Public Health Expenditure Discussion

Reply to week 10 Discussion

Dominique Morgan 

RE: Discussion – Week 10

Brief explanation of how public health expenditures may or may not correlate with desired public health outcomes.

In 2018, government public health expenditures totaled over $93 billion (Centers for Disease Control and Prevention [CDC], 2021). However, it is projected that by 2023, public health’s share of the total healthcare expenditures will fall to 2.4% (Himmelstein & Woolhandler, 2016). Overall, healthcare spending has slowed down while there has been a steady growth in total expenditures (Kamal et al., 2020). There may be a potential impact on how public health expenditures could correlate with desired public health outcomes. With a decline in spending, there could potentially be consequences such as a weakened response to new health threats, an inability to overcome health disparities, and a destabilization of prevention activities (Himmelstein & Woolhandler, 2016). Studies have shown that for both developing and developed countries, improvements in public health rise as their economic performance increases (Raghupathi & Raghupathi, 2020). Public Health Expenditure Discussion

Compare the differences in public health expenditures between the United States and one other country.

Population-wise, Ethiopia is the second-largest country in Africa (Central Intelligence Agency [CIA], 2021a). As of 2018, Ethiopia’s current health expenditure rate is 3.3% (CIA, 2021a). Also, as of 2018, Ethiopia’s current health expenditure per capita in U.S. dollars is $24.2 (The World Bank, 2021a). In 2019, Ethiopia’s GDP was over $95 billion (The World Bank, 2021b). Higher economic growth in the last several years made way for positive trends in health and poverty (The World Bank, 2021a). Ethiopia is a good example of how investing in health, infrastructure, agriculture, and more can positively impact the economic status of the nation.

The United States’ economy is described as “the most technologically powerful economy in the world, with a per capita GDP of $59,500” (CIA, 2021b). The current health expenditure rate is 16.9% (CIA, 2021b). The United States spends more on healthcare than any other OECD country in both rate and per person (Organization for Economic Co-operation and Development [OECD], 2019). It is important to note that the OECD (2019) found that higher spending levels have not equated with improved life expectancy, among other health indicators.

Explain any insights you had or conclusions you drew based upon your analysis.

Based on this analysis, I found it interesting that in some cases, increases in spending and health expenditures directly impacted health outcomes, while in others, they did not. Many factors should be considered, from differences in countries, the size of the markets, income distribution, and more. Another insight that I had based on this analysis is that although many countries spend large amounts of money on healthcare, it is not necessarily because they have significant health care needs, but because they have the money to spend (Getzen, 2013). This insight could be potential evidence to refute the claim that high expenditures and more money to spend correlates with better health outcomes.

References

Central Intelligence Agency. (2021). The world factbook: Ethiopia. 

Central Intelligence Agency. (2021b). The world factbook: United States. 

Centers for Disease Control and Prevention. (2021). Health expenditures. 

Getzen, T.E. (2013). Health economics and financing (5th ed.). John Wiley & Sons Inc.

Himmelstein, D.U., & Woolhandler, S. (2016). Public health’s falling share of U.S. health spending. American Journal of Public Health, 106(1), 56–57. 

Kamal, R., McDermott, D., Ramirez, G., & Cox, C. How has U.S. spending on healthcare changed over time? Peterson Center on Healthcare and KFF. 

Organization for Economic Co-operation and Development. (2019). Health at a glance 2019: Key findings for the United States. 

Raghupathi, V., & Raghupathi, W. (2020). Healthcare expenditure and economic performance: Insights from the United States data. Frontiers in Public Health, 8. 

The World Bank. (2021a). Current health expenditure per capita (current US$) – Ethiopia. 

The World Bank. (2021b). Ethiopia. 

Lydie Ultimo 

RE: Discussion – Week 10

International Comparison of Public Health Expenditures

The health of a nation can also be considered a critical asset (Marshall et al., 2018).  When compared with other countries in the world, the United States leads by the greatest margins in terms of health expenditures (Getzen, 2013).  With a population of approximately 315 million (5 percent of the global population), health expenditures for the United States were estimated at $2.3 trillion, versus China with a population of 1.4 billion and health expenditures of $0.2 trillion (Getzen, 2013).  Despite the disparities in health spending, the health status of the U.S. population continues to fall behind other nations (Institute of Medicine, 2002).

Ways Public Health Expenditures May or May Not Align with Outcomes

The health expenditures in the United States have been misaligned in comparison to population health outcomes.  In 2018, health care spending in the U.S. was twice as much as other similar countries at an average of $10,637 in the U.S. versus $5,527 elsewhere (Kurani & Cox, 2020).  Downs and Volpp (2020) indicate that the U.S. has spent approximately 5 to 18 percent of GDP on health care.  On the other hand, health outcomes relative to spending have not improved.  Among the health spending categories in the U.S., the highest concentration of expenses was on clinical care through inpatient and outpatient medical settings followed by prescription drugs and medical goods (Kurani & Cox, 2020).  According to Downs and Volpp (2020), the U.S. ranks 36th worldwide in life expectancy, the obesity rate has tripled from 14 percent in 1960 to over 42 percent in 2018, and Type II diabetes increased tenfold from 1960 to the present.  Moreover, health outcomes in the U.S also indicate a higher suicide rate than other high-income countries, as evidenced by a rate of 7.3 deaths per 100,000 in the United Kingdom versus 13.9 deaths per 100,000 in the U.S. (Tikkanen & Abrams, 2020).

Comparison of Expenditures Between the United States and Another Country

In comparing the health expenditures among wealthy nations, Switzerland followed the U.S. as the second-highest spending nation, though the U.S. expenditures were 42 percent higher than Switzerland (Kamal et al., 2020).  In 2015, health expenditures in Switzerland were estimated at 12.1 percent of GDP versus the U.S. which was at 16.7 percent of GDP (Organization for Economic Co-operation and Development (OECD, 2017).  Unlike the U.S., as a high health spending nation, Switzerland achieved better health indicators than the U.S., including a life expectancy of 83.6 years (Kamal, 2019).  Infant mortality is another key health indicator that demonstrates the disparities in outcomes between the U.S. and Switzerland.  In 2015 the infant mortality rate in Switzerland was 3.5 deaths per 1000 births versus the U.S. which was at 6.1 deaths per 1000 births (Hoi & Ganzer, 2017).  Also, in 2012 the U.S. obesity rate was estimated at 35.5 as compared to Switzerland at 10.3 (Hoi & Ganzer, 2017). Public Health Expenditure Discussion

Personal Insights on the Country Comparison

The dichotomy between health expenditures and outcomes in the U.S. has demonstrated the need to consider the overall aspects that contribute to optimal health.  Downs and Volpp (2020) posit that spending alone does not contribute to better health, and that lifestyle and environment are critical in ensuring improved health.  With an aging population and increasing rates of chronic health conditions in the U.S., disease prevention and health promotion strategies are essential to promote population health.  National initiatives such as Healthy People 2030 have established key objectives to target health promotion (U.S. Department of Health and Human Services, 2021).  Such efforts can support the prioritization of the social determinants of health to address health disparities and improving overall health outcomes.

References

Downs, S., & Volpp, K. G. (2020). Improving health outcomes in the US: Let’s stop relying on people swimming upstream. New England Journal of Medicine Catalyst. 

Getzen, T. E. (2013). Health economics and financing (5th ed.). John Wiley and Sons

Hoi, G. W. S., & Ganzer, T. (2017). Do American and Swiss patients get what they pay for? Swissinfo. 

Institute of Medicine. (2002). The future of the public’s health in the 21st century. National Academies Press. 

Kamal, R. (2019). How does U.S. life expectancy compare to other countries? Peterson Center for Health Care. 

Kamal, R., Ramirez, G., & Cox, C. (2020). How does health spending in the U.S. compare to other countries? Peterson Center for Health Care. 

Kurani, N. & Cox, C. (2020). What drives health spending in the U.S. compared to other countries. Peterson Center of Health Care. 

Marshall, L., Finch, D., Cairncross, L., & Bibby, J. (2018). Briefing: The nation’s health as an asset-building evidence on the social and economic value of health. The Health Foundation. 

Organization for Economic Co-operation and Development. (2017). Health policy in Switzerland. 

Tikkanen, R., & Abrams, M. K. (2020). U.S. health care from a global perspective, 2019: Higher spending, worse outcomes? The Commonwealth Fund. 

U.S. Department of Health and Human Services. (2021). Health people 2030: Building a healthier future for all.