Health
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 almost 79 years, slightly below the average of 80 years. Life expectancy for women is 81 years, compared with 76 for men, a slightly smaller gender difference than the OECD average gap of six years, with a life expectancy of 83 years for women and 77 for men.
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 accounts for 17.6% of GDP in the United States, by far the highest share in the OECD, and more than eight percentage points higher than the OECD average of 9.5%. The United States spent 8233 USD per person on health in 2010, two-and-a-half times the OECD average of 3268 USD, and the highest rate in the OECD. Between 2000 and 2009, total health spending in the United States increased in real terms by 4.3% per year on average, a slightly slower growth rate than the OECD average of 4.7%. This rate slowed down significantly to 2.7% in 2010.
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 15.1%, one of the lowest rates among OECD countries. Much of this decline can be attributed to policies aimed at reducing tobacco consumption through public awareness campaigns, advertising bans and increased taxation. In many OECD countries, large proportions of the population are overweight or obese. Soaring obesity rates make the US the fattest country in the OECD with 35.9% of adults found to be obese, more than double the OECD average rate of 17.8%. Overweight and obesity rates have increased steadily since the 1980s for both men and women. Furthermore, some 35% of US children are currently overweight or obese. 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?” 90% 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, answers have been found to be a good predictor of people’s future health care use. Gender, age and social status may affect answers to this question. On average in OECD countries, men are more likely to report good health than women, with an average of 71% for men and 66% for women. In the United States, the average is 90% for men and 89% for women. Not surprisingly, older people report poorer health, as do those who are unemployed, or who have less education or income. About 96% of the top 20% of the adult population in the United States rate their health as ‘good’ or ‘very good’, compared to about 74% for the bottom 20%.
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.
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