Comparison of Health Care Spending by Age in 8 High-Income Countries

This cross-sectional study compares health care spending by age in the US with spending in 8 other high-income countries.


Introduction
The United States spends more on health care than any other country. 1 Unlike many other highincome countries, which have largely uniform financing schemes for health care, the US has different financing schemes for different populations. The degree to which this fragmentation in US financing explains higher spending is not clear. Some policy makers believe that expanding the Medicare model, which has a financing system that more closely resembles that of other high-income countries (ie, it is government run and tax financed), could reduce spending substantially. To examine whether this policy has potential, this cross-sectional study compared nominal and relative spending in the US, by 5-year age groupings, with that of other high-income countries that have more homogenous financing systems. This comparison allows us to better understand spending differentials between the US and other countries for people aged 65 years or older, as well as for other age groups.

Methods
This cross-sectional study was granted exemption from institutional review board approval and informed consent by the London School of Economics because the data used are publicly available and cannot be linked back, directly or indirectly, to any individuals. This article followed the relevant portions of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines. We used data from the Organisation for Economic Co-operation and Development 2 to examine variations in total current health care spending per capita, by age cohort, for the US and 7 other high-income countries (ie, Australia, Canada, Germany, Japan, the Netherlands, Switzerland, and the United Kingdom) in 2015. These data were derived from national sources and the "Health Expenditures by Diseases and Conditions" report. 3 For the US, per capita health spending by age cohort

Results
For all 7 comparator countries, the mean (SD) per capita spending in health care was $4924 ($937).
In the US, per capita health care spending was $9524, or 1.9-fold higher than the mean for the 7 comparator countries. The Figure illustrates US and comparator countries' health care expenditures per capita by age cohort. The absolute difference between US spending and that of the other countries for ages 0 to 4 years was $3899, and that difference decreased at approximately age 5 years, after which it slowly increased. The difference increased faster after age 65 years, peaking at $18 645 for ages 80 to 84 years. The

Discussion
This cross-sectional study found that the US spent a mean of 1.9-fold more on health care per capita compared with the mean of 7 high-income countries. The ratio of spending in the US to that in comparator countries was lower for people aged 65 years and older (2.0-fold the mean) than for those aged 20 to 64 years (2.3-fold). However, the Medicare-eligible population in the US still spent 100% more per capita on health care than older adults spent in the 7 comparator countries. In addition, the narrowing in the spending gap for individuals aged 65 and older was driven by substantial increases in spending among those aged 85 years and older in the comparator nations, not by a reduction in spending in the US older population. Moreover, in absolute dollar amounts, not ratios, this spending gap actually increased to be the largest among individuals 65 years and older, with the typical person in the US spending nearly $18 600 more at approximately age 80 years than the typical person in these other