It's widely known that U.S. health care costs exceed those of most other countries. But a Kaiser Family Foundation report released last week finds that the growth of U.S. health care costs continues to surpass similar countries at an astounding clip—roughly 4 percent a year since 1980.
According to the report, which compared spending in the 15 Organisation for Economic Co-operation and Development (OECD) countries that rank in the top three-fifths of per capita national income and aggregate national income, U.S. health care spending per capita reached $7,538 in 2008, while the average for all 15 surveyed countries was slightly under $4,000. Those costs accounted for 16 percent of U.S. G.D.P.; the second highest country was France, at 11.2 percent. The report noted that while increased GDP per capita is broadly linked with increased health spending, the U.S. is still an outlier compared with other wealthy countries.
Interestingly, while U.S. costs far exceed other countries, U.S. public expenditures on health care are broadly in line with the 14 other countries, coming in at only 0.2 percent above the average. U.S. private sector spending on health care costs, meanwhile, accounts for 8.5 percent of national GDP, roughly double the share of the second country on the list, Switzerland.
The report includes few assertions about why the U.S. situation is so different from other developed, industrialized countries with similar economies. However, the conclusion does point out that U.S. health care spending, while higher than most countries in 1970, 1980 and 1990 and 2000, didn't really begin to take off at atmospheric rates until after a "brief respite" in the 1990s—commonly attributed, though not in the report, to the rise and fall of HMOs and managed care.
Some health care experts are counting on ACOs to reprise the brief success of HMOs in curbing costs. Brent James, M.D., Chief Quality Officer for Intermountain Healthcare, told me at Intermountain's Clinical Quality and Accountable Care Seminar last month that he had some optimism that ACOs could serve as an improved version of managed care. That remains to be seen, of course, and plenty of skeptics have lined up on the other side of that issue.
Given the lead time for accurately surveying health care costs, we're probably at least a decade off from gleaning any insights into the impact of ACOs and, for that matter, any ACA provision, on overall costs. The Kaiser report, meanwhile, ends by sounding a mildly optimistic note that the gulf between U.S. health care costs and those of the rest of the developed world will finally lead to some national soul-searching.
"The growing difference between America's spending and other developed countries may encourage an examination of what people in the U.S. are getting for their healthcare dollar," the report concludes.
If and when the U.S. finally bends the health care cost curve, what will be the key driver? E-mail your prescription to firstname.lastname@example.org.Brent James Intermountain's Clinical Quality and Accountable Care Seminar bush 2011