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

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

Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola

The west African Ebola epidemic that began in 2013 exposed deep inadequacies in the national and international institutions responsible for protecting the public from the far-reaching human, social, economic, and political consequences of infectious disease outbreaks. The Ebola epidemic raised a crucial question: what reforms are needed to mend the fragile global system for outbreak prevention and response, rebuild confidence, and prevent future disasters? To address this question, the Harvard Global Health Institute and the London School of Hygiene & Tropical Medicine jointly launched the Independent Panel on the Global Response to Ebola. Panel members from academia, think tanks, and civil society have collectively reviewed the worldwide response to the Ebola outbreak. After difficult and lengthy deliberation, we concluded that major reforms are both warranted and feasible. The Panel's conclusions off er a roadmap of ten interrelated recommendations across four thematic areas: 1 Preventing major disease outbreaks All countries need a minimum level of core capacity to detect, report, and respond rapidly to outbreaks. The shortage of such capacities in Guinea, Liberia, and Sierra Leone enabled Ebola to develop into a national, and worldwide, crisis. Recommendation 1: The global community must agree on a clear strategy to ensure that governments invest domestically in building such capacities and mobilise adequate external support to supplement eff orts in poorer countries. This plan must be supported by a transparent central system for tracking and monitoring the results of these resource flows. Additionally, all governments must agree to regular, independent, external assessment of their core capacities. Recommendation 2: WHO should promote early reporting of outbreaks by commending countries that rapidly and publicly share information, while publishing lists of countries that delay reporting. Funders should create economic incentives for early reporting by committing to disburse emergency funds rapidly to assist countries when outbreaks strike and compensating for economic losses that might result. Additionally, WHO must confront governments that implement trade and travel restrictions without scientific justification, while developing industry-wide cooperation frameworks to ensure private firms such as airlines and shipping companies continue to provide crucial services during emergencies. 2 Responding to major disease outbreaks When preventive measures do not succeed, outbreaks can cross borders and surpass national capacities. Ebola exposed WHO as unable to meet its responsibility for responding to such situations and alerting the global community. Recommendation 3: A dedicated centre for outbreak response with strong technical capacity, a protected budget, and clear lines of accountability should be created at WHO, governed by a separate Board. Recommendation 4: A transparent and politically protected WHO Standing Emergency Committee should be delegated with the responsibility for declaring public health emergencies. Recommendation 5: An independent UN Accountability Commission should be created to do systemwide assessments of worldwide responses to major disease outbreaks. 3 Research: production and sharing of data, knowledge, and technology Rapid knowledge production and dissemination are essential for outbreak prevention and response, but reliable systems for sharing epidemiological, genomic, and clinical data were not established during the Ebola outbreak. Recommendation 6: Governments, the scientific research community, industry, and non-governmental organisations must begin to develop a framework of norms and rules operating both during and between outbreaks to enable and accelerate research, govern the conduct of research, and ensure access to the benefits of research. Recommendation 7: Additionally, research funders should establish a worldwide research and development financing facility for outbreak-relevant drugs, vaccines, diagnostics, and non-pharmaceutical supplies (such as personal protective equipment) when commercial incentives are not appropriate