• Worthwhile Canadian initiative: report cards!

    The Conference Board of Canada has recently updated its Health Outcomes by Country report cards using the latest data from the OECD. They score themselves a B. Guess which country is at the bottom of the list?

    The details are here. I wrote about a prior version of this report card in 2010.

    Interestingly, the U.S. is near the top (2nd) in self-reported health status–we say we’re healthy–but in all other measure we’re near the middle or bottom of the pack. Canada, as it turns out is number one in self-reported health status, despite having relatively little to crow about itself (other than, perhaps, being not as bad as the U.S.). Looks like North America has a superiority complex. On the other hand, it’s hard for dead people answer survey questions. The U.S. is last in infant mortality (Canada is nearly so) and life expectancy.


    • But Austin, everyone “knows” the US has the best health-care system in the world. This data must be French, or something.

      Unless you define “best” as: paying specialist MDs and hospitals and drug makers and device makers and insurance executives very handsomely, without regard for the outcomes of the treatments they provide (or pay for) — with that definition, the US surely is the “best.”

    • Man, reading through all of those reports is depressing. America is last on society, last on health, last on environment, and second-to-last on education. I need to down a carton of ice cream after that.

    • Switzerland and France have healthcare systems similar to that of the USA. (http://www.theatlantic.com/business/archive/2012/03/france-and-us-health-care-twins-separated-at-birth/254033/)

      Also I bet that some states, like Utah and North Dakota would do very well by the criteria.

      Here are the criteria that they use:

      To measure health performance, we evaluate Canada and 16 peer countries on the following 11 report card indicators: life expectancy; self-reported health status; premature mortality; mortality due to cancer; mortality due to circulatory disease; mortality due to respiratory disease; mortality due to diabetes; mortality due to diseases of the musculoskeletal system; mortality due to mental disorders; infant mortality; and mortality due to medical misadventures.

      We in the USA:

      Drive more = more road fatalities and injuries
      Have more homicide = more early death and injuries
      40 years ago smoked more – there is about a 40 year delay in smoking deaths
      Get more fertility treatments = higher infant mortality
      Have more citizens of Africa decent who have lower birth average weight and higher infant mortality. Note Hispanics have higher average birth weights and lower that average infant mortality despite having less access to medical care.
      The mentally ill have more rights.
      We have more war injuries and deaths.

      We do have a problems with cost and access though.

    • Japan’s self reported health is the worst. Go figure.


    • -Here’s to hoping that someday someone will actually make an effort determine the extent to which the differences between the outcomes measured in each country are driven by how well the peopulation is taking care of itself, vs how well doctors and hospitals are taking care of them.

      Without that information, it’s not clear what anyone who wants to improve the performance of…doctors and hospitals is going to gain any useful insights from this kind of apples to oranges comparison. The average Asian American lives 2-3 years longer than the average Canadian. Is that because the health care that they get is better?

      -There’s *massive* variation from one cohort to the next within the US, and equally massive variations in the same geographic area. Does anyone think that the variations in infant mortality and life expectancy between say, Brookline and Dorchsester has anything to do with the performance of the BU Medical Center vs Beth Israel?

      -Danei et al (PLOS Medicine, 2010), and Murray et al (Plos Medicine, 2006) look at mortality variations and their physiological correlates in the US. Anyone surprised Danei et all find that smoking, high-blood pressure, diabetes, and obesity explain so much of the variation between the groups that Danei et al documented (35 years between the highest and lowest groups)?

      Once you control for deaths by murder, accidents, etc how much of the mortality variation between groups in the US can be explained in terms of anything that doctors and hospitals have a meanginful capacity to influence? The connection between access to medical care and the clinical efficacy of the care delivered is only loosely correlated with life expectancy in the US. It’s interesting that the default assumption seems to be that there’s a tight and meaningful connection everywhere else.