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QJM. 2017 Feb 1;110(2):61-65. doi: 10.1093/qjmed/hcw187.

American health care paradox-high spending on health care and poor health.

Author information

From the Yale School of Public Health, New Haven, CT.
University of Chicago, Chicago, IL.
Harvard Business School, Boston, MA.



For decades, US taxpayers have been lamenting the high cost of health care. Since the mid-1980s, Americans have had double-digit spending on health care. Despite this investment, Americans are less healthy than their European and Scandinavian counterparts across an array of health measures.


We sought to explore how inadequate attention to the social, behavioral and environmental determinants of health may contribute to the American health care paradox of high health care spending and poor health outcomes.


Mixed methods.


We report previous findings related from a 10-year analysis of national-level health and social service spending and health outcome data from the Organization of Economic and Cooperation and Development (OECD). We also put forth case studies representing different socioeconomic strata to illustrate the relationship between health care and social service spending and health.


Although the US spending more of its GDP on health care than any other country, it is not a high spender when one sums spending on both health care and social services. The U.S. however has the lowest ratio of our social service spending to health care spending in the OECD, and countries with lower ratios on average have worse health outcomes. Cases from diverse socioeconomic strata demonstrate how limited attention to the social determinants of health can result in extremely high health care costs and poor health outcomes.


Greater investment in addressing the social, behavioral and environmental determinants of health may foster better health without accelerating health care costs in America.

[Indexed for MEDLINE]

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