Is the U.S. Health-Care System What’s Really Ailing Us?

You’ve probably heard that while the U.S. spends a whole lot of money on medical care, our citizens aren’t healthier than in other countries that spend far less.

In fact, a new study published online in Health Affairs finds that fifteen-year survival rates for U.S. 45- and 65-year-olds declined from 1975-2005, relative to a dozen other developed countries. The survival rate for 45-year-old women is now the lowest among those countries.

Explanations offered for the U.S.’s lagging health stats usually include our diverse population, smoking habits, obesity problems, car-crash and homicide rates and number of uninsured.

The authors of the new Health Affairs study, however, systematically go through those reasons and explain why they can’t explain the gap — for example, obesity rates were actually increasing more slowly during that 30-year period in the U.S. than in many other countries. “We can be confident about what isn’t responsible,” Peter Muennig, one of the study’s authors and an assistant professor of health policy and management at Columbia’s Mailman School of Public Health, tells the Health Blog.

Muennig and his co-author, Sherry Glied, a Mailman professor who is on leave at HHS, speculate that the U.S. system itself, with its ever-rising rate of health-care spending, may be to blame. First, Muennig explains, as health costs rise, “the cost of insurance must also rise, putting it further and further out of the reach of employers” and of individuals. Coverage deteriorates, even for people who do have insurance.

In addition, the authors note that when health care eats up an ever-greater portion of the federal budget, funding for other programs that might improve survival — public-health efforts, education and community-development programs — gets squeezed out.

Moreover, the fee-for-service structure of the system, combined with an emphasis on specialty care, may not only boost spending but also lead to unnecessary procedures and perhaps “secondary complications.” And fragmented care “leads to poor communication between providers, sometimes conflicting instructions for patents, and higher rates of medical errors.” (The authors emphasize that it’s not known whether these factors are actually influencing the health of the population.)

“These findings undercut critics who might argue that the U.S. health-care system is not in need of major changes,” the authors write. The study was funded by the Commonwealth Fund — which has advocated for many of the changes in the health-care overhaul law.

Do you agree with their theory?

Further reading:

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