The OECD has just published Health at a Glance 2021, a compendium of health care statistics across the (mostly) high-income countries that make up its membership. Some of the graphs confirm standard reactions to the US health care system: that is, it costs much more than other countries, but the health outcomes for Americans are often no better or worse than in countries that spend less on health care. That said, I was also struck in skimming through the report by several graphs which suggest that, by international standards, Americans have some reasons to like their health care system.
First, here are a few of the standard comparisons. These first two figures show national health care spending as a share of GDP and on a per capita basis. On both measures, the US spends far more than other countries on health care.
But despite this high level of health care spending, basic measures of US health outcomes are not especially good. There are lots of examples, but here are a few. The first graph shows that US life expectancy is not especially good by international standards: indeed, the growth in US life expectancy since 1970 isn’t all that good, either. The second graph show US rankings on infant mortality: just beating out China, but not quite as good as Russia. The third graph looks at mortality from what the OECD classifies as “preventable” conditions and “treatable” conditions. For example, lung cancer is classified as “preventable” through reductions in smoking, while breast and colorectal cancers are classified as “treatable.” By either measure, US mortality rates are disturbingly high.
Given these high costs and sub-average outcomes, what do Americans have to be pleased about in their health care system? A few examples caught my eye. One is how people rate their own health. It turns out that by international standards, a low proportion of Americans rate their health as “bad” or “very bad,” while a high percentage rate it as “good” or “very good.” (Although the second figure also shows that the gap between how Americans in the top income group and bottom income group rate their own health is substantial.)
Americans tend to feel satisfied with the quality of health care available in their area–at least more so than people in Sweden, the United Kingdom, or Japan.
It also turns out that when it comes to out-of-pocket health care costs, the US does reasonably well in these international comparisons: for example, the share of household consumption going to out-of-pocket health care spending in the US is the same as in Canada, only a bit higher than in the United Kingdom, and lower than in Sweden, Denmark, or Norway.
This final group of comparisons showing some ways in which Americans like their health and their health care system are not intended to suggest that the US health care system broadly understood (that is, understood to include public health efforts that happen outside the health care system itself) doesn’t need some meaningful reforms to reduce costs and to improve access and health outcomes. But it does perhaps help to explain why meaningful reform has been hard to achieve.
