Expensive Healthcare Doesn’t Help Americans Live Longer

Among developed countries, a new report says, the U.S. ranks very low in translating health dollars into longer lives—particularly for women
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We already know American healthcare is pricey, much more so than that of other industrialized countries. But a new analysis published this week in the American Journal of Public Health points out that all that spending doesn’t translate to longer lives for Americans.

The results are particularly atrocious for women: Among the 27 industrialized nations studied, the United States ranks 25th when it comes to reducing women's deaths by spending more on healthcare.

Months of life expectancy gained from a $100 increase in health spending (AJPH)

The authors used data from Organization for Economic Cooperation and Development member countries collected between 1991 and 2007, and they performed a regression analysis while controlling for behavior and economic factors.

The result: Every additional $100 the U.S. spends on healthcare per person translated into a gain of less than half a month of life expectancy. In Germany, the best-performing nation, every additional $100 spent resulted in an additional four months of life.

In most of the countries, health spending boosted the life expectancy of men more so than that of women, and this was true in the U.S., as well. Jody Heymann, dean of the UCLA Fielding School of Public Health and one of the study’s authors, attributes this partly to the fact that women are more frequently misdiagnosed for certain conditions, and to the problem that, prior to a 1993 NIH mandate that women be included in clinical studies, most medical research was historically performed on male subjects.                               

But overall, the main reason the U.S. lags in longevity is that we spend far less on preventive measures than other countries do, Heymann said. Three-quarters of our healthcare spending goes toward treating chronic problems like diabetes and hypertension, and 45 percent of Americans have a chronic health condition.

“Diabetes expenditures, for example, have tripled in a generation,” she told me. “That has to do with how expensive it is to treat diabetes, but that also has to do with the dramatic increase in the number of people who have diabetes. We are doing little to make sure people have opportunities for physical activity, a decent diet—the things that would help with their risk of developing cancer and diabetes.”

“Prevention,” to Heymann, doesn’t just mean physicals and screenings. She points out that access to fresh food and “active” transportation, such as bike lanes, are sorely lacking in many parts of the country. In 2009, Time analyzed why the southern U.S. contains some of the most obese states in the nation and found that not only is there little public transportation in the South, it’s too hot to exercise outside for much of the year, there’s a dearth of sidewalks, and high poverty levels mean people tend to eat less-healthy food.

The better-performing nations in Heymann’s study have worked to reduce poverty, since being poor can worsen health outcomes. They also promote physical activity more aggressively, and they weave more prevention counseling, such as nutritionist appointments, into their medical systems.

There are obvious things the U.S. could be doing better, she says.

“When you put soda machines in high schools, it's bad for kids' health. Or when you subsidize corn syrup so that eating high-fructose foods is inexpensive,” she said. “There's a lot that could be done.”

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Olga Khazan is an associate editor at The Atlantic, where she covers health.

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