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Americans spend more, yet rate health lower than others do

Americans pay much more for health care, per capita, than citizens of other industrial democracies, yet are far more likely to describe their health as "fair" or "poor".
The Register-Guard
May 17, 2004

You get what you pay for, the old saw goes. But when it comes to health care, Americans are paying more and feeling worse than their counterparts in Canada and Europe, according to a new study published by a pair of Oregon researchers.

"We spend much more than any industrialized country on a per capita basis and we get much less in return," said report co-author Dr. Bentson McFarland of Oregon Health & Science University. "It's a terrible waste of resources and, of course, it's inequitable."

The report suggests that unequal and uncoordinated care is to blame.

McFarland and Portland State University's Mark Kaplan, the lead author, found that Americans spent $3,939 per capita on health care in 1997, compared with Canadians who spent $2,187 per capita and residents of European Union nations who spent $1,773 per capita.

The United States also outpaced other nations in health care spending as a percentage of gross domestic product: We spend 13 percent of our GDP on health care, compared with 9 percent in Canada and 8 percent in the European Union.

At the same time, Americans were far more likely to describe their own health as "fair" or "poor" than were Canadians and Europeans across nearly all age groups. Starting at age 30, Americans had a significantly higher prevalence of poor self-rated health than their Canadian and European counterparts; the disparity between health care spending and self-rated health increased with age.

The research confirms and complements earlier findings that show the United States, despite an expensive and technologically advanced health care system, lags behind its industrialized counterparts in major indicators of public health, including lower life expectancy at birth and higher maternal and infant mortality, as well as self-rated health.

The Oregon study is the first to conduct an international comparison of self-reported health status, which McFarland said is a powerful predictor of life expectancy.

The report, published in the June edition of the Journal of Epidemiology & Public Health, comes on the heels of Cover the Uninsured Week, a nonpartisan campaign to secure health coverage for every American.

An estimated 44 million Americans, including 8.5 million children and at least 20 million working Americans, have no health insurance, according to the Robert Wood Johnson Foundation.

About 511,000 Oregonians - one in seven - lack health insurance. The figure is likely to go up in July, when further reductions in the Oregon Health Plan are due to take effect, said Ken Rutledge, head of the Oregon Association of Hospitals and Health Systems.

Rutledge's group reported that while overall hospital admissions increased by less than 2 percent in the past year, the number of patients admitted without health insurance jumped by 39 percent.

It's a troubling trend, not only for Oregon hospitals and uninsured, but also for anyone who pays taxes, insurance premiums or medical bills, Rutledge said. Employers and people with insurance pay higher premiums and medical bills to cover the cost of treating the uninsured, he said.

The same trends can be seen nationally: Seven in 10 emergency physicians say the number of uninsured patients they treated in the past year increased, and eight in 10 say it's likely to increase in the coming year, according to a survey from the American College of Emergency Physicians conducted with support from the Johnson foundation.

The poll of nearly 2,000 physicians found overwhelming agreement that the uninsured patients they treat are more likely to delay care, suffer from illness, and put their physical and financial health in jeopardy than are patients with coverage.

Fifty-seven percent said providing basic health coverage to all Americans should be the No. 1 goal for improving the nation's health care system.

Several factors are at play here, McFarland said.

"For one thing, we have the most inequitable `health system' in the industrialized world," he said. "Poor people get terrible or no health care."

Another problem, he said, is that we spend our money foolishly.

"We spend too many dollars on expensive procedures that have little or no impact on overall health, and spend too few of our precious dollars on preventive, public health-oriented interventions."

Investment in simple, ordinary needs, such as child care, housing and nutrition, can go a long way in improving people's health.

Finally, it comes to a question of philosophy, he said.

"All the other industrialized countries see health care as a public utility, like fire protection and water," he said. "We've tried and failed for 50 years to see health care as a profit-making enterprise. We have to switch over to the public utility model."

Doing so is easier said than done with risk-averse politicians, he said.

"We have a system in which leaders devote themselves to avoiding issues that focus on public welfare," he said. "The focus of our politicians is on campaign contributions."

Marc Shapiro of Eugene, an advocate for universal health care, said he's not surprised by the latest findings that show a disparity in how health care is delivered in the United States.

"We have to deal with it," he said. "Virtually every study that's been done, all point in the same direction."

Lawmakers, he said, "have to come to grips with the fact we have a failed system and we need action."

The Associated Press contributed to this report.

Tim Christie can be reached at 338-2572.