Death by bad health care

Aug 5, 2009 1:55 PM

As we noted previously, comparing different countries’ health care systems is tough because of the many variables involved, such as the fact that the U.S. has both the highest rate of overweight and obesity and the lowest smoking rate of the eight industrialized countries we’ve been looking at. And let’s not even get into matters like diet: how to compare Japanese who live on rice, fish, and vegetables to the wine-and-cheese-loving French to the fast-food-eating Americans?

Enter the concept of "amenable mortality." Invented years ago in the United States and used worldwide by researchers ever since, it’s basically a body count of people who die for want of "timely and effective health care." A higher rate is bad, because it means the country’s health care system is falling down on its one and only job, which is to keep people healthy and do the best job possible of treating them if they get sick.

Examples of the types of deaths we’re talking about:

Adults who die from breast or colon cancer before age 75, indicating lack of timely mammograms or colon screens or care.
Children who die before age 14 from vaccine-preventable or easily treatable illnesses such as coughs, measles, asthma, and other respiratory problems.
Diabetics who die before age 50 from complications that could easily have been prevented with proper medical management.
People who die from infections or hypertension before age 75, a symptom of lack of preventative and appropriate care, including blood pressure control.

Back in the mid-1990s, two British researchers measured amenable mortality in 19 industrialized countries. At the time, the U.S. ranked 15th out of the 19 (above*).

Last year, the same two researchers published an update, in the January-February, 2008 issue of the scholarly journal Health Affairs. (You need a subscription to access the full article but can read a good summary of it here.) Sadly, the U.S. had by this time fallen to last place (right*).

"We got better by 4 percent, but the other countries got better by 16 percent, and the United Kingdom just blew right by us," says Cathy Schoen, M.S., senior vice president for research and evaluationof the Commonwealth Fund, a non-profit health care research organization.

If the U.S. could improve and reach the average of 18 other countries, much 75,000 deaths a year would be saved. If the U.S. could reach the rate of the top three countries, there would be 101,000 fewer deaths per year.

Something to keep in mind the next time you hear a politician boast that the U.S. has "the best health care in the world" or warn of the supposed horrors of the British or Canadian systems.

—Nancy Metcalf, Senior Program Editor

*Click image to enlarge

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