U.S. Spends the Most on Health Care, Has Worst Health Outcomes

• by Carolyn Hendler, MD

• Published October 22, 2023
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Despite the United States spending twice as much money on health care, the health of Americans is worse than other high income nations in the Organization for Economic Cooperation and Development (OECD), according to a 2023 report by the Commonwealth Fund.¹ In 2021, the U.S. expenditure for health care was $11,912 per person. Germany was next on the list with $7,382 spent per person, and South Korea had the lowest expenditure per person at $3,914.²

The report looked in depth at the health care expenditures for twelve developed high income countries, including Canada, Australia, Japan, France, Germany, the Netherlands, New Zealand, South Korea, Sweden, Norway, Switzerland and the United Kingdom. Comparing the U.S. to the average of 38 high income countries in the OECD,³ the health of people living in the U.S. is the worst. The U.S. had the lowest life expectancy at birth; highest infant and maternal death rate; highest death rate from avoidable causes; highest obesity rate, along with the highest rate of multiple chronic diseases among these countries.⁴

One of the findings in the report is that Americans saw doctors less often than people did in other countries and spent more money when they did. Out of the 12 developed countries studied, the U.S. was the only one that did not have universal health care coverage. In 2021, it was estimated that about 8.6 percent of Americans did not have health care insurance.⁵

Health spending increased in all counties since the COVID-19 pandemic, but the cost increase was far higher in the U.S. In 2021, the U.S. spent 17.8 percent of gross domestic product (GDP) on health care. This is twice as much as Germany, which was the second highest spender, spending four times as much as South Korea, and twice as much as the average of all countries studied. Health spending includes public programs such as Medicaid, which includes the Children’s Health Insurance Program (Medicaid), private insurance, employer paid insurance and out of pocket spending.⁶

Americans Have Highest Infant and Maternal Mortality Rates and Lowest Life Expectancy

In 2020, life expectancy in the U.S. was 77 years, which is three times lower than the average of the countries. Avoidable deaths, which means that there is treatment and prevention available for the condition that caused the death, was the highest in the U.S compared to the other countries.

Maternal mortality rates in the U.S. continue to be the highest of all the countries studied with almost 24 deaths within a year after birth for every 100,000 live births. This is three times the rate of maternal deaths than in most of the other countries and 19 times the rate of the Netherlands.^{7 8} According to the Commonwealth Fund report, in 2020, the U.S. had an infant mortality rate of 5.4 infant deaths within a year of every 1,000 live births—the highest infant mortality rate of all countries studied.

U.S. Has Highest Rates of Chronic Illness

Obesity rates in the U.S. were nearly twice as high as the average of the other countries, which may play a role in the high rate of chronic illness among Americans, including diabetes, hypertension and cardiovascular disease.⁹ The report authors said that the U.S. has the third highest suicide rate, after South Korea and Japan, and added, “Elevated suicide rates, which have dramatically increased during the COVID-19 pandemic, can indicate a high burden of mental illness.”

Chronic disease has been increasing in the U.S. for decades and, in 2020, three out of 10 adults – or 30 percent – said they had been diagnosed with two or more types of chronic illness in their lifetime. Chronic illness conditions include cancer, asthma, diabetes, heart disease, hypertension, anxiety and depression.¹⁰ Only a quarter of the other countries reported similar rates of chronic poor health.¹¹

The U.S is the highest user of early detection techniques for cancer. Screening for breast and colorectal cancer were the highest of all the countries. The country also has one of the highest rates of influenza vaccine uptake, with two thirds of older Americans receiving the flu shot.¹²

Authors of the report suggested that the high spending on healthcare in the U.S. is due to elevated costs of health care; the higher cost of doctors and nurses compared to other countries; the high cost of prescription medication; lack of affordable care for all Americans,  and the failure to prevent and manage chronic illness.^{13 14}

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