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Comment & Response
August 28, 2018

Comparing Spending on Medical Care in the United States and Other Countries—In Reply

Author Affiliations
  • 1Department of Health Policy, London School of Economics and Political Science, London, England
  • 2Harvard Global Health Institute, Cambridge, Massachusetts
  • 3Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
JAMA. 2018;320(8):840. doi:10.1001/jama.2018.8020

In Reply Drs Goodman and Valenti raise the important issue that social spending likely affects health outcomes, and we agree. While the somewhat lower-than-average investment in social spending in the United States may not be driving higher health care spending, it is likely a driver of worse health outcomes.1 As their letter notes, although many poor individuals in the United States may have access to excellent health care, they cannot easily access food or safe housing, factors that have a profound effect on health. Given that the United States has a much higher poverty rate than many of the other countries we studied, its lower-than-average social spending is particularly problematic for population health. Instead of justifying social spending as a way to reduce health care spending, social spending should be invested in for the most important reason of all: it likely improves health and well-being.

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