There are 2 manner ins which I could have spent twice as much on doughnuts. I might have purchased two times as many doughnutsI could have bought the exact same variety of doughnuts however got actually expensive ones and paid twice as much, or some combination thereof. Right? If we're spending twice as much as other high-income nations, we're achieving that by either doing twice as much health care, paying two times as much for the exact same amount of healthcare, or some combination.
Total spending is amount times rate. This concept that we're overusing health care, that we're doing so much to our patients, we're delivering so much healthcare, that's why we invest a lot. All the policy stuff has to do with attempting to reduce that overuse, our culture of overuse. I would state that much of the policy focus has actually been on the amount side of things.
Let's take a look at the information. One hypothesis I frequently hear is, as an American culture, we are quick to go the doctorat the drop of the hat, I get a little pain, Americans are off to see the physician. We first ask the question, let's take a look at medical professional visits per capita (how to get free health care).
This is doctor visits 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 method, in Japan, the mean is 13. The typical Japanese sees their physician more than when a month. For every 24-year-old who hasn't gone in four years, there are individuals who are going every other week.
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6 and we're an excellent bit below that. We're not seeing the physician as much as these other nations. Then individuals look at that and state, "Ah, maybe the issue is inadequate. Inadequate prevention, inadequate primary care, and it's all Rehab Center leading to a lot of hospitalizations. The problem is overuse of medical facilities.
We said, let's take a look at health center discharges per population. And here is the mean, right, 149 per thousand population. And here is the United States: a bit second-rate. Surprisingly, Germany appears like a little bit of the outlier, where hospitalizations per population are much, much greater. The other thingso this is just 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 way shorter, way much shorter.
is? Yeah, 3. In the Medicare population it resembles four, 4 and a half, because they're a bit older, but in the 3 to 4 days. In Japan, about 14. Right? I remained in Japan a few years ago visiting a community healthcare facility. It was amazing to me. There were clients 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 simply observing them 2 days post-oral prescription antibiotics, just making certain they're fine. It's fascinating in terms of, if you consider it: less hospitalizations, shorter lengths of stay. And what you realize is we spend far less days in the medical facility than any other high-income country.
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The third, on this overutilization bit is that, the problem is we do too many tests and procedures. I put a little asterisk therein to remind myself to make a point, which is, of course, 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 enjoy to enter more on thisis the sense that the issue is that the physicians in Americawe're just out there overtesting, overprocedurizing, charge for service.
So, let's take a look at some empirical data, and there's a bit of assistance for a few of this and not so much for others, but let's take a look at the data. MRIs. MRIs, we are high. Sure, we have more MRIs per population than average, but not some crazy outlier. Knee replacements, here we really are number one.
We https://b3.zcubes.com/v.aspx?mid=6776930&title=rumored-buzz-on-a-health-care-professional-is-caring-for-a-patient-who-is-about-to-begin-taking-etha have more weight problems than nearly all of these nations, in fact, than any of these nations, so it's not a total surprise that we're going to get more knee replacements. Hip replacements, I expected 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 actually a little listed below average. Coronary angioplasty, a procedure that has actually gotten a lot of attention for concerns about overuse. Sure enough, we're a little bit on the high side, and here's Germany once again ... Once 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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health care expense is primarily about offering excessive care, about overutilization. Right? I do not see it. We have less hospitalizations, less medical professional check outs - what does cms stand for in health care. Tests and procedures, I view as a blended bag. Right? We do more MRIs, and knee replacements, and angioplasties. We do less hip replacements. The way I think of it is, when it comes to usage of healthcare services, we're above average on some things, we're below par on other things, and usually, we're pretty averageon utilization.
Another fast one, I'm going to simply show you this information and then keep going. Really, this is one I have actually even said publiclywithout data and it turns out I was wrongthe one concept 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 entered my office and they said here's the information on specialty mixand the data was that here was the mean across these nations, and here was the U.S., right in the middle. I didn't believe it. I simply thought this can't be right.
The percentage of doctors who are main care, and on the right is Sweden and Denmark, where it's just 2233% in France, 54% of medical professionals are primary carethe biggest obstacle with this figure is everyone calls it all various terms. Is it family doctors? Is it generalists? Is it medical care doctors? What we did was we said, we do not care what you call it, let's discuss what individuals are in fact doing in the office.
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And after that we Get more information went to both nationwide stats offices of each of these countries along with three to 5 specialists from each country, and we revealed them their information (who led the reform efforts for mental health care in the united states?). I remember speaking to the people from Switzerland and saying, "Hey, we discover that 48% of your medical professionals are medical care, based upon this definition.
The 43% for the U.S. comes from the Kaiser Household Structure, which is an outstanding source of information, 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 contrast. a health care professional is caring for a patient who is taking zolpidem.