The American Healthcare Struggle

Healthcare systems play a significant role in the pursuit and promotion of global health. Including a spectrum of services, operating across a range of providers, and utilizing funding from both public and private sources, healthcare systems around the world are diverse to say the least. It would be easy to assume that the higher a nation's GDP, the higher their health status as a result of a higher quality of healthcare systems. But as safe and seemingly secure an assumption that is, you may be surprised to realize that indeed that it is not necessarily the case. Now, here in America, where we are inundated by the media outcry of how terrible the state of healthcare is within our country, that may not have come as a shock. However, when you break down the numbers and actually take a look at the statistics facing our nation in comparison to those of other high-income countries the results are embarrassing.

Figure 1:Health expenditure per capita (provided by OECD)

The US spends two and a half times the amount of money in healthcare expenditures than the average OECD country. Two and a half times?!  For that amount of money one would think that the US had the best health outcomes as well as the lowest mortality rates across the board when looking at the five key indicators of health. Again, you would be disappointed.

Table 1: Key indicators of health (provided by the WHO)

	Life expectancy at birth	Infant mortality rate	Neonatal mortality rate	Maternal mortality rate	Under 5 mortality rate
USA (2009)	78 years	6.5	4	21	7.6
France (2009)	81.8	3.5	2	8	4.3

So what is the reason behind the lag in American healthcare? Why are we constantly ranked so low in comparison to many of our global peers?

As shown in Figure 1, the US the healthcare system is extremely fragmented, with roughly 50% of our healthcare determined by private vectors (OECD, 2012). In contrast, France, one of the top ranked countries in terms of global health by the World Bank, spends comparatively little in the private sector, focusing the majority of its efforts through public offerings. Not to say that the public sector is the way to go. But leading economists believe it plays a part:

“ My explanation for the relative high prices Americans pay for health care relative to other countries is that the payment side of the health care market in the private sector is fragmented, weakening the bargaining power of individual insurers, especially vis-à-vis the increasingly consolidated hospital sector….”

An incredibly enlightening little tool to play around with can be found at this website. Healthcare bluebook allows people to search for basic health care services in their area and determine the price of each procedure. We invite you to play with this and see how the results change based on location. Or click here to see how consumerreports.org finds the US spread of pricing wanting. 

The United States is constantly left in the dust, struggling to maintain its superior status among the leading nations in healthcare systems. Until some drastic changes are made to the management of these systems, however, it is very unlikely to change in our favor.  From the data, it is easy to conclude why United States Citizens pay far more than their counter parts for health care. However, the question remains as to how we got here in the first place and why is there not an outpouring of cry to change. The answer is very simple; it goes back to the fundamental beliefs of the majority of the stakeholders in this nation that access to healthcare services is not considered a right, but a luxury that must be obtained by picking yourself up by the bootstraps, working hard and not asking for help. The following quote from the NY Times helps to sum up this idea.

     “Our reliance on private enterprise to provide the most essential of services stems, in part, from a more narrow understanding of our collective responsibility to provide social goods.  Private American healthcare has stood out for decades among industrial nations, where public universal coverage has long been considered a right of citizenship.” 

In order to implement change, to lower the cost of healthcare, we must first change the mindset of the stakeholders holding the majority of the vote.  We must think of healthcare as a right of citizenship.  Only when that has been achieved, can healthcare services transition from a for profit business to an essential social service.