The US was one of the few countries in which less than 50% of health care costs were publicly financed.
Nonetheless, health care spending was so high in the US that US public funds, as well as private funds, for
health care were among the highest of the 34 countries.
Despite its high health care costs, the US had 2.5 practicing physicians per 1000 population, below the average
for all 34 countries of 3.2/1000. The US, however, had a higher level of nurses/1000 population than the
combined average for the 34 countries (11.1/1000 vs. 8.7/1000).
The US had fewer hospital beds than the average for the combined 34 countries (3.1 beds/1000 population vs.
4.8 beds/1000), but ranked higher than average in availability of medical technology (e.g., computed
tomography).
The ACA mandates some reductions in out-of-pocket costs and in health care delivery reforms, but it is possible that
the greatest long-term cost savings may come from its encouragement of primary prevention services and programs.
According to 2002 data from the US Medical Expenditure Panel Survey, 5% of the population accounted for 49% of
total health care expenses. Individuals with multiple chronic conditions (some of which may be preventable)
accounted for 44% of total health care expenses.
10
Conclusion
The intent of the ACA is to reform how insurance and health systems work to ultimately improve health care access,
quality, and individual and public cost. If successful, the ACA has the potential to improve individual health and,
ultimately, population health. Compared with other countries, the US has a much stronger focus on diagnostic and
treatment-related technology than on primary prevention.
8.9
Many believe that this focus has translated into our high
rates of potentially preventable causes of morbidity and mortality, such as obesity,
7
and explains our poor
international ranking in infant survival
5
and in life expectancy.
6
We also have deep social disparities in health
outcomes.
4
Such disparities have complex etiologies that may not have been completely addressed by medical care,
which is why the ACA’s strong endorsement of primary prevention public health efforts may have the long-term
effect of reduced disparate health outcomes among economically and socially vulnerable citizens.
REFERENCES
1
Democrats. Issues: health care. Available at: http://www.democrats.org/issues/health_care.
2
GOP. Repealing Obamacare. Available at: http://www.gop.com/2012-republican-platform_renewing/#Item6
3
American Public Health Association. Why do we need the Affordable Care Act? April 2013. Available at:
http://www.apha.org/advocacy/Health+Reform/ACAbasics/.
4
U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. National Healthcare Disparities Report,
2012. Available at: http://www.ahrq.gov/research/findings/nhqrdr/nhdr12/nhdr12_prov.pdf
5
Central Intelligence Agency. The world factbook. 2013 estimates of infant mortality rates worldwide. Available at:
https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html
6
Central Intelligence Agency. The world factbook. Life expectancy at birth. Available at: https://www.cia.gov/library/publications/the-
world-factbook/rankorder/2102rank.html.
7
Nardin R, Zallman L, McCormick D, et al. The uninsured after implementation of the Affordable Care Act: a demographic and geographic
analysis. Available at: http://healthaffairs.org/blog/2013/06/06/the-uninsured-after-implementation-of-the-affordable-care-act-a-
demographic-and-geographic-analysis/
8
Commonwealth Fund. International Profiles of Healthcare Systems, 2012.
http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2012/Nov/1645_Squires_intl_profiles_hlt_care_systems_
2012.pdf
9
The Organisation for Economic Co-operation and Development. OECD health data 2013. How does the United States compare?
Available at: http://www.oecd.org/unitedstates/Briefing-Note-USA-2013.pdf
10
Stanton MW, Rutherford MK. The high concentration of US health care expenditures. Research in Action Issue 2006;19. Rockville
(MD): Agency for Healthcare Research and Quality. AHRQ Pub. No.06-0060. Available at:
http://www.ahrq.gov/legacy/research/ria19/expendria.pdf
Dr. Wendy Hellerstedt is the Director of the Center for Leadership Education in Maternal and Child Public
Health and an Associate Professor in the School of Public Health.
Funding for the Center, US-DHHS/HRSA/Maternal and Child Health Bureau T76-MC00005 (Hellerstedt, PI)
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