Overall Health Care Effectiveness

The health care debate has been very vigorous, both in the country and on this website. The Right claims the US has the best health care system in the world. This belief is undoubtedly due to the very low government involvement in US health care system. More government involvement or at least more restrictive government involvement will undoubtedly (the classic argument goes) lead toward worse health care, as the government moves slower than the free market does. The free market is the best solution for all things economic. To be sure, a single provider system, like the US military enjoys or like the United Kingdom has would exemplify the philosophy the Right espouses. In these systems the government is the only provider. If you wanted to go to school, get a medical degree and start your own practice you’d be blocked by the government from doing that in the UK. But what the Left proposes is a far cry from a single provider system. They’re instead proposing a single payer system, similar to medicare. This still leaves competition available in the actual health care market: doctors, hospitals, clinics; albeit the long term effects on the health insurance industry are unclear.

In earlier articles we discussed the effectiveness of the health care system, precisely to test the Right’s hypothesis. The measures for effectiveness we’ve used are: longevity, infant mortality, 5 year cancer survival rate and preventable death rate. In all but one of these the US has ranked last, and interestingly, on the other the US ranked first. This is a somewhat confusing result, so in this article we’ll combine all 4 of these measures into a single “health care effectiveness” metric and see how the US compares to other countries.

Before we begin it is important to note that we’ll give up some things to get a single measure of “health care effectiveness”. One thing that we’ll give up is meaning. The very nature of combining a cancer survival statistic with a longevity statistic means that the resulting number will be just a number. It will not have any simple connection to the real world. The number won’t mean percent of people living past a certain age, it won’t mean years of life after cancer, it won’t mean anything other than higher scores are better than lower scores. Again the point of doing this isn’t to get a number it’s to get a sense of how the US compares to other similar countries around the world. And with this in mind, an arbitrary or a meaningful number will do equally as well.

How to combine these 4 quantities? For any given country, we could just add them all together and divide by 4. But there are problems with this approach. Let’s take a broad look at all the numbers:

BEST WORST
Longevity 82.30 77.90
Cancer Survival 77.18 55.12
Infant Mortality 1.89 4.13
Preventable Deaths 64.79 109.65

Instead of simply averaging, we’re going to first scale each individual quantity to make it fit from 50 to 100. The worst score in each category will be assigned a value of 50 and the best score will be assigned a value of 100 and the remaining values will be linearly scaled to fit in between. Note this also “flips” those scores where the best score is a lower one (like infant mortality). After we’ve done this then we’ll average the scores. Why a low of 50 and not 1 or zero? No real reason except to not lead the casual reader astray. Recall many of the earlier articles included the rankings of less developed countries. Even the lowest scoring developed country scored significantly better than the average developing country. So we’re going no lower than 50 here merely to remind the reader that other countries not on this list may well score lower than 50.

For those interested in the details, a few tables at the end of this article include the data used. Note here we are using the “adjusted infant mortality” number, where we ignore infant deaths occurring less than 24 hours after birth. This was discussed in an earlier article. Without further ado let’s get to the results.

The graph below shows the results for the 11 countries that were in all 4 studies. By this Combined Score Japan ranks first, with France and Sweden close together for second place. In last place is the United Kingdom with the US in the 2nd to last place. Some may have been expecting the US to score last, some may find a measure of vindication that the UK is in fact in last place. But is there anything to be learned from this ranking?

average

Let’s examine this by looking more closely at the components of the combined scores. The graph below is a little busy but it’s worth studying. It shows for each country the value of each component of its combined score. Japan has excellent marks in 3 of the 4 quantities and a moderate mark in cancer survival. Contrast this to France and Sweden. Each has an excellent mark in one area and moderate marks in 3 of the other areas. Japan really seems to be doing something right here and we’ll see just how well they stand out in a moment.

AllData

On the other end of the scale we have the US and the UK. The UK scores poorly (below 65) in all 4 areas, while the US scores dead last in 3 of the 4 areas (all 3 marks are in the same location so they’re impossible to distinguish) and first place in one of them. It is this first place showing that catapults the US above the UK. Indeed, a score of 83 on the scaled cancer survival rate would have left the US tied with the UK, so a score of 100 really pushes it ahead. But, for health care, which of those 2 countries would you prefer to live in, the US or the UK? It may depend on what stage of life you are in. Adults with grown children may prefer the superior cancer survival feature of the US and ignore the only slightly better longevity score the UK has. But by this measure my answer is neither.

And let’s drive this point home by concluding with a “dot plot” comparison of these results. Here the lead that Japan has over France and Sweden is very clear. Similarly the lead the US has over the UK is quite noticeable, but also noticeable is how far the US and UK are from the rest of the pack. To be sure, this is only 11 countries. Remember that only countries that showed up in all 4 measures are reported here. There are several countries that scored poorly on 3 of the 4 measures (Portugal and Denmark for example) which may fill in the gap between 2nd to last place US and 3rd to last place Netherlands. So don’t read too much into the size of the gap.

AverageDots

In terms of health care effectiveness, Japan, France and Sweden should be our role models. And anyone using the UK as a typical example of what “socialized medicine” will bring, is intentionally choosing the worst example.

Post Script

Just today the US released a new report that ranked the US infant mortality rate a bit worse than the data used above. This article points out that most of the poor showing of the US is due to premature births. Indeed we discussed this very fact several months ago because there was a conjecture that the US counts live births differently than other countries. The statistic we used above removed all infant mortality data for infant deaths occuring within the first 24 hours to offset this possibility. This updated study includes information on which countries count live births similar to the US. In short most of them do. (It also included infant mortality rates for premature births, data that wasn’t available to us earlier.) How does this affect our conclusions?

Recall that on two of the 4 statistics we used, we “leaned Right”. The cancer survival rate statistic may have a significant component due to the “lead time bias” where people aren’t really living longer, just having their cancer detected earlier. We acknowledged this possibility but since we had no way to quantify it we ran with the data as is. Also, as mentioned earlier, the infant mortality statistic was altered to adjust as best we could adjust, to varying reporting measures in different countries. It just turns out that this had a favorable result for the US. But it also may have masked some legitimate health concerns in the US.

Adjusting for these factors and adding in the new infant mortality statistics would undoubtedly lower the US ranking. But look at the charts above one more time. It’s unclear if the US would be reduced below the UK’s ranking, but that’s beside the point, isn’t it? If you’re on the Left, aren’t the reported statistics bad enough? If you’re on the Right, can you really come up with more reasons that will significantly improve the US’s ranking? For both, isn’t the US already sufficiently bad to be worthy of a change to its health care system vs the status quo?

Tables

Table 1 – Original Scores (sorted alphabetically by country)

High
Scores Bad
High
Scores Good
Country Preventable

Deaths

All
but 1D

Infant

Cancer

Survival

Longevity
Austria 84.48 2.67 70.22 79.4
Finland 93.34 2.03 65.70 78.9
France 64.79 2.79 70.35 80.2
Germany 90.13 2.81 67.32 79.1
Japan 71.17 2.13 65.08 82.3
Netherlands 81.86 3.33 66.92 79.2
Norway 79.79 2.34 64.26 79.8
Spain 73.83 2.97 64.27 80.5
Sweden 82.09 1.89 67.64 80.5
United
Kingdom
102.81 3.54 55.12 79.0
United States 109.65 4.13 77.18 77.9

Table 2 – Scaled Scores (sorted by rank of Combined Score)

Country PD
Scaled
IM
Scaled
CS
Scaled
L
Scaled
Combined
Japan 92.89 94.65 72.57 100.00 90.03
France 100.00 79.97 84.52 76.14 85.16
Sweden 80.72 100.00 78.36 79.55 84.66
Spain 89.92 75.88 70.72 79.55 79.02
Norway 83.28 89.95 70.71 71.59 78.88
Austria 78.05 82.57 84.21 67.05 77.97
Finland 68.18 97.05 73.98 61.36 75.14
Germany 71.76 79.54 77.65 63.64 73.14
Netherlands 80.97 67.95 76.75 64.77 72.61
United
States
50.00 50.00 100.00 50.00 62.50
United
Kingdom
57.62 63.16 50.00 62.50 58.32

2 comments for “Overall Health Care Effectiveness

  1. Michael
    November 5, 2009 at 9:33 am

    As always thought provoking presentation of information. It seems the data assumes that results are strongly correlated to health care systems. There are other variables that will affect the results of some of the categories. Simple examples are genetics and diet. Japan and Sweden are highly homogeneous societies, with a very high concentration of ethnically similar people. Whereas the US and to a lesser extent UK are hetrogeneous societies made up of a broad mix of ethnic and racial categories. The same is true of Japan and diet. There diet is credited with being weighted toward healthy food choices. It seems that both of these factors could be part of the factors affecting the statistics being analyized. Though I have no idea how to do it, it seems that to compare health systems one would need to normalize the data for factors that are affecting outcomes but not being compared.

    Thanks again for your fantastic information.

  2. numbersguy
    November 6, 2009 at 12:06 pm

    Thanks for your comments Michael. The only thing I’m assuming is that if the US is spending a lot on health care we ought to see some tangible benefits from it. We see an excellent result regarding 5 year cancer survival, but that’s the only one so far. However, I understand your point. It could be the diversity of the US population is a contributor to the below average scores.

    One way to adjust for it would be to track these statistics by race and income. Race here would be “native/predominant” race for country. It would compare Asians in Japan vs Hispanics in Spain and Caucasians in the US. For example, I found some information that hinted that African Americans have a slightly higher infant mortality rate than Caucasians. But that reference didn’t make a strong claim and didn’t affirm that this effect was present even after factoring out income differences.

    I’m only reporting on research done by others or statistics gathered by others. Sometimes I discuss correlations between statistics that previously were uncorrelated. This article is one such example, but it’s not really original research. I’m at the mercy of published reports and I haven’t found a report that directly addresses the issue you raise. If you find one I’d be interested in learning of it.

Leave a Reply

Your email address will not be published. Required fields are marked *