It is no secret the United States is a blatant outlier among wealthy nations in medical spending. We spend 18 percent of our G.D.P. on healthcare. Meanwhile, Australia, Canada, Denmark and Japan spend half that amount. Nevertheless, life expectancy in the U.S. is the lowest of these counties and infant mortality is the highest.
The question arises: Why does the U.S. spend so much more for healthcare that performs the worst compared with other nations? Contrasting the U.S. with other first-world nations allows us to better understand the issues facing our healthcare system.
Many assumptions about why the U.S. spends so much on healthcare have turned turn out to be inaccurate. One assumption is we have too few physicians. According to the New England Journal of Medicine, the U.S. lands squarely in the middle with regard to the number of available doctors per population. Although we smoke fewer cigarettes and drink less alcohol, our rate of obesity and diabetes are still the highest in the world.
Another assumption is we use more healthcare than other countries. That turns out not to be true. As a country, we went to the hospital half as often as the Germans. We consulted doctors a third less than the Japanese. We spent fewer days in the hospital than the Swiss or the Dutch.
Another assumption is we do more procedures than other countries. Again, not true. In frequency high-cost medical procedures — such as knee-replacement, cataract surgery, cesarean deliveries, and coronary bypass grafts — the U.S. is in the top two or three, but not off the charts in terms of procedures performed. The difference is what things cost. An MRI in the U.S. costs $1,150, which is eight times more than an MRI costs in most other countries.
Pharmaceutical prices are unquestionably a culprit. Drugs that cost thousands of dollars here in the U.S. cost only hundreds in most other countries — even though they are produced in the U.S. Labor also contributes to the high cost of U.S. healthcare; American doctors and nurses got paid substantially more than their counterparts in other countries. Finally, the U.S. led in administrative waste, easily topping the charts in this area.
When something exists by itself, you cannot contrast one thing to another. By comparing healthcare in the U.S. to that of other countries, it highlights areas of concern and promotes examination and focus. Without comparison, “it is what it is.” But comparing forces you to look at things differently if someone else is doing much better than you.
What I’d like to know is comparable information about dentistry and how we compare to other first-world countries. What would comparing our dental system with other countries’ reveal about our system?
Research Challenges
It would be beneficial to develop a study that compares access and costs of dentistry in the U.S. with access and costs in other wealthy nations. This study might uncover why dentistry is so expensive in the U.S. compared with other countries. This study might reveal where we stand regarding access to dentistry compared with other countries. And, if possible, I recommend adding some agreed-upon healthcare measures such as percent of children who are seen by a dentist, or tooth loss.
I understand that comparative research uses a methodology that aims to make comparisons across different countries or cultures. A major problem in comparative research is that the data sets in different countries may not use the same categories, or define categories differently (for example, by using different definitions of poverty). But without comparing our dental system to others, we will not be able to contrast elements of our system to other systems.
The focus on cost and access to dentistry is going to increase dramatically in intensity and volume over the coming years, particularly as the chronic disease-oral inflammation link continues to become more important in medical diagnosis and treatment. Furthermore, this study might reveal some areas that could uncover better ways to manage costs and improve access.
One barrier to the report of findings might be the arrogance of the U.S. dentists who feel they are essentially doing the “right” thing, virtuously justifying the way dentistry is currently practiced. But their assumptions might come into a very different light when dentistry in the U.S. is compared to other first-world countries.
Also, this study would create a different context about dentistry in the U.S. — looking at the whole rather than an aggregate made up of many individual parts. How is dentistry as an industry doing as compared with dentistry in other countries? This is the question I ask you to address.
Let’s see where dentistry in the U.S. stands in terms of access, cost, and health outcomes compared with other countries.
— Marc
