There are 2 methods that I could have invested twice as much on doughnuts. I might have purchased twice as many doughnutsI could have purchased the same number of doughnuts but got actually elegant ones and paid twice as much, or some combination thereof. Right? If we're spending two times as much as other high-income countries, 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 combination.
Total spending is amount times rate. This notion that we're overusing healthcare, that we're doing so much to our patients, we're providing so much healthcare, that's why we spend so much. All the policy stuff is about attempting to lower that overuse, our culture of overuse. I would state that much of the policy focus has been on the amount side of things.
Let's take 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 discomfort, Americans are off to see the physician. We initially ask the concern, let's take a look at medical professional visits per capita (who is eligible for care within the veterans health administration?).
This is physician sees per capita in a given year: The mean is about 6. 6, and the United States is about 4. By the method, in Japan, the mean is 13. The typical Japanese sees their doctor more than when a month. For each 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 good bit below that. We're not seeing the medical professional as much as these other countries. Then individuals take a look at that and state, "Ah, perhaps the issue is insufficient. Insufficient avoidance, insufficient primary care, and it's all resulting in a lot of hospitalizations. The problem is overuse of healthcare facilities.
We said, let's take a look at hospital 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 higher. The other thingso this is just hospitalizations, right? Hospital discharges per populationanybody have a sense of how our lengths of stay compare to those of other nations, these other nations? We're way shorter, way much shorter.
is? Yeah, three. In the Medicare population it's like four, 4 and a half, because they're a little bit older, however in the 3 to four days. In Japan, about 14. Right? I remained in Japan a few years ago visiting a neighborhood health center. It was impressive to me. There were clients sitting around playing cards around a table.
Right? It resembles they got the four days of IV, then they switched to the oral, and now we're simply observing them two days post-oral prescription antibiotics, just making sure they're fine. It's interesting in terms of, if you consider it: less hospitalizations, shorter lengths of stay. And what you recognize is we spend far less days in the healthcare facility than any other high-income country.
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The third, on this overutilization bit is that, the issue is we do a lot of tests and treatments. I put a little asterisk therein to advise myself to make a point, which is, of course, when you speak about we do too many tests and procedures, a huge part of that hypothesisa big part of the driving element in the policy world, and I enjoy to get into more on thisis the sense that the issue is that the doctors in Americawe're just out there overtesting, overprocedurizing, fee for service.
So, let's take a look at some empirical information, and there's a little bit of assistance for some of this and not so much for others, however let's take a look at the information. MRIs. MRIs, we are high. Sure, we have more MRIs per population than typical, however not some crazy outlier. Knee replacements, here we truly are number one.
We have more obesity than almost all of these countries, actually, than any of these nations, 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 said, "Oh, our knee replacements are high, our hip replacements are going to be high." Remarkably, not so much.
Significance, once again, we see Germany revealing up near the top, however we're really slightly below par. 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 again ... Again, what we see is we're a little high on some things but not necessarily others, and here's Germany on coronary angioplasty.
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healthcare cost is mainly about supplying excessive care, about overutilization. Right? I do not see it. We have less hospitalizations, fewer medical professional check outs - what is single payer health care. Tests and procedures, I view as a variety. Right? We do more MRIs, and knee replacements, and angioplasties. We do less hip replacements. The method I consider it is, when it pertains to usage of healthcare services, we're above average on some things, we're below par on other things, and typically, we're quite averageon utilization.
Another quick one, I'm going to simply show you this information and after that keep going. Really, this is one I've even stated publiclywithout information and it ends up I was wrongthe one idea that has shown up over and over again is that all these countries are mainly main care, we're mainly specialists, which the specialist-primary care physician mix Drug Abuse Treatment is off.
Then the very first time my colleaguesI https://gumroad.com/elbertfxm0/p/excitement-about-what-is-a-health-care-proxy-bdea0853-7c17-4763-b1c2-55c6ef9af58f remember they came into my office and they said here's the information 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 simply believed this can't be right.
The percentage of physicians who are main care, and on the right is Sweden and Denmark, where it's just 2233% in France, 54% of physicians are main carethe greatest challenge with this figure is everyone calls it all various terms. Is it basic practitioners? Is it generalists? Is it main care medical professionals? What we did Addiction Treatment was we said, we do not care what you call it, let's talk about what people are really performing in the office.
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And then we went to both nationwide stats workplaces of each of these nations as well as 3 to five specialists from each nation, and we showed them their information (why doesn't the united states have universal health care). I keep in mind speaking with the men from Switzerland and stating, "Hey, we find that 48% of your medical professionals are medical care, based on this definition.
The 43% for the U.S. originates from the Kaiser Household Foundation, which is an exceptional source of information, utilizing 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, but this is our finest at doing an apples-to-apples contrast. what is single payer health care.