Why does the US spend more on healthcare than other high-income countries and still have lower life expectancy?

Dr. Jose Francisco Figueroa is an Associate Professor of Health Policy and Management at the Harvard T.H. Chan School of Public Health, Assistant Professor of Medicine at Harvard Medical School, and a practicing Internist and Associate Physician at the Brigham and Women's Hospital. His research focuses on the drivers of healthcare spending and clinical outcomes and whether reforms aimed at improving healthcare quality and costs lead to better population health outcomes.

In this episode, Dr. Figueroa walks through three of his papers to build a case that is more nuanced than it first appears. The US healthcare system, it turns out, performs reasonably well on the things it controls—screening, diagnosis, chronic disease management. The problem lies outside the system: roughly 70% of the increase in avoidable deaths in the US is driven by drug use, alcohol, suicide, homicide, and traffic accidents, which are causes that clinical care cannot fix. Meanwhile, public health policies that could address those causes—such as regulations, taxes on harmful products, firearm laws—lag well behind peer countries. Also, a major policy lever of the past two decades, value-based payment reform, hasn’t moved the needle, in part because it was designed to change what happens inside the system rather than what drives people to die prematurely outside of it.

This episode will give you insights about why improving healthcare alone will not close the gap the US is currently facing. It makes the case for stronger public health infrastructure targeting the root causes of premature death.

Useful resources:

• Figueroa JF, Duggan CE, Joynt Maddox KE. Value-Based Payment in Medicare: Progress, Challenges, and Future Directions. Journal of Health Politics, Policy and Law. 2025;50(6):1059-1079. doi:1215/03616878-11995200
• Papanicolas I, Niksch M, Figueroa JF. Avoidable Mortality Across US States and High-Income Countries. JAMA Intern Med. 2025;185(5):583. doi:1001/jamainternmed.2025.0155
• Papanicolas I, Sawaya T, Bleich SN, Figueroa JF. Comparing US prevention efforts to other high-income countries. The Lancet Public Health. 2025;10(11):e988-e1000. doi:1016/S2468-2667(25)00222-1

Host: Dr. Salma Abdalla Editors: Catalina Melendez Contreras Marketing: Kinkini Bhaduri Music: Eden Avery / Melting Glass from Epidemic Sound https://www.epidemicsound.com/track/2fqOXWpHab/

The views and opinions expressed by the guest in this episode do not necessarily reflect those of their institution, the funders, or the podcast team.