CHapter 30

Health Outcomes, Access, and Costs in the United States

Overview of Health Expenditures

• Spending: The U.S. spent over $10,000 per person on healthcare in 2017.

  • This is nearly 2.5 times the average of 36 advanced and emerging OECD countries.

• GDP Contribution: Healthcare expenditures accounted for 17.2% of the U.S. Gross Domestic Product (GDP) in 2017.

• Sustainability: Rising healthcare spending is unsustainable, limiting funds available for other critical areas (e.g., education, infrastructure).

Major Drivers of Healthcare Costs

• Higher Prices: Factors contributing to higher costs include:

  • Labor costs.

  • Pharmaceutical prices.

  • Administrative expenses.

• Physician Influence: Physicians typically do not know the costs of interventions and may benefit from higher expenditures strangely.

Health Outcomes

• Comparison to Other Countries: Despite high spending, U.S. health outcomes are poorer than in many other countries.

  • Life Expectancy: U.S. life expectancy is about two years below the average among OECD countries, a drop from being above average in 1970.

• Health Disparities: Social determinants of health are unequally distributed, influencing health outcomes across different population groups.

Access to Healthcare

• Access Issues: The U.S. ranks poorly in healthcare access, lagging behind nearly all OECD countries.

  • 22% of U.S. population skipped medical visits due to costs.

  • 18% did not buy prescribed medicines due to financial constraints.

• Low-Income Impact: 43% of low-income adults report unmet medical needs due to costs, highlighting significant access barriers.

• International Perspective: Universal access to adequate health insurance is deemed a fundamental societal obligation in other countries.

Social Determinants of Health

• Contributing Factors to Mortality:

  • Drug overdoses, suicides, and alcoholic liver disease contribute to rising mortality rates among non-Hispanic whites in the U.S.

• Key Social Determinants:

  • Education level.

  • Racial segregation.

  • Social support availability.

  • Poverty and income inequality.

• Neighborhood Challenges: Poor neighborhoods often lack essential services such as fresh food sources, public transit, and education, leading to high mortality from preventable conditions.

Strategies for Improvement

• Triple Challenge: U.S. health policy must address:

  • Reducing healthcare spending.

  • Improving healthcare outcomes.

  • Expanding health access.

• Primary and Secondary Prevention: Focus on enhancing care in prevention and the implementation of evidence-based guidelines.

• Resource Allocation: Shift resources from acute care towards preventive measures and social services, particularly for individuals with chronic conditions.

• Addressing Disparities: Target interventions at populations facing significant health outcome disparities to improve overall health and societal fairness.

• Community Collaboration: Engage with community organizations to address the social determinants of health effectively.

Conclusion

• Comprehensive Approach: Improvements in health outcomes require addressing both healthcare delivery and the broader social environment.

• Evidence-Based Assessment: Evaluate health interventions empirically to understand their efficacy and avoid misallocation of resources.