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Old News: Quote of the Day: “The most efficient way to improve population health is to focus on those at the bottom” Sherry A. Glied, formerly of HHS


An article in the New York Times from May 14, 2018, calls it a “Medical Mystery”: health spending per capita in the United States has increased dramatically compared to other developed countries since 1980, but life expectancy and fifteen-year survival expectancy has deteriorated.  The article references research published almost ten years ago by Peter Muennig and Sherry Glied in “Health Affairs”, which  analyzes comparative survival expectancy in forty-five and sixty-five year olds since 1975 in a dozen highly developed countries.  The research shows increases in spending per capita in the US compared to a dozen other countries (such as Great Britain and Switzerland), all of which have “universal coverage” health care “insurance.”  The United States has no universal health care payment– generally, families have been insured under health plans subsidized by employers since WW II, and those over sixty-five have had insurance through the federal government (Medicare); a percentage of poor people have health care paid for by Medicaid, which has had poor acceptance by health care providers.

This research, and other studies referenced in the NYT article, shows relative increases in health care spending but losses in life expectancy compared to other highly developed countries since 1980.  This relative deterioration cannot be explained by differences in smoking, obesity, traffic accidents, or firearms mortality.  There may be some correlation between increased spending on specialty care and other “unnecessary” medical expenditures and loss of life expectancy.  In other words, some medical care may be increasing mortality rather than decreasing it.

In any case, comparison of countries that provide universal health care protection with the United States, which has relatively poor health care access for those at the bottom of the income distribution, reveals higher spending and lower life expectancies, with deterioration over the last thirty-five to forty years.  It appears that payment for health care for poor people is more efficient than payment for health care for well-to-do people.  Poor people have poorer nutrition, higher accident and homicide mortality, and lower rates of preventive health care in spite of programs like Medicaid.

These findings are strong arguments in favor of more and better health care, particularly preventive health care, for poor people.  In addition to providing subsidized health care for all people living below the national median income, emphasis on preventive care is likely to provide substantial benefits in life expectancy and health.  On the other hand, payments to drug companies for expensive drugs that are helpful to small populations are unlikely to provide much overall health benefit.

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