Final Blog Post

"What makes people in Japan and Germany healthier?"

This is the question that guided me through my project. Is it universal coverage? Better medical technology? The ability to share important health data? Or is it simply a difference in lifestyles? 

I measured health by average life expectancy. Japanese are the healthiest, with an average life expectancy of 82.7 years. Germans live 80.3 years on average and Americans rank 42nd in life expectancy, with an average of 78.8 years of age. The United States is ranked number one in medical research and technology, yet our citizens have poorer health than many other developed countries around the world. To find out why, I analyzed the healthcare systems in the United States, Japan, and Germany. 

United States

The United States healthcare system is very fragmented, with many different payers paying select groups of providers. The International Common Wealth Fund (linked in the title) broke down each type of insurance plan offered in the United States. Medicare, which insures 16% of our population, pays for those that are sixty-five and older and for people with select disabilities. Medicaid pays for low-income populations and insures nearly 20% of United States citizens. Employer-sponsored insurance programs cover 55.4% of the population. Private insurance, which is sold through health insurance marketplaces, insures 14.6% of the population and military health insurance covers 4.5% of the population. The United States is unique in that there are 33 million people, or 10% of the population, that are uninsured. We are also unique because our healthcare cost more than every other country in the world. The image above shows the average cost of a hip replacement in the United States compared to the cost of the same surgery in Japan and Germany. The graph below shows our healthcare costs per capita compared to other countries' systems.

Even though we spend more and cover fewer people, there are some positive aspects of the U.S. healthcare system, too. The Affordable Care Act (ACA), passed in 2010, drastically changed the lives of millions of previously uninsured people. Medicaid was expanded in many states, premiums were offered to more low-income individuals, and everyone became required to pay a fine if they chose not to purchase insurance. As a result, 17.6 million previously uninsured Americans acquired coverage.

The United States is also ranked #1 in most advanced in medical technology. Our county has benefited from the latest medical innovations, which have contributed to lower death and disability rates. We also have every other country beat for the number of research papers published each year. The graph to the left shows just how far ahead the U.S. is in collaborative and non-collaborative research publications. This trend has been sustained because the U.S. heavily invests in research and development, which leads to medical advancements.

Despite our advancements and our high spending, we rank 42nd in life expectancy. Consumers are also dissatisfied with their care. 52% of Americans report not being able to get same or next-day appointments (only worse than Canada). Our doctors are ranked 9th in well-prepared to manage complex needs and we are ranked last in the ability to see a doctor after business hours, not taking emergency departments into consideration. The United States healthcare system has a long way to go if it wants to compete on a global scale.

Japan 

Japan's healthcare system is one of the least expensive and has some of the best health outcomes. Everyone in Japan is required to have a health insurance policy, either through their employer or a private insurer. Payroll taxes allow the government to give subsidies or pay for those that are too poor to afford coverage on their own.  Healthcare costs in Japan are so low because the government heavily negotiates prices with hospitals, 80% of which are privately owned. Hospitals are also not-for-profit entities, which helps keep prices down. There are complaints from medical professionals because of low pay, but patients and payers praise the inexpensive system. 

Many accredit Japanese' long lives to their healthier lifestyles. Japanese children are taught to live healthy lifestyles at very young ages. According to Today, over 98% of children walk or bike to school. They are also taught to eat healthier, consume fewer calories per bite, and practice life-long habits of regular exercise. Shockingly, Japanese citizens also visit the doctor three times as much as Americans. 

In my summary section of my report, I tried to answer whether Japan's health success was a result of lifestyle, healthcare system, or both. 

Germany

German's healthcare system also ensures that all citizens have coverage and access to medical care. Citizens and permanent visitors can get their insurance through "sickness funds", which are competing, not-for-profit, nongovernmental health insurance funds. "Sickness funds" are comprised of two main types of insurance funds: statutory health insurance (SHI) and substitutive private health insurance (PHI). All employed individuals earning less than 54,900 euros are mandatorily covered by SHI, and their dependents are covered free of charge. Others can receive coverage by purchasing a private health insurance plan. States own most of the hospitals and they are regulated by self-governing associations. It is mandatory for all Germans to have insurance.

Although many may consider German diet to be unhealthy, there are health promoters that may contribute to Germany's longer life expectancy. Germans benefit from fresh, whole foods and incredibly clean air that promote active lifestyles. They also practice life-long habits of exercise and tend to enjoy outdoor sports. Despite stereotypically unhealthy diets, Germans are more than two times less likely to be obese than Americans. These habits may contribute to their longer lives. 

Health technology is also advanced in Germany. 90% of German physicians use EHRs, compared to only 83% of American physicians using them in the United States. Germany is also one of the first countries to use a health card. All 71 million legal customers of health insurance in Germany receive a health smart card. These cards contain medical, policy, insurance, and contact information and link to a patient's medical record, making it easy for providers to look up a patient's health data. 

Summary and Overview

The overarching question I wanted to answer was "why are Germans and Japanese citizens healthier than Americans?" 

Is it a result of insurance coverage? There is 100% health insurance coverage in Germany and Japan, while only 90.9% of the American population is covered. What does not having insurance do? According to Keith Joiner, professor in the University of Arizona medical school and in Eller's economics department, 25% of uninsured report forgoing needed care and 2/3 of these uninsured citizens report a lack of a usual source of medical care. He also found that uninsured citizens are also less likely to receive preventive care, are more likely to be hospitalized for conditions that could have been prevented, and are more likely to die in the hospital. Therefore, I concluded that lack of insurance coverage is a factor of our nation's poorer health. 

I concluded that lifestyle contributes to overall health outcomes as well. The U.S. Department of Health and Human Services states that improved health-conscious lifestyles have contributed to the global rise in life expectancy. Thanks to modern science, we now know that our diets, exercise, and sleep contribute to our overall health. We also know that is it important to abstain from tobacco and excessive alcohol consumption. 

We may have modern medicine, share health data, and know that health-promoting behaviors contribute to our overall health, but we in the United States have not been great at practicing healthy behaviors. We also do not provide universal access to health care. Until we address these problems, we may never be able to better compete with other developed countries on health outcomes.