Performance of the US Health Care System
Here’s some of the data I promised you the other day, giving a more detailed look at the performance of the US health care system compared with those of other industrialized countries.
First let’s take a look at the very young. How well does the US health care system take care of children and mothers, both before and after birth? The following table gives a few indicators:
Notes: Infant mortality rates from OECD, showing 2001 data; other data from the WHO, showing data for the year 2000.
The US does worst, or tied for worst, in every measure. The US health care system simply does not do a very good job in caring for the very young.
So how about the elderly? The following table gives details about the length and quality of life that senior citizens can receive in developed countries around the world.
Note: Data from year 2001. Source: WHO.
Not only is the US’s life expectancy at or near the bottom of the industrialized world, but Americans spend more of their shorter lives in poor health (as defined by the WHO).
Now recall the data I showed you the other day describing how much the US spends on health care. Americans spend nearly twice as much as people in other developed countries spend on health care. Our closest competitor for health care costs is Switzerland, which still spends just 60% of what the US spends, per capita. And yet all of these countries acheive better health outcomes: longer lives, fewer dead babies and children, and more quality of life for their elderly.
One last point: some have argued that the US’s poor showing on all of these measures is simply an artifact of demographic or other differences between the US and other developed nations, and not a function of the US’s health care system. It turns out that this is something that is fairly straightforward to determine using some econometrics.
One example is given in a 2003 OECD Working Paper titled “The US Health System: An Assessment and Prospective Directions for Reform,” by Elizabeth Docteur, Hannes Suppanz and Jaejoon Woo. They test the influence that various demographic indicators (e.g. income per capita, fertility, education levels, and income distribution) have on infant mortality and life expectancy statistics in a panel of OECD countries. Then they use those results to estimate how much of the US’s poor results simply reflect these demographic characteristics, and how much are unexplained.
They find that such demographic factors do not explain any of the US’s bad health statistics. (The US’s low level of publicly provided health care does explain about one-third of the US’s low life expectancy, however.) The conclusion is that there is something idiosyncratic about the US health care system that results in poor outcomes despite its enormous costs. The average American simply receives unambiguously worse health care while paying twice as much as citizens of the rest of the developed world.
Kash
I see a lot of quibbling about minutiae here. My basic feeling is that, in the United States, the level medical care is determined primarily by what the insurance companies will pay. Or refuse to pay in some cases. I am an engineer and have had “typical” insurance plans over the years. All of them had limits on what a doctor could do to treat any medical problem. Most had prohibitions on specific types of care such as chiropractic. And, over the years, I have had to fight with insurance companies at times just to get the basics.
I wish people could get over squabbling about which country is best. I think that it is clear that it is not the US. In talking with people over the years, I have heard many tales of insurance company meddling and also of incompetence on the part of medical professionals. It seems to me that we should expect and demand better.
One final thought. As an engineer, when I need to estimate the cost to buy a particular product or service, I calculate the cost to produce the item. I then double it to take overhead into account. This provides a fairly accurate estimate of my cost. So, it would follow that for every dollar that the provider bills, someone pays the insurance company $2.
We need to get away from the squabbling and start demanding results. If you are in favor of staying with an insurance-based system, then start demanding that they do a good job and give us the same quality and level of service as that enjoyed in other industrialized countries.
Last item. If you think that we are already doing that. think of this example. In Germany, if a person has a leg amputated above the knee, that person is entitled to any prosthetic knee and leg that is compatible with his or her condition and life style. In the United States, most amputees find that they have to justify any modern prosthesis and getting a computerized knee is almost impossible until they buy it with their own funds. If you do not believe this, take the time to call some local prosthetists or people at Otto Bock, Ossur, Endolite. You might be surprised.
In any event, get away from the philosophical/politival bull and start thinking in terms of making the system better and more cost-effective.
very thoughtful……….
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