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US Spends Most on Health Care of Rich Countries But Has Worst Life Expectancy

A new report uncovers the myriad ways in which the U.S. is a global outlier in health spending and health outcomes.

As the only wealthy country without universal health care, the U.S. is a global outlier, with both the highest health care spending and the worst health outcomes across several metrics, a new report by the Commonwealth Fund confirms.

A report released on Tuesday found that, in 2021, the latest year for which data is available, the U.S. spent 17.8 percent of its gross domestic product (GDP) on health care. This is nearly twice the proportion that the average country in the Organisation for Economic Co-operation and Development (OECD) — a group of 38 wealthy countries in the global North — spent on health care in 2021, or about 9.6 percent.

The difference between U.S. spending and that of other OECD countries is also stark when broken down by dollars per capita. The U.S. spent over $10,600 per capita on health care in 2021. This is nearly double the per capita spending of the next highest country, Germany, and three or four times the amount spent by South Korea, New Zealand, and Japan, which each spent about $3,000 to $4,000 per capita.

Despite spending extreme amounts of money on health care, the U.S. also has the worst or among the worst health outcomes of OECD countries, the report found.

In 2020, for instance, the life expectancy at birth in the U.S. was 77.0 years, while people on average across the OECD were expected to live 80.4 years at birth using the most recent data.

This can be explained in part by the fact that the United States has by far the highest death rates in several areas.

The U.S. has the highest number of avoidable deaths per population, with 336 avoidable deaths per 100,000 people versus 225 on average in OECD countries; the highest infant and parental mortality, with 23.8 parents dying per 100,000 live births versus the OECD average of 9.8 deaths; the highest COVID-19 death rate; and by far the highest number of deaths from assault, due in large part to gun violence, with 7.4 deaths due to assault per 100,000 people. This is nearly seven times higher than the country with the next highest assault death rate, New Zealand, which has 1.3 assault deaths per 100,000 people.

Other metrics also indicate the U.S.’s inferiority in health care. The U.S. has the highest rate of obesity, an indicator for other conditions, and the highest rate of adults with multiple chronic conditions like asthma, cancer, depression and diabetes.

Despite this, the U.S. has among the lowest rates of practicing physicians per population of OECD countries and among the lowest number of doctors’ visits per person per year, the report found. This could be due to the fact that many people simply can’t access health care to begin with — in 2021, 8.6 percent of the U.S. had no health insurance. Almost by definition, this is the highest proportion of uninsured people in any OECD country because every other OECD country has a form of universal health care.

This data follows other research that has similarly found that the U.S. spends the most on health care and expenses like prescription drugs, in part due to the strength of the health products and pharmaceuticals lobby.

As a result of high costs, millions of Americans are avoiding or putting off seeking care. Gallup polling from earlier this month found that 38 percent of Americans report that they or a family member put off seeking medical treatment in 2022, an all-time high. Over one in four Americans said that they had put off treatment for a “very” or “somewhat” serious condition.

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