There are 2 methods that I might have spent twice as much on doughnuts. I might have bought twice as numerous doughnutsI could have purchased the very same variety of doughnuts however got actually fancy ones and paid twice as much, or some mix thereof. Right? If we're investing twice as much as other high-income nations, we're accomplishing that by either doing twice as much healthcare, paying two times as much for the exact same amount of healthcare, or some mix.
Total spending is quantity times cost. This idea that we're excessive using health care, that we're doing so much to our patients, we're delivering so much health care, that's why we spend a lot. All the policy stuff is about trying to lower that overuse, our culture of overuse. I would say that much of the policy focus has actually been on the amount side of things.
Let's have a look at the data. One hypothesis I frequently hear is, as an American culture, we are quick to go the doctorat the drop of the hat, I get a little pain, Americans are off to see the doctor. We first ask the question, let's take a look at medical professional check outs per capita (who is eligible for care within the veterans health administration).
This is physician visits per capita in a given year: The mean has to do with 6. 6, and the United States is about 4. By the Mental Health Delray method, in Japan, the mean is 13. The typical Japanese sees their medical professional more than when a month. For every single 24-year-old who hasn't gone in 4 years, there are people who are going every other week.
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6 and we're a great bit below that. We're not seeing the doctor as much Mental Health Facility as these other countries. Then individuals look at that and say, "Ah, possibly the problem is insufficient. Not enough prevention, not enough medical care, and it's all resulting in a lot of hospitalizations. The problem is overuse of healthcare facilities.
We stated, let's look at health center discharges per population. And here is the mean, right, 149 per thousand population. And here is the United States: a little bit second-rate. Surprisingly, Germany appears like a little the outlier, where hospitalizations per population are much, much greater. The other thingso this is simply hospitalizations, right? Medical facility discharges per populationanybody have a sense of how our lengths of stay compare to those of other nations, these other nations? We're method shorter, way much shorter.
is? Yeah, three. In the Medicare population it resembles four, four and a half, because they're a bit older, but in the 3 to four days. In Japan, about 14. Right? I remained in Japan a couple of years ago visiting a community hospital. It was remarkable to me. There were patients sitting around playing cards around a table.
Right? It's like they got the 4 days of IV, then they changed to the oral, and now we're just observing them 2 days post-oral prescription antibiotics, just making sure they're fine. It's fascinating in terms of, if you https://gumroad.com/ithriso5b1/p/things-about-what-purpose-does-a-community-health-center-serve-in-preventive-and-primary-care-services think of it: fewer hospitalizations, shorter lengths of stay. And what you realize is we spend far less days in the hospital than any other high-income nation.
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The 3rd, on this overutilization bit is that, the issue is we do a lot of tests and procedures. I put a little asterisk therein to remind myself to make a point, which is, naturally, when you talk about we do too numerous tests and treatments, a huge part of that hypothesisa big part of the driving element in the policy world, and I'm delighted to enter into more on thisis the sense that the issue is that the medical professionals in Americawe're simply out there overtesting, overprocedurizing, charge for service.
So, let's take a look at some empirical data, and there's a little bit of assistance for a few of this and not so much for others, but let's appearance at the data. MRIs. MRIs, we are high. Sure, we have more MRIs per population than average, however not some insane outlier. Knee replacements, here we really are top.
We have more weight problems than nearly all of these countries, actually, than any of these countries, so it's not an overall surprise that we're going to get more knee replacements. Hip replacements, I expected similar numbers on hip replacements. I stated, "Oh, our knee replacements are high, our hip replacements are going to be high." Surprisingly, not so much.
Meaning, once again, we see Germany appearing near the top, however we're in fact a little listed below average. Coronary angioplasty, a treatment that has gotten a lot of attention for concerns about overuse. Sure enough, we're a little bit on the high side, and here's Germany once again ... Once again, what we see is we're a little high up on some things but not necessarily others, and here's Germany on coronary angioplasty.
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health care expense is primarily about supplying excessive care, about overutilization. Right? I do not see it. We have less hospitalizations, less physician visits - how does the health care tax credit affect my tax return. Tests and treatments, I see as a variety. Right? We do more MRIs, and knee replacements, and angioplasties. We do fewer hip replacements. The way I consider it is, when it comes to utilization of health care services, we're above average on some things, we're below par on other things, and typically, we're quite averageon utilization.
Another fast one, I'm going to simply show you this information and after that keep going. Really, this is one I've even said publiclywithout data and it turns out I was wrongthe one idea that has come up over and over again is that all these nations are mainly main care, we're mostly experts, and that the specialist-primary care doctor mix is off.
Then the first time my colleaguesI remember they came into my office and they said here's the data on specialty mixand the information was that here was the mean across these countries, and here was the U.S., right in the middle. I didn't believe it. I just thought this can't be right.
The percentage of doctors who are medical care, and on the right is Sweden and Denmark, where it's only 2233% in France, 54% of medical professionals are main carethe most significant challenge with this fact is everyone calls it all different terms. Is it family doctors? Is it generalists? Is it main care medical professionals? What we did was we said, we don't care what you call it, let's talk about what people are in fact performing in the office.
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And after that we went to both nationwide statistics workplaces of each of these countries in addition to 3 to five experts from each country, and we revealed them their information (which of the following are characteristics of the medical care determinants of health?). I keep in mind talking to the guys from Switzerland and saying, "Hey, we find that 48% of your medical professionals are primary care, based on this definition.
The 43% for the U.S. comes from the Kaiser Family Structure, which is an outstanding source of data, utilizing the AMA Masterfile nationwide service. There are other studies and information from the U.S. that put the number a little lower. We can have a dispute about which number is best, but this is our best at doing an apples-to-apples comparison. what does a health care administration do.