The U.S. gets relatively low ROI for its relatively exorbitant spending on healthcare, noted once again in the latest Health at a Glance, the annual OECD report on member nations’ healthcare systems. The report includes U.S. country data asking, “How does the United States compare?” with its sister OECD countries.

The answer is, “not well across most population health, access, and mortality measures.”

For the Cliff’s Notes/Where’s Waldo top-line of the research, find the two long bars in this chart heading “south” of the OECD average, and one long blue bar going “north.” The northern climbing bar is health care spending in the U.S. compared with other developed countries, surpassing the ceiling, “higher than OECD average.” The two negative brown bars are obesity and population coverage, indicating that the U.S. outcomes for these two metrics are far worse performing than the OECD average.

The arithmetic here is “spend more, get (much) less.” Specifically, spend lots more, and achieve epidemic levels of obesity and poor access to healthcare services for American health citizens.

There are other negative brown bars that show low-performing outcomes, like “consultations skipped due to cost:” in other words, self-rationing due to healthcare costs. The U.S. also doesn’t fare well on the ultimate healthcare outcome: life expectancy, which for both men and women falls below the OECD average.


Here’s the health spending chart from the report, showing the U.S. far outspends other developed countries in the OECD. The OECD average is $4,003 per capita/citizen. The U.S. spends more than twice that per person, at $9,892, followed by Switzerland which spends $7,919 and Luxembourg at $7,463. The Swiss live to 83.0 years at birth, and the Luxembourgers, to 82.4, based on OECD data.

Americans on average die at 78.8 years.

[As a matter of policy, both Switzerland and Luxembourg have a form of universal health coverage, both with compulsory social insurance.]

Health Populi’s Hot Points:  The CDC published new data on the prevalence of obesity in America earlier this month, identifying a  markedly greater obesity prevalence among adults in nonmetropolitan than metropolitan counties in 2016: 34.2% in nonmetros vs. 28.7% in metro areas. Overall obesity prevalence in the U.S. was 29.6% in 2016; it was highest in the East South Central region (35.3%), the West South Central (33.9%), the South (32.0%), and the Midwest (31.4%).

The CDC observed that, “one possible contributing factor [to the obesity prevalence difference] is the high rate of persistent poverty in the South, which also is affected by the largest difference in poverty rate between metropolitan and nonmetropolitan county residents.”

In the U.S. comparative country notes, the OECD featured this third chart which shows that the nation has the highest obesity rate in the world by a narrow margin after Mexico. Obesity is a risk factor for many diseases, some shown in the bar chart that calculates costs attributable to obesity and overweight by condition.

The greatest costs are garnered by high blood pressure, diabetes (Type 2), chronic back pain, and osteoarthritis. In the Weighing Down America study, the Milken Institute gauged that health conditions related to obesity and overweight totaled $428 billion.


The direct medical expenses generated through treating diseases borne by obesity accounted for over 14% of U.S. healthcare spending in 2014.

Adding in indirect costs, the total costs of obesity-related conditions equaled 8.2% of America’s gross domestic product.

Of course, money isn’t everything: costs are very personal to people in terms of quality of life, disability, mobility, self-efficacy, and personal productivity and goal-achievement. These personal costs take a toll on Americans’ lives beyond the monetary.

Analyzing the U.S. country data in the context of fellow OECD nations points to some constructive policy prescriptions for the U.S. that can nudge the country’s health outcomes, healthcare costs, and health system performance for the better. These policies would address food access and nutrition quality; education that promotes overall literacy, health literacy and digital literacy; promoting physical activity through improving public recreation opportunities, paved sidewalks and bicycle paths; and, universal healthcare coverage that also promotes a strong primary care backbone for all Americans.