Health care costs and outcome comparisons
The following information compares the United States to a number of other countries in terms of spending on health care, and health care outcomes. The countries to be used for comparison, and the reasons they were chosen, are:
- France: The World Health Organization ranked France No. 1 in the world in terms of the provision of health care.
- Switzerland: Switzerland is second to the U.S. in health care costs per capita.
- Canada: We are often compared to our neighbor to the north. What is the reality of the data?
- Costa Rica: Costa Rica is ranked just ahead of the U.S. by the World Health Organization.
World Health Organization Rankings
The World Health Organization (WHO) conducted a study in the year 2000 in which it ranked the countries of the world based on a combination of health care measures. For the countries included in our comparison, the rankings were:
France: 1st
Switzerland: 20th
Canada: 30th
Costa Rica: 36th
U.S.: 37th
There have been criticisms of the WHO rankings because they included two measures not strictly related to health care outcomes. The first was based on the distribution of health care costs, with countries being ranked higher if the rich paid more than the poor. The second such measure was based on the distribution of health care provision itself, with countries being ranked higher if health care is provided to all on an equitable basis.
The U.S. would certainly have fared poorly in these measures, and they must account for at least part of the reason for the low U.S. ranking. Still, revised rankings developed by the London School of Hygiene and Tropical Medicine, that considered only those indicators that were directly related to the quality of the health care system, had a similar result. In this study, which included only advanced industrialized countries, the U.S. ranked 16th out of 19 countries.
Health Care Spending
U.S. spending on health care far exceeds that of any other country in the world, both on a per capita basis, and as a percent of Gross Domestic Product (GDP). Here are the comparisons with our other selected countries (based on 2002 data):
Per Capita Spending Expressed in International Dollars
(Note: Using ‘International Dollars’ adjusts the exchange rate of the various currencies to account for relative purchasing power.)
United States: $4,887
Switzerland: $3,322
Canada: $2,792
France: $2,567
Costa Rica: $ 562
Spending as a Percent of GDP
United States: 13.9%
Switzerland: 11.0%
France: 9.6%
Canada: 9.5%
Costa Rica: 7.2%
Costa Rica has a highly acclaimed health care system, and a WHO ranking comparable to the U.S., but spends only 11.5% as much per capita as the U.S.
Selected Health Care Outcomes
Let’s look at some individual measures of health care outcomes for the selected countries.
Life Expectancy at Birth
| |
Male |
Female |
Total |
| Switzerland: |
77.7 |
83.3 |
80.6 |
| Canada: |
77.2 |
82.3 |
79.8 |
| France: |
75.9 |
83.5 |
79.7 |
United States: |
74.6 |
79.8 |
77.3 |
Costa Rica: |
74.8 |
79.5 |
77.1 |
Child Mortality (under age 5) (per 1,000)
| |
Male |
Female |
| France: |
5 |
4 |
| Switzerland: |
6 |
5 |
| Canada: |
6 |
5 |
| United States: |
9 |
7 |
| Costa Rica: |
12 |
10 |
Adult Mortality (age 15-59) (per 1,000)
| |
Male |
Female |
Switzerland: |
92 |
51 |
| Canada: |
95 |
58 |
| France: |
133 |
60 |
Costa Rica: |
127 |
74 |
| United States: |
140 |
83 |
Healthy Life Expectancy at Birth (number of years without serious health conditions)
| |
Male |
Female |
Total |
| Switzerland: |
71.1 |
75.3 |
73.2 |
| Canada: |
70.1 |
74.0 |
72.0 |
| France: |
69.3 |
74.7 |
72.0 |
| United States: |
67.2 |
71.3 |
69.3 |
| Costa Rica: |
65.2 |
69.3 |
67.2 |
Health Care Coverage
According to the U.S. Census Bureau, 43.6 million people (15.2 percent of the population) lacked health care coverage in the U.S. in 2002. That number is up from 41.2 million the previous year.
In the other selected countries, 100 percent of the population has health care coverage at all times.
Health Care Systems
Three of the selected countries - Switzerland, Canada and France – spend, respectively, 68 percent, 57 percent and 52.5 percent of U.S. expenditures per capita. In spite of the much lower spending, each of these countries achieves significantly better health care outcomes, and each covers 100 percent of their population. Costa Rica, spending 11.5 percent of the U.S. per capita, achieves comparable health care outcomes to the U.S., with some measures being better and some worse.
Clearly, there is something to be learned from the health care systems of these other countries. Future materials from MAPE will compare legal, financial and administrative characteristics of various national health care systems. We will look at advantages and disadvantages of each, trying to understand if there are systemic changes that may help address our own health care crisis.
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The World Health Organization is at www.who.int.
Extensive information on the uninsured in the U.S. is available at www.statecoverage.net.
