Key Findings
Most OECD countries have enjoyed large gains in life expectancy over the past decades, thanks to improvements in living conditions, public health interventions and progress in medical care. While life expectancy in the United States used to be 1 ½ year above the OECD average in 1960, it is now, at 78 years in 2008, one year below the average of 79 years.
Higher life expectancy is generally associated with higher healthcare spending per person, although many other factors have an impact on life expectancy (such as living standards, lifestyles, education and environmental factors). Health spending accounted for 16% of GDP in the United States in 2008, by far the highest share in the OECD, and seven percentage points higher than the average of 9% in OECD countries. Following the United States were France, Switzerland and Germany, which allocated respectively 11.2%, 10.7% and 10.5% of their GDP to health.
The United States spent 7,538 USD on health per person in 2008, two-and-a-half times greater than the OECD average of 3,060 USD. Americans spent more than twice as much as relatively rich European countries such as France, Germany and the United Kingdom. The United States spends much more on health than any other OECD country on a per capita basis and as a share of GDP. This higher expenditure can only be partly explained by the high income level of US citizens. The extra $750bn that America spends on health more than expected is not due to greater ‘need’ due to aging or sickness, but instead to higher prices for medical goods and services.
Throughout the OECD, tobacco consumption and excessive weight gain remain two important risk factors for many chronic diseases.
In the United States, the proportion of adults who smoke daily has been cut by more than half over the past thirty years, falling from 33.5% in 1980 to 16.5% in 2008. This is the lowest rate among OECD countries after Sweden. Much of this decline can be attributed to policies aimed at reducing tobacco consumption through public awareness campaigns, advertising bans and increased taxation.
Soaring obesity rates make the US the fattest country in the OECD. Overweight and obesity rates have increased steadily since the 1980s in both men and women. In the United States, the obesity rate among adults - based on actual measures of height and weight - was 33.8% in 2008. This is the highest rate among OECD countries. Three out of four people are projected by the OECD to be overweight or obese within 10 years. 40% of American children are currently overweight. Of these, half are obese -- the highest rate in the OECD.
Childhood obesity rates have become relatively stable in the last ten years, suggesting that substantial further growth is unlikely and overweight rates in boys might even begin to fall. Still, obesity’s prevalence foreshadows increases in the occurrence of health problems (such as diabetes, cardiovascular diseases and asthma), and higher health care costs in the future.
When asked, "How is your health in general?", 88% of people in the United States reported to be in good health, much higher than the OECD average of 69%. Despite the subjective nature of this question, the answers have been found to be a good predictor of people’s future health care use.
Better Policies for Better Lives
Reduce inefficiencies in healthcare to reduce spending
In most countries, health spending is largely financed out of taxes or social security contributions, with private insurance or ‘out-of-pocket’ payments playing a significant but secondary role. This is not the case in the United States where the government plays the smallest role in financing health spending. The public share of health expenditure in the United States was 46.5% in 2008, much lower than the OECD average of 72.8%.
However, the level of health spending in the United States is so high that public (i.e. government) spending on health per person is greater than in all other OECD countries, excepting only Norway and Luxembourg. For this amount of public expenditure in the United States, government provides insurance coverage only for the elderly and disabled people (through Medicare) and some of the poor (through Medicaid and the State Children’s Health Insurance Program, SCHIP), whereas in most other OECD countries this is enough for government to provide universal primary health insurance. Public spending on health in the United States has been growing more rapidly than private spending since 1990, largely due to expansions in coverage.
Indicators
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