Health care spending in the United States and other high-income countries

Health care spending in the United States is a major concern and is higher than in other high-income countries, but there is little evidence that efforts to reform US health care delivery have had a meaningful influence on controlling health care spending and costs

Performance of UK National Health Service compared with other high income countries: observational study

Objective To determine how the UK National Health Service (NHS) is performing relative to health systems of other high income countries, given that it is facing sustained financial pressure, increasing levels of demand, and cuts to social care. Design Observational study using secondary data from key international organisations such as Eurostat and the Organization for Economic Cooperation and Development. Setting Healthcare systems of the UK and nine high income comparator countries: Australia, Canada, Denmark, France, Germany, the Netherlands, Sweden, Switzerland, and the US. Main outcome measures 79 indicators across seven domains: population and healthcare coverage, healthcare and social spending, structural capacity, utilisation, access to care, quality of care, and population health. Results The UK spent the least per capita on healthcare in 2017 compared with all other countries studied (UK $3825 (£2972; €3392); mean$5700), and spending was growing at slightly lower levels (0.02% of gross domestic product in the previous four years, compared with a mean of 0.07%). The UK had the lowest rates of unmet need and among the lowest numbers of doctors and nurses per capita, despite having average levels of utilisation (number of hospital admissions). The UK had slightly below average life expectancy (81.3 years compared with a mean of 81.7) and cancer survival, including breast, cervical, colon, and rectal cancer. Although several health service outcomes were poor, such as postoperative sepsis after abdominal surgery (UK 2454 per 100 000 discharges; mean 2058 per 100 000 discharges), 30 day mortality for acute myocardial infarction (UK 7.1%; mean 5.5%), and ischaemic stroke (UK 9.6%; mean 6.6%), the UK achieved lower than average rates of postoperative deep venous thrombosis after joint surgery and fewer healthcare associated infections. Conclusions The NHS showed pockets of good performance, including in health service outcomes, but spending, patient safety, and population health were all below average to average at best. Taken together, these results suggest that if the NHS wants to achieve comparable health outcomes at a time of growing demographic pressure, it may need to spend more to increase the supply of labour and long term care and reduce the declining trend in social spending to match levels of comparator countries

Early social distancing policies in Europe, changes in mobility & COVID-19 case trajectories: insights from Spring 2020

Background Social distancing have been widely used to mitigate community spread of SARS-CoV-2. We sought to quantify the impact of COVID-19 social distancing policies across 27 European counties in spring 2020 on population mobility and the subsequent trajectory of disease. Methods We obtained data on national social distancing policies from the Oxford COVID-19 Government Response Tracker and aggregated and anonymized mobility data from Google. We used a pre-post comparison and two linear mixed-effects models to first assess the relationship between implementation of national policies and observed changes in mobility, and then to assess the relationship between changes in mobility and rates of COVID-19 infections in subsequent weeks. Results Compared to a pre-COVID baseline, Spain saw the largest decrease in aggregate population mobility (~70%), as measured by the time spent away from residence, while Sweden saw the smallest decrease (~20%). The largest declines in mobility were associated with mandatory stay-at-home orders, followed by mandatory workplace closures, school closures, and non-mandatory workplace closures. While mandatory shelter-in-place orders were associated with 16.7% less mobility (95% CI: -23.7% to -9.7%), non-mandatory orders were only associated with an 8.4% decrease (95% CI: -14.9% to -1.8%). Large-gathering bans were associated with the smallest change in mobility compared with other policy types. Changes in mobility were in turn associated with changes in COVID-19 case growth. For example, a 10% decrease in time spent away from places of residence was associated with 11.8% (95% CI: 3.8%, 19.1%) fewer new COVID-19 cases. Discussion This comprehensive evaluation across Europe suggests that mandatory stay-at-home orders and workplace closures had the largest impacts on population mobility and subsequent COVID-19 cases at the onset of the pandemic. With a better understanding of policies’ relative performance, countries can more effectively invest in, and target, early nonpharmacological interventions

Rethinking health system accountability to patients: female sterilization & patient reported performance measurement

Female sterilization is a widespread and viable method of fertility control, but this is only the case when done with the full consent of women undergoing the procedure. Involuntary sterilization is considered an act of violence and, when systematic, a crime against humanity. While often framed as a historical practice or limited to isolated cases, I find that routinized forms of coercive sterilization are a widespread and contemporary issue. Made up of four related papers, this dissertation examines how we think about and measure informed consent, and in turn quantify human rights abuses amongst sterilized women. In the first empirical chapter, I provide the first quantification of a human rights-based framework presented in the WHO's “Interagency Statement on Eliminating Forced, Coercive and Otherwise Involuntary Sterilization,” using patient-level data from over 180,000 sterilized women. The second empirical chapter re-evaluates the roll out of a large nation-wide policy; employing an instrumental variable (IV) approach to estimate the effect of increased institutional delivery on tubal ligation practice patterns. The third and fourth empirical chapters look at how people rate their care. This process involves testing conceptual equivalence and construct validity of patient ratings with 65 qualitative subjects as well as an examination of how these measures preform quantitatively. The goal of this work is to see if commonly used performance measures adequately capture instances of coercion and explore why patients who are subject to coercion might rate their care highly. This body of work problematizes status quo approaches in patient-centeredness measurement with practical implications for quantifying rights abuses for an important population: sterilized women. The findings are relevant given current accounting practices that may mask, rather than reveal, issues of coercion in healthcare as well as the demographic effects of uninformed sterilization concentrated within specific populations

Do men and women “lockdown” differently? Examining Panama’s Covid-19 sex-segregated social distancing policy

State-enforced curtailment of mobility – through social distancing and national or subnational lockdowns – has become a key tool to reduce COVID-19 transmission. Panama instituted a sex-segregated mobility policy to limit people’s circulation whereby women were allowed to leave the home for essential services on Monday, Wednesday, and Friday; and men on Tuesday, Thursday, and Saturday. Through a retrospective analysis of Global Positioning System (GPS) data, this paper presents an overview of aggregate mobility patterns in Panama following the policy implementation. The paper looks at relative mobility for women and men, examining differences by volume and type of movement. The results identify lower visits to all community location categories on women-mobility days; however, we find no statistically significant difference in aggregate mobility to workplaces. The results discuss the implications of these findings and the ethical questions raised regarding the use of sex and gender identity in COVID-19 policies

The relationship between health spending and social spending In high-income countries: how does the US compare?

There is broad consensus that the US spends too much on health care. One proposed driver of the high US spending is low investment in social services. We examined the relationship between health spending and social spending across high-income countries. We found that US social spending (at 16.1 percent of gross domestic product [GDP] in 2015) is slightly below the average for Organization for Economic Cooperation and Development (OECD) countries (17.0 percent of GDP) and above that average when education spending is included (US: 19.7 percent of GDP; OECD: 17.7 percent of GDP). We found that countries that spent more on social services tended to spend more on health care. Adjusting for poverty and unemployment rates and the proportion of people older than age sixty-five did not meaningfully change these associations. In addition, when we examined changes over time, we found additional evidence for a positive relationship between social and health spending: Countries with the greatest increases in social spending also had larger increases in health care spending