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Health Reform: Is the US System Broken?

John on August 20, 2009 at 1:37 pm

Over at Reuters, James Pethokoukis notes a new study of the US Health System with some surprising results. First, here’s the abstract:

Life expectancy in the United States fares poorly in international comparisons, primarily because of high mortality rates above age 50. Its low ranking is often blamed on a poor performance by the health care system rather than on behavioral or social factors. This paper presents evidence on the relative performance of the US health care system using death avoidance as the sole criterion. We find that, by standards of OECD countries, the US does well in terms of screening for cancer, survival rates from cancer, survival rates after heart attacks and strokes, and medication of individuals with high levels of blood pressure or cholesterol. We consider in greater depth mortality from prostate cancer and breast cancer, diseases for which effective methods of identification and treatment have been developed and where behavioral factors do not play a dominant role. We show that the US has had significantly faster declines in mortality from these two diseases than comparison countries. We conclude that the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system.

Here is their explanation of one of the most significant factors in our lower life expectancy:

measures of population health such as life expectancy do not depend only on what transpires within the health care system – the array of hospitals, doctors and other health care professionals, the techniques they employ, and the institutions that govern access to and utilization of them. Such measures also depend upon a variety of personal behaviors that affect an individual’s health such as diet, exercise, smoking, and compliance with medical protocols. The health care system could be performing exceptionally well in identifying and administering treatment for various diseases, but a country could still have poor measured health if personal health care practices were unusually deleterious. This is not a remote possibility in the United States, which had the highest level of cigarette consumption per capita in the developed world over a 50-year period ending in the mid-80′s (Forey et al. 2002). Smoking in early life has left an imprint on mortality patterns that remains visible as cohorts age (Preston and Wang 2006; Haldorsen and Grimsrud 1999). One recent study estimated that, if deaths attributable to smoking were eliminated, the ranking of US men in life expectancy at age 50 among 20 OECD countries would improve from 14th to 9th, while US women would move from 18th to 7th (Preston,
Glei, and Wilmoth 2009).

One more intriguing detail on the success of the US system:

Because they are not subject to this potential bias, we pay special attention to mortality rates. In particular, in the second half of the paper we investigate comparative mortality trends for prostate cancer and breast cancer. We document that

  • effective methods of screening for these diseases have been developed relatively recently;
  • these diagnostic methods have been deployed earlier and more widely in the US than in most comparison countries;
  • effective methods are being used to treat these diseases; and
  • the US has had a significantly faster decline in mortality from these diseases than comparison countries.

Finally, a useful comparison chart on cancer survival rates (click for full size):
cancer survival rates

President Obama has made much of using the best science to make sure treatments given to patients are effective. Maybe in light of this study, we should start by applying that thinking to the system as a whole.

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Category: Health & Education |

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