Despite high healthcare spending, America is lagging in life expectancy

Despite spending a lot of money on healthcare, the United States continues to lag behind other nations when it comes to gains in life expectancy, according to a Commonwealth Fund-supported study published today as a Health Affairs Web First.

The study looked at health spending, behavioral risk factors like obesity and smoking and 15-year survival rates for men and women ages 45 and 65 in the United States and 12 other countries (Australia, Austria, Belgium, Canada, France, Germany, Italy, Japan, the Netherlands, Sweden, Switzerland, and the United Kingdom).

“It was shocking to see the U.S. falling behind other countries even as costs soared ahead of them,” said lead author Peter Muennig, assistant professor at Columbia University’s Mailman School of Public Health. “But what really surprised us was that all of the usual suspects – smoking, obesity, traffic accidents and homicides – are not the culprits."

"The U.S. doesn’t stand out as doing any worse in these areas than any of the other countries we studied, leading us to believe that failings in the U.S. healthcare system, such as costly specialized and fragmented care, are likely playing a large role in this relatively poor performance on improvements in life expectancy,” he added.

According to the study, while the United States has gained in 15-year survival rates decade-by-decade between 1975 and 2005, other countries have experienced even greater gains, leading the United States to slip in the rankings even as per capita healthcare spending increased at more than twice the rate of the comparison countries.

Fifteen-year survival rates for men and women ages 45 and 65 in the United States have fallen relative to the other 12 countries over the past 30 years. Forty-five-year-old U.S. white women fared the worst – by 2005 their 15-year survival rates were lower than that of all the other countries. The survival rates of this group in 2005 had not even surpassed the 1975 15-year survival rates for Swiss, Swedish, Dutch or Japanese women.

The United States’ ranking for 15-year life expectancy for 45-year-old men also declined, falling from third in 1975 to 12th in 2005, according to the study, “What Changes In Survival Rates Tell Us About U.S. Healthcare.”

The researchers say the nation's failure to make greater gains in survival rates despite spending more on healthcare may be attributable to flaws in the healthcare system. They point to the role of unregulated fee-for-service payments and the nation's reliance on specialty care as possible drivers of high spending without commensurate gains in life expectancy.

“This study provides stark evidence that the U.S. healthcare system has been failing Americans for years,” said Commonwealth Fund President Karen Davis. “It is unacceptable that the U.S. obtains so much less than should be expected from its unusually high spending on healthcare relative to other countries.”

“The good news is that the Affordable Care Act will take significant steps to improve our healthcare system and the health of Americans by expanding health insurance, improving primary care and holding healthcare organizations accountable for their patients’ overall health and ensuring the coordination of primary care and specialty care to eliminate errors, waste of patients’ time and wasteful duplication of tests and services,” she added.

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