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Universal Healthcare and Life Expectancy: A Global Perspective

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JC Scull often writes about women's issues and accomplishments.

universal-healthcare-and-life-expectancy-a-global-perspective

Changing Attitudes About Universal Healthcare Coverage

The Covid-19 pandemic is changing cultural, social, political and economic boundaries on a global scale. Past arguments in opposition to a government managed healthcare approach are becoming less relevant as we see large numbers of infected patients experiencing hospital stays lasting weeks.

We see many vulnerable populations being the ones that also struggle with affording health insurance. As workers are furloughed or laid-off, many lose their health care coverage and we wonder how will they manage if they find themselves infected with the SARS-CoV-2 virus and are faced with hospital bills potentially in the tens of thousands of dollars.

It is also becoming painfully clear that a healthy and viable work force is important for the economic well-being of the nation. More importantly, as we look toward countries we consider our peers we realize that their citizens live longer and can rely on healthcare systems that are consistently present to improve their lives and well-being.

Will COVID-19 be the turning point?

Life Expectancy

The world’s life expectancy today stands at 73.2 years. A mere 70 years ago in 1950, it was a trifling 48 years. This included a high childhood mortality rate which has steadily declined from 43% in 1800 to 3% in 2019. Prior to the 1950s, once individuals were able to make it past the age of 21 by avoiding childhood diseases, they could expect to live into their late 60s.

These improvements in global life expectancies could not have been possible without the eradication of certain diseases responsible for the death of children and adults alike. Improvements in medical care and treatments have also greatly contributed to the expansion of life expectancy. Diseases once considered deadly such as diabetes, hypertension, hepatitis C and HIV are now manageable.

At the turn of the 20th century among the leading causes of death were infectious diseases such as flu, tuberculosis, gastrointestinal infections, and diphtheria. Today, improvements in sanitation, vaccine development and medical treatments such a antibiotics have led to remarkable declines in the deaths from infectious diseases that plagued the world in the early 20th century and before.

Today, however, we struggle with other ailments that keep us from reaching what scientists call ‘maximum life span’, currently pegged at 100–110 years of age. Accordingly, the longest human lifespan belongs to Jeanne Calment of France, born in 1875, who lived to the age of 122 years and 164 days. Besides Calment, there have been few humans that have made it beyond the 110 year threshold.

The upper limit for how long humans can potentially live is known as the Hayflick limit. It describes the number of times the cells of any living species can divide. For humans, this number is somewhere between 50 and 70 times, which translates to approximately 120 years. Scientist are experimenting with laboratory mice and other animal species regarding oxygen consumption and telomeres, (a compound structure at the end of a chromosome thought to be the human biological clock), in the hopes that the maximum human age can be expanded.

Globally, life expectancy varies by country. It typically represents the life span of a newborn but more importantly it is an indicator of the overall health of a country. While on the short term, life expectancy can fall due to unforeseen events such as famine, war, plague, or natural disasters, when viewed on a longer term basis it can describe social, political and economic conditions.

Improvements in health and welfare increase life expectancy, pointing to people’s longevity as an indicator of how well-off a nation is. Consequently, life expectancy can vary as much as thirty years depending upon where a person lives. This is evident in the case of Hong Kong who enjoys the highest life expectancy of 85.29 years and Chad with a dismal 55.17: the lowest.

universal-healthcare-and-life-expectancy-a-global-perspective

Economic Development and Life Expectancy

Various factors influence life expectancy. Some of these are food supply, access to housing, education and quality affordable health services. For the most part these factors are affected by income and national wealth as higher wages imply access to these benefits.

However, as national income and wealth reach a certain level, a direct correlation between these factors and life expectancy begins to become opaque. One notable example is the United States, one of the wealthiest countries in the world, where life expectancy has declined in the last three years. Currently at 78.6 years, it trails Japan and Switzerland by five years. It also lags behind less developed countries such as Cuba, Guadeloupe, Slovenia, Chile, Barbados, Lebanon, Curacao and Costa Rica.

Among chief reasons regarding the U.S.’s low life expectancy when compared to other developed countries, experts cite economic disparity, the opioid epidemic, rising suicide rate, obesity and the inaccessibility to health coverage of 27.5 million Americans or 8.5% of the population.

The United States is the only one among OECD nations (Organization for Economic Cooperation and Development, a group of 36 countries, most of which considered developed with high income economies) not to have a system of comprehensive universal health care. Although it does have specific components, such as Medicare, Medicaid and the Department of Veterans Affairs that provide universal health care to certain portions of the population.

Dr. Ky Stoltzfus, assistant professor of Internal Medicine and Population Health at the University of Kansas Medical Center said: “The U.S. continues to have lower life expectancy compared to other developed countries, which is concerning. We spend more per capita GDP on healthcare than any other country, yet we don’t receive the anticipated health benefits from such spending,”

Also concerning is the fact that individual U.S. states that score high in life expectancy, still rank low among OECD nations.

Universal Health Coverage

Universal health care is a system that provides quality medical services to all citizens in a country. Typically, the government provides it to all regardless of their ability to pay. It is an expensive approach to providing health wellness to any nation, but mostly funded through payroll taxes, premiums and co-pays.

A multi-country cross-sectional study (conducted by the World Health Organization, UNDP-Education and World Bank) on the influence of Universal Health Coverage on life expectancy found that people’s longevity is significantly lengthen when health care is widely available at little or no cost to the consumer.

It concluded that as a comprehensive system of wellness, Universal Health Coverage facilitates a wide range of health services that significantly improves life expectancy. It accomplishes this through child vaccination, promotion of healthy lifestyles, preventive care and a more equitable distribution of health care across all socio-economic levels.

Other benefits of a well-managed Universal Health Coverage program are lower medical costs. This is typically accomplished by the government’s control over prices through negotiation and regulation. Additionally, lower administrative costs are reached as doctors and hospitals deal with one government agency only. For example, Canadian and British doctors spend one quarter of the time American doctors spend dealing with insurance companies.

Other benefits include uniformity of care across all sectors of society at affordable prices. Currently, in the United States health care providers must focus on profit. They do this by offering the latest technology, expensive services and by paying doctors more. However, they must also target wealthy clients, while other less well-off patients receive standard services with larger co-pays. In the case of the uninsured, quality medical services are often out of their reach.

Studies show that preventive health care reduces the need for expensive emergency room usage. Currently, in the United States 46% of emergency room patient visits are the result of not having a regular doctor of their own or not having another source of care. In essence, they have been using emergency rooms as their primary care physician. This health care inequality is one of the reasons behind the rising cost of medical care.

Universal Health Care also prevents future social costs by providing early childhood care. These costs to society include welfare dependency, crime and other health issues. It also accomplishes this by teaching families how to make healthy lifestyle choices and by preventing chronic diseases.

universal-healthcare-and-life-expectancy-a-global-perspective

Types of Health Care Coverage

There are various approaches that countries use in their health care policy. There are four basic models, however some countries have created their own hybrid variations that fit their individual needs.

The four basic models are:

Socialized medicine — This is a case in which all hospitals are owned by the government. Additionally, all doctors and nurses are government employees. The National Health Service (NHS) in the United Kingdom is an example of this system. Cuba is another example of socialized medicine.

Studies have shown that on the long term socialized medicine is one of the most cost-effective systems. One disadvantage, however, is that both doctors and patients have less choices in the range of treatments and procedures available.

Single-payer system — It is a system under which the government pays for medical costs for its citizens, in essence acting as a health insurance provider. Doctor’s offices and hospital can either be private for profit or nonprofit. Doctors do not work for the government. This type of system allows more choices of doctors, hospitals and procedures. It is, however, more expensive than socialized medicine. Some of the countries operating a single-payer system are Canada, Taiwan and South Korea.

Private insurance — In this system private insurance companies cover medical costs. By law everyone is mandated to purchase some type of health insurance plan and the companies providing benefits are regulated by the government. Private insurance systems provide the most consumer choices but are the most expensive. Switzerland, Germany and Japan are among some of the countries using this system. In the case of Germany, citizens are required to purchase insurance from 118 not-for-profit “Sickness Funds” that are regulated by the government. The Affordable Care Act (ACA) is structured as a private insurance program.

Out-of-Pocket Approach — While all industrialized countries and some developing countries have established health care systems, the vast majority do not. Out of 195 countries, less than 70 offer some sort of health care program. The rest are countries too poor or disorganized to provide mass medical care. Unfortunately, in the out-of-pocket system the rich get medical care but the poor stay sick or die. These are countries where hundreds of millions of people go their entire lives without ever going into a hospital or seeing a doctor.

universal-healthcare-and-life-expectancy-a-global-perspective

Countries with Universal Health Care

The following is a list of countries with higher life expectancy than the U.S. The list shows the type of health care system they employ as well as their per capita GDP PPP.

Keep in mind that implementing a universal health care system does not automatically guarantee a high life expectancy. As previously stated, life expectancy represents how well-off a country is. This includes distribution of wealth, education, life styles, socioeconomic status, employment and overall well-being. It is also influenced by other social factors as well, such as: lack of exercise; genetic factors; environmental factors; overcrowded housing; lack of clean drinking water and adequate sanitation.

However the quality of the health system and its accessibility also plays an important role.

Chart Key:

PP: Public/Private health insurance. Some people receive healthcare via primary private insurance. Those who are ineligible receive benefits directly from the government:

PI: Public insurance. Government collects dues from employees and employers. In order to qualify a person has to be employed or registered as unemployed. All other receive benefits from various government agencies.

SP: Single payer

SOC: Socialized medicine.

MPI: Mandatory private insurance subsidised by the government.

NUI: Non-universal insurance system. Some citizens have private health insurance, some are eligible for subsidized public health care, while some are not insured at all.

CountryLife ExpectancyType of Health Care CoveragePer Capita GDP PPP

United States

79.11

NUI

$67,486

Hong Kong

85.29

PI

$67,587

Japan

85.03

PI

$46,827

Macao

84.68

PI

$113,352

Switzerland

84.25

MPI

$67,558

Singapore

84.07

PI

$105,689

Italy

84.01

SP

$41,582

Spain

83.99

SP

$43,007

Australia

83.94

PP

$55,171

Iceland

83.52

SP

$52,150

South Korea

83.50

PI

$46,452

Israel

83.49

MPI

$40,337

Sweden

83.33

SP

$55,989

France

83.13

PI

$48,640

Malta

83.06

SP

$49,589

Canada

82.96

SP

$52,144

Norway

82.94

SP

$79,638

Ireland

82.81

SP

$86,988

New Zealand

82.80

SP

$42.045

Greece

82.80

SP

$31,616

Luxembourg

82.79

PI

$112,045

Netherlands

82.78

MPI

$60,299

Portugal

82.65

SP

$34,933

Finland

82.48

SP

$49,548

Belgium

82.17

PI

$50,904

Austria

82.05

PP

$55,171

Germany

81.88

PP

$55,306

Slovenia

81.85

SOC

$40,344

United Kingdom

81.55

SOC

$48.169

Cyprus

81.51

PP

$42,956

Denmark

81.40

SP

$55,675

Taiwan

81.04

SP

$57,214

Costa Rica

80.94

PI

$18.651

Chile

80.74

PP

$27,150

Qatar

80.73

PP

138,910

Maldives

79.89

SP

$24,796

Barbados

79.64

SOC

$19,364

Curacao

79,41

MPI

$25,590

Poland

79.27

PI

$35,651

Lebanon

79.27

SP

$15,599

Cuba

79.18

SOC

$11,900

Estonia

79.18

PI

13,093

universal-healthcare-and-life-expectancy-a-global-perspective

The U.S. Health Care System

While the vast majority of other countries have each adopted one singular health care model for all of their citizens, the United States maintains many separate systems for separate classes of people. (Veterans Administration, private insurance, Medicare and Medicaid.) However, operating one system exclusively is not only simpler but less expensive and fairer.

The National Research Council and Institute of Medicine (NRC/IOM) recently released a report stating that the United States has a three-decades-long ‘health disadvantage’ causing Americans to die and suffer from illness and injury at “rates that are demonstrably unnecessary.” It also states that the nation’s health and economic well-being are at risk as it spends far more per capita on healthcare than other high-income countries, yet exhibiting poor health outcomes.

Compared to other developed countries in the NRC/IOM study, the U.S. ranks as worst for infant mortality, low birth weight, obesity, diabetes, heart disease, chronic lung disease, disability, adolescent pregnancy, sexually transmitted infections, drug-related deaths, injuries and homicides.

Additionally, the research shows that poor health outcomes in the United States disproportionately impact ethnic minorities, educational levels, race, geographic location, sexual orientation and socioeconomic levels. Groups impacted can range from rural residents not able to obtain health insurance; to higher incidence of untreated diabetes among Latinos; to African-American women dying of cervical cancer at twice the rate of white women.

In spite of its poor performance when compared to other developed countries, the United States national health spending is projected to grow at an average annual rate of 5.4 percent from 2019 to 2028, ultimately reaching $6.2 trillion annually. It currently stands at $3.6 trillion as of 2018.

This represents $11,172 per person, or 17.7% of Gross Domestic Product (GDP). On the other hand, Canada’s total health expenditure per person is $7,068. Additionally, today the U.S. spends $2,500 per person on health care administrative costs, while Canada spends $550.

Three Reasons Why the U.S. Healthcare System is Poor

The three best performing health care systems in the world, according to the Commonwealth Fund are the United Kingdom, the Netherlands, and Australia. The lowest performer, however, is the United States, even though it spends the most. In fact, David Blumenthal, the president of the Commonwealth Fund has described three reasons why the United States has been lagging behind other developed countries for the last three decades. These reasons are:

  1. A lack of insurance coverage by a portion of the population. Blumenthal claims that data indicate that having insurance lowers mortality. He said that having health insurance “is equivalent to a public-health intervention.” In 2016 more than 27 million people in the U.S. were uninsured, often because they live in a state that didn’t expand Medicaid, they can’t afford coverage or are undocumented.
  2. Administrative inefficiency. Patients and doctors waste a lot of time on billing and insurance claims. Other countries such as the Netherlands who also rely on private health insurers, minimize these problems by creating standardized basic benefit packages which reduce administrative burden for providers. They also create predictable co-payments for patients further reducing operational costs. Additionally, insurance companies offer a wide variety of plans that cover many different treatments and procedures. This forces doctors to spend countless hours coordinating with insurance companies to provide care.
  3. Under-performing primary care caused by a disorganized, fragmented, inefficient and under-resourced system. Blumenthal says that the Commonwealth Fund found in 2014 that “many primary-care physicians struggle to receive relevant clinical information from specialists and hospitals, complicating efforts to provide seamless, coordinated care.” Besides in investing in primary care he also claims that “we don’t invest in social services, which are important determinants of health” This includes services like home visiting, improved housing and subsidized healthy food. All of this can play an important role in extending the work of doctors as well as improving chronic disease outcomes.

Five Reasons Why U.S. Health Care is So Expensive

Most experts point to several reasons why health care costs in the U.S. are the highest in the world. These are:

  1. Americans pay more for health care services but they also pay more for administrative costs due to the complexity of the country’s health care system.
  2. Doctors in the U.S. use more technology in their practices. This includes PET, CT, and MRI exams. For example the U.S. has 35 MRI machines for every million people while France only has 8. One of the reasons for this is that most U.S. providers make more money by performing more tests. In essence, the more a doctors treats, the more they can earn. In other countries, as in the case of France a more conservative approach is taken.
  3. Health care premiums have been rising at a faster pace than both wages and inflation. In the last decade, average family premiums have increased by 55%, while workers’ earnings increased by 26%. and inflation by 17%, over the same period. Today, annual family premiums for employee-sponsored health insurance has risen to an average of close to $20,000 annually.
  4. Drug manufacturers own patents in the U.S. for ‘blockbuster’ drugs for which they charge exponentially more than the rest of the world. New medications like Harvoni, which treats Hepetitis C, has an average cost $1,125 per pill. This translates to an 8-week treatment costing $63,000 and a 12-week course going for $94,000. A cost that is thousands more than in Europe. Insulin, a lifesaving medication for diabetics, costs $350 in the U.S. while only $50 in Canada. Some of the new chemotherapy therapies have been known to cost nine times as much in the U.S. as in other countries. Unfortunately, these are only but a few examples of how drug manufacturers use the American health care marketplace to pad their profits.
  5. Diagnostic tests and surgery are also hugely more expensive in the United States than in other countries. An MRI can cost as much as $3,500 in the U.S. while half of that much in Europe. A coronary bypass in the U.S. can be upwards of $40,000, depending on the region of the country, while in Germany it costs less than half that amount. Childbirth in the U.S. costs an average of $12,000 while in Spain it is only $2,000.
  6. The mean salary of a doctor in the United States is $313,000 annually. Doctors practicing some specialties can make substantially more. In Italy, however, a doctor’s salary averages about $140,000 per year. In Spain the average is $180,000 and in Germany around $100,000, which is the same as in the U.K.

Resources

Comments

JC Scull (author) from Gainesville, Florida on June 29, 2020:

Thank you Arthur.

Arthur Russ from England on June 29, 2020:

A very comprehensive, informative, and well balanced article.

JC Scull (author) from Gainesville, Florida on June 22, 2020:

Thank you Ivana.

Ivana Divac from Serbia on June 22, 2020:

This is a very interesting read. Informative, well-written, and brings up many important questions and points.

JC Scull (author) from Gainesville, Florida on June 21, 2020:

Thank you Pamela.

Pamela Oglesby from Sunny Florida on June 21, 2020:

This is a wealth of information about life expectency. I found you article to be full of interesting facts, JC.

JC Scull (author) from Gainesville, Florida on June 21, 2020:

Thank you Liz. With all the issues NHS has faced, but it still rocks!! It's a great system.

JC Scull (author) from Gainesville, Florida on June 21, 2020:

Thank you Mary!

Liz Westwood from UK on June 21, 2020:

This is an interesting study of healthcare systems. In the UK we have much to be grateful for with the National Health Service, although its funding and management are often contentious political topics.

Mary Norton from Ontario, Canada on June 21, 2020:

This is so informative. It is sad that several attempts at changing the health care system in the United States have not been successful. When the focus is on the health of the population and not on money, maybe this will change.

JC Scull (author) from Gainesville, Florida on June 21, 2020:

Thank you Ann!!

JC Scull (author) from Gainesville, Florida on June 21, 2020:

Thank you Lorna. Always a pleasure to hear from you.

Ann Carr from SW England on June 21, 2020:

Clear, detailed and informative article. I had no idea about the disparity of the US system. Our NHS in Britain has its problems but generally works well. My experiences have been good. At the moment our workforce is fantastic despite having PPE difficulties (the fault of government organisation).

Thanks for explaining such a diverse approach around the world.

Ann

Lorna Lamon on June 21, 2020:

An excellent article JC and with so many Healthcare systems under strain at the moment, I feel those with universal health care should have a better outcome. Here in the UK we pay our health insurance as soon as we start working, in the hope that when we need to use it, the majority of treatment will be free. However, it also depends on Governments investing in this system, otherwise it will not be fit for purpose. A healthy workforce is dependent on a good health system - a no brainer really. I always enjoy your artlicles.

JC Scull (author) from Gainesville, Florida on June 20, 2020:

Thank you Jason, You too.

Jason Nicolosi from AZ on June 20, 2020:

Hi JC, Excellent article. Very interesting and informative. I loved your chart too. The article was easy to read and follow. Great job! Stay safe and healthy.

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