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Musings on the US medical system

by edwin Wed May 30th, 2007 at 06:49:24 PM EST

An amateurish attempt of understanding WHO results in healthy life expectancy:

http://www.who.int/whosis/whostat2006_mortality.xls (warning xls spread sheet)
Data sorted on healthy life expectancy

HALE - Healthy life is the number of healthy years one can expect to live.
Here are a few selected countries: (life male/female healthy life male/female)

Rank country life hale
1Japan79/8672/778
2San Marino79/8471/76
11Canada78/8370/74
29United States75/8067/71
32Cuba75/8067/70


First of all Canada is a thoroughly mediocre country when it comes to health care - coming in at position 11. Japan appears to be the best country closely followed by San Marino. Following San Marion is Sweden, Switzerland, Monaco and Iceland.

The US is a stunning 29th. Looking at Cuba at 32 should cause a certain amount of embarrassment and shock. While my list doesn't show it due to rounding, the average women in the US has just under 2 years more healthy life expectancy than the average Cuban. For men that figure shrinks to about a quarter of a year.

Cuba looks truly impressive, being #1 in the 3rd world for health care. The United States should be worried that Cuba may catch up and surpass them.

Ok, what's up? This is where conjecture and trying to make sense of various articles I have read comes in. Cuba seems to work very hard on preventative medicine. Perhaps Cuba has driven preventative medicine close to a realistic limit. When looking at what are the success of a country under cold war harassment and economic blockade this is truly an impressive result. At some point toys start playing more and more of a major effect on health care. Those few extra years require ever increasing amounts of money to pull off.

The US has the toys. Who knows, it may have more toys than anyone else. I have an aunt in Los Angeles who receives top-notch medical care - probably better than what I receive in Canada. What's up? Part of that answer can be found in my own health. As a child I occasionally had "stomach" pains. We never went to see a doctor and they always went away. To try to diagnose what may be nothing at all was prohibitively expensive to a family that had a working class income and didn't have good medical insurance. As an adult, in Canada, I have been diagnosed with a rare disease. It does not matter how good the toys are if you are unable to use them. My impression is that crisis medicine is truly at a high art in the US. Tests are relatively easy and waiting lists are shorter. You have to have the insurance though. But it is not only the tests and access. Preventative medicine is also required, and it does not pay nearly as well as crisis medicine. US medicine has proven to be a very expensive way to get limited results.

So what is the life expectancy of my aunt who is blessed with good health insurance? That is unknown, but one imagines that the rich get something for their money. Probably there is a strong correlation between access to health care and life expectancy. The rich get better medical care and probably live longer. What that translates into is this:

The median Cuban probably lives longer and has a healthier life than a median American. At any given time it may be true that for a specific condition you would be better off in the US than Cuba, but on whole you would be better off in Cuba health wise.

Lets look at it in terms of numbers. The average American gives 5.5 years of their life in order reap the benefits of a libertarianized medical system. The US has a population of 301,140,000 more or less. To oversimplify, if this was Japan we would expect 3,650,000 deaths a year. In Canada we would expect 3,741,000 deaths a year. In the US we would expect 3,886,000 deaths a year. The US pays 235,000 deaths a year compared to Japan or 145,000 deaths a year compared to Canada. Forget about US soldiers dying in Iraq, or dying from gun violence. The big deaths are within the medical system - murdered by American health care.

Full table

RankLife FMHealth FM
192Sierra Leone37402730
191Lesotho39443033
190Angola38423235
189Zimbabwe37343433
188Swaziland36393335
187Zambia40403535
186Malawi41413535
185Burundi42473337
184Liberia39443437
183Niger42413635
182Afghanistan42423536
181Burkina Faso47483536
180Botswana40403635
179Somalia43453638
178Mozambique44463638
177Democratic Republic of the Congo42473539
176Central African Republic40413738
175Mali44473738
174Rwanda44473640
173Côte d'Ivoire41473841
172United Republic of Tanzania47494041
171Guinea-Bissau45484041
170Chad45484042
169Ethiopia49514142
168Cameroon50514142
167Nigeria45464142
166Uganda48514244
165Djibouti54574343
164Namibia52554344
163Haiti53564344
162Benin52534345
161South Africa47494345
160Kenya51504445
159Mauritania55604346
158Togo52564446
157Guinea52554446
156Equatorial Guinea42444546
155Congo53554547
154Lao People's Democratic Republic58604747
153Cambodia51584649
152Senegal54574749
151Sudan56604750
150Madagascar55594750
149Yemen57614851
148Gambia55594851
147Ghana56584950
146Timor-Leste61664852
145Eritrea58624951
144Iraq51614951
143Gabon55595053
142Myanmar56635053
141Nepal61615251
140Papua New Guinea58615152
139Bhutan62655353
138Tuvalu61625353
137Pakistan62635452
136India61635354
135Kiribati63675256
134Bangladesh62635553
133Bolivia63665455
132Sao Tome and Principe57605455
131Turkmenistan56655257
130Comoros62675455
129Tajikistan62645356
128Marshall Islands60645456
127Nauru58655357
126Guyana62645357
125Kyrgyzstan59675258
124Mongolia61695358
123Kazakhstan56675359
122Solomon Islands66705557
121Azerbaijan63685659
120Guatemala65715560
119Iran (Islamic Republic of)68725659
118Micronesia (Federated States of)68715758
117Maldives66685957
116Indonesia65685759
115Honduras65705661
114Russian Federation59725364
113Fiji66715761
112Suriname65705761
111Democratic People's Republic of Korea65685860
110Vanuatu67695859
109Egypt66705860
108Grenada66695860
107Ukraine62735564
106Philippines65725762
105Uzbekistan63695861
104Dominican Republic64705762
103Palau67705960
102Samoa66705960
101El Salvador68745762
100Brazil67745762
99Republic of Moldova64715762
98Thailand67735862
97Morocco69735961
96Belize65725862
95Lebanon68725962
94Niue68745962
93Algeria69726062
92Belarus63745765
91Cape Verde67715963
90Peru69736062
89Armenia65725963
88Jordan69736062
87Saint Vincent and the Grenadines66736062
86Seychelles67785765
85Viet Nam69746063
84Albania69745963
83Saudi Arabia68746063
82Nicaragua67716063
81Saint Kitts and Nevis69726063
80Sri Lanka68755964
79Cook Islands70756163
78Syrian Arab Republic70746063
77Tonga71706262
76Antigua and Barbuda70756064
75Paraguay70746064
74Ecuador70756064
73Trinidad and Tobago67736064
72Turkey69736163
71Colombia68775866
70Mauritius69756065
69Tunisia70746164
68Saint Lucia71776164
67Latvia66765868
66Romania68766165
65Malaysia69746265
64Lithuania66785968
63The former Yugoslav Republic of Macedonia69766265
62Bahamas70766166
61Libyan Arab Jamahiriya70756265
60Dominica72766266
59Serbia and Montenegro70756365
58United Arab Emirates76796464
57Oman71776365
56Estonia66785969
55China70746365
54Venezuela (Bolivarian Republic of)72786267
53Bahrain73756464
52Bosnia and Herzegovina70776266
51Georgia70776267
50Bulgaria69766367
49Hungary69776268
48Jamaica70746466
47Qatar76756764
46Brunei Darussalam76786566
45Argentina71786268
44Mexico72776368
43Barbados71786368
42Poland71796368
41Panama73786468
40Uruguay71796369
39Slovakia70786369
38 72796469
37Kuwait76786767
36Costa Rica75806569
35Chile74816570
34Cyprus77826768
33Republic of Korea73806571
32Cuba75806770
31Czech Republic73796671
30Portugal74816772
29United States of America75806771
28Slovenia73816772
27Ireland75816872
26Denmark75806971
25Singapore77826971
24United Kingdom76816972
23New Zealand77826972
22Greece77826973
21Finland75826974
20Belgium75816973
19Netherlands77817073
18Malta76817073
17Israel78827072
16Austria76826974
15Luxembourg76816974
14Germany76827074
13Norway77827074
12France76836975
11Canada78837074
10Andorra77837075
9Spain77837075
8Australia78837174
7Italy78847175
6Iceland79837274
5Monaco78857175
4Switzerland78837175
3Sweden78837275
2San Marino79847176
1Japan79867278

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I think you are assuming these numbers judge the efficacy of the various healthcare systems, and they do not.  These numbers simply measure the life spans of people in the various countries.  Life span is influenced by many other things, and just a few examples:
1.  How healthy is the life style of the population?
-Americans live a notoriously unhealthy life style.  Take weight as just one example.  Americans have got to be the fatest people in the world, and an incredible number of diseases come with being overweight--diabetes, cardiac artery disease, etc.
-The murder rate is very high in America.  Many would say due to the basically unrestricted control on guns.  But it's also due to a very diverse society, where frictions can develop.  But let me not discuss the cause, but just note the fact.
-Drug and alcohol abuse are very high in America.  This hurts health in general, of course.  But it also has a very direct impact on births, unfortunately.  The number of pre-mature babies, crack babies, etc, are outrageously high.  And of course not only is this very sad, but deaths before the age of one have significant impact on overly longevity numbers.
-There are many more points to be made here, but I'll leave these as examples supporting the overall point.
2.  Certain ethnic groups seem to have longer lifespans due to good genes.  Japan and Iceland in particular would benefit from that.  The US is of course extremely diverse, and will not compare favorably to those two countries.

Comparing medical systems is certainly doable, but to get it right it requires going to a much lower level of detail.  so for example, if you want to see how well a group of medical systems handle coronary artery disease, you would have to look at groups of, for example, men, in a certain age bracket, who present with very similar health overall (half of one group can't be diabetics while 10% of another group or diabetics--this impact would likely heavily bias the results), and the men would have to be broken into groups with similar levels of stenosis and likely in the same set of coronary arteries--but for example, one group couldn't have 50% of the patients being treated for occlusions in four vessels, and another group have 5% being treated for four vessel occlusions.

You would also have to look at access to healthcare.  are there groups of people who are not treated?  How quickly are they diagnosed and treated?  So for example in the US, we have found that one of the key variables in handling heart attacks is how quickly the patient is rushed to the ER, and how quickly he makes it to the OR.  

There are many more points to be made that explain the reason that such gross statistics are totally inadequate to assess medical systems.  But hopefully this has provided some help.

Certainly such statistics as these do raise questions.  Why are there these differences?  And they may very well be a criticism in a broader sense of the overall US life style, if you could factor out ethnicity impacts for example.  But they are not valuable in assessing healthcare systems.

by wchurchill on Wed May 30th, 2007 at 08:31:33 PM EST
How a country deals with things like weight are considered health issues in most countries. The same with the more general heading of life style. I think that this is partially why Cuba rates so high. Health care goes way beyond broken arms and cancer. Most countries have treated couch potato syndrome as a health issue. In Canada there has been an ongoing attempt to get people off the couch doing something.

When it comes to the murder rate - it appears to be about 13,000 people per year, or about 10% of the difference in life expectancy between Canada and the US. (.042802 per 1,000). It seems perfectly reasonable to treat this too as a health issue.

I am thoroughly confused as to how access to health care is not part of health care.

The actual survival rate or the actual ability to handle coronary arteries seems to fail to deal with prevention - a key component of health care.

I find it amazing that Japanese - for example, would be predisposed to live over 5 years longer than Americans.

Certainly what I have presented is a rough look, but I think that it is far from useless.


aspiring to genteel poverty

by edwin (eeeeeeee222222rrrrreeeeeaaaaadddddd@@@@yyyyaaaaaaa) on Wed May 30th, 2007 at 09:12:08 PM EST
[ Parent ]
You said
I am thoroughly confused as to how access to health care is not part of health care.
 But of course access is part of measuring the healthcare system.  As is time to the ER for heart attacks.  As is time from the ER to the OR, which was the point of my comment following
You would also have to look at access to healthcare.  are there groups of people who are not treated?  How quickly are they diagnosed and treated?  So for example in the US, we have found that one of the key variables in handling heart attacks is how quickly the patient is rushed to the ER, and how quickly he makes it to the OR.

You said

The actual survival rate or the actual ability to handle coronary arteries seems to fail to deal with prevention - a key component of health care.
No, this would not be measuring prevention.  It would be measuring treatment.

You said

I find it amazing that Japanese - for example, would be predisposed to live over 5 years longer than Americans.
last time I looked, Americans were not classified as an ethnic group.  And I didn't say Japanese were presdisposed to live five years longer than Americans.

You said

Health care goes way beyond broken arms and cancer. Most countries have treated couch potato syndrome as a health issue.
Actually I think you'll find that America has been in the forefront of suggesting lifestyle changes. You might take warnings regarding cigarettes and public information campaigns, and compare how quickly the US got on this as opposed to other countries.   I get plenty of advice on exercize and the right diet, right here in the USA.  But at the end of the day, in America we are all free to make our own decisions regarding these words of advice. the fact that we may ignore them and put on weight might be a very valid criticism of our society, but not of our healthcare system.
by wchurchill on Thu May 31st, 2007 at 01:57:54 AM EST
[ Parent ]
thanks for this interesting diary.

i think that we can learn immense amounts from studying how different diseases are connected to different diets, and how when people travel and live abroad, changing their diets to match their new environments, succumb to the problems that occur in the adopted area.

i'd love to know more about this.

iceland is full of hot springs, and has a strong superstition still active in the peoples' imaginations.

san marino is tiny, and resembles italy entirely. the only distinction i'm aware of is in banking laws.

japan....strong traditions, reverence for culinary basics.

italy, if you can get over the 'best-dressed third world' issues, (basically chill out about the problems and have a goodish life anyway, like the italians do), is understandable, (strong traditions, reverence -to the point of fetishisation and way beyond! - for culinary basics.

it's very hard to see obvious connections, but i find it endlessly fascinating to search for them anyway.

meanwhile, i'd love to find links about regional and national diseases, and how changing your habitat can influence your chances to live a long, healthy life.

what would you google to find them, migeru, master wikiman?

'The history of public debt is full of irony. It rarely follows our ideas of order and justice.' Thomas Piketty

by melo (melometa4(at)gmail.com) on Thu May 31st, 2007 at 04:54:30 AM EST
San Marino, Monaco and Andorra are all tiny, virtually city states. Andorra, as might be expected, falls between Spain and France on the list. The other two both have a higher proportion of rich compared to the surrounding countries but also benefit from the health systems there too.

I would also suspect that all three have a population that is far more active than might be expected. They are after all very "vertical" countries and slogging up and down hills all the time is good exercise. There is also the tradition of the evening stroll to meet, greet and show off.

by Londonbear on Fri Jun 1st, 2007 at 04:11:43 AM EST
[ Parent ]


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