Transcript Five Myths About American Health Care Christopher J. Conover, PhD Center for Health Policy and Inequalities Research Duke University February 28, 2012

Five Myths About American
Health Care
Christopher J. Conover, PhD
Center for Health Policy and Inequalities Research
Duke University
February 28, 2012
Road Map
• Myth #1: Relative to other countries, the U.S.
spends “too much” on health care
• Myth #2: Other countries do better at
controlling health spending growth
• Myth #3: The U.S. abysmal infant mortality
rates compared to other nations
• Myth #4: The U.S. has much lower life
expectancy relative to its competitors
• Myth #5. The U.S. has worse health outcomes
than its peers
Myth #1:
Relative to other countries, the U.S.
spends “too much” on health care
19.4a | The conventional wisdom is that U.S. health spending is 60
percent above its expected level given the nation’s per person GDP
Health spending per person (U.S. purchasing power parity, 2006 dollars)
$9,500
$8,500
US
$7,500
$6,500
”Excess spending”
Luxembourg
Norway
Iceland
$5,500
$4,500
$3,500
$2,500
Ireland
$1,500
$500
10,000
18,000
26,000
34,000
42,000
50,000
58,000
66,000
74,000
GDP per Person (U.S. Purchasing Power Parity, 2006 dollars)
19.4b | Once sub-national areas are taken into account, U.S. health
spending is almost exactly where it is expected to be given U.S. GDP
Health spending per person (US purchasing power parity, 2006 dollars)
US-MA
OECD Countries
US States
CA Provinces
AU States
Best-Fit Model
US-PA
US (All)
US-NY
US-NJ
US-CA
US-TX
US-CO
FRANCE
NORWAY
$10,500
$9,500
$8,500
$7,500
$6,500
$5,500
$4,500
$3,500
PORTUGAL
IRELAND
UK
$0
$10,000
$20,000
$30,000
$40,000
$50,000
GDP Per Capita (US Purchasing Power Parity, 2006 dollars)
Note: all areas with less than 4.1 million population have been excluded.
$2,500
$1,500
$500
$60,000
Myth #2:
Other countries do better at
controlling health spending growth
1.6a | The difference between the U.S. and other G7 nations in the
health spending share of GDP has grown wider since 1980
NHE as a Percentage of GDP
US (#1)
17
France (#5)
Germany (#3)
14
Canada (#7)
Italy (#6)
11
UK (#4)
Japan (#2)
8
5
2
1960
1965
1970
1975
1980
1985
1990
1995
2000
Figures in parentheses show country ranking within OECD based on size of GDP in 2007.
2005
1.6b | For 50 years, growth in real health spending per capita has not
been noticeably higher in the U.S. relative to other G7 countries
Compound Annual Growth Rate in Inflation-Adjusted Health Spending per Capita
1960-70
1970-80
1980-90
1990-2000
2000-2007
16
14
12
10
8
6
4
2
0
U.S.
Japan
Germany
UK
France
Italy
Canada
Countries ranked by size of GDP in 2007. Growth rates estimated from real NHE per
capita (calculated in chained 2005 U.S. dollars using a GDP price deflator)
1.6c | The U.S. advantage in inflation-adjusted non-health GDP per
capita has increased since 1980 relative to nearly all G7 nations
U.S. margin of advantage in non-health inflation-adjusted GDP per capita (2005 dollars)
1960
1980
2007
$11,000
$10,000
$9,000
$8,000
$7,000
$6,000
$5,000
$4,000
$3,000
$2,000
$1,000
$0
Japan
Germany
UK
France
Italy
Canada
Countries ranked by size of GDP in 2007. Inflation-adjusted GDP per capita is measured
in constant chain series, 2005 U.S. dollars, as reported in Penn World Tables.
Myth #3:
The U.S. abysmal infant mortality
rates compared to other nations
19.10 | Except for Sweden and Norway, the U.S. generally leads to
world in saving the lives of premature infants
Infant mortality index (U.S. = 100)
350
300
Sweden
Norway
U.S.
England/ Wales
Austria
Finland
Scotland
Denmark
Northern Ireland
250
200
150
100
50
0
22-23 Weeks 24-27 Weeks 28-31 Weeks 32-36 Weeks 37+ Weeks
Note: countries ranked from best to worst for infants with the shortest gestation period.
Myth #4:
The U.S. has much lower life
expectancy relative to its competitors
19.9a | Once higher-than-average U.S. rates of violent deaths have
been taken into account, the U.S. leads the world in life expectancy
Mean life expectancy at birth, 1980-1999
Raw Life Expectancy
Standardized Life Expectancy
Note: Countries are ordered by standardized life expectancy derived by assigning each
country the mean OECD fatal injury rate for the period shown; figures in parentheses
denote ranking on unstandardized life expectancy at birth.
80
79
78
77
76
75
74
73
72
Myth #5:
The U.S. has worse health outcomes
than its peers
19.11a | The U.S. leads the world in female cancer survival rates for
the leading causes of cancer deaths
Five-year female cancer survival rate indexes (U.S. = 100)
U.S. Whites
U.S.
Sweden
France
Switzerland
Italy
Germany
Denmark
U.S. Blacks
England
120
100
80
60
40
20
0
Breast
Cervical
Thyroid
Note: countries ranked from best to worst for breast cancer
19.11b | Despite a larger uninsured population, cancer screening rates
for adults 50 and older are much higher in the U.S. than in Europe
European cancer screening rates as a percentage of U.S. rates
50-64
65-74
60%
75 & Over
50%
40%
30%
20%
10%
0%
Mammography
Pap Smear
Colonoscopy
PSA
Conclusions
• The U.S. health system has many problems
• But other countries do not offer a magic bullet
• Misconceptions helped put health reform on
the wrong path: government-controlled
health care
• Governor Mitch Daniels: “Smart decisions
always start with clarity about the facts”