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Monday, June 18th 2007

Why Do International Comparisons Peeve Me So?

It’s All The System’s Fault!

Before I go off on my little tangent I’d like to admit (as I always do) that the U.S. has one of them least efficient health care systems the world over. It fails to value prevention, it fails to control costs, it fails to identify evidence based procedures.

It also allows the freest choice for those who can afford it and single handedly drives biomedical and pharma innovation.

All that aside, as I’ve made it clear over the years it really annoys me when people throw the cost of health care in this country out there and then really imprecise measures of quality – such as life expectancy – and pass it off like this country isn’t getting value for what it spends. Here’s the LAT article (via THCB) which has required this post.

Amid stacks of reports, all with wonky measures of access, equity, efficiency and medical outcomes, two statistics stand out. The U.S. spends more on medical care than any other nation, and gets far less for it than many countries. According to the 2006 analysis by the Organization for Economic Cooperation and Development, the U.S. spends an annual $6,102 per person — more than any other country and more than twice the average of $2,571. Yet Americans have the 22nd highest life expectancy among those nations at 77.2 years compared with the analysis’ average of 77.8 years. People in Japan, the world leader in longevity, live an average of 81.8 years.

Talk about me almost blowing my top.

Look, we’re only talking about magnitude here because all can admit the “faults” of the American health care system. But the magnitude; the degree to which blame can be heaped on the system itself is important because of the level of outrage that is building. Personally, I think it is insulting that groups like the Commonwealth Fund think they have to stay on message and dumb down the findings and explanations for the general consumer.

Because while I admit the comparative shortcomings of the American healthcare system a lot of these numbers owe something to the way this country lives. Ignoring that fact; continually marching out really multivariable figures as evidence of this country’s shortcomings is annoying.

Plenty of our health woes are on us as patients, not on faults of the system.

Americans in general lead some of the unhealthiest lives in the western world. Rightly throwing out those Pacific Island nations America is the second fattest country in the world, it has some of the highest rates of diabetes in the world, it has a higher mortality per 1000 females due to cardiovascular disease than any nation you’ll see held up as a glorious example of health care done right.

Get out of Dodge if you think much of that can be put on access issues or on a failure of American medicine to promote disease prevention. Us stuffing Big Mac’s down our faces (and importantly doing it longer and at a greater rate than other countries) isn’t a public health failure. That is a societal problem.

The best evidence says Americans are sicker than their Canadian counterparts, sicker than their British counterparts, independent of their access to care or the quality of care they receive.

And yet time and time again the implication is that we spend more on health care and we die sooner solely because of some flaw in the health care system itself. Baloney. Plenty of those figures can be put on the fact that we’re sicker. Hey, what a novel notion; you’re obese you have a shorter life expectancy and larger medical necessities. Translation: you spend more on health care and you still die sooner.

Dump the United State’s epidemiology on France. Dump our history of obesity, our obesity rates, all our other chronic disease rates. Dump our wealth gap on France because even though the Commonwealth Fund study “Mirror, Mirror on the Wall” points out that…

Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick, not getting a recommended test, treatment or follow-up care, not filling a prescription, or not seeing a dentist when needed because of costs.

…studies clearly have defined that lower income means less utility of health care resources, even if you have access to them. Dump our ethnic and genetic heterogeneity on them. Dump all of that on any health care system and watch what happens to their life expectancy. Maybe not our levels, but it’ll drop like a brick by contention.

Yes the American health care system is a wreck in many ways. But just stop contrasting America’s health care expenditures with such ridiculous, imprecise quality measures. Give me that one, not so unreasonable, concession and I’ll stop wasting posts whining about it.