• Best in the world, my a**

    By now, I’m sure you’ve read an article on how we’re dying at higher rates of so many, many things compared to the rest of the world. All that is from an IOM report that I haven’t had the time to read fully yet.

    But Austin pointed me to a site which allows you to look at some of their data in charts. Honestly, I’d like to post them all. Since I can’t do that, I’ll focus on some of my favorites. Let’s start with pregnancy and birth.

    This is deaths from maternal conditions related to pregnancy:

    Maternal Conditions

    That’s moms dying, not kids. Look at how many more mothers – women – die from pregnancy related conditions in the US than in any other comparable country.

    Here’s deaths from perinatal conditions:

    Perinatal conditions

    Here’s deaths from prematurity and low birth weight:

    Prematurity

    Here’s deaths from birth ashyxia and birth trauma:

    Birth Asphyxia

    Here’s deaths from neonatal infections and other conditions:

    Neonatal Infections

    Here’s how much we spent on health care per person, relative to other countries, leading up to 2008:

    Spending per capita.007

    Best in the world? Keep on telling yourself that.

    @aaronecarroll

    Share
    Comments closed
     
    • I’d be really interested to see the US figures broken down either by income or by health insurance coverage. My personal experience, having lived in the US, UK and Switzerland, is that the US healthcare is top-notch IF you have excellent health insurance (or the money not to care about it, I suppose). Admittedly, it’s been 12 years since I’ve lived in the US but I did have one child there.

      It’d be interesting to break down the UK stats into private vs NHS as well.

      • As I say all the time, it’s not our care that’s broken, it’s the system. We could do so much better.

    • I agree! I don’t think people who have healthcare realise the massive massive difference it makes. If you took US with insurance and US without insurance as two separate and put those in, it would be a jarring graph, I’d bet. I just wanted to see it.

      I’m interested in the UK one because people here go on and on and on about how private maternity care is so dangerous.

    • What this post misses is that the incoming health of patients may be different. I read the article posted at the beginning, and it talks about how the US has much higher levels of crime, car accidents, drug overdoses, etc.

      These charts don’t prove that our health system is worse. It could be the case that people needing medical assistance in the US need more than they do in other countries (which the article suggests). The higher spending could then be caused by the increased needs.

    • On mortality <50yo, report conveys that 2/3 of attributable risk due to public health issues like guns, accidents, etc.

      Given rates of death in younger demographic contribute to overall life expectancy, as cited, significant wake up call for public health investment. We emphasize obesity and other modifiable risks, but surprisingly, the difference between US and OECD stems from things we know about, but overlook. The collective sum of all the poisonings, shootings, car crashes add up. I was surprised much of the disparity rested in those issues.

      Brad

    • I wonder how much the fact that more fertility treatment is more common in the USA and thus we have more multiple births effects these outcomes.

      Also race probably has some impact. Notice Japan does much better than Denmark on all the measures.

    • Aaron is ignoring the massive impact race (and other demographics) that are proxies for overall incoming health status have on these outcomes. For instance, if we matched Swedish-Americans with Sweden, we would have a much, much different chart or even if just excluding the African-American community which has persistent and large health differences (much higher rates of maternal complications, infant mortality,etc.)

      These charts make a nice story but let’s not ignore inconvenient facts in favor of a great story and natural temptation to bash the US system…

    • OK, first of all, other countries are not all homogenous. There’s lots of diversity in many other countries.

      Even if that were true, and race was the real factor, then you’d expect the US to place somewhere in the middle of other countries, with “unhealthy races” drawing us down and “healthy races” drawing us up.

      That’s not the case. We wind up at the bottom. This is in spite of a growing Hispanic population, which often has a higher life expectancy than you might expect (search “Hispanic paradox”)

      Finally, there is no natural temptation to bash the US system. Nor are these data solely an indictment of the health care system. There’s plenty of blame to go around for individuals, policies, as well as the system.

      But thanks for telling me what I “ignored”. It’s always delightful when you slip in those personal attacks.

    • Aaron
      No snark here.

      Do you actually know if a heterogeneity index exists? You assume ethnic mix of US middling, but I have never seen data on where we stand. The Swiss, Dutch, and Nordic countries may lie on on end of the spectrum, and perhaps Canada, US, UK on the other–but I dont know, and am clueless re: variation.

      Brad

    • Wiki chart of foreign-born population for each country in 2005. Click on the % column to sort. High %: Switzerland 23%, Australia 20%. Canada 19%, Low %: Japan 2%, Finland 3%, Italy 4%. Higher range: U.S. 13%.

      http://en.wikipedia.org/wiki/List_of_countries_by_foreign-born_population_in_2005

    • 1. Isn’t the health care per capita graph comparing apples and oranges, with the U.S. being the apple? All the other countries have universal coverage whereas the U.S.Census Bureau reports: “In 2010, the percentage of people without health insurance, 16.3 percent, was not statistically different from the rate in 2009. The number of uninsured people increased to 49.9 million in 2010 from 49.0 million in 2009.” http://www.census.gov/hhes/www/hlthins/data/incpovhlth/2010/highlights.html (I realize some uninsured people have the ability to pay for health care ouf of pocket. Are they more than offset by people who have insurance but don’t get care because they can’t afford co-pays and/or are subject to annual/lifetime limits?

      2. Ignoring all the gloomy graphs on outcomes and after following these international comparisons for several years, I still don’t understand why health-care costs twice as much per person in the U.S. as in Canada (and most other countries).

      For all the complexity of health care delivery, basic accounting suggests there are a limited number of causes of variances: volume (U.S. delivers twice as much quantity of health care services to Americans compared to Canadians i.e. twice as many doctor visits, hospital stays, lab tests, MRIs, pills, etc), or price (the price charged for each service is twice as expensive in the U.S. than in Canada, i.e. twice as much for doctors, for pharma, for hospital stay, for administrative costs, etc.) or some combination of the two. (I am well aware of the weaknesses of the Canadian system but it is a similarly large country, sparsely populated with large urban concentrations, and broadly similar climate, cultural, and economic systems.)

      3. I have never interpreted any of the posts on this site as “U.S. bashing”. Instead, it’s more like a patient visiting his family doctor with a list of symptoms – in my opinion, we’re all hoping she can diagnose the underlying diseases and recommend a course of treatment!

    • Aaron in re your points:

      1. I never said other countries were homogenous. That is in fact why I advocate comparing similar demographic groups (at least as much as one can) in order to get around population heterogeneity.

      2. Assuming the US would place in the middle of the pack with healthy and unhealthy races is ridiculous as that assumes that our mix of demography is not skewed in any particular direction and somehow evens out. This is not likely the case as we have far higher numbers of some groups than others and frankly, we would need much better data than we have in order to establish this point.

      3. The Hispanic paradox is interesting but not dispositive given that the Hispanic community is only doing well relative to the expected baseline for a group with their characteristics. It would be quite a stretch to imply that a country with a high percentage of Hispanics is going to be similar in outcomes to Japan, no matter the quality of the health system.

      4. You are the one who snarks about “best in the world” at the end of your post, which obviously is an indictment of the US system. Given you have had much stronger (and better supported) posts (see your series on the US health care system) in the past, categorizing you as a critic of the system is hardly unfair.

      Also, given I share your views to some degree, I do not view it as a personal attack to imply that.

      5. Finally as to your point about “ignoring” demography, I have mentioned it in response to several of your posts over the last year without significant response. You consistently choose to use aggregate data rather than those studies which do control for racial demographics (see the Swedish-American comparison to Sweden, etc) and while there are multiple legitimate reasons for you to do so (e.g., much larger sample sizes, etc), it is not a personal attack to point out reality.

      On a personal note: I found your response extremely disappointing. It displayed a sort of hypersensitivity to criticism that I find puzzling given that the purpose of a blog to some degree is not only to publish the latest data but to bring enlightenment to your critics (or to adjust your own views as needed), however ill-informed you view them.

      • As to (5), it’s the difference between discussing the data, and lecturing everyone on things “Aaron is ignoring”. If you can’t see the relative differences in your tone versus others’, I can’t help you.

        As to (2), thanks for calling what I said “ridiculous”, but it’s not. If we are a mix of races form other countries, you would expect us to do somewhere in the middle. Not the average, but we’d draw from countries that do better and countries that do worse. We’re last. That’s not what you’d expect from a heterogeneous country.

    • The maternal mortality rate for our nation, by itself, represents the most unacceptable attribute of our nation’s healthcare industry. Looking state by state, the rate varies from a low of 1.9 (Maine) to a high of 20.9 (Virginia). Besides Maine, the states with the lowest maternal mortality rates include Vermont, Indiana and (amazingly) Alaska. It would be impossible to explain the best and worst states on the basis of socio-economic characteristics.

      Clearly, our nation does not have a widely trusted and deeply supported tradition to be sure that our nation’s healthcare is culturally acceptable for and justly accessible by each citizen. It is equally unlikely that an elaborate strategy for arranging healthcare insurance for all citizens will solve the problems causing the high maternal mortality rate. The 2010 report by Amnesty InternationalUSA explains why. A trip to Alaska should be the starting point for progress. Nothing short of a 75% reduction in 10 years should be agreeable to any citizen.

    • Recall recent HA study on Mexican Americans you blogged on re: paradox:
      http://content.healthaffairs.org/content/31/12/2727.abstract

    • Aaron–

      In re (2), the US doesn’t draw equally (or at least roughly similarly) from countries that do better than us and from countries that do worse than us. Your rebuttal assumes this fact when it is quite clear that Denmark (to choose one high performing country) is not a significant contributor to our diversity.

      Our statistics are highly influenced by Americans that are originally from countries like Mexico, Angola (where many African-Americans originate from), El Salvador, India, China, etc. and to a much greater degree than say the relative contribution of Austria or the Netherlands (high scorers above). Even in countries like Sweden that too take in significant numbers of immigrants, the incoming population scores significantly higher on many health measures than some segments of our heterogeneous population.

      Lastly, your logic would be far more convincing if this was a list of all the world’s nations or even of significant contributors to the US population. Instead this is a small subset of nations, mostly rich and homogenous with healthier lifestyles, so being “last” is not exactly illustrative of much.

      Also, I will not respond to your comments on tone as I don’t see those as really relevant to the data or the argument you are making.

    • The statistics are confusing. The death rate in the US is quoted as 0.4/100K. Given ~3M births/year in the US, that works out to a total of 12 deaths country-wide related to maternity, which seems very low. In any case 12 is not a statistically meaningful number of samples to establish a real rate. The rates in other countries with lower populations are even less meaningful.

      Perhaps it’s not deaths/pregancy, but rather deaths/woman/year due to pregnancy? If so then you need to factor in different fertility rates in different countries.