Curbing U.S. Health Care Costs: Lessons From Europe?

Abstract

The U.S. health care system is the world’s most expensive, consuming almost 20% of the economy and forecast to swallow half within decades if current trends continue. Yet despite the hefty cost, the U.S. lags behind many countries in Europe and other developed nations for health outcomes and quality of services, according to metrics from the Organisation for Economic Co-operation and Development (OECD), such as life expectancy, mortality, and safety. “No one would sensibly argue that we don’t have a health care spending problem,” said Peter Bach, M.D., associate attending physician at Memorial Sloan–Kettering Cancer Center in New York. Yet “there is no evidence that we provide better health care to our population as a whole than these other countries.” Although some solutions to bending the health care cost curve, long the norm elsewhere, remain anathema to most Americans (most notably nationalized health care with a single-payer system better able to negotiate lower prices), other options with a view to offering long-term savings are gaining support. These alternatives include establishing panels that assess cost- and clinical-effectiveness in determining which drugs and treatments Medicare covers, emphasizing patient-oriented primary care, and boosting preventive care. “Many countries have better-func t ion i ng, lower-cost health care systems that outperform the United States. We must learn from them,” concluded the American College of Physicians (ACP), which represents 130,000 physicians and medical students, in a report comparing the U.S. with other nations such as Denmark, the UK, and Germany. “The high cost of health care in the U.S. is not correlated with high quality and efficiency in the delivery of services or improved health outcomes,” the group noted the next year in another report on affordable care. A September 2011 Lancet Oncology Commission report, “Delivering Affordable Cancer Care in High-Income Countries,” called particular attention to the high costs of cancer care. The 37 experts in the author group wrote, “Cancer care in the USA is fast becoming unaffordable except for the well insured and most affluent,” while some expenses are “unwarranted and contribute to the high cost.”