Several factors within the current US healthcare industry contribute to inefficiencies within the system, leading to poor-quality care and patient outcomes.

In a JAMA opinion piece, Victor R. Fuchs, PhD, from Stanford University in California, discussed and compared factors in US medical care with those of other nations, particularly in terms of quality of life, length of life, morbidities, mortality outcomes, and life expectancy.

Compared with the United Kingdom, the per capita spending for medical care is approximately twice as high in the United States, but life expectancy at birth is around 3 years lower in the United States than in the United Kingdom. However, these differences may be a reflection of a higher poverty rate in the United States, rather than inefficiencies in medical care.

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A higher proportion of patients in the United States also use knee replacement surgery than in the United Kingdom, demonstrating that patients in the United States may have a higher quality of life, even if their life expectancy is lower. In addition, a higher prevalence of obesity is observed in the United States vs in other high-income countries, which may contribute to higher morbidity and mortality outcomes.

To determine whether US medical care is inefficient relative to that in other high-income countries, life expectancy would have to be lower in the United States, even after adjusting for medical care contributors other than life expectancy. Dr Fuchs noted that poorer results are possibly observed with individual patient-physician interventions relative to other countries to a greater degree in the United States. Misallocation of medical resources could be another contributor to poorer outcomes in the United States compared with in other countries.

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“The United States’ fragmented financing of health care results in excessive administrative costs and may contribute to inefficiencies in other ways as well,” Dr Fuchs concluded. “Excessive use of some technologies in the US may be another important factor.”


Fuchs VR. Is US medical care inefficient? JAMA. 2018;320(10):971-972.