Unbiased Analysis of Today's Healthcare Issues

Low Life Expectancy in the United States: Is the Health Care System at Fault?

Written By: Jason Shafrin - Sep• 08•09

Americans pay more for medical care than any other country and have one of the highest levels of income per capita of any country in the world. Despite its immense wealth and healthcare spending, the United States ranks 50th in life expectancy, worse than Jordan, South Korea, and Bosnia and Herzegovina. In a Commonwealth Fund report, the U.S. ranks last among 19 countries according to the criteria of “Mortality amenable to medical care.”

Despite these facts Preston and Ho (2009) claim that the American medical system is in fact very good. Instead of using overall life expectancy, Preston and Ho use more accurate measures of how well the American health care system operates. One could use the incidence rate of disease. However, effective diagnosis and early diagnosis will inflate statistics measuring incidence–since early stage disease is found in more patients–but also increases the probability a treatment is successful. For instance, “the United States has a higher prevalence than Europe of the major adult diseases, including cancer, heart disease, and diabetes (Thorpe et al. 2007; Avendano et al. 2009). But higher prevalence could reflect higher incidence, better detection, or longer survival resulting from more successful treatment…Relatively high survival rates imply either that the disease has been detected unusually early or that treatment is unusually successful.”

The thesis of the paper is that the U.S. does a better job of screening patients for cancer as well as providing more aggressive treatment. The authors find:

“mortality reductions from prostate cancer and breast cancer have been exceptionally rapid in the United States relative to a set of peer countries. We have argued that these unusually rapid declines are attributable to wider screening and more aggressive treatment of these diseases in the US…5-year survival rates from all of the major cancers are very favorable; survival rates following heart attack and stroke are also favorable (although one-year survival rates following stroke are not above average); the proportion of people with elevated blood pressure or cholesterol levels who are receiving medication is well above European standards.”

This still leaves the question of why life expectancy is so low when the U.S. health care system is good. Likely the reasons are behavioral (e.g., smoking, obesity, stress) or public health related (e.g., clean drinking water, sanitation, pollution), and are not due to problems within the medical system. While the U.S. health care system is far from perfect, it is likely comparable or slightly superior to the medical care received in other developed countries.

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10 Comments

  1. Meredith says:

    You seriously don’t think it’s worth mentioning the number of people who don’t have health insurance as a contributing factor to life expectancy? Come on, who are you trying to fool?

    Behavioral contributors is a valid point.

    However, the suggestion that lack of clean drinking water and sanitation are factors made me laugh out loud. It’s been about three quarters of a century since we could pin deaths on dirty water in this country. Clean drinking water and sanitation might be an issue if lots of people were dying of bacterial illness. The one place you’re most likely to get a fatal infection in this country is in a hospital or nursing facility.

    Treating some of the people very well doesn’t mean we have a good healthcare system. Sorry.

  2. What about infant mortality rates (U.S. is #37 I think). Is this behavioral or environmental, too? What about deaths from treatable deceases (U.S. is #19 out of 19 surveyed countries)?

  3. [...] via Healthcare Economist · Low Life Expectancy in the United States: Is the Health Care System at Fault…. [...]

  4. v says:

    To the previous commenters:

    The infant mortality rates in the U.S. are actually a simple function of the fact that in the U.S., the rate fo survival for prematurely born infants is so much higher and also that we count stillbirths on our statistics which most countries do not. Neither of these contributing factors makes the larger point about the health system that you seem to think the mortality rate implies…

    As for the uninsured, they have, after controlling for socioeconomic factors, almost identical outcomes as the insured which is most likely a function of the fact that emergency care in this country is available to all and that many of the biggest killers in this country are heavily influenced by behavioral factors independent of health care…Hardly the strong case for reform that you would imply…I admit that clean drinking water and sanitation are not major causes of morbidity in America…Finally, as to your final point, “Treating some of the people very well doesn’t mean we have a good healthcare system” that is a value judgment; to me, a good health care system treats the sickest (i.e. those with cancer, those about to die, etc.) the best and lets the strong ones (relatively) earn money for their own preventive care i.e. unequal treatment is not necessarily a bad system…Like it or not, our health care system does this, albeit in an inefficient manner…

  5. Hm, are you saying that infant mortality rate in U.S. is high because of the high survival rate of premature babies? I’m not sure I’m following the logic (shouldn’t high survival rate decrease mortality rate?). I’ve heard the argument about discrepancies in counting, but I have hard time believing that all countries that rank better than us use different criteria. If I’m not mistaken, Canada, Scandinavian countries, and some others count premature babies with relatively low odds of survival as live births, and yet they still do better than us. BTW, our stillbirth rate is not great either. And what about deaths from treatable deceases?

  6. [...] the Healthcare Economist: Americans pay more for medical care than any other country and have one of the highest levels of [...]

  7. Meredith says:

    “As for the uninsured, they have, after controlling for socioeconomic factors, almost identical outcomes as the insured which is most likely a function of the fact that emergency care in this country is available to all and that many of the biggest killers in this country are heavily influenced by behavioral factors independent of health care…”

    Source please. I’d like to know how they judge outcomes and in what population. I find it hard to believe, for example, that uninsured people with diabetes actually have the same rates of poor outcomes like kidney failure, amputation, blindness, heart attack, and stroke as people with insurance.

    “a good health care system treats the sickest (i.e. those with cancer, those about to die, etc.) the best and lets the strong ones (relatively) earn money for their own preventive care i.e. unequal treatment is not necessarily a bad system…Like it or not, our health care system does this, albeit in an inefficient manner…”

    Fine, I’ll let you ignore mortality measures. However, you still can’t make the claim that we have a good system because of life expectancy, which you haven’t yet properly explained. Sanitation is not a factor, which you’ve already admitted, so what you’re saying is the entire life expectancy difference is due to behavior? And changes in behavior like smoking cessation and weight loss should be considered entirely independent from our health care system?

  8. Check this out: “How Does the Quality of U.S. Health Care Compare
    Internationally: Timely Analysis of Immediate Health Policy Issues:
    August 2009″ by Elizabeth Docteur and Robert A. Berenson (http://www.rwjf.org/files/research/qualityquickstrikeaug2009.pdf)

  9. KK says:

    My belief is that if someone is going to participate in an intellectual discussion board they should know how to spell the word disease and if you don’t know how to spell it you should learn. The high survival rate of premature babies may contribute to the high infant mortality rate because more babies are surviving that shouldn’t have. Therefore, they are more susceptible to disease and infections due to their underdeveloped immune system. Still having trouble with the concept? Well, do some research and look up the word disease while you are at it.

  10. Code Red says:

    [...] evidence that perhaps we really do get our money’s worth out of the U.S. system.  I am not the first to blog about this study, but I think it is important enough to do all I can get the message [...]

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