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What is driving the growth in health care costs and what can be done about it? California Assembly Select Committee on Health Care Delivery Systems and Universal Coverage December 11, 2017 Larry Levitt Senior Vice President Kaiser Family

  1. What is driving the growth in health care costs and what can be done about it? California Assembly Select Committee on Health Care Delivery Systems and Universal Coverage December 11, 2017 Larry Levitt Senior Vice President Kaiser Family Foundation @larry_levitt

  2. On average, other wealthy countries spend about half as much per person on health than the U.S. spends Total health expenditures per capita, U.S. dollars, PPP adjusted, 2015 United States $9,451 Switzerland Netherlands Germany Sweden Austria Comparable Country… $4,908 Belgium Canada France Australia Japan United Kingdom Source : OECD (2017), "OECD Health Data: Health expenditure and financing: Health expenditure indicators", OECD Health Statistics (database). DOI: 10.1787/health-data-en (Accessed on March 19, 2017 Peterson-Kaiser Health System Tracker

  3. The gap between the U.S. and comparable countries on health spending has widened Total health expenditures as percent of GDP, 1970 – 2015 18% United States 16% 17% 14% 12% 11% 10% 8% Comparable country 6% average 4% 2% 0% 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 Source : Kaiser Family Foundation analysis of OECD data. Peterson-Kaiser Health System Tracker

  4. Mortality rates have fallen steadily in the U.S. and in comparable OECD countries Overall age-adjusted mortality rate per 100,000 population, 1980-2013 1400 1223 1200 1184 United States 1000 826 800 Comparable 723 Country Average 600 400 200 0 1980 1985 1990 1995 2000 2005 2010 Source : OECD (2017), "OECD Health Data: Health status: Health status indicators", OECD Health Statistics (database). DOI: 10.1787/health-data-en (Accessed on March 17, 2017). Notes : Break in series in 1987 and 1997 for Switzerland; in 1995 for Switzerland; in 1996 for Netherlands; in 1998 for Australia, Belgium, and Germany; in 1999 for United States; in 2000 for Canada and France; and in 2001 in the United Kingdom. All breaks in series coincide with changes in ICD coding. Peterson-Kaiser Health System Tracker

  5. The U.S. has the lowest insured rate of comparable countries Percent of total population covered by private and/or public health insurance in 2015 United Kingdom 100.0% Switzerland 100.0% Sweden 100.0% Japan 100.0% Canada 100.0% Australia 100.0% Germany 100.0% France 99.9% Comparable Country Average 99.9% Austria 99.9% Netherlands 99.9% Belgium 99.0% United States 90.9% 86% 88% 90% 92% 94% 96% 98% 100% Source : Kaiser Family Foundation analysis of data from OECD (2017), “OECD Health Data: Social Protection,” OECD Health Statistics (da tabase). (Accessed on November 12, 2017). Note: Data for Japan were unavailable for 2015, so data from the previous year are shown. Peterson-Kaiser Health System Tracker

  6. In recent years, health spending growth has slowed in the U.S. and in comparable countries Average annual growth rate in total health expenditures per capita, U.S. dollars, PPP adjusted Comparable country average United States 8% 7.2% 7% 5.7% 6% 5.2% 5% 4.2% 4.2% 3.6% 4% 3% 2% 1% 0% 2000-2005 2005-2010 20010-2015 Source : OECD (2017), "OECD Health Data: Health expenditure and financing: Health expenditure indicators", OECD Health Statistics (database). DOI: 10.1787/health-data-en (Accessed on March 20, 2017). Notes : Available data are for Australia, Austria, Belgium, Canada, Japan, Netherlands, Sweden, Switzerland, and United Kingdom. These are the countries included in comparable country averages Peterson-Kaiser Health System Tracker

  7. The U.S. has fewer physician visits per capita than most comparable countries Doctors Consultations, per capita, in all settings, 2010 14 13.1 12 9.9 10 8.1 7.7 8 7.4 6.9 6.7 6.6 6.6 6 5.0 4.0 4.0 4 2 0 Switzerland United United Australia Netherlands France Austria Belgium Canada Comparable Germany Japan States Kingdom Country Average Source : OECD (2013), "OECD Health Data: Health care utilisation", OECD Health Statistics (database). doi: 10.1787/health-data-en (Accessed on October 29, 2014). Notes : In cases where 2011 data were unavailable, data from the countries' last available year are shown. Peterson-Kaiser Health System Tracker

  8. There are fewer doctors per capita in the U.S. than there are in most comparably wealthy countries Practicing physicians, density per 1,000 population, 2013 Austria 5.0 Sweden 4.1 Switzerland 4.0 Germany 4.0 Comparable Country Average 3.4 Australia 3.4 France 3.1 Belgium 3.0 United Kingdom 2.8 United States 2.6 Canada 2.5 Japan 2.3 0 1 2 3 4 5 6 Source : OECD (2017), "Health care resources", OECD Health Statistics (database). doi: 10.1787/health-data-en (Accessed on 13 April 2017). Notes : Data for Japan is for 2012. Peterson-Kaiser Health System Tracker

  9. Patients in the U.S. have much shorter average hospital stays than patients in comparable countries Average number of days in the hospital per visit (all causes) (2010) Japan 18.2 Germany 9.5 Switzerland 9 Comparable Country Average 8.1 Austria 7.9 Canada 7.7 United Kingdom 7.4 Belgium 6.9 Sweden 6 France 5.7 Netherlands 5.6 Australia 5 United States 4.8 0 2 4 6 8 10 12 14 16 18 20 Source : Kaiser Family Foundation analysis of 2013 OECD data: "OECD Health Data: Health care utilisation", OECD Health Statistics (database). doi: 10.1787/health-data-en (Accessed on September 10, 2014). Notes : In cases where 2010 data were unavailable, data from the countries' last available year are shown. Peterson-Kaiser Health System Tracker

  10. U.S. leads comparable OECD countries in MRI use Number of MRI exams performed per 1,000 population (2013) United States 107 Germany 95 France 82 Belgium 77 Comparable Country Average 64 Canada 54 Netherlands 50 Australia 28 Sources : OECD (2013), "OECD Health Data: Health care resources", OECD Health Statistics (database). doi: 10.1787/health-data-en (Accessed on September 10, 2014). Notes : In cases where 2011 data were unavailable, data from the countries' last available year are shown. Some countries, such as Japan, are omitted because data are not available for both indicators. Peterson-Kaiser Health System Tracker

  11. The average price of an MRI in the U.S. is significantly higher than in other comparable countries Average price of an MRI (2013) $1,145 $461 $350 $138 Switzerland Australia Netherlands United States Source : International Federation of Health Plans (2013), “2013 Comparative Price Report, Variation in Medical and Hospital Prices by Country” Peterson-Kaiser Health System Tracker

  12. The average price of an angioplasty or bypass in the U.S. is higher than in other comparable countries Average price of an Angioplasty (2013) Average price of Coronary bypass surgery (2013) $30,000 $80,000 $75,345 $27,907 $70,000 $25,000 $60,000 $20,000 $50,000 $42,130 $15,000 $40,000 $36,509 $10,897 $30,000 $10,000 $8,477 $20,000 $15,742 $5,295 $5,000 $10,000 $0 $0 Netherlands Australia Switzerland United States Netherlands Switzerland Australia United States Source : International Federation of Health Plans (2013), “2013 Comparative Price Report, Variation in Medical and Hospital Prices by Country” Peterson-Kaiser Health System Tracker

  13. The average price of drugs in the U.S. is much higher than in other countries (example: Enbrel) Average Price, 2013 $2,500 $2,225 $2,000 $1,646 $1,509 $1,500 $1,117 $1,017 $1,000 $500 $0 Switzerland England Netherlands Canada United States Source : International Federation of Health Plans Notes: U.S. average prices are calculated using commercial claims data from Truven MarketScan Research databases. Methods and sources for comparable countries can be found here: http://www.ifhp.com/1404121 Peterson-Kaiser Health System Tracker

  14. The U.S. has the highest percentage of specialists among comparable OECD countries General Practice Specialist Not Defined United States Sweden Norway Switzerland United Kingdom Austria Comparable Country Average Belgium Germany France Canada Australia Source : OECD (2013), "OECD Health Data: Health care resources", OECD Health Statistics (database). doi: 10.1787/health-data-en (Accessed on September 10, 2014). Notes : In cases where 2012 data were unavailable, data from the countries' last available year are shown. Peterson-Kaiser Health System Tracker

  15. Compared to other wealthy countries, the U.S. has a similar number of nurses per capita Nurses, density per 1,000 population (2012) 14 12.8 12.4 12.3 11.9 11.6 11.5 12 11.1 11.1 10.5 10 9.1 8 6 4 2 0 Australia Belgium Canada Comparable France Germany Japan Netherlands Sweden United Country States Average Source : OECD (2013), "OECD Health Data: Health care resources", OECD Health Statistics (database). doi: 10.1787/health-data-en (Accessed on September 10, 2014). Notes : In cases where 2012 data were unavailable, data from the countries' last available year are shown. Peterson-Kaiser Health System Tracker

  16. The growth in premiums paid by employers and workers have far outpaced wages over time

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