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Americans Spend More on Health Care but Feel Worse, According to New Report

   Portland, Ore.

Americans spend twice as much on health care as their European and Canadian counterparts, yet they are more likely to rate their own quality of health as poor, says a new report, "Spending more, feeling worse: medical care expenditures and self-rated health," forthcoming in the June 2004 edition of the Journal of Epidemiology & Community Health.

The report shows that Americans spent $3,939 per capita on health care in 1997, compared with Canadians who spent $2,187 per capita, and residents of European Union nations (EU-15) who only spent $1,773 per capita on medical expenditures. The United States also far outpaced other nations in health care expenditures expressed as a percentage of gross domestic product (GDP) -- United States: 13 percent GDP; Canada: 8.9 percent GDP; and EU-15: 8.1 percent GDP.

Paradoxically, Americans were more likely to rate their own health as "fair" or "poor" than Canadians and Europeans; beginning at age 30, Americans had a significantly higher prevalence of poor self-rated health despite spending nearly double their counterparts. The report points to the disparity between self-rated health and health care spending, noting that the differences increased with age, underscoring the need for better care and more complete coverage across the entire life span.

"A striking difference between the U.S. and its industrial counterparts, all of whom have universal health care coverage, are the significant and growing disparities in access to health care goods and services across income and age groups," said Mark Kaplan, M.D., Ph.D., the report's lead author and a professor at Portland State University.

"This study, like many others, shows that the United States' health care system is failing and urgently needs reform," said report co-author Bentson McFarland, M.D., Ph.D., Oregon Health & Science University professor of psychiatry.

The report confirms and complements earlier research indicating that the expensive and technologically advanced health care system in the United States does not yield comparable population health outcomes -- the United States lags behind its industrialized counterparts in major indicators of population health, including lower life expectancy at birth and higher maternal and infant mortality, as well as self-rated health. The report suggests that unequal and uncoordinated provision of care, along with other inefficiencies in the U.S. health system, may explain why Americans spend more but feel worse.

The report was written by Kaplan of PSU's School of Community Health, currently a visiting professor and Fulbright Scholar at the University of Ottawa studying the Canadian approach to population health. The report was co-authored by McFarland, OHSU School of Medicine, Department of Psychiatry, who studies the organization and financing of health services and conducts research on the relationships between finances and quality of care; Jason Newsom, Ph.D., PSU Institute on Aging; and Nathalie Huguet, M.A., PSU School of Community Health.

Comparative data for the report came from the 1996-1997 Canadian National Population Health Survey, the 1996 U.S. National Health Interview Survey, and the 1996 European Commission Eurobarometer, and the Organization for Economic Cooperation and Development (

Members of the media interested in receiving more information or copies of the report may contact David Santen at Portland State (503-725-8789; or Christine Decker at OHSU (503-494-6397;

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