There are two manner ins which I could have invested two times as much on doughnuts. I might have bought two times as many doughnutsI might have bought the exact same variety of doughnuts however got really elegant ones and paid two times as much, or some combination thereof. Right? If we're spending two times as much as other high-income countries, we're achieving that by either doing twice as much healthcare, paying two times as much for the same quantity of health care, or some mix.
Total costs is quantity times rate. This idea that we're excessive using health care, that we're doing so much to our patients, we're providing a lot healthcare, that's why we spend so much. All the policy things has to do with trying to decrease 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 have a look at the information. One hypothesis I frequently hear is, as an American culture, we fast to go the doctorat the drop of the hat, I get a little discomfort, Americans are off to see the medical professional. We first ask the concern, let's take a look at doctor visits per capita (how many health care workers have died from covid).
This is doctor gos to per capita in a given year: The mean has to do with 6. 6, and the United States has to do with 4. By the way, in Japan, the mean is 13. The typical Japanese sees their doctor more than once a month. For each 24-year-old who hasn't entered 4 years, there Rehabilitation Center are people who are going every other week.
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6 and we're an excellent bit below that. We're not seeing the medical professional as much as these other countries. Then people take a look at that and say, "Ah, perhaps the issue is inadequate. Not enough prevention, inadequate main care, and it's all causing a lot of hospitalizations. The issue is overuse of healthcare facilities.
We said, let's look at medical 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 little the outlier, where hospitalizations per population are much, much greater. The other thingso this is just hospitalizations, right? Medical facility discharges per populationanybody have a sense of how our lengths of stay compare to those of other nations, these other countries? We're way much shorter, method much shorter.
is? Yeah, three. In the Medicare population it's like four, four and a half, since they're a bit older, however in the 3 to 4 days. In Japan, about 14. Right? I was in Japan a few years ago going to a neighborhood hospital. It was exceptional to me. There were clients sitting around playing cards around a table.
Right? It resembles they got the 4 days of IV, then they switched to the oral, and now we're simply observing them two days post-oral prescription antibiotics, just making certain they're fine. It's interesting in regards to, if you think about it: fewer You can find out more hospitalizations, shorter lengths of stay. And what you recognize is we invest far fewer days in the medical facility than any other high-income nation.
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The third, on this overutilization bit is that, the issue is we do too lots of tests and treatments. I put a little asterisk therein to remind myself to make a point, which is, obviously, when you speak about we do too numerous tests and procedures, a big part of that hypothesisa big part of the driving consider the policy world, and I'm delighted to enter more on thisis the sense that the issue 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 little bit of support for a few of this and not so much 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 primary.
We have more obesity than nearly all of these countries, really, than any of these countries, so it's not a total surprise that we're going to get more knee replacements. Hip replacements, I expected similar numbers on hip replacements. I said, "Oh, our knee replacements are high, our hip replacements are going to be high." Remarkably, not a lot.
Significance, once again, we see Germany appearing near the top, but we're in fact a little second-rate. Coronary angioplasty, a treatment 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 always others, and here's Germany on coronary angioplasty.
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health care expense is mainly about providing too much care, about overutilization. Right? I don't see it. We have fewer hospitalizations, fewer doctor visits - how does universal health care work. Tests and treatments, I view as a variety. Right? We do more MRIs, and knee replacements, and angioplasties. We do fewer hip replacements. The method I consider it is, when it pertains to utilization of health care services, we're above average on some things, we're below average on other things, and typically, we're pretty averageon usage.
Another quick one, I'm going to simply show you this data and then keep going. Actually, this is one I've even stated publiclywithout information and it turns out I was wrongthe one concept that has actually come up over and over again is that all these countries are primarily primary care, we're mainly professionals, and that the specialist-primary care doctor mix is off.
Then the first time my colleaguesI remember they entered into my office and they said here's the information on specialized mixand the data was http://damienpnow258.jigsy.com/entries/general/the-only-guide-to-how-much-does-health-care-cost that here was the mean throughout these nations, and here was the U.S., right in the middle. I didn't think it. I just believed this can't be right.
The proportion of medical professionals who are medical care, and on the right is Sweden and Denmark, where it's only 2233% in France, 54% of doctors are primary carethe biggest challenge with this statistic is everyone calls it all different terms. Is it basic practitioners? Is it generalists? Is it main care doctors? What we did was we said, we do not care what you call it, let's discuss what individuals are in fact performing in the office.
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And after that we went to both nationwide stats workplaces of each of these nations in addition to three to 5 specialists from each country, and we revealed them their information (which of the following is not a result of the commodification of health care?). I remember speaking with the guys from Switzerland and saying, "Hey, we discover that 48% of your medical professionals are medical care, based upon this definition.
The 43% for the U.S. comes from the Kaiser Household Foundation, which is an outstanding source of information, using 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 a debate about which number is best, but this is our best at doing an apples-to-apples contrast. a health care professional is caring for a patient who is taking zolpidem.