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Why Do We Have Worse Survival Rates?

By October 13, 2010Commentary

The usual description of the US health system is that it is very high cost and not as good quality as the systems in other developed countries.  The lower life expectancies and survival times in the United States are frequently cited as an indicator of that poorer quality.  Objections are raised to this perception on the basis of different demographics and cultural factors in the United States.  An article in Health Affairs attempts to extend this discussion by comparing the United States to twelve other developed countries and concludes that our health system is primarily responsible for the extent of poorer outcomes.   (HA Article)

The researchers looked at ethnic and gender subgroups to try to account for demographic differences and also considered the effects of obesity, smoking rates, homicides and car accidents.  While survival rates between 1975 and 2005 increased in all the countries, they increased less in the United States.  The researchers noted that at the same time spending rose faster in the United States, which has far and away the greatest per capita expenses, although most of that is attributable to unit prices not utilization.  They thus conclude that we are getting little bang for the buck compared to other countries.

Explaining differences in major outcomes like life expectancy or survival time across nations is not simple.  One problem with this analysis is that the underlying data could well be suspect.  It draws on information reported by the various countries to international bodies.  There is not a common set of formats or definitions and the quality of data collection and reporting in each country could vary significantly.  Another issue is that the data for the US is aggregated across a much larger and more diverse population than any of the other countries.  If a subset of the American population exactly similar to that in the other countries, which tend to be well-off more homogenous ones, was used, the analysis might be very different.  The researchers did limited adjustment for this possibility, only looking at a couple of cultural factors which might significantly affect health spending, and did not account for others–rates of illegitimacy and drug use, or amount of exercise, or attitudes toward seeking health care, for example–which probably greatly affect health and survival in the United States.  Notwithstanding the caveats, this research is a helpful exploration into differences in health system performance.

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