US ranked 46th in world Health Care efficiency(bloomberg.com)
bloomberg.com
US ranked 46th in world Health Care efficiency
http://www.bloomberg.com/visual-data/best-and-worst/most-efficient-health-care-countries
6 comments
> say, roughly equal to early 1990s US standards
If you think any Developed country in the world has healthcare equal to early 1990s US standards, you're very confused.
If you're talking about Developing or undeveloped countries, why would you want to compare the richest country in the world to developing or undeveloped countries? I would have expected you to aim higher than the bottom of the heap.
If you think any Developed country in the world has healthcare equal to early 1990s US standards, you're very confused.
If you're talking about Developing or undeveloped countries, why would you want to compare the richest country in the world to developing or undeveloped countries? I would have expected you to aim higher than the bottom of the heap.
I'm talking about developing countries... which I think should be praised for figuring out how to maximize efficiency and value to serve very poor populations at low cost.
I was around in the 1990s (in the US) and at the time I thought the healthcare system did a pretty good job. A decade or two later and for most diseases, little has changed about the treatments/practices.
So for 95% of healthcare issues, 1990s medicine is just as good as 2013 medicine. The fallacy upon which much of the cost bloat is built is the idea that all costs should be increasing b/c quality is increasing in some key areas (like cancer treatment).
Ironically, the areas in the US that offer the biggest area for improvement are things like basic systems and process improvements... things like being sure someone helps the 70 year old patient walk the hall twice a day to retain mobility during a hospital stay (even if the reason for the hospital stay is something like a bad cold, a fall, or dehydration from vomiting). Most of the things that can offer significant outcome improvements are very low tech.
I was around in the 1990s (in the US) and at the time I thought the healthcare system did a pretty good job. A decade or two later and for most diseases, little has changed about the treatments/practices.
So for 95% of healthcare issues, 1990s medicine is just as good as 2013 medicine. The fallacy upon which much of the cost bloat is built is the idea that all costs should be increasing b/c quality is increasing in some key areas (like cancer treatment).
Ironically, the areas in the US that offer the biggest area for improvement are things like basic systems and process improvements... things like being sure someone helps the 70 year old patient walk the hall twice a day to retain mobility during a hospital stay (even if the reason for the hospital stay is something like a bad cold, a fall, or dehydration from vomiting). Most of the things that can offer significant outcome improvements are very low tech.
It's highly misleading. It might be more useful to see an analysis of the marginal change in outcomes per spend, where spend is measured in terms of the average wage hour in a particular country.
Wow, it's amazing to me that a sentence with such contorted grammar and logic could be the start of the highest rated comment here.
The US health care "system" has been discussed here a lot. Unless you've been asleep, you should know a variety of corrupt rent seekers suck more wealth here than the average GDP of a medium sized third world country.
Yes, it's inefficient, it's supremely, ungodly inefficient. It might not be the largest "wealth-sink-hole" the world has ever known but it's up there. Yes, there's real health care and even cutting treatments on the edge of this monster. Whatever.
The monster is real.
And other, even marginally first world countries don't do this. http://en.wikipedia.org/wiki/Health_care_in_Australia
Wow, it's amazing to me that a sentence with such contorted grammar and logic could be the start of the highest rated comment here.
The US health care "system" has been discussed here a lot. Unless you've been asleep, you should know a variety of corrupt rent seekers suck more wealth here than the average GDP of a medium sized third world country.
Yes, it's inefficient, it's supremely, ungodly inefficient. It might not be the largest "wealth-sink-hole" the world has ever known but it's up there. Yes, there's real health care and even cutting treatments on the edge of this monster. Whatever.
The monster is real.
And other, even marginally first world countries don't do this. http://en.wikipedia.org/wiki/Health_care_in_Australia
The simplest way to improve efficiency would be to crack down on end of life care abuses. However the population that benefits, senior citizens, is one of the most entrenched and powerful political lobbying groups in the US.
There is something bizarre about the American psyche that leads us to overspend on end of life care. It makes no sense. Countries like France and Canada don't allow it and get huge efficiency gains b/c of it.
Americans are also uniquely litigious. We expect doctors to be perfect and demand extreme degrees of training and accountability. The minute the smallest mistake is make (the kind which most of us make dozens of times per day in our normal jobs) we expect the legal system to assist us with revenge and remuneration. This not only ads tremendous cost but drives up the quality of doctors to the point where there are barely enough people qualified to go through medical training. Top tier med schools typically over admit and have to weed out a few students each year. Still others burn out b/c they could not handle the rigor.
It would make sense for us to significantly lower the bar on physician quality and for the government to stop providing reimbursement for much of the costly end of life care that is now routine... but those solutions will never fly.
Most of the critiques about our system (and this one, disguised as a plea for efficiency) are complaints about what has happened prices after the market has responded to all the incentives, psychologies, laws, etc. This leads to the proposed solutions usually being variations on price controls.
Americans want to be fat, we want to smoke, we want to have our "insurance" pay $200K for our last week of life hooked up to a dozen machines while our semi-estranged families arrange time off work to fly in and not feel too bad about themselves for being absent from our lives..., and we want to be able to file a lawsuit if a 1 in 100 mistake occurs. These are the privileges that we pay top dollar for.
There is something bizarre about the American psyche that leads us to overspend on end of life care. It makes no sense. Countries like France and Canada don't allow it and get huge efficiency gains b/c of it.
Americans are also uniquely litigious. We expect doctors to be perfect and demand extreme degrees of training and accountability. The minute the smallest mistake is make (the kind which most of us make dozens of times per day in our normal jobs) we expect the legal system to assist us with revenge and remuneration. This not only ads tremendous cost but drives up the quality of doctors to the point where there are barely enough people qualified to go through medical training. Top tier med schools typically over admit and have to weed out a few students each year. Still others burn out b/c they could not handle the rigor.
It would make sense for us to significantly lower the bar on physician quality and for the government to stop providing reimbursement for much of the costly end of life care that is now routine... but those solutions will never fly.
Most of the critiques about our system (and this one, disguised as a plea for efficiency) are complaints about what has happened prices after the market has responded to all the incentives, psychologies, laws, etc. This leads to the proposed solutions usually being variations on price controls.
Americans want to be fat, we want to smoke, we want to have our "insurance" pay $200K for our last week of life hooked up to a dozen machines while our semi-estranged families arrange time off work to fly in and not feel too bad about themselves for being absent from our lives..., and we want to be able to file a lawsuit if a 1 in 100 mistake occurs. These are the privileges that we pay top dollar for.
Americans want to be fat
You're making nonsense statements apparently dictated by your ideology. The average American is confronted by a variety of choices and often windups making choices which results in them being fat.
Of course they are unhappy with the result and don't want to be fat in any non-cockeyed sense of 'want'.
But of course such desires don't matter unless there is a concrete policy to prevent such things.
With a little more sophistication, one might spin out the point that Americans democratically and collectively decided that having the option of cheap and dubious junk food is more important than remaining thin and fit. Sure but that argument hinges on American democracy not having been fully captured by various corporations which benefit from these short-sighted and unhealthy policies.
You're making nonsense statements apparently dictated by your ideology. The average American is confronted by a variety of choices and often windups making choices which results in them being fat.
Of course they are unhappy with the result and don't want to be fat in any non-cockeyed sense of 'want'.
But of course such desires don't matter unless there is a concrete policy to prevent such things.
With a little more sophistication, one might spin out the point that Americans democratically and collectively decided that having the option of cheap and dubious junk food is more important than remaining thin and fit. Sure but that argument hinges on American democracy not having been fully captured by various corporations which benefit from these short-sighted and unhealthy policies.
So you think there should be laws to prevent people from behaving in a shortsighted way?
Some people's utility function is simply short-term oriented. I speak from experience -- I had the fried chicken (at a variety of different NYC gastro pubs) four times in the past month. Definitely short-sighted and foolish for my health and BMI.
Similarly, doing a startup is not rational. Most fail and the expected returns are worse than if the money were invested in an index fund.
Unless you advocate some kind of police state that enforces constraints on aspects of peoples' utility function that most of us happily enjoy choosing, I don't think you'll be able to achieve the kind of world you envision (corporations or not).
Even if we try to "nudge" behavior using subtle approaches, as Thaler and Sunstein advocate, there are practical limits, and a system of laws to enforce "good nudges" gets absurd pretty quickly.
I think my argument is supported by Michael Moore's conclusion in Bowling for Columbine. America is a unique and odd place. There is something about America that gives those who are down on their luck the hope to put that last quarter into a slot machine. It's the same thing that leads people to drop out of Harvard or Stanford to do a startup.
America's healthcare debacle is just as much a function of our unique psyche, and it's inseparably linked to some of the greatest aspects of our culture... for example our faith in medical breakthroughs and the optimism that fosters, our desire to fight mortality and disease through science, and our odd secular crutch of granting doctors too much authority.
Some people's utility function is simply short-term oriented. I speak from experience -- I had the fried chicken (at a variety of different NYC gastro pubs) four times in the past month. Definitely short-sighted and foolish for my health and BMI.
Similarly, doing a startup is not rational. Most fail and the expected returns are worse than if the money were invested in an index fund.
Unless you advocate some kind of police state that enforces constraints on aspects of peoples' utility function that most of us happily enjoy choosing, I don't think you'll be able to achieve the kind of world you envision (corporations or not).
Even if we try to "nudge" behavior using subtle approaches, as Thaler and Sunstein advocate, there are practical limits, and a system of laws to enforce "good nudges" gets absurd pretty quickly.
I think my argument is supported by Michael Moore's conclusion in Bowling for Columbine. America is a unique and odd place. There is something about America that gives those who are down on their luck the hope to put that last quarter into a slot machine. It's the same thing that leads people to drop out of Harvard or Stanford to do a startup.
America's healthcare debacle is just as much a function of our unique psyche, and it's inseparably linked to some of the greatest aspects of our culture... for example our faith in medical breakthroughs and the optimism that fosters, our desire to fight mortality and disease through science, and our odd secular crutch of granting doctors too much authority.
I know the US healthcare system has problems, but really? Worse than Cuba or Libya?
You're going to get some weird results if you use life expectancy without filtering out the impact of variables that have nothing at all to do with healthcare (i.e. automobile accidents, incidence of premature births, etc).
You're going to get some weird results if you use life expectancy without filtering out the impact of variables that have nothing at all to do with healthcare (i.e. automobile accidents, incidence of premature births, etc).
Cuba
Have you not seen Sicko [1] by Michael Moore? Cuba has a fantastic universal health care system. A friend from Canada lived and worked there for 3 years, he had some amazing things to say about it, and how much the Canadian system could learn from it.
Libya
A poster on Reddit who lives there mentioned that before all the crap going down now, Libya too had a fantastic Universal Health Care system. The Redditor in question mentioned it's comparable to the stories you hear from Scandinavian countries, Australia, NZ, etc. etc. (i.e. horrible car crash, totally free. Years of Cancer treatment, totally free, etc.)
[1] http://en.wikipedia.org/wiki/Sicko
Have you not seen Sicko [1] by Michael Moore? Cuba has a fantastic universal health care system. A friend from Canada lived and worked there for 3 years, he had some amazing things to say about it, and how much the Canadian system could learn from it.
Libya
A poster on Reddit who lives there mentioned that before all the crap going down now, Libya too had a fantastic Universal Health Care system. The Redditor in question mentioned it's comparable to the stories you hear from Scandinavian countries, Australia, NZ, etc. etc. (i.e. horrible car crash, totally free. Years of Cancer treatment, totally free, etc.)
[1] http://en.wikipedia.org/wiki/Sicko
Before you start to quote a recognizable authority on healthcare (i.e. Michael Moore), you may want to read some of the rebuttals of the movie.
Apparently the video was shot at the hospitals that are either used by the ruling class or ex-pats. Most of the hospitals that Cubans have access to don't even have the necessary basic supplies.
http://en.wikipedia.org/wiki/Healthcare_in_Cuba#Criticism
Now don't get me wrong, I'm not saying Cuba doesn't do a lot with what they have, but the comparison is simply ridiculous.
Apparently the video was shot at the hospitals that are either used by the ruling class or ex-pats. Most of the hospitals that Cubans have access to don't even have the necessary basic supplies.
http://en.wikipedia.org/wiki/Healthcare_in_Cuba#Criticism
Now don't get me wrong, I'm not saying Cuba doesn't do a lot with what they have, but the comparison is simply ridiculous.
That is not the situation for most Cubans. Much of my family lives in Cuba, and their experiences aren't so great. It's amazing given the low income of the country, but there really isn't the access to medicine and modern technology that developed countries get.
It's worth mentioning that, unlike Cuba, Libya is a wealthy country by at least some yardsticks - it has significant oil money and has used at least some of that money to improve the average standard of living.
Really.
You don't remember that Michael Moore movie, do you? Well, the US hasn't actually done anything to solve the problems since then.
Cuba is a vastly less wealthy country than the US. I notice in the chart it has a higher life expectancy. Poverty usually isn't a way to increase life expectancy. One must presume they're doing something right.
You don't remember that Michael Moore movie, do you? Well, the US hasn't actually done anything to solve the problems since then.
Cuba is a vastly less wealthy country than the US. I notice in the chart it has a higher life expectancy. Poverty usually isn't a way to increase life expectancy. One must presume they're doing something right.
> Poverty usually isn't a way to increase life expectancy. One must presume they're doing something right.
Poverty actually can be a way to increase "life expectancy", depending on how it's calculated. If a baby is about to be born horribly ill and/or premature, a poor country is likely to let it die quickly and be counted as stillborn; a rich country will apply heroic measures to keep it alive for long enough that it counts as a childhood death instead. (in the US it does anyway - the US records infant deaths differently than Europe and this also has a big effect on calculated life expectancy)
Cuba also can't afford a lot of cars or roads to drive them on, so fewer people die in auto accidents. (If you adjust for fatal accidents, US life expectancy apparently climbs to at or near the top of the chart)
Poverty actually can be a way to increase "life expectancy", depending on how it's calculated. If a baby is about to be born horribly ill and/or premature, a poor country is likely to let it die quickly and be counted as stillborn; a rich country will apply heroic measures to keep it alive for long enough that it counts as a childhood death instead. (in the US it does anyway - the US records infant deaths differently than Europe and this also has a big effect on calculated life expectancy)
Cuba also can't afford a lot of cars or roads to drive them on, so fewer people die in auto accidents. (If you adjust for fatal accidents, US life expectancy apparently climbs to at or near the top of the chart)
This is about as meaningful as ranking the US healthcare system in terms of the average height of doctors.
One of the major topics that comes up when discussing taxpayer funded universal healthcare is the fear of "Government inefficiency", which (we're lead to believe) will eventually result in increased Health Care costs.
These numbers and rankings show the United States spends drastically more than countries with universal healthcare, showing that the profit for the private healthcare industry is larger than any "Government inefficiencies".
The rankings show if the United States adopted a taxpayer funded Universal Healthcare model similar to those of Developed countries, the end-of-the-day costs for healthcare would go down, and everyone would actually have more money, not less.
These numbers and rankings show the United States spends drastically more than countries with universal healthcare, showing that the profit for the private healthcare industry is larger than any "Government inefficiencies".
The rankings show if the United States adopted a taxpayer funded Universal Healthcare model similar to those of Developed countries, the end-of-the-day costs for healthcare would go down, and everyone would actually have more money, not less.
No, the rankings really don't show that. What they show is a rating based on "life expectancy (weighted 60%), relative per capita cost of health care (30%); and absolute per capita cost of health care (10%). Countries were scored on each criterion and the scores were weighted and summed to obtain their efficiency scores. Relative cost is health cost per capita as a percentage of GDP per capita. Absolute cost is total health expenditure, which covers preventive and curative health services, family planning, nutrition activities and emergency aid."
I should also point out life expectancy is a "crock" because some of these countries do no include live births that are under a certain number of weeks. Look at the comparison of Germany vs. France vs. US.
I should also point out life expectancy is a "crock" because some of these countries do no include live births that are under a certain number of weeks. Look at the comparison of Germany vs. France vs. US.
> This is about as meaningful as ranking the US healthcare system in terms of the average height of doctors.
Can you share some details why? I don't think it is that obvious what you mean.
I see "life expectancy", "health care costs as a % of GDP/capita" and "health-care cost per capita" and some efficiency index that I can't immediately tell how it was computed. It seems "interesting" on the surface though.
Can you share some details why? I don't think it is that obvious what you mean.
I see "life expectancy", "health care costs as a % of GDP/capita" and "health-care cost per capita" and some efficiency index that I can't immediately tell how it was computed. It seems "interesting" on the surface though.
Life expectancy is not solely determined by medical care though, there are many confounding factors which are, if anything, far more important than medical care. Ranging from genetic to cultural to socio-economic.
Edit: Also, health related statics can be tricky things to measure correctly, even though it may seem simple. It can depend on how countries define live births, for example, which varies greatly from country to country. Moreover, it's not necessarily a good proxy for "health". If someone breaks their arm, for example, and is unable to get it set by a doctor then they could live the entire rest of their life with a disabling injury, perhaps with a great deal of pain, even though they may end up living just as long as anyone else. Similarly, someone may spend the last decade of their life in a very pitiable state, suffering from dementia or alzheimer's and being mistreated often though receiving enough care to live a long life while someone in another country may receive a far better level of care in their old age but die earlier because they had better access to unhealthy foods throughout their life. Or, someone may live longer through heroic means of end-of-life care (intubation, forced feedings, resuscitation, artificial respiration, etc.) which extends their nominal life though may not extend the time period of their life where they are actually properly living.
Even more importantly, this is just a shitty infographic, there is no sourcing, no description of the methodology and standards of data gathering and analysis. And yet this comes from an alleged news organization. The quality of this "report" is below the standard that would be accepted in elementary school.
Edit: Also, health related statics can be tricky things to measure correctly, even though it may seem simple. It can depend on how countries define live births, for example, which varies greatly from country to country. Moreover, it's not necessarily a good proxy for "health". If someone breaks their arm, for example, and is unable to get it set by a doctor then they could live the entire rest of their life with a disabling injury, perhaps with a great deal of pain, even though they may end up living just as long as anyone else. Similarly, someone may spend the last decade of their life in a very pitiable state, suffering from dementia or alzheimer's and being mistreated often though receiving enough care to live a long life while someone in another country may receive a far better level of care in their old age but die earlier because they had better access to unhealthy foods throughout their life. Or, someone may live longer through heroic means of end-of-life care (intubation, forced feedings, resuscitation, artificial respiration, etc.) which extends their nominal life though may not extend the time period of their life where they are actually properly living.
Even more importantly, this is just a shitty infographic, there is no sourcing, no description of the methodology and standards of data gathering and analysis. And yet this comes from an alleged news organization. The quality of this "report" is below the standard that would be accepted in elementary school.
Off-topic (but oh-my-god) from same site.
http://www.bloomberg.com/visual-data/best-and-worst/most-cas...
1: Industrial and Commercial Bank of China
$518.5B
http://www.bloomberg.com/visual-data/best-and-worst/most-cas...
1: Industrial and Commercial Bank of China
$518.5B
I am surprised the US is even that high!
We're not last!?!
The US certainly skews toward reduced efficiency for the purpose of better outcomes for some edge cases.
The average fully insured American gets worse healthcare than the president, precisely because the risk/reward calculus of preventative care, emergency care, diagnostics, etc., is viewed to be different for the president compared to the average citizen. Put differently, ensuring the president's good health is done at the cost of a bit of efficiency.
So efficiency is related to class, with the highest class people being able to "afford" lower healthcare efficiency as a kind of luxury.
Correspondingly, in countries with much lower per capita income, it's possible to deliver healthcare that is remarkably good (say, roughly equal to early 1990s US standards) for a fraction of the price of modern care.
Diseases of affluence get lots of health care spending, and many (like heart disease) offer low yield for each additional dollar. There are a few areas (some cancers) in which you'd very much prefer to be treated with 2013 medicine rather than 1992 medicine.
To opine on this issue entails a significant value judgement about the relative importance of various diseases... effectively picking winners and losers, with every dollar saved in the name of efficiency offering a benefit to one person and causing harm to another...