Wednesday, January 9, 2008

Health Care in America

I've seen this figure twice now, so I decided to go to the original article published in Health Affairs, Jan./Feb. 2008), by Ellen Nolte, Ph.D., and C. Martin McKee, M.D., D.Sc., both of the London School of Hygiene and Tropical Medicine.

It's a pretty interesting read. The measure rates of death due to amenable causes in 19 developed nations in 1997-98 and 2002-03. Their criteria for "amenable causes" is:

The selection of causes of death considered amenable to health care is based on our previous systematic review. In brief, for this paper we considered conditions such as bacterial infections, treatable cancers, diabetes, cardiovascular and cerebrovascular disease, and complications of common surgical procedures. We also included ischemic heart disease (IHD); however, in line with accumulating evidence suggesting that only up to half of premature mortality from IHD may be potentially amenable to health care, we here considered only half of IHD deaths to be "amenable." Throughout this paper, the term "amenable" mortality always includes half of IHD deaths.
They found the US was ranked 15th out of 19 in 1998 in our rate of death from amenable causes fr people aged 0-74. in 2003, we slipped to 19th. Dead last.

Here's the rub, though. We actually improved our death rate, but nearly as much as other countries improved theirs. Thus we got lapped. Here's the figure that illustrates the percentage change in death rate from 1998 to 2003:

We improved our rate by about 4%. The country that improved it's rate second worst was Greece, and they managed to improve it by 10.5%. Austria and Ireland managed to improve their rates by about 25%.

They speculate on what could be happening in the US:

The rate of amenable mortality is a valuable indicator of health care system performance, although it is important to note that the underlying concept should not be mistaken as definitive evidence of differences in effectiveness of health care but rather as a an indicator of potential weaknesses in health care that can then be investigated in more depth. At the same time, the findings presented here are consistent with other cross-national analyses, demonstrating the relative underperformance of the U.S. health care system in several key indicators compared with other industrialized countries. The underlying reasons for the observed lack in progress in the United States as a whole are likely to be manifold; however, it is equally clear that an aggregate national figure of amenable mortality as presented here will inevitably conceal large variations in terms of geography, race, and insurance coverage, among many other factors. This was recently demonstrated in the State Scorecard on Health System Performance, which revealed a twofold difference across the fifty states and District of Columbia on the measure of amenable mortality in 2002. It also estimated that if all states achieved levels seen in the best-performing state on this measure, about 90,000 premature deaths might be avoided annually. However, this figure still falls short of the 101,000 deaths that could be avoided if the United States were to achieve levels of amenable mortality seen in the three top-performing countries.
But don't let anyone tell that you we don't have the best health care in the country...

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