Ranking: U.S. 1st in health care spending, 37th in health

September 20, 2009
By ANNE GEGGIS
Staff Writer

For the money spent on health care, Americans are getting rooked.

It seems health is one of those things that money can't buy. All international studies show that Americans spend the most, as measured by the percentage of gross national product spent on health.

But all that spending has only bought the country 37th place in overall health-system performance, as measured by indicators such as a nation's overall health and the effectiveness of its system, according to the World Health Organization's ranking of nations. The ranking was formulated in 2000 but is still used as a primary resource by governments and health organizations.

From the academic side, here's the most common diagnosis for the high price of U.S. health care: a highly complex and fragmented payment system that weakens the demand for health care and has high administrative costs that don't improve anyone's health.

"The system not only is unnecessarily complex, duplicative, ineffective and dangerous, but also poorly functioning," said Les Beitsch, associate dean at Florida State University College of Medicine and director of the Center for Medicine and Public Health as well as the Division of Health Affairs.

But ask Halifax Health Chief Executive Officer Jeff Feasel, and he has two words to describe the cure for what's ailing the U.S. health care system: "more money."

The continual shortfalls in Medicare and Medicaid reimbursements undoubtedly frames his perspective. As the government's reimbursement for health care of the elderly and the poor shrinks or stagnates, so does 65 percent of Halifax Health's revenues. Technically, area doctors haven't had a raise from one of their biggest single payers -- Medicare -- since 2002.

BEST IN THE WORLD?

Still, in town-hall meetings nationally, it's become apparent that some of the discomfort with reforming U.S. health care stems from the belief that the system is the most advanced in the world and reform will dismantle that. And those observers have a point, says Florida State's Beitsch.

"There are parts of the health care system that are extremely high-functioning -- happening on the individual level -- not on the system's level," Beitsch said.

The ways in which the U.S. health system stacks up against the systems that the World Health Organization ranks as better functioning offers insights into ways Americans stand out, good and bad.

We smoke less than almost every country, but we're the world's heavyweights. If magnetic resonance imaging scanners could cure, rather than just diagnose, we'd be the world's healthiest: The United States has more MRIs than any other industrialized nation per 100,000 people.

To address the system's problems, some argue, reform has to come not only for how health care is paid for, but how much is needed and how it's used.

"We don't have a health care system, we have a disease-care system," said Dr. Bonnie Sorensen, chief of the Volusia County Health Department.

"We wait until people are sick before they enter the health care system and then spend gargantuan amounts on disease care," she said. "For the health system to be reformed, we need to be spending more time and money on prevention efforts."

TAKE CARE OF YOURSELF

Health care dollars are disproportionately focused on a small percentage of the population sick with a handful of ailments, studies show.

In 2002, the 5 percent of people with the greatest health care expenses in the U.S. population spent 49 percent of the overall health care dollar. Meanwhile, the lower 50 percent of spenders accounted for 3 percent of the national health care dollar, according to the U.S. Agency for Healthcare Research and Quality.

The government report singles out obesity as the major driver of increased growth in spending. In three of the five most expensive chronic conditions -- mood disorders, diabetes, heart disease, asthma and hypertension -- obesity is often related to the condition.

It presents a personal challenge for each resident living in the nation with the highest density of McDonald's restaurants. Cecil Wilson, a Winter Park physician who's the president of the American Medical Association, said costs cannot be contained without Americans taking more personal responsibility for their health. The diabetes expenses alone are enough to convince him.

"It's the largest piece of the pie," he said of diabetes management, which is commonly needed as a result of poor diet and exercise habits.

But the role of individual behavior in health care reform is controversial, according to Niccie L. McKay, an associate professor and director of the master's program in health administration at the University of Florida.

"It smacks of blaming the victim," she said.

But part of what's fueling opposition to the government's plan to distribute health care to more people is the feeling that the need for it is often the result of poor choices.

"I'm getting to be what society would consider to be old. . . but I'm in better shape than people who are half my age," said Jim Oddie, a Wilbur-by-the-Sea businessman who also worked as a district representative for former U.S. Rep. Tom Feeney, R-Oviedo. He allows that there are some people who are born with illness and become sick through no fault of their own.

But largely, he said, "I don't have sickness because I take care of myself."

anne.geggis@news-jrnl.com

Less Bang for Health-Care Bucks?

No. 37 is where the United States' health status was ranked by the World Health Organization. Here's how U.S. health care stacks up in other ways (in most recent statistics available):

· No. 1 in total health costs as a percentage of gross domestic product.

· $878 per person spent on pharmaceuticals -- the most among the world's 30 largest economies.

· 2.4 practicing physicians per 1,000 people in the United States. Countries with fewer physicians per 1,000 are Canada, Japan, Mexico, New Zealand, Poland, South Korea and Turkey.

· 3.1 hospital beds per 1,000 people -- the fewest beds per 1,000 among the world's 30 largest economies, except for Mexico, where there are 1.7 beds per 1,000.

· 34.3 percent of Americans are obese (with a body mass index of 30 or higher), the most of any developed country.

· 25.9 magnetic resonance imaging units per million people makes the United States No. 1 among the world's largest economies. The United Kingdom, in contrast, has about one third the number of the U.S.

· 84.5 coronary bypasses per 100,000 people makes the U.S. the second most bypassed among developed nations, topped by Germany which has 131.8 bypasses for every 100,000 people.

· 15.4 percent of the U.S. population are daily smokers -- the second smallest percentage among the world's 30 largest economies (only the Swedes smoke less).

SOURCES: World Health Organization, Organisation for Economic Co-operation and Development

More information:
· Compare the U.S. to the world in key health indicators

These statistics should be the only real thing to concern Americans yet they are being herded like cattle by capitalists into ignoring health costs Americans are paying for what benefits? We have to ask ourselves exactly who benefits from America's health system? It isn't your average American citizen.