According to a new report from the Commonwealth Fund, the United States continues to have the highest healthcare spending among several peer nations—while also having some of the worst health outcomes.

Report details and findings

For the study, researchers compared data from the Organisation for Economic Co-operation and Development (OECD)'s Health Statistics 2022 database and the Commonwealth Fund International Health Policy Survey 2022. In total, 11 high-income countries, including the United States, Germany, and Canada, were included in the report.

Since the 1980s, healthcare spending has increased across all 11 countries, in part due to new medical technologies, rising health costs, and a higher demand for services. In addition, the pandemic led to an even greater increase in healthcare spending due to the costs of COVID-19 tests, vaccines, relief funds, and more.

In 2021, the United States spent 17.8% of its gross domestic product on healthcare—almost twice the OECD average of 9.6%. The countries with the next highest percentages were Germany (12.8%), France (12.4%), and the United Kingdom (11.9%).

The United States also spent significantly more money per capita on healthcare than peer countries. In 2021, the United States almost $12,000 on healthcare per capita, including over $1,200 in household out-of-pocket costs.

U.S. health spending was almost twice as high as the second-closest country Germany, which spent roughly $7,000, and four times as high as South Korea, which had the lowest healthcare spending per capita at around $4,000.

However, despite high U.S. healthcare spending, Americans see doctors less frequently than people in many other countries, and the United States has one of the lowest numbers of practicing physicians per 1,000 population.

The U.S. healthcare system "can seem designed to discourage people from using services," the researchers wrote. "High out-of-pocket costs lead nearly half of working-age adults to skip or delay getting medical care."

The United States also has worse health outcomes than other countries. In 2020, U.S. life expectancy at birth was 77 years, three years lower than the OECD average. So far, provisional data suggests that U.S. life expectancy dropped even farther in 2021.

Avoidable deaths refer to those that are preventable and treatable, such as through effective public health measures and timely care. In 2020, the United States had 336 avoidable deaths per 100,000 people, which was significantly higher than any other country.

The United States also had the highest rates of infant and maternal deaths of all the countries. In 2020, the infant mortality rate in the United States was 5.4 deaths per 1,000 live births, compared to the OECD average of 4.1 deaths per 1,000 live births.

The U.S. maternal mortality rate was 23.8 deaths per 100,000 live births—substantially higher than the OECD average of 9.8 deaths per 100,000 live births. According to the researchers, a high rate of C-sections, inadequate prenatal care, and socioeconomic inequalities may contribute the country's high infant and maternal mortality rates.

The United States also had the highest rates of death from assaults and COVID-19 and had the third highest rate of suicide deaths behind Japan and Korea.

As a whole, U.S. adults were in worse health compared to adults in other countries. For example, the U.S. obesity rate was much higher than other countries'. Over 40% of the total U.S. population is considered obese, compared to the OECD average of 25%.

U.S. adults were also the most likely to have two or more chronic conditions, such as diabetes, heart disease, or more, at 30.4%. In comparison, the rates among residents of other countries ranged from 17% to 25.9%.

Commentary

Overall, health experts say the findings reflect familiar trends in U.S. healthcare spending and outcomes and underscore a need for changes in the healthcare system going forward.

"It validates the fact that we continue to spend more than anybody else and get the worst health outcomes. So we're not getting the best value for our health care dollar," said Dr. Georges Benjamin, executive director of the American Public Health Association, who was not involved in the report.

"The big takeaway for me is that Covid did not become the great equalizer [among nations]. It did not help our case at all," Benjamin said. "If anything, it exposed the existing holes in our health care system."

"Americans are living shorter, less healthy lives because our health system is not working as well as it could be," said Munira Gunja, senior researcher at the Commonwealth Fund's International Health Policy Program and the report's lead author. "… Even though we have made some steps over the past decade to improve health access and coverage, the rates are getting worse. It's a big wakeup call for the health policy and health care industry that we are in a crisis and we need to make changes." (Reed, Axios, 1/31; Cortez, Bloomberg, 1/30; Howard, CNN, 1/31; Hou, "Changing America," The Hill, 1/31; Gunja et al., The Commonwealth Fund, 1/31)