How does the health care system in the US differ from the system in other developed countries?

As Republicans decide what to do with the current healthcare policy, nearly 26 million Americans remain without insurance – and that number could soon rise

Despite US legislation in 2010 that moved the country closer to achieving universal healthcare, costs have continued to rise and nearly 26 million Americans are still uninsured according to the Congressional Budget Office.

As Republicans decide whether to repeal or replace the struggling healthcare policy, how does the existing US healthcare system compare with those in other countries?

Broadly speaking, the World Health Organization (WHO) defines universal health coverage as a system where everyone has access to quality health services and is protected against financial risk incurred while accessing care.

A brief history of the healthcare systems used today

Among the 35 OECD member countries, 32 have now introduced universal healthcare legislation that resembles the WHO criteria.

In Germany, the world’s first national health insurance system shows how UHC often evolves from an initial law. Originally for industrial labourers, cover gradually expanded to cover all job sectors and social groups, with today’s German workers contributing around 15% of their monthly salary, half paid by employers, to public sickness funds.

Established in 1948 to be free at the point of use, the UK’s NHS has almost totemic status for Britain’s rising, ageing population who scrutinise it like perhaps no other policy area. While care from GP services to major surgery remains free as intended, the system is under unprecedented financial strain from a funding gap estimated to be in the billions.

Under France’s state-run equivalent of the UK’s NHS, the majority of patients must pay the doctor or practitioner upfront. The state then reimburses them in part or in full. Workers make compulsory payments into state funds used to reimburse between 70% and 100% of the upfront fees, while many people pay into other schemes to cover the balance.

In the mid-1960s, the United States implemented insurance programs called Medicare and Medicaid for segments of the population including low income and elderly adults. In 2010, Obamacare became the closest the US has come to a system of UHC. A legal mandate now requires all Americans to have insurance or pay a penalty. About 26 million people remain without health insurance despite these advances.

Spending compared with life expectancy

Life expectancy in the US is still lower than other developed countries, despite health funding increasing at a much faster pace.

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Who provides healthcare and how is it paid for?

How healthcare is funded has a direct effect on the level of healthcare people have access to.

How could the US healthcare system change?

Donald Trump ran on a campaign to repeal and replace the Affordable Care Act, popularly known as Obamacare, but discord among Republicans has highlighted the political challenges faced with implementing a healthcare system, much less trying to change it.

With millions still uninsured and the financial burden of healthcare still quite high, the current US policy falls short of the WHO threshold.

Thus far, separate bills introduced in the House and the Senate were estimated to see steep increases in the number of uninsured from current levels.

Estimated uninsured under existing and proposed healthcare plans

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Americans on average continue to spend much more for health care—while getting less care—than people in other developed countries

The United States, on a per capita basis, spends much more on health care than other developed countries; the chief reason is not greater health care utilization, but higher prices, according to a study from a team led by a Johns Hopkins Bloomberg School of Public Health researcher.

The paper appears in the January issue of Health Affairs.

The researchers determined that the higher overall health care spending in the U.S. was due mainly to higher prices—including higher drug prices, higher salaries for doctors and nurses, higher hospital administration costs and higher prices for many medical services.

The paper finds that the U.S. remains an outlier in terms of per capita health care spending, which was $9,892 in 2016. That amount was about 25 percent higher than second-place Switzerland’s $7,919. It was also 108 percent higher than Canada’s $4,753, and 145 percent higher than the Organization for Economic Cooperation and Development (OECD) median of $4,033. And it was more than double the $4,559 the U.S. spent per capita on health care in 2000—the year whose data the researchers analyzed for a 2003 study.

The researchers, along with the late Princeton health care economist Uwe Reinhardt, who died in 2017, came to the same conclusion in their well-known 2003 study, “It's the prices, stupid: why the United States is so different from other countries.” The new analysis is in part a tribute to the late Reinhardt.

“In spite of all the efforts in the U.S. to control health spending over the past 25 years, the story remains the same—the U.S. remains the most expensive because of the prices the U.S pays for health services,” says lead author Gerard F. Anderson, PhD, a professor in the Bloomberg School’s Department of Health Policy and Management. 

Both studies were based on an analysis of health care use and spending in the U.S. and the other industrialized countries that are members of the OECD. The updated study was co-authored by Peter Hussey, PhD, vice president of the RAND Corporation and Dean Varduhi Petrosyan, PhD, of the American University of Armenia.

Anderson and his colleagues noticed one big difference between 2003 and 2016: a widening of the gap between what public insurers and private insurers pay for the same health care services. In order to lower per capita health care spending, the authors recommend that the U.S. should focus on what private insurers and self-insured corporations pay, since they pay significantly more than public insurers.

The researchers also found that health spending in the U.S. has been growing faster than the other OECD countries in spite of efforts to control spending in the U.S. Overall U.S. health spending increased at an average rate of 2.8 percent annually between 2000 and 2016, which is greater than the OECD median annual increase of 2.6 percent. Per capita, inflation-adjusted spending on pharmaceuticals also increased much more quickly in the U.S.—at a rate of 3.8 percent per year, compared to just 1.1 percent for the OECD median.

During the same period, U.S. gross domestic product (GDP) per capita increased by only 0.9 percent annually, which means that health care continues to represent a larger share of GDP. U.S. health care spending in 2016 totaled 17.2 percent of GDP, compared to just 8.9 percent for the OECD median.

Not only does the U.S outspend other OECD countries, on the whole it has less access to many health care resources. The researchers found that in 2015, the most recent year for which data were available in the U.S., there were only 7.9 practicing nurses and 2.6 practicing physicians per 1,000 population, compared to the OECD medians of 9.9 nurses and 3.2 physicians.

Similarly, the U.S. in 2015 had only 7.5 new medical school graduates per 100,000 population, compared to the OECD median of 12.1, and just 2.5 acute care hospital beds per 1,000 population compared to the OECD median of 3.4.

Although the U.S. ranked second in the numbers of MRI machines per capita and third in the numbers of CT scanners per capita—implying a relatively high use of these expensive resources—Japan ranked first in both categories, yet was among the lowest overall health care spenders in the OECD in 2016.

“It’s not that we’re getting more; it’s that we’re paying much more,” Anderson says.

“It’s Still The Prices, Stupid: Why The US Spends So Much On Health Care, And A Tribute To Uwe Reinhardt,” was written by Gerard Anderson, Peter Hussey and Varduhi Petrosyan.

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Media contacts for the Johns Hopkins Bloomberg School of Public Health: Barbara Benham at 410-614-6029 or  and Robin Scullin at 410-955-7619 or .

How do healthcare systems differ around the world?

Around the world, health-care systems differ widely. Countries adopt different systems to provide health care to their citizens, with different levels of government and private sector involvement. The crucial result is that the services exist—and that people can access and afford them.

What are the differences in the healthcare system of developed and developing nations?

A conventional medical doctor might prescribe a medication to lower blood pressure. A naturopathic healer may suggest diet and exercise changes or herbal remedies. One of the biggest differences between developed and developing countries is resources, including money, infrastructure, people, education, and products.

How does the US healthcare system differ from the UK healthcare system?

In the UK, a national system of healthcare, paid for by all citizens through taxes, provides a universal safety net. The US has settled for a complicated mix of private insurance and government subsidized programmes, often managed by private companies. The result is not just whether one has or does not have insurance.

Does the US have the best health care compared to other countries?

The U.S. ranks last in a measure of health care access and quality, indicating higher rates of amenable mortality than peer countries.