JAMA Forum: OECD Report Offers a Contrast in Perception vs Reality in US Health Care

kevinnbass

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Interesting brief article. Discusses latest OECD report of developed countries' health metrics. Addresses many objections to metrics one often finds on SDN and in other discussions on this topic. Pasted below.

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http://newsatjama.jama.com/2013/11/27/jama-forum-oecd-report-offers-a-contrast-in-perception-vs-reality-in-us-health-care/

JAMA Forum: OECD Report Offers a Contrast in Perception vs Reality in US Health Care
BY AARON CARROLL, MD, MS on NOVEMBER 27, 2013

Last week, the Organisation for Economic Co-operation and Development (OECD) released its latest report comparing a number of developed countries’ health care metrics. As always, the data are hotly contested. That doesn’t mean we can’t learn something.

According to the report, the United States fares extraordinarily poorly. Let’s start with the fact that in 2011, US life expectancy at birth was 26th lowest among the 40 countries profiled. Some will argue that this is because of things like traffic accidents or suicide, which can’t be entirely blamed on the health care system. And those people are right, to a point. The rate of US traffic accident deaths is high (with a rank of 7 among 36 countries assessed), and so is the rate of suicide deaths (ranking 13 among 36 countries). But the US health care system could help prevent some of those deaths. Moreover, almost all the research used to justify this as the cause of our low life expectancy is flawed.

The US infant mortality rate (deaths per 1000 live births) was higher than in all but 9 of the 40 countries included in the rankings. Some will try to explain this metric as the result of differences in how different countries measure premature birth. Research has examined whether standardizing definitions changes the results much, and it doesn’t. At some point, we have to own this.

Even when the United States does better in some rankings, it’s certainly not “best-in-the-world” bragging rights. The OECD report says the nation has the tenth-lowest rates in cancer mortality overall, fourth-lowest rates in deaths following a stroke, and sixth-highest rates of influenza vaccination for the elderly. It also comes in 12th place in the number of hip replacements per 100 000 population—which is still shocking given how often US consumers are told that rationing is rampant in the rest of the world.

It’s easy to try to blame this poor showing on “lifestyle,” but the data suggest such an assumption might be at least partly off the mark. Among 15-year-olds, those in the United States had the second-lowest rate of smoking (after Iceland) and were the least likely to have “experienced drunkenness” at least twice. Among adults in 40 countries, those in the United States have the sixth-lowest rate of daily smoking and rank 17th in the amount of alcohol they consume. On the other hand, obesity is clearly a problem: of the 40 countries ranked, the United States has the highest adult obesity rate.

The US health care workforce is small, ranked 28th in the number of physicians per population and 29th in the production of medical graduates. The United States also has relatively few hospital beds (ranking 27 of 40) and doesn’t use them much, as reflected in a 24th-place ranking (of 25 countries) in the occupancy rate of acute care beds.

What the United States does have is lots of technology. The nation has the second-highest number of magnetic resonance imaging (MRI) scanners and the third-highest number of computed tomography (CT) scanners available per million population. Those machines aren’t idle, either: on a population basis, the United States ranks number 1 in MRI examinations and number 2 in CT examinations.

Of 31 countries assessed, the United States had the second-highest rate for avoidable hospital admissions for asthma and the tenth-highest rate for chronic obstructive pulmonary disease. Avoidable admissions for diabetes in the United States were the ninth highest (of 25 countries assessed).

The point is that the United States clearly isn’t close to the “best-in-the-world” rhetoric we hear so often. This is especially problematic given that the one category where we are clearly, totally, unequivocally number 1 is health care spending.



The United States is spending up to 4 times more per person than some of the other countries in the OECD report. We spend more in public money than most of these other countries do in total.

That’s a problem. Because given that many keep harping on the fact that the United States doesn’t have enough money to spend on the things we find important, it seems silly to spend this much on health care without seeing better results.

I concede that some of these things can’t be fixed by the health care system. But they could be fixed by more public health spending or spending in totally different areas. And that can’t occur if so much is spent on health care.

At some point, one must acknowledge that this type of spending can only be justified by incredible quality that places the United States first (or at least near the top) in most metrics. The amount of money being spent has to be justified with clear and consistent population-level data, not anecdotes.

Otherwise, we’re just deluding ourselves—and that may be borne out by evidence, too. According to this report, US consumers believe everything is fantastic. The one metric where we absolutely shine is perceived health: we’re number 1 when it comes to the percentage of adults reporting to be in good health. That may not be supported by the rest of the report, but that hasn’t seemed to make a difference before.

***

About the author: Aaron E. Carroll, MD, MS, is a health services researcher and the Vice Chair for Health Policy and Outcomes Research in the Department of Pediatrics at Indiana University School of Medicine. He blogs about health policy at The Incidental Economist and tweets at @aaronecarroll.

About The JAMA Forum: JAMA has assembled a team of leading scholars, including health economists, health policy experts, and legal scholars, to provide expert commentary and insight into news that involves the intersection of health policy and politics, economics, and the law. Each JAMA Forum entry expresses the opinions of the author but does not necessarily reflect the views or opinions of JAMA, the editorial staff, or the American Medical Association. More information is available here and here.
 

Narmerguy

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Thanks for sharing, OP. That's a good read.
 

SunsFun

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It was refreshing to read about infant mortality and how an argument of different metrics rather than poor quality doesn't really hold much water. Too bad we haven't seen it prior to people making that claim in a safety net thread.
 

Lucca

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Really interesting, thanks for this!
 

CarlosDanger

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Aaron Carroll is the man. His and Austin Frakt's blog is my favorite source of quality heath policy research.
 
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Starry

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Fantastic post. Reminds me of studies that show more technology is not always better - robotic surgeries come to mind. It also reminds me of the study showing how higher CEO pay correlates with more spending on technology, but not with patient mortality.

I'm waiting for the people in the safety net thread to show up and start arguing. :)
 

Awesome Sauceome

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Check out the documentary "money and medicine." I think it was made by PBS or something. It also brings up concepts such as this and is really interesting. It discusses some of the ethical and moral challenges that America has sort of been sucked in to that cause us to spend so much money while still not having exceedingly high quality care (comparatively to other ranking countries).
 
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Harpsx

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Great read. However this is something that has been pointed out time and time again, and, at this point, is something we need to accept to really push healthcare reform in the right direction.

At some point, one must acknowledge that this type of spending can only be justified by incredible quality that places the United States first (or at least near the top) in most metrics. The amount of money being spent has to be justified with clear and consistent population-level data, not anecdotes.
 
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kevinnbass

kevinnbass

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Aaron Carroll is the man. His and Austin Frakt's blog is my favorite source of quality heath policy research.
Agreed :)

Check out the documentary "money and medicine." I think it was made by PBS or something. It also brings up concepts such as this and is really interesting. It discusses some of the ethical and moral challenges that America has sort of been sucked in to that cause us to spend so much money while still not having exceedingly high quality care (comparatively to other ranking countries).
Great, I just found it online and watched it. It was awesome, thanks :)

Link to online documentary: http://video.pbs.org/video/2283573727/
 

inycepoo

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Good summary article, but I'm surprised articles like this still make JAMA. American exceptionalism is no news to historians and political scientists. The sad part is that it ain't gonna change any time soon in any area, not just health care.
 
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kevinnbass

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Good summary article, but I'm surprised articles like this still make JAMA. American exceptionalism is no news to historians and political scientists. The sad part is that it ain't gonna change any time soon in any area, not just health care.
What. The divergence between American healthcare spending and that of other developed countries is only 30 years old. Making this so-called "not new" "American exceptionalism", in fact, new.

But hey, it's more fun to pronounce all of history with a single, self-satisfied stroke than to actually get things right.

Add a prophetic one-liner, and I'm sure that was quite a gratifying post to make. Trolling usually is.
 

CarlosDanger

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Good summary article, but I'm surprised articles like this still make JAMA. American exceptionalism is no news to historians and political scientists. The sad part is that it ain't gonna change any time soon in any area, not just health care.
The false perception about our healthcare isn't a super new idea, but he's addressing people's criticisms of this data, which is pretty relevant right now.

Plus, these numbers comparing countries come out every so often, so they change a little every time, and we talk about trends and so forth.
 

inycepoo

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What. The divergence between American healthcare spending and that of other developed countries is only 30 years old. Making this so-called "not new" "American exceptionalism", in fact, new.

But hey, it's more fun to pronounce all of history with a single, self-satisfied stroke than to actually get things right.

Add a prophetic one-liner, and I'm sure that was quite a gratifying post to make. Trolling usually is.
You're missing the point. The point is that the underlying cause (American exceptionalism) for articles like these to even have to discover a "contrast in perception vs. reality" is the same problem that has been around for more than a century. Exorbitant health care spending particular is a more recent development, but there wouldn't be a need to have to debunk the myth that "America is the best in ____" if our exceptionalist attitude didn't exist. The general perception would have been that we're weaker in a lot of things compared to other countries, but obviously that's not reality right now. The attitude exists and will continue to do so, regardless of how many of these articles appear in high-impact journals. That's neither prophetic nor trolling. Just an indication that we have a ways to go as a country.
 

Starry

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Something that really struck me was that Americans are #1 in %adults reporting to be "in good health." Well, I think that the article below is pertinent. I often hear comments by, no offense, bigger people who say things about being "skinny fat" and how being big doesn't mean being unhealthy if you exercise, eat right, etc. Although it may seem like common sense, perhaps studies like this prove, without a doubt, that being overweight is not good for you, no matter how healthy you think you are.

There is no such thing as healthy obesity, according to a meta-analysis of 8 studies involving more than 60,000 adults. Caroline K. Kramer, PhD, MD, a researcher at Mount Sinai Samuel Lunenfeld-Tanenbaum Research Institute in Toronto, Ontario, Canada, and colleagues reported their results in an article published online December 2 in Annals of Internal Medicine.
Here's the research article: http://annals.org/article.aspx?articleid=1784291