There are 2 methods that I could have spent twice as much on doughnuts. I might have purchased two times as numerous doughnutsI could have bought the exact same variety of doughnuts however got really expensive ones and paid two times as much, or some mix thereof. Right? If we're spending two times as much as other high-income countries, we're achieving that by either doing twice as much healthcare, paying two times as much for the very same quantity of health care, or some combination.
Total costs is amount times cost. This concept that we're overusing healthcare, that we're doing so much to our clients, we're delivering so much healthcare, that's why we spend so much. All the policy stuff is about attempting to decrease that overuse, our culture of overuse. I would say that much of the policy focus has actually been on the quantity side of things.
Let's have a look at the data. One hypothesis I often hear is, as an American culture, we are quick to go the doctorat the drop of the hat, I get a little pain, http://mariohqjb510.theburnward.com/avedis-donabedian-defined-health-care-quality-as-having-which-of-the-following-components-can-be-fun-for-anyone Americans are off to see the medical professional. We first ask the question, let's take a look at doctor check outs per capita (what is single payer health care?).
This is physician sees per capita in a given year: The mean has to do with 6. 6, and the United States has to do with four. By the way, in Japan, the mean is 13. The average 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 individuals who are going every other week.
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6 and we're a great bit below that. We're not seeing the physician as much as these other nations. Then people take a look at that and state, "Ah, possibly the problem is insufficient. Insufficient prevention, inadequate primary care, and it's all causing too lots of hospitalizations. The problem is overuse of healthcare facilities.
We stated, let's take a look at healthcare facility discharges per population. And here is the mean, right, 149 per thousand population. And here is the United States: a bit below par. Interestingly, Germany appears like a bit of the outlier, where hospitalizations per population are much, much greater. The other thingso this is simply hospitalizations, right? Health center discharges per populationanybody have a sense of how our lengths of stay compare to those of other countries, these other nations? We're method much shorter, method shorter.
is? Yeah, three. In the Medicare population it resembles 4, four and a half, since they're a little bit older, but in the 3 to four days. In Japan, about 14. Right? I was in Japan a few years ago checking out a neighborhood hospital. It was impressive to me. There were patients relaxing playing cards around a table.
Right? It resembles they got the 4 days of IV, then they switched to the oral, and now we're simply observing them 2 days post-oral antibiotics, simply making sure they're great. It's intriguing in terms of, if you consider it: less hospitalizations, much shorter lengths of stay. And what you realize is we spend far less days in the healthcare facility than any other high-income nation.
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The 3rd, on this overutilization bit is that, the issue is we do too numerous tests and procedures. I put a little asterisk therein to remind myself to make a point, which is, obviously, when you discuss we do a lot of tests and procedures, a huge part of that hypothesisa big part of the driving consider the policy world, and I'm delighted to get into more on thisis the sense that the problem is that the doctors 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 bit of support for some of this and not so much for others, however let's appearance at the data. MRIs. MRIs, we are high. Sure, we have more MRIs per population than typical, however not some crazy outlier. Knee replacements, here we really are number one.
We have more obesity than practically all of these countries, really, than any of these nations, so it's not an overall surprise that we're going to get more knee replacements. Hip replacements, I anticipated equivalent numbers on hip replacements. I said, "Oh, our knee replacements are high, our hip replacements Addiction Treatment Center are going to be high." Remarkably, not a lot.
Meaning, again, we see Germany revealing up near the Drug Rehab top, but we're really a little second-rate. Coronary angioplasty, a treatment that has actually gotten a great deal of attention for issues about overuse. Sure enough, we're a little bit on the high side, and here's Germany once again ... Again, what we see is we're a little high on some things but not always others, and here's Germany on coronary angioplasty.
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healthcare expense is mostly about providing too much care, about overutilization. Right? I do not see it. We have less hospitalizations, fewer doctor gos to - what is a health care delivery system. Tests and treatments, I see as a combined bag. Right? We do more MRIs, and knee replacements, and angioplasties. We do fewer hip replacements. The way I believe about it is, when it pertains to utilization of health care services, we're above average on some things, we're listed below average on other things, and usually, we're quite averageon utilization.
Another fast one, I'm going to just show you this data and after that keep going. In fact, this is one I've even stated publiclywithout data and it turns out I was wrongthe one concept that has turned up over and over once again is that all these nations are mostly medical care, we're mostly specialists, which the specialist-primary care physician mix is off.
Then the very first time my colleaguesI remember they came into my workplace and they said here's the data on specialty mixand the data 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 believed this can't be right.
The percentage of medical professionals who are medical care, and on the right is Sweden and Denmark, where it's just 2233% in France, 54% of physicians are primary carethe biggest challenge with this fact is everybody calls it all various terms. Is it general practitioners? Is it generalists? Is it main care medical professionals? What we did was we stated, we do not care what you call it, let's talk about what people are in fact doing in the office.
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And then we went to both national data offices of each of these countries in addition to 3 to five experts from each nation, and we revealed them their data (what is the affordable health care act). I remember speaking with the men from Switzerland and stating, "Hey, we find that 48% of your doctors are medical care, based on this meaning.
The 43% for the U.S. originates from the Kaiser Household Structure, which is an outstanding source of data, using the AMA Masterfile nationwide service. There are other studies and data from the U.S. that put the number a little lower. We can have a dispute about which number is best, however this is our best at doing an apples-to-apples comparison. what is single payer health care?.