Why Does Healthcare Cost So Much in the United States?

Different costs for the same procedure in 2009. Figures from the OECD.

Staying healthy in the United States is expensive. In fact, in 2009, the average annual cost of health care was $7,960 per person — two and a half times what it was in Japan for the same year.

That’s just one of the numbers that were pored over in the new report out by the Organization for Economic Cooperation and Development, which compared health care costs across all 34 of its members. The report illustrates significant variation between costs in different countries.

But there were also some commonalities. Health spending has grown more quickly than GDP in the last decade in all of the member countries, except in Luxembourg.

And, Health at a Glance 2011 shows that obesity rates have doubled or even tripled in many countries since 1980. In more than half of OECD countries, 50 percent or more of the population is now overweight, if not obese. The obesity rate in the adult population is highest in the United States — rising from 15 percent in 1980 to 34 percent in 2008 — and lowest in Japan and South Korea, at 4 percent.

Graphic courtesy: OECD

The differences in cost of health care aren’t anything new. Frontline produced a documentary on the subject, “Sick Around the World” in 2008, which you can view here.

So what are some of the reasons that health care costs more in the United States? Are we healthier because of it?

PBS Newshour posed a few of these key questions to Matthias Rumpf from the OECD earlier this week. Answers were edited for space and clarity.

NEWSHOUR: From an international perspective, why are health care costs in the United States so much higher than any other OECD country?

MATTHIAS: High spending by the U.S. on health must either be because the price of healthcare is higher than in other countries, or else because it provides more health activities than other countries, or a combination of the two. Evidence suggests that both factors are important, but particularly prices. The same set of hospital interventions (including the normal delivery of a baby, a Caesarean section, a hip or knee replacement, etc.) cost 60 percent more in the United States than in a selection of other countries. Similarly, 50 high-selling pharmaceuticals cost 60 percent more in the United States than in Europe. But the United States also uses a lot of expensive diagnostic tests, such as MRI and CT scans, and performs a lot of interventions where it is not always clear-cut whether the procedure is necessary or not — tonsillectomies, knee replacements, and so on. On the other hand, perhaps surprisingly, the U.S. does not have many doctors relative to its population, not many hospital beds, and people do not spend long in hospital when they have to be admitted. Overall, therefore, high prices are the main reason for high health care spending in the United States.

NEWSHOUR: In which areas is the U.S. particularly lacking?

MATTHIAS: The primary care system — the network of family doctors and clinics that people can go to when they first think they have a health problem, and that can advise people on how to stay healthy — is underdeveloped in the United States. This is bad for people’s health, but also raises overall costs. For example, most people with diabetes, asthma or difficulties in breathing (COPD) should not need to be treated in hospital. They require monitoring, but this does not need to happen in hospitals, it is something that the primary care system should manage. It is far cheaper for a family doctor to check that people are following their treatment properly and that it is appropriate, than for things to go wrong and someone to be admitted to hospital as an emergency. Greater attention to the primary care system is urgently needed in the United States.

NEWSHOUR: Does the U.S. provide too much health care?

MATTHIAS: It is almost impossible to say this definitively. Only a physician can really judge the needs of his patients. However, there are reasons to be concerned. The number of tonsillectomies, knee replacements, hip replacements, coronary grafts, Caesarian sections, MRI and CT diagnostic tests and several other areas are much higher in the United States than in most other countries. These are procedures where it is not always definite that they should take place — it is up to the physician and the patient to decide what is best. In countries where there is a greater stress on controlling costs, and different tort law rules, there are fewer such interventions. It is probable that the medical culture in the United States is more likely to ‘do something’ than in other countries — yet overall health outcomes are not better in the United States.

NEWSHOUR: How do Americans compare with other nations in terms of general health?

MATTHIAS: The United States has the highest proportion of adults — 90 percent — reporting that they are in good health, far above the OECD average of 69 percent.

Yet, life expectancy is lower than the OECD average, at 78.2 years compared to 79.5, in 2009. This is despite the United States being a rich country and spending so much on health care. It also has a large rate of premature mortality — people dying before the age of 70 – at 50 percent higher than the OECD average for females, and 30 percent higher for males. Not all of this is due to the healthcare system of course. For instance, there is not much that the health care system can do to prevent deaths from traffic accidents or homicides.

In the United States as in other countries, there are important disparities in health status across different population groups, defined by race or by socioeconomic status. For example, the life expectancy at age 25 for people with the lowest level of education compared with the highest level of education in the United States is 11-16 years less for men and 10-12 less for women. A range of interventions, including some related to the health care system and other broader measures of population health and prevention, are needed to reduce these disparities.

Infant mortality is another indicator that has traditionally been used to gauge both the performance of the health care system and broader socioeconomic factors. Rates are generally low in OECD countries. However the U.S. rate, at 6.5 deaths per 1000 live births, is well above the OECD average of 4.4.

NEWSHOUR: Has the U.S. always been more expensive in terms of health care? If not, when did things start changing?

MATTHIAS: Health expenditure as a share of GDP in the U.S. has always been higher than the OECD average, but the gap has widened a lot in recent decades. Some countries have had similar shares in the past — Canada in the 1960s — but since 1970, the U.S. has outstripped all other high-income OECD countries, with a five-fold increase in health spending per capita in real terms. Health expenditure as a share of GDP was 40 percent higher than the OECD average in 1970. It is now 80 percent higher.

NEWSHOUR: Can we learn from other countries that have brought down costs?

MATTHIAS: No countries have brought down costs — health care costs are rising everywhere (with the occasional year-to-year variation), so the real issue is whether other countries are providing good quality care at lower costs than the United States. A few things are common to the high-performing health systems:

  • An emphasis on primary care, to ensure that most care takes place outside of (expensive) hospitals
  • A system which encourages use of (cheaper) generic drugs, when there are alternatives to expensive brands
  • Tight regulations of prices and fees, for at least those services that are paid for by public programs
  • Adherence to clinical guidelines, so that excessive use of expensive diagnostics or unnecessary health care is prevented

It’s also important to note that talking about ‘the United States’ is misleading. Some of the health care provided in the United States has more in common with the ‘national health service’ model of national provision of integrated care — the Veterans Administration, for example. Some of the health care provided by the VA, and indeed in the private sector, is probably the best in the world. Some other health care is, however, poor. The variation is enormous, and talking about averages sometimes confuses people.

After all, many people in the United States probably think that publicly-owned and operated health care is necessarily unresponsive to people’s wishes and the staff are undermotivated.

This can indeed happen, but is far from being the general rule in many OECD countries, who have efficient, well-financed, responsive health care systems — but at much lower cost than in the United States.

NEWSHOUR: Are there any health care areas in which the U.S. system is faring better than other countries?

MATTHIAS: When we look at the quality of cancer care, the United States stands out as having excellent results. Screening rates for breast and cervical cancer are excellent, so problems can be diagnosed early on. Your chances of living five years after being diagnosed with breast cancer, or cervical cancer, or indeed several other cancers, are better in the United States than almost anywhere else in the world.

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Posted: December 6th, 2011 | Author: | Under: Health & Medicine | Tags: , , , , , , ,

8 Startups That Are Shaking Up The Healthcare Industry

Health care is one of the most searched topics on the Internet. From questions about which plan is best for you, to information about different medical conditions, the Web is often the first place people turn for answers.

Check out these eight startups that are revolutionizing the way we understand and utilize our health care to make life a little easier.

1. stickk

With its roots beginning at Yale University, stickK co-founder Dean Karlan noticed a need for accountability when it came to personal health. Karlan himself fell victim to the habit of setting weight-loss goals and never seeing them through. After entering into a financial contract with a friend to lose 38 pounds each, Karlan realized the true power of accountability. With major money on the line and an added ‘no negotiation’ clause, both men found themselves 38 pounds lighter at the end of their trial. Inspired by his success, Karlan wanted to share his newfound “Commitment Contracts” with the world.

So, how exactly do these contracts work? You begin your contract by setting a personal goal. This goal can be anything from shedding some unwanted pounds to quitting a bad habit, such as smoking. Once you set your goal, you can add financial incentives—deciding where you want your money to go, should you fail. Then comes your referee. Users can designate a friend to be their personal goal monitor—who reports back to stickK on your progress. Finally, you can select supporters to cheer you on in your commitment to personal health.

2. ZocDoc

In 2007, ZocDoc was created to provide the citizens of New York with a way to make dentist appointments online. Four years later, it has evolved into a Web site that now serves 12 major cities in the U.S and over 60 fields of expertise. ZocDoc allows users to search by medical specialty, along with your insurance provider and zip code. With one click, all of the doctors in the selected field in your area and insurance network are visible—along with their available appointments. By clicking on an appointment time, you can actually book the appointment on the spot.

ZocDoc continues to be at the forefront of this technology—even adding an app for your phone. They also produce a blog that offers information on everything from different medical conditions to healthy lifestyle practices.

3. Cake Health

If you ask the average person to explain a hospital bill or insurance plan in depth, the answer you’ll often receive is a blank stare. Medical bills and insurance paperwork are the bane of most patients’ existence. That’s exactly what Rebecca Woodcock, co-founder of Cake Health, grew tired of after watching a friend find herself in financial and unnecessary trouble due to a medical condition.

Cake Health offers users a way to track, organize and understand their medical bills and insurance policies. Once you enter your health care information into your personal and secure account, you are able to see exactly where your money is going and even track your deductibles and claims history. Cake Health also offers users alerts and reminders for things like possible overcharges, reaching your deductible and prescription refills.

4. One Medical Group

One Medical Group believes in more quality time with your doctor and less time in the waiting room. Founded by Dr. Tom X. Lee, One Medical caters to an atmosphere of hospitality. Much like with a concierge doctor, patients are given the time and care not often seen in today’s medical offices.

With locations in San Francisco, D.C. and New York, One Medical is changing the way patients interact with their doctors. The practitioners see, at a maximum, 16 patients per day—about 9 less than the average doctor. This allows patients more quality time with their doctors. Patients can also log in to their personal account to book same-day appointments, view medical records and even refill prescriptions—saving an extra trip to the doctor. One Medical also allows patients to email their doctor directly with questions and even treatment updates.

5. RedBrick Health

A health technology and services company, RedBrick Health is leading the health care industry to Consumer-Owned health. This concept allows employers to promote wellness in their company, as they guide their employees to take ownership of their personal health.

RedBrick offers personal wellness programs—such as biometric health screenings—to employers looking to decrease their insurance costs. These programs reward healthy behavior in employees while also promoting long-term healthy lifestyle choices. They believe healthier employees increase productivity in the workplace. RedBrick stands by their mission to help people live the fullest and healthiest lives they can possibly live.

6. Avado

With products for both the provider and patient sectors, Avado is changing the way doctors run their practices—making visits easier on their patients. Their Patient Relationship Management (PRM) system offers a way to effectively engage in a partnership with their patients. The PRM allows doctors to send patients reminders to take their vitals, perform their physical therapy and even reminders to take their medicine.

Avado allows patients to have a true relationship with their physicians, and at the same time, feel like they have a voice with their personal health care. Avado’s PRM system is a great way for patients to record and track their health history by uploading their vital statistics. This tool is not only helpful to individuals, but to families in need of organization when it comes to their medical needs.

7. Bloom Health

With a vested interest in both employers and their employees, Bloom Health is changing the way you can choose health insurance. Bloom Health offers employers a way to give their employees options when it comes to health care.

How does it work? Employers offer a defined amount of money toward each employee, and through Bloom Health’s personality report, individuals can choose which plan suits them best. After taking a quiz, employees are given the best insurance plans based on their individualized results. Next, they can compare and contrast plans against what they currently have. Should the employee choose a different plan, Bloom Health takes care of the application process with one click.

8. Sharecare

Realizing the educational power of the Internet, Dr. Mehmet Oz and Jeff Arnold created Sharecare—an interactive Q&A platform to provide quality health care information to the public. Sharecare gives people clear and concise information about their health, all in one place.

Renowned doctors, expert researchers and leading medical professionals come together to offer the most current treatment options, wellness advice, nutrition information and much more. Commercial brands answer questions about their products, so users can make an informed decision about their well-being.

Sharecare established an Advisory Board, hosting the finest medical professionals in the industry. They represent the different areas of medical expertise and are committed to consumer health education. Sharecare also has an A-Z reference library for many medical topics. Simply type in a question and get instant answers from top medical professionals around the world.

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Posted: October 23rd, 2011 | Author: | Under: Health & Medicine, Technology | Tags: , , , , , , , , ,

Groupon + Doctors = Legal?

Groupon and other similar social sites, like Living Social and CoupTessa, are all the rage now.  But is it legal for doctors and dentists to advertise their services on these websites?

Groupon is a deal-of-the-day website that features discounted gift certificates usable at local or national companies.  If a certain number of people sign up for the offer, then the deal becomes available to all; if the predetermined minimum is not met, no one gets the deal that day. It is said that this reduces risk for retailers, who can treat the coupons as quantity discounts as well as sales promotion tools. Groupon makes money by keeping approximately half the money the customer pays for the coupon.

Some doctors see Groupon as just another marketing opportunity and offer discounts on elective or cosmetic procedures like liposuction and veneers. Others have rejected it as an unprofitable. Still others view advertisement on social sites that require customers to prepay for services as borderline unethical, citing concerns that there is additional pressure for patients to go through with a procedure when they are having second thoughts.

So is it thumbs-up or thumbs-down for Groupon?

While there is no definitive answer to that question, the rumblings emerging from medical societies and healthcare lawyers that have looked at the issue lean towards thumbs-down.

According to Sun Sentinel, “because the websites keep as much as half of the patient’s payment … the online discounts could be interpreted as the practitioners splitting their fees” which is a no-no under many state laws or regulations prohibiting the “corporate practice of medicine.”  Furthermore, Groupon’s fee can also be construed as “paying kickbacks to find new patients,” which is a serious offense under federal and most state laws.

Medicare, American Medical Association, and other medical trade groups have not yet taken a position on this issue. Two medical boards in Oregon, however, banned dentists and chiropractors from giving Groupon-style discounts. Also, the Palm Beach County Medical Society has recently warned members about Groupon advertising “because the issue is still in doubt,” reported Sun Sentinel.

While the domestic reaction to social coupons for healthcare services has been somewhat modest, across the Atlantic at least one medical society, the British Association of Aesthetic Plastic Surgeons, has strongly condemned the practice of marketing of serious medical procedures such as breast augmentation and nose jobs on discount websites. The Association’s former President, Adam Searle, expressed his disapproval, in part, as follows:

This trivialisation and commoditization of medical procedures is appalling. It seems to have come down to the level of loyalty cards, money-off vouchers, and even competition prizes. This belittling of the seriousness of undertaking a medical procedure degrades not only our specialty but also the medical profession as a whole.

Another former president of the British Association of Aesthetic Plastic Surgeons also stated, in part, as follows:

Selling surgical procedures without patients being first assessed for suitability is highly unethical and goes against every guideline and recommendation from the General Medical Council and the surgical associations.

For now, however, since the jury is still out, caveat venditor.

(Taken from KevinMd.com)

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Posted: October 21st, 2011 | Author: | Under: Health & Medicine, Viewpoints | Tags: , , , , , , ,

FDA favors Orphan Drugs

Over the last few years there’s been a big increase in Big Pharma’s interest in rare diseases. With Genzyme’s success with drugs like Myozyme helping light the way, giants like GlaxoSmithKline, Pfizer, Merck and Novartis have been organizing their own rare disease drug shops. And the FDA’s more flexible attitude in how it judges the data from clinical trials for these drugs – as well as the 7 years of marketing exclusivity they earn along with some hefty tax credits – hasn’t hurt.

In a new study, the National Organization for Rare Diseases decided to put the FDA’s professed flexibility to the test, examining 135 non-cancer orphan drugs which had been approved by the agency. And the FDA comes out with a clap on the back, earning NORD’s seal of approval for being willing to demonstrate its flexibility in 90 of those rare drug programs. Writes NORD: “The study supports the FDA assertion that it exercises flexibility when reviewing applications for orphan drugs.”

The study also notes that the FDA can demonstrate its flexibility in a number of ways, most notably by regulators’ willingness to accept a far more limited set of clinical trial data for an orphan drug, including instances where a single trial was enough to warrant an approval. In 58 cases regulators were willing to customize the approval process to the therapy.

The Wall Street Journal notes that not everyone is happy with the FDA’s approach to these orphan drugs. Public Citizen’s Sidney Wolfe, an outspoken critic of the pharma industry, had this to say: “There are all kinds of other benefits already written into law. Why should the standard of approval be different if you have a rare disease than for non-rare diseases?”

NORD does want the FDA to go a step further in spelling out its approach to orphan indications.

“It is time for that policy to be clearly enunciated as a formal FDA policy, and for FDA medical reviewers to incorporate and recognize this flexibility in a systematic way into their evaluations of each new therapy in development and under FDA review for Americans with any rare disease.”

– see the study from NORD
– read the article from The Wall Street Journal

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Posted: October 18th, 2011 | Author: | Under: Health & Medicine | Tags: , , , , , , , , , ,

Video Games = Cure for AIDS?

Who would have imagined that video-game players would solve a molecular puzzle that has baffled scientists for years?!!


Taken from MSNBC:

Video-game players have solved a molecular puzzle that stumped scientists for years, and those scientists say the accomplishment could point the way to crowdsourced cures for AIDS and other diseases.

“This is one small piece of the puzzle in being able to help with AIDS,” Firas Khatib, a biochemist at the University of Washington, told me. Khatib is the lead author of a research paper on the project, published today by Nature Structural & Molecular Biology.

The feat, which was accomplished using a collaborative online game called Foldit, is also one giant leap for citizen science — a burgeoning field that enlists Internet users to look for alien planetsdecipher ancient texts and do other scientific tasks that sheer computer power can’t accomplish as easily.

“People have spatial reasoning skills, something computers are not yet good at,” Seth Cooper, a UW computer scientist who is Foldit’s lead designer and developer, explained in a news release.To play games online provide a framework for bringing together the strengths of computers and humans.”

Click here to read more about it.

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Posted: September 19th, 2011 | Author: | Under: Health & Medicine, Technology | Tags: , , , , , , ,