A common refrain in the Republican debate last night was that US health care, while overly expensive, is nevertheless the best in the world. What evidence is there for this statement? How do we define and measure the quality of health care, and what results do we find when we do so?
(1) The U.S. remains the most productive nation in medical research. (Not surprising because it is so big.) For evidence look at patents, numbers of medical research articles published in prestigious journals, or number of citations of medical research articles.
(2) The U.S. has many centers offering world class specialty care. (Also not surprising because it is so big.) For evidence, consider the number of wealthy foreigners who come to the U.S. for medical care (e.g., Shah of Iran).
(3) I think the average U.S. practicing physician may be a little better trained than the average in other countries because medical training in the U.S. is better. You might consider the fact that foreigners often come to the U.S. for advanced training as indirect evidence.
So if you define the quality of health care by #1, #2, or #3 you might feel that “US health care…is… the best in the world.” I wouldn’t define quality of health care this way.
Measuring “the quality of health care” is not easy.
Yes, you need to define ‘best health care’ first.
I’m sure the US has superbly equipped hospitals and very well trained surgeons for those who can afford to pay.
However poor people without insurance are probably better off in a National Health system.
Which is why I asked the question “how do we define and measure the quality of health care?”
You’ll find some interesting stuff in the World Health Organization’s Core Health Indicators database. If you have excel or something that can handle a .csv file you can play around with it.
In terms of Per Capita total expenditure on health, the US is at the top of the list.
In terms of life expectancy and infant mortality (regarded as an indicator of overall population health), the US is down the list a ways (but not too far).
Interestingly, the US is way down the list in terms of hospital beds.
And then the download function crapped out 
IMO (yeah, I know), the US is tops in research, technical accomplishment, and education, but it falls apart at getting that stuff out to underserved areas and becomes an utter confusion of who’s gonna pay who, or not, or which doctor is covered by your insurance and who just dropped your coverage, etc. amongst most other people. If you’re rich or have super-duper insurance coverage it’s not too bad.
It is very difficult to define this.
One way is to ask, “Where do people go for healthcare if money and destination are no object, and to which doctors do people turn if money and destination are no object?” The US would rank high against such a criterion.
A second way is to ask, “Which country has equal access for all to the exact same standard of care?” A country like Cuba would rank above the US using such a ranking.
A third way is to ask, “How healthy are the citizens/children/geezers/groupx in this country?” Here the US is sort of average but there is a large caveat: The more heterogeneous the population, either by genetic heritage or cultural groupings, the less accurate these numbers are in terms of reflecting directly on the healthcare system. A nation with a population that is homogeneous for their genetic and cultural heritage, with educated and relatively wealthy citizens, will have an easier time executing an effective healthcare strategy (Sweden, say)
A fourth way is to ask, “Which healthcare system is creating innovation in healthcare techniques and pharmacology?” Here the US would rank high. If AIDS drugs are cheaper elsewhere but were developed here at great expense, it’s hard to praise a system which simply swipes them from us, and then criticize US healthcare for being so expensive.
…and so on. Last nite a couple of the Repub debaters made a remark about whether more Canadians come to the US for healthcare or vice versa. I won’t enter the fray on that, but looking at “the best healthcare” might reasonably incorporate such a criterion.
I guess I’m trying to ask specifically about the quality of care given, which is independent from medical research or access issues. Is there no way to look at health outcomes independently of access issues demographic differences between countries?
I don’t think this factoid really adds anything meaningful to the discussion - rich people can always get the best health care possible no matter where they are - they could just travel to the US. The best health care is available in the US because the US is the richest country in the world. That doesn’t really have anything to do with the US health care system, other than that the US doesn’t expressly forbid private provision of health care. Rich people by and large are above “the system” no matter where they come from. The comparison between Canadians coming to the US and vice versa is meaningless, because Americans who cannot afford health care generally are not in a position to pull up roots and move to another country on a dime, whereas rich Canadians don’t have that problem - they’re rich. If you want to measure the efficacy of “the system”, then it would only make sense to do so on the basis of how well cared for the POOREST citizens are.
I don’t think the US provides the best health care… certainly not if you take into account availability. I am quite well off, yet am unable to obtain insurance at any price due to a pre-existing condition and being self-employed. Many years ago I needed to spend a couple hours in an outpatient clinic for minor surgery… for $12,000.
The same care in Thailand would have cost me perhaps $800.
And yet in the US we have the odd situation of having decent health care for the very poor, pretty damn good health care for the very wealthy, and a huge lack of healthcare availability for the middle working class.
I find the US c-section and infant mortality and breastfeeding rates horrifying, and a good indicator that something is wrong with our system, but that’s mostly because those are the areas of health care I’m most interested in. And even there it requires more knowledge of statistics than I have to sort out the real numbers: are our infant mortality rates so high because we delay fetal death by caring for micropreemies and preemies until they die? Would that be considered a death here and a miscarriage in Nigeria? Or is it due to our higher ceasarian and intervention rate, poor prenatal care and insufficient support of nursing mothers in the first months after birth? Or maybe the obesity epidemic has more less-healthy women giving birth than in other countries? There are just so many factors in this one small area of healthcare to consider, I can’t wrap my brain around just this part, much less offer a useful opinion about the system as a whole.
The World Health Organization's ranking of the world's health systems, by Rank Depends on criteria. We are way down on many of them.
The poor do not get decent health care. It is difficult to obtain. Spending your day in an emergency room to get care is not a good deal. Preventative health care is unobtainable for most of the poor.
We do constantly claim it loud and long convincing ourselves it is true.
http://www.foxnews.com/story/0,2933,293008,00.html Heres where we rank in life expectancy. 42nd
http://www.foxnews.com/story/0,2933,293008,00.html Heres where we rank in life expectancy. 42nd
I think perhaps we’re talking past one another. When I say the poor can get “decent” care, I mean those poor enough to qualify for state health care plans, like Medicare, Medicaid or Kids Care. Those people can go see regular doctors during regular office hours for a small copay and get drugs at a great discount. They have preventative care coverage for very small or no copays, depending on the state they live in and the plan there.
It’s the people who make slightly too much to qualify for those that have to rely on emergency rooms for a chest cold. (I was thrilled last year when our household income was $4 lower than the three years previous - $4 annually was how much we were “overqualified” for state reimbursement of part of our private policy premiums!) It’s those people who work, but don’t get paid enough, and often for part-time positions or independent contractor work so they don’t have employer provided health insurance, *not *the very poorest people, who go without decent health care and preventative care here.
One of my friends has herself and four kids on welfare. They get well-child visits and immunizations for nothing. I have to pay for those out of pocket until my $2500 deductible is up each year. If her kid’s cough is unnerving, she can go to the doctor for $5 out of pocket. I have to decide if I take my kid to the doctor or we eat fresh vegetables this week. I don’t want to be all “poor me”, because we’re incredibly lucky people, and when my daughter was born too early, having health insurance saved us from bankruptcy. But it still sucks that her colds turn to bronchitis while I try to put off a doctor visit I can’t pay for - and I HAVE insurance.
http://www.webmd.com/news/20050202/medical-bills-can-lead-to-bankruptcy In truth health cost is the leading cause of bankruptcy.
WhyNot writes:
> One of my friends has herself and four kids on welfare. They get well-child visits
> and immunizations for nothing. I have to pay for those out of pocket until my
> $2500 deductible is up each year. If her kid’s cough is unnerving, she can go to
> the doctor for $5 out of pocket. I have to decide if I take my kid to the doctor or
> we eat fresh vegetables this week. I don’t want to be all “poor me”, because
> we’re incredibly lucky people, and when my daughter was born too early,
> having health insurance saved us from bankruptcy. But it still sucks that her
> colds turn to bronchitis while I try to put off a doctor visit I can’t pay for - and I
> HAVE insurance.
I wouldn’t call you middle class. You’re working class. If you have to choose between eating enough in a week and going to a doctor, you’re not middle class. I don’t like the habit in the U.S. of using middle class in an overly wide fashion. You’re not in the same social class as a family of four who makes $150,000. Your needs are vastly different from theirs.
And, to a UK national, it would be free.
We also need to define “provides.” There are many who for one reason or another do not avail themselves of what’s technically “provided.” A person without adequate insurance, for example, may have low-cost clinics available, but the use of those might require a long wait, and the person decides not to use them for preventive care because it’s so inconvenient. So technically the service is “provided,” but in reality it’s not provided in a way that is usable.
I think the quality of our healthcare could be judged by how much we resort to lawsuits against healthcare providers.
By that standard, we are FAR ahead!
I’d argue that this is a reasonable single indicator, and not a good one.
In Canadia, Americans occasionally get free health care, for example after skiing injuries. The Canadian system isn’t set up to readily handle US claims (or, really, most any claims, since its pretty much free). As a result you hear of stories of the injured American saying “what do I owe you” to the Canadian emergency doctor, who says “I don’t know, what do you have on you?”, or else the American says, “I’ll send you the money when I get home.”
On a related note, I find it interesting that the one sector of the US system that has Canadian style health care is the military.