5 Stories: Health Expense

The hardest “easy” story around probably is “where does the US spend its health care money?” Easy because the US has by far the most expensive healthUSEUSmall care system in the world. One would expect that finding the areas where our spending is significantly higher than other countries would be easy. Easier than finding those areas if we were only 10% more expensive or 20% more expensive. We’re a lot more expensive!!! How hard can it be to find where we’re more expensive? Hardest because, when you drill down into the issue it becomes complicated and difficult to describe. But let’s start with the simple part first.

A key component of good infographic design is choosing what to graph. Edward Tufte’s great example of the Challenger explosion shows the power of simply asking the key unspoken question. In this case, “do cold temperatures lead to booster rocket damage“. Similarly the health care expense question is NOT how much we’re spending, but is instead where are we spending that’s higher than the norm?

Consider, for example two categories of health care, cancer related spending and other non-cancer disease spending. At first blush since the cancer spending is so much higher than the non-cancer spending, it appears that should be the focus of our attention. If we could bring that cost down then we’d be saving a bunch of money. But suppose we also had access to similar data for England, Germany, Switzerland, or a European average (for example), and we then compared their spending on these areas with the US’s spending.


Disease2Now, suddenly we see a different story. Since the US is spending about the same amount per-capita on cancer treatments as the European average we should be skeptical that the US will be able to achieve significant cost reduction in cancer treatment. Furthermore while non-cancer disease treatment has a lower total expense, the US is spending more than the European average and realizing cost savings here should be easier.

This is why total spending is a red-herring. The items to focus on, the easiest savings to realize, are those where the US is spending more than the international average. Additionally, reader confidence in the numbers is enhanced if the charts cover the entire discrepancy. For example, as mentioned before the US spends $6096 per capita on health care while the European average is approximately $2723. If an analysis of European vs US spending were to sum up to something close to the total discrepancy ($3373) then there’d be increased confidence that the study was comprehensive and accurate.Disease3

However, the reality may not be so easily analyzed. Health care has many overlapping facets. One way to slice the data is like we’ve shown above, by the type of “ailment” the patient is having treated. But an equally valid slice is to follow the money and analyze where the patients dollars go. These items may include doctors’ fees, diagnostic procedures, drug costs, and etc. Some additional insights may be gleaned by looking at the health care data from that perspective. But telling the story from both perspectives would be tricky because of the overlapping nature of these expenses. For example, the full savings from a reduction in doctors’ fees and cancer treatments cannot be realized because some of those doctors fees are already counted toward treating cancer.

VennDiagramAnd this is why health care expense is one of the hardest infographic stories around. The data is vast, multi-faceted and interacts with itself in ways that are difficult to unravel. This isn’t to say that developing such a story is impossible. Indeed parts may have already been done by the Congressional Budget Office and by the staff of many members of the US House and Senate. But it’s also possible that in the rush to get that bill analyzed mistakes like the double counting example above may have crept into several analyses.

Unlike the other articles in this series I’m stopping short of suggesting a particular infographic that could have been used to tell the story. I do believe that an infographic can tell it, but without digging into the data the exact nature of that infographic is hard to predict. It could be similar to the 4th image above (Health Costs by Ailment) or it could be something more visually complex. But this story is different from the other stories in this series in another way, specifically, it hasn’t been told at all. What’s surprising is given the magnitude of this bill and the billions of dollars it will cost over the next several years and the dire need we are in of fixing our health care system that a comprehensive and simple-to-understand study has not been completed at all, either as an infographic or in text. It’s hard but possible, and more importantly necessary. Proceeding to overhaul health care without it is like planning an expedition without ever looking at a map.

* This is an actual average for high HCI European countries. Detail is available here

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