Health Care Spending in United States Reaction Paper

Health Care Spending in United States Reaction Paper Health Care Spending in United States Reaction Paper The purpose of this paper is to explore selected current information related to Advanced Practice Registered Nurse (APRN) / health care administration and health care policy, organization and financing. This is MY analysis/reaction/opinion of the conten t, thus it should NOT have any quotations from the article. papanicolas_2018_sc_180001__1_.pdf ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Health Care Spending in United States Reaction Paper. Clinical Review & Education JAMA | Special Communication Health Care Spending in the United States and Other High-Income Countries Irene Papanicolas, PhD; Liana R. Woskie, MSc; Ashish K. Jha, MD, MPH IMPORTANCE Health care spending in the United States is a major concern and is higher than in other high-income countries, but there is little evidence that efforts to reform US health care delivery have had a meaningful influence on controlling health care spending and costs. OBJECTIVE To compare potential drivers of spending, such as structural capacity and utilization, in the United States with those of 10 of the highest-income countries (United Kingdom, Canada, Germany, Australia, Japan, Sweden, France, the Netherlands, Switzerland, and Denmark) to gain insight into what the United States can learn from these nations. Viewpoint page 977 and Editorials pages 983, 986, 988, and 990 Animated Summary Video Supplemental content and Audio CME Quiz at jamanetwork.com/learning EVIDENCE Analysis of data primarily from 2013-2016 from key international organizations including the Organisation for Economic Co-operation and Development (OECD), comparing underlying differences in structural features, types of health care and social spending, and performance between the United States and 10 high-income countries. When data were not available for a given country or more accurate country-level estimates were available from sources other than the OECD, country-specific data sources were used. FINDINGS In 2016, the US spent 17.8% of its gross domestic product on health care, and spending in the other countries ranged from 9.6% (Australia) to 12.4% (Switzerland). The proportion of the population with health insurance was 90% in the US, lower than the other countries (range, 99%-100%), and the US had the highest proportion of private health insurance (55.3%). For some determinants of health such as smoking, the US ranked second lowest of the countries (11.4% of the US population ?15 years smokes daily; mean of all 11 countries, 16.6%), but the US had the highest percentage of adults who were overweight or obese at 70.1% (range for other countries, 23.8%-63.4%; mean of all 11 countries, 55.6%). Life expectancy in the US was the lowest of the 11 countries at 78.8 years (range for other countries, 80.7-83.9 years; mean of all 11 countries, 81.7 years), and infant mortality was the highest (5.8 deaths per 1000 live births in the US; 3.6 per 1000 for all 11 countries). The US did not differ substantially from the other countries in physician workforce (2.6 physicians per 1000; 43% primary care physicians), or nursing workforce (11.1 nurses per 1000). The US had comparable numbers of hospital beds (2.8 per 1000) but higher utilization of magnetic resonance imaging (118 per 1000) and computed tomography (245 per 1000) vs other countries. The US had similar rates of utilization (US discharges per 100 000 were 192 for acute myocardial infarction, 365 for pneumonia, 230 for chronic obstructive pulmonary disease; procedures per 100 000 were 204 for hip replacement, 226 for knee replacement, and 79 for coronary artery bypass graft surgery). NURS 6307Phoenix Health Care Spending in United States Reaction Paper Health Care Spending in United States Reaction Paper. Administrative costs of care (activities relating to planning, regulating, and managing health systems and services) accounted for 8% in the US vs a range of 1% to 3% in the other countries. For pharmaceutical costs, spending per capita was $1443 in the US vs a range of $466 to $939 in other countries. Salaries of physicians and nurses were higher in the US; for example, generalist physicians salaries were $218 173 in the US compared with a range of $86 607 to $154 126 in the other countries. CONCLUSIONS AND RELEVANCE The United States spent approximately twice as much as other high-income countries on medical care, yet utilization rates in the United States were largely similar to those in other nations. Prices of labor and goods, including pharmaceuticals, and administrative costs appeared to be the major drivers of the difference in overall cost between the United States and other high-income countries. As patients, physicians, policy makers, and legislators actively debate the future of the US health system, data such as these are needed to inform policy decisions. JAMA. 2018;319(10):1024-1039. doi:10.1001/jama.2018.1150 1024 Author Affiliations: Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts (Papanicolas, Woskie, Jha); Harvard Global Health Institute, Cambridge, Massachusetts (Papanicolas, Woskie, Jha); Department of Health Policy, London School of Economics and Political Science, London, England (Papanicolas, Woskie). Corresponding Author: Irene Papanicolas, PhD, Department of Health Policy, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, England (i.n.papanicolas @lse.ac.uk). (Reprinted) jama.com © 2018 American Medical Association. All rights reserved. Downloaded From: by a University of Texas – Rio Grande Valley User on 07/29/2018 Health Care Spending in the United States and Other High-Income Countries T he United States spends more per capita on health care than any other nation, substantially outpacing even other very high-income countries. 1,2 However, despite its higher spending, the United States performs poorly in areas such as health care coverage and health outcomes.3-5 Higher spending without commensurate improved health outcomes at the population level has been a strong impetus for health care reform in the United States.6 Although it is well known that the United States spends more on health care than other countries, less is known about what explains these differences. The consensus has been that the US fee-for-service system is a primary factor, 7 leading to fragmentation, overuse, and an underinvestment in social determinants of health, 8-10 JAMA.COM driving high utilization of health care services and poor outcomes. Older studies have found that the United States may underinvest in social services,11 although other data suggest that higher prices Animated Summary Video Health Care Spending in the in the United States, especially United States and Other for pharmaceuticals, may be High-Income Countries a contributor to spending differences. 12,13 One study suggested that increasing rates of outpatient spending and remuneration of clinicians is a major contributor to the cost difference between the United States and other countries. NURS 6307Phoenix Health Care Spending in United States Reaction Paper Health Care Spending in United States Reaction Paper. 14 Given that other high-income countries are able to spend less and achieve better health outcomes, a more nuanced, data-driven understanding of all aspects of health care cost are needed to assist in reform of the US health care system. The Organisation for Economic Co-operation and Development (OECD) and the Commonwealth Fund have recently collected and made available increasingly comparable data on inputs and performance of the health care systems across high-income countries. Using these and related data, we compared performance of the United States with 10 other high-income countries on key metrics that underpin health care spending. By examining granular data, we sought to understand why US health care costs are so much higher and where policy makers might target their efforts to encourage a more efficient system. + Methods Selection of Comparison Countries Ten high-income countries were selected for comparison. These countries were chosen because they were among the highestincome countries in the world, had relatively high health care spending, and had populations with similar demographic characteristics that have similar burdens of illness.3,15 Based on these criteria, the United Kingdom (consisting of England, Scotland, Wales, and Northern Ireland), Canada, Germany, Australia, Japan, Sweden, France, Denmark, the Netherlands, and Switzerland were chosen for comparison. These 10 selected countries represent different geographic areas and diverse health system structures. jama.com Special Communication Clinical Review & Education Key Points Question Why is health care spending in the United States so much greater than in other high-income countries? Findings In 2016, the United States spent nearly twice as much as 10 high-income countries on medical care and performed less well on many population health outcomes. Contrary to some explanations for high spending, social spending and health care utilization in the United States did not differ substantially from other high-income nations. Prices of labor and goods, including pharmaceuticals and devices, and administrative costs appeared to be the main drivers of the differences in spending. Meaning Efforts targeting utilization alone are unlikely to reduce the growth in health care spending in the United States; a more concerted effort to reduce prices and administrative costs is likely needed. Conceptual Framework and Indicator Selection To better understand the higher US health care costs relative to other high-income countries, a range of outcomes were explored. We first analyzed comparative data on general health system spending, including spending by function. Next, comparative inputs, including labor costs and structural capacity (which, aside from contributing to direct costs, may also influence maintenance costs or influence the price to use equipment) were examined. Because many of the leading explanations relating to higher health care costs involve the transformation of health care dollars to health care outcomes,16 we extended the analysis to examine a range of intermediate outputs—namely, access, utilization (inpatient, outpatient, major procedures), pharmaceutical spending and utilization, patient experience, and quality of care—as well as valued health system outcomes, such as population health. NURS 6307Phoenix Health Care Spending in United States Reaction Paper Health Care Spending in United States Reaction Paper. To provide a broader context of overall factors that can contribute to differences in health care spending, we also examined social spending, as well as demographic differences, risk factors, and prevalence of disease. In line with previous international comparisons, the health care system included all groups whose primary intent is to improve health.5,17 This approach resulted in the presentation of a total of 98 indicators across 7 domains: (1) general spending; (2) population health; (3) structural capacity; (4) utilization; (5) pharmaceuticals; (6) access and quality; and (7) equity. In each domain, measures were selected that were available across the majority of the countries in the analysis. We were unable to find comparable pricing data for most areas, such as for diagnostic procedures and treatments, except for workforce remuneration and pharmaceuticals. In the area of quality, the focus was on indicators that captured quality of prevention, primary care, and inpatient care across the areas of appropriateness, effectiveness, experience, and safety. In the area of access to care, variations related to financial costs as well as waiting times were explored. In addition, reflecting equity, variations related to service availability, quality of care, and cost were assessed. Data Sources Data were extracted from a range of databases compiled by international organizations, with the majority coming from the OECD. (Reprinted) JAMA March 13, 2018 Volume 319, Number 10 © 2018 American Medical Association. All rights reserved. Downloaded From: by a University of Texas – Rio Grande Valley User on 07/29/2018 1025 Clinical Review & Education Special Communication Health Care Spending in the United States and Other High-Income Countries Figure 1. Spending Rank (highest to lowest) General 1 2 3 4 5 6 7 8 9 10 11 Mean Overall population (in millions) US 323 Japan 127 Germany 83 UK 66 France 64 Canada 36 Australia 24 NLD 17 Sweden 10 CHE 8 Denmark 6 69 Population ?65 y, % Japan 25.1 Germany 21.4 Sweden 19.9 France 18.2 Denmark 18.1 CHE 17.5 UK 17.3 NLD 17.3 Canada 15.7 Australia 14.7 US 14.5 18.2 GDP per capita, US $ (in thousands) CHE 54.00 Denmark 53.40 US 52.10 Sweden 51.60 NLD 46.30 Australia 45.10 Germany 42.90 Canada 42.40 France 41.00 UK 38.50 Japan 37.50 45.90 Land area (× 1000 sq km) Canada 9985 US 9834 Australia 7741 France 549 Sweden 450 Japan 378 Germany 357 UK 244 Denmark 43 NLD 42 CHE 42 2697 Poverty rate, % below poverty line of 60% US 24 Japan 22 Canada 21 Australia 20 UK 18 Sweden 17 CHE 17 Germany 16 France 15 NLD 15 Denmark 12 18 Total spending on health, % of total national GDP US 17.8 CHE 12.4 Sweden 11.9 Germany 11.3 France 11 Japan 10.9 Denmark 10.8 NLD 10.5 Canada 10.3 UK 9.7 Australia 9.6 11.5 Public spending on health, % of total national GDP Sweden 10 NLD 9.5 Denmark 9.2 Germany 8.7 France 8.7 Japan 8.6 US 8.3 CHE 7.7 UK 7.6 Canada 7.4 Australia 6.3 8.4 Mean spending on health per capita, US $ US 9403 Sweden 6808 CHE 6787 Denmark 6463 NLD 5202 Germany 5182 Canada 4641 Australia 4357 Japan 3727 France 3661 UK 3377 5419 Health spending Health expenditure by function of care as a % of total national health expenditure Inpatient care NLD 32 Australia 31 France 30 CHE 28 Denmark 28 Germany 27 Japan 27 UK 24 Sweden 21 US 19 Canada 17 26 Outpatient care US 42 Australia 39 Canada 36 Denmark 34 CHE 33 Sweden 31 UK 30 Japan 27 Germany 23 France 23 NLD 22 31 Long-term care Sweden 26 NLD 26 Denmark 24 CHE 19 Japan 19 UK 18 Germany 16 Canada 14 France 11 US 5 Australia 2 16 Medical goods Germany 20 France 20 Canada 20 Japan 20 Australia 17 UK 15 US 14 CHE 13 Sweden 12 NLD 12 Denmark 10 16 Governance and administration US 8 Germany 5 NLD 4 CHE 4 Canada 3 Australia 3 UK 2 Sweden 2 Denmark 2 France 1 Japan 1 3 Home-based care France 4 US 3 UK 3 Japan 3 Germany 1 Sweden 0 NLD 0 Canada 0 Australia 0 CHE NA Denmark NA 2 Preventive care Canada 6 UK 5 NLD 4 US 3 Germany 3 Sweden 3 Denmark 3 Japan 3 France 2 CHE 2 Australia 2 3 Other France 9 US 6 Australia 6 Germany 5 Sweden 5 Canada 4 UK 3 CHE 1 Japan 1 NLD 0 Denmark 0 4 Population with health care coverage, % UK 100 Sweden 100 CHE 100 Denmark 100 Canada 100 Japan 100 Australia 100 France 99.9 NLD 99.9 Germany 99.8 US 90 99 GDP indicates gross domestic product; NA, not applicable. NURS 6307Phoenix Health Care Spending in United States Reaction Paper Health Care Spending in United States Reaction Paper. CHE indicates Switzerland; NLD, the Netherlands. See eTable 1 in Supplement 2 for data ordered by country. Data on structural equipment, workforce, utilization, pharmaceutical spending, access, and quality were accessed from OECD.stat and the OECD 2015 Health Care at a Glance report. Additional data on health spending, health system, and country characteristics were obtained from the World Bank International Bank for Reconstruction and Development–International Development Association database and the 2016 OECD Health Systems Characteristics Survey. Data on retail pharmaceutical spending per capita were obtained from the OECD for all countries. Data on total pharmaceutical spending per capita were obtained from Intercontinental Marketing Services or the International Federation of Pharmaceutical Manufacturers and Associations. Pharmaceutical data on country-level output of new chemical entities was taken from Daemmrich.18 Population perceptions of the health system and select access measures were obtained from the 2016 Commonwealth Fund Survey of Consumers.15 1026 All data on per capita spending, gross domestic product (GDP), and remuneration were translated into US dollar equivalents, with exchange rates based on purchasing power parities of national currencies. Remuneration data were then converted to 2017 dollars using the US Consumer Price Index in line with Laugesen and Glied.19 Data on health spending are presented by function of care as a percentage of the country’s total spending on health consistent with System of Health Accounts categorization, with adaptations for outpatient spending to address issues of comparability with the United States’ National Health Expenditure Accounts (eTable 2 in Supplement 1). When OECD data were not available for a given country or more accurate country-level estimates were available, country-specific data sources were used. The focus was on indicators from 2013 onward with an occasional exception. For example, for the United States, data for the horizontal index, neonatal mortality by low birth weight, and antibiotic prescribing were from 2009, 2004, and 2004, respectively. JAMA March 13, 2018 Volume 319, Number 10 (Reprinted) © 2018 American Medical Association. All rights reserved. Downloaded From: by a University of Texas – Rio Grande Valley User on 07/29/2018 jama.com Health Care Spending in the United States and Other High-Income Countries Special Communication Clinical Review & Education Figure 2. Health Spending as a Percentage of Gross Domestic Product 20 Spending on Health as a % of GDP 18 Total health spending Mean 16 Government health spending Mean Private health spending Mean 14 12 10 8 6 4 2 0 United States United Kingdom Germany Sweden France Supplement 1 includes tables that provide a breakdown of sources and methods for the data reported herein. In these tables, we note issues of comparability and timeliness for each indicator, such as workforce.NURS 6307Phoenix Health Care Spending in United States Reaction Paper In figures describing data for each of the 7 domains, a simple mean of the data for each indicator across all 11 countries is presented in the final column. Throughout the Results section in the text, all comparative findings are presented descriptively. Results Demographic Characteristics and Health Care Spending In 2016, the US population was significantly larger than all comparison countries at 323 million (Figure 1 and eTable 1 in Supplement 2). Japan had the next largest population with 127 million. The US system also covered the second largest geographical area (9 834 000 sq km), following Canada (9 985 000 sq km). The other countries other than Australia had much smaller land mass. In 2016, the United States spent 17.8% of its GDP on health care (range of the other countries, 9.6%-12.4%; mean of all 11 countries, 11.5%) (Figure 1 and Figure 2) and had almost double the health spending per capita (mean, $9403) compared with the other countries (range, $3377-$6808; mean of all 11 countries, $5419). Although the United States spent more, the percentage of the population with health insurance in the United States was 90%, lower than in all of the other countries (range, 99%-100%). All systems had relatively similar levels of public spending as a percentage of GDP (defined as spending from government and/or social or compulsory insurance funds), with the United States spending at about the mean level (8.3%) of all the countries, although, unlike the other countries, this spending covered only about 37% of the population. By expenditure as a function of care, the United States spent only 19% of its health spending on inpatient care, which excludes same-day hospital care. This proportion was less than that of all other countries, with Australia (31%) and the Netherlands (32%) spending the most (Figure 1). The United States spent a greater proportion than the other countries on outpatient care (44% compared with a mean of 31%) and governance and administration, which includes activities relating to planning, regulating, and managing health systems and services (8% compared with a mean of 3%). jama.com The Netherlands Switzerland Denmark Canada Japan Australia Across the 11 countries, the United States had the lowest percentage of the population older than 65 years (14.5% compared with a mean of 18.2%) and also had the highest rate of poverty, with 24% of the population living below the poverty line, followed by Japan (22%) and Canada (21%). The United States ranked below the mean but was not an outlier with regard to total social spending (spending on old age, incapacity, l … Purchase answer to see full attachment Student has agreed that all tutoring, explanations, and answers provided by the tutor will be used to help in the learning process and in accordance with Studypool’s honor code & terms of service . Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10