New study shows US ranked last in preventable deaths

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According to this study amongst the leading industrialized nations, the US ranks dead last. Not only are more people not getting the care they need and dying than our counterparts in the West, but our inability to provide a solution is making the problem worse. The final sentance says it all:

""The fact that other countries are reducing these preventable deaths more rapidly, yet spending far less, indicates that policy, goals and efforts to improve health systems make a difference," Schoen added in a statement."

Our lack of such policies, goals, and efforts is slamming our healthcare system, and hence our workforce and economy. As us pre-meds will be entering practice in 8 or so years, and with such a huge election coming up, what do you think we can and should do to turn this around?

http://www.msnbc.msn.com/id/22554235/wid/11915773&GT1=10815

France best, U.S. worst in preventable deaths

British study's rankings based on access to timely and effective health care

sourceReuters2.gif
updated 7:44 a.m. MT, Tues., Jan. 8, 2008

WASHINGTON - France, Japan and Australia rated best and the United States worst in new rankings focusing on preventable deaths due to treatable conditions in 19 leading industrialized nations, researchers said on Tuesday. If the U.S. health care system performed as well as those of those top three countries, there would be 101,000 fewer deaths in the United States per year, according to researchers writing in the journal Health Affairs. Researchers Ellen Nolte and Martin McKee of the London School of Hygiene and Tropical Medicine tracked deaths that they deemed could have been prevented by access to timely and effective health care, and ranked nations on how they did. They called such deaths an important way to gauge the performance of a country's health care system. Nolte said the large number of Americans who lack any type of health insurance — about 47 million people in a country of about 300 million, according to U.S. government estimates — probably was a key factor in the poor showing of the United States compared to other industrialized nations in the study. "I wouldn't say it (the last-place ranking) is a condemnation, because I think health care in the U.S. is pretty good if you have access. But if you don't, I think that's the main problem, isn't it?" Nolte said in a telephone interview. In establishing their rankings, the researchers considered deaths before age 75 from numerous causes, including heart disease, stroke, certain cancers, diabetes, certain bacterial infections and complications of common surgical procedures. Such deaths accounted for 23 percent of overall deaths in men and 32 percent of deaths in women, the researchers said.

France did best — with 64.8 deaths deemed preventable by timely and effective health care per 100,000 people, in the study period of 2002 and 2003. Japan had 71.2 and Australia had 71.3 such deaths per 100,000 people. The United States had 109.7 such deaths per 100,000 people, the researchers said. After the top three, Spain was fourth best, followed in order by Italy, Canada, Norway, the Netherlands, Sweden, Greece, Austria, Germany, Finland, New Zealand, Denmark, Britain, Ireland and Portugal, with the United States last.

Previous rankings
The researchers compared these rankings with rankings for the same 19 countries covering the period of 1997 and 1998. France and Japan also were first and second in those rankings, while the United States was 15th, meaning it fell four places in the latest rankings. All the countries made progress in reducing preventable deaths from these earlier rankings, the researchers said. These types of deaths dropped by an average of 16 percent for the nations in the study, but the U.S. decline was only 4 percent. The research was backed by the Commonwealth Fund, a private New York-based health policy foundation.

"It is startling to see the U.S. falling even farther behind on this crucial indicator of health system performance," Commonwealth Fund Senior Vice President Cathy Schoen said. "The fact that other countries are reducing these preventable deaths more rapidly, yet spending far less, indicates that policy, goals and efforts to improve health systems make a difference," Schoen added in a statement.
 
I was hoping someone would start this thread; I can easily imagine it coming up in an interview, but I also am really bothered by this.

I walked out of my office and mentioned the study to a group of people, and got a strong reaction of, "So. Not my problem." This reaction was from an M4 going into family med. He/she actually compared France's universal healthcare to universal Fine Italian Resturaunt Dining.

I wonder if she went to public school. Or should I say, "universalized education"?
 
Most of these preventable deaths could have been prevented by the people who died rather than the health care system. Diabetes, stroke and heart disease and some cancers are the direct result of excessive eating and drinking as well as smoking. Furthermore we drive everywhere rather than walk. We need to get off our fat lazy duffs and start exercising.

On the other hand one item that never comes up in these comparative studies is orthopedic neglect in Canada and Europe. Need a knee or hip replacement in Canada or the UK? The doctor will be happy to see you in 18 months. What does this cost these countries in terms of low productivity?
 
Most of these preventable deaths could have been prevented by the people who died rather than the health care system. Diabetes, stroke and heart disease and some cancers are the direct result of excessive eating and drinking as well as smoking. Furthermore we drive everywhere rather than walk. We need to get off our fat lazy duffs and start exercising.


yes those disease are all preventable with healthy diets and exercise....however, do you know what the 3rd leading cause of death in the U.S. is (behind heart disease and cancer, respectively)........ medical error. if you'd like a source ill go find it for you but i dont feel like getting it right now
 
yes those disease are all preventable with healthy diets and exercise....however, do you know what the 3rd leading cause of death in the U.S. is (behind heart disease and cancer, respectively)........ medical error. if you'd like a source ill go find it for you but i dont feel like getting it right now

It only appears that way because accountability (and unnecessary malpractice litigation) is higher in the US than virtually anywhere else in the world. It's in the lime light here in the States.
 
yes those disease are all preventable with healthy diets and exercise....however, do you know what the 3rd leading cause of death in the U.S. is (behind heart disease and cancer, respectively)........ medical error. if you'd like a source ill go find it for you but i dont feel like getting it right now
Please. That statistic is so vague as to be nearly meaningless. They'll call something a death due to medical error even if it only shaves a single day off of someone's life.
 
It only appears that way because accountability (and unnecessary malpractice litigation) is higher in the US than virtually anywhere else in the world. It's in the lime light here in the States.

i do agree with you on the unnecessary malpractice litigation, thats about the only thing i think the republicans have right. suing a psychiatrist for a patients suicide is ridiculous..... but i dont think thats a very common occurrence, that specific one at least. but maybe i am wrong.
 
Most of these preventable deaths could have been prevented by the people who died rather than the health care system. Diabetes, stroke and heart disease and some cancers are the direct result of excessive eating and drinking as well as smoking. Furthermore we drive everywhere rather than walk. We need to get off our fat lazy duffs and start exercising.

On the other hand one item that never comes up in these comparative studies is orthopedic neglect in Canada and Europe. Need a knee or hip replacement in Canada or the UK? The doctor will be happy to see you in 18 months. What does this cost these countries in terms of low productivity?

I have a feeling most the people breaking hips aren't contributing a whole lot to productivity to begin, what with being geezers and all.
 
A significant chunk of "preventable death" in this country is also due to the fact that we Americans keep people alive much longer than we should, which would skew the hell out of whatever statistics they lumped together for this ridiculous list. They don't do what we do in a lot of other countries. How many days does an otherwise, for-all-intents-and-purposes dead patient need in the ICU on a respirator with tubes and lines crammed into every imaginable orifice before he/she develops overwhelming sepsis? Aspiration pna? C diff? I hate studies like this because "preventable death" is gauged differently in different countries.
 
Most of these preventable deaths could have been prevented by the people who died rather than the health care system. Diabetes, stroke and heart disease and some cancers are the direct result of excessive eating and drinking as well as smoking. Furthermore we drive everywhere rather than walk. We need to get off our fat lazy duffs and start exercising.

I agree with this point to an extent. I have always advocated for two things: A reform of the delivery system itself, and better promotion/encouragement of healthy lifestyles. I certainly think that with the latter it is important to start young. We need to re-introduce more PE and other activities in school, plus promote healthy cafeteria selections. But there are problems with this approach alone. For one, we are already struggling to do this. And of course, regardless of what we do in schools, parents will do whatever they want outside of it. Plus this does nothing for the adults themselves, who have the given right to eat as much as they want and exercise as little as they want. I hate to say it, but for many, you can scream down their throat all day and they will just keep eating (and feeding their kids the same way). So we both agree poor lifestyles are a problem, and we need change, but how do we bring about this change?

And that's where I think reforming our delivery system itself comes to play. Our country is the grand daddy of capitalism, Americans like incentives. The beauty of reforming the healthcare system is that we can incorporate incentives for choosing better lifestyles and hit two birds with one stone. For example, discounting your rate for loosing weight and staying there, or choosing not to smoke. This is similar to what car insurance companies currently do for not getting a ticket or avoiding accidents. With this, families would receive a financial incentive for living healthier lifestyles. This makes sense, because those who choose healthy lifestyles will be costing our economy less in the long run. Certainly, we need to push lifestyle change in other ways, but America responds to incentives, and to be the most effective we need to provide an immediate benefit. Money talks.
 
A significant chunk of "preventable death" in this country is also due to the fact that we Americans keep people alive much longer than we should, which would skew the hell out of whatever statistics they lumped together for this ridiculous list.

We are actually pretty low on the list of life expectancy for industrialized countries. So in other words, no.
 
We are actually pretty low on the list of life expectancy for industrialized countries. So in other words, no.

That has little to do with the amount of futile care given in the US. We are talking about interventions that extend life for very short periods of time, days,weeks, maybe months. Lifestyle issues have a lot to do with lower life expectancy. Lack of insurance probably plays a small role too.
 
We are actually pretty low on the list of life expectancy for industrialized countries. So in other words, no.

Excuse me, but "life expectancy" has nothing to do with my point. I was not speaking in terms of linear age of patients, but rather about the condition of these patients at the point which they acquired/died from these "preventable" causes. The article refers to death from bacterial infections and complications of surgical procedures - all of which are very commonly the causes of the ultimate demise of already very critically and/or terminally ill patients - patients who might not be kept alive in other countries and their medical systems (and left to die of "natural" or "non-preventable" causes), but who are routinely preserved to that point in our own. That was my point - that the term "preventable illness" depends on context.
 
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I think the high death rate maybe due to the problem that nearly 50% population is obese, it is not a health care issue but a social issue. Since doctors in US do not have the right to force people to loose weight.
 
I think the high death rate maybe due to the problem that nearly 50% population is obese, it is not a health care issue but a social issue. Since doctors in US do not have the right to force people to loose weight.
Ah, this is also a good point. I agree. 👍
 
Also let's not forget the United States has a large influx of immigrants without health insurance. Obesity and cost of health care are major factors but immigration problems should not be overlooked.
 
"People who don't have insurance tend to forgo, postpone or delay health care when they need it. It also leads to presentation at a later stage when less can be done. [...]
The report focused only on people whose lives might have been extended by widely available medical or surgical interventions. The authors looked at more than 30 conditions that cause preventable deaths before age 75, including tuberculosis, thyroid disease, appendicitis, tetanus infections, abdominal hernia, colon cancer, measles and epilepsy. Deaths caused by leukemia, cervical cancer and diabetes were included only if victims were under 50 years old.''
http://www.bloomberg.com/apps/news?pid=20601103&sid=aicuTZz3sykc
This article provides other reasons why there may be problems comparing the U.S. to the other countries in the study, namely diversity. Am I the only one who sees the problem with the reasoning that the reason we came out the worst in the study is because we are really the best in healthcare. Give me a break.
 
This article provides other reasons why there may be problems comparing the U.S. to the other countries in the study, namely diversity.
Uh... Ever been to France, Australia, or England? These countries are mighty diverse as well. Per capita, immigration in Australia's even bigger than ours.
Am I the only one who sees the problem with the reasoning that the reason we came out the worst in the study is because we are really the best in healthcare. Give me a break.
The U.S. has some of the greatest medicine in the world; the U.S. has some of the worst healthcare in the world. You can't say we have great healthcare when lots of people don't have it because of our system and when lots of folks die younger because of our system.

Pre-meds have a tendency to glorify physicians and our health system. Physicians are not gods: many have ego problems, some have terrible patient skills and many make lots and lots of mistakes. And our healthcare system in this country just plain sucks. Talk to doctors about this, or better yet, talk to your elders who are actual users of this healthcare system.

The healthcare system is a big topic at medical school interviews. If you're going to trumpet it during the application process or interview, you'd better have lots of data I haven't seen, because otherwise it'll ding you. Most experts will tell you it's not working by just about any yardstick.

Hearing lots of premeds (and some med students) talk about healthcare is like hearing 12 year olds talk about sex. Have some conversations about frequent users of the system and see how many trumpet it. Read some of the texts (some are very palatable, like "Understanding Health Policy). It's hard to walk away with the impression that our system is hunky-dorey.
 
On the other hand one item that never comes up in these comparative studies is orthopedic neglect in Canada and Europe. Need a knee or hip replacement in Canada or the UK? The doctor will be happy to see you in 18 months. What does this cost these countries in terms of low productivity?
What's probably more telling is that many, many Americans would gladly pay the very nominal tax increase (it was an extra 3% in the last study I saw) to get the sort of free health care that you get in Canada (and this says nothing of the other social services they get as well).

But very, very few Canadians would push a button to adopt our healthcare system. In fact, no country that I know of has modeled there system on ours. Everyone's running from it? Is it because the rest of the world is just dum ferriners who don't know how good we have it? Or is it because our system is frankly pretty awful?
 
What's probably more telling is that many, many Americans would gladly pay the very nominal tax increase (it was an extra 3% in the last study I saw) to get the sort of free health care that you get in Canada (and this says nothing of the other social services they get as well).
It would take more than a 3% tax increase to get universal health care though, and we all know it. We're never going to get Canada's system here, because of various and sundry things like obesity, entitlement, litigation, and the save-the-octogenarian-at-all-costs mentality.
 
Uh... Ever been to France, Australia, or England? These countries are mighty diverse as well. Per capita, immigration in Australia's even bigger than ours.

The U.S. has some of the greatest medicine in the world; the U.S. has some of the worst healthcare in the world. You can't say we have great healthcare when lots of people don't have it because of our system and when lots of folks die younger because of our system.

Pre-meds have a tendency to glorify physicians and our health system. Physicians are not gods: many have ego problems, some have terrible patient skills and many make lots and lots of mistakes. And our healthcare system in this country just plain sucks. Talk to doctors about this, or better yet, talk to your elders who are actual users of this healthcare system.

The healthcare system is a big topic at medical school interviews. If you're going to trumpet it during the application process or interview, you'd better have lots of data I haven't seen, because otherwise it'll ding you. Most experts will tell you it's not working by just about any yardstick.

Hearing lots of premeds (and some med students) talk about healthcare is like hearing 12 year olds talk about sex. Have some conversations about frequent users of the system and see how many trumpet it. Read some of the texts (some are very palatable, like "Understanding Health Policy). It's hard to walk away with the impression that our system is hunky-dorey.

well said.
 
What are the thoughts on providing insurance for everyone instead of "universal healthcare". We were the only country in the study lacking insurance for every person. It seems to me that insurance is pretty smart: we know how many people will need care, just not who, so let everyone contribute to the pot.
How do the top ranked countries deal with managed care?
 
A significant chunk of "preventable death" in this country is also due to the fact that we Americans keep people alive much longer than we should, which would skew the hell out of whatever statistics they lumped together for this ridiculous list.

The study did actually set a standard age for all countries to be compared with: "Specifically, they looked at deaths amenable to health care before age 75 between 1997–98 and 2002–03."

They don't do what we do in a lot of other countries. How many days does an otherwise, for-all-intents-and-purposes dead patient need in the ICU on a respirator with tubes and lines crammed into every imaginable orifice before he/she develops overwhelming sepsis? Aspiration pna? C diff? I hate studies like this because "preventable death" is gauged differently in different countries.

This one I can't judge, and most of us in this forum probably don't know what doctors in France, Japan, and Australia will do to keep a patient alive. But I would be interested to see if allowing the death of a vegetative patient would be considered a preventable death.

And for the purposes of science, I would hope (and expect) that the criteria used to categorize a preventable death is in the US, would be the same criteria used in all the other countries in the study.
 
And for the purposes of science, I would hope (and expect) that the criteria used to categorize a preventable death is in the US, would be the same criteria used in all the other countries in the study.
Lots of studies don't necessarily compare apples to apples, which is why the US looks like it has a much higher infant mortality rate than comparable countries.
 
Pre-meds have a tendency to glorify physicians and our health system. Physicians are not gods: many have ego problems, some have terrible patient skills and many make lots and lots of mistakes.
Why don't you go ahead and tell me Santa Claus and the Tooth Fairy don't exist while you're at it? 🙁
 
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Uh... Ever been to France, Australia, or England? These countries are mighty diverse as well. Per capita, immigration in Australia's even bigger than ours.

The U.S. has some of the greatest medicine in the world; the U.S. has some of the worst healthcare in the world. You can't say we have great healthcare when lots of people don't have it because of our system and when lots of folks die younger because of our system.

Pre-meds have a tendency to glorify physicians and our health system. Physicians are not gods: many have ego problems, some have terrible patient skills and many make lots and lots of mistakes. And our healthcare system in this country just plain sucks. Talk to doctors about this, or better yet, talk to your elders who are actual users of this healthcare system.

The healthcare system is a big topic at medical school interviews. If you're going to trumpet it during the application process or interview, you'd better have lots of data I haven't seen, because otherwise it'll ding you. Most experts will tell you it's not working by just about any yardstick.

Hearing lots of premeds (and some med students) talk about healthcare is like hearing 12 year olds talk about sex. Have some conversations about frequent users of the system and see how many trumpet it. Read some of the texts (some are very palatable, like "Understanding Health Policy). It's hard to walk away with the impression that our system is hunky-dorey.

I think I agree with this post 100%.

The US is the best place in the world to be if you have a trauma related injury or an acute chrisis that needs medicine. It is the worst place to be if you have a chronic disease that needs healthcare. And chronic diseases are by far the most expensive to treat long-term and damage our economy way more than all the cases of acute trauma you can muster.

Healthcare is a common topic at interviews, so I strongly recommend the advice given in the last paragraph to all pre-meds. Please check out some books about healthcare, and do not base your opinions off of only the media, Sicko, and your fellow premeds!

What's probably more telling is that many, many Americans would gladly pay the very nominal tax increase (it was an extra 3% in the last study I saw) to get the sort of free health care that you get in Canada (and this says nothing of the other social services they get as well).

I do not believe that if we funded a system at the federal level we can limit taxes to only 3%. A federal system would need to be funded with general taxes, such as payroll taxes. For one, these taxes are high and nobody wants them any higher. Secondly, federal income taxes are completely exposed to the bullcrap of politics and rationing. Before you know it, some of that money would be used for the military, or education, and not healthcare. So we would either have a poor, unresponsive system or we would have to keep raising taxes.

I think that if we funded a system at the state level, using sales tax, we can keep it down. State sales tax is generally exclusive, meaning they can only be used for one thing. I also like a proposed idea to use an in-lieu employer tax. Basically, you tax employers that do not provide insurance for their employees. Since our system is anchored by employee group insurance for the worforce, this encourages employers to buy insurance for their employees, and if they still don't they still bear some of the cost. With innovative approaches like this we can keep taxes under about 3%. But with a single tax there is no way we can keep it under 3%.
 
What are the thoughts on providing insurance for everyone instead of "universal healthcare". We were the only country in the study lacking insurance for every person. It seems to me that insurance is pretty smart: we know how many people will need care, just not who, so let everyone contribute to the pot.
How do the top ranked countries deal with managed care?

You mis-understand what "universal healthcare" means. UH simply means everyone is covered and has access. How we go about doing that can vary. So providing insurance for everone is actually a form of universal healthcare. This is a common misconception.

You probably meant, when you said "universal healthcare," either socialized system, government takeover, or a single payer system (which can all be interrelated in some proposals, but not always)
 
I get that insurance is specific and healthcare is very general. I've been treated in a socialized healthcare system. It was free. No strings.

I am looking for thoughts on universal healthcare insurance. Is it a good compromise? The other countries ahead of the U.S. seem to differ with regards to how socialistic their systems are, but we were the ONLY country out of the nineteen with no universal insurance coverage.
 
The US is the best place in the world to be if you have a trauma related injury or an acute chrisis that needs medicine. It is the worst place to be if you have a chronic disease that needs healthcare. And chronic diseases are by far the most expensive to treat long-term and damage our economy way more than all the cases of acute trauma you can muster.
I still don't think that's the appropriate distinction. There are many chronic diseases that are managed excellently, but the problem is that many people can't afford access to care that manages their chronic disease, not that the care is inadequate if you can pay for it.
 
I still don't think that's the appropriate distinction. There are many chronic diseases that are managed excellently, but the problem is that many people can't afford access to care that manages their chronic disease, not that the care is inadequate if you can pay for it.

Now that I look back maybe I could have worded it differently. My apologies if my post was misinterpreted. I meant to speak more along the lines of our failed delivery system for chronic disease rather than the actual quality you get when you do have access.
 
I get that insurance is specific and healthcare is very general. I've been treated in a socialized healthcare system. It was free. No strings.

I am looking for thoughts on universal healthcare insurance. Is it a good compromise? The other countries ahead of the U.S. seem to differ with regards to how socialistic their systems are, but we were the ONLY country out of the nineteen with no universal insurance coverage.


I think it is a good compromise. I don't feel a completely socialized system would work here, we do not have a socialized culture or economy. We can't simply take Australia's or Canada's system and plop it down here. So a truely American system would still incoprorate a lot of privitization and the employer based system we (at least traditionally) have.

The problem is though, you can't cover everybody in a completely capitalized system. You need some government intervention or plan to cover those who cannot support themselves. I like an idea similar to our education system (similar, not exact though), which is really semi privatized. There is the public school system (not run at a federal level, but at a local level), but you can "opt" out of it if you can afford private school. In healthcare, we could have a government provided insurance (aka public school). You still have to pay for it, but it is subsidized according to income (lower income you pay little, higher income you pay as much as private insurance would charge). This provides competition for HMOs at the high income levels and covers everybody at low-mid income. And if we provide incentive for more employers to insure their workers as I prevously described, the government program would actually be relatively small. (not nearly as proportionally big as our public schools).

The government plan wouldn't even have to be really part of the government per se. Similar to, say, Amtrak; it's stock is owned by the govt and it is subsidized, but run independently. I think that is a good "compromise" as you speak of.
 
The guy quoted in the study says access to care is the problem in the U.S. Is it wrong to say that the lower class and elderly population have access to care? They are already covered by medicare and medicaid. The portion of the population that doesn't have access is the middle class because they postpone treatment to avoid paying out-of-pocket, high deductibles, or increased premiums if they seek health care. The working class "can't afford to get sick," but are already taxed to support a healthcare system for those who can't/don't work.
 
The guy quoted in the study says access to care is the problem in the U.S. Is it wrong to say that the lower class and elderly population have access to care? They are already covered by medicare and medicaid. The portion of the population that doesn't have access is the middle class because they postpone treatment to avoid paying out-of-pocket, high deductibles, or increased premiums if they seek health care. The working class "can't afford to get sick," but are already taxed to support a healthcare system for those who can't/don't work.

No that's right. The income group at the greatest risk and where most of the uninsured fall is the middle class, those who do not qualify for medicaid yet still cannot afford private insurance.

The quality of what medicaid/care has to offer is another debate, but as far as access goes you are correct and somewhat ironic that the working class has to subsidize many non-workers (although this is a generalization) and yet don't get a break themselves.
 
On the other hand, access to care is more difficult in the medicare/medicaid system due to the fact that many providers will not accept patients with this coverage. I imagine that this contributes to the preventable deaths figures as well.

I just spoke to a career health insurance guy, and he thinks that government regulation of cost, not government management, is a part of the solution.
 
aaaand the thread died

Yeah, dissapointing. I tried to word the original post to make it specific to pre-allo so it wouldn't move, but I guess I failed. Topics in Healthcare is a good idea for a forum but kind of a wasteland...the boneyard of threads that were moved here.
 
that's something we're working on (regrouping the forums)

But don't let this thread die!!!

Maybe while regrouping the forums you could classify them as either "Community" (Like pre-med-> residents etc.) or "Informative" (Research, financial aid, Healthcare etc.), or something along those lines. Just thinking it would make it a little easier for people to find their way around

Perhaps in the high traffic forums like pre-allo/osteo or the MS boards we could have a sticky with links to all the "Informative" forums such as this one, research, financial aid etc. There is nobody who wouldn't benefit from discussing these topics but I don't think a lot of people know about these threads.
 
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