America is the country where people spend the most on healthcare and live the shortest amount of time, when compared to Western Europe, Japan, Australia and Canada - that is, the rest of the developed world. Although life expectancy has improved in the USA over the last thirty years, it has improved much faster elsewhere. According to a study published by the Commonwealth Fund, called What Changes in Survival Rates Tell Us About US Health Care, the USA's disappointing performance is not linked do such factors as crime, automobile accidents, smoking or obesity.

Authors Peter Muennig and Sherry Glied at Columbia University covered health care spending, risk factors that are associated with premature death, such as obesity and smoking, and survival rates over a 15-year period for 45 to 65 year-old males and females in 13 countries, including the USA, UK, Switzerland, Sweden, the Netherlands, Japan, Italy, Germany, France, Canada, Belgium, Austria and Australia.

All countries achieved gains in 15-year survival rates through the period 1975 to 2005, even the USA did. However, America has not been able to keep up as most of the other countries achieved higher gains, while the USA gradually slipped down the league. This is despite per capita spending on health care in the USA rising at over twice the rate of the other countries' over the same period.

The survival rate for 45-year old American-Caucasian females is the lowest of all 13 countries. In fact, the survival rate for this particular group did not even reach the 1975 fifteen-year survival rates for Japanese, Dutch, Swedish or Swiss 45-year old females.

In 1975 the 15-year life expectancy for a 45-year old male in the USA ranked 3rd, in 2005 it slipped to 12th.

Why has this occurred, if such factors as smoking rates have dropped faster in the USA during the 30 year period of study than in the other countries?

USA does have higher obesity rates than in the other countries. But this was also the case in 1975, when America's life expectancy rivaled many on the list. If fact, obesity rates grew faster in the other countries from 1975 onwards, even though they overtook the USA in life expectancy and pulled ahead.

Homicide and traffic fatalities have not increased significantly in their share of US deaths since 1975 either, the authors report.

The authors believe the main problem lies in some failings in the US health care system. America spends a far higher percentage of GNP (gross national product) on health care than any of the other countries, but it has a system of unregulated fee-for-service payments and relies on specialty care, both of which push up prices without providing proportionate gains in life expectancy.

Peter Muennig, assistant professor at Columbia University's Mailman School of Public Health, and lead author, said:

It was shocking to see the U.S. falling behind other countries even as costs soared ahead of them. But what really surprised us was that all of the usual suspects - smoking, obesity, traffic accidents, and homicides - are not the culprits. The U.S. doesn't stand out as doing any worse in these areas than any of the other countries we studied, leading us to believe that failings in the U.S. health care system, such as costly specialized and fragmented care, are likely playing a large role in this relatively poor performance on improvements in life expectancy.

Commonwealth Fund President Karen Davis, said:

This study provides stark evidence that the U.S. health care system has been failing Americans for years. It is unacceptable that the U.S. obtains so much less than should be expected from its unusually high spending on health care relative to other countries." The good news is that the Affordable Care Act will take significant steps to improve our health care system and the health of Americans by expanding health insurance, improving primary care, and holding health care organizations accountable for their patients' overall health and ensuring the coordination of primary care and specialty care to eliminate errors, waste of patients' time, and wasteful duplication of tests and services.

Health Care Spending and Life Expectancy (Source: OECD 2007)
  • Australia
    Life expectancy 81.4 years
    Per capita health expenditure $3,137
    Percentage of GDP spent on health care 8.7%
  • Canada
    Life expectancy 80.7 years
    Per capita health expenditure $3,895
    Percentage of GDP spent on health care 10.1%
  • France
    Life expectancy 81 years
    Per capita health expenditure $3,601
    Percentage of GDP spent on health care 11%
  • Germany
    Life expectancy 79.8 years
    Per capita health expenditure $3,588
    Percentage of GDP spent on health care 10.4%
  • Japan
    Life expectancy 82.6 years
    Per capita health expenditure $2,581
    Percentage of GDP spent on health care 8.1%
  • Norway
    Life expectancy 80 years
    Per capita health expenditure $5,910
    Percentage of GDP spent on health care 9%
  • Spain
    Life expectancy 80 years Per capita health expenditure $2,871
    Percentage of GDP spent on health care 8.1%
  • Sweden
    Life expectancy 81 years
    Per capita health expenditure $3,323
    Percentage of GDP spent on health care 9.2%
  • United Kingdom
    Life expectancy 79.8 years
    Per capita health expenditure $2,992
    Percentage of GDP spent on health care 8.4%
  • USA
    Life expectancy 78.1 years
    Per capita health expenditure $7,290
    Percentage of GDP spent on health care 16%
35% of America's health care expenditure is incurred by private health insurance, the highest in the OECD. Despite spending significantly more on health care, there are fewer doctors per capita in the USA than in most other OECD countries.

In 2006, infant mortality was 6.7 live births per 1,000 in the USA compared to an OECD average of 4.7.

Source: The Commonwealth Fund, OECD

Written by Christian Nordqvist