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Your Health Care System in Graphics

I've already praised David Leonhardt's article on health care rationing. Now I want to praise the graphic that accompanied it.


17leonhardt-graf01-2.jpg


As the graphic suggests, there are some conditions where the American health care system does a very good job. Some conditions where it does a mediocre job. And some conditions where it does a bad job. The average person suffering from average diseases would not have a strong reason to prefer being insured in America, France or Japan.

But that person would have an extremely strong reason to prefer paying for health care in France or Japan. Health care in America costs nearly twice as much per person as it does in other developed nations. In general, we'd expect a good that cost twice as much as another good to be quite a bit better. But there's no real evidence of that in American health care. In fact, for a lot of us -- notably, the un- and underinsured -- it's quite a bit worse.


By Ezra Klein  |  June 18, 2009; 9:05 AM ET
Categories:  Charts and Graphs , Health Reform , Health of Nations  
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Comments

Though I'm not familiar with the literature on cross-national comparisons, the kidney transplant example is probably a bad one. Transplants are assigned based on degree of failure; any nation could achieve excellent rates by transplanting only the healthiest patients. Furthermore, kidneys are one of the few places where the old "diversity" canard actually does play a role; kidney failure is an epidemic in the African American community that deserves to get more attention.

Overall though, we certainly don't get what we pay for.

Posted by: CarlosXL | June 18, 2009 9:46 AM | Report abuse

CarlosXL's point about kidney transplant is a good one.

Conversely, there is a lot of evidence suggesting that the apparent superiority of the US in breast cancer statistics may be due to our numbers being influenced by lead time (detecting cancers earlier in their course, so that while the eventual day of death is not changed, the time spent with the diagnosis is increased) and by diagnosis of a large number of non-lethal cancers that would not go on to kill the patient.

Prostate cancer is not included in your chart, but the issue of survival in prostate cancer is even worse a problem.

To fix these questions, we need good scientific studies, something that is lacking because we have jumped on management patterns based on intuitive appeal, not scientific evidence.

The basic point, that US health care is much more expensive without having better results, stands.

Posted by: PatS2 | June 18, 2009 10:07 AM | Report abuse

If you have, say, 20 different measures of patient outcomes and 5 countries you're comparing, then you can expect that each country will lead in about four categories if overall quality of care is equal across nations.

Problem is, people who refuse to acknowledge issues in our health care system can cherry-pick examples where our system performs better than other countries, ignoring instances where we perform worse.

By the way, is there any discussion of moving organ donation from opt-in to opt-out? There are thousands of people who die each year on transplant lists, yet no country with an opt-out system has a shortage of organs.

Posted by: davestickler | June 18, 2009 3:35 PM | Report abuse

Ezra - So what else is new?

BTW survival rates are a terrible statistic. In order to be counted as a survivor, two events have to occur. First the disease has to be detected, then you have to live 5 years. If the disease is not detected, but you still have it, and you live 20 years, you are not a survivor. This statistic is used because it favors a lot of detection and intervention. In the US that's how physicians make money. In other countries they have found that for some diseases, you get better results by not going all out with detection.

I'm a 70 year old male so I'm interested in prostate cancer. Most of these cancers are very slow growing and you die from something else before it kills you. In the US physicians routinely perform PSA tests to find it, and when they do, they treat it. In Europe they do not give PSA tests. Thus we have much better survival rates, but we do not have better mortality rates due to prostate cancer. Mortality rates are the correct statistic. In addition, some people die from the treatment and others spend miserable lives from the side effects of the treatment. Finally, our approach is much more expensive. If you are interested, Finland has done an extensive study of prostate cancer. I have forbidden my doctor from performing the PSA test.

I don't have mortality rates for prostate cancer handy, but I do have mortality rates for cancer in general. Here they are.

Per 1000 people the US has 321.9, Australia 298.9, Canada 296.4, France 286.1, Austria 280, Sweden 268.2 Finland 255.4, and the UK 253.5.

Posted by: lensch | June 19, 2009 12:34 AM | Report abuse

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