There are 2 ways that I could have spent twice as much on doughnuts. I could have purchased two times as numerous doughnutsI could have bought the exact same number of doughnuts but got really fancy ones and paid two times as much, or some combination thereof. Right? If we're spending two times as much as other high-income nations, we're attaining that by either doing twice as much health care, paying twice as much for the same quantity of health care, or some combination.
Overall spending is quantity times price. This concept that we're excessive using health care, that we're doing so much to our clients, we're delivering a lot health care, that's why we invest so much. All the policy things is about trying to lower that overuse, our culture of overuse. I would say that much of the policy focus has been on the quantity side of things.
Let's take an appearance at the data. One hypothesis I often hear is, as an American culture, we are quick to go the doctorat the drop of the hat, I get a little pain, Americans are off to see the medical professional. We initially ask the question, let's look at physician check outs per capita (how did the patient protection and affordable care act increase access to health insurance?).
This is doctor check outs per capita in a given year: The mean has to do with 6. 6, and the United States is about 4. By the method, in Japan, the mean is 13. The typical Japanese sees their doctor more than when a month. For each 24-year-old who hasn't gone in 4 years, there are individuals who are going every other week.
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6 and we're an excellent bit below that. We're not seeing the physician as much as these other countries. Then individuals look at that and state, "Ah, perhaps the issue is inadequate. Insufficient prevention, not enough primary care, and it's all causing a lot of hospitalizations. The issue is overuse of hospitals.
We said, let's take a look at healthcare facility discharges per population. And here is the mean, right, 149 per thousand population. And here is the United States: a little bit second-rate. Remarkably, Germany looks like a bit of the outlier, where hospitalizations per population are much, much greater. The other thingso this is simply hospitalizations, right? Hospital discharges per populationanybody have a sense of how our lengths of stay compare to those of other countries, these other countries? We're way much shorter, way much shorter.
is? Yeah, 3. In the Medicare population it's like four, 4 and a half, because they're a bit older, but in the 3 to four days. In Japan, about 14. Right? I remained in Japan a few years ago checking out a neighborhood health center. It was remarkable to me. There were clients sitting around playing cards around a table.
Right? It resembles they got the four days of IV, then they switched to the oral, and now we're just observing them 2 days post-oral antibiotics, just making certain they're fine. It's intriguing in terms of, if you think of it: fewer hospitalizations, shorter lengths of stay. And what you realize is we spend far fewer days in the healthcare facility than any other high-income country.
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The 3rd, on this overutilization bit is that, the issue is we do too many tests and procedures. I put a little asterisk in there to remind myself to make a point, which is, naturally, when you talk about we do a lot of tests and treatments, a big part of that hypothesisa huge part of the driving consider the policy world, and I more than happy to enter into more on thisis the sense that the problem is that the physicians in Americawe're just out there overtesting, overprocedurizing, fee for service.
So, let's take a look at some empirical data, and there's a bit of support for some of this and not a lot for others, however let's take a look at the data. MRIs. MRIs, we are high. Sure, we have more MRIs per population than typical, however not some crazy outlier. Knee replacements, here we truly are number one.
We have more weight problems than nearly all of these nations, really, than any of these Drug Rehab Center countries, so it's not an overall surprise that we're going to get more knee replacements. Hip replacements, I expected similar numbers on hip replacements. I stated, "Oh, our knee replacements are high, our hip replacements are going to be high." Surprisingly, not so much.
Meaning, once again, we see Germany appearing near the top, but we're really slightly below par. Coronary angioplasty, a procedure that has actually gotten a lot of attention for concerns about overuse. Sure enough, we're a little bit on the high side, and here's Germany again ... Once again, what we see is we're a little high on some things however not necessarily others, and here's Germany on coronary angioplasty.
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health care expense is mostly about supplying excessive care, about overutilization. Right? I don't see it. We have fewer hospitalizations, less physician sees - what does a health care administration do. Tests and procedures, I view as a combined bag. Right? We do more MRIs, and knee replacements, and angioplasties. We do less hip replacements. The method I believe about it is, when it pertains to usage of healthcare services, we're above average on some things, we're second-rate on other things, and typically, we're quite averageon utilization.
Another fast one, I'm going to just show you this data and after that keep going. Actually, this is one I've even stated publiclywithout information and it turns out I was wrongthe one concept that has shown up over and over again is that all these nations are primarily medical care, we're primarily professionals, and that the https://trevorwjaw388.mystrikingly.com/blog/how-to-take-care-of-mental-health-can-be-fun-for-everyone specialist-primary care doctor mix is off.
Then the very first time my colleaguesI remember they came into my office and they said here's the information on specialized mixand the information was that here was the mean across these countries, and here was the U.S., right in the middle. Hop over to this website I didn't believe it. I just believed this can't be right.
The proportion of physicians who are medical care, and on the right is Sweden and Denmark, where it's just 2233% in France, 54% of physicians are primary carethe most significant obstacle with this statistic is everybody calls it all different terms. Is it basic professionals? Is it generalists? Is it medical care physicians? What we did was we said, we do not care what you call it, let's speak about what individuals are actually doing in the office.
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And then we went to both national statistics offices of each of these countries as well as three to five specialists from each nation, and we revealed them their data (how does electronic health records improve patient care). I remember talking with the people from Switzerland and stating, "Hey, we find that 48% of your medical professionals are medical care, based upon this definition.
The 43% for the U.S. comes from the Kaiser Family Structure, which is an exceptional source of information, utilizing the AMA Masterfile nationwide service. There are other surveys and information from the U.S. that put the number a little lower. We can have an argument about which number is best, however this is our best at doing an apples-to-apples contrast. why is free health care bad.