US health care: A reality check on cross-country comparisons

John Hoff, H.E. Frech, and Stephen T. Parente

The United States spends substantially more on health care per capita than other developed countries. Based on comparison data of health status, the Organisation for Economic Co-operation and Development (OECD) published a report on health system performance, finding that the US system does not perform better than systems in countries that spend less. On many measures, US health status is inferior to those of other countries. We find these cross-country comparisons unable to adequately differentiate between health system performance and other confounding factors that determine health. In this Outlook, we provide a comprehensive critique of the OECD report and suggest several ways in which to strengthen the analysis. This includes improving the accuracy of infant mortality rates, employing life expectancy and premature mortality measures that are less sensitive to external factors, improving controls for external elements, and distinguishing between country-specific differences in health status and countries’ health care system efficiency.

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