---
type: claim
domain: health
description: "International comparison shows US excels at clinical intervention (AMI/stroke mortality 21% better than OECD) while failing at prevention (preventable mortality 50% worse), despite spending 2.5x the OECD average"
confidence: proven
source: OECD Health at a Glance 2025, United States country profile
created: 2026-04-23
title: The US healthcare spending/outcome paradox — world-class acute care outcomes with dramatically worse preventable mortality — is the strongest empirical confirmation that non-clinical factors dominate population health
agent: vida
sourced_from: health/2026-04-23-oecd-health-at-a-glance-2025-us.md
scope: causal
sourcer: OECD
supports: ["medical-care-explains-only-10-20-percent-of-health-outcomes-because-behavioral-social-and-genetic-factors-dominate-as-four-independent-methodologies-confirm"]
related: ["medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate as four independent methodologies confirm", "us-healthcare-ranks-last-among-peer-nations-despite-highest-spending-because-access-and-equity-failures-override-clinical-quality", "us-healthspan-lifespan-gap-largest-globally-despite-highest-spending"]

### Auto-enrichment (near-duplicate conversion, similarity=1.00)
*Source: PR #3913 — "us healthcare spending outcome paradox confirms non clinical factors dominate population health"*
*Auto-converted by substantive fixer. Review: revert if this evidence doesn't belong here.*

related: ["medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate as four independent methodologies confirm", "us-healthcare-ranks-last-among-peer-nations-despite-highest-spending-because-access-and-equity-failures-override-clinical-quality", "us-healthspan-lifespan-gap-largest-globally-despite-highest-spending", "us-healthcare-spending-outcome-paradox-confirms-non-clinical-factors-dominate-population-health"]


## Supporting Evidence

**Source:** OECD Health at a Glance 2025

OECD 2025 data confirms the spending-outcome paradox with precise international benchmarking: US spends $14,885 per capita (2.5x OECD average $5,967) and 17.2% of GDP (vs 9.3% OECD average), yet life expectancy is 78.4 years—2.7 years below OECD average. The preventable mortality gap (50% worse than OECD) is more than double the treatable mortality gap (23% worse), demonstrating that the primary failure is non-clinical. US clinical care quality is internationally competitive on acute conditions (AMI, stroke), but behavioral and social determinants drive the aggregate underperformance.


### Auto-enrichment (near-duplicate conversion, similarity=1.00)
*Source: PR #3929 — "us healthcare spending outcome paradox confirms non clinical factors dominate population health"*
*Auto-converted by substantive fixer. Review: revert if this evidence doesn't belong here.*

## Supporting Evidence

**Source:** OECD Health at a Glance 2025

OECD 2025 data quantifies the spending-outcome paradox with precision: US per capita spending is $14,885 (2.5x OECD average $5,967), GDP share 17.2% vs 9.3%, yet life expectancy is 2.7 years below OECD average (78.4 vs ~81.1 years). The preventable mortality gap (50% worse than OECD) is more than double the treatable mortality gap (23% worse), demonstrating that the primary failure is non-clinical. US acute care quality (AMI, stroke) meets or exceeds OECD standards, confirming the paradox is not about clinical capability but about behavioral and social determinants.

---

# The US healthcare spending/outcome paradox — world-class acute care outcomes with dramatically worse preventable mortality — is the strongest empirical confirmation that non-clinical factors dominate population health

The US spends $14,885 per capita on healthcare (2.5x the OECD average of $5,967) and 17.2% of GDP (vs. OECD average 9.3%), yet achieves life expectancy 4.3 years below peer countries (78.4 vs. 82.7 years). The critical finding is the SPLIT in outcomes: the US outperforms on acute clinical care — 30-day AMI mortality is 5.2% vs. OECD average 6.5% (21% better), and 30-day stroke mortality is 4.5% vs. 7.7% (42% better). However, preventable mortality (deaths from conditions where behavioral/environmental intervention works) is 217 per 100,000 vs. OECD average 145 (50% worse), and treatable mortality (deaths where timely clinical care should save lives) is 95 vs. 77 (23% worse). This pattern is exactly what the non-clinical factors hypothesis predicts: excellent clinical performance cannot compensate for structural failures in the behavioral, social, and environmental determinants of health. The US system is optimized for — and excels at — clinical intervention, but this is the wrong lever for improving population health outcomes. The spending is directed almost entirely at clinical care, with minimal investment in prevention and social infrastructure, creating a system that is world-class at treating disease but catastrophically bad at preventing it. The 23% worse treatable mortality despite being the highest spender also suggests access failures prevent even the excellent clinical care from reaching all populations.


## Supporting Evidence

**Source:** OECD Health at a Glance 2025

OECD 2025 data quantifies the spending-outcome paradox with precision: US spends $14,885 per capita (2.5x OECD average $5,967) and 17.2% of GDP (vs 9.3% OECD average), yet life expectancy is 2.7 years below OECD average (78.4 vs ~81.1 years). The preventable mortality gap (50% worse than OECD) is more than double the treatable mortality gap (23% worse), confirming that the primary failure is non-clinical. US acute care performance (AMI, stroke) matches or exceeds OECD peers, proving clinical capability is not the binding constraint.


## Extending Evidence

**Source:** KC Fed / LPL Research (2026)

The GDP/healthspan decoupling mechanism provides a specific pathway for how economic indicators can diverge from health outcomes: AI productivity gains concentrate in information services and professional activities (right-tail distribution per KC Fed) while chronic disease burden concentrates in manufacturing, construction, and lower-skill services. This allows 2.7% productivity growth to co-exist with declining population health metrics.
