America: sicker and shorter[health care]

[Ace Pace]

Couldn't come up with a better title.

There have been a pair of interesting reports recently that have examined the health and wellbeing of various industrialized nations across the globe, and they both paint the US in a rather bad light.

The subject of healthcare in the US can be a contentious one, and it's also an area where peoples' perceptions don't always align with the facts on the ground. It's also going to become a hotter topic in the coming months. The release of Sicko, the latest piece of agitprop from filmmaker Michael Moore, and the upcoming US presidential election are both going to raise the issue of healthcare in America.

The first report, from the Commonwealth Fund, contains the results of several years' worth of surveys from patients and primary care physicians from the US, UK, Australia, New Zealand, Canada, and Germany between 2004 and 2006. Several different measures of healthcare were assessed: quality of care (including the right care, safe care, coordinated care and patient-centered care), access, efficiency, equity, and healthy lives. In each of these measures, with the exception of the right care, the US came last out of six.

[What makes this result so scandalous is the amount of money the US pours into healthcare each year: $6,000 per-patient per-year costs, a sum more than double any of the other nations. Yet 15 percent of the population have no coverage due to a lack of any form of universal health care. Despite all this money spent, efficiency in the US system is well below that of its peers. Layers of administrative bureaucracy exist that aren't present abroad, per-patient costs are double, as stated above, electronic medical records have had a low rate of adoption, and patients frequently visit emergency rooms for conditions that could have been treated by a regular doctor had one been available. [/

The effects of failing US healthcare are also showing up in other studies. A report in the journal Social Science Quarterly looks at the relative decline in the height of US citizens in relation to their European counterparts. Prior to World War II, US citizens were some of the tallest people on the planet, but since then their heights have stagnated; Europeans are now on average between 2 and 6 mm taller, despite the US position as the most affluent nation on earth. Like the previous study, this data reflects the growing disparity in prosperity in the United States, where income inequality is higher now than at any time since the Gilded Age. Poor access to preventative healthcare and adequate nutrition during childhood has a significant effect on adult height, and this, coupled with the decline in various other measures of health outcomes, will have social and economic consequences for years to come.

[General Zod]

Hardly surprising at all, and more damning fuel to the fire. I managed to get lucky in that my employer actually has health-care packages for full-time employees. Otherwise I'd be up the shit creek.

[The Duchess of Zeon]

There's the actual ratings chart, which is the most relevant portion of the study to be posted here. The interesting thing is that the USA came in first in right care. Now, what is the definition of "right care", and how can we preserve that while dealing with the serious deficiencies in every other category?

Incidentally this study seems to indicate that Canada is the second worst of the lot. I'd like to hear some input from Canadians on that.

[Admiral Valdemar]

I often find, when worrying about the inherent waste within the NHS, that looking at the gross neglect of the people the US system has despite far more funding makes the problems seem tame by comparison.

I'd like to see France on that list too, since France apparently beats the UK by a great deal, at least in treating the likes of cancer or doctor to patient ratio.

[Aaron]

I'm Canadian and I have zero complaints regarding our health care system. I've had seven surgeries and never had to wait more than one month to get in. All my diagnostic tests are also done in a similar time frame and I've never had a problem finding a doctor nor had to wait longer than a month to see a specialist. My health care is primarily handled by Veterans Affairs but we have to use the civilian system as the VA Hospitals are all gone so in effect VA pays and I use the same system as everyone else. My wife has also had similar wait times for her specialist appointments. And my sister who had a heart valve replacement also waited less than a month for surgery.

As far as I'm concerned I'm getting top notch care and my money's worth.

[metavac]

Check out the TCF report PDF. The breakdown of those rankings are extremely interesting, especially in the areas of 'right' and 'safe' care.

[Cincinnatus]

There's the actual ratings chart, which is the most relevant portion of the study to be posted here. The interesting thing is that the USA came in first in right care. Now, what is the definition of "right care", and how can we preserve that while dealing with the serious deficiencies in every other category?

Incidentally this study seems to indicate that Canada is the second worst of the lot. I'd like to hear some input from Canadians on that.

The study says that "right care" is preventative care. Why they didn't just call it that, I don't know. I don't see how Universal Health care would lead to worse preventative care, so it's probably something doctor's are trained to do better in the US.

[metavac]

The study says that "right care" is preventative care. Why they didn't just call it that, I don't know. I don't see how Universal Health care would lead to worse preventative care, so it's probably something doctor's are trained to do better in the US.

Actually, "right care" is grouped into both preventative and chronic categories. Chronic care is divided into six categories, with Canada and the US dropping to the bottom of the pack when it comes to the following three:

1. Physicians reporting it is easy to print out a list of patients by diagnosis or health risk

2. Physicians reporting it is easy to print out a list of all medications taken by individual patients, including those prescribed by other doctors

3. Primary care practices that routinely use non-physician clinicians to help manage patients with chronic diseases

[Darth Wong]

The lack of access to a central database of patient conditions and medications is something I can attest to, and it's part of the nature of the decentralized nature of our health-care system (naturally, the most "privatized" part of it). Family doctors in Canada are basically private businesses, but they bill the government for their services instead of billing the patient. There are conditions limiting the amount they can bill per service and other things, and that's the extent of government involvement. Despite the American right-wing and its deceitful attempt to paint Canada's system as a massive centralized government bureaucracy, it's really more like a government health insurance plan combined with public and private health care providers.

Of course, that would lead to the inevitable question of how the Americans can actually do better than us on that score since they are also decentralized, but Americans tend to stay with the same health care provider organization for a long time. This is a provider organization that is typically attached to their place of employment, and will maintain its own records. If they do move, it will be because they changed jobs. In Canada I know many people who just bounce from free clinic to free clinic, never bothering to settle down with a particular doctor or make sure that records are transferred from one doctor to another.

Having said that, I wonder at the study's methods, since outcomes do not seem to be correlated to their input criteria as one can notice from looking at their own chart. Contrary to popular belief, Canadians do not have vastly different health habits from Americans. We aren't quite as bad but the idea that our citizen health is due to some massive change of lifestyle at the border is bogus.

[Stark]

A centralised list of patients etc was proposed in Australia, I believe, but there was resistance to adopting it (for privacy reasons I think).

[metavac]

Having said that, I wonder at the study's methods, since outcomes do not seem to be correlated to their input criteria as one can notice from looking at their own chart. Contrary to popular belief, Canadians do not have vastly different health habits from Americans. We aren't quite as bad but the idea that our citizen health is due to some massive change of lifestyle at the border is bogus.

That's largely because the margin in the reported difference in the health between Americans and Canadians in all age groups is three percent, which varies between 1 and 5 percent in each age group (see here). While statistically significant and even more glaring when compared to difference in per capita health care spending between both countries, we're still talking about a small difference in groups reporting good or fair health at rates in the mid-80s.

While I'm not suspicious of the methodology, I wouldn't try and extrapolate a great deal beyond the narrow findings in the TCF study. It relies on data from two primary care health surveys, which may decouple its findings from a broader discussion of general health in OECD countries. After all, primary care studies would favor the American insured, a class that may diminish or not even exist in countries where more and more health care services are spun out into the public sector. Also, most of the areas where the US or Canada trail by wide margins are in areas concerning medical records, referrals and what I think amounts to billing. Once again, it seems that critics of American health care will mostly find meat by jointly considering the US's wide lead in health care spending with its comparably mediocre performance in all categories save 'safe care.'

[Vympel]

But - but - but - Rudy Giuliani said in the first Republican debate that America's health system is the greatest in the world.

Surely you're not saying Benito Giuliani is completely full of shit?

[Darth Wong]

But - but - but - Rudy Giuliani said in the first Republican debate that America's health system is the greatest in the world.

Surely you're not saying Benito Giuliani is completely full of shit?

It is the greatest in the world ... at making money. The American health care system extorts more money from its citizens than any other health-care system on the planet. As a business, it's a smashing success.

[Sea Skimmer]

Last I read the great height of Americans was supposed to considered a health risk?