Reading, Writing, and Reflecting

This month, the Organisation for Economic Co-operation and Development (OECD) released a comprehensive health data report, comparing health care statistics across OECD countries.   Their website and study can be found here and an excel file with a sampling of their data is also available.     With the recent flurry around the Obama administration’s health care proposals, it feels like a good time to look at some of the more interesting data sets to me:

• Healthcare Spending as a % of GDP
• Doctor Consultations, Number per Capita
• Hospital Beds per 1000 Population

Healthcare spending as a % of GDP: 2006

Source: Organisation for Economic Co-operation and Development

Doctor Consultations, Number per Capita: 2006

Source: Organisation for Economic Co-operation and Development

Hospital Beds per 1000 Population:  2006

Source: Organisation for Economic Co-operation and Development

These three graphs highlight some key relationships amongst the sample countries:

• The US has the highest health care spend as a % of GDP at 16%, but is on the lower end of doctor consultations and number of hospital beds per capita.    This suggests the higher spending in the US isn’t necessarily related to volume of doctor visits and stays in hospital visits; but rather the cost per visit is likely higher than other countries.
• Interestingly, Japan has the highest number of doctor visits and hospital beds per capita, but at 8% of GDP, is half of the US level and lower than most of the European countries.   They’ve created a system which supports more visits, but clearly less expensive individual visits.
• European countries are fairly consistent in their level of GDP % but vary in doctor visits and hospital beds.

In this week’s Newsweek magazine, I read an article that provides some additional insight into how the culture and priorities of the US, Japan, and UK explain some of these data relationships.  Jacob Weisberg reviews the recently released book, The Healing of America, by TR Reid in his article We Are What We Treat, Fixing health care, American Style.  A noteworthy passage:

“In his new book The Healing of America, the journalist T. R. Reid employs a clever device for surveying the world’s health systems: he takes an old shoulder injury to various countries. In the United States, a top orthopedist recommends joint-replacement surgery, costing tens of thousands of dollars. In France and Germany, doctors steer him instead toward a regime of physical therapy. In Britain, they tell him to go home. In India, he is treated, quite effectively, with herbs, massage, and meditation……. the lesson I took away from his book was somewhat different: health-care systems are not just policy choices, but expressions of national character and values. The alternatives he describes work not just because they’re well designed but because they reflect the expectations and traditions of their societies.”

Weisberg goes on to write,

“All advanced, wealthy countries have health systems that are more egalitarian and cost-effective than ours (the US). Each also has its quirks, which reinforce familiar stereotypes. Britain, land of the stiff upper lip, provides what to us seems shockingly minimalist treatment. It doesn’t even cover regular physicals for adults, which is what you get when you spend 8 percent GDP on health care (versus our 16 percent). The Japanese, on the other hand, love doctors and visit them, on average, 14.5 times per year, three times the U.S. rate. They do this in an orderly, ritualized way, usual-ly bringing a bottle of sake or cash in an envelope as a gratuity.”

An interesting way to think about national health care policies and spending levels.   Figuring out the best type of reforms to the US health care policy will be difficult, but it may not be as simple as following a country that spends less than the US without considering both the national character of that country as well as tailoring the policies to the unique characteristics of the US.