

US ranked 46th in world Health Care efficiency - grecy
http://www.bloomberg.com/visual-data/best-and-worst/most-efficient-health-care-countries

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grandalf
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.

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...

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grecy
> 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.

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grandalf
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.

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refurb
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).

~~~
grecy
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](http://en.wikipedia.org/wiki/Sicko)

~~~
refurb
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](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.

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grandalf
This is about as meaningful as ranking the US healthcare system in terms of
the average height of doctors.

~~~
grecy
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.

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protomyth
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.

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igravious
Off-topic (but oh-my-god) from same site.

[http://www.bloomberg.com/visual-data/best-and-worst/most-
cas...](http://www.bloomberg.com/visual-data/best-and-worst/most-cash-in-the-
world-companies)

1: Industrial and Commercial Bank of China

$518.5B

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flaktrak
I am surprised the US is even that high!

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bjr-
We're not last!?!

