similar to those used in the U S There are three important things that stand out when you compare these countries to the U S.
They use a common fee schedule so that hospitals, doctors and health services are paid similar rates for most patients they see in the United States how a health care service is paid depends on the type insurance a patient This means that health care services can select patients who have an insurance policy that pays more generous than other patients with lower-paid insurance, such as Medicaid.
They are flexible to respond if they believe that some costs exceed what they budgeted In Japan, if spending in a specific area seems to grow more rapidly than expected, they lower costs for the same region, in France an organization called CNMATS monitors close expenditure across all kinds of services and if they see a particular area is growing faster than expected or deemed in the public interest, they can intervene by lowering the price of this service, these countries also complement the lowering costs with other tools, for example, they monitor how many generic drugs a doctor prescribes and can send someone from the insurance fund to visit doctors' offices to encourage them to use cheaper generic drugs, possibly in comparison, the US payment rates are much less flexible they are often the law and assured nce Medicare can not change the rates without approval by Congress This makes it very rigid system for cost control.
There are few methods to control the rising costs of private insurance in the United States in the management of their company, private insurers are constantly faced a choice between asking health care providers to contain costs or pass higher costs to patients higher premiums Many of them find it difficult to do the first.
NewsHour there particular areas of care where U S passes more What are the successful models from other countries use to reduce costs in these areas.
Pearson spending on almost all areas of health care is higher in the US than in other countries, for example, almost 900 per person per year goes on administrative costs This is much higher than, say, France, which spends 300 per person, but also a system in which health care services are reimbursed in a manner similar to the U S.
In part, higher costs are also because the United States has been slow to embrace the benefits of information and communication in improving the administration of its system and reducing waste in Sweden, for example all prescription drugs is an electronic message is sent directly to the doctor's office to the pharmacy Not only does this cut down on medical errors, it is also thought to save 1-2 hours by pharmacists per day.
NewsHour For hospital care in particular, how much more U S consecrate we know why it is more What can learn the U S of the other OECD countries in this area.
Pearson A large amount of higher overall hospital spending in the US can be explained by the settlement services of the costs in US hospitals rather than because US hospitals deliver more services when we look through a wide range of hospital services to both medical and surgical, the average price the United States is 85 percent higher than the average in other OECD countries to put this in perspective, a hospital stay in the United States costs more than 18 000 on average, countries that are closest to spend so much in Canada, the Netherlands, Japan spend between 4000 and 6000 less per stay in all OECD countries, the average cost of a hospital stay is about one third that of the United States in 6200.
As we have already said, many OECD countries use strong regulation to set prices that hospitals can charge for different services, and some of them, even the budgets set for how hospitals many can pass the quality of care in hospitals in these countries is comparable to that in the United States and the universities are still able to attract the best students to medicine.
If a strict price control is not a path that the US wishes to follow an interesting example that the United States could learn from is Switzerland, where the national government provides a ranking of hospital services from high to groups cost insurers and hospitals across different regions then use the classification of the national government to negotiate what prices they have to pay at all levels.
This approach still leaves room for price differences between regions and States, but it could help smooth out some of the big differences you see in the prices paid for the same services in the same hospital, the patient is on Medicare, Medicaid or their health insurer.
NewsHour What specific procedures Why the cost of a hip replacement in the U S double what it costs in Germany, for example.
Pearson The table below gives some examples of prices of certain common procedures in the United States compared to some of the countries with the best quality health systems in the world that He shows.
A coronary bypasses between costs nearly 50 percent more than in Canada, Australia and France, and are double the price in Germany.
Hip and knee replacements are generally cheaper in other countries that the U S.
PTCA coronary angioplasty are much more expensive in the US than elsewhere.
It is difficult to precisely unravel why prices are higher in the United States, but two things are apparent US doctors receive a higher income than in the other countries and the United States uses more expensive diagnostic procedures More generally with so many different types of insurance, no organization has a strong incentive to reduce wasteful practices and to ensure that all Americans get the value for the very high levels of expenditure when they are sick.
NewsHour The American system is known for more tests and treatment, while CT and MRI, knee replacement to bypass surgery How serious is the more test and why are there occurs mechanisms in place to prevent this in other OECD countries.
Our data suggest that the US does more testing than other OECD countries, the United States has 100 MRIs and CT tests 265 to 1,000 people in 2010, more than twice the average of other OECD countries tonsillectomy He does more and more knee replacements than any other OECD It also has more caesarean sections and coronary bypass procedures as in most other countries.
These procedures and the use of expensive diagnostic tests are all subject to the doctor's opinion if they are desirable or not the fact that American doctors decide that more procedures and tests are desirable compared to their peers of other countries could be due to several different things, such as.
A fear of litigation which sees doctors test for everything so they can not be accused of not having covered all the bases.
Payments that mean that doctors are paid more if they do more interventions, regardless of medical necessity.
Because patients require more tests and services It is comforting often feel that medical problems are diagnosed and treated, regardless of whether they are medically necessary Because these services are often paid by insurance policies, the immediate cost of additional treatment for a patient is often absent or very low.
It is often argued that the differences in the tests may reflect differences in patient needs and between countries, however, looking at the Dartmouth Institute documented that there are large variations in medical practice in different regions to States STATES that can not be explained by differences in population structure or differences in disease They found that bypass surgery rate was five times higher in some regions reference hospitals in the United States than in others between 2003 and 2007 as well, the regional variations of hip replacement and knee replacement are substantial, the rate of four to five times higher in some regions compared to others in 2005-06.
Some OECD countries have seen their medical profession and those responsible for health policy to develop clinical guidelines to promote a more rational use of MRI and CT in the UK since the creation of the Advisory Committee for diagnosis National Institute of health and clinical excellence NICE, a number of guidelines have been issued on the appropriate use of MRI and CT for different purposes.
NewsHour U S do less than other countries in some cases.
Pearson It is likely that this happens in some cases, the United States fewer doctors and fewer visits to doctors in relation to its population The United States also fewer hospital beds to population size and stays on average shorter hospital compared to other countries because the lower numbers of doctors may help explain why they are more expensive; there is less competition for patients.
Having fewer hospital beds and shorter hospital stays can also be a good sign that the excessive use of hospitals waste is avoided in the American system of health insurance in the United States has long pioneered how hospitals are paid, providing a fixed amount for a patient with a particular condition This means that hospitals are encouraged to treat as soon as possible patients and it also shows how a broader reform in the United States could have significant effects the costs.
NewsHour Where's the U S get value for their health care money.
Pearson If the insured, the waiting time for patients U are among the lowest of OECD countries are relatively fewer patients only 20 percent wait more than four weeks for an appointment or more specialist four months for elective surgery 7 percent.
U S patients also have better results OECD Health shows that cancer survival rate at five years for breast cancer is higher in the U S than in other OECD countries 89 3 percent compared to OECD average of 83 5 between 2004 and 2009; the survival of colorectal cancer is among the top 64 5 per cent relative to the OECD average of 59 percent 9, 2004-09.
Most obviously, the United States leads the world in search of health care and the approval process relatively shorter drugs the FDA, this means that advanced drugs and treatments are available more quickly the American patients than anywhere else the average time of the first global launch of a new drug to be used is 1 3 years in the US the lowest of all OECD countries the United States is also trialing over new procedures and salaries, the National Institutes of Health currently recording 119.469 ongoing clinical trials in the US widely than any other OECD country.
The United States also opened the way for safer hospitals and quality of health care, with programs such as the Institute for Healthcare Improvement's 100,000 Lives Campaign trigger major cultural changes in several thousand hospitals clinical institutions that signed innovative centers like Johns Hopkins and Mayo clinic that provide laboratory research and clinical practice together have greatly benefited patients.
The size and diversity of the American system has also provided room for more experimentation to try to find better ways to provide examples of health care the world looks at present include accounting care organizations, which seeking to better manage risk sharing by giving providers flexibility to coordinate and provide health care while holding them responsible for the costs and results and the model medical Home, which aims to coordinate care and better involve patients and families with health coaches, care transition paths and other interventions to reduce costly readmissions Unfortunately, while the United States is better to try these innovations on a relatively small scale, then beats deploy successful innovations at national level.
NewsHour there particular areas U S hurts relative to other OECD countries.
Overall, the life expectancy of a US citizen, to 78 two years shorter than the average of OECD countries 79 5 years and there are a number of specific areas where US health care is low compared to other countries.
The United States needs stronger policies in the fight against lifestyles that lead to poor health While many states are making efforts to reduce smoking, there are fewer policies against the harmful use of alcohol in the United States you would find in other OECD countries, such as higher alcohol taxes or minimum prices.
The United States could certainly do a lot more on obesity is a big risk factor ill health in the United States more than you find in other OECD countries for adult overweight and obesity rates are the highest in the OECD, and continued to grow, even in the last two years, while they have almost stabilized in some other OECD countries, such as England, France and Italy children of overweight and obesity rates are also very high, but they have been relatively stable over the past 10 years, the slides below show that the United States does poorly both in terms of diet and physical activity, even in comparison with other countries with high obesity in all age groups.
The first lady of the movement Let campaign is great, but it can not do much if it is not supported by other support measures for the advice of doctors and programs to help encourage modes healthier life vary widely with different insurance plans the US national program to cover breast and Pap test for women with low income, why not have one to cover lifestyle tips for low-income people advertising regulation is left to the food and beverage industry, such as the IFBA commitments and this is not likely to have a major impact.
In terms of health care, the largest areas of concern are the quality of primary care and care coordination for long-term conditions of asthma, easily managed by GPs disease in the community should require the hospitalization of very few opportunities in the United States, however, the rate of admission to hospital for asthma are more than double the average population of 120 OECD 6.1 million compared to an OECD average 51 8 2009.
A similar picture emerges for chronic obstructive pulmonary disease 230 admissions per 100,000 population compared to an OECD average of 198, 2009 These results can be improved through better health care in a survey by the Commonwealth Fund of seven nations Australia, Canada, Germany, Netherlands, New Zealand, the United Kingdom and the United States, 16 percent of US patients reported delays in notification about abnormal test result the highest reported proportion and only 75 percent of primary care physicians said they often or always received correspondence specialist after referral suggesting systemic care coordination problems.
Tune Editor's Note in the PBS NewsHour Wednesday for the full report of Betty Ann Bowser health correspondent Virginia Mason Medical Center Toyota inspired approach to improving care and lowering costs Everyday Health page NewsHour, we will continue to explore why the health care system of the United States is so expensive and what can be done about it.
Tuesday What steps can you take to make your next stay safer and cheaper Hari Sreenivasan talks with hospital Elizabeth Bailey, author of the hospital's patient list 10 simple checklists to keep you safe, Sane and organized.
In a Thursday Report of the laptop, Betty Ann Bowser examines the decision of Virginia Mason to remove a staple of the American Hospital in the waiting room.
Health costs How U, health costs, other OECD countries.