teleo-codex/inbox/archive/health/2026-04-23-oecd-health-at-a-glance-2025-us.md

---
type: source
title: "OECD Health at a Glance 2025: United States Country Profile"
author: "OECD"
url: https://www.oecd.org/en/publications/health-at-a-glance-2025_15a55280-en/united-states_3517f35e-en.html
date: 2025-11-01
domain: health
secondary_domains: []
format: statistical report
status: processed
processed_by: vida
processed_date: 2026-04-23
priority: high
tags: [OECD, international-comparison, health-spending, outcomes, life-expectancy, preventable-mortality, clinical-effectiveness, US-health-system]
extraction_model: "anthropic/claude-sonnet-4.5"
---

## Content

OECD Health at a Glance 2025 — United States country profile. Annual flagship report on OECD health system performance.

**Life expectancy:**
- US: 78.4 years
- OECD average: 81.1 years (US is 2.7 years below OECD average)
- Comparable countries (similar income): 82.7 years (US is **4.3 years below peer average**)

**Health spending:**
- US: **$14,885 per capita** (USD PPP)
- OECD average: $5,967 per capita
- US spends **2.5x OECD average** — the highest absolute and proportional health spending in the OECD
- US: **17.2% of GDP** on health vs. OECD average 9.3%

**Outcome paradox — where the US is BETTER:**
- 30-day mortality after acute myocardial infarction (AMI): **5.2%** vs. OECD average **6.5%** (US is better)
- 30-day mortality after stroke: **4.5%** vs. OECD average **7.7%** (US is better)
- US has more resources than OECD average on 6 of 10 key health system resource indicators

**Outcome paradox — where the US is WORSE:**
- **Preventable mortality**: 217 per 100,000 vs. OECD average **145** (US is 50% worse — preventable = deaths from conditions where behavioral/environmental intervention works)
- **Treatable mortality**: 95 per 100,000 vs. OECD average **77** (US is 23% worse — treatable = deaths where timely clinical care should save lives)
- Overall life expectancy: 4.3 years below peer-country average

**Related peer-reviewed study:**
"Association of Health and Social Spending With Health Outcomes in OECD Countries" (PubMed 40705475) — investigates whether health vs. social spending explains outcome differences across OECD countries.

## Agent Notes

**Why this matters:** This is the cleanest empirical illustration of Belief 2 (80-90% non-clinical factors) in the KB. The data shows:
- The US is EXCELLENT at acute clinical care (AMI, stroke outcomes are better than OECD average)
- The US is TERRIBLE at preventing the conditions that require that clinical care (preventable mortality 50% worse than OECD average)
- The US spends 2.5x the OECD average — all on clinical intervention, almost none on prevention/social infrastructure

This is exactly the pattern Belief 2 predicts: excellent clinical performance cannot compensate for structural failures in the behavioral/environmental determinants of health. More clinical spending doesn't move the needle on life expectancy if the system ignores what causes disease in the first place.

**Disconfirmation relevance for Belief 2:**
I was looking for evidence that clinical intervention dominates health outcomes — evidence that would challenge Belief 2. I found the opposite: the US is world-class at clinical intervention and still underperforms on life expectancy. The spending/outcome gap is explained by what we spend on (clinical care) vs. what determines outcomes (preventable causes — behavioral, social, environmental). Belief 2 is confirmed, not disconfirmed.

**Additional nuance:** The "treatable mortality" gap (23% worse than OECD despite being the highest spender) suggests that even the clinical care access question is real — not all Americans access the world-class clinical care the US system provides. The structural access failures noted in Sessions 22-25 (GLP-1 access gaps, Medicaid fragmentation) are visible in this aggregate outcome.

**What surprised me:** The AMI and stroke 30-day mortality data showing the US outperforms OECD. This is often missed in simple "US healthcare fails" narratives. The US DOES deliver excellent acute care — when patients can access it. The failure is at the preventive and access levels, not at the acute clinical level. This matters for framing: Belief 2 doesn't say "clinical care doesn't work" — it says clinical care (which IS excellent in the US) is the wrong lever for improving population health outcomes.

**KB connections:**
- Direct evidence for Belief 2 (non-clinical factors dominate) — the international comparison is the cleanest version of this evidence
- Directly relates to the healthcare misalignment claims (Belief 3): the US system is excellently aligned for clinical intervention and structurally misaligned for prevention
- Preventable mortality gap supports Belief 1 (compounding failure): we're losing because we're addressing the wrong thing
- Informs SDOH ROI claims: countries spending more on social infrastructure and less on clinical care achieve better overall outcomes

**Extraction hints:**
- CLAIM: "The US healthcare spending/outcome paradox — world-class acute care outcomes, dramatically worse preventable mortality — is the strongest empirical confirmation that non-clinical factors dominate population health"
- DATA POINTS: US $14,885/capita vs. OECD $5,967; life expectancy 4.3 years below peer average; preventable mortality 50% worse; AMI mortality 21% better
- These data points could ENRICH existing SDOH and healthcare misalignment claims rather than generate new standalone claims

**Context:** OECD Health at a Glance is published annually and is the gold standard international health comparison. These are PPP-adjusted purchasing power parity figures, so the comparison is valid across income levels.

## Curator Notes (structured handoff for extractor)
PRIMARY CONNECTION: Belief 2 (non-clinical factors) + healthcare misalignment claims (Belief 3) + SDOH ROI claims
WHY ARCHIVED: The US spending/outcome paradox is the most powerful international evidence for Belief 2. The dual finding — better at acute care (where clinical intervention is decisive), worse at preventable mortality (where behavioral/social factors are decisive) — is exactly what the belief predicts.
EXTRACTION HINT: The extractor should note the SPLIT finding: US is better on AMI/stroke (clinical) and worse on preventable mortality (behavioral/social). This split IS the evidence. Don't just extract "US spends more and gets worse outcomes" — extract the mechanism: clinical excellence doesn't compensate for preventive failures.