The health care graph

by on January 11, 2008 at 5:17 pm in Medicine | Permalink


Here is Ezra Klein, here is Paul Krugman on the same.  If we put the partisanship aside, and view this as raw statistics, what lessons can be drawn?  The biggest surprise is Japan — a country whose health care institutions are not generally popular — at number two.  Spain and Italy and #4 and #5 are less extreme examples of the same point.  Do the Germans and Danes really kill so many extra people through their health care systems?  Would you really rather get sick in Greece?

Nothing in this post is intended as apology for the United States health care system, but if we are going to look at the numbers let’s consider all of them.  If there is any lesson about the French  — who are a clear first — it is that they do something right for health care apart from having so much government involvement.  What might that be?  What do we learn about what makes for a good health care system?  Is there a correlation between health care performance and policy?  I don’t see it, maybe there is one, but I’m wondering if people are willing to draw lessons from this diagram consistently or not.

I might add I find it easy to believe that American health care institutions make a disproportionate share of stupid errors, or are responsible for lots of patient mistreatments, so I am not trying to undo our presence on the right hand side of this graph.  I do, however, walk away suspicious of the concept of "amenable" mortality.

Addendum: It’s much worse than I thought, read this, which includes a free link to the supposedly gated study.

Second addendum: Out there on the mea culpa watch, or not, here is DSquared.

1 Paul January 11, 2008 at 6:04 pm

If you look at the details of the study, you’ll find they don’t actually study health care at all, just disease incidence. So this just says that US has some less healthy life-styles than some other countries, which we already knew. A more detailed analysis of the paper is here:

2 G January 11, 2008 at 6:12 pm

As for medical mistakes on the job, I’d bet on a conditional Intrade contract that is due to the very long work hours many residents, nurses and doctors put it. I’m sure the additional time and money required to become a licensed health care practitioner in the USA has a lot to do with that, but there are probably good reasons those markets aren’t clearing.

All-in-all I’d also bet much of Europe’s centrally-planned health care system is better than America’s centrally-placed health care system. That really doesn’t surprise me, given the size difference of the countries involved.

For the most part, however, I’d bet the anti-market bias in health care is the result of political entrepreneurship on the part of much of the health care industry. In America, there is still room for more financial involvement in medical care, so political “entrepreneurs” can take advantage of that. Elsewhere, this “market” has already been exploited.

3 roland January 11, 2008 at 6:58 pm

As a health care professional I’m sensitive to these numbers and have studied them before. The conclusions I draw are this. America persues more lost causes than many other countries. A telling statistic is the share of health care dollar spent in the last 30 days of life. This number is dramatically higher in the US than any other country. In essence, in the US we have difficulty getting away from losers. Be it the 85 year old with renal failure or the fifty year old alcoholic with liver failure our goal is to treat (and cure) all comers. Not so in many other countries. (Liver transplants for alcoholics are highest in the US). If you exclude the sickest patients most likely to have complications the US moves to the left on that graph (likely past France). So our problem is not the care but patient selection.

4 Jay January 11, 2008 at 10:27 pm

I posted this concern over on Thoma’s blog and simply got 1 sneer from the religious left. This data is without a doubt incomplete. This means nothing, without a tally of the number of “amenable” deaths prevented in these countries.
Case in point, since the PhD leaves me to speculate, lets say the U.S. treated 300 patients / 100,000 population successfully. And France treated 100 / 100,000 population successfully. Would you rather have an “amenable” disease in the U.S (300/410 chance of surviving) or France (100/165).

5 Barkley Rosser January 12, 2008 at 12:13 am

Just two observations.

1) Several years ago France was rated as having the world’s best health care system
in the world by the WHO. Do not know what their criteria were, but these numbers fit
in. When we were there and needed health care, it was excellent. Note: doctors
actually visit patients in their homes, even those who are foreign visitors. I am
old enough to remember when my family’s doctor visited the house when were sick when
I was a kid. Can someone explain just exactly why it is that they do not do so anymore?
Is this perhaps one of those examples of backward-bending supply curves for the overpaid?

2) I picked up the latest UN Human Development Report while I was at the AEA meetings in
New Orleans. Denmark is tied with the US at 29th in life expectancy in the world at 77.9
as of the 2005 numbers in there. Frankly, I do not know why Denmark is down in the garbage
dump with the US on this, given its mostly good performance on most social indicators.

6 Daniel Goldberg January 12, 2008 at 1:36 am


My comments are here (go to the Update):

7 anon January 12, 2008 at 5:53 am


I come from a country where house visits by a family doc. are still the norm. You wonder why you lost that in the US?

It’s an artificial doctor shortage propagated by the vested interests of current doctors! You let practicing docs have too much say in the certification process. Tell me, what incentive does a practicing doc. have to allow more to graduate and ruin his margins?

Reform those licensing boards etc. to make doctor “production” more market oriented. If needed “import”!

8 Charlie January 12, 2008 at 9:01 am

Are these statistics correlated with obesity rates? Looks like they may be.

9 Geoff Hamilton January 12, 2008 at 12:08 pm

Are these stats correlated to account for access to health care? Potentially, someone with an incurable condition (a very serious heart failure, for instance) might be making it to the hospital in time to die in the U.S. and not in Greece. This would make the death “amenable to health care” in the U.S. but not in Greece even though it’s actually a credit to the U.S. system that the patient made it to hospital at all.

In other words, I’m guessing that the number of deaths “amenable to health care” in Sudan is close to zero because health care is, for the most part, so inaccessible that only patients with stable conditions are able to make to hospital.

10 graeme January 12, 2008 at 1:20 pm

You couldn’t manage a second post for the dsquared bit? It’s really not clear to me why the two studies are necessarily so contradictory. The 150,000 (violent) deaths number is fairly misleading, given the large increase recorded in nonviolent deaths. Since both studies used the same methodology, I’m not sure why you think an apology is needed, considering all dsquared did was argue against nonsensical statistical arguments.

11 A Tykhyy January 12, 2008 at 3:12 pm

Correlated with obesity — yes, very probably, but not caused by it. As someone noted in the discussion, the absolute death rate from a certain condition is not enough to gauge the performance of the health system per se. The incidence rates of the condition are also important. As a contrived example, consider two 3rd world countries, one has malaria mosquitoes and the other doesn’t. Deaths from malaria are certainly amenable to health care, but the first country will look much worse than the second even if their health care systems are the same (or absent). In fact, the first country might even have a better health care system and still look worse on the absolute death rate graph.

Caveat: this is *not* a defense of the U.S. health care system, of which I (luckily?) have no experience anyway.

12 save_the_rustbelt January 12, 2008 at 9:28 pm

Why give so much credibility to a study with a weird definition not really subject to accurate measurement?

Just because Krugman gives it instant credibility does not mean the paper deserves credibility.

13 Jason January 12, 2008 at 9:53 pm

Several years ago France was rated as having the world’s best health care systemin the world by the WHO. Do not know what their criteria were, but these numbers fit

If you’re referring to the WHO World Health Report, I believe the sole health indicator used in the rankings was disability adjusted life expectancy. Which is meaningless as a measure of the performance of a health care system, because there are so many other things that influence life expectancy more than the quality of health care services.

The French health care system is going bankrupt. The public insurance fund has been in deficit every year since 1986. See this recent article from the Canadian Medical Association Journal on what it calls the “hard choices” facing France over the future of its health care system.

14 Mark Westling January 13, 2008 at 7:19 am

I posted this over at Coyote Blog but I’d like to see people’s thoughts over here. If the biggest single difference in the numbers between the US and the UK and France are deaths due to ischaemic heart disease, then could we be looking at differences in emergency medical services? I’ve heard anecdotal evidence that the fire brigade / EMS in Ireland has improved greatly, so maybe we’re seeing more people in Europe surviving heart attacks.

15 Jason January 13, 2008 at 3:17 pm

Randall Parker,

Not to mention differences between countries in violent crime rates, differences in accident rates, differences in stress levels arising from differences in work patterns, family and community life, differences in pollution levels, differences in climate, differences in rates of smoking, alcohol and drug use, and so on. Each of these variables, and numerous others, may significantly affect mortality rates independently of any effects from the health care system.

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Wow! Its a good article on the health care.This article provides a healthy comparison about different countries’s health care system

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