US leads world in health care spending yet key health outcomes lag


The U.S. spends as much as three times more on health care per person as other high-income countries, yet residents are often less likely to visit doctors, according to a report that highlights poor returns for the nation’s large investment.

The pandemic has widened discordances between medical spending and health results in the U.S. and the rest of the world, findings from the Commonwealth Fund study show. The only high-income country that doesn’t guarantee access to health care, the U.S. spent almost 18% of its gross domestic product on health and related services in 2021.

The report adds to a litany of indicting data from the U.S., where half of adults are worried about medical costs that sometimes force them to delay or forgo care, according to a recent study, and life expectancy of 77 years ranks 39th among all nations. One glaring problem is that Americans visit the doctor just four times a year, trailing most other wealthy countries, perhaps because of cost and a lack of practicing physicians, the authors said.

The American health system “can seem designed to discourage people from using services,” they wrote in the report, U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes. “High out-of-pocket costs lead nearly half of working-age adults to skip or delay getting needed care.”

The U.S. spends $10,687 per person each year on health-care programs and insurance, plus another $1,225 for household out-of-pocket costs, the research found. That compares to less than $4,000 for both components in South Korea, the lowest of 13 countries the group tracked, and just over $7,000 in Germany, the second-biggest spender after the U.S.

Yet Americans are seen by doctors less than half as often as people in the Netherlands, Germany, Japan and Korea, and the U.S. has fewer physicians per patient than any other member nation of the Organization for Economic Co-operation and Development, according to the report. Hospital stays, less than five days on average, are also shorter than those in peer countries.

The pandemic has taken an exceptionally high toll on the U.S., which has the highest COVID death rate of any country. Avoidable deaths from ailments like diabetes, high blood pressure and preventable cancers outstrip every other wealthy country, the researchers said. The U.S. also leads wealthy nations in infant and maternal mortality.

Other vulnerable populations include Black Americans, who die four years younger on average than Whites, while American Indians and Alaska Natives die seven years sooner.

The findings “demonstrate the importance of a health-care system that supports chronic disease prevention and management, the early diagnosis and treatment of medical problems, affordable access to health-care coverage, and cost-containment,” the researchers concluded. “Other countries have found ways to do these things well; the U.S. can as well.”

2023 Bloomberg L.P.

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