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Things vary by country. Here in the US, health care spending (measure $ per GDP) has been nearly twice the level of many other advanced nations while health ca

Things vary by country. Here in the US, health care spending (measure $ per GDP) has been nearly twice the level of many other advanced nations while health care been subpar and continues to decline compared to other nations. The reasons the US spends much and does so badly for its citizens are very complex in overall but one simplification that I think makes the inefficiency obvious is this; we have a full state sponsored system - medicare and etc as well as a full private health care system and they each cost money.

defrost 4y ago
I lived and worked in a number of countries, I'm Australian by birth and retirement. I once read a detailed an convincing argument that the US system had too many layers between sources of health care money (taxes + payments in private insurance) and end point (delivery of health care) with no incentive or structures to keep the middle ground lean and mean. ie. Way too many people and groups prifiting richly from the pipeline flow of healthcare money with too many lobbyists motivated to keep that status quo. It's not that the US has dual systems, more that they don't compete on outcomes but that the private system is motivated to increase profit and hamstring the public system.
- maxerickson 4y ago
  There's not really a public system (outside the military and IHS). The government acts as a payor into the private system (in many cases, driving a hard bargain where you want any of their money you have to take their prices for everything).
refurb 4y ago
Every time this comes up I share a link to the McKinsey study from 10 years ago. You can google it. It’s worth a read, it’s an insightful analysis. They basically adjust spending by GDP, then compare the US to other OCED nations, then split spending across a dozen categories of healthcare spending. The biggest cost driver? Out-patient procedures. It’s not just that it costs more (it does), but volume is way higher than other countries and one of the biggest drivers of the higher spending seen in the US. For in-hospital care, the US is marginally higher. Drug spending is higher, but it’s 50% more for 10% of spending, so marginal. It’s lower in durable equipment spend. And much higher in R&D spend, though the impact isn’t huge. Americans get a lot more out-patient procedures than other countries. That’s the biggest cost driver of US healthcare. Is it cost effective? Not sure that’s been answered yet.

defrost 4y ago

I lived and worked in a number of countries, I'm Australian by birth and retirement. I once read a detailed an convincing argument that the US system had too many layers between sources of health care money (taxes + payments in private insurance) and end point (delivery of health care) with no incentive or structures to keep the middle ground lean and mean. ie. Way too many people and groups prifiting richly from the pipeline flow of healthcare money with too many lobbyists motivated to keep that status quo. It's not that the US has dual systems, more that they don't compete on outcomes but that the private system is motivated to increase profit and hamstring the public system.

maxerickson 4y ago
There's not really a public system (outside the military and IHS). The government acts as a payor into the private system (in many cases, driving a hard bargain where you want any of their money you have to take their prices for everything).

refurb 4y ago

Every time this comes up I share a link to the McKinsey study from 10 years ago. You can google it. It’s worth a read, it’s an insightful analysis. They basically adjust spending by GDP, then compare the US to other OCED nations, then split spending across a dozen categories of healthcare spending. The biggest cost driver? Out-patient procedures. It’s not just that it costs more (it does), but volume is way higher than other countries and one of the biggest drivers of the higher spending seen in the US. For in-hospital care, the US is marginally higher. Drug spending is higher, but it’s 50% more for 10% of spending, so marginal. It’s lower in durable equipment spend. And much higher in R&D spend, though the impact isn’t huge. Americans get a lot more out-patient procedures than other countries. That’s the biggest cost driver of US healthcare. Is it cost effective? Not sure that’s been answered yet.