To Fix Health, Help the Poor

Elizabeth W. Bradley and Lauren Taylor of the Yale Global Health Leadership Institute published a study in the journal BMJ Quality and Safety that compared 30 industrialized countries, their health outcomes, the amount of money spent on health care and where each country spent it. The following includes an excerpt and key points from the op-ed they published in the New York Times on December 8, 2011.

  • The U.S. spends more than any other country on traditional healthcare associated expenses, but it ranks 10th in healthcare spending if you expand the criteria to include spending on social services like rent subsidies, employment-training programs, unemployment benefits, old-age pensions, family support and other services that can extend and improve life. (29 percent of its G.D.P. in 2005, for example, as compared to 33-38 percent of the G.D.P. of the top healthcare spenders.)
  • For every dollar the U.S. spends on health care, it spends 90 cents on social services. In comparison, the peer countries spend $2 on social services for every dollar spent on health care, meaning that the U.S. is spending less on health care and allocating its resources disproportionately in comparison to its peer countries that have higher health outcomes.
  • Overall, the study found that countries with high healthcare spending relative to social spending had lower life expectancy and higher infant mortality than countries that favored social spending.
  • The impact of sub-par social conditions on health and health costs has been well documented. For example, the Boston Health Care for the Homeless Program tracked the medical expenses of 119 chronically homeless people for several years. In one five-year period, the group accounted for 18,834 emergency room visits estimated to cost $12.7 million.


“It’s time to think more broadly about where to find leverage for achieving a healthier society,” wrote Bradley and Taylor. “One way would be to invest more heavily in social services…. Out of respect for individuals’ rights, our current social programs are mostly opt-in, leaving holes for the undocumented, uneducated and unemployed to slip through cracks and become acutely ill. Emergency rooms, though, are not allowed to opt out of providing these people extraordinarily expensive medical treatment before discharging them back to wretched conditions and their inevitable return to the E.R.

“It is Americans’ prerogative to continually vote down the encroachment of government programs on our free-market ideology, but recognizing the health effects of our disdain for comprehensive safety nets may well be the key to unraveling the ‘spend more, get less’ paradox. Before we spend even more money, we should consider allocating it differently.”

Excerpts of this article were reprinted with permission from the New York Times.

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