Reforming Our Health Care Financing System Won't Mean Anything if Americans Don't Start Taking Better Care of Themselves

Ken Thorpe, along with associates David Howard and Katya Galactionova, of Emory University has expanded on his earlier work on chronic disease in the U.S. and its impact on our health care costs in a web article for the journal Health Affairs. He compares chronic disease in the U.S. and Europe and looks at the difference as a means to help explain our higher health care costs.

As all of the Republican and Democratic presidential candidates, and the rest of us, debate how to get everyone access to health insurance the alarming decline in America's overall health, and its impact on our inability to afford health insurance, seldom gets more than lip service.

It's going to take a lot more than passing references to wellness and prevention. We've been talking about, and implementing soft programs in that space, for almost 30 years and Americans have just gotten more sloppy about their personal health. As I have posted before, we need to hit this problem, particularly America's obesity epidemic, head-on. The notion that younger adults and children may be the first generation in our history to have poorer health than the last should scare all of us--and make us understand health care isn't just an access and price issue.

This from the article's abstract:

"The United States spends more on health care than any European country. Previous studies have sought to explain these differences in terms of system capacity, access to technologies, gross domestic product, and prices. We examine differences in disease prevalence and treatment rates for ten of the most costly conditions between the United States and ten European countries using surveys of the noninstitutionalized population age fifty and older. Disease prevalence and rates of medication treatment are much higher in the United States than in these European countries. Efforts to reduce the U.S. prevalence of chronic illness should remain a key policy goal.

"The United States spends far more on health care than any European country. U.S. per capita spending in 2004 was $6,037, compared with $3,094 in the Netherlands, $3,169 in Germany, and $3,191 in France. Even Switzerland, which has the highest per capita health spending of any European country, spends only two-thirds as much per capita as the United States spend.

"Previous studies have sought to explain these differences in terms of system capacity (that is, physicians, nurses, and hospital beds per capita), access to advanced technologies such as magnetic resonance imaging (MRI), gross domestic product (GDP) (that is, the "income effect"), and prices. Neither system capacity nor access to technology appears to account for the higher level of spending in the United States compared with these European countries. However, GDP is strongly related to health care spending. A 1 percent increase in GDP per capita is associated with (at least) a 1.2 percent rise in per capita health care spending, and cross-national variation in per capita GDP explains nearly 90 percent of the variation in this spending. However, even when the relationship between GDP and health spending is taken into account, the United States remains a substantial outlier: Per capita spending is 42 percent higher than predicted.

"More recent U.S.-European comparisons have attributed the unexplained residual spending in the United States to higher health care prices--a component of spending per treated case. Because prices cannot be observed directly for most services, the conclusion is based on Organization for Economic Cooperation and Development (OECD) data showing little difference in capacity--physicians, nurses, and hospital beds per capita and hospital days per capita--between the United States and OECD countries. Thus, the residual (and unmeasured) differences in spending are thought to reflect higher payments for services in the United States.

"Higher U.S. spending may also reflect greater disease burden and higher rates of disease treatment. Differences in diagnosed and treated disease prevalence have received less attention in the literature on spending in the United States and Europe, except as measures of system performance. However, within the United States, increases in chronic disease rates have contributed to the growth of health care spending.

"There are several reasons why disease treatment rates might be higher in the United States. First, higher rates of obesity and, up until the 1970s, smoking place Americans at higher risk for a number of chronic conditions. Second, the U.S. medical system might have a greater propensity to screen for disease more aggressively and treat less severe cases of disease.

"Previous studies have shown that disease and treatment rates are higher in the United States than elsewhere. A recent comparison of British and U.S. surveys of the population age fifty and older found that U.S. respondents were more than twice as likely as their British counterparts to report having been diagnosed with diabetes and were also more likely to report having been diagnosed with other conditions. Disease-specific comparisons between the United States and European countries have also found that prevalence and treatment rates are higher in the United States.

"In this paper we examine differences in doctor-diagnosed and medication-treated disease prevalence between the United States and ten of the largest European countries. We find that both diagnosed prevalence and treatment rates are higher in the United States. We cannot directly calculate the link between higher treatment rates and spending, but we show that U.S. health care spending would be lower if treatment rates were reduced to European levels."

Access the entire article: Differences in Disease Prevalence As A Source of the U.S.-European Health Care Spending Gap

Earlier post: The Obesity Epidemic--It's Time to Deal With it the Same Way We Did Smoking