U.s. health care paradox: How spending more is getting us less

We sought to understand the way in which national expenditures in health and social services relate to health outcomes across 30 OECD countries. We conducted a mixed methods study using 12 years of OECD data (1995-2007) and 40 in-depth interviews with international and domestic health and social service providers and users. We performed a pooled cross-sectional analysis and estimated a series of mixed effects models to examine the correlations between five population health outcomes and total health expenditures, total social service expenditures, and the ratio of health-to-social service expenditures. The ratio of social-to-health spending, adjusted for health spending and GDP, was associated with three of the five population health outcomes. Results did not differ when the US was from the analysis.

Data from the in-depth interviews suggested 4 recurrent themes expressed by US service providers and clients or patients. These themes reflected the effects of comparative underinvestment in social services: 1) frontline personnel are stretched to respond to service users' concerns with limited resources, 2) a more holistic approach was desired by both health care and social service providers, 3) delivering holistic care demands challenging intersectoral collaboration 4) barriers in establishing relationships between health and social providers have deep roots.

Our findings shed light on the US health care paradox of high health care spending and poor outcomes. The US may not be getting the impact it expects from health care investment due to limited attention to social services that produce health.