Why Is U.S. Health Care So Expensive? Some of the Reasons You’ve Heard Turn Out to Be Myths

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A mind surgical procedure staff at Lenox Hill Hospital in New York City. Does the United States actually have too many specialists?CreditBéatrice de Géa for The New York Times

Maybe the United States well being care system isn’t that weird in any case.

Compared with peer nations, the United States sends folks to the hospital much less typically, it has a smaller share of specialist physicians, and it offers folks about the identical variety of hospitalizations and medical doctors’ visits, in accordance with a new study. The high quality of well being care seems to be fairly good, it finds, whereas its spending on social companies outdoors of well being care, like housing and schooling, regarded pretty typical.

If you’ve been listening to most of the widespread narratives that search to elucidate the excessive prices of America’s well being system and the nation’s comparatively low life expectancy, these outcomes would possibly shock you. Analysts are keen on describing the system as wasteful, with too many sufferers getting too many companies, pushed by too many specialist medical doctors and too few social helps.

But a big and complete overview in The Journal of the American Medical Association punctures a whole lot of these pat explanations. The paper, performed by a analysis staff led by Ashish Jha, compiled detailed information from the well being care methods of the United States and 10 different wealthy developed nations, and tried to check these hypotheses. The group included nations with single-payer well being care methods, like Britain and Canada, and international locations with aggressive non-public insurance coverage markets, like Switzerland and the Netherlands.

Dr. Jha, the director of the Harvard Global Health Institute, mentioned he got here to the mission with a way of the traditional knowledge about how the United States differed from its friends. But, after assembling the information from the international locations’ well being ministries, he modified his thoughts about a variety of key assumptions.

“We know we spend much more than everybody else, and we’ve regarded for straightforward explanations — issues like greed within the system, fee-for-service medication, overutilization,” he mentioned. But the analysis, he mentioned, didn’t match his expectations. “I’ve been different international locations and seeing there’s a whole lot of fee-for-service in different international locations, and different international locations are battling overutilization.”

When it got here to most of the measures of well being system perform, the United States was in the course of the pack, not an outlier, as Dr. Jha had anticipated. Many analysts have known as for the nation to shift its doctor coaching away from specialty care and towards extra main care medication, for instance. But the research discovered that 43 % of U.S. medical doctors follow main care medication, about typical for the group.

It’s typically argued that sufferers within the United States use an excessive amount of medical care. But the nation was under common on measures of how typically sufferers went to the physician or hospital. The nation did rank close to the highest in its use of sure medical companies, together with costly imaging exams and particular surgical procedures, like knee replacements and C-sections.

The information are in line with different proof that well being care methods are beginning to converge, as info and applied sciences unfold all over the world amongst medical doctors and directors.

Bruce Landon, a professor of coverage and medication at Harvard Medical School, mentioned that the complaints about rising well being care prices are a worldwide challenge. Even although different international locations spend lower than the United States, few consider they’ve discovered a method to tame spending perpetually.

“I don’t suppose there’s any of those international locations the place when you went and talked to them individually, they wouldn’t say they’re having a well being care price disaster,” he mentioned. “They’re all battling paying for brand new expertise and the price of the system.”

The information didn’t recommend that any nation had a plug-and-play coverage template for devising a lower-cost, high-performing system. The methods tended to carry out higher than the United States on some measures and worse on others, with lots of idiosyncrasies.

Some consultants who reviewed the outcomes questioned in regards to the accuracy of all of the paper’s information factors, which had been quite a few and drawn from an array of worldwide sources. Dr. Jha acknowledged that the numbers will not be excellent however described the hassle as cautious and extra complete than earlier comparisons.

There had been two areas the place the United States actually was fairly completely different: We pay substantially higher prices for medical companies, together with hospitalization, medical doctors’ visits and pharmaceuticals. And our complicated cost system causes us to spend much more on administrative prices. The United States additionally has the next charge of poverty and extra weight problems than any of the opposite international locations, doable contributors to decrease life expectancy that will not be defined by variations in well being care supply methods.

Just as a result of different international locations use the hospital extra doesn’t imply that each hospitalization within the United States is acceptable. Jonathan Skinner, a professor at Dartmouth, who has studied patterns in well being care use within the United States, famous that there most likely is cash to be saved by eliminating a number of the additional scans and operations which are far more widespread within the United States than elsewhere.

“It’s not that we’re shopping for extra pizzas, we’re simply paying extra for every pie,” Dr. Jha mentioned. “But that doesn’t imply you can’t nonetheless purchase fewer pizzas.”

Margot Sanger-Katz is a home correspondent and writes about well being take care of The Upshot. She was beforehand a reporter at National Journal and The Concord Monitor and an editor at Legal Affairs and the Yale Alumni Magazine. @sangerkatzFacebook

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