Various metrics for quality

Yesterday on the radio I talked about quality in the United States’ health care system.  I mentioned a handful of metrics that could be used, and that they showed our quality to be surprisingly poor.  And – inevitably – I got an email like this:

According to an article I read not to long ago (sorry, can’t remember the publication)We are so far down on that certain list because of the way the different countries report those numbers. Supposedly some of the countries don’t count infant deaths that occur within 24 to 48 hours of birth. While some count those but do not count deaths as a result of certain parent induced problems like Fetal Alcohol Syndrome. According to the article I’m referring to the U.S. counts all infant deaths regardless of the time frame or reason. If I remeber correctly most of these “ranking” lists were coming from the WHO and each country had its own reporting standards as to how they counted infant mortality rates.

This is a common retort to the use of infant mortality as a metric.  Somehow the source is always real, but unknown.  But here, look at the data:

We are the worst.  Do you really think that every other country is massaging their data, year after year, in order to make themselves look better?  If so, why don’t we do the same?  What would be the motive behind the United States choosing to report their data in such a way as to make itself look bad year after year after year?  Can you come up with a reason?

And even so – I don’t care.  Every metric is flawed.  Pick another.  How do you account for our terrible maternal mortality:

Or percentage of kids immunized:

Or life expectancy:

Or number of physicians:

Or – most importantly – preventable years of life lost:

We do surprisingly bad in all of them.

Which is the more logical conclusion: (1) We have a separate excuse to explain why the measurements are wrong in every metric you might use, or (2) our system just isn’t that good?

*All of these are OECD health data comparing the 10 richest rountries in the world.  The United States data is self-reported.  Data are not available for China and South Korea.

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