U.S. Health Care Spending: Comparison with Other OECD Countries

[Excerpt] The United States spends more money on health care than any other country in the Organization for Economic Cooperation and Development (OECD). The OECD consists of 30 democracies, most of which are considered the most economically advanced countries in the world. According to OECD data, the United States spent $6,102 per capita on health care in 2004 — more than double the OECD average and 19.9% more than Luxembourg, the second-highest spending country. In 2004, 15.3% of the U.S. economy was devoted to health care, compared with 8.9% in the average OECD country and 11.6% in second-placed Switzerland. Why does the United States spend this amount on health care? Economists break health care spending into two parts: price and quantity (which includes the number of visits to health care providers and the intensity of those visits). In terms of quantity, OECD data indicate that the United States has far fewer doctor visits per person compared with the OECD average; for hospitalizations, the United States ranks well below the OECD and is roughly comparable in terms of length of hospital stays. The intensity of service delivery is a different story: the United States uses more of the newest medical technologies and performs several invasive procedures (such as coronary bypasses and angioplasties) more frequently than the average OECD country. In terms of price, the OECD has stated that there is no doubt that U.S. prices for medical care commodities and services are significantly higher than in other countries and serve as a key determinant of higher overall spending. What does the United States get for the money it spends? Said slightly differently, does the United States get corresponding value from the money it spends on health care? The available data often do not provide clear answers. For example, among OECD countries in 2004, the United States had shorter-than-average life expectancy and higher-than-average mortality rates. Does this mean that the U.S. system is inefficient in light of how much is spent on health care? Or does this reflect the greater prevalence of certain diseases in the United States (the United States has the highest incidence of cancer and AIDS in the OECD) and less healthy lifestyles (the United States has the highest obesity rates in the OECD)? These are some of the issues that confound international comparisons. However, research comparing the quality of care has not found the United States to be superior overall. Nor does the U.S. population have substantially better access to health care resources, even putting aside the issue of the uninsured. Although the United States does not have long wait times for non-emergency surgeries, unlike some OECD countries, Americans found it more difficult to make same-day doctor’s appointments when sick and had the most difficulty getting care on nights and weekends. They were also most likely to delay or forgo treatment because of cost. The OECD data and other research provide some insight as to why health care spending is higher in the United States than in other countries, although many difficult research issues remain. This report presents some of the available data and research and concludes with a summary of study findings

Care services for frail older people in South Korea

This paper examines the changed social circumstances of older people in South Korea and specifically the increased need for formal health and social services for those who are frail and have no informal carers. The article begins with a summary account of the country's exceptionally rapid demographic, economic and social transformations, which demonstrates a widening gap between the population's expectations and needs, and health and social service provision. It then examines the recently initiated and now burgeoning welfare programmes, with particular attention to health and social services for sick and frail older people. Most extant care services are accessed mainly by two minorities: the very poor and the rich. The dominant policy influence of physicians and a history of conflict between traditional and western medicine probably underlies the low current priority for ‘care’ as opposed to ‘cure’, as also for the management of chronic conditions and rehabilitation. Neither long-term care services nor personal social services are well developed. There is a marked disparity between the acute services, which are predominantly provided by private sector organisations in a highly competitive market and broadly achieve high standards, and public primary care and rudimentary residential services. The latter are weakly regulated and there are many instances of low standards of care

U.S. International Trade: Trends and Forecasts

[Excerpt] This report provides an overview of the current status, trends, and forecasts for U.S. import and export flows as well as certain balances. The purpose of this report is to provide current data and brief explanations for the various types of trade flows along with a brief discussion of trends that may require attention or point to the need for policy changes. The use of trade policy as an economic or strategic tool is beyond the scope of this report but can be found in various other CRS reports. Further detail on trade in specific commodities, with particular countries or regions, or for different time periods, can be obtained from the Department of Commerce, U.S. International Trade Commission, or by contacting the authors of this report

Financing health care in high-income countries

The main lesson from the experience of high-income countries with health care financing is a simple one: financing reforms should support the ultimate goal of universal coverage. Most high-income countries started with voluntary health insurance systems, which were then gradually extended to compulsory social insurance for certain groups and finally reached universal coverage, either as nationwide social health insurance schemes or as tax-financed national health services. The risk pooling and prepayment functions are essential. Moreover, the revenue collection mechanisms, whether as general tax revenues or payroll taxes, are secondary to the basic object of providing financial protection through effective risk pooling mechanisms. The experience of high-income countries indicates that private health insurance, medical savings accounts, and other forms of private resource collection are supplementary methods for increasing universal coverage.

Why Does Population Aging Matter So Much for Asia? Population Aging, Economic Security and Economic Growth in Asia

Asia as a whole is experiencing a rapid demographic transition toward older population structures. Within this broader region-wide trend, there is considerable heterogeneity, with different countries at different stages of the demographic transition. In this paper, we document Asia’s population aging, describe the region’s old-age support systems, and draw out the regional socioeconomic implications of population aging and old-age support systems. Population aging gives rise to two fundamental challenges for the region – (1) developing socioeconomic systems that can provide economic security to the growing number of elderly and (2) sustaining strong growth in the face of aging over the next few decades. Successfully addressing those two challenges will be vital for ensuring Asia’s continued economic success in the medium and long term.

Migration in the Asia-Pacific Region: Trends, factors, impacts

This paper provides a comprehensive assessment of international migration in the Asia-Pacific region and reviews internal migration in China. After putting Asia-Pacific migration in a global context, it reviews trends in migration and the impacts of migrants in the major migrantreceiving countries, patterns of migration and their development impacts in migrant-sending countries, the human development impacts of migration, and three policy issues, viz, new seasonal worker programs for Pacific Islanders in New Zealand and Australia, required local sponsorship of foreigners in the Gulf countries, and the economic effects of migrants in the US and Thailand. Recent trends in internal migration in China, which shares attributes of international migration because of the hukou (household registration) system, are also assessed.International labor migration, migrant workers, guest workers, Asia

Why is son preference so persistent in East and South Asia? a cross-country study of China, India, and the Republic of Korea

Son preference has persisted in the face of sweeping economic and social changes in China, India, and the Republic of Korea. The authors attribute this to their similar family systems, which generate strong disincentives to raise daughters while valuing adult women's contributions to the household. Urbanization, female education, and employment can only slowly change these incentives without more direct efforts by the state and civil society to increase the flexibility of the kinship system such that daughters and sons can be perceived as being more equally valuable. Much can be done to this end through social movements, legislation, and the mass media.Gender and Development,Health Monitoring&Evaluation,Anthropology,Public Health Promotion,Population&Development,Adolescent Health,Anthropology,Life Sciences&Biotechnology,Health Monitoring&Evaluation,Population&Development

An Introduction to Korean Culture for Rehabilitation Service Providers

[Excerpt] The purpose of this monograph is to provide recommendations to busy rehabilitation service providers in the U.S. for effectively working with persons who hold traditional Korean values. The topics of Korean history, immigration, culture, language, religion, food, views on disabilities and rehabilitation services typically available in Korea are covered briefly to provide the reader with a quick overview and background. For those who seek more detailed information, the references cited in each section can be used as a starting point. For those with prior background knowledge of Korea, I suggest reading Part II first, in which I introduce Korean culture with case stories in the context of rehabilitation process