Some experts disagree about the rationales and remedies for this country's higher administrative costs and prices.
Simply comparing total healthcare spending in the U.S. versus other countries may be misleading because the quality and intensity of services here may be higher, said Katherine Baicker, dean of the University of Chicago Harris School of Public Policy, who wrote an editorial accompanying the JAMA article. What really matters, she argues, is the value of each additional dollar spent.
"It's really important to figure out whether we're consuming the same healthcare as other countries and just paying more, or consuming more intensive versions than other countries," Baicker said.
On quality and outcomes, however, the JAMA study found a mixed picture for the U.S. compared with other countries. The U.S. ranked low on population health outcomes such as life expectancy and maternal and infant mortality, while rating well on mortality rates on heart attack and stroke outcomes.
Contrary to widespread belief, the study found that U.S. medical utilization rates are not that different overall from rates in other advanced countries with much lower total spending. The U.S. was in the middle of the pack on hospitalization rates for heart attacks, chronic obstructive pulmonary disease and pneumonia, with a lower percentage of total spending on inpatient and long-term care than most of the other countries.
It was on prices where the U.S. was the clear outlier. Driven by sharply higher prices for brand-name drugs, the U.S.' per-capita pharmaceutical spending was more than twice as high as average spending in the other 10 countries—$1,443 versus $680, the study found.
Prices for procedures and services also were much higher in the U.S. The International Federation of Health Plans reported in 2015 that coronary artery bypass graft surgery cost $78,318 on average in the U.S., compared with $34,224 in Switzerland and $14,579 in Spain.
Abdominal CT scans cost an average of $844 in the U.S., compared with $483 in New Zealand, $233 in South Africa, and $85 in Spain. Average payment for an MRI was $1,119 in the U.S., $455 in South Africa, and $215 in Australia.
"We just charge so much more for everything," said Elisabeth Rosenthal, editor-in-chief of Kaiser Health News and author of a new book on the factors driving up U.S. healthcare costs. "We don't negotiate on a large scale like other countries."
The U.S. also pays physicians and nurses significantly more than other wealthy countries do, which further hikes prices and spending, according to the JAMA study. The average pay for specialist physicians in the U.S. was $316,000 in 2016, compared with an average of $182,657 for all 11 of the countries surveyed. Generalist physicians in the U.S. earned $218,173, compared with an average of $133,723 in all 11 countries. U.S. nurses earned $74,160 on average, compared with $51,795 in all 11 countries.
Healthcare industry executives in the U.S. also make far more on average than their counterparts in other countries. Experts say that because of greater income disparities in the U.S. than in other countries, healthcare professionals here expect to be paid more to keep up with their counterparts in other industries.
"If you pay less, there will be fewer doctors," Baicker cautioned.