Surprise, Surprise: Older Americans are Sicker than their European Counterparts
Filed under: Elderly, Quality Improvement, preventive care
Health care spending in the United States has increased substantially over the past decades — making the United States the world’s biggest health care spending nation. Despite spending the most on health care — 2 to 3 times more than European countries per capita — older Americans across the wealth spectrum fare worse than their European counterparts.
A study published in the American Journal of Public Health, Health Disadvantage in US Adults Aged 50 to 74 Years: A Comparison of the Health of Rich and Poor Americans With That of Europeans, Avendano et al. attempt to explain this phenomenon. Avendano et al. note,
In this international study, we found that US adults of all wealth levels reported worse health than did Europeans at comparable wealth levels. Poor Americans were at particularly worse health compared with their English or other European counterparts, but even well-off Americans reported health comparable to substantially poorer Europeans. Differences in behavioral risk factors accounted for only a fraction of these disparities.
As behavioral factors were insufficient to account for this disparity, Avendano et al. distinguish between national health care systems.
Features of the US health care system may contribute to the worse health of Americans compared with Europeans. In particular, most European countries have a stronger primary care orientation than does the United States. Previous evidence suggests that a strong primary care system is associated with better health outcomes, partly because it entails a stronger focus on primary prevention, a more equitable distribution of resources, and a higher efficacy of the health system.
Investing less at the primary care stage where prevention is key, necessarily means that there is a greater focus on disease maintenance or amelioration after its onset. Which is to say that Americans, for the most part, are not afforded significant medical attention until they are sick.
In addition to having a stronger focus on primary care than the United States, European countries have greater protections for their poor. European countries offer virtually universal health care coverage, so even the poor have relatively unfettered access to necessary care. The United States on the other hand, has an uninsured population totaling 41 million (or over 45 million by some estimates).
The fact that health disparities in England still persists despite access to care,
suggests that mechanisms outside the health care system may also be involved. Wealth enhances access to material resources such as housing, and is a source of immediate consumption in periods of economic strain. Wealth may also increase sense of control over life and other psychosocial resources that can enhance health.
This study gives further credence to the notion that America has at least something to learn from the European health care system. Universal health care is one component, but focusing more keenly on primary care and easing the social burdens of the poor are another. Racial health disparities is also an issue that has to be addressed in the United States, but this study restricted its study population to non-Hispanic Whites in order to determine what factors beyond those attributable to race are at issue in the United States’ lag behind its European peers. Given the fact that racial health disparities are prevalent in the United States, it would not strain reason to conclude that the gap between Americans and Europeans would be exacerbated if racial minorities were included. The correlation between economic status, residential segregation and well being may help explain why this is the case.
The United States health care system clearly demonstrates that dollars spent is no indication of the quality or efficacy of health care actually received. Moving into a more cost-effective health care paradigm that provides access to comprehensive care at a stage where it can impact long-term health is essential. The Avendano study offers proof of this.
