There are 2 ways that I could have invested two times as much on doughnuts. I might have bought two times as numerous doughnutsI could have purchased the same variety of doughnuts however got really elegant ones and paid twice 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 same amount of health care, or some mix.
Total spending is amount times cost. This idea that we're excessive using health care, that we're doing so much to our clients, we're delivering so much healthcare, that's why we invest a lot. All the policy stuff is about attempting 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 take an appearance at the data. One hypothesis I typically hear is, as an American culture, we fast to go the doctorat the drop of the hat, I get a little discomfort, Americans are off to see the doctor. We initially ask the question, let's take a look at physician visits per capita (what is health care policy).
This is physician gos to per capita in a given year: The mean is about 6. 6, and the United States has to do with 4. By the way, in Japan, the mean is 13. The typical Japanese sees their medical professional more than once a month. For every single 24-year-old who hasn't entered four years, there are people who are going every other week.
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6 and we're an excellent bit listed below that. We're not seeing the doctor as much as these other countries. Then people look at that and say, "Ah, possibly the problem is insufficient. Insufficient prevention, insufficient medical care, and it's all leading to too many hospitalizations. The issue is overuse of healthcare facilities.
We stated, let's 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. Surprisingly, Germany appears like a little the outlier, where hospitalizations per population are much, much higher. The other thingso this is simply hospitalizations, right? Hospital discharges per populationanybody have a sense of how our lengths of stay compare to those of other nations, these other countries? We're method shorter, method much shorter.
is? Yeah, 3. In the Medicare population it's like 4, 4 and a half, since they're a little bit older, however in the 3 to 4 days. In Japan, about 14. Right? I was in Japan a couple of years ago going to a community health center. It was exceptional 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 switched to the oral, and now we're just observing them 2 days post-oral antibiotics, just making sure they're fine. It's intriguing in terms of, if you believe about it: less hospitalizations, much shorter lengths of stay. And what you recognize is we invest far fewer days in the medical facility than any other high-income country.
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The third, on Alcohol Rehab Center this overutilization bit is that, the problem is we do too many tests and treatments. I put a little asterisk therein to remind myself to make a point, which is, obviously, when you talk about we do too many tests and procedures, a big part of that hypothesisa big part of the driving consider the policy world, and I'm delighted to enter into more on thisis the sense that the problem is that the doctors in Americawe're just out there overtesting, overprocedurizing, fee for service.
So, let's look at some empirical information, and there's a bit of assistance for some of this and not a lot for others, but let's take a look at the information. 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 primary.
We have more weight problems than nearly all of these nations, actually, than any of these nations, so it's not a total surprise that we're going to get more knee replacements. Hip replacements, I anticipated comparable numbers on hip replacements. I stated, "Oh, our knee replacements are high, our hip replacements are going to be high." Remarkably, not a lot.
Meaning, again, we see Germany appearing near the top, but we're really slightly below average. Coronary angioplasty, a treatment that has actually gotten a great deal of attention for issues about overuse. Sure enough, we're a bit on the high side, and here's Germany once again ... Again, what we see is we're a little high up on some things but not always others, and here's Germany on coronary angioplasty.
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health care cost is mostly about supplying excessive care, about overutilization. Right? I don't see it. We have fewer hospitalizations, less physician sees - when it comes to health care. Tests and procedures, I see as a variety. Right? We do more MRIs, and knee replacements, and angioplasties. We do fewer hip replacements. The way I think of it is, when it concerns utilization of health care services, we're above average on some things, we're below average on other things, and usually, we're pretty averageon utilization.
Another quick one, I'm going to just reveal you this information and then keep going. Really, this is one I have actually even said publiclywithout information and it turns out I was wrongthe one idea that has actually come up over and over again is that all these countries are primarily 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 office and they stated here's the data on specialized mixand the data was that here was the mean throughout these countries, and here was the U.S., right in the middle. I didn't think it. I just believed this can't be right.
The proportion of doctors who are primary care, and on the right is Sweden and Denmark, where it's only 2233% in France, 54% of physicians are primary carethe biggest challenge with this statistic is everyone calls it all different terms. Is it basic professionals? Is it generalists? Is it main care medical professionals? What we did was we stated, we don't care what you call it, let's speak Rehab Center about what people are actually carrying out in the workplace.
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And after that we went to both national data workplaces of each of these countries along with 3 to 5 experts from each nation, and we showed them their information (which of the following are characteristics of the medical care determinants of health?). I keep in mind talking with the guys from Switzerland and saying, "Hey, we discover that 48% of your physicians are medical care, based upon this meaning.
The 43% for the U.S. originates from the Kaiser Household Foundation, which is an outstanding source of information, using 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 an argument about which number is best, however this is our finest at doing an apples-to-apples contrast. a health care professional is caring for a patient who is taking zolpidem.