Health Care

Is Our Health Care Spending Worth It?

Many people know by now that the United States spends much more on health care than any other country, and that health outcomes are not a lot better (and in many instances worse). That raises the question: Is our health care spending actually worth it?

It’s tricky to figure out the extent of the roles that the environment, genetics and social support play in improving health. Nevertheless, the best evidence tells us that health care is still very valuable, even at U.S. prices.

Consider this analogy: If you had to choose between no transportation and a new $50,000 luxury car, the car is worth it. This is the U.S. health system. Expensive, but better than nothing.

But that doesn’t mean using the bus or even buying a used economy car for $10,000 wouldn’t be more cost-effective. This is what many other nations are doing. (We should acknowledge that other nations are also benefiting from innovation in health care that is driven by high American spending without paying as much for it.)

How can such expensive health care be worth it? One piece of the puzzle is connecting health care to longevity. Research published in 1994 by scholars from King’s College in London and Harvard used clinical studies to estimate the effect of medical interventions for common diseases on mortality reduction. With this approach, they estimated that of the 7.5 years of life expectancy gained between 1950 and the early 1990s, three years (or 40 percent) could be attributed to health care.

Nearly all of this longevity gain is because of declines in infant mortality and in death from cardiovascular disease. Health care interventions deserve credit for much of both. For example, a study by the Centers for Disease Control and Prevention epidemiologist Earl Ford and colleagues found that half of declines in deaths from coronary heart disease between 1980 and 2000 could be attributed to the health system. But reduced smoking rates also had a substantial effect.

Beyond longevity, the King’s College/Harvard study looked at the effect of medical intervention on broader well-being. It found that health care could improve the quality of life for patients with a wide variety of conditions, including unipolar depression, heart disease, osteoarthritis, pain accompanying terminal cancer, peptic ulcers, gallstones, migraines, bone fractures and vision and hearing impairments.

Naturally, this work and other studies like it have limitations. For one, even as patients get treatment, they also may make lifestyle changes, whether from a doctor’s encouragement or of their own accord. So some of the improvement in longevity and quality of life that we may attribute to health care could actually be a result of changes in diet, exercise and the like.

For another, lifestyle and environmental factors could — and almost certainly do — play a role in causing some of the conditions the health system subsequently treats. In other words, the health system may be quite good at making us healthy, but other things outside the system may have made us sick in the first place.