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US spends way more on healthcare, but has worse outcomes than wealthy peers

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The US spends far more money on healthcare when compared to other high-income countries, yet remains without universal health-insurance coverage and performs worse on several key health indicators, according to a new report.

Using data from the Organization for Economic Cooperation and Development, which compiles health statistics across its 38 member countries, as well as from other sources, the Commonwealth Fund compared spending and health outcomes in the US to those of 12 other countries and found it devoted nearly 18% of its total gross domestic product to healthcare costs in 2021, or nearly twice the amount the average OECD country spends, despite lacking a universal health-insurance program.

All the while, the US had the highest rates of infant and maternal mortality among high-income nations, the highest rates of avoidable deaths and deaths by physical assault, and the lowest life expectancy of the countries examined by the nonprofit healthcare think tank: Canada , Australia, France, Germany, Japan, the Netherlands, New Zealand, Norway, South Korea, Sweden, Switzerland and the UK

“Americans are living shorter, less healthy lives because our health system is not working as well as it could be,” Munira Gunja, a senior researcher for the Commonwealth Fund’s International Program in Health Policy and Practice Innovations and the lead author of the report published Tuesday, said in a statement. “To catch up with other high-income countries, the administration and Congress will have to expand access to healthcare, act aggressively to control costs, and invest in health equity and social services we know can lead to a healthier population.”

As of 2021, 8.6% of Americans lacked health insurance, compared to a still-higher uninsured rate of 9.2% pre-pandemic.

One potential reason for that slight boost in coverage: Pandemic-era requirements have kept people continuously enrolled in Medicaid, the government’s health-insurance program for low-income people, for the duration of the public-health emergency. That may end in March, though, and disrupt healthcare coverage for both people who are no longer eligible and people who are eligible but face “churn,” or the administrative process of temporarily losing their coverage and regaining it.

Amid that potential backslide in care, a majority of US adults also believe the government should ensure its people have healthcare coverage, though a majority believe that coverage should be based on private insurance, according to a Gallup poll published this month.

Notably, residents in high-income countries that ensure health-insurance coverage seem to visit the doctor more frequently, but experience better health outcomes, according to the Commonwealth Fund report.

Americans see the doctor at about four visits per person, per year, compared to an average among OECD countries of 5.7 visits, and have a life expectancy at birth of 77 years — three years lower than the OECD average. Americans also had the highest rates of avoidable death among the countries the Commonwealth Fund analyzed; the highest infant mortality rate, at 5.4 deaths per 1,000 live births; the highest maternal mortality rate; the highest rate of assault deaths, a category that includes gun violence; the highest obesity rate; the highest rate of multiple chronic conditions; and the highest rate of deaths from COVID-19.

To move away from these trends, the Commonwealth Fund said, the US should further address affordability and overall health spending costs while better preventing and managing common conditions.

“The findings of our international comparison 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 — among the key functions of a high -performing system,” the report said. “Other countries have found ways to do these things well; the US can as well.”