U.S. health care costly, ineffective

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U.S. health care costly, ineffective

The United States has the worst health outcomes among developed nations, and when costs are considered, one could argue that it has the worst health system in the entire world.

As proof, the U.S. ranks 50th in infant mortality and 51st in life expectancy globally. This despite the fact that Americans spend 50 per cent more money on health care than the second-highest nation, and approximately double that of most developed countries.

Because of these concerns, the National Institutes of Health commissioned the National Research Council and the Institute of Medicine to convene the top American experts to review the literature and explain why.

To limit their exhaustive task, the expert committee reviewed only peer nations or developed countries. This extensive list included Canada, Australia, Switzerland, Sweden, Italy, Norway, Netherlands, Spain, United Kingdom, France, Austria, Germany, Denmark, Portugal, Finland and Japan.

To begin, the committee compared life expectancy and found that was last among the 17 countries for men and 16th for women. In comparison to the top country, American men lived 3.7 fewer years and its women lived 5.2 years fewer.

The experts also reviewed other health outcomes. In comparison to its 16 peer nations, the U.S. fared much worse for infant mortality, child deaths before age five, low birth weight, injuries, homicides, sexually transmitted infections, HIV and AIDS, drug-related deaths, obesity, diabetes, heart disease, chronic lung disease and disability.

Americans also were much more likely to consume more calories, use drugs, not wear seat belts and use firearms in acts of violence.

The only good news was that the United States had slightly higher rates of cancer survival. However, this finding is dubious. I explained in a previous column that screening for breast cancer, prostate cancer and so on are prone to a lead time bias. In plain language, most screening simply informs a patient of his death earlier, without a real change in mortality time.

For these reasons, the authors titled their final report U.S. Health in International Perspective: Shorter Lives, Poorer Health. Poor health outcomes were found across all ages, gender and socioeconomic groups.

"We were struck at the gravity of these findings," panel chair Dr. Steven Woolf wrote.

The authors found that the greatest predictors of poor health outcomes in the U.S. were social and economic conditions. They concluded:

"The United States has higher rates of poverty, especially child poverty, and income inequality and lower rates of social mobility. Other countries are outpacing the U.S. in the education of young people, which also affects health. And Americans benefit less from safety net programs that can buffer the negative health effects of poverty and other social disadvantages."

This conclusion might be known to some people. However, the authors also found that American health disadvantage cannot be explained fully by poverty. "Even advantaged Americans - those who are white, insured, college-educated or upper-income - are in worse health than similar individuals in other countries," they reported.

This last finding is harder to explain. The prestigious Dr. Michael Marmot of Britain suggests in his book The Status Syndrome that income inequality not only affects the poor negatively but the rich as well.

Dr. Otis Brawley, medical and scientific director for the American Cancer Society, writes in his book How We Do Harm that wealthy people access too much health care.

He argues that excessive and illogical use of medical treatment not only is adding unnecessary cost but is actually harming individuals and entire populations.

"It would be a mistake for people to respond to this by saying we need to spend more money on health care," Woolf said in an interview with CNN Health. The panel chair noted that other countries spend much less money on health care, but have higher health outcomes.

This is because countries that spend less money on health care have more money available for investments that have an impact on health - such as income, education and employment initiatives.

"With lives and dollars at stake, the United States cannot afford to ignore this problem," the authors conclude. "Addressing the U.S. health disadvantage will require a societal commitment."

If the U.S. simply copied the Japanese system, it could save $1.3 trillion a year and enjoy the highest health outcomes in the world.