An interesting stat: amenable mortality

Great Debates
1

http://www.commonwealthfund.org/Publications/In-the-Literature/2011/Sep/Variations-in-Amenable-Mortality.aspx

The concept of “amenable mortality” refers to unnecessary and untimely premature deaths from certain causes that are potentially preventable with timely and effective health care. Amenable mortality is one of many indicators used to measure health system performance across nations. This Commonwealth Fund–supported study examined trends in amenable mortality for people under age 75 in 16 high-income countries between 1997–1998 and 2006–2007.

n 2006–2007, amenable mortality accounted for 24 percent of deaths under age 75 in the 16 countries studied.

Rates were lowest in France, with 55.0 deaths per 100,000 people, followed by Australia (56.9 per 100,000) and Italy (59.9 per 100,000). The highest levels were in the United States, with 95.5 deaths per 100,000 people, followed by the United Kingdom (82.5 per 100,000) and Denmark (80.1 per 100,000).

I think few would be surprised at the US being #1 in excess deaths, access to health care can be a problem here. Britain at #2 should also surprise no one, given the time it takes to access health care and the strain on resources. Denmark surprised me though, I’d been under the impression that they had one of the best run systems in the world. Canada, surprisingly, wasn’t part of the study.

Does anyone think the ACA will improve our ranking? I’m sure it will improve our absolute amenable mortality rate, but will it enable us to pass Britain and Denmark?

2

You really have a hard on for Britain, don’t you? Why is healthcare a strain on resources in the UK? It spends 7.5% of its GDP on healthcare: less than the US, Germany, France, Belgium, Italy, Denmark, Sweden, Greece, and 10 other countries. To compare, France, number one on your list, spends 9.5% of its GDP on healthcare. Maybe the UK isn’t putting enough of a strain on its resources.

And what is the data showing that access times in the UK are higher than other countries?

3

What the fuck?! Where’s Canada?

4

Something is wrong there. If it’s not the design of the system, what is it?

5

I wonder if some of the US’s problem can be attributed to it being much more spread out than, say, France. If someone is dying of something technically preventable but fast acting way out in rural Texas, the chances of them surviving are much lower than the same guy dying of the same thing in a night club in the middle of NYC.

Heck, I don’t envy anybody getting deathly ill in the middle of an Alaskan winter, what with some of the tiny towns that are almost solely accessible by air.

I wonder how the US’s stats compare to other countries when you only take into account areas around the same distance from major hospitals as much of Europe has.

6

Very good point. (Jragon)

And when you reread the OP, it’s clear that there are a lot of potential variables that could influence the findings. It’s pretty vague.

7

Definitely. Any opinion on whether the health care law will improve our relative standing?

8

I always had that same problem until someone taught me, “Canada is our neighbor to the north.” See if that helps you. :slight_smile:

9

[QUOTE=study]
The causes of death considered amenable to health care include selected childhood infections, treatable cancers, diabetes, cerebrovascular disease and hypertension, and complications of common surgical procedures. The authors also included ischemic heart disease, but only considered 50 percent of such deaths as amenable to health care.
[/QUOTE]

I would guess that easier access to preventive healthcare, earlier access to care, regular follow-up of patients with a chronic health issue would help for some of these conditions (cancer, diabetes, hypertension…)

10

We have a lot of rural spaces, but not that many people actually live in them. 85% of the US is urban or suburban. Of the population that’s rural, something like 70% live adjacent to urban areas. So I’m skeptical that there are enough people that are distant from hospitals and doctors to make an appreciable difference in national statistics.

Well, according to the study you linked:

Since high costs and lack of universal coverage are the main two issues addressed by the ACA, I assume it will improve our standing.

I think passing European countries is do-able. On most metrics countries that spend more per-capita on healthcare do better (France, for example, usually scores at the top few countries, and also spends the most). The only outlier is the US, we spend a huge amount more then other countries, and yet have average or worse then average outcomes. Presumably if the ACA makes the effects of our spending similar to that of the rest of the Industrial world, we’ll move to the top of most metrics. Even if we significantly reduce spending, we’re still likely to be spending more then anyone else per-capita.

11

[QUOTE=adaher]
Rates were lowest in France, with 55.0 deaths per 100,000 people
[/QUOTE]

le smug

:slight_smile:

There are plenty of rural areas in France, dude. Rural as in “out in the boonies for realz, no cell phone or dedicated internet coverage, no hospital in a fifty miles radius as the crow flies but it turns out you’re in the mountains so it’s more like a hundred and pray your brakes don’t give along the way”. There were still some isolated villages not connected to the phone grid as late as the mid-90s.

In fact, outside of the ~10 major cities (Paris, Marseilles, Lyon, Bordeaux, Toulouse, Lille, Montpellier, Strasbourg, Nantes, Nice…) the country is really more Peoria than Metropolis when I think about it. Outside of Ile-de-France (which is pretty much Japan-level urbanized) you can probably start from the town hall of any city, walk for half an hour in any one direction and end up staring at a cow, or at least a field of some description :D.
Actually, that sounds like a fun Streetview diversion. Guess I’m not getting any work done today.

12

Could it have something to do with individuals not seeking healthcare in time?

13

That’s why I was supposing when I said that the US health care law might result in an improvement by allowing people to have access to preventive care, to seek medical care earlier, etc…

14

Well…I do think that we have an excellent healthcare system and should count our blessings. Not only by comparison with the USA (there are so many horror stories there, including some that happened to dopers) but even by comparison to, say, our British neighbours.

I can’t think of a single thing to complain about in France. We have quite top-notch medical care, boosted by a strong tradition of medical research (that, I’m convinced, we owe to Pasteur, but that’s another topic) which is essentially free, we get to choose any doctor we want and don’t have to search low and high to find one taking new patients, we don’t have waiting lists, doctors make house calls, we have doctors available in the middle of the night (at least in urban areas), we even have medical emergency services coming with a doctor and reanimation equipment (as opposed to only paramedics in some other countries), and so on.

While I was writing I thought about a couple issues :

-Dentistry. It’s clearly not affordable for people with low incomes.

-Psychiatry : for some reason I can’t fathom, there’s a shortage’s of psychiatrists in France. Private psychiatrists overcharge quite a lot so are also unaffordable for low income people, and psychiatric hospitals can’t face the demand, either.

-Rural areas : less and less doctors are willing to set up shop there. Having been raised in a remote village, I can understand why now that I’m an adult. The expectations of people there were almost ludicrous. My childhood doctor must have been some sort of a saint, and there’s no way I’d do the work he was doing.

(Also, there’s the issue of having to chase the doctor down the hall when you’re in an hospital and want to know something about your or your relatives condition :wink: )
My only fear is that with raising costs and an aging population, the system might not be nearly as good when I’ll grow older and need it the most.

15

How much of that is attitude driven? I have fairly good health insurance, but haven’t seen my PCP in five years. Many of my friends in their 50s and 60s are similarly blasé about their health.

16

Patient compliance surely plays a significant role. Reading the link, I see that included in this category are “diabetes, cerebrovascular disease and hypertension”. The big three, in other words, which require a significant lifestyle change if they’re to get better, and are largely considered incurable in a meaningful sense.

Of course, yes, I hope that increased access to preventative medicine will mean more people have their conditions identified early so that they can be treated…but when treatment largely consists of the things people do and put into their mouths every single day, there’s not a whole huge lot I as a nurse can do except educate and nag.

And, of course, encourage funding for research into making Quarter Pounders with Cheese healthful food. :wink:

17

Meh, even if you get an appointment, you’re just going to get a diagnosis of “ennui”.

18

I believe the US comes off comparativly worse then. Such comparisons would put it in the class of the Nordics, Canada and other first world countries with low population density. The US has almost exactly the same population density as Finland.

That is a basic attribute of a public health measurements.

Health care systems deal with tens of thousands of issues, in a vast number of environments. Any single area of measurement is likly to be skewered by local conditions. For example, the health care system of Tanzania may look quite good if we look at deaths due to skin cancer. And Denmark probably do not lose a lot of people to malaria.

When comparing the performance of health care systems, large overarching measures are chosen, so the confounding factors will cancel each other out.

Besides amendable mortality, average lifespan, and infant mortality are common measurements. Less commonly, under-5 mortality, maternal mortality, HALEs (healthy life expectancy) or DALYs (disability-adjusted life years) are used.

19

Where, the UK? You are looking at stats showing the UK had a better rate of amenable mortality and much lower costs than the US and you want to know what is wrong with their system? Again, I ask why do you think the NHS is draining their resources when they are 18th in percent of GDP spent on healthcare and what data you have that shows the UK has longer waiting times?

I know that the sight of people celebrating their healthcare system at the Olympics rocked your Libertarian world view, but that doesn’t excuse you from having to back up your assertions.

20

Agreed wholeheartedly - our health care rocks. It’s one of the few things we really got right, and one of the things I’d feel proud about if I was inclined to be proud about my country (which always seemed a bit silly to me, but that’s a different topic).
Sure, we pay for it. A lot. But we get our money’s worth, and more.

Yes, that and most things eye-related. Neither are really well-covered by regular Social Security, and even private insurance is shitty about those. Earing aids are another very expensive item.
But there’s a reason for that, really - not everyone will get cancer, and not everyone will break a leg, and not everyone will develop cystic fibrosis ; so in these sort of cases the burden of the few can be comfortably shared by the many. OTOH** everybody **has dental ordeals and will regularly need some teeth drilled through, filled in or yanked out ; and similarly if you don’t start in life with a pair of glasses you sure as shit are going to end up with one down the road. Unless you live fast, I guess.
So in these two particular areas there’s really not much to be done but grin, bear it and pay your own way - I doubt there’s a HC system out there that has solved the problem (but then, I don’t know much about foreign HC systems besides the American one).

nod. It’s getting bad enough that they’ve been asking my sister & brother-in-law if they would put themselves on call for absolute emergencies.
They’re veterinarians.

But then, you can say the same of just about every profession. Except bar-tabacs :).

I’m not sure that’s really an issue, or won’t be for a while yet. Pensions, sure ; and people living longer also means they’ll see more doctors before it’s over… but the health care side of Social Security is pretty healthy (heh) financially.