Reuters                               Thursday January 7, 1999

Journal Calls U.S. Health Care Expensive, Inadequate

        By Gene Emery

BOSTON - The New England Journal of Medicine sharply criticized the
U.S. health care system in a series of articles it began publishing
Thursday, calling it ``the most expensive and most inadequate in the
developed world.''

The series, which will continue over several months, aims to provide
an overview of the complicated U.S. health system while examining
its weaknesses.

Journal Executive Editor Marcia Angell said U.S. citizens pay $3,925
per person for health care each year, far more than the $2,500 spent
for each person in Switzerland, the second most expensive country.

About 13.6 percent of the money in the U.S. economy is currently
devoted to health care and that rate is expected to grow to 16.6
percent in 2002, the journal said.

There are three reasons why Americans pay about $1,000 more per
person than what would be expected based upon the country's per
capita income, it said.

``Physicians in the United States are paid more than those in other
countries'' for the same amount of work, a day in the hospital costs
more, and new expensive technologies are embraced more rapidly, the
journal reported.

``The American health care system is at once the most expensive and
the most inadequate system in the developed world, and it is
uniquely complicated,'' it said.

The journal said the U.S. health care system hits the poor and
families hardest. For example, those over 65 with incomes below the
poverty level and who qualify for Medicaid assistance typically
spend 35 percent of their income on health care. The rate is even
higher -- about half -- for people who do not receive Medicaid.

Although prescription drugs account for 8 percent of personal health
expenses, or $78.8 billion, the price for medicines is the fastest
growing item in the health care bill, the journal said.

``In recent years, spending for prescription drugs has increased at
double-digit rates,'' the journal said. The hike was 14.1 percent in
1997, the most recent year for which figures are available.

``There are several explanations for this acceleration in costs,''
the journal said, ``including broader insurance coverage of
prescription drugs, growth in the number of drugs dispensed, more
approvals of expensive new drugs by the Food and Drug Administration
and direct advertising of pharmaceutical products to consumers.''

The biggest chunk of spending -- 38 percent -- goes for hospital
care, half of which is paid by Medicare and Medicaid, with private
insurance covering about one-third.

Another 19.9 percent or $217.6 billion is paid to doctors.

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