Political Discussions
US medical care ranks 37th in world.
Posted by polybore • 8/12/09 • Subscribe to this Discussion [RSS] • Report This Topic
Topics: medical care, NHS, WHO, world health organisation
Polybore has taken time off watching the public Granny and Grandpa executions we have here in the UK to ask what, to polybore, seem fundamental questions for those considering the necessity or otherwise of US health reform.
Why does the worlds superpower have a medical system that ranks 37th in the world (World Health Organisation)?
Why does the UK despite its much maligned State health system have higher life expectancy rates than the US?
How can the UK (rank 18) have a superior medical system to the US but spend significantly less on health care?
User Comments
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We have the most expensive system, but many confuse that with the best. You're going to see attacks by people here for even daring to utter such a statement, but what you're talking about reflects my personal experience both in Germany (a mixed system such as being proposed here) and the US. And I've never heard any British friends complain.
I find it very strange that Britain, whose system was one even Margaret Thatcher didn't undo, should serve as a socialist bugaboo of right-wingers and insurance companies here. British citizens must be scratching their head over the role their system plays in right-wing rhetoric here. (Canadians too.)
More effective and efficient health care. That's some bogeyman.-
Here's an example of the lengths some people will go to in order to get basic care: latimesblogs.latimes.com/lanow/2009/08/hundreds-spend-the-night-at-the-foru... We're not talking a sustainable health care system here.
Here's a related story: www.nytimes.com/2009/08/13/health/13clinic.html?hpw
How bad is it that people need to go to these lengths for what is essentially charity? Helluva system. -
"... no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means."
Aneurin Bevan, UK Health Minister responsible for the foundation of the NHS in 1946.
The UK is angry about how the NHS is being misrepresented. For example an IBD (Investors Business Daily) editorial stated that Stephen Hawking would not be alive today if he had lived in the UK under NHS care. Well actually Stephen Hawking is British and says "I would not be here without the NHS".
Note they have now revised the article (as noted at the start). www.ibdeditorials.com/IBDArticles.aspx?id=333933006516877
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Life expectancy isn't the best plave to look for information.
Diet for instance has too much to do with that.
What you should look for is the result of care, where the survival rates etc are better in the US than in England.
You can't blame the Hospitals for the US population being among the fattest in the world.-
Point taken but...
UK has an obesity problem which not quite on a par with the US is significant. 1/2 of the uk population obese vs 2/3 US. Also we drink a lot more alcohol than they do in the US.
Last time polybore checked the UK was on a par or better than the US in specific survival rates except cancer. However this is explained by the over diagnosis of and unnecessary treatment of cancer in the US.
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Polybore is enraged by the misrepresentation of the NHS. It took a while, did not really want to go partisan on this topic, but am now fully engaged.
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Okay, where do I begin? The World Health Organization report is rigged due to its questionable methodology. One of the main indicators in their rankings is financial distribution. In other words, they assume that socialized medicine is "free" because there are no or very low premiums. This is bogus because it does not take into account that taxation is heavy in countries with socialized medicine.
"The WHO study has been criticized in a study published in Health Affairs for its methodology and lack of correlation with user satisfaction ratings."
en.wikipedia.org/wiki/Health_care_in_the_United_States
However, from the WHO report -
"The United States dominates the biopharmaceutical field, accounting for three quarters of the world’s biotechnology revenues and spending in research and development. In addition, the U.S. produces more new pharmaceuticals, medical devices, and affiliated biotechnology than any other country, or the Western European nations combined."
The WHO also says -
"Several small countries – San Marino, Andorra, Malta and Singapore are rated close behind second- placed Italy."
Tell me, how many of you would like to go to Malta or Andorra or San Marino for treatment if you were diagnosed with cancer? Or with cardiac problems? Of any of a host of other possibly terminal conditions?
In the WHO report, the United States ranked first in "Responsiveness."
"Responsiveness: The nations with the most responsive health systems are the United States, Switzerland, Luxembourg, Denmark, Germany, Japan, Canada, Norway, Netherlands and Sweden. The reason these are all advanced industrial nations is that a number of the elements of responsiveness depend strongly on the availability of resources. In addition, many of these countries were the first to begin addressing the responsiveness of their health systems to people's needs."
But what is "responsiveness" as defined by the WHO?
"Responsiveness includes two major components. These are (a) respect for persons (including dignity, confidentiality and autonomy of individuals and families to decide about their own health); and (b) client orientation (including prompt attention, access to social support networks during care, quality of basic amenities and choice of provider)."
Our autonomy and ability to choose our own doctors, patient dignity (how much dignity does a patient have that is left laying on a stretcher for hours, sometimes days at a time due to health rationing?), access to social support and quality of basic amenities are what put us at the top of the "Responsiveness" list. Funny how the WHO burys that part in its report.
So, if you break it down, the only thing the United States fails in is how much money is spent per capita on health care. But when you look at the rate of survivability of something that used to be almost certainly fatal and compare that to today's survivability rates, then you get a better picture of where that money goes. Something say, like cardiovascular problems, or heart disease.
"From 1995 to 2005 the death rate from coronary heart disease declined 34.3 percent."
www.americanheart.org/presenter.jhtml?identifier=4478
Pretty amazing, huh? I think it is money well spent.
But lets look a little deeper. Go back more than 10 or so years.
"Since 1970, death rates from cardiovascular diseases have fallen by almost 50 percent and death rates from stroke have fallen by
60 percent"
And from the same source:
"Cholesterol reducing drugs such as statins are being used by millions
of Americans to prevent heart disease and strokes, to decrease recurrence of heart attacks and to reduce the need for bypass surgery. Statins also improve survival of heart transplant patients.**
*SOURCE: THE CENTERS FOR DISEASE CONTROL AND PREVENTION (WWW.CDC.GOV)
**SOURCE: NATIONAL INSTITUTES OF HEALTH {WWW.NIH.GOV/}
HOW RESEARCH SAVES MONEY:
The average life-span of Americans increased from 50 years in 1900 to 77 years in 2000. Steadily declining mortality rates from cardiovascular disease since the mid-1960s is a significant reason for longer, more productive lives.*
It is difficult to place a dollar value on human life, but economists
have estimated that years of productivity gained through the prevention and treatment of cardiovascular diseases contributed $1.5 trillion to the nation’s economy each year from 1970 to 1990.*
A NIH-sponsored study found that the bioengineered clot-busting drug called t-PA saves $4,400 for each patient in health care costs. The NIH predicts that $100 million a year could be saved if this drug is used more widely."
www.laskerfoundation.org/advocacy/pdf/factsheet2cardiovasc.pdf
So summing it up I would say that, yes the United States does have the most expensive health care in the world. But look at how many lives it has saved and look also at all the drugs and medical devices and techniques that we have pioneered. These have helped not only Americans, but people all over the world.
You have to be careful when you read the our health care system ranks 37th in the world. Before jumping to conclusions, one must read the report and dissect the methodologies used. That WHO report rewards countries with socialized medicine because the WHO has a bias towards that type of health care systems.-
OK lets leave the ranking system aside and just crunch some straight forward data.
Life expectancy is longer in the UK than in the US
Healthy life expectancy is longer in the UK than the US
Probability of dying under 5 is lower in the UK than the US
Probability of dying between the ages of 15 and 60 years is lower in the UK than the US
The US spends twice the percentage of GDP that the UK does on healthcare but can only achieve an inferior health car system.
www.who.int/countries/usa/en/
compared with
www.who.int/countries/gbr/en/
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Here's a report from The World about media coverage that includes Gordon and Sarah Brown joining the twitter campaign to defend the unjustly maligned NHS. www.theworld.org/2009/08/13/covering-americas-health-care-reform/
The World is a coproduction of the BBC, PRI (Public Radio International), and WGBH (Boston Public Radio).
This same page links to two related articles in The Guardian and The Washington Post:
"'Evil and Orwellian' – America's right turns its fire on NHS"
www.guardian.co.uk/world/2009/aug/11/nhs-united-states-republican-health
"Health-Reform Rhetoric Gets Personal for Britons"
www.washingtonpost.com/wp-dyn/content/article/2009/08/12/AR2009081202955.ht...
I'm glad to see Britons fighting back. Maybe the US system isn't their problem, but maligning their achievement is ignorant and just plain wrong.-
The British find the fact that these US anti health care reformists use the NHS to illustrate their argument astonishing when the NHS actually proves the exact opposite of their point.
Any sensible point that the anti reformers might be trying to make is completely lost by their remarkable display of ignorance and stupidity. -
The opposers (as opposers do on many topics) are not actually looking for facts to improve their understanding. They are looking for case by case example and using it as fear mongering.
I loved a skit Hannity had on a little while ago. He had some kid go to CA, claim to fall and hurt his wrist and then go to an emergency room. Hannity was all over it because the kid with a boo boo on his wrist hadn't been seen after 5 hrs and how bad the CA system was. Our OB sent my pregant wife to the emergency room for an emergency C-section because the child's life was at risk. It took us 6 hours to get past the secretary and another 4 before a surgery room opened. Sometimes we got closer to surgery but someone else with a more pressing issue needed it. Then we got bumped again. That was with a life threatening situation. Sorry the kid didn't get a bandaid in a rush. -
"The opposers (as opposers do on many topics) are not actually looking for facts to improve their understanding. They are looking for case by case example and using it as fear mongering."
The far right in America has learned this tactic from Hannity, Limbaugh, Beck and other divisive pundits. -
Both sides do it in a pinch although the Hannity's of the world are very skilled at it.
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Fear mongering? Like when Obama talked for how many weeks about how awful the economy was and the stock market plunged like a pregnant pole-vaulter?
Here is a very good article on why El Presidente does this sort of thing.
www.latimes.com/news/opinion/commentary/la-oe-goldberg10-2009mar10,0,641463...
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If the WHO report is rigged, how does one decide which data is good enough to quote and which data is garbage?-
I don't know if I would say rigged but you have to be careful with all of these ratings. They all come done to a small group of people are had to weigh a lot of factors and come up with what they thought worked best (for their agenda). You have to read who funded it, their methodology and carefully review their outcomes. Two people can look at the same facts and have two very different outcomes. It doesn't mean that either of them are wrong.
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The WHO has been sharply criticized in their made up methodology. It ranks the countries with socialized medicine higher because they are more "fair." This article is a very good, objective break down of the WHO methodology. In the category called "responsiveness," which basically breaks down to quality in health care, the United States ranked number ONE in the world.
The article sums up the WHO methodology in this way:
"It is misleading for an efficiency or system performance indicator to rely heavily on life expectancy when many determinants of life expectancy are beyond the realm of the health sector. Another criticism of the report is that the WHO has not made an adequate effort to distinguish between efficiency and equity. This results in a bias against countries with greater inequality, such as the United States and South Africa. While this bias may be defensible politically, it is more difficult to defend in a performance analysis of health systems."
www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1447380
I don't believe that the WHO is an evil entity, intent on making some countries look bad and others look good. I think that they are a bureaucracy that unintentionally misleads with some of their findings. This would be, in my opinion the fact that the WHO favors socialized medicine as more "fair." -
anticsrocks The reason that the US is comparable to South Africa is that they both have "greater inequality".
Says it all really. -
Ouch.
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That is one of the problems that I have with their measurement system. I don't care if the really rich have Jonny's made out of gold foil. I do care if the median American "ME" gets quality care. I do care if the poor get quality care.
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@poly...Explain "inequality." Or what you think it means, I s'pose.
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Meaning exactly the same as it means in the article you quoted.
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"During the last decade, the global community started to deal with poverty and inequality across the world in a much more systematic way – by setting the MDGs and bringing the issue of inequality to the core of social policy-making."
That is from the WHO report. As you can see, for the WHO, inequality is the basis for what they interpret as "social policy-making." In other words, countries that aren't gravitating towards socialized medicine receive lower rankings. That is a built in bias.
Further, I hate to disappoint you and mark, poly; but a great many scientists have problems with the WHO report. They see through the bias and recommend changes.
What is wrong with it:
"The scientific objections that were made about the WHR 2000 composite
index can be summarized as follows:
* there was no agreement on whether the five components of the index
were universally appropriate (Coyne and Hilsenrath 2002)
* the components of the index refer to different definitions of the health system (for example, health outcomes to a very broad definition, responsiveness to a narrow definition based predominantly on health care)
* the components of the index refer to different time periods (for example, health outcomes to a long period, responsiveness to the current period)
* the rescaling of the component indicators onto a 0 to 100 scale was arbitrary, and its consequences difficult to understand
* the weights used in the composite index were derived from key informant interviews and were not representative of population preferences (Almeida et al. 2000; Williams 2000; Smith 2002)
* the methodology for deriving the weights was flawed – in particular, the questionnaire used did not elicit the required relative marginal valuation of an extra unit of performance (Smith 2002)
* the measurement of the individual components of the index was poor
* the treatment of ‘missing data’ was inadequate, and there were too many missing data to make the composite indicator credible (Nord 2002; McKee 2001; Häkkinen 2000)
* the rankings reported in WHR 2000 are sensitive to the weights used (Oswaldo Cruz Foundation 2000)
* the methods used were not validated or exposed to adequate scientific review."
The changes they recommend:
"Specific recommendations in the literature included:
* WHO should publish the underlying data, but not aggregate it into a
single index
* comparisons should be reported only for clusters of comparable countries different transformations (such as z-scores) should be used for the
component measures (Oswaldo Cruz Foundation 2000)
* different weights or component measures might be used for different
clusters of countries, reflecting different circumstances, priorities and
objectives
* WHO should offer more support for understanding the composite scores
and translating into local action
* satisfaction, coverage and process measures should be incorporated into
the index
* better methodology should be adopted for inferring weights (Appleby and
Street 2001)
* better methodology should be adopted for the analysis of uncertainty
* a research and development effort on the use on composites should be
considered by WHO." -
Just as I thought poly, you didn't know what you were talking about.
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An interesting side effect of the Republican attacks on the UK NHS is that it has resulted in damage to their chums in the British Conservative party.
The Conservative Party have close links to some of the most vociferous Republicans who have been bandying around "evil" and such like. However the Conservative Party has been careful until recently to reassure the UK public that the NHS would be safe when they are in government.
Unfortunately (for Conservatives) this debate has encouraged a few Conservative party members to speak publicly about the NHS in a way that is seriously off message. David Cameron who is (was) odds on favourite to be the next PM is not best pleased.
The NHS is very, very popular in the UK and any hint that the Conservatives are not behind the NHS 100% will be damaging at the election.
www.timesonline.co.uk/tol/news/politics/article6797749.ece-
That is interesting, because I was thinking New Labour was becoming vulnerable. Or am I wrong about their loss of popularity?
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Of course, you know someone is going to pop up and take those quotes as an argument against the Congressional plan, even though nothing of the sort is even being considered here. Trying to fight those lies is like playing Wack a Mole, only it's not as challenging or fun.
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New Labour is very vulnerable just now. But a week is a long time in politics and they have just under a year. Gordon Brown will not give up and although victory is still highly unlikely he may be able to restrict the Conservative majority.
The US Republicans have made Brown's mind up for him and he looks set to put the NHS boot into the Conservatives. That and it looks like UK is coming out of recession by the third quarter so a sure fire landslide Tory victory is, perhaps, not so certain.
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"Why does the UK despite its much maligned State health system have higher life expectancy rates than the US?"
Life expectancy and healthcare are barely related. Actual diseases that arise in the US have among the best outcomes in the world for Gastro-Intestinal disorders, Heart Disease, and Cancers, but these diseases arise more often because Americans, as a people, are less likely to walk and exercise, less likely to eat well, and more likely to drink alcohol then any other group of people in the world. They also have some of the highest workplace stress levels in the world. These factors have a far greater affect on life expectancy then the quality of your health insurance.-
Access to health care is relevant, and quality of insurance affects access. If you have no access, it doesn't matter how good the results are for those who actually get treated. This is all about access, which lack of insurance and new restrictions invented by insurance bureaucrats deny more people than is acceptable. This country ought to be ashamed of where it stands, and it ought to change that, instead of making lame excuses for its uneven performance.
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The UK consumes far more alcohol than the US as do a number of countries eg. France, Germany, Austria and so on.
Your average US citizen is not as disease ridden as you think they are pretty much on a par (unhealthy wise) with any developed nation. -
@MS: But if you're so disease-ridden that you must be treated every week, you probably won't live as long as that Central Asian yogurt farmer who lives to 85, regardless of how good your care is. Also, most of the more credible results oriented statistics I've looked at in the past seem to indicate that America is towards the top, not the bottom. It is only this kind of fallacious indirect nonsense where the measured variables have maybe a 10% correlation with medical care that shows us at the bottom. The only real health statistic I've found that America ranks low on is Infant Mortality, which may have something to do with all those religious groups (Amish & Mennonite, big part of the Midwest, and some other ND groups in the PNW) practicing primitivism (midwives) and having 7-children families.
@polybore: Only if you really slant the statistics. Fact of the matter is, we have no physical actrivity in this country, and that's more dangeorus then drinking. -
It is not just life expectancy and infant mortality that the UK health system does better in. For example their are more doctors in the UK per thousand people
Infant mortality (per 1,000 live births)
US 6.7
UK 4.8
Practising physicians (per 1,000 people)
US 2.4
UK 2.5
The NHS gets better results for half the money.
Health spending as a share of GDP
US 16%
UK 8.4% -
@polybore: Increasing the number of doctors per citizen is a matter of one factor and one factor only, the availability of medical school. Creating socialized health care will do nothing for that situation but waste valuable money that could be spent building medical schools. Worse, many states don't allow private medical schools to be built. Right now, in order to get in to medical school in the US, you must have a perfect GPA, extracuricullar activities, and pass a bizarre memorization test of completely worthless knowledge. While we appreciate the commitment to excellence, at least one of these requirements could be eliminated without any adverse effect on the quality of the doctors.
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@polybore...What, no links to your sources?
As to infant mortality rates, it is higher in the United States. One of the main factors is pre-natal drug use. Of course drug use is usually higher among the poor. That is why infant mortality rates vary between socio-economic status in the U.S. But more importantly, the way that infant deaths are counted among highly developed countries adds to the confusion.
"Problems of definition and measurement, however, hamper cross-national comparisons of health statistics. Alternative measures of infant mortality may provide better information but cannot completely compensate for differences among countries in the overall rates of reporting of adverse pregnancy outcomes. For example, very premature births are more likely to be included in birth and mortality statistics in the United States than in several other industrialized countries that have lower infant mortality rates.
Variations in infant mortality rates among the states and between different racial and ethnic groups in this country are greater than the differences between the United States and many other countries. Black infant mortality rates, in particular, are exceptionally high, and the relative gap between black and white infant mortality rates has been increasing over time.
Low birthweight is the primary risk factor for infant mortality and most of the decline in neonatal mortality (deaths of infants less than 28 days old) in the United States since 1970 can be attributed to increased rates of survival among low-birthweight newborns. Indeed, comparisons with countries for which data are available suggest that low birthweight newborns have better chances of survival in the United States than elsewhere."
www.cbo.gov/doc.cfm?index=6219&type=0
Infant mortality rates: U.S. 6.26 - UK 4.85
www.globalhealthfacts.org/topic.jsp?i=93
Practicing Physicians? I found this:
"This chart shows the number of practising physicians (or doctors) per 1,000 people. Between 1995 and 2005, the number of practising physicians in the UK increased by 39 per cent.
Although this was the steepest increase of any of the countries shown, figures for the UK remain below those of comparable countries, particularly France and Germany."
www.health.org.uk/current_work/research_development/qquip_charts/charts/pra...
And I also found this about the number of practicing Physicians:
U.S. 2.3 - UK 2.2
Not bad, taking into account the population differences.
www.nationmaster.com/graph/hea_phy_per_1000_peo-physicians-per-1-000-people
As far as amount spent per GDP, I think I addressed this issue extensively. We do spend more, but we also get more. The world gets more. The United States is the leader in research and development of not only new drugs, but also new procedures. We lead in Nobel Prizes in Medicine. The number of deaths of once nearly fatal heart attacks is down dramatically, with the number of lives saved in the tens of thousands. So, yeah we spend more. But I think if you ask any of those surviving heart patients or their families, they would definitely say it was worth it.
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Of course, we know that Britain's health care system is irrelevant to the debate, because that kind of option is not even being considered. Still, it sure would be nice if we could look at and learn from it.
Here's another defense of the British system, this time on the NPR Health Blog: www.npr.org/blogs/health/2009/08/britains_health_service_defend.html-
Indeed even if the US was looking at having a system similar to the NHS, which they most definitely are not, they probably couldn't have it.
After the Second World War there was a strong national feeling that those returning from fighting overseas and those who had suffered on the home front deserved a Britain that was better than before the War. This was the main driver for the creation of the NHS.
The NHS has taken 60 years of development to get where it is now. Interestingly if you go back to the creation of the NHS in 1946 the arguments for and against the idea where broadly similar to those going on in the US just now (albeit in a far more civilised manner).
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The statistics that show a higher life expectancy in the UK than in the US are also highly questionable, because in this country Republicans count life from the moment the father meets the mother.
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