US Has Highest Infant, Maternal Mortality Rates Despite the Most Health Care Spending

The United States has the highest infant and maternal mortality rates out of any other high-income country and simultaneously spends the most on health care, according to a report released Tuesday by the Commonwealth Fund.

The report evaluated US health spending, outcomes, status, and service use compared with Australia, Canada, France, Germany, Japan, the Netherlands, New Zealand, Norway, South Korea, Sweden, Switzerland, and the United Kingdom. In addition, US health system efficiency was compared with the Organisation for Economic Co-operation and Development (OECD) average of the 38 high-income countries that had available data from December 2022.

Of all countries in 2020, the United States possessed the highest infant mortality rate at 5.4 deaths per 1000 live births, which is markedly higher than the 1.6 deaths per 1000 live births in Norway, which has the the lowest mortality rate.

US maternal mortality in 2020 was over 3 times the rate in most of the other high-income countries, with almost 24 (23.8) maternal deaths for every 100,000 live births.

The authors cited a few reasons behind the danger of giving birth in the United States, including:

• Inadequate prenatal care
• High rate of cesarean section
• Poverty, which contributes to chronic illnesses like obesity, diabetes, and heart disease

The United States has lower life expectancy and much worse health outcomes than other countries, although the country spends 2-4 times as much on health care as most other high-income nations. In 2021, the United States spent 17.8% of gross domestic product on health care, nearly twice as much as the average OECD country.

The average OECD life expectancy is 80.4 years, while in the United States it is 77 years overall, although racial and ethnic disparities skew the numbers in different directions. For Black Americans, life expectancy is 74.8 years; for American Indians or Alaska Natives, it is 71.8 years. For White Americans, life expectancy is 78.8 years, below that of Hispanic Americans (81.9 years) and Asian Americans (85.6 years).

Other Findings: Health Coverage, Health Status, Avoidable Deaths, Assault Deaths

Every country in the study guarantees government or public health coverage to all residents, except the United States, where 8.6% of the population had no form of health insurance in 2021.

The US obesity rate (42.8) was almost twice as high as the OECD average (25); obesity drives chronic conditions such as diabetes, hypertension, and cancer. Accordingly, US residents had the highest rates of chronic conditions, with 3 out of 10 in 2020 reporting having 2 or more conditions such as asthma, diabetes, depression, heart disease, and others.

The United States also had the highest rate of avoidable deaths, almost 350 per 100,000, compared with the OECD average of 225 per 100,000.

The United States also possess the highest rate of physical assault deaths, including gun violence, with 7.4 deaths per 100,000 people. This number is at least 7 times higher than every other high-income country except New Zealand, and way above the OECD average of 2.7.

Researchers also found the highest rate of death due to COVID-19 in the United States, compared with similar countries. More than 3000 deaths occurred for every 1 million COVID-19 cases between January 22, 2020, and January 18, 2023.

The authors cited 3 reasons for the disparities that make the United States an outlier compared with other high-income countries: unaffordable coverage, high costs, and limited access to effective primary care to better prevent and manage chronic health conditions.

They said the Inflation Reduction Act will help older Americans and is “a step in the right direction,” but said more needs to be done for the United States to become on-par with other countries.

The report had some limitations, as the researchers noted that the effects of the COVID-19 pandemic probably made health outcomes worse and might be remaining. They also said that they couldn’t categorize the data by race and ethnicity.

Future collection of racial and ethnic data worldwide is recommended so that policy makers can make cross-country comparisons and see how health outcomes compate in vulnerable and historically neglected groups.

Reference

Gunja MZ, Gumas ED, Williams II RD. U.S. health care from a global perspective, 2022: accelerating spending, worsening outcomes. Issue Brief (Commonw Fund). Published online January 31, 2023. doi:10.26099/8ejy-yc74