JAMA: U.S. spends the most on healthcare—and imaging is a reason why

New research, published online March 13 in the Journal of the American Medical Association, shows that the U.S. spends twice as much on healthcare as any other high-income country in the world. Heavy utilization of imaging technology was a contributing factor.

Researchers compared general spending, population health, structural capacity, utilization, pharmaceuticals, access to quality and equity in the U.S. and 10 other high-income countries, including Canada, the U.K., Germany, Japan and Sweden. Data were collected from 2013 to 2016 from international organizations such as the Organization for Economic Co-Operating and Development.  

In 2016, the U.S. spent 17.8 percent of its gross domestic product (GDP) on medical spending, according to study results. In comparison, other countries spent 9.6 percent to 12.4 percent of GDP on healthcare.

Utilization in the U.S. was similar to those of other nations—except in medical imaging. The U.S. performed the second highest number of imaging exams, researchers found, and had the second highest MRI and CT technology utilization rate, following Japan. According to the study, the U.S. performed 118 MRIs per 1,000 people compared with a mean in all 11 countries of 82 per 1,000 population. The U.S. mean was 245 CTs per 1,000 population and 151 per 1,000 in other countries.

The average cost of a CT exam in the U.S. was $896 per scan as compared to $97 in Canada, $279 in the Netherlands, and $500 in Australia. Additionally, the average cost for an MRI in the U.S. was $1,145 compared with $350 in Australia and $461 in the Netherlands, the researchers wrote. Japan had the greatest number of MRI and CT scanners per one million people, at 52 and 107, respectively. 

The U.S. had the second highest number of MRI units (38) and the third highest number of CT scanners (41).

"If the U.S. did less imaging and fewer of 25 common procedures, and lowered prices and the number of procedures to levels in the Netherlands, it would translate into a savings of $137 billion," wrote Ezekiel Emanuel, MD, PhD, of the Perelman School of Medicine at the University of Pennsylvania, in an accompanying editorial according to Reuters. “Regardless of what is done with the money, it would be more valuable than paying high prices for a large number of CT and MRI scans, up to a third of which may be deemed unnecessary and carry radiation risks, and many expensive but not necessary surgical procedures."

Researchers believe that targeting utilization alone is not enough to reduce U.S. healthcare spending. A more concerted effort to reduce prices and administrative costs is needed.

“There’s no doubt that administrative complexity and higher drug prices both matter, as do higher prices for pretty much everything in U.S. healthcare,” lead author Irene Papanicolas of the London School of Economics and the Harvard T.H. Chan School of Public Health in Boston told Reuters. “These inefficiencies are likely the product of a number of factors including a reliance on fee-for-service reimbursement, the administrative complexity of the U.S. health care system and the lack of price transparency across the system.”