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The U.S. Spends More Public Money on Healthcare Than Sweden or Canada

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The U.S. Spends More Public Money on Healthcare Than Sweden or Canada

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The U.S. Spends More Public Money on Healthcare Than Sweden or Canada

The Chart of the Week is a weekly Visual Capitalist feature on Fridays.

The underlying challenges in fixing U.S. healthcare may be multi-faceted and complex, but the overall diagnosis is clear: costs are out of control.

According to a 2015 health report using data from the Organization for Economic Co-operation and Development (OECD), per capita spending on private healthcare in the U.S. is $4,516 per year.

That’s 5x higher than that of the median OECD country, which pays $806 per year.

Of course, the high cost of private care makes sense, because the U.S. has a system that largely revolves around the private sector. If companies and individuals are covering most of their healthcare expenses, then public expenditures should be extremely low, right?

Here’s the kicker. The U.S. spends more public money on healthcare per capita than Canada, Sweden, Denmark, Germany, Switzerland, France, Japan, Australia, New Zealand, and the United Kingdom. In fact, each year the U.S. government spends $4,197 per person, while the OECD median spend is $3,677.

In other words, costs seem to be out of whack across the board in the United States, regardless of whether it is private or public care being discussed. Further, the above numbers are from before the recent double-digit hikes in premiums for most states under Obamacare.

No Bang For the Buck

Combine public and private together, and it totals to 17.5% of GDP being spent on healthcare in 2015. This number is as high as it has ever been, and it dwarfs expenditures in other countries around the world.

Here’s another look at the problem, this time with costs charted against life expectancy – something we previously posted last year.

U.S. Healthcare is a Global Outlier, and Not in a Good Way

Courtesy of: Our World in Data

Spending keeps rising, but the effect of that spending seems to have decreasing marginal returns on life expectancy – a metric that is an important indicator for the overall effectiveness of any health system.

It’s clear that Americans aren’t getting bang for their buck when it comes to medical treatment – so how is it to be fixed?

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Chart of the Week

Global Shutdown: Visualizing Commuter Activity in the World’s Cities

Amid the COVID-19 crisis, cities are dramatically slowing down. Today’s chart demonstrates the impact of lockdowns on commuter activity worldwide.

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Staying Put: The COVID-19 Commuter Decline

Every day, millions of people worldwide rely on public transport networks to get around. But in times of crisis, bustling cities with high volumes of commuter traffic can come to a dramatic halt.

Today’s chart breaks down daily data from Citymapper’s Mobility Index, according to trips planned on the transport app across 41 select cities.

The results paint a unique picture of how social distancing and lockdown measures are impacting commuter and economic activity in major urban hubs.

Cities With the Biggest Drops in Activity

As the government response to the COVID-19 pandemic intensifies and people are urged to stay home, transit activity is dropping everywhere.

However, some areas are seeing more of a reduction in activity than others. Where has activity declined the most over the month?

RankCityCountry04-Mar11-Mar18-Mar25-MarTotal Change (%)
#1Vienna🇦🇹 Austria128%92%9%6%-122%
#2Lisbon🇵🇹 Portugal128%108%24%12%-116%
#3Istanbul🇹🇷 Turkey117%103%20%10%-107%
#4Barcelona🇪🇸 Spain105%86%6%4%-101%
#5Brussels🇧🇪 Belgium107%96%15%7%-100%
#6São Paolo🇧🇷 Brazil112%113%33%12%-100%
#7New York City🇺🇸 USA104%85%17%7%-97%
#8Madrid🇪🇸 Spain100%65%5%4%-96%
#9Los Angeles🇺🇸 USA108%81%23%13%-95%
#10Melbourne🇦🇺 Australia113%110%53%20%-93%

*Note: Data measures the % of city moving compared to 100% baseline.

Overall, Vienna and Lisbon are the cities with the biggest average drop in commuter activity over the past few weeks. This decline in mobility is correlated with a spike in the proportion of COVID-19 cases in the population:

  • Austria
    March 4: 2.6 per million
    March 25: 586 per million
  • Portugal
    March 4: 0.4 per million
    March 25: 232 per million

That said, not every city is seeing a precipitous decline in activity — let’s look at those next.

Standing Still, or On Guard

Cities that saw lower decreases in commuter activity over recent weeks can generally be slotted into three categories:

  1. Cities that were already on or near shutdown (Seoul, Milan)
  2. Cities that have so far avoided major impacts from the virus (St. Petersburg)
  3. Cities that successfully mitigated spread (Singapore)

Here are the 10 cities on the list that saw the lowest changes in activity:

RankCityCountry04-Mar11-Mar18-Mar25-MarTotal Change (%)
#1Seoul 🇰🇷 South Korea48%43%41%37%-11%
#2Hong Kong🇭🇰 China (SAR)50%52%48%37%-13%
#3Singapore🇸🇬 Singapore90%88%79%62%-28%
#4Milan🇮🇹 Italy43%10%5%3%-40%
#5Tokyo🇯🇵 Japan63%54%42%21%-42%
#6St Petersburg🇷🇺 Russia114%114%85%69%-45%
#7Moscow🇷🇺 Russia112%113%75%54%-58%
#8Rhine-Ruhr🇩🇪 Germany75%72%28%15%-60%
#9Stockholm🇸🇪 Sweden97%83%34%32%-65%
#10Lyon🇫🇷 France75%97%6%4%-71%

*Note: Data measures the % of city moving compared to 100% baseline.

St. Petersburg is still seeing commuter activity at 69% of normal levels as of March 25th, as the proportion of confirmed COVID-19 cases in Russia remains low, at roughly 3.4 per million.

Milan has the lowest activity of any city at 3%, and has been in shutdown for most of the month.

Although Singapore’s total COVID-19 cases grew from 18.8 to 95.4 per million, it still has 62% commuter activity. Interestingly, Singapore is one of the few countries that has been able to properly control and manage its COVID-19 outbreak.

Biggest Weekly Declines

As the month progressed, various cities showed stark one-week declines in commuter activity based on official healthcare recommendations and growing case numbers.

After a government lockdown announced on March 9, Rome experienced the sharpest decline of -75% commuter activity in the week from March 4 to March 11. Currently, there is only 5% activity compared to usual, similar to Milan.

In the second week of March, COVID-19 cases in France jumped fourfold, from 27.3 per million to 118.4 per million people. As a result, Lyon saw a whopping -91% drop in commuter activity—going from 97% on March 11 to 6% on March 18.

Over the past week, as cases in Australia reached 95 per million, Sydney and Melbourne exhibited the highest average declines at -36% and -33% in commuter activity respectively.

Full List of 41 Cities

Here’s the full list of cities, courtesy of Citymapper.

City, CountryMarch 4March 11March 18March 25Total Change (%)
Vienna, Austria128%92%9%6%-122%
Lisbon, Portugal128%108%24%12%-116%
Istanbul, Turkey117%103%20%10%-107%
Barcelona, Spain105%86%6%4%-101%
Brussels, Belgium107%96%15%7%-100%
São Paulo, Brazil112%113%33%12%-100%
New York City, U.S.104%85%17%7%-97%
Madrid, Spain100%65%5%4%-96%
Los Angeles, U.S.108%81%23%13%-95%
Melbourne, Australia113%110%53%20%-93%
Amsterdam, Netherlands98%86%13%6%-92%
Washington DC, U.S.97%82%15%6%-91%
San Francisco, U.S.96%65%9%6%-90%
Boston, U.S.97%77%16%7%-90%
Chicago, U.S.97%92%16%7%-90%
Montréal, Canada103%104%31%14%-89%
Paris, France95%89%8%6%-89%
London, UK100%91%36%12%-88%
Manchester, UK100%91%42%13%-87%
Sydney, Australia106%99%56%20%-86%
Mexico City, Mexico109%110%53%23%-86%
Rome, Italy91%16%6%5%-86%
Copenhagen, Denmark97%80%11%11%-86%
Berlin, Germany93%86%26%12%-81%
Birmingham, UK99%91%45%18%-81%
Toronto, Canada97%91%32%19%-78%
Vancouver, Canada94%89%38%16%-78%
Philadelphia, U.S.89%85%22%13%-76%
Monaco, Monaco81%50%12%7%-74%
Hamburg, Germany85%72%20%12%-73%
Seattle, U.S.80%51%19%8%-72%
Lyon, France75%97%6%4%-71%
Stockholm, Sweden97%83%34%32%-65%
Rhine-Ruhr, Germany75%72%28%15%-60%
Moscow, Russia112%113%75%54%-58%
St Petersburg, Russia114%114%85%69%-45%
Tokyo, Japan63%54%42%21%-42%
Milan, Italy43%10%5%3%-40%
Singapore, Singapore90%88%79%62%-28%
Hong Kong, Hong Kong50%52%48%37%-13%
Seoul, South Korea48%43%41%37%-11%

*Note: Data measures the % of city moving compared to 100% baseline.

The COVID-19 pandemic is affecting everything from the stock market to the environment. With cities actively working to keep populations in isolation and healthy during this time, it may take a while before commuter activity returns to normal.

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Chart of the Week

Ranked: Global Pandemic Preparedness by Country

This interesting pre-COVID19 report ranked countries by their level of preparedness for the outbreak of infectious diseases and pandemics

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Global Health Security Index

Ranked: Global Pandemic Preparedness by Country

The world has experienced many pandemics throughout its history, but not every era has had the benefit of modern medicine and hindsight.

However, even with the readily available medical expertise and equipment that exists today, it is still unevenly distributed throughout the globe. Combine this with a highly interconnected global economy, and large populations are still at risk from infection.

Today’s chart pulls data from the 2019 Global Health Security Index, which ranks 195 countries on health security. It reveals that while there were top performers, healthcare systems around the world on average are fundamentally weak—and not prepared for new disease outbreaks.

Pathways for Commerce and Disease

Modern transportation and trade have linked the farthest stretches of the world to fuel a global economy. Physical distance plays less a limiting role and more an enabling one to form a flat world as Thomas Friedman put it, creating opportunities for commerce anywhere in the world.

A person can sell dishware from his home in Cusco, Peru, online to a customer in Muncie, Indiana, with products manufactured in China, from materials sourced in Africa.

While these connections sound sterile, there are people interacting with one another to procure, manufacture, package, and distribute the goods. The connections are not just through products, but also people and animals across many borders.

Now, add up the interactions within the global food supply chain with plants and livestock and tourism industries and place them under the pressures of climate change, urbanization, international mass displacement, and migration—and the volume and variety of opportunities for disease transmission and mutation becomes infinite.

The same pathways of global commerce become the transmission vectors for disease. A cough in Dubai can become a fever in London with one flight and one day.

You Cannot Manage What You Do Not Measure

Despite this, we still live with national healthcare systems that look inward towards national populations, with less of a focus on integrating what is happening with the outside world.

The Global Health Security (GHS) Index is the first comprehensive effort to assess and benchmark health security and related capabilities by nation, and it tracks six key factors to come up with an overall score for each of the 195 countries in the ranking:

  1. Prevention
    Prevention of the emergence or release of pathogens
  2. Detection and Reporting
    Early detection and reporting for epidemics of potential international concern
  3. Rapid Response
    Capability of rapidly responding to and mitigating the spread of an epidemic
  4. Health System
    Sufficient and robust and health system to treat the sick and protect health workers
  5. Compliance with Global Norms
    Compliance with international norms by improving national capacity, financing plans to address gaps
  6. Risk Environment
    Risk environment and country vulnerability to biological threats

Note: The GHS Index is a project of the Nuclear Threat Initiative (NTI) and the Johns Hopkins Center for Health Security (JHU), and was developed with The Economist Intelligence Unit (EIU).

Country Overall Rankings

Overall, the rankings uncover a distressing insight. Global preparedness for both epidemics and pandemics is weak, with the average score in the index sitting at 40.2 out of 100.

The countries with the highest scores have effective governance and politics systems in place, while those with the lowest scores fall down for their inadequate healthcare systems—even among high-income countries.

Here are the 50 highest-ranking countries in the index:

RankCountryGHS Index Score
#1🇺🇸 United States83.5
#2🇬🇧 United Kingdom77.9
#3🇳🇱 Netherlands75.6
#4🇦🇺 Australia75.5
#5🇨🇦 Canada75.3
#6🇹🇭 Thailand73.2
#7🇸🇪 Sweden72.1
#8🇩🇰 Denmark70.4
#9🇰🇷 South Korea70.2
#10🇫🇮 Finland68.7
#11France68.2
#12Slovenia67.2
#13Switzerland67
#14Germany66
#15Spain65.9
#16Norway64.6
#17Latvia62.9
#18Malaysia62.2
#19Belgium61
#20Portugal60.3
#21Japan59.8
#22Brazil59.7
#23Ireland59
#24Singapore58.7
#25Argentina58.6
#26Austria58.5
#27Chile58.3
#28Mexico57.6
#29Estonia57
#30Indonesia56.6
#31Italy56.2
#32Poland55.4
#33Lithuania55
#34South Africa54.8
#35Hungary54
#35New Zealand54
#37Greece53.8
#38Croatia53.3
#39Albania52.9
#40Turkey52.4
#41Serbia52.3
#42Czech Republic52
#42Georgia52
#44Armenia50.2
#45Ecuador50.1
#46Mongolia49.5
#47Kyrgyz Republic49.3
#47Saudi Arabia49.3
#49Peru49.2
#50Vietnam49.1

You can view the complete rankings of all 195 countries on the GHS Index website.

Interestingly, 81% of countries score in the bottom tier for indicators related to biosecurity—and worse, 85% of countries show no evidence of having completed a biological threat-focused simulation exercise in conjunction with the World Health Organization (WHO) in the past year.

Confirmed COVID-19 Cases vs. Global Health Security Score

Many healthcare systems have had their security tested with the outbreak of COVID-19.

global health secutiry score vs covid19 cases

Although it is still extremely early, there appears to be a relationship between a nation’s health security and its ability to cope with pandemics.

Takeaways: A World Unprepared

While there may be top performers relative to other countries, the overall picture paints a grim picture that foreshadowed the current crisis we are living through.

“It is likely that the world will continue to face outbreaks that most countries are ill positioned to combat. In addition to climate change and urbanization, international mass displacement and migration—now happening in nearly every corner of the world—create ideal conditions for the emergence and spread of pathogens.” – The Global Health Security Index, 2019

The report outlined eight critical insights about global health security in 2019 that reveal some of the problems countries are now facing.

  1. National health security is fundamentally weak globally. No country is fully prepared for epidemics or pandemics, and every country has important gaps to address.
  2. Countries are not prepared for a globally catastrophic biological event.
  3. There is little evidence that most countries have tested important health security capacities or shown that they would be functional in a crisis.
  4. Most countries have not allocated funding from national budgets to fill identified preparedness gaps.
  5. More than half of countries face major political and security risks that could undermine national capability to combat biological threats.
  6. Most countries lack basic health systems capacities critical for epidemic and pandemic response.
  7. Coordination and training are inadequate among veterinary, wildlife, and public health professionals and policymakers.
  8. Improving country compliance with international health and security norms is essential.

A Stark Reality

The intention of the Global Health Security Index is to encourage improvements in the planning and response to one of the world’s most omnipresent risks–infectious disease outbreaks. When this report was released in 2019, it revealed that even the highest ranking nations still had gaps to fill in preparing for a pandemic.

Of course, hindsight is 20/20. The COVID-19 outbreak has served as a wake-up call to health organizations and governments around the world. Once all of the curves have been flattened, the next version of this report will undoubtedly be viewed with renewed interest.

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