U.S. Healthcare Lags in Preventing the Preventable

From Kevin Drum, a study that compares the 19 most highly-developed nations in the world on the basis of their success in preventing "amenable mortality," that is, deaths from preventable causes such as "bacterial infections, treatable cancers, diabetes, cardiovascular and cerebrovascular disease, and complications of common surgical procedures."  Kevin sums it up pretty well, so I’ll just shamelessly reprint the original post, snark and all:

A pair of researchers has just published an update that compares various countries on their rates of "amenable mortality," defined as deaths that are "potentially preventable with timely and effective health care." In 1997, the United States ranked 15th out of 19 industrialized countries. So how are we doing now?

Answer: we’re now 19th out of 19. The rest of the countries have improved their performance by an average of 16%, while the U.S., that well-known engine of healthcare innovation, has improved by only 4%. So now we’re in last place.

But there’s a bright side: at least our healthcare isn’t funded by the government, like it is in France. Keep that in mind if someone you know dies of preventable causes. Their odds would have been a whole lot better in Paris, but who’d want to live in a socialist hellhole like that anyway?

This difference is likely explained not by the fact that American health-care is "worse" across the board, but that there are large gaps in America’s health-care system that leave millions of people without easy access to preventive care.  "Public" hospitals, which provide care to the poor and uninsured, have been closing at a fast clip lately, according to the New York Times: "There are 300 fewer public hospitals today than 15 years ago, with hospitals having closed in Los Angeles, Washington, St. Louis and Milwaukee."

The same article describes treatment of a gunshot victim in the emergency room at Atlanta’s Grady Memorial Hospital, which is likewise chronically underfunded, poorly-managed, and facing closure:

The ER did not have a working X-ray machine that night, so doctors had to roll in a portable one to locate the bullet. The X-rays were produced on film rather than digitally, causing a 10-minute delay in diagnosis. There were gurneys without wheels, and a computer system so outdated that doctors had to call up four separate programs to compile records on a single patient.

The very poorest Americans qualify for a government program called Medicaid which pays for their healthcare, but the case-by-case compensation rates for Medicaid are well below the actual cost of the care provided.  If a hospital has to finance the care of too many Medicaid and uninsured patients, and doesn’t get enough well-insured patients to make up the resulting shortfall, it will simply go under.

As with America-Europe comparisons in so many other fields (education, political influence, etc.), the pattern in Europe is of stellar health care for the rich, and consistent access to reasonable quality health care for everyone else.  Reasonably good health care is all most people need, and its easy availability in Europe probably goes a long way to explaining the graph above.

In the U.S. there’s even more stellar health care for the rich, pretty good healthcare for the middle class, and a drastic drop-off in quality and availability for the lower-middle class and below — that is, people who cannot afford to pay for the medical services they need.  It’s just speculation, but I rather doubt it’s preventable deaths among America’s upper-middle class that are reflected in the Commonwealth Fund study… 

5 thoughts on “U.S. Healthcare Lags in Preventing the Preventable

  1. How the heck did Italy manage to come in 5th out of 19?? If poor Beppe Grillo reads this, he’ll fall in a coma straight away. There’s got to be some flaw in the research. ;-))

  2. I do see some issues with the definition of “amenable”:

    – Do countries with better documentation and statistics get automatically accounted for worse?
    – Is every bacterial infection “amenable”?

    There are other factors which may have a comparably large influence as the structure of a health care system, e.g. common attitudes toward and knowledge about illnesses, infrastructure/population density (which may help explain Scandinavia’s ranks), and climate.
    Moreover, many health issues depend on the people’s risk behavior, so one might have to take that into account as well.

    I should note that I have not followed the link to the original above 😉

  3. This should come as no surprise. My feeling is that France may have the best-performing health care system on earth with a combination of public and private finance combined with private-system accountability. Much like the US university system (also a world-beater). Seeing the Nordics come high comes as no surprise, and Germany better than the US seems about right.

    Italy ang Greece are something of a surprise. I suspect cooked statistics as a possible cause. Italy has a lot of undocumented aliens who seem to fall outside the Italian welfare system. They may not make it into the national health statistics either. I’m not as familiar with Greece, save a (very) passing impression that it may be similar to Italy in this respect gathered during a vacation.

  4. This should come as no surprise. My feeling is that France may have the best-performing health care system on earth with a combination of public and private finance combined with private-system accountability. Much like the US university system (also a world-beater). Seeing the Nordics come high comes as no surprise, and Germany better than the US seems about right.

    Italy ang Greece are something of a surprise. I suspect cooked statistics as a possible cause. Italy has a lot of undocumented aliens who seem to fall outside the Italian welfare system. They may not make it into the national health statistics either. I’m not as familiar with Greece, save a (very) passing impression that it may be similar to Italy in this respect gathered during a vacation.

  5. This should come as no surprise. My feeling is that France may have the best-performing health care system on earth with a combination of public and private finance combined with private-system accountability. Much like the US university system (also a world-beater). Seeing the Nordics come high comes as no surprise, and Germany better than the US seems about right.

    Italy ang Greece are something of a surprise. I suspect cooked statistics as a possible cause. Italy has a lot of undocumented aliens who seem to fall outside the Italian welfare system. They may not make it into the national health statistics either. I’m not as familiar with Greece, save a (very) passing impression that it may be similar to Italy in this respect gathered during a vacation.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.