Running head: SPENDING VERSUS OUTCOMES

Spending Versus Outcomes: An Analysis of Healthcare Disparity in the United States

Josh Lyder

1 April 2016

Youngstown State University

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Abstract

This research study seeks to determine and analyze the health disparities between health

spending and outcomes disparities between health spending and outcomes in the United States.

Despite spending a vast amount of dollars on health care in the U.S., patient outcomes are not

greatly influenced by the expenditure. Multiple variables have been researched, which are

thought to contribute to this health care imbalance, such as preventative care, U.S. culture,

healthcare system and coverage in America, and some types of technology used. It is important

for nurses to be educated about this gap and variables that contribute to it in order to provide

better care to patients. Providing better care in hospitals, clinics, and other health settings can

help to improve U.S. health outcomes.

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Introduction

The American Dream is an idea that has been ingrained within the U.S. population since

childhood. This dream paints a picture of a country that has the answers to all its troubles, and

solutions to any problem it encounters. Even as adults, the illusion of the American Dream leads

individuals to believe that the United States is undoubtedly the greatest country in the world.

This dream, however, is being proven wrong by present day research that shows the disparities in

these beliefs. One of the most prevalent of which is healthcare spending and outcomes in this

country.

As a nation, the United States is spending more money per capita on healthcare than any

other country in the world, however in the 2010 World Health Organization [WHO] rankings the

U.S. falls in the 37th place for overall health outcomes. This statistic shows a massive disparity

in the money the United States spends on the healthcare system and the benefits American

people receive in result. As a health care professional it is important to be knowledgeable on

current health care problems facing health practice and to create solutions for what can be done

in order to minimize the healthcare inequality.

There are a variety of factors to blame for this imbalance including the lack of

importance placed on preventative care, cultural practices, healthcare systems and technology,

and healthcare coverage. These are all issues that cause the United States to suffer in preventable

issues such as water quality, sanitation, hyperglycemia, hypertension, breastfeeding rates, and

obesity (World Health Organization, 2010).

These factors play a specific and important role in healthcare practices and can be held

partially responsible for lacking outcomes. Actions such as teaching and encouraging patients to

practice preventative care such as scheduling regular doctors appointments can start to benefit
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those patient outcomes. Also grasping different U.S. cultural tendencies and what exactly those

practices put patients at risk for. Being able to understand and to teach the current healthcare

system and coverages is another crucial component to ensure that patients have access to the best

possible care. It is also vital for health practice to identify these factors affecting patient

outcomes and for medical professionals to try and improve upon these various factors.

Literature Review

Health Expenditure
The United States has ranked 37th amongst 191 industrial countries such as France, Italy,

Spain, and Japan in regards to health outcomes (World Health Organization, 2000). In order to

understand this low rank, it is important to be able to recognize the measures being evaluated

within healthcare and why the U.S. ranks so low within those measures. According to findings

provided by the Commonwealth fund Organization [CWFO], the nation was insufficient in areas

such as quality, access, efficiency, equity, and healthy lives (Davis, Stremikis, Squires, &

Schoen, 2014). Despite these alarming statistics, the United States is one of the biggest spenders

on health care. Out of the total gross domestic product, GDP, in the U.S, 17.7% is spent on health

care within the country (Davis, Stremikis, Squires, & Schoen, pp. 8-9, 2014). In comparison to

France who only spends 11.6%, Norway who spends 9.3%, and Australia who spends 8.9% total

percent of health care expenditure in regards to GDP (Davis, Stremikis, Squires, & Schoen,

2014). According to data collected by Organization for Economic Co-operation and

Development [OECD], all of these countries rank higher than the United States in regards to

quality of care (2013). So where is all of the U.S. money exclusive to healthcare being spent?

There are numerous factors that are contributing to the excessive expense such as cost of new

technology and prescription drugs, preventative care and health culture in America, and also
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higher government spending, in regards to lack of a universal health care system (Department for

Professional Employees, 2014).

Technology such as machines such as CAT scans, MRI machines, respiratory ventilators,

medical procedures, drug therapies, and even electronic medical record systems can account for

much of the increased percentage of GDP in the U.S. These medical machines and prescription

therapies do not come without a high cost to the country and are used in virtually every aspect of

health care today.

A side-effect of this medical technology has to do with the American culture. The cultural

aspect touches on the idea that many Americans believe illnesses can always be cured through

advancing medical surgeries, procedures, and improving pharmaceuticals (Callahan, 2008) This

idea also goes along with the way Americans feel that they need an answer immediately to their

health problems, and expect that technology be used to cure any problem. Often this leads people

to assume that prescription drugs can be used whether or not it is necessarily needed. In some

cases, healthcare professionals may order a treatment or test to be done because the patient

demands it.

Preventative Medicine
One contributing factor that can be identified in the United States is our practice in

preventative medicine. It has been shown that the treatment and management of medical

conditions will result in more monetary spending on healthcare than if medical resources would

have been used to prevent the conditions in the first place (Cohen, Neumann, Weinstein 2008).

This could very well indicate a major issue with U.S. healthcare spending practices. One could

easily infer that a significant increase in the preventative care provided in the United States

would lead to a smaller amount of people seeking care for conditions for which they have been

diagnosed.
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One of the biggest preventable factors that contribute to increased healthcare cost is

obesity. Chronic Diseases are the leading cause of death and disability in the United States.

Chronic diseases and conditions such as heart disease, stroke, cancer, type 2 diabetes, obesity,

and arthritisare among the most common, costly, and preventable of all health problems. To

prevent chronic diseases from affecting the US people there needs to be impactful teaching about

prevention strategies in health care settings. With around 1.5 billion adults worldwide being

either overweight or obese, attention to this problem must be made (Pharmacoeconomics, 2009).

Obesity has a major role in chronic disease development and is associated with increased

medical and pharmaceutical costs. There are multiple factors that can contribute to chronic

disease development: a few of which would be lack of exercise, diet, and smoking

(Pharmacoeconomics, 2009). Changes have occurred in diet and in physical activity patterns,

particularly in the last one or two decades of the 20th century (International Journal of Obesity

2004). One of the three major goals of Healthy People 2000 is to increase the span of healthy

life for Americans, and the first two priorities for health promotion focus on physical activity

and nutrition. With that being said, getting regular exercise in your schedule is one of the best

things that health care providers can encourage. Exercising is great for your blood pressure,

cholesterol, weight, energy level, and even your mood, to name just a couple of the many

benefits. Changes in diet directly correlate with changes in body stature, body composition, and

morbidity. People have shown that caloric sweetener use increases substantially with gross

national product (GNP) per capita of the country and urbanization increase (International Journal

of Obesity 2004). Patients should be advised to avoid foods that are high in sweeteners, fats, or

processed should be eaten in moderation. As mentioned previously obesity is directly linked to

morbidities such as hypertension, high cholesterol, diabetes, heart disease, and cancer. All of
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which cost considerably more to treat than the price of healthy food and exercise. These facts

make the United States obesity rate one of the single biggest healthcare cost factors. Healthcare

professionals should stress the importance of refraining from tobacco use and smoking cessation.

There was a study done between a smoking cohort versus a healthy living cohort, after 60 years

736 persons are still alive in the healthy-living cohort as opposed to 483 people in the smoking

cohort. The smoking cohort was the first cohort to become extinct, while the healthy- living

cohort is the last group to lose all its members (International Journal of Obesity 2004).

Preventative services such as cancer screenings, annual checkups, and vaccinations are also very

important health habits that directly correlate with health outcomes.

Another factor that plays into the United States ranking would be the rate of

immunizations. According to the World Health Organization study (2010) the U.S. ranked 51st

among the studied nations in the rate at which infants, less than one year of age, are immunized

for MMR, TDAP, and Hepatitis. This ranking reflects strongly upon not only the elevated infant

death rate in the country, but also indicates a reason in which more money will be spent on care

in the future. In a study of daycares, it was found that children receiving the MMR within 12

months of birth only had a disease prevalence of 8.6% as opposed to 41% for the infants who did

not (Barabeig et al, 2013). Statistic like this clearly show that the U.S. ranking in immunizations

could very easily not only have an effect on the health status of the population, but also an

increase in the money spent on healthcare. With medical coverage geared more toward giving

infants immunizations and the relative inexpensiveness, when compared to compensatory

medical treatment, the U.S. can make a stride toward correcting this deficit.

Healthcare Systems
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One last contributing factor that could be said to influence the healthcare disparity would

be the vast difference in the United States healthcare system as opposed to other industrialized

nations. As of the 2010 World health organization study, the U.S. was the only country without a

national universal healthcare system. Almost six years later the United States have taken steps

toward having said system through the affordable care act, although this is a very new system

that is just starting to spread nationally. It will take time to determine if the new system in place I

having a major effect on the spending deficit. According to the Census Bureau (2014) the rate of

uninsured individuals in the United States has dropped from 13.3% in 2010 to 10.4%. This

shows a mild, however promising result stemming from the Affordable Care Act. This makes the

case that the United States could possibly see an improvement in their world rankings in the next

decade or so if the plan continues to yield statistical improvements which can generate health

status improvements. The specific ways in which the Affordable Care Act could potentially help

in decreasing the discrepancy include lowering medication costs and making the cheaper

medications more readily available and expansions in preventative programs such as well-baby

visits, mammograms, pap smears, and other diagnostic studies (Stanhope 2015).

Conclusion
In conclusion the research has pointed to multiple different causative factors for the

health care disparity including cultural factors, lack of preventative medicine, lack of full

implementation of a universal system, and technological expenses. Within the next decade or two

there may be a shift in the disparity because of further implementation of the Affordable Care

Act. The other primary method that would need implemented in order to shift this disparity

would be a higher priority placed on preventative medicine which would also be pushed by a

further expansion in the ACA. Therefore health professionals must be educated and operate on
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the same medical premise in order to give the maximum care that has always been associated

with American idealism.

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