Where's the good data?

[Nords]

Let me split these comments off from another thread and start anew.

Originally Posted by OldMcDonald

I've said it before, but its worth repeating - all of the "1st world" countries that have universal care have longer average lifespans than the US, despite the US spending as much as twice as much or more on a per capita basis - I don't even understand how anyone can argue that we have the "best" health care sytem in the world...it's simply not true but any metrics that matter to the average individual, or to the society as a whole.

Originally Posted by Rich_in_Tampa

Meaningful outcomes measurements, even when corrected for lifestyle risk, rate the US health care system as OK, but not stellar, with expenses that outpace everyone else by 30% or more. Much more in many cases.

I'm becoming very cynical about medical data.

For example, it turns out that the big improvement in the median lifespan isn't mainly due to people actually living longer. It's raised by having fewer people dying younger. The statistics didn't make any promises either way, and I appreciate that it's a subtle concept, but "living longer" can generate a lot of false hope until you realize that the last century's real lifespan gains were mainly due to public health initiatives like sewage systems... and not just by having a few more people live past 100.

Same skepticism with comparisons between mortality rates and healthcare costs. Is it possible that U.S. doctors & ERs tackle patients that other countries would have declared DOA? What about neonatal intensive care that costs millions before the patient dies? Hopeless organ transplant cases where the patient's care costs millions waiting for a tissue match? Heroic geriatric ICU end-of-life efforts for patients who in other countries would probably die at home? Outlandish R&D expenses for diagnostic equipment & drugs that save only a few lives and would be regarded as way past diminishing returns were it not for the fact that these patients are someone's family?

If the U.S. is tackling a higher proportion of the tougher cases then a tremendous cost is incurred with a much lower survival rate. Does anyone know if this effect is considered or adjusted for?

[Rich_in_Tampa]

Originally Posted by Nords

If the U.S. is tackling a higher proportion of the tougher cases then a tremendous cost is incurred with a much lower survival rate. Does anyone know if this effect is considered or adjusted for?

Nords, acuity level is incorporated into utilization studies but generally not in population studies of life expectancy. Anecdotally, it is consensus that we tend to throw a lot of re$ource$ at patients other countries would not do the same for.

For example, kidney failure at age 80 in most countries would be a terminal event, treated for comfort. Here, we are more able and willing to send such a person for chronic hemodialysis. Maybe it increases their survival by a year or two, wiht every-other-day dialysis. Our ICUs are filled with old people in the last year of their life no matter what care they receive. Right or wrong? Don't know.

The net effect of doing this is to increase expenses per capita, and to increase survival and life expectancy. So while your observation is pertinent to the cost-per-capita figure, I think it still leaves the survival data pretty well intact, or even worse for us.

To follow on your insight, maybe we are more willing and able to spend money on quality of life issues, in addition to longevity: joint replacements, extensive rehabilitation for injuries and strokes, psychotherapy, nerve blocks for pain and others. I think that's admirable when not taken to the extreme (though perhaps not at the societal cost of others being deprived of life-saving care, mass prevention measures and so on).

We can afford both types of care here, maybe for less than we are spending now.

[WanderALot]

I definitely think the US healthcare system needs an overhaul. Possibly some sort of national catastrophic coverage as others have suggested. However, looking at the life expectancy statistic of different countries as compared to the US, the one thing that I noticed is most of the high expectancy countries are either much more homogeneous than the US and/or are much smaller than the US. Comparing Luxemborg to the US seems a little unfair. We absorb a lot more immigrants than other countries, most of whom come from 2nd or 3rd world countries with lack of access to basic healthcare.

Not trying to make an excuse, but just trying to understand the differences in the life expectancy rates.

[larry]

Originally Posted by Rich_in_Tampa

For example, kidney failure at age 80 in most countries would be a terminal event, treated for comfort. Here, we are more able and willing to send such a person for chronic hemodialysis. Maybe it increases their survival by a year or two, wiht every-other-day dialysis.

Regarding finding good data, my FIL started dialysis in Oct. of this year and is 87 and in rather good health and has an upbeat spirit about the whole thing. My question is what is the life expectancy of someone in this general condition at this age? I understand that each individual is different but I could not locate data regarding this.

I think US health care is probably more cutting edge than some other countries and if I were to become ill, I'd rather do it in the good ol' USA. Somehow, though, I think that I could become forced to seek treatment outside the US if costs continue to rise.

[donheff]

Originally Posted by larry

I think US health care is probably more cutting edge than some other countries and if I were to become ill, I'd rather do it in the good ol' USA. Somehow, though, I think that I could become forced to seek treatment outside the US if costs continue to rise.

I think this quote captures the essence of the problem. I too would prefer to be here if I have a serious medical problem. But it is insane that the biggest worry retirees have in the richest country in the world is being driven into the poor house by medical expenses.

[Martha]

Originally Posted by larry

I think US health care is probably more cutting edge than some other countries and if I were to become ill, I'd rather do it in the good ol' USA. Somehow, though, I think that I could become forced to seek treatment outside the US if costs continue to rise.

Cutting edge for some conditions and for some people in some places.

A study by the Commonwealth Fund from 2005 compared wait times to get care in the US, Canada, England, Australia, New Zealand and Germany. Canada and the US adults with a health problem were the most likely to wait six days or more to see a doctor. Germany managed to see people the most quickly, with 70% seen by the next day.

Emergency room wait times in the US can be 8 hours and up in some areas, especially urban areas.

Our primary care system leaves a lot to be desired.

A study published in JAMA a few years ago from the Johns Hopkins school of public health compared health conditions in the US with 12 other leading industrialized countries. The US was last place on numerous indicators, such as infant mortality. It managed to get up to second to last on life expectancy for women at age 15.

The US low rankings were attributed to two primary factors. One was the number of unisured. The second was the weak primary care system in the US. This is true for even the insured. Five of the seven top rated countries have very strong primary care sytsems.

[ladelfina]

maybe we are more willing and able to spend money on quality of life issues, in addition to longevity: joint replacements, extensive rehabilitation for injuries and strokes, psychotherapy, nerve blocks for pain and others.

In Italy my MIL had her second knee replacement last year at the age of 80; the first knee was done at age 77. Otherwise she would be in a wheelchair, but is still up and around and walking to Mass daily. After a fixed period in a rehab hospital the state was (IMO) stingy with physiotherapy so she did end up paying for some extra home visits out of pocket. The rest was "free". They are (anecdotally) also somewhat tight-fisted with painkillers, but in any case many people here are loathe to even take a single aspirin/paracetemol/ibuprofen when they have a headache or flu. (?)


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Just came across this anecdotal article about treatment in Britain vs. the US.
http://www.opinionjournal.com/extra/?id=110006785