Health spending in OECD countries in 2004 and trends in the health of older Americans

Health Spending In OECD Countries In 2004: An Update, by Gerard Anderson, Bianca Frogner, and Uwe Reinhardt. "In 2004, the U.S. health care system continued to provide less access to health care resources than the health systems in many other [industrialized] countries; however, the United States continued to have the highest level of spending," Anderson and coauthors report.

As in prior years, higher U.S. spending stemmed primarily from its relatively high per capita gross domestic product (GDP) and "the much higher prices that Americans pay for health care services."

Per capita U.S. health spending was $6,102, about 2.5 times greater than median spending in 2004 -- the most recent year for which standardized international data is available -- for the countries in the Organization for Economic Cooperation and Development (OECD). The U.S. ranked first in outpatient expenditures at 3.6 times the median OECD country primarily because of higher spending on physician services. By contrast, the U.S. was essentially tied for fourth in inpatient spending at twice the median OECD country. Perhaps surprisingly, the U.S. spent the most per capita on public health and prevention, although the researchers caution that the high U.S. spending levels in this area could reflect higher prices in this country, rather than provision of more resources and use of more services.

The authors observe that chronic disease accounts for 80 percent of health care use in most OECD countries. Five of the most common chronic diseases account for half to two-thirds of all causes of mortality in high-income countries. The relatively high U.S. chronic disease prevalence and mortality "may be associated" with the high number of Americans who are overweight and obese, according to Anderson and his colleagues. U.S. tobacco and alcohol consumption per capita, also tied to chronic disease risk, was below the OECD medians in 2004. The authors note, however, that current rates of certain chronic diseases may be due to the long-term effects of previously higher smoking rates in the U.S. Moreover, OECD data do not track the best predictor of alcohol-related problems: the number of people who drink to excess.

Trends In The Health Of Older Americans, by Ellen Kramarow, James Lubitz, Harold Lentzner, and Yelena Gorina. Bringing together data from many federal sources, Kramarow and coauthors show that in recent decades, the health of older Americans has improved on nearly all major indicators, including longevity, self-reported health, and functioning.

For example, life expectancy at ages 65 and 85 increased from 13.8 and 4.7 years, respectively, in 1950 to 18.7 and 6.8 years, respectively, in 2004. The proportion of older people reporting fair or poor health declined between 1982 and 2005 from 34.8 percent to 27.3 percent for women and from 35.5 percent to 26.1 percent for men. Reported health status has improved even for those with chronic conditions, but it is unclear whether this reflects improved functioning, reduced expectations, or earlier diagnosis of conditions in milder stages.

"Although we can not link improved functioning at the population level directly to particular medical interventions, our data show large increases in interventions that are designed to enable older people to maintain or regain functioning, and improve quality of life," the authors say. They point in particular to the cardiac revascularization procedures of angioplasty and bypass surgery and to the replacement of joints such as the hip and knee. For example, between 1995 and 2004 alone, the rate of angioplasty almost tripled, with the largest percentage increases occurring among people age 85 and older.

The authors say that new medical technologies may lead to a continuation of these favorable trends, but they offer some cautions. Among them: African Americans continue to lag behind other groups on most health measures; we still know little about whether the cognitive functioning of elderly Americans is improving; and today's middle-aged Americans -- tomorrow's elderly -- report higher levels of obesity and certain chronic conditions than the preceding generation.

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org.