Americans Pay More, Get Less from Health Care

March 16, 2018
Dylan Fisher

Despite spending the most on health care, Americans experience shorter life expectancy, higher obesity rates, and a higher rate of infant death.

Welcome to Practice Rounds, our weekly column exploring what's being covered in the larger world of health care.

Americans Get Less for More in Health Care

According to a new study published in JAMA, Americans pay more than any other country for health care and get inferior results. The study, done by researchers at Harvard University, revealed despite spending the most on health care, Americans experience shorter life expectancy, higher obesity rates, and a higher rate of infant death.

So where is all of the money going? One of the main drivers of America's high health care cost is brand name prescription drugs, according to the study. In the U.S., people spend nearly double ($1,443) on pharmaceutical drugs compared to the average of other countries ($749).

Another takeaway from the study is that although the U.S. spends more on health care, fewer people are covered. In 2016, about 90 percent of the population had health care coverage in the U.S. But we spent about 18 percent of our GDP on healthcare. Other countries spent much less of their GDP on health care, ranging from 9 percent in Australia to 12 percent in Switzerland, while having more than 99 percent of the population covered.

Study: NPs, Physicians Face Similar Liability Risks

According to a new study, the growing need for primary-care providers will be filled by nurse practitioners (NPs), not primary care physicians. NPs are growing in care responsibilities and expected to represent nearly one third of the family practice workforce by 2025, according to the study.

The study, published by The Doctors Company, the nation's largest physician-owned medical malpractice insurer, identifies the top risk management issues faced by NPs. The majority of these issues derive from clinical and administrative mistakes such as absence of written protocols or a failure to adhere to nurse practitioner scope of practice.

For the study, the Doctors Company looked at NP medical malpractice claims over a six-year period and compared them to claims against primary-care physicians to identify risk management issues that may be unique to nurse practitioners. The study also found that while top NP risk areas are fairly equivalent to those of physicians and can be addressed by similar strategies, many risk factors can be addressed if physicians understand NP laws and regulations within their state, while supporting NPs in providing care within the practice.

FDA Announces Plan to Cut Nicotine in Cigarettes

On Thursday, the Food and Drug Administration (FDA) announced a plan to reduce smoking rates by lowering nicotine in cigarettes to minimally or non-addictive levels. Lowering nicotine in cigarettes would strip them of all or most of their addictive power, which could lead to 5 million adults quitting smoking within a year of the plan going into place, according to analysis published in The New England Journal of Medicine.

Furthermore, the analysis includes the potential for another 8 million people to quit smoking within five years of the plan being put into place. By 2100, the plan would prevent 33 million people who are now children or young adults from ever taking up tobacco, saving 8 million lives.

Because the tobacco industry is likely to fight these proposals, it could be eight to 10 years before reduced-nicotine cigarettes become a reality, according Erika Sward, assistant vice president of national advocacy for the American Lung Association.

Quote of the Week

Negotiating Favorable Value-Based Contracts with Payers

"We have an entire generation of providers, an entire health care delivery system that was literally formed [around the concept] that our job is to take care of sick people. In the course of the decade, the message is changing and we're now telling people we need to take care of people in a way that they never get sick."

Tamm Kritzer on the challenge of switching to value-based contracts