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Mole's Progressive Democrat

The Progressive Democrat Newsletter grew out of the frustration of the 2004 election. Originally intended for New York City progressives, its readership is now national. For anyone who wants to be alerted by email whenever this newsletter is updated (usually weekly), please send your email address and let me know what state you live in (so I can keep track of my readership).

Location: Brooklyn, New York, United States

I am a research biologist in NYC. Married with two kids living in Brooklyn.

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  • Thursday, November 19, 2009

    An Updated Look at Healthcare Statistics

    I have in the past analyzed the actual health outcomes we get for the amount we pay for our healthcare in the US, and it doesn't add up. I recently came across a site that allows me to do this analysis again, and to analyze the details of expenditure on healthcare. Herein I am comparing the US with several other nations, comparing how much we spend both per capita and as a % of GDP, what percentage of this expenditure is public spending, the availability of care (hospital beds, nurses and physicians per capita), and various health outcomes (healthy life expectancy, maternal mortality, chance of living to 65, etc.). Here are the numbers: (playing with http://www.nationmaster.com )

    Total (private and public) Expenditure per capita (in US $):

    1. US: $6,096.2
    2. Luxembourg: $5,904
    3. Switzerland: $5,571.9
    4 Norway: $5,404.7

    9. Sweden: $3,532

    12. Netherlands $3,441.7

    17. Canada: $3,037.6
    18. UK: $2,899.7
    19 Japan: $2,831.1
    20 Finland: 2,664.3

    27 Israel: 1,533.5 $

    72 Cuba: 229.8 $

    Bottom line: we spend the most, counting both public and private money, of ANY NATION IN THE WORLD on healthcare. Nations like Canada, UK, Japan, Finland and Israel spend about half of what we spend. So when you look at what is outlined below, consider whether we are getting twice as much as nations like Canada, UK, Japan, Finland and Israel are getting.

    Total expenditure (public and private) on health as % of GDP
    1 United States: 14.6%

    4 Switzerland: 11.2%

    15 Canada: 9.6%
    15 Norway: 9.6%

    23 Sweden: 9.2%

    25 Israel: 9.1%

    30 Netherlands: 8.8%

    43 Japan: 7.9%

    47 United Kingdom: 7.7%

    53 Cuba: 7.5%

    56 Finland: 7.3%

    79 Luxembourg: 6.2%

    Bottom line: we also spend the most of any nation as a percentage of GDP on healthcare. We spend more than Switzerland. The UK, Finland, Luxembourg, and Japan spend about half what we spend as a percentage of GDP. Again, consider whether we are getting our money's worth in comparison with these nations that spend about half of what we do.

    Public Spending as % of total healthcare costs:
    (some nations I am looking aren't mentioned in regards to this figure)
    3 Luxembourg: 85.4%
    4 Norway: 85.3%
    4 Sweden: 85.3%

    7 United Kingdom: 83.4%

    12 Finland: 75.7%

    20 Canada: 69.9%

    22 Switzerland: 57.9%

    24 United States: 44.9%

    Bottom line: we spend about half of the public money compared with nations like Luxembourg, Norway, Sweden and the UK. Keep in mind that we also spend twice as much total as many of these nations (as a percentage of GDP), so that means we are each PRIVATELY paying out of pocket the difference.

    Next I want to consider some measures of whether we are getting comparable care in terms of things like available hospital beds, nurses and physicians per capita. Given that we are paying the top price for our care, do we have the healthcare providers available for the money we pay.

    Hospital beds per 1000 people:

    4 Japan: 14.3 per 1,000 people

    21 Finland: 7.2 per 1,000 people

    33 Israel: 6.1 per 1,000 people

    36 Luxembourg: 6 per 1,000 people
    36 Switzerland: 6 per 1,000 people

    50 Cuba: 4.9 per 1,000 people

    55 Netherlands: 4.7 per 1,000 people

    62 United Kingdom: 4.2 per 1,000 people

    69 Norway: 3.8 per 1,000 people

    71 Canada: 3.7 per 1,000 people
    72 Sweden: 3.6 per 1,000 people

    81. US 3.3 per 1,000 people

    Bottom line: we fall short when it comes to available hospital beds. It is true that Sweden, Canada and Noway are comparable, but they also spend far less than we do on healthcare. Other nations, also spending less than we are, have far more hospital beds per capita available. You want to know why hospital care tends to be inferior and rationed in America? It is because the money we spend on healthcare is NOT going to providing enough hospital space to meet our needs. Even Cuba does better by this measure than we do, and Israel, Finland and Japan have about twice as many hospital beds available than we do.

    Nurses per capita:
    (Cuba and Israel not reporting??)
    1. Finland: 14.7 per 1,000 people

    3 Netherlands: 13.4 per 1,000 people
    4 Switzerland: 10.7 per 1,000 people

    6 Norway: 10.3 per 1,000 people
    7 Canada: 9.9 per 1,000 people

    12 Sweden: 8.8 per 1,000 people
    12 United Kingdom: 8.8 per 1,000 people

    14 United States: 8.1 per 1,000 people
    15 Japan: 7.8 per 1,000 people

    Bottom line: once again we fall below. We are NOT getting the care we are paying for.

    Physicians per capita

    2 Cuba: 5.91 per 1,000 people

    13 Israel: 3.82 per 1,000 people

    26 Sweden: 3.3 per 1,000 people

    34 Norway: 3.1 per 1,000 people 2003
    34 Netherlands: 3.1 per 1,000 people

    43 Luxembourg: 2.7 per 1,000 people

    46 Finland: 2.6 per 1,000 people

    52 United States: 2.3 per 1,000 people

    55 United Kingdom: 2.2 per 1,000 people

    58 Canada: 2.1 per 1,000 people

    64 Japan: 2 per 1,000 people

    Here we fall short, but Canada, Japan, UK, Finland and Luxembourg are comparable. All of these pay less than we do. So by this measure America pays more money for similar service.

    So the next thing to look at is whether the money we pay actually delivers good health in the end. I want to look at a series of very bottom line measures of health to see how we rank. Again, we pay the most, so we should be ranking the best in most of these measures if we are getting our money's worth. The fact that we rank mediocre on available hospital beds, nurses and physicians per capita already suggests we aren't getting what we pay for. But what about health out comes?

    Healthy Life Expectancy:
    (Cuba and Israel not reporting??)
    1 Japan: 73.6 years
    2 Switzerland: 72.8 years
    3 Sweden: 71.8 years

    10 Norway: 70.8 years
    11 Luxembourg: 70.6 years

    15 Finland: 70.1 years

    17 Canada: 69.9 years
    17 Netherlands: 69.9 years

    20 United Kingdom: 69.6 years

    22 United States: 67.6 years

    Bottom line: we do relatively poorly here. Nations that pay half what we do, but using a higher percentage of public money to cover it, do comparably or better than we do.

    Maternal Mortality:
    (Luxemburg and Canada not reporting??)

    95 Cuba: 33 per 100,000

    116 Japan: 8 per 100,000
    116 United States: 8 per 100,000

    121 United Kingdom: 7 per 100,000
    121 Netherlands: 7 per 100,000

    124 Norway: 6 per 100,000
    124 Finland: 6 per 100,000

    130 Switzerland: 5 per 100,000
    130 Sweden: 5 per 100,000
    130 Israel: 5 per 100,000

    One thing to note here is that this statistic is one measure where Cuba does poorly, though compared to other third world nations they do well. They pay about 1/30th we do for healthcare, but in this case they aren't faring well enough, I'd say. However, we do poorly compared with many of the nations that spend half what we do. So although we beat Cuba, I don't think that is something to be proud of.

    % of life lived in ill health (female)
    (Cuba and Israel not reporting??)

    6 United States: 13.5%

    8 Canada: 12.6%
    9 Netherlands: 11.9%

    15 Norway: 11.4%

    18 United Kingdom: 11.3%

    21 Sweden: 11.1%
    22 Luxembourg: 11%

    26 Finland: 10.8%

    28 Japan: 10.6%
    29 Switzerland: 10.2%

    We do pretty comparably here with the other nations I am comparing us to. But I think again it is critical to realize we are not beating nations that spend half what we do on healthcare.

    Probability of reaching 65 (Male)
    1 Israel: 85.1%
    2 Sweden: 84.8%

    5 Japan: 84%

    8 Netherlands: 82.7
    9 Canada: 82.3%
    10 Switzerland: 82.2%
    10 Norway: 82.2%

    14 United Kingdom: 81.5%

    19 Luxembourg: 80.1%

    28 Cuba: 78.1%

    30 Finland: 77.9%

    32 United States: 77.4%

    Bottom Line: Well we are comparable with Cuba here, even though we spend 30 times what Cubans pay for healthcare.

    The take home message: The American healthcare system is way too expensive, gives mediocre outcomes and puts the burden excessively on individuals and businesses. Nations that spend half as much but fund it more through public finances (yes...that means taxes) have far better out comes.

    This is the same as what I saw last time I did this kind of analysis a couple of years ago. Last time I looked at a wider range of health outcomes and focused on the fact that we ranked with nations like Albania, Slovenia, and Croatia while the nations that ranked best were nations like Sweden, Japan, UK and Canada, nations with a far more "socialized" healthcare system. So I focused on the fact that socialized systems did better, and I took on faith that they also spent less.

    Well, this analysis covers fewer healthcare outcomes (enough to confirm my previous analysis that we get mediocre outcomes) but includes data that shows we really do spend the most by any measure, put the burden more on businesses and individuals rather than using public funding, have worse coverage (meaning less actual healthcare services), AND have mediocre outcomes.

    Folks, we are doing it wrong. It doesn't even make capitalist sense because we are spending more for less. That is BAD BUSINESS! Hell, even Switzerland spends less, puts in more public funding, and gets better outcomes. We have a failed system and we need to pay attention to how the nations with the best outcomes with half the cost do it. Those nations are Sweden, Cananda, Finland, Israel, the UK and Japan. They do it better by all measures. Why shouldn't we learn from them?


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