• We’re #1? – ctd.

    Remember that “study” from the Legatum Institute that showed we were the best in the world in terms of health? I’d moved on, but Kenneth Thomas hasn’t. He contacted the Institute and got more information:

    This is more confusing than illuminating. While some variables are more highly weighted than health spending, for example, individuals’ satisfaction with their health, the difference in scores are tiny; by contrast, the differences in health care spending are gigantic. As the report states, the U.S. spends “66% more than the next country (Norway), 84% more than Canada, 133% more than the UK, and 205% more than New Zealand.”

    He compares the US with France, using Legatum’s data, and finds:

    France has substantial edges on all but one of the objective measures (infant mortality is less than half the U.S. rate), is essentially tied on the satisfaction measures, provides more than twice as many hospital beds per thousand population, and only trails – by a huge margin, of course – in spending on health care. Spending almost exactly half what the U.S. spends, the French get an extra 3 years of healthy life, fewer than half the deaths from respiratory diseases, and less than half the infant mortality. As Carroll asked, how is spending a measure of health? This is a more methodological question I’ll take up in a future post.

    I look forward to that!

    • “Spending almost exactly half what the U.S. spends, the French get an extra 3 years of healthy life, fewer than half the deaths from respiratory diseases, and less than half the infant mortality.”

      I wonder what factors comprise this difference (3 years of life, etc) … is ‘health care system’ the driving force behind these benefits? Or is the difference more cultural, rather than health-system-structural? In other words, can we take only this information and conclude that the US spends too much on health care for such (relatively) poor results, or can we say that the French people have different lifestyles, traditions, customs, and food preferences than Americans?

    • France’s low infant mortality rate is artificial. France excludes a large category of risky births from its definition of live birth, thus not reporting many deaths of infants. See this analysis by the American Centers for Disease Control and Prevention:

      • Thanks for the citation; the info there is useful to know. As Lt already said, CDC gave standardized rates excluding births before 22 weeks and the U.S. is still substantially behind France, but no longer twice as high. I think it doesn’t change things too much because that’s not actually a large category of overall births or even premature births.

    • @ak mike
      Yeah France is still better than us by a good margin even when reporting is standardized as is discussed in that very article you cite. Very interesting piece though. Worth a read for anyone interested in the nuances of the infant mortality data (an issue that has become a standard of public health debate).

    • Actually, France’s advantage in infant mortality, at least in health care as opposed to health, is even less than noted by Kenneth and Lt. First, you will note in the CDC analysis that for some reason USA has far more premature births (even over 22 weeks) then does France. Although USA is much better at saving these babies than is France, the sheer numbers of these higher-risk births raise the infant mortality rate.

      Second, a variety of other sources indicate that French reporting frequently classifies babies who die within 24 hours of birth as stillborn rather than live births. US reporting requires any baby with any sign of life to be classified as a live birth. So the numbers are further distorted in France’s favor by an unknown amount.

      The tentative conclusion that I think reasonably follows is that US obstetrical care is better than is that of France, but the health of mothers and infants is not as good.

    • @AK Mike

      Nice to know that there’s at least one other person out there who understands the limitations of using overaggregated and artifact laden statistics like infant mortality and life expectancy as a basis for making international comparisons of clinical efficacy.