Study Assesses U.S., European Health Care Spending

Americans may be sicker than their European counterparts, but patients in the United States also are more likely to encounter aggressive disease screening and treatment, according to a recently published study comparing health care costs in the United States with those in 10 European countries.

"Differences in Disease Prevalence As a Source of the U.S.-European Health Care Spending Gap" found that per-capita health care costs were higher in the United States than in Europe, largely because of differences in disease prevalence. However, the study's authors, including lead author Kenneth Thorpe, Ph.D., chair of the department of health policy and management at the Emory University Rollins School of Public Health in Atlanta, concluded that the U.S. health care system "takes a more aggressive approach to detecting and treating patients with mildly symptomatic or asymptomatic disease than is the case in Europe."

The study in the Oct. 2 Health Affairs noted that per-capita health care spending in the United States in 2004 was $6,037. That same year, per-capita health care spending was lower in each of the 10 European countries studied, including Austria, France and Italy. At $4,045, Switzerland had the highest per-capita health spending of the European countries studied, but still spent only two-thirds as much as the United States.

The data showed that Americans age 50 or older were in overall poorer health than their European counterparts. The authors attributed higher U.S. rates of serious chronic illnesses, such as heart disease, hypertension and diabetes, to higher rates of obesity and smoking.

But Americans fared better than Europeans when the study looked at the number of study respondents who had been diagnosed with a disease and the number who had been prescribed medication for diagnosed diseases. For example, of the 21.8 percent of U.S. patients diagnosed with heart disease, 60.7 percent were taking medication to treat the condition, a "treated prevalence" rate of 13.2 percent. By comparison, 11.4 percent of Europeans in the same age group had heart disease. Only 54.5 percent of those patients were taking medications to treat the disease, a treated prevalence rate of just 6.2 percent.

"Overall, Americans age 50 and older were more likely than their counterparts in the European countries to receive medications for six of the nine conditions for which medications were recorded," said the authors.

The study also found that disease screening was more aggressive in the United States than in Europe. For instance, the authors estimated that in 2004, the prevalence of diagnosed cancer was more than double in the United States compared with Europe -- 12.2 percent versus 5.4 percent -- leading the authors to ask: "Are Americans really more likely to develop malignant tumors or are they just screened more intensely than Europeans?"

The study assessed the impact of aggressive treatments on patient outcomes in the United States. "The use of cholesterol and blood pressure medications has increased sharply in the United States over the past 20 years, while hypertension and hyperlipidemia prevalence has declined," noted the authors.

They added that the additional spending associated with higher rates of medication treatment for hypertension appeared to be yielding overall net reductions in health care spending. The authors concluded that efforts to reduce the U.S. prevalence of chronic illness should remain a key policy goal.